2017-01-20T08:39:55-06:00 2016-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2015-07-01 942237120 MARIN COMMUNITY CLINIC % DAVID KLINETOBE MARI 4154481500 9 COMMERCIAL BLVD STE 100 NOVATO CA 94949 LINDA TAVASZI CHIEF EXECUTIVE OFFI 2016-10-27 true Brian D Todd P00422601 4178658701 2015 2021-01-29 14:40:06Z MARIN COMMUNITY CLINICS LINDA TAVASZI 1177 E FRANCISCO BLVD SAN RAFAEL CA 94901 37855591 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. 15 15 401 15 0 0 3807704 4931780 31360014 32878812 12 30962 -12275 -10146 35155455 37831408 207930 0 0 0 20308639 23999407 32382 77139 77139 10682514 12019936 31231465 36096482 3923990 1734926 33931470 38222103 8409944 10979643 25521526 27242460 X TO IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY BY PROVIDING HIGH QUALITY, COST-EFFECTIVE, CULTURALLY SENSITIVE, PATIENT-CENTERED HEALTH CARE. true false 19051122 20654547 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. 4099608 10271069 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. 723460 1627663 BEHAVIORAL HEALTH SERVICES - OFFERED TO CHILDREN, TEENS, AND ADULTS AND INCLUDES PSYCHIATRY AND COUNSELING BY LICENSED CLINICAL SOCIAL WORKERS. 241154 325533 24115344 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 false false false false false false false false false true 65 0 true 401 true false false false false false false false false false false X 15 15 false false true false false false false true true false false true true false 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 CHAIR 3.0 0.0 X X 0 0 0 GRACE HUGHES CHAIR ELECT 3.0 0.0 X X 0 0 0 DANIEL A SEGEDIN TREASURER 3.0 0.0 X X 0 0 0 ALYSSA H MORRIS SECRETARY 3.0 0.0 X X 0 0 0 VRANNA LYNN HINCK MEMBER-AT-LARGE 3.0 0.0 X X 0 0 0 WILLIAM KERR BOARD MEMBER 1.0 0.0 X 0 0 0 CRISTINA A MACKENZIE CHCCHPC BOARD MEMBER 1.0 0.0 X 0 0 0 FRANK TAVEL BOARD MEMBER 1.0 0.0 X 0 0 0 NILDES CARDOSO BOARD MEMBER 1.0 0.0 X 0 0 0 MARTHA J HANSEN BOARD MEMBER 1.0 0.0 X 0 0 0 MICHAEL S HARRIS BOARD MEMBER 1.0 0.0 X 0 0 0 SUE MACE BOARD MEMBER 1.0 0.0 X 0 0 0 TEO MARTINEZ BOARD MEMBER 1.0 0.0 X 0 0 0 VERONICA RODRIGUEZ BOARD MEMBER 1.0 0.0 X 0 0 0 STACY SCOTT BOARD MEMBER 1.0 0.0 X 0 0 0 LINDA TAVASZI PHD CHIEF EXECUTIVE OFFICER 40.0 0.0 X 238461 0 7272 DAVID KLINETOBE CHIEF FINANCIAL OFFICER 40.0 0.0 X 198961 0 1845 MARGARET DRACKER CHIEF OPERATIONS OFFICER 40.0 0.0 X 192714 0 38280 MITESH POPAT MD CHIEF MEDICAL OFFICER 40.0 0.0 X 245227 0 31324 CONSTANZA KADERA DDS CHIEF DENTAL OFFICER 40.0 0.0 X 183458 0 37171 BABAK ETTEKAL MEDICAL DIRECTOR 40.0 0.0 X 197098 0 32394 PAUL KIM DENTIST 40.0 0.0 X 145986 0 30237 LEAH CANVASSER IT DIRECTOR 40.0 0.0 X 151486 0 9928 JEANETTE KROLIKOWSKI PHYSICIAN 32.0 0.0 X 145860 0 14049 MIKOYAN M LAGRIMAS DENTIST 40.0 0.0 X 145850 0 12566 1845101 0 215066 31 false true false MCC BUILDING MAINTENANCE 7049 REDWOOD BLVD STE 108 NOVATO CA 94945 CLEANING & MAINTENAN 220814 WATECH COMPUTER SERVICES 1866 STAR BATT DRIVE ROCHESTER HILLS MI 48309 COMPUTER SERVICES 157246 FOWLER ELECTRIC 44 SPRAUER ROAD PETALUMA CA 94952 ELECTRICAL