2019-02-20T16:58:32-06:00 2018-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2017-07-01 942237120 MARIN COMMUNITY CLINIC % DAVID KLINETOBE MARI 4154481500 9 COMMERCIAL BLVD Suite 100 NOVATO CA 94949 MITESH POPAT CHIEF EXECUTIVE OFFI 2018-12-14 true Krystal K Creach P01248198 4178658701 167.68.126.162 43032920190515000003 2019-02-20 P AE6E5E46D41BC60DF08B4BEE75B34EFCBA1C7A6F 53056B394AD20B3E44043C09DB34A60C153D8917 2017 2019-02-21 02:37:17Z MARIN COMMUNITY CLINICS MITESH POPAT 9 COMMERCIAL BLVD SUITE 100 NOVATO CA 94949 50724623 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. 17 17 501 32 107660 24021 5194587 5434051 39115945 44906728 -38082 103913 -14308 -13681 44258142 50431011 0 0 0 0 27702678 32480782 77416 40381 283161 13633390 14147909 41413484 46669072 2844658 3761939 40602355 42408899 10181590 8043966 30420765 34364933 TO IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY BY PROVIDING HIGH QUALITY, COST-EFFECTIVE, CULTURALLY SENSITIVE, PATIENT-CENTERED HEALTH CARE. false false 24302706 31846452 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. 8825273 11256336 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. 1638753 1803940 BEHAVIORAL HEALTH SERVICES - OFFERED TO CHILDREN, TEENS, AND ADULTS AND INCLUDES PSYCHIATRY AND COUNSELING BY LICENSED CLINICAL SOCIAL WORKERS. 34766732 true true false true false false false false false true true false false false true false true false false false false false false true true false false false false true false false false false false false false false true false false false false false false false false true 63 0 true 501 true true true false false false false false false false false false false X 17 17 false false true false false false false true true false false true true true true true true true true false CA X DAVID KLINETOBE 4155268532 9 COMMERCIAL BLVD SUITE 100 NOVATO CA 94949 JOHN E BOLAND III DDS MSD IMMEDIATE PAST BOARD CHAIR 3.0 0.0 X X 0 0 0 JERRY OKEN BOARD CHAIRMAN 3.0 0.0 X X 0 0 0 DANIEL A SEGEDIN TREASURER 3.0 0.0 X X 0 0 0 SUE MACE MEMBER-AT-LARGE 3.0 0.0 X X 0 0 0 WILLIAM B KERR SECRETARY 1.0 0.0 X X 0 0 0 ALYSSA MORRIS BOARD MEMBER 1.0 0.0 X 0 0 0 FRANK TAVEL MD BOARD MEMBER 1.0 0.0 X 0 0 0 ABIGAIL CADELINA BOARD MEMBER 1.0 0.0 X 0 0 0 NILDES CARDOSO BOARD MEMBER 1.0 0.0 X 0 0 0 MARTHA HANSEN BOARD MEMBER 1.0 0.0 X 0 0 0 MICHAEL HARRIS BOARD MEMBER 1.0 0.0 X 0 0 0 TEO MARTINEZ 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 CRISTINA A MACKENZIE CHC CH CHAIR ELECT 1.0 0.0 X X 0 0 0 FRESHTE KASHANI BOARD MEMBER BEG 08/2017 1.0 0.0 X 0 0 0 MARTIN WEIL BOARD MEMBER BEG 05/2018 1.0 0.0 X 0 0 0 DAVID KLINETOBE CHIEF FINANCIAL OFFICER 40.0 0.0 X 241759 0 14426 LINDA TAVASZI PHD CEO END 08/2017 40.0 0.0 X 174786 0 9009 MITESH POPAT CEO BEG 08/2017 40.0 0.0 X 283156 0 30478 CONSTANZA KADERA CHIEF DENTAL OFFICER 40.0 0.0 X 203711 0 33717 LEAH CANVASSER CHIEF ADMINISTRATIVE OFFICER 40.0 0.0 X 179913 0 9961 JOSE CHIBRAS-SAINZ CHIEF MEDICAL OFFICER 40.0 0.0 X 240578 0 9707 BABAK ETTEKAL MEDICAL DIRECTOR 32.0 0.0 X 218924 0 32077 ELIZABETH SHAW MEDICAL DIRECTOR 36.0 0.0 X 181967 0 20137 XAVIER PEREZ MEDICAL DIRECTOR 40.0 0.0 X 227989 0 12620 JON FROYD PHYSICIAN 40.0 0.0 X 218927 0 9949 MAI MAGLIOCCO LEAD