2023-05-08T08:38:33-05:00 2022-06-30 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2021-07-01 942237120 MARIN COMMUNITY CLINIC % LEIGHA ANDREWS MARI 4154481500 9 COMMERCIAL BLVD Suite 100 NOVATO CA 94949 DAVID KLINETOBE INTERIM CEO 1111111111 2023-05-15 true LEIGHA ANDREWS 999009999 Krystal K Creach P01248198 4178658701 2023-03-03 3 2021 2023-04-26 12:10:37Z MARIN COMMUNITY CLINIC LEIGHA ANDREWS 9 COMMERCIAL BLVD SUITE 100 NOVATO CA 94949 76103465 false X WWW.MARINCLINIC.ORG X 1973 CA TO IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY BY PROVIDING HIGH QUALITY, COST-EFFECTIVE, CULTURALLY SENSITIVE, PATIENT-CENTERED HEALTH CARE. 13 13 725 35 0 0 12007352 19410129 52682044 54407010 352847 296050 -14512 5533 65027731 74118722 0 0 0 0 43217734 46211224 0 0 767961 17284414 17515377 60502148 63726601 4525583 10392121 54207311 64134827 7225961 8298621 46981350 55836206 TO IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY BY PROVIDING HIGH QUALITY, COST-EFFECTIVE, CULTURALLY SENSITIVE, PATIENT-CENTERED HEALTH CARE. false false 42004851 40094974 PRIMARY CARE - PEDIATRIC CARE (INCLUDING AFTER HOURS), ADULT CARE (INCLUDING AFTER HOURS), TEEN HEALTH CARE, IMMUNIZATIONS, ANNUAL CHECKUPS, CHRONIC CARE MANAGEMENT, FAMILY PLANNING FOR MEN AND WOMEN, OBSTETRICS AND GYNECOLOGY, INCLUDING BREAST AND CERVICAL SCREENING AND EDUCATION, POST-NATAL CARE, AND REFERRALS FOR SPECIALTY CARE. PHYSICAL MEDICINE AND REHABILITATION, NEUROLOGY, NUTRITION, ORTHOPEDIC SURGERY, COMPLEMENTARY AND ALTERNATIVE MEDICINE, UROLOGY, GASTROENTEROLOGY, DIAGNOSTIC RADIOLOGY, COVERAGE FOR EMERGENCIES DURING AND AFTER HOURS, CANCER SERVICE, VISION SERVICES. 13633010 11449802 ORAL HEALTH - PREVENTIVE AND RESTORATIVE DENTISTRY. SERVICES INCLUDE: EXAMS AND X-RAYS, ORAL HYGIENE INSTRUCTIONS, CLEANINGS, TOOTH DECAY REMOVAL AND FILLINGS, EXTRACTIONS, ROOT CANALS AND CROWNS DENTURES. EXPANDED SERVICES SEVEN DAYS A WEEK, DENTAL EMERGENCY SERVICES. 2537023 2862234 BEHAVIORAL HEALTH SERVICES - OFFERED TO CHILDREN, TEENS, AND ADULTS AND INCLUDES PSYCHIATRY AND COUNSELING BY LICENSED CLINICAL SOCIAL WORKERS. 58174884 true true false true false false false false false true true false false false true false true false false false false false false false true false false false false true false false false false false false false false true false false false false false false false false true 75 0 true 725 true false false false false false false false false false false false false X 13 13 false false false false false false false true true false false true true true true true true true true false CA X LEIGHA ANDREWS 4155268532 9 COMMERCIAL BLVD SUITE 100 NOVATO CA 94949 MITESH POPAT CEO 40.0 0.0 X 391732 0 26744 DAVID KLINETOBE CHIEF FINANCIAL OFFICER 40.0 0.0 X 281368 0 21226 JOSE CHIBRAS ADOLFO MEDICAL DIRECTOR 40.0 0.0 X 285035 0 14588 LISA WARD MEDICAL DIRECTOR 40.0 0.0 X 277505 0 21017 MELANIE ROSE THOMPSON CHIEF MEDICAL OFFICER 40.0 0.0 X 274271 0 23551 ELIZABETH SHAW MEDICAL DIRECTOR 36.0 0.0 X 246398 0 15865 XAVIER PEREZ MEDICAL DIRECTOR 40.0 0.0 X 245778 0 7850 CONSTANZA KADERA CHIEF DENTAL OFFICER 40.0 0.0 X 233327 0 17047 BICH-NGOC AKI DENTIST 40.0 0.0 X 226115 0 807 LEAH CANVASSER CHIEF INFORMATION OFFICER 40.0 0.0 X 216930 0 6936 JERRY OKEN SECRETARY 3.0 0.0 X X 0 0 0 DANIEL A SEGEDIN CHAIR 3.0 0.0 X X 0 0 0 ALYSSA MORRIS BOARD MEMBER 1.0 0.0 X 0 0 0 STACY SCOTT BOARD MEMBER 1.0 0.0 X 0 0 0 ELIZABETH VILLALOBOS BOARD MEMBER 1.0 0.0 X 0 0 0 FRESHTE KASHANI MEMBER-AT-LARGE 3.0 0.0 X X 0 0 0 MARTIN WEIL TREASURER 3.0 0.0 X X 0 0 0 ANA TAFOLL BOARD MEMBER 1.0 0.0 X 0 0 0 WADE FLORES BOARD MEMBER 1.0 0.0 X 0 0 0 JIM TAVASZI BOARD MEMBER 1.0 0.0 X 0 0 0 NELSON BRANCO CHAIR ELECT 3.0 0.0 X X 0 0 0 KATHLEEN ROCHE BOARD MEMBER 1.0 0.0 X 0 0 0 MARK JACOBS BOARD MEMBER BEG 12/21 1.0 0.0 X 0 0 0 2678459 0 155631 88 false true false WATECH COMPUTER SERVICES INC 900 DORIS ROAD AUBURN HILLS MI 48326 PROFESSIONAL SERVICE 797311 MCC BUILDING MAINTENANCE 83 HAMILTON DRIVE STE 104 NOVATO CA 94949 CLEANING AND MAINTEN 412266 MARIN HEALTH MEDICAL NETWORK 9 COMMERCIAL BLVD STE 200 NOVATO CA 94949 PROFESSIONAL SERVICE 410006 UC REGENTS - SCHOOL OF OPTOMETRY CL 230 MINOR HALL UNIVERSITY OF CA BERKELEY CA 94720 PROFESSIONAL SERVICE 358496 AUGUST-JAYE CONSTRUCTION PO BOX 1425 ROHNERT PARK CA 94927 CONSTRUCTION 239097 5 131882 14866037 4412210 266487 19410129 NET PATIENT SERVICE REVENUE 624100 47553018 47553018 CAPITATION REVENUE 624100 3800386 3800386 QUALITY IMPROVEMENT PROGRAM 624100 2667052 2667052 OTHER INCOME 624100 386554 386554 54407010 179634 179634 0 0 85601 85601 0 85601 85601 1984166 1866264 1486 117902 -1486 116416 116416 36925 131882 116993 -80068 -80068 0 0 0 0 0 0 0 74118722 54407010 301583 0 0 0 0 1493132 772062 721070 0 34692591 32566896 1687232 438463 432022 411690 14631 5701 6540590 6060760 399660 80170 3052889 2816137 199662 37090 0 37772 37772 219699 219699 0 0 0 3476762 3256031 172162 48569 0 1560103 1298813 207838 53452 1449525 1196715 207630 45180 0 2152359 1962070 164308 25981 87379 72139 12516 2724 0 154851 127843 22181 4827 2408 2408 0 2114141 1549590 564551 231673 197421 34252 MEDICAL SUPPLIES & DRUGS 5200781 5200781 LICENSES, DUES, SUBSCRIPTIONS 551133 455011 78944 17178 RECRUITING & RETENTION 276791 228517 39648 8626 63726601 58174884 4783756 767961 1888668 2440887 12438284 19969349 1294249 1623477 6016579 5281612 0 0 0 0 0 0 628760 600201 754474 706494 38753298 19557957 19484863 19195341 9413453 10142658 0 0 0 0 0 1341356 2287981 2833452 54207311 64134827 4642903 5078728 0 0 87893 584887 0 0 0 0 0 0 0 0 79165 59006 2416000 2576000 7225961 8298621 X 45213166 52107217 1768184 3728989 46981350 55836206 54207311 64134827 10392121 -1537265 X false true X true true true X 5434051 5773047 8960885 12007352 19410129 51585464 44906728 47639308 47998044 52682044 54407010 247633134 0 0 0 50340779 53412355 56958929 64689396 73817139 299218598 0 0 0 299218598 203588 367318 329623 181131 265235 1346895 0 203588 367318 329623 181131 265235 1346895 0 0 50544367 53779673 57288552 64870527 74082374 300565493 0.99552 0.99573 0.00448 0.00427 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 28500 28500 false SCHEDULE C, PART II-B, QUESTION 1I OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS ANNUAL DUES TO CALIFORNIA PRIMARY CARE ASSOCIATION (CPCA) - A PORTION OF WHICH MAY BE ATTRIBUTABLE TO LOBBYING. 1595068 -237977 49521 9587 1297983 1093265 557001 45461 9737 1595068 1108290 37410 43366 9069 1093265 1068897 89456 41350 8713 1108290 1027362 93891 43421 8935 1068897 1.00000 true false 5457750 5457750 21490141 12579378 8910763 1560751 1100703 460048 8092957 5877876 2215081 2151699 2151699 19195341 0 EST DUE TO THIRD PARTIES 2576000 2576000 70432921 -1537265 55712 945017 -536536 70969457 3149265 3149265 74118722 63900792 55712 118479 174191 63726601 63726601 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS: THE MARIN COMMUNITY FOUNDATION (THE FOUNDATION) RECEIVES DONATIONS AND MANAGES AN ENDOWMENT FUND, THE MARIN COMMUNITY CLINIC ENDOWMENT OF THE MARIN COMMUNITY FOUNDATION. THE ASSETS FROM THIS AND OTHER ENDOWMENTS ARE MAINTAINED IN THE FOUNDATION'S ENDOWMENT FUND AND ARE POOLED ON A MARKET VALUE BASIS. INVESTMENT RETURN FROM SECURITIES IN THE ENDOWMENT FUND IS ALLOCATED TO THE INDIVIDUAL ENDOWMENTS BASED ON THE RELATIONSHIP OF THE FAIR VALUE OF THE INTEREST OF EACH ENDOWMENT TO THE TOTAL FAIR VALUE OF THE ENDOWMENT FUND, AS ADJUSTED FOR ADDITIONS TO OR DEDUCTIONS FROM THESE ACCOUNTS. THE FOUNDATION MAKES QUARTERLY DISTRIBUTIONS TO THE ORGANIZATION FOR INVESTMENT RETURNS RECEIVED ON THESE ENDOWMENTS BASED ON THE FOUNDATION'S SPENDING POLICY. AS THE SPENDING POLICY IS AT THE DISCRETION OF THE FOUNDATION AND CAN BE CHANGED, THE ENDOWMENT CONTRIBUTIONS ARE CONSIDERED CONDITIONAL AND ARE NOT RECORDED AS ASSETS OF THE ORGANIZATION. DURING THE YEARS ENDED JUNE 30, 2022 AND 2021, THE FOUNDATION'S SPENDING POLICY WAS TO DISTRIBUTE 4.50 PERCENT OF THE ROLLING 12 QUARTER AVERAGE OF THE MARKET VALUE OF THE POOLED FUND. THE ORGANIZATION RECEIVED DISTRIBUTIONS OF $49,521 AND $45,461 FOR THE YEARS ENDED JUNE 30, 2022 AND 2021, RESPECTIVELY, WHICH ARE INCLUDED IN CONTRIBUTION REVENUE ON THE STATEMENT OF OPERATIONS. AT JUNE 30, 2022 AND 2021, THE BALANCES OF THE ENDOWMENT FUND WERE $1,297,983 AND $1,595,068 RESPECTIVELY. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D OTHER REVENUE ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $ 945,017 NET ASSETS RELEASED FROM RESTRICTION SCHEDULE D, PART XI, LINE 4B OTHER REVENUE ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 3,246,566 CONTRIBUTIONS WITH DONOR RESTRICTIONS 21,178 CONTRIBUTIONS FOR PROPERTY, PLANT & EQUIPMENT (116,993) SPECIAL EVENT EXPENSES (1,486) LOSS ON DISPOSAL OF ASSETS ------------ $ 3,149,265 SCHEDULE D, PART XII, LINE 2D OTHER EXPENSES ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ 116,993 SPECIAL EVENT EXPENSES 1,486 LOSS ON DISPOSAL OF ASSETS ----------- $ 118,479 JUDITH SNEAD GRANT WRITI false SUMMER SOLSTICE 168807 131882 36925 750 44782 1200 70261 0 168807 131882 36925 750 44782 1200 70261 116993 -80068 X X false false false false false false false false false DAVID KLINETOBE CHIEF FINANCIAL OFFICER 271368 0 10000 0 0 0 8356 0 12870 0 302594 0 MITESH POPAT CEO 336732 0 55000 0 0 0 7701 0 19043 0 418476 0 LISA WARD MEDICAL DIRECTOR 277505 0 0 0 0 0 1044 0 19973 0 298522 0 JOSE CHIBRAS ADOLFO MEDICAL DIRECTOR 285035 0 0 0 0 0 8562 0 6026 0 299623 