2020-06-30T08:42:36-05:00 2019-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2018-07-01 680262003 MENDOCINO COAST CLINICS INC MEND 7079641251 205 SOUTH STREET FORT BRAGG CA 95437 LUCRESHA RENTERIA EXEC DIRECTOR 7079641251 2020-06-18 1 TERRI REXRODE CPA MST P00096513 9206620016 2020-05-02 74.87.127.216 2020-06-18 11:16:15 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 2018 2021-01-29 14:40:06Z LUCRESHA RENTERIA 205 SOUTH STREET FORT BRAGG CA 95437 12895057 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. 9 9 153 12 0 0 2052783 2475128 9484381 10167206 515 563 159337 163722 11697016 12806619 6500 8425 0 0 7322617 8079842 0 0 0 4311080 4198583 11640197 12286850 56819 519769 7747636 8094939 3075594 2903128 4672042 5191811 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. 1 0 3966078 8425 4161613 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING MEDICAL SERVICES.DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 19,812 VISITS TO PATIENTS OF THE MEDICAL DEPARTMENT. 1608736 1875274 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING DENTAL SERVICES. DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 9,288 VISITS TO PATIENTS OF THE DENTAL DEPARTMENT. 1481806 1723583 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING PEDIATRICS SERVICES. DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 6,531 VISITS TO PATIENTS OF THE PEDIATRICS DEPARTMENT. 1051863 1251256 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING OB/GYN SERVICES. DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 4,862 VISITS TO PATIENTS OF THE OB/GYN DEPARTMENT. 1091349 1198605 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING BEHAVIORAL HEALTH SERVICES. DURING THE CURRENT FISCAL YEAR, MENDOCINO COAST CLINICS PROVIDED 6,319 VISITS TO PATIENTS OF THE BEHAVIORAL HEALTH DEPARTMENT. 88778 79775 MENDOCINO COAST CLINICS, INC. IS A PRIMARY CARE CLINIC PROVIDING WELLNESS CENTER SERVICES. 2231990 2529636 9288610 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 61 0 153 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 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 PATRICIA ANDROFF DIRECTOR 4.00 X 0 0 0 CLAUDIA BOUDREAU SECRETARY 4.00 X X 0 0 0 CHRISTOPHER KNOERDEL DIRECTOR 4.00 X 0 0 0 SARA O'DONNELL VICE CHAIR 4.00 X X 0 0 0 MARISOL HERNANDEZ DIRECTOR 4.00 X 0 0 0 DAPHNE HANEY TREASURER 4.00 X X 0 0 0 KELLY GRIMES CHAIR 4.00 X X 0 0 0 PAMELA MERRITT DIRECTOR 4.00 X 0 0 0 SIMON HODSON DIRECTOR 4.00 X 0 0 0 LUCRESHA RENTERIA EXEC DIRECTOR 40.00 X 116780 0 25748 LAWRENCE GOLDYN MED DIRECTOR 40.00 X 202107 0 22580 JUDITH WATERMAN CONTRACTED CFO 5.00 X 0 0 0 TADEUS ULATOWSKI DENTIST 40.00 X 143370 0 6493 BRENT WRIGHT PHYSICIAN 40.00 X 210788 0 21804 TARA MCLEER PHYSICIAN 40.00 X 158947 0 20010 CHRISTOPHER ROBSHAW PHYSICIAN 40.00 X 125463 0 27680 JAMES THOMAS PHYSICIAN ASSISTANT 40.00 X 126063 0 21083 1083518 0 145398 9 0 1 0 MACMAN MANAGEMENT HEALTHCARE 1930 DEL PASO RD STE 120 SACRAMENTO CA 95834 BILLING SERVICE 294460 GABRIEL'S CLEANING SERVICE PO BOX 2221 FORT BRAGG CA 95437 CLEANING SERVICE 169525 WIPFLI LLP 125 E MILL STREET UKIAH CA 95482 CONSULTING SERVICE 102200 3 40000 2030825 404303 2475128 PATIENT SERVICE FEES 621400 10167206 10167206 10167206 563 563 129260 40000 88438 40822 40822 MEANINGFUL USE INCENTIVE 621110 110500 110500 OTHER INCOME 900099 12400 12400 122900 12806619 10290106 0 41385 8425 8425 367215 224687 142528 6045207 5238079 807128 122163 105665 16498 1057802 906772 151030 487455 410752 76703 34170 34170 3475 3475 116500 116500 1039204 422656 616548 43107 43107 152893 67793 85100 649215 649215 420380 345593 74787 25332 25332 57381 34070 23311 75445 51791 23654 211180 146694 64486 38800 14599 24201 SUPPLIES - PHARMACEUTIC 454060 454060 SUPPLIES-PHARMACEUTICAL 399400 399400 SUPPLIES-CLINICAL 345441 345441 132600 112133 20467 12286850 9288610 2998240 0 1272469 1328067 10205 10150 29988 193426 1355936 1747614 186488 159667 7300979 2644964 4792228 4656015 100322 7747636 8094939 1311946 1300054 11378 4718 1713167 1587456 39103 10900 3075594 2903128 X 4672042 5191811 4672042 5191811 7747636 8094939 519769 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 5569608 1530496 4039112 38590 16098 22492 1257857 1098370 159487 1000 1000 4656015 12806619 0 12806619 0 12806619 12286850 0 12286850 0 12286850 CRAB FUNDRAISER 169260 40000 129260 88438 169260 40000 129260 88438 88438 40822 X 0 0 0 0 0 0 0 0 0 LAWRENCE GOLDYN MED DIRECTOR 202107 0 0 0 0 0 7163 0 15417 0 224687 0 0 0 BRENT WRIGHT PHYSICIAN 210788 0 0 0 0 0 6387 0 15417 0 232592 0 0 0 TARA MCLEER PHYSICIAN 158947 0 0 0 0 0 4617 0 15393 0 178957 0 0 0 CHRISTOPHER ROBSHAW PHYSICIAN 125463 0 0 0 0 0 6963 0 20717 0 153143 0 0 0 FORM 990, PART III, LINE 2 WELLNESS CENTER SERVICES WERE ADDED IN AUGUST 2018. FORM 990, PART VI, SECTION A, LINE 3 WIPFLI LLP CONTRACTED CFO JUDITH WATERMAN $34,170. 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. PART XII, LINE 2C THERE HAS BEEN NO CHANGE TO THIS PROCESS FROM THE PRIOR YEAR.