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CLINICA SIERRA VISTA General Information Contact Information Nonprofit CLINICA SIERRA VISTA Address 1430 Truxtun Ave., Suite #400 Bakersfield, CA 93302 Phone (661) 635-3050 Fax 661 869-1503 Web Site Web Site Facebook Facebook Twitter Twitter Email phelpsb@clinicasierravsita.org At A Glance Organization's type of tax exempt status Organization received a competitive grant from the community foundation in the past five years Community Foundation staff conducted a site visit? Public Supported Charity No 1

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Statements & Search Criteria Statements Mission Statement It shall be the mission of Clinica Sierra Vista to provide high quality and comprehensive primary and preventative health care services at the most efficient cost to the underserved populations of Kern, Fresno and Inyo counties regardless of ability to pay, and to seek necessary resources to meet the growing health care demands while maintaining the corporation's financial integrity. We strongly believe in everyone's right to quality health care; therefore, no one is denied services based on race, religion, ethnicity, sex, age, disability or economic status. Background Statement In 1971, Clinica Sierra Vista was created to provide health care to poor migrant farm workers who harvest the lush agricultural fields in the southern San Joaquin Valley. For over thirty-nine years, Clinica Sierra Vista has been providing comprehensive primary care services to the uninsured and underinsured people of Kern, Inyo, and (most recently) Fresno counties. Clinica's service area encomasses several thousand square miles of farmland, desert, and mountains; it is the nation's third largest federally-qualified health center. All CSV sites are fully staffed year-round and operate on the medical home model. Primary care services are provided directly by CSV at each of its 23 health centers. Patients who require specialty care are referred to providers who accept low income patients. For specialty care not covered by referral, CSV contracts with community physicians to provide services directly at CSV health centers. Such services include infectious disease, podiatry, pediatric urology, pediatric dermatology, plastic surgery, pain management, general surgery, and pulmonology. Having on-site contracted specialty providers helps ensure timely access to care for CSV patients. To ensure compliance and to monitor continuity, CSV employs referral clerks at each health center to manage referrals into and through care, including specialty care providers both on- and off-site. Impact Statement Provided Medical, Dental, Behavioral Health, and Social Services through 527,926 patient visits by the underserved populations of Kern and Fresno Counties. Needs Statement 1. Benefit application assistance, for assisting families with enrolling in Medi-Cal, Healthy Families, and Cal Fresh (formerly called Food Stamps). This program is crucial to enrolling eligible children and adults in programs that will allow them to access health care, dental care, and behavioral health services. Without the application assistance program, thousands of families would not have the ability to successfully apply on their own and receive these critical benefits to keep healthy and well. Current funding needs: $250,000. 2. Mobile Medical and Mobile Dental Services provide basic care for underserved populations, including homeless children and adults, migrant farmer workers and their families, and other isolated or hard-to-reach populations. Many of these individuals are uninsured so we have to raise the funds to cover most of the cost of fuel, maintenance, supplies, medications, and staff. Current funding needs: $150,000 Mobile Medical Unit, and $150,000 Mobile Dental Unit. 3. In 2009, AFLP lost over 68% of its funding when the State of California eliminated all state general funds and corresponding matching federal funds for this program. This reduced the number of cases served in Kern County by 56% and nearly doubled caseload size. To effectively work with teen parents and their babies and make meaningful and lasting changes, caseloads must be at a reasonable size. This program helps reduce poor birth outcomes, reduces repeat pregnancies, increases school participation and graduation, and reduces child abuse and neglect. Current funding needs: $400,000. 4. CSV operates three family resources in Southeast Bakersfield, Mojave, and Ridgecrest. With the Great Recession impacting Kern County more profoundly than many other areas of the state and nation, our clients are more hard pressed to meet even the basic needs of their families, including food, shelter and clothing. Current funding needs: $5,000 to $10,000 per family resource center to help purchase food, household supplies and appliances, bus passes, gas cards, diapers, and formula/baby food. 5. CSV's Patient Navigator Program assists our patients dealing with chronic disease such as diabetes and asthma as well as breast and cervical cancer. Patient Navigators help link patients to medical and social services and provide information and education on how to stay healthy and avoid the negative consequences of an out of control chronic disease or condition. Current funding needs: $175,000. Service Categories 3