0 BICH-NGOC AKI DENTIST 226115 0 0 0 0 0 0 0 807 0 226922 0 CONSTANZA KADERA CHIEF DENTAL OFFICER 233327 0 0 0 0 0 7018 0 10029 0 250374 0 LEAH CANVASSER CHIEF INFORMATION OFFICER 206730 0 10200 0 0 0 5882 0 1054 0 223866 0 MELANIE ROSE THOMPSON CHIEF MEDICAL OFFICER 274271 0 0 0 0 0 8252 0 15299 0 297822 0 ELIZABETH SHAW MEDICAL DIRECTOR 246398 0 0 0 0 0 5895 0 9970 0 262263 0 XAVIER PEREZ MEDICAL DIRECTOR 245778 0 0 0 0 0 7372 0 478 0 253628 0 X 1 228682 FMV X 1 37805 FMV false false false SCHEDULE M, PART I, LINE 20, COLUMN (B) NUMBER OF CONTRIBUTIONS: THE NUMBERS ENTERED IN COLUMN B REPRESENT THE NUMBER OF DONORS WHO CONTRIBUTED THESE ITEMS DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW POLICY: THE AUDIT COMMITTEE REVIEWS THE FORM 990 PRIOR TO FILING AND WORKS WITH THE FINANCE COMMITTEE AND MANAGEMENT TO IMPLEMENT ANY CHANGES. THE AUDIT COMMITTEE REPORTS TO THE BOARD AND THE BOARD APPROVES THE FORM 990 SUBMISSION WHICH IS RECORDED IN ITS REGULAR MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ANNUALLY MEMBERS OF THE BOARD AS WELL AS MCC KEY EMPLOYEES ARE PROVIDED WITH A COPY OF THE CURRENT CONFLICT OF INTEREST POLICY. BOARD MEMBERS AS WELL AS MCC KEY EMPLOYEES ARE REQUIRED TO SELF-DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST. CONTRACTS AND MAJOR PURCHASES ARE ALSO SCRUTINIZED FOR POTENTIAL CONFLICT OF INTEREST. THE POLICIES OF MARIN COMMUNITY CLINIC BOARD OF DIRECTORS REQUIRE REGULAR DISCLOSURE OF MEMBER (1) AFFILIATIONS (AS TRUSTEE, BOARD MEMBER, OFFICER, EMPLOYEE, ADVISORY COMMIT MEMBER, DEVELOPMENT COMMITTEE MEMBER, VOLUNTEER, ETC.) WITH ANY OTHER ORGANIZATION WITH WHICH MCC MAY HAVE A FINANCIAL RELATIONSHIP, AND (2) AFFILIATIONS OF PERSONS WITH WHOM YOU HAVE A CLOSE PERSONAL RELATIONSHIP (SUCH AS A MEMBER OF THE IMMEDIATE FAMILY OR A MEMBER OF HOUSEHOLD) WITH ANY OTHER ORGANIZATION WITH WHICH THE MCC MAY HAVE A FINANCIAL RELATIONSHIP. EMPLOYEES, VOLUNTEERS AND BOARD MEMBERS HAVE A CONTINUING RESPONSIBILITY TO ADVISE THE BOARD SECRETARY OF ADDITIONAL AFFILIATIONS AS THEY MAY ARISE. ANY CONFLICT OF INTEREST WILL BE REVIEWED ON A CASE BY CASE BASIS ALONG WITH ANY APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION SETTING PROCEDURE: THE ORGANIZATION'S HR DIRECTOR OBTAINS INDUSTRY COMPENSATION DATA FROM LOCAL AND STATE RESOURCES TO BE USED FOR COMPARISON PURPOSES. DATA FROM ASSOCIATION SURVEYS (NACHC, CPCA, PAYSCALE) AND ANY RECOMMENDATIONS ARE REVIEWED AND REPORTED TO THE EXECUTIVE COMMITTEE FOR APPROVAL AND DISCUSSION. THE BOARD REVIEWS THE CEO'S PAY RATE ANNUALLY OR AS NECESSARY IF THERE IS A CHANGE IN STAFF. FORM 990, PART VI, SECTION B, LINE 15B COMPENSATION SETTING PROCEDURE: THE ORGANIZATION'S HR DIRECTOR OBTAINS INDUSTRY COMPENSATION DATA FROM LOCAL AND STATE RESOURCES TO BE USED FOR COMPARISON PURPOSES. DATA FROM ASSOCIATION SURVEYS (NACHC, CPCA, PAYSCALE) AND ANY RECOMMENDATIONS ARE REVIEWED AND REPORTED TO THE CEO. THE CEO REVIEWS THE PAY RATE ANNUALLY OR AS NECESSARY IF THERE IS A CHANGE IN STAFF. THE BOARD THEN APPROVES ANY INCREASES IN COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST. REQUESTED DOCUMENTS WILL BE MAILED TO THE REQUESTOR.