2014-11-14T15:15:35-06:00 2013-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2013-01-01 271376321 PRIMA MEDICAL FOUNDATION PRIM 4158425031 HANGAR 4 4 HAMILTON LANDING NO 100 NOVATO CA 94949 WAYNE FAIRCHILD CEO 4158425031 2014-11-13 1 RENIE BURBANK P00159653 4159561500 2013 2015-11-30 17:44:51Z WAYNE FAIRCHILD HANGAR 4 4 HAMILTON LANDING NO 100 NOVATO CA 94949 40559086 0 X WWW.PRIMAMEDGROUP.COM X 2010 CA TO PROVIDE THE RECRUITMENT AND RETENTION OF PHYSICIANS, BECOME THE MODEL OF CHOICE FOR PHYSICIANS, IMPROVE CLINICAL QUALITY, PATIENT ACCESS AND ENHANCE ON-GOING STABILITY AND FINANCIAL VIABILITY FOR PHYSICIANS AND THEIR SPONSERS. 12 12 150 12 0 0 6581810 11202923 27435521 29176179 0 0 350000 179984 34367331 40559086 2247 0 0 0 7748166 9034020 0 0 0 26604206 30061082 34354619 39095102 12712 1463984 10431543 11733596 10394912 10232981 36631 1500615 X TO PROVIDE THE RECRUITMENT AND RETENTION OF PHYSICIANS, BECOME THE MODEL OF CHOICE FOR PHYSICIANS, IMPROVE CLINICAL QUALITY, PATIENT ACCESS AND ENHANCE ON-GOING STABILITY AND FINANCIAL VIABILITY FOR PHYSICIANS AND THEIR SPONSERS. 0 0 35253992 29176179 PRIMARY CARE PROGRAM PROVIDES MARIN & SONOMA COUNTY COMMUNITY WITH PRIMARY CARE SERVICES FOR ADULTS & CHILDREN IN NOVATO, SAUSALITO, PRIMA KIDS IN MILL VALLEY, SONOMA, TAMALPAIS & TERRA LINDA. OBGYN PROGRAM PROVIDES OBGYN SERVICES INCLUDING LABOR & DELIVERY TO MARIN & SONOMA COUNTIES AS WELL AS PROVIDES PHYSICIAN & CNM HOSPITALISTS CALL COVERAGE FOR MARIN GENERAL HOSPITAL AND SONOMA VALLEY HOSPITAL. SEE SCHEDULE OPRIMA MEDICAL FOUNDATION PROVIDES SURGICAL SERVICES FOR MARIN & SONOMA COUNTIES IN THE AREAS OF GENERAL SURGERY, ORTHOPEDICS, AND BREAST ONCOLOGY. IN ADDITION, THE COMPANY PROVIDES INTESIVIST SERVICES AND OFFERS A PEDIATRIC AFTER HOURS CLINIC AND HOSPITALIST CALL COVERAGE.PMF IS A NONPROFIT PUBLIC BENEFIT CORPORATION WHICH PROVIDES MEDICAL SERVICES PURSUANT TO A PROFESSIONAL SERVICES AGREEMENT WITH THE PRIMA MEDICAL GROUP, INC., A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION. PMF PROVIDES THESE MEDICAL SERVICES TO BOTH INSURED AND UNINSURED RESIDENTS LOCATED PRIMARILY IN MARIN AND SONOMA COUNTIES IN CALIFORNIA. THESE SERVICES ARE PROVIDED AT TWELVE OUTPATIENT CLINICS THAT IT OWNS AND OPERATES AND AT THREE LOCAL HOSPITALS. THE MEDICAL SERVICES ENCOMPASS MULTIPLE SPECIALTIES INCLUDING: INTERNAL MEDICINE, FAMILY MEDICINE, GENERAL PRACTICE, GERIATRICS, PEDIATRICS, OBSTETRICS, GYNECOLOGY, INFECTIOUS DISEASE, GENERAL SURGERY, COLORECTAL SURGERY, BREAST SURGERY, BARIATRICS, ORTHOPEDICS, DERMATOLOGY, PULMONARY MEDICINE, AND CRITICAL CARE. THESE SERVICES ARE FUNDED BY PATIENT, INSURANCE AND OTHER THIRD PARTY BILLINGS AND BY COLLECTIONS, CONTRIBUTIONS AND LOANS FROM LOCAL HOSPITALS. PATIENTS ARE SERVED WITHOUT LIMITATION BASED ON THEIR ABILITY TO PAY, PROVIDED THEY ARE RESIDENTS OF MARIN OR SONOMA COUNTIES. 35253992 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 40 0 1 150 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 1 0 1 1 0 0 0 1 0 0 0 1 1 1 0 CA X CHERI HAWKINS 4158425031 HANGAR 4 4 HAMILTON LANDING STE 100 NOVATO CA 94949 LEE DOMANICO CHAIRMAN 1.00 X X 0 0 0 KELLY MATHER VICE CHAIRMAN 1.00 X X 0 0 0 DAVID COX TREASURER 1.00 X X 0 0 0 MARK WEXMAN SECRETARY 1.00 X X 0 0 0 HARVEY BICKOFF BOARD MEMBER 1.00 X 0 0 0 NELSON BRANCO MD BOARD MEMBER 1.00 X 0 0 0 ROBERT COHEN MD BOARD MEMBER 1.00 X 0 0 0 CHARLES T FISCHER MD BOARD MEMBER 1.00 X 0 0 0 JOSEPH HABIS MD BOARD MEMBER 1.00 X 0 0 0 JUSTUS LEACHMAN BOARD MEMBER 1.00 X 0 0 0 ROBERT NEWBURY MD BOARD MEMBER 1.00 X 0 0 0 JOEL SKLAR MD BOARD MEMBER 1.00 X 0 0 0 DENNIS MONDRAGON INTERIM CEO 40.00 X 165810 0 17829 SUSAN SCHNEIDER MANAGER OF AFTER HOURS CLINIC - RN 40.00 X 130002 0 13538 MELANIE WICE DIRECTOR OF MIDWIFERY 40.00 X 122418 0 8312 PATRICIA MARSHALL PARNELL DIRECTOR OF SPECIALITY SERVICES 40.00 X 114666 0 7165 LINDA WRIGHT NURSE PRACTITIONER 40.00 X 110222 0 7050 643118 0 53894 5 0 1 0 BLACKHAWK MANAGEMENT GROUP LLC 160 CHURCHILL LANE NOVATO CA 94945 MANAGEMENT CONSULTING 330000 MOSS ADAMS LLP PO BOX 748369 LOS ANGELES CA 900748369 ACCOUNTING SERVICES 187805 2 778672 10424251 11202923 NET PATIENT SERVICES 621400 23155591 23155591 OTHER HMO REVENUE 621400 4724994 4724994 CAPITATION PREMIUM 621400 1295594 1295594 29176179 179984 0 179984 179984 179984 40559086 29176179 0 179984 183638 183638 6230159 6230159 76326 76326 1763087 1763087 780810 780810 22240432 19755003 2485429 336243 336243 184515 184515 551009 551009 163631 163631 1092982 1092982 124503 124503 2432427 2432427 11679 11679 122292 122292 77306 77306 664092 664092 93847 70797 23050 DRUGS AND IMMUNIZATIONS 1431242 1431242 TRIAGE SERVICE 181215 181215 353667 92803 260864 39095102 35253992 3841110 0 1666574 727612 3801628 3617707 170871 204463 592712 503351 5562177 2016671 4025738 3545506 174020 3134957 10431543 11733596 1074229 2129445 254115 1050 9066568 8102486 10394912 10232981 X 36631 1500615 36631 1500615 10431543 11733596 1463984 0 X X 0 1 X 1 0 X 3554177 3522954 6581810 11202923 24861864 9900417 23396678 27435521 29356163 90088779 13454594 26919632 34017331 40559086 114950643 0 0 0 114950643 13454594 26919632 34017331 40559086 114950643 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2382983 867028 1515955 576578 249388 327190 2602616 900255 1702361 3545506 RELATED PARTY RECEIVABLES 3134957 3134957 PAYABLE TO PRIMA MEDICAL GROUP 969410 RELATED PARTY PAYABLES 3908517 LINE OF CREDIT 2000000 DEFERRED RENT LIABILITY 1224559 8102486 X 40559086 0 40559086 0 40559086 39095102 0 39095102 0 39095102 PART X, LINE 2: THE FOUNDATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ASC 740. ASC 740 CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESENTING A MINIMUM PROBABILITY THRESHOLD THAT A TAX POSITION MUST MEET BEFORE A FINANCIAL STATEMENT BENEFIT IS RECOGNIZED. THE MINIMUM THRESHOLD IS DEFINED BY ASC 740 AS A TAX POSITION THAT IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAXING AUTHORITY, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT TO BE RECOGNIZED IS MEASURED AS THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT OF BEING REALIZED UPON ULTIMATE SETTLEMENT. AS OF DECEMBER 31, 2013, THE FOUNDATION HAD NO UNCERTAIN TAX POSITIONS. X 0 0 0 0 0 0 0 0 0 DENNIS MONDRAGON INTERIM CEO 165810 0 0 0 0 0 0 0 17829 0 183639 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A KEY PERSONS DESIGNATED TO APPOINT MEMBERS OF THE GOVERNING BODY INCLUDE SENIOR MANAGEMENT OF MARIN GENERAL HOSPITAL, MERITAGE MEDICAL NETWORK & PRIMA MEDICAL GROUP. FORM 990, PART VI, SECTION B, LINE 11 PRIMA MEDICAL FOUNDATION'S FORM 990 IS REVIEWED BY THE CONTROLLER AND THE CEO OR COO. IT IS ALSO READILY AVAILABLE TO THE BOARD OF DIRECTORS UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND COO'S COMPENSATION ARE SET BY THE FOUNDATION'S BOARD THROUGH NEGOTIATION REGARDING COMPLETE LISTING OF DUTIES AND AGREEMENT TO ACCOMPLISH CERTAIN GOALS. COMPARABILITY DATA WAS USED TO THE EXTENT THAT IT WAS AVAILABLE AND A WRITTEN CONTRACT WAS SIGNED. OTHER KEY EMPLOYEES IN PMF ARE GENERALLY HIRED THROUGH RECRUITING AGENCIES. SALARY IS ESTABLISHED AT MARKET RATES REPRESENTED IN THE REGION BY JOB TITLE AND DESCRIPTION OF DUTIES TO BE ACCOMPLISHED. THESE ARE COMPARED WITH OTHER SALARY SURVEYS AND PUBLICATIONS SUCH AS MGMA. FORM 990, PART VI, SECTION C, LINE 19 PRIMA MEDICAL FOUNDATION MAKES THIS INFORMATION READILY AVAILABLE FOR PUBLIC INSPECTION DURING REGULAR BUSINESS HOURS AT THEIR PRINCIPAL OFFICE. 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT - THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. MARIN GENERAL HOSPITAL 250 BON AIR ROAD GREENBRAE CA 94904 942823538 HOSPITAL CA 501(C)(3) 3 MARIN GENERAL HOSPITAL 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0