PHYSICIAN ADULT MED 40.0 0.0 X 182275 0 21032 2353985 0 203113 45 false true false PRIMA MEDICAL FOUNDATION 9 COMMERCIAL BLVD STE 200 NOVATO CA 94949 PROFESSIONAL SERVICE 438693 WATECH COMPUTER SERVICES 1866 STAR NATT DR ROCHESTER HILLS MI 48309 COMPUTER SERVICES 394382 MCC BUILDING MAINTENANCE 7049 REDWOOD BLVD STE 108 NOVATO CA 94945 CLEANING AND MAINTEN 355300 UC REGENTS SCHOOL OF OPTOMETRY 230 MINOR HALL BERKELEY CA 94720 PROFESSIONAL SERVICE 345295 FOWLER ELECTRIC 44 SPRAUER ROAD PETALUMA CA 94952 CONTRACTOR SERVICES 123390 7 138799 3879184 1416068 228412 5434051 NET PATIENT SERVICE REVENUE 624100 37203860 37203860 EHR INCENTIVE 624100 24500 24500 OTHER INCOME 624100 255437 147777 107660 CAPITATION REVENUE 624100 3225768 3225768 QUALITY IMPROVEMENT PROGRAM 624100 4197163 4197163 44906728 203588 203588 0 0 19800 19800 0 19800 19800 160456 137919 122212 22537 -122212 -99675 -99675 0 138799 33481 -33481 -33481 0 0 0 0 0 0 0 50431011 44799068 107660 90232 0 0 0 0 1431201 487713 943488 0 23955159 18750673 5062062 142424 349652 278809 70843 4777799 3316761 1434768 26270 1966971 1479487 475906 11578 0 51876 51876 137042 137042 0 40381 40381 0 2684159 2219597 441617 22945 0 1313426 807051 480567 25808 924610 123717 793148 7745 0 1309155 975456 333687 12 66187 17026 48557 604 0 177883 103540 73716 627 148129 148129 0 2103594 1479416 624178 151555 151555 MEDICAL SUPPLIES & DRUGS 4486009 4486009 RECRUITING & RETENTION 258603 3065 254303 1235 BAD DEBT 158032 158032 LICENSES, DUES, SUBSCRIPTIONS 153397 74390 78843 164 24252 5990 14894 3368 46669072 34766732 11619179 283161 7236081 1841427 2756020 6813214 1199284 559433 3559939 4342973 0 0 0 0 0 0 404970 472395 664349 776931 32216588 12382810 20691440 19833778 4035777 6889492 0 0 0 0 0 0 54495 879256 40602355 42408899 2261045 2655748 0 0 77177 65500 0 0 0 0 0 0 4643368 1822718 0 0 3200000 3500000 10181590 8043966 X 30188618 33957974 232147 406959 0 0 30420765 34364933 40602355 42408899 3761939 182229 X false true X true true true X 4147883 3807704 4931780 5194587 5434051 23516005 27309884 31360014 32878812 39109395 44906728 175564833 0 0 0 31457767 35167718 37810592 44303982 50340779 199080838 0 0 0 199080838 10803 10812 44999 75949 203588 346151 0 10803 10812 44999 75949 203588 346151 0 0 31468570 35178530 37855591 44379931 50544367 199426989 0.99826 0.99912 0.00174 0.00088 X false false false false false false false false true 32590 32590 false SCHEDULE C, PART II-B, QUESTION 1I OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS ANNUAL DUES OF $32,590 TO CALIFORNIA PRIMARY CARE ASSOCIATION (CPCA) - A PORTION OF WHICH MAY BE ATTRIBUTABLE TO LOBBYING. 1027362 93891 43421 8935 1068897 944576 137303 46380 8137 1027362 998294 11490 -11221 46524 7463 944576 561023 436320 20129 13546 5632 998294 284517 254780 36996 12992 2278 561023 1.00000 true false 4533750 4533750 19767113 7861609 11905504 1027869 452827 575042 6887856 4068374 2819482 19833778 0 EST DUE TO THIRD PARTIES 3500000 3500000 50230683 182229 83006 14116 279351 49951332 479679 479679 50431011 46749739 83006 155693 238699 46511040 158032 158032 46669072 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, 2018 AND 2017, THE FOUNDATION'S SPENDING POLICY WAS TO DISTRIBUTE 5.5% OF THE ROLLING 12 