2021-05-04T12:09:07-05:00 2020-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2019-07-01 680262003 MENDOCINO COAST CLINICS INC MEND 7079641251 205 SOUTH STREET FORT BRAGG CA 95437 LUCRESHA RENTERIA EXEC DIRECTOR 7079641251 2021-05-02 1 TERRI REXRODE CPA MST P00096513 9206620016 2021-05-02 2019 2022-09-23 18:48:47Z LUCRESHA RENTERIA 205 SOUTH STREET FORT BRAGG CA 95437 13363024 0 X WWW.MENDOCINOCOASTCLINICS.ORG X 1994 CA MENDOCINO COAST CLINICS, INC. PROVIDES HEALTH CARE SERVICES TO ALL WITHOUT REGARD TO RACE, CREED, NATIONAL ORIGIN, PHYSICAL DISABILITY, SEXUAL ORIENTATION OR ABILITY TO PAY FOR SERVICES TO THE EXTENT THE SERVICES ARE AVAILABLE AT THESE FACILITIES. 10 10 143 12 0 0 2475128 4014322 10167206 9045452 563 1226 163722 206407 12806619 13267407 8425 6452 0 0 8079842 8426855 0 0 0 4198583 4576324 12286850 13009631 519769 257776 8094939 9370618 2903128 3921031 5191811 5449587 X MENDOCINO COAST CLINICS, INC. PROVIDES HEALTH CARE SERVICES TO ALL WITHOUT REGARD TO RACE, CREED, NATIONAL ORIGIN, PHYSICAL DISABILITY, SEXUAL ORIENTATION OR ABILITY TO PAY FOR SERVICES TO THE EXTENT THE SERVICES ARE AVAILABLE AT THESE FACILITIES. 0 0 4054945 6452 4284796 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING MEDICAL SERVICES.DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 19,405 VISITS TO PATIENTS OF THE MEDICAL DEPARTMENT. 1289243 1453043 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING PEDIATRICS SERVICES. DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 5,806 VISITS TO PATIENTS OF THE PEDIATRICS DEPARTMENT. 1505005 1244028 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING DENTAL SERVICES. DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 7,649 VISITS TO PATIENTS OF THE DENTAL DEPARTMENT. 948754 1083938 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING BEHAVIORAL HEALTH SERVICES. DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 6,513 VISITS TO PATIENTS OF THE BEHAVIORAL HEALTH DEPARTMENT. 955835 975384 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING OB/GYN SERVICES. DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 3,838 VISITS TO PATIENTS OF THE OB/GYN DEPARTMENT. 82481 156165 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING WELLNESS CENTER SERVICES. 1987070 2215487 8836263 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 57 0 143 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CA X WIPFLI LLP 7074631463 125 E MILL ST UKIAH CA 95482 LAWRENCE GOLDYN MED DIRECTOR 40.00 X 245375 0 23228 CHRISTOPHER ROBSHAW PHYSICIAN 40.00 X 236122 0 28777 BRENT WRIGHT PHYSICIAN 40.00 X 210989 0 20717 LUCRESHA RENTERIA EXEC DIRECTOR 40.00 X 144336 0 29396 DONAVAN SPENCER PHYSICIAN 40.00 X 135411 0 30194 JAE DO KIM PHYSICIAN 40.00 X 145037 0 18290 TADEOUS ULATOWSKI DENTIST 40.00 X 147483 0 2752 KELLY GRIMES CHAIR 4.00 X X 0 0 0 DAPHNE HANEY TREASURER 4.00 X X 0 0 0 CLAUDIA BOUDREAU SECRETARY 4.00 X X 0 0 0 JUDITH WATERMAN CONTRACTED CFO 3.00 X 0 0 0 ARACELI RIVAS DIRECTOR 4.00 X 0 0 0 CHRISTOPHER KNOERDEL DIRECTOR 4.00 X 0 0 0 CLARE BERCOT ZWERLING DIRECTOR 4.00 X 0 0 0 CHRISTINE KELLY DIRECTOR 4.00 X 0 0 0 TREVOR ORCHARD DIRECTOR 4.00 X 0 0 0 RIO PARFREY DIRECTOR 4.00 X 0 0 0 YADIRA SANCHEZ DIRECTOR 4.00 X 0 0 0 1264753 0 153354 9 0 1 0 MACMAN MANAGEMENT HEALTHCARE 