Community Clinics Areas of Service Areas Served Areas Bakersfield Arvin Delano Frazier Park Kern County Kern River Valley Lake Isabella Lamont Lebec Mojave Ridgecrest Taft Mc Farland Wofford Heights Clinica Sierra Vista (CSV) has provided comprehensive primary and preventative medical, dental, behavioral health, and social services to the medically underserved for 39 years. Social services, such as Women, Infants, and Children (providing over 44,000 vouchers earch month), Medically Vulnerable Infant Program, Adolescent Family Services, Family Resource Centers, and Health Insurance Enrollment Assistance, in conjunction with health services, allow CSV to profoundly impact our communities. CSV operates twenty-three (23) primary care medical health centers, six (6) dental centers, and (6 ) behavioral health centers in Kern, Inyo, and Fresno Counties. CSV serves an ethnically diverse and geographically dispersed population. CSV's service area includes urban, rural, and frontier communities encompassing serveral thousand square miles of farm land, desert and mountainous regions. Historically, 27% of CSV patients live below the federal poverty level (FPL), 92% live below 200% of the FPL, 30% are migrant and seasonal farmworkers, and 35% do not have health insurance. In 2008, CSV served 5,944 homeless individuals by providing medical, dental, behavioral health services in addition to case management and respite services. CSV is now serving a growing number of uninsured since the August 2009 unemployment rates in the areas we serve range from 10% to 36% and California's Medi-caid optional benefits were eliminated, which includes the elimination of adult dental services. Service Area Zip Codes: 89061, 89041, 89048, 89060, 92309, 92328, 92384, 92389, 93205, 93220, 93222, 93255, 93261, 93263, 93309, 93311, 93312, 93313, 93314, 93501, 93505, 93518, 93555, 93561, 93609, 93611, 93612, 93619, 93630, 93722, 93203, 93215, 93225, 93240, 93241, 93243, 93250, 93280, 93284, 93285, 93301, 93304, 93305, 93307, 93308, 93701, 93702, 93703, 93704, 93705, 93706, 93709, 93710, 93711, 93712, 93720, 93721, 93723, 93725, 93726, 93727, 93728. 4

Programs Programs Adolescent and Family Services (AFS) Description AFS provides several home visiting/case management services for specific targeted populations in various locations in Kern County. These programs include the following: 1. Adolescent Family Life Program/AFLP (Bakersfield, Arvin/Lamont, and East Kern) serving pregnant and parenting teens and their babies; 2. Cal-Learn Program (county-wide) serving pregnant and parenting teens and their babies who are receiving cash aid and have not graduated from high school; 3. Differential Response (CSV managers four out of seven service areas in Kern County) serving families at-risk of CPS intervention for suspected child abuse and/or neglect; 4. Prop 10 Family Resource Centers (Mojave, Ridgecrest, and SE Bakersfield) serving low income families with children ages 0-5. 5. These programs serve over 1,200 families each month. Paraprofessional case managers carry caseloads of 25 to 50, depending on the program and acuity of the caseload. Families are assessed for the strengths and needs, care plans are developed, and families are linked to any needed services or resources to stabilize the family, insure that the children are healthy and safe, and children are ready to learn. Budget $3,049,060.00 Category Population Served Short Term Success Long term Success Human Services, General/Other Family Services for Adolescent Parents Families, Alcohol, Drug, Substance Abusers, Unemployed, Underemployed, Dislocated Through case manager and linkages to community services and resource, the following short-term impacts will be achieved: 1. Families have a safe place to live and their immediate needs are being met. 2. There is adequate income to meet the family s ongoing basic needs, including access to public benefits, including health insurance, and employment services. 3. Parent and their children have access to medical, dental, and behavioral health services. 4. Children are going to school and making adequate progress toward high school graduation. 5. Where present, family members are addressing mental health issues, substance abuse, and domestic violence through appropriate services and support. The main objectives of AFS are to help families achieve stability, provide a safe and nurturing home for their children, and reach their educational and vocational goals. This also means addressing any underlying issues that prevent individuals and families from achieving these goals, including physical and mental health issues, substance abuse, domestic violence, and other legal, educational, and psycho-social barriers. The ultimate goal is to help families to become self-sufficient and that each family member becomes a productive member of society. 5

