2019-05-10T11:46:29-05:00 2018-06-30 910189318 MOSS ADAMS LLP 10960 WILSHIRE BLVD SUITE 1100 LOS ANGELES CA 90024 990 2017-07-01 680259045 MENDOCINO COMMUNITY HEALTH CLINIC INC MEND 7074724584 333 LAWS AVENUE UKIAH CA 95482 TIMOTHY J DOLAN CFO 7074724584 2019-05-09 1 LAUREN A HAVERLOCK P00545829 3104770450 2019-05-01 172.90.17.200 2019-05-09 16:22:33 PD P 41F3D51277C721D7E64869098416E4BAA04E310D 41F3D51277C721D7E64869098416E4BAA04E310D 2017 2020-04-17 16:48:07Z CAROLE PRESS 333 LAWS AVENUE UKIAH CA 95482 41155348 0 X WWW.MCHCINC.ORG X 1992 CA MENDOCINO COMMUNITY HEALTH CLINIC INC. PROVIDES MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO PATIENTS IN MENDOCINO AND LAKE COUNTIES. OUR MISSION: TO PROVIDE THE HIGHEST QUALITY HEALTH CARE TO MEMBERS IN OUR COMMUNITIES. 12 12 437 12 0 0 6248823 6445998 33697263 34695127 2792 9202 50435 0 39999313 41150327 84757 79095 0 0 24676050 26353125 0 0 0 10498610 12825957 35259417 39258177 4739896 1892150 24254794 27298849 10467522 11619427 13787272 15679422 TO PROVIDE THE HIGHEST QUALITY HEALTHCARE FOR EVERYONE IN OUR COMMUNITIES. 0 0 18067185 79095 23489540 MEDICAL SEGMENT SERVICES INCLUDE PRIMARY CARE, OBSTETRICAL AND GYNECOLOGICAL SERVICES, PEDIATRICS, INTERNAL MEDICINE AND SPECIALTY SERVICES. WE PROVIDED 107,759 ENCOUNTERS TO PATIENTS AT OUR THREE SERVICE SITES DURING THE FISCAL YEAR ENDED 6-30-18, EMPLOYING 176 FTES. PATIENTS ARE ABLE TO PARTICIPATE IN OUR PROGRAMS REGARDLESS OF ABILITY TO PAY FOR SERVICES. THE COMPANY OFFERS SLIDING SCALE PAYMENT OPTIONS FOR THOSE WHO QUALIFY BASED ON THEIR INCOME. THE COMPANY RESPONDS TO OUR COUNTIES' HEALTHCARE NEEDS THROUGH PREVENTIVE STRATEGIES AND TREATMENT OF ILLNESS. WE OFFER CARE TO PATIENTS WITH SPECIAL NEEDS OR BARRIERS TO CARE, INCLUDING THE HOMELESS, ELDERLY, THOSE WITH SUBSTANCE ABUSE DISORDERS AND PATIENTS WITH HIV. 7671182 0 7606389 DENTAL CARE: THE COMPANY OFFERS COMPREHENSIVE DENTAL SERVICES TO OUR PATIENTS, INCLUDING EXAMINATIONS, CLEANING AND PERIODONTAL TREATMENT, FILLINGS AND RESTORATIONS, EXTRACTIONS, LIMITED ROOT CANALS AND DENTURES. SPECIALTY PROGRAMS INCLUDE TREATMENT FOR PATIENTS WHO ARE PREGNANT, HIV PATIENTS AND THOSE WITH DEVELOPMENTAL DISABILITIES. WE REFER PATIENTS IN NEED OF ORAL SURGERY TO A NETWORK OF SPECIALISTS IN NORTHERN CALIFORNIA. DENTAL SERVICES ARE OFFERED TO PATIENTS AGES 1 YEAR AND ONWARD. THE COMPANY PROVIDED 32,620 ENCOUNTERS IN THE FISCAL YEAR ENDED 6-30-2018. 2970484 0 3599198 MENTAL HEALTH CARE: THE COMPANY PROVIDES MENTAL HEALTH CARE SERVICES, INCLUDING PRIMARY CARE CONSULTATIONS, COUNSELING AND PSYCHOTHERAPY. WE PROVIDED 14,395 PATIENT ENCOUNTERS DURING THE FISCAL YEAR ENDED 6-30-2018. 