1930 DEL PASO RD STE 120 SACRAMENTO CA 95834 BILLING SERVICE 315641 WIPFLI LLP 125 E MILL STREET UKIAH CA 95482 CONSULTING SERVICE 187105 GABRIEL'S CLEANING SERVICE PO BOX 2221 FORT BRAGG CA 95437 CLEANING SERVICE 182065 3 10000 3606301 398021 4014322 PATIENT SERVICE FEES 621400 9045452 9045452 9045452 1226 1226 150122 10000 95617 54505 54505 MEANINGFUL USE INCENTIVE 621110 85000 85000 OTHER INCOME 900099 66902 66902 151902 13267407 9197354 0 55731 X 6452 6452 442335 268603 173732 6218360 5264738 953622 115508 100633 14875 1182767 1002581 180186 467885 390144 77741 38940 38940 15 15 124135 124135 1370237 28394 1341843 38767 38767 173633 128434 45199 657317 657317 415558 60995 354563 27197 27197 98868 78243 20625 77536 54839 22697 198143 148231 49912 43494 15458 28036 SUPPLIES - PHARMACEUTIC 482766 482766 SUPPLIES-PHARMACEUTICAL 391079 391079 SUPPLIES-CLINICAL 308180 308180 130459 106493 23966 13009631 8836263 4173368 0 1328067 3357427 10150 10125 193426 165231 1747614 1234283 159667 140518 7306141 2843107 4656015 4463034 8094939 9370618 1300054 1164932 4718 525737 1587456 2227637 10900 2725 2903128 3921031 X 5191811 5449587 5191811 5449587 8094939 9370618 257776 0 X X 0 1 X 1 1 1 X PART I, LINE 3 MENDOCINO COAST CLINICS, INC. IS A NONPROFIT PROVIDING HEALTH CARE SERVICES TO SOCIALLY AND ECONOMICALLY DEPRESSED SECTORS OF MENDOCINO COUNTY IN CALIFORNIA. ITS EXEMPT STATUS WAS APPROVED UNDER IRC 509(A)(1) AND 170(B) (1)(A)(III). IT IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL AND THEREFORE IS NOT REQUIRED TO COMPLETE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 433924 433924 5569607 1684369 3885238 38590 18670 19920 1263020 1140068 122952 1000 1000 4463034 13267407 0 13267407 0 13267407 13009631 0 13009631 0 13009631 CRAB FUNDRAISER 160122 10000 150122 95617 160122 10000 150122 95617 95617 54505 X 0 0 0 0 0 0 0 0 0 LAWRENCE GOLDYN MED DIRECTOR 245375 0 0 0 0 0 6022 0 17206 0 268603 0 0 0 CHRISTOPHER ROBSHAW PHYSICIAN 236122 0 0 0 0 0 5337 0 23440 0 264899 0 0 0 BRENT WRIGHT PHYSICIAN 210989 0 0 0 0 0 3322 0 17395 0 231706 0 0 0 LUCRESHA RENTERIA EXEC DIRECTOR 144336 0 0 0 0 0 6377 0 23019 0 173732 0 0 0 DONAVAN SPENCER PHYSICIAN 135411 0 0 0 0 0 8484 0 21710 0 165605 0 0 0 JAE DO KIM PHYSICIAN 145037 0 0 0 0 0 895 0 17395 0 163327 0 0 0 TADEOUS ULATOWSKI DENTIST 147483 0 0 0 0 0 0 0 2752 0 150235 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 WIPFLI LLP CONTRACTED CFO JUDITH WATERMAN $38,940. FORM 990, PART VI, SECTION B, LINE 11B LINE 11B EXPLANATION - A COPY OF THE FORM 990 AND ALL RELATED SCHEDULES AND STATEMENTS IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE UPDATED AND REVIEWED PERIODICALLY BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS WILL REVIEW ANY POTENTIAL CONFLICTS AND TAKE APPROPRIATE ACTION. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION OF KEY EMPLOYEES IS REVIEWED BY THE FULL BOARD OF DIRECTORS WHO ARE INDEPENDENT FROM THOSE IN WHICH COMPENSATION IS BEING REVIEWED. THE BOARD OF DIRECTORS APPROVE AND DOCUMENT ANY CHANGES TO COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 28,394. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,394. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,341,843. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,341,843.