SERVICES 136144 BKD LLP CPA ADVISORS PO BOX 1190 SPRINGFIELD MO 658011190 AUDIT/TAX/CONSULTING 101020 4 86364 3222340 1623076 4931780 NET PATIENT SERVICE REVENUE 624100 28200415 28200415 EHR INCENTIVE 624100 369750 369750 OTHER INCOME 624100 48270 48270 CAPITATION REVENUE 624100 2752210 2752210 QUALITY IMPROVEMENT PROGRAM 624100 1508167 1508167 32878812 34199 34199 0 0 10800 10800 0 10800 10800 3237 -3237 -3237 -3237 86364 20946 -20946 -20946 0 0 0 37831408 32878812 20816 0 0 0 0 1174713 928980 245733 0 17446947 11517105 5929842 191293 111948 79345 3667548 2338457 1329091 1518906 1031679 487227 0 32127 32127 161943 161943 0 77139 77139 0 2985996 2299370 686626 0 1447488 845224 602264 664251 97467 566784 0 1111193 798418 312775 70426 19466 50960 0 111572 58858 52714 241274 241274 0 1596449 1083743 512706 153895 4533 149362 MEDICAL SUPPLIES & DRUGS 2825463 2825463 RECRUITING & RETENTION 273727 1747 271980 LICENSES, DUES, SUBSCRIPTIONS 156785 50942 105843 BAD DEBT 100882 100882 86465 1062 85403 36096482 24115344 11903999 77139 10391782 9140311 12056 2502 392837 1081339 3155000 2541688 0 0 0 0 0 0 243401 430327 490087 568941 31989283 10138976 18743106 21850307 0 2540624 0 0 0 0 0 0 503201 66064 33931470 38222103 1758638 1934484 0 0 109920 139806 0 0 0 0 0 0 5826386 5680353 0 0 715000 3225000 8409944 10979643 X 25271737 27005878 249789 236582 0 0 25521526 27242460 33931470 38222103 1734926 6431 -20423 X false true X true true true X 6700469 3648719 4147883 3807704 4931780 23236555 22023420 22508006 27309884 31360014 32878812 136080136 0 0 0 28723889 26156725 31457767 35167718 37810592 159316691 0 0 0 159316691 7341 10804 10803 10812 44999 84759 0 7341 10804 10803 10812 44999 84759 0 0 28731230 26167529 31468570 35178530 37855591 159401450 0.99947 0.99970 0.00053 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 12825 12825 false SCHEDULE C, PART II-B, QUESTION 1I OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS ANNUAL DUES OF $12,825 TO CALIFORNIA PRIMARY CARE ASSOCIATION (CPCA) - A PORTION OF WHICH MAY BE ATTRIBUTABLE TO LOBBYING. 998294 11490 -11221 46524 7463 944576 561023 436320 20129 13546 5632 998294 284517 254780 36996 12992 2278 561023 273816 25170 12628 1841 284517 272888 11544 2701 11544 1773 273816 1.00000 true false 0 4533750 4533750 16335983 4124365 12211618 5063360 2782281 2281079 5727102 3232330 2494772 0 329088 329088 21850307 0 EST DUE TO THIRD PARTIES 3225000 3225000 37871886 6431 117963 173505 297899 37573987 257421 257421 37831408 36137746 117963 24183 142146 35995600 100882 100882 36096482 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, 2016 AND 2015, 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 $46,524 AND $13,547 FOR THE YEARS ENDED JUNE 30, 2016 AND 2015, RESPECTIVELY, WHICH ARE INCLUDED IN THE STATEMENT OF OPERATIONS. AT JUNE 30, 2016 AND 2015, THE BALANCE OF THE ENDOWMENT FUND WAS $944,576 AND $998,294, 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: $ 274,387 NET ASSETS RELEASED FROM RESTRICTION (100,882) BAD DEBT EXPENSE ------------ $ 173,505 SCHEDULE D, PART XI, LINE 4B OTHER REVENUE ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 281,604 TEMPORARILY RESTRICTED CONTRIBUTIONS (20,946) SPECIAL EVENT EXPENSES (3,237) LOSS ON DISPOSAL OF ASSETS ------------ $ 257,421 SCHEDULE D, PART XII, LINE 2D OTHER EXPENSES ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ 20,946 SPECIAL EVENT EXPENSES 3,237 LOSS ON DISPOSAL OF ASSETS ----------- $ 24,183 SCHEDULE D, PART XII, LINE 4B OTHER EXPENSES ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 100,882 BAD DEBT EXPENSE X X X X X X X true JUDITH SNEAD GRANT FUNDR false 1025000 77139 1025000 77139 CA SUMMER SOLSTICE 86364 86364 770 361 500 19315 0 86364 86364 770 361 500 19315 20946 -20946 X X false false false false false false false false false LINDA TAVASZI PHD CHIEF EXECUTIVE OFFICER 235799 0 0 0 2662 0 6804 0 468 0 245733 0 0 0 DAVID KLINETOBE CHIEF FINANCIAL OFFICER 198961 0 0 0 0 0 1845 0 0 0 200806 0 0 0 BABAK ETTEKAL MEDICAL DIRECTOR 196969 0 0 0 129 0 2616 0 29778 0 229492 0 0 0 PAUL KIM DENTIST 145711 0 0 0 275 0 4659 0 25578 0 176223 0 0 0 LEAH CANVASSER IT DIRECTOR 148778 0 0 0 2708 0 2294 0 7634 0 161414 0 0 0 JEANETTE KROLIKOWSKI PHYSICIAN 145721 0 0 0 139 0 0 0 14049 0 159909 0 0 0 MIKOYAN M LAGRIMAS DENTIST 145734 0 0 0 116 0 4432 0 8134 0 158416 0 0 0 MARGARET DRACKER CHIEF OPERATIONS OFFICER 192059 0 0 0 655 0 5408 0 32872 0 230994 0 0 0 MITESH POPAT MD CHIEF MEDICAL OFFICER 245112 0 0 0 115 0 6780 0 24544 0 276551 0 0 0 CONSTANZA KADERA DDS CHIEF DENTAL OFFICER 183230 0 0 0 228 0 5987 0 31184 0 220629 0 0 0 FORM 990, PART III, LINE 2 NEW PROGRAM SERVICES: DURING THE FISCAL YEAR, THE FOLLOWING SERVICES WERE ADDED TO THE ORGANIZATION'S SCOPE OF SERVICES: PHYSICAL MEDICINE AND REHABILITATION, DIAGNOSTIC RADIOLOGY, NUTRITION, AND EMERGENCY COVERAGE DURING AND AFTER HOURS. FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICES: HEALTH EDUCATION - ASTHMA, CARDIO, CHRONIC PAIN, DIABETES, HEALTHY EATING. FORM 990, PART VI, SECTION A, LINE 4 CHANGES TO ORGANIZATIONAL DOCUMENTS: DURING FY16, THE ORGANIZATION AMENDED ITS BYLAWS TO INCLUDE THE FOLLOWING SIGNIFICANT CHANGES: - ADDITION OF AN ANNUAL REVIEW AND APPROVAL OF THE CASH AND BOARD DESIGNATED FUNDS POLICY AND INVESTMENT POLICY STATEMENT. - BOARD APPROVAL NECESSARY TO AUTHORIZE THE USE OF BOARD DESIGNATED SPECIAL RESERVE WITH A 2/3 MAJORITY VOTE. - MODIFICATION OF THE 2/3 VOTE REQUIREMENT WOULD REQUIRE A 2/3 VOTE FOR PASSAGE. 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, LINES 12B & 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 COMMITTEE 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 YOUR IMMEDIATE FAMILY OR A MEMBER OF YOUR 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, LINES 15A & 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) 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. REVIEW OF OTHER OFFICER OR KEY EMPLOYEE COMPENSATION: CEO REVIEWED 2015 BY BOARD CHAIR CFO REVIEWED 2015 BY CEO COO REVIEWED 2015 BY CEO CMO REVIEWED 2015 BY CEO CDO REVIEWED 2015 BY CEO 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.