28708851 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 67 0 1 437 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X TIMOTHY J DOLAN 7074724584 333 LAWS AVENUE UKIAH CA 95482 JERRY CHANEY CHAIR 2.00 X X 0 0 0 JOHN PAVONI SECRETARY/TREASURER 1.00 X X 0 0 0 JIM MARILL VICE CHAIR 1.00 X X 0 0 0 CARLOS FRAUSTO DIRECTOR 1.00 X 0 0 0 BILL MERGENER DIRECTOR 2.00 X 0 0 0 DIANE CLATTY DIRECTOR 1.00 X 0 0 0 TOM JORDAN DIRECTOR 1.00 X 0 0 0 JACUELINE WILLIAMS DIRECTOR 1.00 X 0 0 0 MAYRA OCHOA DIRECTOR 1.00 X 0 0 0 WAYNE MENGER DIRECTOR 1.00 X 0 0 0 KAREN OSLUND DIRECTOR 1.00 X 0 0 0 CORRIGAN GOMMENGINGER DIRECTOR 1.00 X 0 0 0 CAROLE PRESS CEO 40.00 X 185967 0 7284 JILL DAMIAN COO 40.00 X 135381 0 3061 JEFF WIEDENFELD CIO 40.00 X 172163 0 3737 TIMOTHY DOLAN CFO 40.00 X 154053 0 3384 JERRY DOUGLAS CMO 40.00 X 318599 0 9125 DOUG LEWIS DENTAL DIRECTOR 40.00 X 189748 0 13567 KAREN CRABTREE CARE FOR HER DIRECTOR 40.00 X 376201 0 12507 ADWOA CHRISTY PHYSICIAN 40.00 X 316992 0 15314 STEVEN WIRTH PHYSICIAN 40.00 X 306155 0 15314 ANNE STOHRER PHYSICIAN 40.00 X 304789 0 9131 GUY TERAN PHYSICIAN 40.00 X 270056 0 15314 JAMES DOTSON PHYSICIAN 40.00 X 241548 0 5252 2971652 0 112990 50 0 1 0 JAVIER ARROYO PO BOX 231 CALPELLA CA 95418 CHIROPRACTIC 174600 BKD LLP 910 E ST LOUIS STREET SPRINGFIELD MO 65801 ACCOUNTING/AUDIT/TAX 170538 2 5786078 659920 474442 6445998 PATIENT SERVICE 624100 31053908 31053908 OTHER 624100 3298934 3298934 EHR INCENTIVE REVENUE 624100 212500 212500 EXEMPT RENTAL INCOME 900099 129785 129785 34695127 3050 3050 11173 5021 6152 6152 6152 41150327 34695127 0 9202 79095 79095 1534240 664333 869907 19774766 15464530 4310236 650987 482543 168444 2910518 2130883 779635 1482614 1122901 359713 98763 98763 187138 187138 1339125 1124851 214274 153357 19069 134288 2041000 683328 1357672 917097 260399 656698 1076433 499199 577234 107231 57686 49545 228826 129256 99570 5124 5124 902994 600637 302357 230426 63252 167174 MEDICAL SUPPLIES & DRUG 4700877 4683831 17046 BAD DEBT 536997 536997 LICENSES, DUES, & SUBSC 163722 64673 99049 RECRUITING & RETENTION 136847 36264 100583 39258177 28708851 10549326 0 216777 347778 4338188 3809610 648546 514939 2675335 3067511 75022 77061 380916 421165 25024879 9633549 13546069 15391330 2373941 3669455 24254794 27298849 3556659 3919944 6910863 7699483 10467522 11619427 X 13755389 15671922 31883 7500 0 0 13787272 15679422 24254794 27298849 1892150 0 X 0 1 X 1 1 1 X 4880287 4497087 5630544 6248823 6445998 27702739 23564237 26457238 28899478 33697263 34695127 147313343 28444524 30954325 34530022 39946086 41141125 175016082 0 0 0 175016082 2288 1468 162662 217366 3050 386834 2288 1468 162662 217366 3050 386834 28446812 30955793 34692684 40163452 41144175 175402916 0.99780 0.99760 0.00220 0.00240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 27800 27800 0 PART II-B, LINE 1(I) OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) AND THE CALIFORNIA PRIMARY CARE ASSOCIATION (CPCA). A PORTION OF THESE DUES MAY BE USED FOR LOBBYING PURPOSES. 