QUARTER AVERAGE OF THE MARKET VALUE OF THE POOLED FUND. THE ORGANIZATION RECEIVED DISTRIBUTIONS OF $43,421 AND $46,380 FOR THE YEARS ENDED JUNE 30, 2018 AND 2017, RESPECTIVELY, WHICH ARE INCLUDED IN THE STATEMENT OF OPERATIONS. AT JUNE 30, 2018 AND 2017, THE BALANCE OF THE ENDOWMENT FUND WAS $1,068,897 AND $1,027,362, 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: $ 172,148 NET ASSETS RELEASED FROM RESTRICTION (158,032) BAD DEBT EXPENSE ------------ $ 14,116 SCHEDULE D, PART XI, LINE 4B OTHER REVENUE ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 406,960 TEMPORARILY RESTRICTED CONTRIBUTIONS 228,412 CONTRIBUTION FOR PP&E (122,212) LOSS ON DISPOSAL OF ASSETS (33,481) SPECIAL EVENT EXPENSES ------------ $ 479,679 SCHEDULE D, PART XII, LINE 2D OTHER EXPENSES ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ 122,212 LOSS ON DISPOSAL OF ASSETS 33,481 SPECIAL EVENT EXPENSES ----------- $ 155,693 SCHEDULE D, PART XII, LINE 4B OTHER EXPENSES ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 158,032 BAD DEBT EXPENSE X X X X X X X true PRG Consulting 5340 SOUTH QUEBEC STREET SUITE 250 GREENWOOD VILLAGE CO 80111 Letter Writing false 0 40381 -40381 0 40381 -40381 SUMMER SOLSTICE 138799 138799 1808 900 9623 21150 0 138799 138799 1808 900 9623 21150 33481 -33481 X X false false false false false false false false false DAVID KLINETOBE CHIEF FINANCIAL OFFICER 241759 0 0 0 0 0 6763 0 7663 0 256185 0 LINDA TAVASZI PHD CEO END 08/2017 174786 0 0 0 0 0 5199 0 3810 0 183795 0 MITESH POPAT CEO BEG 08/2017 283156 0 0 0 0 0 6777 0 23701 0 313634 0 BABAK ETTEKAL MEDICAL DIRECTOR 218924 0 0 0 0 0 6982 0 25095 0 251001 0 ELIZABETH SHAW MEDICAL DIRECTOR 181967 0 0 0 0 0 5431 0 14706 0 202104 0 XAVIER PEREZ MEDICAL DIRECTOR 227989 0 0 0 0 0 3506 0 9114 0 240609 0 JON FROYD PHYSICIAN 218927 0 0 0 0 0 2561 0 7388 0 228876 0 MAI MAGLIOCCO LEAD PHYSICIAN ADULT MED 182275 0 0 0 0 0 1070 0 19962 0 203307 0 CONSTANZA KADERA CHIEF DENTAL OFFICER 203711 0 0 0 0 0 5976 0 27741 0 237428 0 LEAH CANVASSER CHIEF ADMINISTRATIVE OFFICER 179913 0 0 0 0 0 2723 0 7238 0 189874 0 JOSE CHIBRAS-SAINZ CHIEF MEDICAL OFFICER 240578 0 0 0 0 0 1907 0 7800 0 250285 0 X 1 25000 FMV X DENTAL EQUIPMENT 1 203412 FMV false true false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTORS: THE NUMBER OF CONTRIBUTIONS IS REPRESENTED BY THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: IN THE 3/2018 APPROVED BYLAWS BOARD APPROVAL WILL BE REQUIRED FOR: ANY CAPITAL EXPENDITURE IN EXCESS OF $100,000, UNLESS THE ITEM WAS INCLUDED IN A BOARD APPROVED CAPITAL BUDGET. ANY EXTRAORDINARY EXPENDITURE THAT INCREASES ANNUAL EXPENSES BY MORE THAN $50,000 IN EITHER THE CURRENT OR NEXT FISCAL YEAR, UNLESS THE ITEM WAS INCLUDED IN A BOARD APPROVED OPERATING BUDGET. A NEW OFFICER POSITION WAS ADDED: 8.5 IMMEDIATE PAST CHAIR. THE IMMEDIATE PAST CHAIR BRINGS HIS/HER KNOWLEDGE AND EXPERIENCE TO THE BOARD DISCUSSIONS AND ACTIVITIES. THE IMMEDIATE PAST CHAIR SHALL BE A MEMBER OF THE EXECUTIVE COMMITTEE. 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 EXECUTIVE COMMITTEE AND MANAGEMENT TO IMPLEMENT ANY CHANGES. THE EXECUTIVE COMMITTEE REPORTS TO THE BOARD AND THE BOARD APPROVES THE FORM 990 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.