2015-11-16T15:19:08-06:00 2014-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2014-01-01 271376321 PRIMA MEDICAL FOUNDATION PRIM 4158425000 9 COMMERCIAL BLVD NO 200 NOVATO CA 94949 ROBERT NEWBURY MD CEO 4158425000 2015-11-16 1 RENIE BURBANK P00159653 4159561500 2014 2016-03-07 17:11:31Z X ROBERT NEWBURY MD 9 COMMERCIAL BLVD NO 200 NOVATO CA 94949 39639899 0 X WWW.PRIMAMEDGROUP.COM X 2010 CA 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. 10 7 190 12 0 0 11202923 10375698 29176179 29099200 0 0 179984 165001 40559086 39639899 0 0 0 0 9034020 9836703 0 0 0 30061082 29231177 39095102 39067880 1463984 572019 11733596 13775096 10232981 11702462 1500615 2072634 X 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 SPONSERS. 0 0 35524639 29099200 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. 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. 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. 35524639 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 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 1 0 0 0 1 58 0 1 190 1 0 0 0 0 0 0 0 0 0 0 X 10 7 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 CA X CHERI HAWKINS 4158425031 9 COMMERCIAL BLVD NOVATO CA 94949 X LEE DOMANICO CHAIRMAN/MGH CEO 1.00 39.00 X X 0 1124368 17419 KELLY MATHER VICE CHAIRMAN 1.00 X X 0 0 0 GENE O'CONNELL SECRETARY/MGH BOARD MEMBER 1.00 2.00 X X 0 0 0 JEREMY FAIR TREASURER/MGH TREASURER 1.00 2.00 X X 0 0 0 HARVEY BICKOFF BOARD MEMBER (THRU 7/2014) 1.00 X 0 0 0 NELSON BRANCO MD BOARD MEMBER (THRU 7/2014) 1.00 X 0 0 0 DAVID COX BOARD MEMBER (THRU 7/2014) 1.00 X 0 0 0 JOEL CRISTE BOARD MEMBER/MMN CEO 1.00 39.00 X 0 0 0 CHARLES T FISCHER BOARD MEMBER (THRU 7/2014) 1.00 X 0 0 0 JOHN FRIEDENBERG BOARD MEMBER/MGH CAO 1.00 39.00 X 0 523047 44638 JOSEPH HABIS MD BOARD MEMBER/PMG OFFICER 1.00 2.00 X 0 0 0 PAUL KIRINCIC BOARD MEMBER/MGH CHAIRMAN 1.00 2.00 X 0 0 0 JUSTUS LEACHMAN BOARD MEMBER (THRU 7/2014) 1.00 X 0 0 0 ROBERT MACINNES BOARD MEMBER (THRU 7/2014) 1.00 X 0 0 0 ROBERT NEWBURY MD BOARD MEMBER/PMG OFFICER 1.00 2.00 X 0 0 0 STEVE SCHROEDER BOARD MEMBER/MGH VICE CHAIRMAN 1.00 2.00 X 0 0 0 JOEL SKLAR BOARD MEMBER (THRU 7/2014) 1.00 X 0 0 0 MARK ZIELAZANSKI BOARD MEMBER/MGH CIO 1.00 39.00 X 0 426251 34723 WAYNE FAIRCHILD CEO 40.00 X 244528 0 24607 CHERI HAWKINS CFO 40.00 X 143360 0 22934 LINDA CHOTKEVYS DIRECTOR OF HUMAN RESOURCES 40.00 X 135812 0 24444 JOANNA FU SENIOR DIRECTOR OF OPERATIONS 40.00 X 124184 0 4770 SHERI MATTEO DIRECTOR OF MIDWIFERY 40.00 X 121999 0 19176 769883 2073666 192711 5 0 1 0 VASQUEZ ESTRADA & CONWAY LLP 1000 4TH STREET STE 700 SAN RAFAEL CA 94901 LEGAL SERVICES 750500 JONES DAY 555 CALIFORNIA STREET 26TH FLOOR SAN FRANCISCO CA 94104 LEGAL SERVICES 256705 MOSS ADAMS LLP PO BOX 748369 LOS ANGELES CA 900748369 ACCOUNTING SERVICES 126050 3 8488039 279434 1608225 10375698 NET PATIENT SERVICES 621400 22698365 22698365 OTHER HMO REVENUE 621400 5090951 5090951 CAPITATION PREMIUM 621400 1309884 1309884 29099200 165001 0 165001 165001 165001 39639899 29099200 0 165001 435428 435428 6794040 6794040 79647 79647 1877885 1877885 649703 649703 20316181 18313606 2002575 648022 648022 187813 187813 282024 282024 128589 128589 1197309 1197309 139379 139379 2442435 2442435 24741 24741 116397 116397 84416 84416 802135 802135 682295 589313 92982 DRUGS AND IMMUNIZATIONS 1593752 1593752 TRIAGE SERVICE 181215 181215 404474 74649 329825 39067880 35524639 3543241 0 727612 293991 3617707 3146039 204463 227679 503351 738874 6487124 2818657 3545506 3668467 3134957 5700046 11733596 13775096 2129445 2036596 1050 0 8102486 9665866 10232981 11702462 X 1500615 2072634 1500615 2072634 11733596 13775096 572019 0 X X 0 1 X 1 0 X 3554177 3522954 6581810 11202923 10375698 35237562 9900417 23396678 27435521 29176179 29264201 119172996 13454594 26919632 34017331 40379102 39639899 154410558 0 0 0 154410558 13454594 26919632 34017331 40379102 39639899 154410558 X 0.00000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2458464 1199505 1258959 1391010 481916 909094 2637650 1137236 1500414 3668467 RELATED PARTY RECEIVABLES 5700046 5700046 PAYABLE TO PRIMA MEDICAL GROUP 879891 RELATED PARTY PAYABLES 4644224 LINE OF CREDIT 2000000 DEFERRED RENT LIABILITY 1194421 INSURANCE CLAIMS PAYABLE 298036 LEASE PAYABLE 649294 9665866 X 39639899 0 39639899 0 39639899 39067880 0 39067880 0 39067880 PART X, LINE 2: 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, 2014, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. X X X 0 0 0 0 0 0 0 0 0 LEE DOMANICO CHAIRMAN/MGH CEO 0 724625 0 203000 0 196743 0 17419 0 0 0 1141787 0 0 JOHN FRIEDENBERG BOARD MEMBER/MGH CAO 0 377870 0 145177 0 0 0 14722 0 29916 0 567685 0 0 MARK ZIELAZANSKI BOARD MEMBER/MGH CIO 0 306608 0 119643 0 0 0 13485 0 21238 0 460974 0 0 WAYNE FAIRCHILD CEO 244528 0 0 0 0 0 1058 0 23549 0 269135 0 0 0 CHERI HAWKINS CFO 143360 0 0 0 0 0 0 0 22934 0 166294 0 0 0 LINDA CHOTKEVYS DIRECTOR OF HUMAN RESOURCES 135812 0 0 0 0 0 0 0 24444 0 160256 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 DURING 2014, PMF OBTAINED THEIR TAX EXEMPTION. THEY RESTRUCTURED THEIR GOVERNANCE AND AMENDED AND RESTATED THEIR BYLAWS TO BE COMPLIANT WITH 501(C)(3) REGULATIONS. 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 REVIEWS THE CONFLICT OF INTEREST POLICY TO ENSURE COMPLIANCE. IN ADDITION, PMF DISTRIBUTES A QUESTIONNAIRE TO BOARD MEMBERS ANNUALLY FOR COMPLETION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND COO'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, SECTION A AND SCHEDULE J, PART II A FEW BOARD MEMBERS ARE OFFICERS AT MARIN GENERAL HOSPITAL, A RELATED ORGANIZATION. THEY DEVOTED AN AVERAGE OF ONE HOUR PER WEEK RELATING TO THEIR ACTIVITIES ASSOCIATED WITH SERVING ON THE BOARD OF DIRECTORS. THE REPORTABLE COMPENSATION IS RELATED TO THEIR PROFESSIONAL SERVICES AT MARIN GENERAL HOSPITAL AND WAS UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK AS A MEMBER OF THE BOARD. 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT - THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. MARIN GENERAL HOSPITAL 250 BON AIR ROAD GREENBRAE CA 94904 942823538 HOSPITAL CA 501(C)(3) 3 MARIN GENERAL HOSPITAL 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0