SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
La Esperanza Clinic Inc
 
Employer identification number

74-2699762
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF THE FORM 990: THE 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE CEO AND CFO REVIEW THE FORM 990 IN DETAIL WITH THE CPA PREPARING THE FORM 990. NEXT, THE FINANCE COMMITTEE IS PRESENTED WITH THE 990. ONCE REVIEWED, THE FINANCE COMMITTEE CHAIR PRESENTS THE 990 TO THE ENTIRE BOARD FOR REVIEW AND APPROVAL.
FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: BOARD MEMBERS ARE GIVEN COPIES OF THE CONFLICT OF INTEREST POLICY ANNUALLY TO REVIEW. THE POLICY GIVES THE DEFINITION OF A CONFLICT OF INTEREST AND DESCRIBES ALL ACTIVITIES THAT FALL UNDER THE POLICY. BOARD MEMBERS ARE REQUIRED TO SIGN THE POLICY, ACKNOWLEDGING THEIR UNDERSTANDING. IN ADDITION, THE POLICY STATES THAT EVERY BOARD MEMBER MUST PROMPTLY BRING ANY INFORMATION CONCERNING ANY VIOLATION OF THE POLICY BY ANY OTHER BOARD MEMBER TO THE ATTENTION OF THE CHIEF EXECUTIVE OFFICER OR THE BOARD OF DIRECTORS. IF THE BOARD MEMBER BELIEVES THAT THE CEO MAY BE IMPLICATED IN THE VIOLATION, THE INFORMATION SHOULD BE PROVIDED TO THE CHAIRMAN OF THE BOARD OF DIRECTORS. IF IT IS DETERMINED A CONFLICT EXISTS, THE INDIVIDUAL WITH THE CONFLICT MAY NOT VOTE ON ANY MATTERS RELATING TO THE CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15A & 15B COMPENSATION DETERMINATION AND REVIEW: COMPENSATION FOR TOP MANAGEMENT POSITIONS ARE ANNUALLY DETERMINED THROUGH BOARD OF DIRECTOR DELIBERATIONS. A BOARD OF DIRECTOR SUB-COMMITTEE FIRST REVIEWS THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER'S (NACHC) COMPENSATION SURVEY DATA AND THEN MAKES RECOMMENDATIONS TO THE FULL BOARD. FULL BOARD OF DIRECTOR APPROVAL IS REQUIRED. THE REVIEW IS DOCUMENTED IN THE HR DEPARTMENT'S PERSONNEL FILES. COMPENSATION CONTRACTS FOR OTHER OFFICER AND KEY EMPLOYEE POSITIONS ARE ANNUALLY DETERMINED THROUGH REVIEWS OF THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER'S (NACHC) COMPENSATION SURVEY DATA AND LOCAL PEER SURVEYS. THE MOST RECENT REVIEW WAS CONDUCTED IN 2016 BY MIKE CAMPBELL. THE REVIEW IS DOCUMENTED IN THE HR DEPARTMENT'S PERSONNEL FILES.
FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FOR REVIEW UPON REQUEST. COPIES WILL BE PROVIDED TO THOSE REQUESTING DOCUMENTS.
FORM 990, PART VIII, COLUMN I, LINES 7A, 7B & 7C REALIZED GAINS: THE AMOUNT BEING DISCLOSED IN COLUMN I, LINE 7C REPRESENTS THE REALIZED GAIN OR LOSS BEING ALLOCATED TO LA ESPERANZA THROUGH ITS ENDOWMENT ASSETS HELD BY SAN ANGELO AREA FOUNDATION. THE FOUNDATION HAS A POOLED INVESTMENT PORTFOLIO, AS SUCH PROCEEDS AND BASIS INFORMATION CANNOT BE ACCURATELY DETERMINED.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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