Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 5,483,823 | 7,589,627 | 10,507,696 | 9,270,643 | 7,060,794 | 39,912,583 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf .... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | 5,483,823 | 7,589,627 | 10,507,696 | 9,270,643 | 7,060,794 | 39,912,583 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | 39,912,583 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 5,483,823 | 7,589,627 | 10,507,696 | 9,270,643 | 7,060,794 | 39,912,583 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 188,190 | 48,039 | 24,928 | 155,355 | 455,772 | 872,284 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | 544,428 | 1,471,060 | 693,753 | 297,521 | 444,153 | 3,450,915 |
| 11 | Total support. Add lines 7 through 10 | 44,235,782 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | 2017 OTHER INCOME 537358 2018 OTHER INCOME 423043 2019 OTHER INCOME 544428 2020 OTHER INCOME 1471060 2021 OTHER INCOME 693753 2022 OTHER INCOME 297521 2023 OTHER INCOME 444153 |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 8, CONTRIBUTIONS AND GRANTS | THE DECLINE OF MORE THAN 10% OF THE CONTRIBUTIONS AND GRANTS THIS YEAR COMPARED TO PRIOR YEAR WAS DUE TO THE EXPIRATION OF PANDEMIC RELATED FUNDING MAINLY THE HRSA-ARPA GRANT. |
| FORM 990, PART I, LINE 10, INVESTMENT INCOME | THE INCREASE IN INVESTMENT INCOME THIS YEAR COMPARED TO PRIOR YEAR WAS DUE MAINLY TO THE HIGH YIELDS ON BANK DEPOSITS AND INVESTMENTS. |
| PART FORM 990, PART I, LINE 11, OTHER REVENUE | THE INCREASE OF MORE THAN 10% OF THE OTHER REVENUE THIS YEAR COMPARED TO PRIOR YEAR WAS DUE TO HIGHER THAN ANTICIPATED PAY FOR PERFORMANCE INCENTIVES FROM HEALTH PLANS. |
| FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: | MADE FOR THE COMMUNITY, BY THE COMMUNITY, ARROYO VISTA FAMILY HEALTH CENTER IS A NON-PROFIT COMMUNITY HEALTH CENTER GOVERNED BY A CONSUMER BOARD OF DIRECTORS WITH A TRUSTED TEAM OF HEALTHCARE PROFESSIONALS SERVING THE GREATER NORTHEAST LOS ANGELES SINCE 1981. WE ARE LICENSED BY THE STATE OF CALIFORNIA DEPARTMENT OF HEALTH SERVICES. AS A FEDERALLY QUALIFIED HEALTH CENTER, FUNDING IS PROVIDED THROUGH PUBLIC HEALTH SERVICES ACT, SECTION 330, WITH ADDITIONAL FUNDING FROM LOS ANGELES COUNTY AND PRIVATE SOURCES. WE ARE ACCREDITED BY THE JOINT COMMISSION, WHICH MEANS THAT ARROYO VISTA HAS BEEN RIGOROUSLY INSPECTED, TESTED AND EVALUATED. WE ARE NATIONALLY RECOGNIZED FOR THE HIGHEST LEVEL OF PATIENT SAFETY AND QUALITY OF CARE. AS A CERTIFIED PRIMARY CARE MEDICAL HOME BY THE JOINT COMMISSION, WE FOLLOW CARE COORDINATION AND INTERDISCIPLINARY TEAM CARE MODEL FOR THE PROVISION OF SERVICES. FROM OUR HUMBLE BEGINNING IN 1981 AS A SMALL STOREFRONT CLINIC, WE HAVE GROWN TO A NETWORK OF FOUR HEALTH CENTERS AND A MOBILE CLINIC SERVING EVERY MEMBER OF THE COMMUNITY, WITH OVER 102,000 PATIENT VISITS IN 2023. ARROYO VISTA PROVIDES A COMPREHENSIVE RANGE OF MEDICAL, DENTAL, OPTOMETRY, BEHAVIORAL HEALTH, IMAGING, ENHANCED CARE MANAGEMENT AND PHARMACEUTICAL SERVICES. OUR SERVICES ARE DESIGNED FOR ALL AGES, FROM INFANTS AND CHILDREN, TO TEENS, ADULTS, AND THE ELDERLY. MANY SERVICES ARE PROVIDED AT NO COST, INCLUDING HEALTH EDUCATION, ANNUAL FLU VACCINE CLINICS, IMMUNIZATION FOR CHILDREN, ANNUAL HEALTH FAIR SCREENINGS, AS WELL AS COVID-19 TESTS AND VACCINES. WE ALSO PROVIDE TRANSPORTATION ASSISTANCE AND APPLICATION SUPPORT FOR MEDI-CAL, MEDICARE, AND COVERED CA. SERVICES ARE PROVIDED TO OUR VALUED PATIENTS REGARDLESS OF ABILITY TO PAY. PATIENTS WHO ARE ELIGIBLE FOR SLIDING SCALE DISCOUNTS WILL RECEIVE DISCOUNTS ON PROFESSIONAL AND IMAGING SERVICES. PATIENTS WITH OR WITHOUT INSURANCE, MEDI-CAL AND MEDICARE.....EVERYONE IS WELCOME AT ARROYO VISTA. OUR SERVICES ARE PROVIDED IN A CULTURALLY SENSITIVE, LINGUISTICALLY APPROPRIATE AND COMPASSIONATE MANNER. MANY OF OUR DOCTORS, NURSES, AND ADMINISTRATIVE STAFF COME FROM THE LOCAL COMMUNITY, AND MANY OF US INCLUDING OUR BOARD MEMBERS ARE ALSO PATIENTS OF ARROYO VISTA. |
| FORM 990, PART VI, SECTION B, LINE 11B | EXPLANATION: THE INFORMATIONAL RETURN IS PREPARED BY AN OUTSIDE ACCOUNTANT. IT IS THEN REVIEWED BY THE CFO. ONCE APPROVED, THE RETURN IS PROVIDED TO THE BOARD OF DIRECTORS BEFORE IT IS E-FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EXPLANATION: ARROYO VISTA BOARD MEMBERS SHALL COMPLETE A DIRECTOR QUESTIONNAIRE ANNUALLY CONFIRMING THEIR INDEPENDENT STATUS AND COMPLIANCE WITH THE AGENCY'S CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | EXPLANATION: ARROYO VISTA'S PERSONNEL COMMITTEE HAS RESPONSIBILITY FOR THE REVIEW OF PERSONNEL POLICIES AND PROCEDURES INCLUDING COMPENSATION AND BENEFIT PROGRAMS. ARROYO VISTA EXECUTIVE COMMITTEE'S RESPONSIBILITIES INCLUDE YEARLY EVALUATION OF THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE AND COMPENSATION, WHICH IS THEN PRESENTED TO THE FULL BOARD OF DIRECTORS FOR FINAL REVIEW AND APPROVAL. OTHER OFFICERS AND KEY EMPLOYEES UNDERGO AN ANNUAL APPRAISAL REVIEW TO DETERMINE PROMOTION TO A HIGHER PAY LEVEL OR FOR MERIT INCREASES. THE CEO WILL MAKE THE DECISION ON MERIT INCREASES BASED ON THE SUPERVISOR'S AND/OR EXECUTIVE'S RECOMMENDATION AND EMPLOYEE PERFORMANCE AT THE TIME OF THE APPRAISAL REVIEW. |
| FORM 990, PART VI, SECTION C, LINE 19 | EXPLANATION: ARROYO VISTA MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST, AND TO INDEPENDENT AUDITORS DURING THEIR ANNUAL INDEPENDENT FINANCIAL AUDIT. |
| FORM 990, PART X, LINE 15, OTHER ASSETS | AT MARCH 31, 2018, THE FOUNDATION HAD A RECEIVABLE THAT REPRESENTED UNCONDITIONAL PROMISES TO USE THE FACILITY LOCATED AT 6000 NORTH FIGUEROA STREET, LOS ANGELES, CA 90042, FROM THE CITY OF LOS ANGELES, DEPARTMENT OF GENERAL SERVICES (THE "CITY"). THE INITIAL TERM OF THE AGREEMENT WAS FOR THE RENT-FREE USE OF THE BUILDING FOR 20 YEARS STARTING IN JUNE 1987. THE AGREEMENT WAS AMENDED IN OCTOBER 2014, AND THE LEASE WAS RENEWED FOR ANOTHER 15 YEARS AT A NOMINAL RENT OF $1 PER YEAR. THE FOUNDATION USES THE PREMISES FOR THE PRIMARY OBJECTIVE OF PROVIDING HEALTH CARE SERVICES TO THE COMMUNITY. AS OF MARCH 31, 2024, THE BALANCE FOR THE RECEIVABLE IS $2,880,981. |
| FORM 990, PART XI, LINE 9: | ROUNDING -2. |
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