Program Success Monitored By A client/family chart is maintained on all families enrolled in AFS. All consent forms, assessment forms, care plans, contacts, referrals and progress notes are documents and maintained in the client chart. Client and program level data are entered into a Management Information System for each program (AFLP and Cal-Learn use Lodestar, Differential Response uses ETO; and Prop 10 FRCs use OCERS). Outcome data is reported to funding sources on a monthly or quarterly basis. Each program has specific performance and outcome measures that are used to determine program success. The following measures are monitored by program category: 1. AFLP and Cal-Learn: caseload, clients contacts, school attendance, progress toward high school graduation, birth control method, child s immunizations, repeat pregnancies, repeat births, and referrals/linkages to other health and human services. 2. Differential Response: caseload, clients contacts, family functioning using the Social Condition Matrix, parenting class pre- and post-test surveys, referrals/linkages to other health and human services, and client satisfaction surveys. 3. Prop 10 FRCs: caseload, client contacts, family functioning using the Family Stability Rubric, parenting class pre- and post-test surveys, referrals/linkages to other health and human services, and client satisfaction surveys. Examples of Program Success The following outcomes cover the period 7/1/09 to 6/30/10: AFLP: Caseload served: 338 pregnant/parenting teens Face-to-face visits: 1,473 Repeat pregnancy rate: 6.8% of the caseload reported a repeat pregnancy Repeat births: 2.1% of the caseload reported a repeat birth School participation rate: 62% were in school or had graduated from high school Immunizations: 84% of the children were up-to-date with the recommended childhood vaccinations Cal-Learn: Caseload served: 936 pregnant/parenting teens Face-to-face visits: 4,551 Repeat pregnancy rate: 4.5% of the caseload reported a repeat pregnancy Repeat births: 3.1% of the caseload reported a repeat birth School participation rate: 60% of the clients were in school and 104 completed high school diploma or equivalency Immunizations: 88% of the children were up-to-date with the recommended childhood vaccinations Differential Response: Caseload served: 896 families Face-to-face visits: 4,23 Improvement in Family Functioning: Averaged 15% increase in overall family functioning between intake and exit Parenting Classes: 113 parents completed a parenting class series with the following test score results: Average Pre-test score: 64%, Average Post-test score: 94%, Average % change: 30% Prop 10: Caseload served: 324 families Face-to-face visits: 1,379 Improvement in Family Functioning: 80% to 90% of the families demonstrated improved family functioning depending on site Parenting Classes: 61 parents completed a parenting class series (Ridgecrest and SENP) Children attending Summer Bridge program: 21 (Mojave and Ridgecrest) Children enrolled in center based program (Mojave only): 28 Families receiving in-home child development series: 259 6

Health Insurance Assistance Program Description HIAP consists of Certified Application Assistors that help individuals and families apply for public benefits, including Medi-Cal, Healthy Families, Healthy Kids, and Food Stamps. CAA's walk families through the application process until a final determination of eligibility has been made. Outstationed Eligibilty Workers from the Kern County Department of Human Services process these applications and determine eligibility. CAAs follow-up with families for any missing paper work and help reinitiate the application process when families fail to follow through or run into other barriers. This program is available at all of our health centers in Kern and Fresno Counties. We have a total of 17 Certified Application Assistors (CAAs), in Kern and Fresno Counties. We have a total of 17 Certified Application Assistors (CAAs), who process over 13,000 applications every year. CAAs also participate in health fairs, farmers' markets and other community events to educate the public about these valuable public benefits and services. Budget $650,000.00 Category Population Served Short Term Success Health Care, General/Other Medical Expense Assistance Migrant Workers, Minorities, Families The short-term objectives of the Health Insurance Assistance Program are to: 1. All patients will be screened for health insurance coverage and food stamp eligibility. 2. All patients will be assisted with completing the appropriate application(s) including obtaining all of the backup documentation that is required for each application. 3. CAAs will follow-up with all patients through the application process to ensure that all eligible patients are enrolled into a health plan. 4. For managed care Medi-Cal, all patients are referred and linked to Health Care Options to select their health plan. 5. CAAs follow-up with all patients prior to renewal to ensure continuous coverage. 6. CAAs educate patients and the community about accessing health care to maintain health and wellness. Long term Success Program Success Monitored By The ultimate goal of HIAP is to ensure that CSV patients have continuous health care coverage so that they can have access to medical, dental and behavioral health services through a medical home that can address all of their well care needs, treat, and manage any acute or chronic conditions. CAAs enter all of their data into a CSV created Management Information System. For applications that include children 0-5 years old, CAAs also enter the patient application data into the Children s Health Initiative (CHI) web-based MIS. CAAs work closely with the Outstationed Eligibility Workers to determine if patients are eligible and have completed all the required paperwork and turned in all the back-up documentation. For the 0-5 applications, CSV is paid a stipend for every successful application through funding from First 5 Kern. In 2009, CSV received over 70% of the total stipend funding that is offered to all CAAs throughout the county. The outcomes for each insurance program and food stamp application are tracked and reported monthly to management. Periodic meetings are conducted to reinforce the screening processes and ensure all patients without health care coverage are referred to HIAP. 7