1918365 1918365 15919289 5581001 10338288 3948830 3259543 689287 3238395 793005 2445390 15391330 DEPOSITS 5700 OTHER RECEIVABLES 1831184 EST AMTS DUE FROM THIRD PARTY 1832571 3669455 X 40637713 -505114 -505114 41142827 7500 7500 41150327 38721180 0 38721180 536997 536997 39258177 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2018 AND 2017, THE ORGANIZATION HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -536,997. NET ASSETS RELEASED FROM RESTRICTIONS 31,883. PART XI, LINE 4B - OTHER ADJUSTMENTS: TEMPORARILY RESTRICTED CONTRIBUTIONS 7,500. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 536,997. 1 MENDOCINO COAST CLINIC 205 SOUTH STREET FORT BRAGG CA 95437 680262003 501(C)(3) 79075 GENERAL SUPPORT 1 0 PART I, LINE 2: MCHC PROVIDES DETAILED RECORDS OF EXPENDITURES RELATED TO ITS GRANTS UNDER LAWS ESTABLISHED BY HRSA FOR USE OF GRANT FUNDS. WE RUN REPORTS IN SUPPORT OF OUR DRAWDOWNS OF GRANT FUNDS TO ENSURE THAT WE HAVE MET OR EXCEEDED THE AMOUNT REQUESTED IN EACH DRAWDOWN PRIOR TO REQUESTING FUNDS FROM HRSA. X X X X 0 0 0 0 0 0 0 0 0 CAROLE PRESS CEO 184661 0 254 0 1052 0 4165 0 3119 0 193251 0 0 0 JEFF WIEDENFELD CIO 169430 0 1681 0 1052 0 3737 0 0 0 175900 0 0 0 TIMOTHY DOLAN CFO 151057 0 1254 0 1742 0 3384 0 0 0 157437 0 0 0 JERRY DOUGLAS CMO 306729 0 10256 0 1614 0 6006 0 3119 0 327724 0 0 0 DOUG LEWIS DENTAL DIRECTOR 187880 0 254 0 1614 0 4259 0 9308 0 203315 0 0 0 KAREN CRABTREE CARE FOR HER DIRECTOR 374331 0 256 0 1614 0 6006 0 6501 0 388708 0 0 0 ADWOA CHRISTY PHYSICIAN 315122 0 256 0 1614 0 6006 0 9308 0 332306 0 0 0 STEVEN WIRTH PHYSICIAN 258473 0 46630 0 1052 0 6006 0 9308 0 321469 0 0 0 ANNE STOHRER PHYSICIAN 272919 0 30256 0 1614 0 6006 0 3125 0 313920 0 0 0 GUY TERAN PHYSICIAN 221404 0 46910 0 1742 0 6006 0 9308 0 285370 0 0 0 JAMES DOTSON PHYSICIAN 240240 0 256 0 1052 0 5252 0 0 0 246800 0 0 0 X 1 474442 FMV 0 0 1 0 PART I, COLUMN (B): PART I, COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED WITH THE CFO AND CEO. A FULL COPY OF THE FORM 990 IS AVAILABLE TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS BRIEFED ON ANY TAX RETURN ISSUES THAT ARISE IN THE PREPARATION OF THE RETURN DURING MEETINGS WITH THE FINANCE COMMITTEE OF THE BOARD. THAT COMMITTEE BRINGS A MOTION TO ACCEPT THE TAX RETURN TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS AND THE OFFICERS AND EMPLOYEES OF THE COMPANY FILE A DOCUMENT THAT EITHER DECLARES A POTENTIAL CONFLICT OR STATES THAT NO SUCH CONFLICT EXISTS. THE IS RENEWED ANNUAL WITHOUT EXCEPTION. FORM 990, PART VI, SECTION B, LINE 15 CEO AND CFO COMPENSATION IS VOTED ON AND REVIEWED ANNUALLY BY THE INDEPENDENT BOARD OF DIRECTORS. THE BOARD UTILIZES COMPARABILITY DATA FROM OTHER LOCAL NONPROFITS AS WELL AS THE CPCA COMPENSATION SURVEY. UNDER THE DIRECTION OF THE CEO, ALL EMPLOYEES ARE REVIEWED ANNUALLY FOR PERFORMANCE BY SUPERVISORS UNDER WHOM THEY WORK. COMPENSATION IS REVIEWED ANNUALLY FOR THE COMPANY AS A WHOLE BASED ON AVAILABILITY OF FUNDS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST.