PRIMA MEDICAL FOUNDATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- PRIMA MEDICAL FOUNDATION (EIN 27-1376321)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201603199349309840
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-14T17:40:53-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 Second Street Suite 900 | AddressLine1Txt |
| City | San Francisco | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94105 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271376321 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prima Medical Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PRIM | BusinessNameControlTxt |
| Phone | 4158425000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9 Commercial Blvd No 200 | AddressLine1Txt |
| City | Novato | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94949 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Robert Newbury MD | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4158425000 | PhoneNum |
| Signature | 2016-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Renie Burbank | PreparerPersonNm |
| PTIN | P00159653 | PTIN |
| Phone | 4159561500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Robert Newbury MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9 Commercial Blvd No 200 | AddressLine1Txt |
| City | Novato | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94949 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $41,044,165 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PRIMAMEDGROUP.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | 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 sponsors. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 177 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $10,375,698 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,764,328 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,099,200 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,101,848 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,293 | CYInvestmentIncomeAmt |
| PY Other Revenue | $165,001 | PYOtherRevenueAmt |
| CY Other Revenue | $144,812 | CYOtherRevenueAmt |
| PY Total Revenue | $39,639,899 | PYTotalRevenueAmt |
| CY Total Revenue | $41,018,281 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,836,703 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,519,488 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,231,177 | PYOtherExpensesAmt |
| CY Other Expenses | $29,928,214 | CYOtherExpensesAmt |
| PY Total Expenses | $39,067,880 | PYTotalExpensesAmt |
| CY Total Expenses | $40,447,702 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $572,019 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $570,579 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,775,096 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,707,341 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,702,462 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,064,128 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,072,634 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,643,213 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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 sponsors. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,481,125 | ExpenseAmt |
| Revenue | $10,959,144 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,268,787 | ExpenseAmt |
| Revenue | $6,738,489 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $11,534,242 | ExpenseAmt |
| Revenue | $12,404,215 | RevenueAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $33,284,154 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 55 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 177 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James P McManus | PersonNm |
| Phone | 4158425000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9 Commercial Blvd Ste 200 | AddressLine1Txt |
| City | Novato | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94949 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LEE DOMANICO | ||||||||
| CHAIRMAN/MGH CEO | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $1,568,309 | $17,885 | |
| STEVE SCHROEDER | ||||||||
| VICE CHAIRMAN | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GENE O'CONNELL | ||||||||
| SECRETARY | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JEREMY FAIR | ||||||||
| TREASURER | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOEL CRISTE | ||||||||
| Board Member/MMN CEO (thru 8/2015) | 1.00 | 39.00 | Yes (X) | $0 | $0 | $0 | ||
| JON FRIEDENBERG | ||||||||
| BOARD MEMBER | 1.00 | 39.00 | Yes (X) | $0 | $625,180 | $47,642 | ||
| JOSEPH HABIS MD | ||||||||
| BOARD MEMBER | 1.00 | 39.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL KIRINCIC | ||||||||
| BOARD MEMBER | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KELLY MATHER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK ZIELAZINSKI | ||||||||
| BOARD MEMBER | 1.00 | 39.00 | Yes (X) | $0 | $445,481 | $35,285 | ||
| ROBERT NEWBURY MD | ||||||||
| Chief Executive Officer | 39.00 | 1.00 | Yes (X) | Yes (X) | $75,000 | $0 | $0 | |
| WAYNE FAIRCHILD | ||||||||
| CEO (Thru 10/2015) | 40.00 | 0.00 | Yes (X) | $269,305 | $0 | $21,791 | ||
| CHERI HAWKINS | ||||||||
| CFO (Thru 12/2015) | 40.00 | 0.00 | Yes (X) | $163,796 | $0 | $26,716 | ||
| ALFREDO LIMJOCO | ||||||||
| DIR OF IT (Thru 12/16/2016) | 40.00 | 0.00 | $165,227 | $0 | $6,241 | Yes (X) | ||
| LINDA CHOTKEVYS | ||||||||
| DIR OF HUMAN RESOURCES | 40.00 | 0.00 | $154,783 | $0 | $27,305 | Yes (X) | ||
| SHERI MATTEO | ||||||||
| DIRECTOR OF MIDWIFERY | 40.00 | 0.00 | $138,683 | $0 | $19,658 | Yes (X) | ||
| RANDALL ICHIHANA | ||||||||
| PULMONARY SERVICES MANAGER | 40.00 | 0.00 | $120,711 | $0 | $9,142 | Yes (X) | ||
| JODY BRANHAM | ||||||||
| CERTIFIED NURSE MIDWIFE | 40.00 | 0.00 | $106,699 | $0 | $25,506 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,194,204 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,638,970 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $237,171 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Jones Day | |||||
| 555 California Street 26th Floor | San Francisco | CA | 94104 | Legal SERVICES | $334,469 |
| Moss Adams LLP | |||||
| PO Box 748369 | Los Angeles | CA | 900748369 | ACCOUNTING SERVICES | $144,780 |
| MERRI MARTORI NP | |||||
| 34 WATERBURY LANE | NOVATO | CA | 94949 | NURSE PRACTIONER | $111,381 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $10,151,648 | RelatedOrganizationsAmt |
| Government Grants | $162,680 | GovernmentGrantsAmt |
| All Other Contributions | $450,000 | AllOtherContributionsAmt |
| Total Contributions | $10,764,328 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICES | 621400 | $23,981,800 | $23,981,800 |
| OTHER HMO REVENUE | 621400 | $4,940,643 | $4,940,643 |
| CAPITATION PREMIUM | 621400 | $1,179,405 | $1,179,405 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,101,848 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $144,812 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $144,812 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $144,812 | TotalRevenueColumnAmt |
| Exclusion | $144,812 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $33,177 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $25,884 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,293 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,293 | TotalRevenueColumnAmt |
| Exclusion | $7,293 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,018,281 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,101,848 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $152,105 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $556,607 | TotalAmt |
| Management And General | $556,607 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,139,374 | TotalAmt |
| Program Services | $4,715,981 | ProgramServicesAmt |
| Management And General | $2,423,393 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,996 | TotalAmt |
| Program Services | $84,416 | ProgramServicesAmt |
| Management And General | $44,580 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,046,210 | TotalAmt |
| Program Services | $1,555,287 | ProgramServicesAmt |
| Management And General | $490,923 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $648,301 | TotalAmt |
| Program Services | $467,917 | ProgramServicesAmt |
| Management And General | $180,384 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,822,120 | TotalAmt |
| Program Services | $19,210,040 | ProgramServicesAmt |
| Management And General | $1,612,080 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,066 | TotalAmt |
| Management And General | $100,066 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,305 | TotalAmt |
| Management And General | $172,305 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,414 | TotalAmt |
| Management And General | $343,414 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,690 | TotalAmt |
| Program Services | $46,690 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,527,628 | TotalAmt |
| Program Services | $1,081,677 | ProgramServicesAmt |
| Management And General | $445,951 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,446 | TotalAmt |
| Program Services | $177,446 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,535,123 | TotalAmt |
| Program Services | $2,325,572 | ProgramServicesAmt |
| Management And General | $209,551 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,980 | TotalAmt |
| Program Services | $32,980 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,092 | TotalAmt |
| Program Services | $66,092 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,373 | TotalAmt |
| Management And General | $92,373 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $980,848 | TotalAmt |
| Program Services | $544,820 | ProgramServicesAmt |
| Management And General | $436,028 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,005,657 | TotalAmt |
| Program Services | $978,053 | ProgramServicesAmt |
| Management And General | $27,604 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| drugs AND IMMUNIZATIONS | $1,748,544 | $1,748,544 |
| Triage service | $157,760 | $157,760 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,168 | TotalAmt |
| Program Services | $90,879 | ProgramServicesAmt |
| Management And General | $28,289 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,447,702 | TotalAmt |
| Program Services | $33,284,154 | ProgramServicesAmt |
| Management And General | $7,163,548 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $293,991 | BOYAmt |
| EOY | $240,527 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,146,039 | BOYAmt |
| EOY | $3,148,810 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $227,679 | BOYAmt |
| EOY | $415,862 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $738,874 | BOYAmt |
| EOY | $664,934 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,628,675 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,772,302 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,668,467 | BOYAmt |
| EOY | $2,856,373 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,700,046 | BOYAmt |
| EOY | $2,380,835 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,775,096 | BOYAmt |
| EOY | $9,707,341 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,036,596 | BOYAmt |
| EOY | $2,157,064 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,000,000 | BOYAmt |
| EOY | $2,000,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,665,866 | BOYAmt |
| EOY | $2,907,064 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,702,462 | BOYAmt |
| EOY | $7,064,128 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,072,634 | BOYAmt |
| EOY | $2,643,213 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,072,634 | BOYAmt |
| EOY | $2,643,213 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,775,096 | BOYAmt |
| EOY | $9,707,341 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $570,579 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,522,954 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,581,810 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,202,923 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,375,698 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,764,328 | CurrentTaxYearAmt |
| Total | $42,447,713 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $23,396,678 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,435,521 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $29,176,179 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,099,200 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $30,101,848 | CurrentTaxYearAmt |
| Total | $139,209,426 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $26,919,632 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $34,017,331 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $40,379,102 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $39,474,898 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $40,866,176 | CurrentTaxYearAmt |
| Total | $181,657,139 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $181,657,139 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $165,001 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $144,812 | CurrentTaxYearAmt |
| Total | $309,813 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $165,001 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $144,812 | CurrentTaxYearAmt |
| Total | $309,813 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $26,919,632 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $34,017,331 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $40,379,102 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $39,639,899 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $41,010,988 | CurrentTaxYearAmt |
| Total | $181,966,952 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99830 | PublicSupportCY509Pct |
| Investment Income CY | 0.00170 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,454,299 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,531,420 | DepreciationAmt |
| Book Value | $922,879 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,559,105 | OtherCostOrOtherBasisAmt |
| Depreciation | $872,272 | DepreciationAmt |
| Book Value | $686,833 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,615,271 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,368,610 | DepreciationAmt |
| Book Value | $1,246,661 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,856,373 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RELATED PARTY RECEIVABLEs | Desc |
| Book Value | $2,380,835 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,380,835 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Payable to Prima Medical Group | $880,377 |
| RELATED PARTY PAYABLES | $175,206 |
| DEFERRED RENT LIABILITY | $967,442 |
| Insurance CLAIMS Payable | $374,000 |
| Lease Payable | $510,039 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,907,064 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $41,018,281 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $41,018,281 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $41,018,281 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $40,447,702 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $40,447,702 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $40,447,702 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | PRIMA MEDICAL 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. AT DECEMBER 31, 2015 AND 2014, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LEE DOMANICO | ||||||||||||||
| CHAIRMAN/MGH CEO | $0 | $774,366 | $0 | $793,943 | $0 | $0 | $0 | $17,885 | $0 | $0 | $0 | $1,586,194 | $0 | $0 |
| JON FRIEDENBERG | ||||||||||||||
| BOARD MEMBER | $0 | $402,126 | $0 | $223,054 | $0 | $0 | $0 | $17,726 | $0 | $29,916 | $0 | $672,822 | $0 | $0 |
| MARK ZIELAZINSKI | ||||||||||||||
| BOARD MEMBER | $0 | $330,281 | $0 | $70,116 | $0 | $45,084 | $0 | $14,047 | $0 | $21,238 | $0 | $480,766 | $0 | $0 |
| WAYNE FAIRCHILD | ||||||||||||||
| CEO (Thru 10/2015) | $209,478 | $0 | $0 | $0 | $59,827 | $0 | $0 | $0 | $21,791 | $0 | $291,096 | $0 | $0 | $0 |
| CHERI HAWKINS | ||||||||||||||
| CFO (Thru 12/2015) | $163,796 | $0 | $0 | $0 | $0 | $0 | $2,517 | $0 | $24,199 | $0 | $190,512 | $0 | $0 | $0 |
| ALFREDO LIMJOCO | ||||||||||||||
| DIR OF IT (Thru 12/16/2016) | $165,227 | $0 | $0 | $0 | $0 | $0 | $4,388 | $0 | $1,853 | $0 | $171,468 | $0 | $0 | $0 |
| LINDA CHOTKEVYS | ||||||||||||||
| DIR OF HUMAN RESOURCES | $154,783 | $0 | $0 | $0 | $0 | $0 | $1,799 | $0 | $25,506 | $0 | $182,088 | $0 | $0 | $0 |
| SHERI MATTEO | ||||||||||||||
| DIRECTOR OF MIDWIFERY | $138,683 | $0 | $0 | $0 | $0 | $0 | $4,209 | $0 | $15,449 | $0 | $158,341 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3, Other reportable Compensation | The taxable compensation received by the executive team included benefits such as health and welfare disability, long-term care insurance and life insurance. The other reportable compensation was included in their form W-2. |
| Part I, Line 4a | Wayne Fairchild received a Severance payment OF $59,827. THE AMOUNT WAS INCLUDED IN HIS FORM W-2. |
| Part I, Line 6 | The calculation of bonuses is dependent on many factors that are assigned various weightings. Those factors are: - Patient satisfaction survey scores - Employee satisfaction survey scores - Physician satisfaction survey scores - Excess of revenue over expenses - Revenue growth - Community benefit programs - Quality and safety results |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | EFFECTIVE OCTOBER 1, 2015, DR. ROBERT NEWBURY WAS APPOINTED CEO OF PRIMA MEDICAL FOUNDATION. |
| Form 990, Part VI, Section B, line 11 | PRIMA MEDICAL FOUNDATION'S FORM 990 IS REVIEWED BY THE CONTROLLER AND THE CEO OR COO. An electronic copy is sent to the board of directors 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 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 reviews as needed. |
| Form 990, Part VI, Section B, line 15 | The CEO and CFO'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 VII | Lee Domanico, CEO of MGH, Jon Friedenberg, CAO of MGH, and Mark Zielazinski, CITIO of MGH are listed as members of the board of Prima Medical Foundation. They are employed and compensated by Marin General Hospital (MGH), a related organization. MGH reports 100% of the individual's compensation on W-2's which are issued by MGH. They devoted an average of one hour per week relating to their duties associated with serving on the Board of Directors. The reportable compensation is related to their services provided to Marin General Hospital and is unrelated to the average number of hours per week for their duties as a board member. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARIN GENERAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 bon air road | AddressLine1Txt |
| City | GREENBRAE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94904 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 942823538 | EIN |
| Primary Activities | Hospital | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARIN GENERAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |