2023-11-14T16:22:54-06:00 2022-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2022-01-01 271376321 PRIMA MEDICAL FOUNDATION PRIM 4158425000 9 COMMERCIAL BOULEVARD 200 NOVATO CA 94949 ERIC BRETTNER TREASURER / CFO 4158425000 2023-11-14 1 ERIC BRETTNER 999009999 0 MICHAEL LUMSDEN P01262236 4159561500 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARINHEALTH MEDICAL NETWORK JENNIFER SCHAAB MBA MPH 9 COMMERCIAL BOULEVARD 200 NOVATO CA 94949 141773309 0 X MYMARINHEALTH.ORG/ABOUT-US/MEDICAL-NETWORK/ X 2010 CA ESTABLISHING, OPERATING, AND MAINTAINING MULTI-SPECIALTY MEDICAL CLINICS THROUGHOUT MARIN AND SONOMA COUNTIES. 12 8 475 9 0 0 27743135 22641121 107171262 119116590 11856 15598 27499 0 134953752 141773309 0 0 0 0 34948735 38818231 0 0 0 100003029 102972295 134951764 141790526 1988 -17217 59866922 64247344 54437618 58835257 5429304 5412087 X TO PERFORM AND CARRY OUT CHARITABLE HEALTHCARE FUNCTIONS AND PURPOSES BY ESTABLISHING, OPERATING, AND MAINTAINING MULTI-SPECIALTY MEDICAL CLINICS FOR THE PROVISION OF HEALTHCARE SERVICES IN CALIFORNIA; AND BY ENGAGING IN, SPONSORING, ADVANCING, ENCOURAGING, AND PROMOTING CHARITABLE HEALTHCARE, EDUCATIONAL, AND MEDICAL RESEARCH ACTIVITIES. 0 0 139993043 0 119116590 PRIMA MEDICAL FOUNDATION (DBA MARINHEALTH MEDICAL NETWORK) IS A NONPROFIT PUBLIC BENEFIT CORPORATION WHICH PROVIDES MEDICAL SERVICES IN CONJUNCTION WITH PRIMA MEDICAL GROUP, INC. (PURSUANT TO A PROFESSIONAL SERVICES AGREEMENT), A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION. MARINHEALTH MEDICAL NETWORK PROVIDES THESE MEDICAL SERVICES TO BOTH INSURED AND UNINSURED RESIDENTS LOCATED PRIMARILY IN MARIN AND SONOMA COUNTIES. THANKS TO A STRATEGIC ALLIANCE, MARINHEALTH MEDICAL NETWORK PRACTICES ARE PART OF UCSF HEALTH, AND BACKED BY THE EXPERTISE OF MARINHEALTH MEDICAL CENTER. OUR PRIMARY CARE PROVIDERS AND SPECIALISTS COVER A WIDE RANGE OF PRACTICES, INCLUDING: AFTER-HOURS CARE (ADULT & PEDIATRIC); CARDIOVASCULAR MEDICINE; EAR, NOSE AND THROAT; FAMILY MEDICINE; GENERAL & COLORECTAL SURGERY; HEAD & NECK SURGERY; INTERNAL MEDICINE; OB/GYN & MIDWIFERY; PEDIATRIC CARE; PSYCHIATRY; SUPPORTIVE CARE; UROLOGY; WOMEN'S CARE; BREAST SURGICAL ONCOLOGY; CRITICAL CARE & PULMONOLOGY; ENDOCRINE & DIABETES CARE; GASTROENTEROLOGY; GYNECOLOGIC SURGERY; INFECTIOUS DISEASE; NEUROLOGY; ORTHOPEDIC SURGERY; PRIMARY CARE; RHEUMATOLOGY; UROGYNECOLOGY; AND VASCULAR MEDICINE. 139993043 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 0 0 0 1 69 0 1 475 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 CA X ERIC BRETTNER 4154642090 100B DRAKES LANDING ROAD SUITE 190 GREENBRAE CA 94904 X DAVID KLEIN MD CHAIR 2.00 48.00 X X 0 1799250 41437 GENE MARIE O'CONNELL RN MS VICE CHAIR 2.00 2.00 X X 0 0 0 ERIC BRETTNER TREASURER / CFO 2.00 48.00 X X 0 709710 47457 BRIAN KEEFFE MD SECRETARY 2.00 0.00 X X 0 0 0 JOE ABRAMS BOARD MEMBER 1.00 2.00 X 0 0 0 ANJULI BASU MD BOARD MEMBER 1.00 0.00 X 0 0 0 ANDREW BOTSCHNER BOARD MEMBER / INT CEO THROUGH 5/2022 40.00 0.00 X X 0 0 0 LISA CARMEL BOARD MEMBER 1.00 2.00 X 0 0 0 KEITH CHAMBERLIN MD BOARD MEMBER 1.00 0.00 X 0 0 0 MARY FRIEDMAN BOARD MEMBER 2.00 48.00 X 0 402823 56411 LINDA LANG BOARD MEMBER THROUGH 9/2022 2.00 48.00 X 0 473296 19077 RUSSELL PECKENPAUGH BOARD MEMBER 2.00 40.00 X 0 374242 32787 RIPPLE SHARMA MD FACG BOARD MEMBER 1.00 0.00 X 0 0 0 TARIN M KOEHLER DO BOARD MEMBER 1.00 0.00 X 0 0 0 IRENE TEPPER MD BOARD MEMBER THROUGH 5/2022 1.00 0.00 X 0 0 0 JENNIFER SCHAAB MBA MPH PRESIDENT MHMN START 5/2022 40.00 0.00 X 0 301497 15738 MICHAEL KIM MD VP OF MEDICAL AFFAIRS 40.00 0.00 X 0 426917 23677 BIANCA VIVAS EXECUTIVE DIRECTOR, CLINICAL OPERATIONS 40.00 0.00 X 177934 0 6651 JOLINE TELLECHEA REGISTERED NURSE 40.00 0.00 X 180801 0 7232 MERLIENAIDA GARCIA NURSE PRACTIONER 40.00 0.00 X 184968 0 4015 LISA DE LA FUENTE LEAD CERTIFIED NURSE MIDWIFE 40.00 0.00 X 192886 0 13766 ANOOSHEH NIKKAR PHYSICIAN ASSISTANT 40.00 0.00 X 198850 0 6150 935439 4487735 274398 61 0 1 0 PRIMA MEDICAL GROUP 4 HAMILTON LANDING STE 100 NOVATO CA 94949 PHYSICIAN SERVICES 24426987 CARDIOVASCULAR ASSOCIATES 2 BON AIR ROAD STE 100 LARKSPUR CA 94939 PHYSICIAN SERVICES 13828327 CA ADVANCED IMAGING MEDICAL ASSOCIATES 500 REDWOOD BLVD 300 NOVATO CA 94947 PHYSICIAN SERVICES 8172600 MARIN GASTROENTEROLOGY PARTNERSHIP 200 TAMAL PLAZA 200 CORTE MADERA CA 94925 PHYSICIAN SERVICES 4795003 NORTH MARIN INTERNAL MEDICINE 75 ROWLAND WAY SUITE 200 NOVATO CA 94945 PHYSICIAN SERVICES 2351833 28 22638244 2877 22641121 CONTRACT REVENUE 621400 100781347 100781347 OTHER OPERATING REVENUE 621400 11342841 11342841 NET PATIENT SERVICE REVENUE 621400 6992402 6992402 119116590 15598 15598 141773309 119116590 0 15598 X 31866135 31866135 408605 408605 4504897 4504897 2038594 2038594 210604 210604 -2417 -2417 81014227 81014227 2189228 2189228 25577 25577 8664313 8664313 61292 61292 164284 164284 2728577 2728577 1572599 1572599 MEDICAL SUPPLIES 5067998 5067998 REPAIRS & MAINTENANCE 810319 810319 EQUIPMENT LEASES 276728 276728 TAXES 123466 123466 65500 48803 16697 141790526 139993043 1797483 0 6122472 8757581 24239839 25547046 214489 371161 900133 755456 2118671 1824752 20585518 13090916 10120527 7494602 286107 228867 15864684 19267879 59866922 64247344 15383126 8837579 0 123719 175230 175230 38879262 49698729 54437618 58835257 X 5429304 5412087 5429304 5412087 59866922 64247344 -17217 0 X 0 1 X 1 0 X 12439013 20611825 29968934 27743135 22641121 113404028 31973603 73299377 75376047 107171262 119116590 406936879 44412616 93911202 105344981 134914397 141757711 520340907 0 0 0 520340907 110699 105521 114311 39355 15598 385484 110699 105521 114311 39355 15598 385484 44523315 94016723 105459292 134953752 141773309 520726391 0.99930 0.99880 0.00070 0.00120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4770166 4591166 179000 15762783 8499750 7263033 52569 52569 7494602 DEPOSITS 233519 OPERATING LEASE RIGHT OF USE ASSETS 19034360 19267879 DUE TO RELATED ORGANIZATIONS / AFFILIATES 24173412 OPERATING LEASE LIABILITY 21481295 CONTRACT LIABILITY 4044022 49698729 0 0 0 0 0 0 0 0 0 DAVID KLEIN MD CHAIR 0 1306030 0 486362 0 6858 0 15613 0 25824 0 1840687 0 0 ERIC BRETTNER TREASURER / CFO 0 520196 0 188272 0 1242 0 15978 0 31479 0 757167 0 0 LINDA LANG BOARD MEMBER THROUGH 9/2022 0 346394 0 126563 0 339 0 0 0 19077 0 492373 0 0 MARY FRIEDMAN BOARD MEMBER 0 301234 0 101250 0 339 0 25063 0 31348 0 459234 0 0 MICHAEL KIM MD VP OF MEDICAL AFFAIRS 0 385825 0 40000 0 1092 0 15250 0 8427 0 450594 0 0 RUSSELL PECKENPAUGH BOARD MEMBER 0 306163 0 65703 0 2376 0 21574 0 11213 0 407029 0 0 JENNIFER SCHAAB MBA MPH PRESIDENT MHMN START 5/2022 0 276052 0 25000 0 445 0 15053 0 685 0 317235 0 0 LISA DE LA FUENTE LEAD CERTIFIED NURSE MIDWIFE 192886 0 0 0 0 0 8213 0 5553 0 206652 0 0 0 ANOOSHEH NIKKAR PHYSICIAN ASSISTANT 188850 0 10000 0 0 0 6150 0 0 0 205000 0 0 0 MERLIENAIDA GARCIA NURSE PRACTIONER 184968 0 0 0 0 0 3775 0 240 0 188983 0 0 0 JOLINE TELLECHEA REGISTERED NURSE 180801 0 0 0 0 0 7232 0 0 0 188033 0 0 0 BIANCA VIVAS EXECUTIVE DIRECTOR, CLINICAL OPERATI 177934 0 0 0 0 0 0 0 6651 0 184585 0 0 0 PART I, LINE 3 THE PRESIDENT OF MARIN HEALTH MEDICAL NETWORK IS A PAID EMPLOYEE OF MARINHEALTH MEDICAL CENTER, A RELATED ORGANIZATION. MARINHEALTH MEDICAL CENTER UTILIZED THE FOLLOWING METHODS TO DETERMINE COMPENSATION OF THE PRESIDENT OF MARINHEALTH MEDICAL NETWORK: INDEPENDENT COMPENSATION CONSULTANT AND APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 DURING THE 2022 CALENDAR YEAR THE ORGANIZATION CONTRACTED WITH ANDREW BOTSCHNER, A CONSULTANT WITH HURON CONSULTING GROUP, TO FULFILL THE POSITION OF INTERIM CEO (THROUGH MAY 2022). COMPENSATION PAID TO HURON CONSULTING GROUP BY MARINHEALTH MEDICAL CENTER (A RELATED ORGANIZATION) IN EXCHANGE FOR THESE SERVICES TOTALED $190,000 DURING THE 2022 CALENDAR YEAR. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE SOLE MEMBER (BY DEFINITION OF THE BYLAWS), MARINHEALTH MEDICAL CENTER. THE FORM 990 INSTRUCTIONS ALSO DEFINE "MEMBER" AS ANY PERSON (INCLUDING A CORPORATION) WITH THE POWER TO APPOINT MEMBERS OF THE GOVERNING BODY. ACCORDINGLY, THE ORGANIZATION HAS TWO ADDITIONAL MEMBERS: PRIMA MEDICAL GROUP AND MARIN HEALTHCARE DISTRICT MEDICAL CARE CENTER. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SOLE MEMBER (BY DEFINITION OF THE BYLAWS), MARINHEALTH MEDICAL CENTER, HAS THE POWER TO SELECT 10 OF THE VOTING DIRECTORS, WHICH ARE SELECTED AS FOLLOWS: 5 OF THE APPOINTED DIRECTORS ARE PERSONS WHO ARE NOT EMPLOYEES OF MARINHEALTH MEDICAL CENTER AND ARE SELECTED BY MARINHEALTH MEDICAL CENTER FROM CANDIDATES IDENTIFIED BY THE NOMINATING COMMITTEE OF MARINHEALTH MEDICAL NETWORK; THE ADDITIONAL 5 APPOINTED DIRECTORS MAY BE EMPLOYEES OF MARINHEALTH MEDICAL CENTER AND ARE SELECTED BY MARINHEALTH MEDICAL CENTER WITHOUT ANY NOMINATION PROCESS. IN ADDITION, PRIMA MEDICAL GROUP HAS THE POWER TO APPOINT 2 DIRECTORS, WHO ARE FULL-TIME PHYSICIAN EMPLOYEES OF PRIMA MEDICAL GROUP. LASTLY, THE MEDICAL STAFF OF MARIN HEALTHCARE DISTRICT MEDICAL CARE CENTERS ALSO HAS THE POWER TO APPOINT 2 DIRECTORS WHO ARE MARIN HEALTHCARE DISTRICT MEDICAL CARE CENTER-BASED PHYSICIANS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF MARINHEALTH MEDICAL NETWORK SHALL NOT, WITHOUT PRIOR WRITTEN APPROVAL OF THE MARINHEALTH MEDICAL CENTER (THE ORGANIZATION'S SOLE MEMBER, PER THE BYLAWS), PERFORM OR COMMIT OR AUTHORIZE OR DIRECT ANY OFFICER OF MARINHEALTH MEDICAL NETWORK TO PERFORM OR COMMIT ANY OF THE FOLLOWING ACTIONS: (I) FILE FOR BANKRUPTCY, MAKE A GENERAL ASSIGNMENT FOR THE BENEFIT OF CREDITORS, OR TAKE ANY SIMILAR ACTION; (II) MAKE ANY MATERIAL CHANGE IN THE NATURE OF THE MARINHEALTH MEDICAL NETWORK'S BUSINESS; (III) SELL, EXCHANGE, OR OTHERWISE DISPOSE OF ANY ASSETS OUTSIDE THE ORDINARY COURSE OF BUSINESS; (IV) ENGAGE IN ANY DISSOLUTION, LIQUIDATION, MERGER, CONSOLIDATION, CONVERSION, OR REORGANIZATION OR ISSUE ANY CORPORATE MEMBERS; (V) AMEND MARINHEALTH MEDICAL NETWORK'S ARTICLES OF INCORPORATION OR BYLAWS; (VI) BORROW MONEY IN THE NAME OF MARINHEALTH MEDICAL NETWORK OR UTILIZE PROPERTY (REAL OR PERSONAL) OWNED BY MARINHEALTH MEDICAL NETWORK AS SECURITY FOR SUCH LOANS; (VII) ENTER INTO A MANAGEMENT AGREEMENT WITH ANY PERSON OR ENTITY PURSUANT TO WHICH IT WOULD REASONABLE BE INTERPRETED THAT MARINHEALTH MEDICAL NETWORK IS TRANSFERRING MANAGEMENT CONTROL OF ITS OPERATIONS TO A THIRD PARTY; (VIII) ACQUIRE, PURCHASE, DEVELOP, IMPROVE, SELL, LEASE, OR MORTGAGE ANY CORPORATE REAL ESTATE OR ANY INTEREST THEREIN OR ENTER INTO ANY CONTRACT FOR ANY SUCH PURPOSES; (IX) MAKE ANY LOAN, INVESTMENT, TRANSFER, OR DISPOSITION OF ANY ASSETS OF MARINHEALTH MEDICAL NETWORK OR ENTER INTO ANY CONTRACT OR INCUR ANY LIABILITIES ON BEHALF OF MARINHEALTH MEDICAL NETWORK OTHER THAN FOR FAIR CONSIDERATION AND IN THE ORDINARY COURSE OF BUSINESS RELATING TO ITS NORMAL DAILY OPERATION; (X) ESTABLISH CAPITAL AND OPERATING BUDGETS FOR MARINHEALTH MEDICAL NETWORK OR ADOPT MATERIAL CHANGES THERETO; AND (XI) ANY OTHER ACTION THAT COULD REASONABLY BE EXPECTED TO HAVE A MATERIAL ADVERSE EFFECT ON THE 501(C)(3) STATUS OR TAX-EXEMPT BONDS OF MARINHEALTH MEDICAL NETWORK OR MARINHEALTH MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE DEPARTMENT. THE FORM 990 IS THEN REVIEWED BY THE ORGANIZATION'S CFO AND CEO PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO OFFICERS, DIRECTORS, AND IMMEDIATE FAMILY MEMBERS THEREOF, AND REQUIRES DISCLOSURES TO THE BOARD OF ANY