2023-05-12T10:14:47-07:00 2022-06-30 472251777 CHW LLP 7797 N First Street Suite 15 Fresno CA 93720 990 2021-07-01 680259045 MENDOCINO COMMUNITY HEALTH CLINIC INC MEND 7074724511 333 Laws Avenue Ukiah CA 95482 Rod Grainger CEO 7074724511 2023-02-02 1 Jeremy Ware P00642659 5595495400 2023-02-01 1 11 1 AAL2 X 2021 2023-04-26 12:10:37Z Rod Grainger 333 Laws Avenue Ukiah CA 95482 59521378 0 X 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. 10 10 464 11 0 0 16010851 11098449 35470764 35097352 28607 -1585940 70588 1307012 51580810 45916873 87787 81507 0 0 26178287 26165297 0 0 0 11316191 14117252 37582265 40364056 13998545 5552817 41276382 47857482 11008118 12090008 30268264 35767474 TO PROVIDE THE HIGHEST QUALITY HEALTHCARE FOR EVERYONE IN OUR COMMUNITIES. 0 0 21101689 81507 25867767 MEDICAL CARE: THE COMPANY PROVIDES A VARIETY OF MEDICAL SERVICES, INCLUDING PRIMARY CARE, OBSTETRICAL AND GYNECOLOGICAL SERVICES, PEDIATRICS, INTERNAL MEDICINE, AND SPECIALTY SERVICES. THE COMPANY PROVIDED 77,798 ENCOUNTERS TO PATIENTS AT OUR THREE SERVICE SITES DURING THE FISCAL YEAR ENDED 6-30-2022 AND EMPLOYED 89 MEDICAL EMPLOYEES. 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. 5807781 0 6046268 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. THE COMPANY REFERS 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 26,172 ENCOUNTERS IN THE FISCAL YEAR ENDED 6-30-2022 AND EMPLOYED 40 DENTAL EMPLOYEES. 1956639 0 2661382 MENTAL HEALTH CARE: THE COMPANY PROVIDES MENTAL HEALTH CARE SERVICES, INCLUDING PRIMARY CARE CONSULTATIONS, COUNSELING, AND PSYCHOTHERAPY. THE COMPANY PROVIDED 16,189 PATIENT ENCOUNTERS DURING THE FISCAL YEAR ENDED 6-30-2022 AND EMPLOYED 10 BEHAVIORAL HEALTH AND PSYCHIATRY EMPLOYEES. 0 0 0 28866109 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 48 0 1 464 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Lavonna Schrock 7074682219 333 Laws Avenue Ukiah CA 95482 Donna Smith Care for Her Provider 40 0 X 346195 0 20143 Jerry Douglas Chief Medical Officer 40 0 X 345797 0 20143 Steven Wirth Provider 40 0 X 328949 0 24164 Scott McFarland CEO 40 0 X 313741 0 13720 Stephen Vance Provider 35 0 X 290802 0 20143 Mario Espindola Provider 32 0 X 251569 0 19525 Jeff Wiedenfeld Chief Information Officer 40 0 X 207523 0 4150 Jill Damian Chief Operations Officer 40 0 X 187872 0 22294 Rod Grainger CFO 40 0 X 77688 0 2464 Jerry Chaney Board Secretary 2.0 0 X X 0 0 0 John Pavoni Director 1 0 X X 0 0 0 Victoria Kelly Board Vice Chair 1.4 0 X X 0 0 0 Carlos Frausto Director 1 0 X 0 0 0 Jacqueline Williams Director 1 0 X 0 0 0 Minerva Flores Director 1 0 X 0 0 0 Jeff Adair Director 1 0 X 0 0 0 Jackeline Gonzalez De Orozco Director 1 0 X 0 0 0 Carre Brown Director 1 0 X 0 0 0 Charles Myers Director 1 0 X 0 0 0 Karen Oslund Board Chair 1 0 X X 0 0 0 Stephen Miller Director 1 0 X 0 0 0 2350136 0 146746 51 0 1 0 Javier Arroyo PO Box 231 Calpella CA 95418 Chiropractic Services 167175 CompHealth PO Box 974088 Dallas TX 75397 Contract Services-Physicians 197779 Medical Doctor Associates LLC PO Box 277185 Atlanta GA 30384 Contract Services-Physicians 110837 3 0 0 0 0 10745876 352573 