Examples of Program Success The following outcomes cover the period 7/1/09 to 6/30/10: Medi-Cal applications completed: 9,181 Healthy Families applications completed: 1,800 Healthy Kids applications completed: 398 Kaiser Kids applications completed: 105 Food Stamp applications completed: 1,894 Total applications completed: 13,378 8

Medically Vulnerable Infant Program (MVIP) Description MVIP provides home-based, comprehensive RN nursing case management services to high risk babies coming out of the neonatal intensive care units (NICUs) at Bakersfield area hospitals. These babies are typically premature, very low birth weight, and have multiple medical and/or genetic conditions that require intensive medical case management from qualified registered nurses. These babies are carried for 18 months to 3 years, depending on the severity of the medical needs and the family s resources and ability to access needed services. RN case managers assess each baby s needs and ensure that the family has access to medical and other related services. The babies are assessed for growth and development on a periodic basis. The RN case managers also ensure that all medical visits are scheduled and kept, every baby has a medical home, and that every baby is up-to-date with immunizations and well child check-ups. The RN case managers also link families to other psycho-social services that may be needed on a case by case situation. Budget $487,868.00 Category Population Served Short Term Success Health Care, General/Other Medical Case Management Infants to Preschool (under age 5), Other Health/Disability, Through medical case management and linkages to community services and resource, the following short-term impacts will be achieved: 1. Children with identified special needs will be referred and linked to appropriate services in a timely matter and direct family support services will be promoted and provided. 2.Children will be provided medical and developmental screenings. 3.Children will be connected with a medical home. 4. Children will have health care coverage to meet all of their medical needs. Long term Success Program Success Monitored By The goal of MVIP is to minimize the impact of poor birth outcomes on fragile infants so that they will ultimately reach their highest possible level of development and be on target to start school at the appropriate age, achieve academic success, and become happy, productive adults. A client chart is maintained on all babies enrolled in MVIP. All consent forms, assessment forms, care plans, contacts, referrals and progress notes are documents and maintained in the client chart. Client and program level data are entered into a web-based system called OCERS. Outcome data is reported to First 5 Kern on a quarterly basis and the First 5 Kern Program officer provides feedback on meeting milestone and performance measures. The data are reviewed by the project team on a quarterly basis and any concerns are addressed at monthly MVIP staff meetings. The developmental tool used by the RN case managers is the Ages and Stages Questionnaire, Third Edition (ASQ-3). Immunizations are verified by checking each baby s immunization card. Medical homes are verified by ensuring each baby has a public or private health insurance plan and release of information forms are completed so that the RN case manager can maintain contract with the medical providers serving each baby. 9

Examples of Program Success The following outcomes cover the period 7/1/09 to 6/30/10: 96.5% of the babies received at least two home visits each month 276 developmental screenings were completed on 74 infants 306 linkages were made for other needed services 99.4% have an established medical home 100% are up-to-date on well child check-ups 100% are up-to-date on immunizations 100% of the parents have received education on their child s developmental milestone 100% of the parents have received education on their child s medical condition and care Client story: Baby girl, born at 24 weeks gestation, was discharged after spending four months in the NICU. Baby experienced several near death crises due to fluid build up in the brain while in the NICU. At discharge, baby had a tube (shunt) in her head to drain the fluid from her brain to her stomach. After baby was home one week, the RN case manager made a home visit and noticed swelling around the insertion site and the mother reported baby was sleeping more and becoming increasingly irritable. RN strongly recommended mother follow-up immediately with a neurologist and Children s Hospital in Madera, about 120 miles north of Bakersfield. Mother was initially very reluctant and felt that her baby would be fine and she had limited resources to travel out of town unless it was absolutely necessary. The RN contacted the hospital and spoke with a neurologist who directed the family to come into the emergency room at the hospital. The mother finally complied and the baby was admitted for an infection and underwent surgery to repair the shunt. This clearly illustrates the importance of nursing case management for these vulnerable infants. 10

Leadership & Staff CEO/Executive Director Executive Director Stephen Schilling Term Start Oct 1973 Email schilling@clinicasierravista.org Staff Full Time Staff 817 Part Time Staff 85 Volunteers 45 Contractors 96 Retention Rate 87% Formal Evaluations CEO Formal Evaluation CEO/Executive Formal Evaluation Frequency Senior Management Formal Evaluation Senior Management Formal Evaluation Frequency NonManagement Formal Evaluation Non Management Formal Evaluation Frequency Annually Annually Annually 11

Plans & Collaborations Plans & Policies Organization has a Fundraising Plan? Organization has a Strategic Plan? Management Succession Plan? Organization Policy and Procedures Whistleblower Policy Document Destruction Policy No No Government Licenses Is your organization licensed by the Government? 12

Board & Governance Board Chair Board Chair Company Affiliation Mr. Matthew C. Clark Chain Cohn and Stiles Board Members Name Affiliation Status Ms. Juanita Benavidez Retired Voting Mr. Matthew C. Clark Community Volunteer Voting Ms. Isaiah Crompton Community Volunteer Voting Ms. Robbie Gerds Retired Ms. Maria Moreno Volunteer Voting Ms. Socorro Munoz Retired Voting Mr. Roberto Rivera Retired Voting Ms. Susan Sorrells Volunteer Voting Ms. Angelica Torres Student Ms. Khu Vang Volunteer Voting Board Demographics - Ethnicity African American/Black 1 Asian American/Pacific Islander 0 Caucasian 3 Hispanic/Latino 5 Native American/American Indian 0 Other 0 Asian, 1 Board Demographics - Gender Male 3 Female 7 Unspecified 0 Governance Board Term Lengths 3 Board Term Limits 99 Board Meeting Attendance % 90% Written Board Selection Criteria? Written Conflict of Interest Policy? Percentage Making Monetary Contributions 0% 13

Percentage Making In-Kind Contributions 0% Constituency Includes Client Representation Number of Full Board Meetings Annually 11 Board Co-Chair Board CoChair Socorro Munoz Company Affiliation N/A Term Nov 1991 to Feb 2011 14

Financials Fiscal Year Fiscal Year Start Apr 01, 2012 Fiscal Year End Mar 31, 2013 Projected Revenue $76,296,609.00 Projected Expenses $76,296,609.00 Endowment Value $0.00 Percentage 0% Detailed Financials Revenue and Expenses Fiscal Year 2012 2011 2010 Total Revenue $81,644,019 $76,067,008 $69,806,520 Total Expenses $75,221,377 $69,247,036 $64,228,181 Revenue Sources Fiscal Year 2012 2011 2010 Foundation and Corporation $0 $0 $0 Contributions Government Contributions $34,092,988 $34,280,992 $28,845,599 Federal $17,200,168 $18,692,950 $14,140,841 State $6,796,069 $6,475,202 $6,022,037 Local $6,214,843 $7,117,627 $6,611,479 Unspecified $3,881,908 $1,995,213 $2,071,242 Individual Contributions $482,195 $514,972 $1,017,250 Indirect Public Support $0 $0 $0 Earned Revenue $45,893,136 $40,794,174 $39,616,549 Investment Income, Net of Losses $72,743 $65,076 $39,900 Membership Dues $0 $0 $0 Special Events $0 $0 $0 Revenue In-Kind $0 $0 $0 Other $1,102,957 $411,794 $287,221 15

Expense Allocation Fiscal Year 2012 2011 2010 Program Expense $64,697,565 $59,825,352 $55,000,827 Administration Expense $10,523,812 $9,421,684 $9,227,354 Fundraising Expense $0 $0 $0 Payments to Affiliates $0 $0 $0 Total Revenue/Total Expenses 1.09 1.10 1.09 Program Expense/Total Expenses 86% 86% 86% Fundraising Expense/Contributed Revenue 0% 0% 0% Assets and Liabilities Fiscal Year 2012 2011 2010 Total Assets $60,684,547 $53,143,422 $47,054,112 Current Assets $30,523,901 $28,797,848 $26,788,083 Long-Term Liabilities $4,003,510 $4,569,169 $4,981,973 Current Liabilities $9,998,450 $8,314,308 $8,632,166 Total Net Assets $46,682,587 $40,259,945 $33,439,973 Short Term Solvency Fiscal Year 2012 2011 2010 Current Ratio: Current Assets/Current Liabilities 3.05 3.46 3.10 Long Term Solvency Fiscal Year 2012 2011 2010 Long-Term Liabilities/Total Assets 7% 9% 11% Top Funding Sources Fiscal Year 2012 2011 2010 Top Funding Source & Dollar Amount Government $34,092,988 Government $34,280,992 Earned Revenue $39,616,549 Second Highest Funding Source & Dollar Earned Revenue Earned Revenue Government Amount $45,893,136 $40,794,174 $28,845,599 Third Highest Funding Source & Dollar Amount Individual Contributions $482,195 Individual Contributions $514,972 Individual Contributions $1,017,250 Capital Campaign Currently in a Capital Campaign? No Goal $0.00 Comments CEO Comments Foundation Staff Comments Financial figures taken from Audit and Form 990. Audit and Form 990 are reconciled. Foundations and corporations are included with individual contributions as they were not separated in the Form 990 or Audit. 16