FINANCIAL INTERESTS IN A PROPOSED TRANSACTION OR AGREEMENT. IF THE BOARD DETERMINES THAT THE FINANCIAL INTEREST IS A CONFLICT OF INTEREST, THE INTERESTED DIRECTOR WILL NOT BE A VOTING MEMBER ON THE ISSUE IN QUESTION. THE POLICY REQUIRES AN ANNUAL DISTRIBUTION TO OFFICERS AND DIRECTORS AS WELL AS PERIODIC REVIEW AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DID NOT DIRECTLY COMPENSATE A CEO, OTHER OFFICERS, OR KEY EMPLOYEES DURING 2022. ACCORDINGLY, FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAS BEEN ANSWERED "NO". FORM 990, PART VI, SECTION C, LINE 19 MARINHEALTH MEDICAL NETWORK MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION DURING REGULAR BUSINESS HOURS AT ITS PRINCIPAL OFFICE. FORM 990, PART VII, SECTION A: DAVID KLEIN, MD (CEO OF MHMC), ERIC BRETTNER (CFO OF MHMC), LINDA LANG (CHIEF HUMAN RESOURCES OFFICER OF MHMC), MARY FRIEDMAN (VP OF STRATEGY AND BUSINESS DEVELOPMENT OF MHMC), AND RUSSELL PECKENPAUGH (VP OF INFORMATION SYSTEMS OF MHMC) ARE LISTED AS MEMBERS OF THE BOARD OF MARINHEALTH MEDICAL NETWORK; THEY ARE ALSO EMPLOYED AND COMPENSATED BY MARINHEALTH MEDICAL CENTER (MHMC), A RELATED ORGANIZATION. FORM 990, PART VII AND SCHEDULE J, PART II REPORTS 100% OF THESE INDIVIDUALS' COMPENSATION AS FROM A RELATED ORGANIZATION. IN ADDITION TO THEIR DUTIES WITH MHMC, EACH INDIVIDUAL DEVOTED AN AVERAGE OF TWO HOURS PER WEEK TO MARINHEALTH MEDICAL NETWORK RELATING TO THEIR DUTIES ASSOCIATED WITH SERVING ON THE BOARD OF DIRECTORS. THE COMPENSATION REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II IS RELATED TO THEIR SERVICES PROVIDED TO MHMC AND IS UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK FOR THEIR DUTIES AS BOARD MEMBERS OF MARINHEALTH MEDICAL NETWORK. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERICES: PROGRAM SERVICE EXPENSES 8,381,946. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,381,946. PROFESSIONAL SERVICES AGREEMENT FEES: PROGRAM SERVICE EXPENSES 71,412,577. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 71,412,577. RECRUITMENT & TEMP AGENCY: PROGRAM SERVICE EXPENSES 1,186,379. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,186,379. TRIAGE SERVICE: PROGRAM SERVICE EXPENSES 33,325. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,325. MARIN HEALTHCARE DISTRICT 100B DRAKES LANDING ROAD SUITE 250 GREENBRAE CA 94904 911886269 CORPORATE PARENT CA N/A 0 MARIN GENERAL HOSPITAL 250 BON AIR ROAD GREENBRAE CA 94904 942823538 HOSPITAL CA 501(C)(3) LINE 3 MARIN HEALTHCARE DISTRICT 0 MARIN GENERAL HOSPITAL FOUNDATION 1350 SOUTH ELISEO DRIVE SUITE 110 GREENBRAE CA 94904 946127213 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I MARIN GENERAL HOSPITAL 0 MARIN PETCT IMAGING LLC 4000 CIVIC CENTER DRIVE SUITE 110 SAN RAFAEL CA 94903 833116653 DIAGNOSTIC IMAGING CA N/A 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 1 1 1 0 0