913593 11098449 Net patient service revenue 621400 35097352 35097352 0 0 0 0 0 0 35097352 188279 0 0 188279 0 0 0 0 0 0 0 0 70766 0 0 0 70766 0 70766 0 0 70766 11786356 43930 13583242 21263 -1796886 22667 -1774219 0 0 -1774219 0 1236246 1236246 0 0 1236246 45916873 36333598 0 -1515174 81507 81507 2628564 670835 1957729 18962687 15098602 3864085 424991 305069 119922 2580378 1801153 779225 1568677 1086316 482361 79146 79146 82250 82250 1768382 1430903 337479 102090 2613 99477 1501249 887054 614195 1705991 224464 1481527 1260681 628117 632564 76862 63357 13505 113077 89646 23431 1287224 829825 457399 296749 42266 254483 Medical Supplies 5539318 5524983 14335 0 304233 99399 204834 40364056 28866109 11497947 0 5284403 8054990 11958131 9915088 2277556 2417146 3304985 3398613 635545 605243 33151503 13973526 17646121 19177977 0 2276948 169641 2011477 41276382 47857482 3470234 3568396 1311925 7537884 7209687 0 0 11008118 12090008 X 30268264 35767474 0 0 30268264 35767474 41276382 47857482 5552817 -53607 0 0 0 0 X 0 1 X 1 1 1 X 6445998 6708683 7103139 16010931 11098449 47367200 34695127 35447135 32123135 33456856 35097302 170819555 41141125 42155818 39226274 49467787 46195751 218186755 218186755 3050 2959 38748 28607 188279 261643 3050 2959 38748 28607 188279 261643 41144175 42158777 39265022 49496394 46384030 218448398 0.99880 0.99863 0.00120 0.00137 X 0 1918365 1918365 0 22082150 10389626 11692524 0 0 0 0 0 5441928 3583900 1858028 0 3709060 0 3709060 19177977 0 X 45916873 0 0 0 0 0 45916873 0 0 0 45916873 40364056 0 0 0 0 0 40364056 0 0 0 40364056 Schedule D, Part X, Line 2 The Center has been recognized by the Internal Revenue Service as a non-profit corporation as described in Sec. 501(c)(3) of the Internal Revenue Code (IRC) and is exempt from federal and state income taxes on related income pursuant to Sec. 501(a) of the IRC and California Revenue and Taxation code Sec 23701d. Typically the three preceding tax years remain open and subject to examination by the appropriate government agencies in the United States and California. X X X X 1 0 0 0 0 0 0 0 0 Donna Smith Care for Her Provider 334395 0 10000 0 1800 0 5800 0 14343 0 366338 0 0 0 Jerry Douglas Chief Medical Officer 325029 0 16871 0 3896 0 5800 0 14343 0 365939 0 0 0 Steven Wirth Provider 307275 0 9945 0 11729 0 5800 0 18364 0 353113 0 0 0 Scott McFarland CEO 298189 0 15000 0 552 0 5800 0 7920 0 327461 0 0 0 Stephen Vance Provider 288180 0 0 0 2622 0 5800 0 14343 0 310945 0 0 0 Mario Espindola Provider 240506 0 9975 0 1088 0 5182 0 14343 0 271094 0 0 0 Jeff Wiedenfeld Chief Information Officer 184312 0 0 0 23211 0 4150 0 0 0 211673 0 0 0 Jill Damian Chief Operations Officer 180047 0 0 0 7825 0 3930 0 18364 0 210166 0 0 0 Schedule J, Part I, Line 4 Both CEO and COO were provided severance, one in 12 monthly installments and the other one lump sum, both were board approved. X 16780 913593 FMV 0 0 1 0 Schedule M, Part I Column B was entered by number of items received. 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. THIS IS RENEWED ANNUALLY 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 Available upon request.