Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 7,359,085 | 8,331,190 | 12,439,013 | 20,611,825 | 29,968,934 | 78,710,047 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 28,855,793 | 31,108,681 | 31,973,603 | 73,299,377 | 75,376,047 | 240,613,501 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 36,214,878 | 39,439,871 | 44,412,616 | 93,911,202 | 105,344,981 | 319,323,548 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 319,323,548 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 36,214,878 | 39,439,871 | 44,412,616 | 93,911,202 | 105,344,981 | 319,323,548 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 145,557 | 120,402 | 110,699 | 105,521 | 114,311 | 596,490 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 145,557 | 120,402 | 110,699 | 105,521 | 114,311 | 596,490 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 36,360,435 | 39,560,273 | 44,523,315 | 94,016,723 | 105,459,292 | 319,920,038 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE SOLE MEMBER (BY DEFINITION OF THE BYLAWS), MARINHEALTH MEDICAL CENTER. THE FORM 990 INSTRUCTIONS ALSO DEFINE "MEMBER" AS ANY PERSON (INCLUDING A CORPORATION) WITH THE POWER TO APPOINT MEMBERS OF THE GOVERNING BODY. ACCORDINGLY, THE ORGANIZATION HAS TWO ADDITIONAL MEMBERS: PRIMA MEDICAL GROUP AND MARIN HEALTHCARE DISTRICT MEDICAL CARE CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION'S SOLE MEMBER (BY DEFINITION OF THE BYLAWS), MARINHEALTH MEDICAL CENTER, HAS THE POWER TO SELECT 10 OF THE VOTING DIRECTORS, WHICH ARE SELECTED AS FOLLOWS: 5 OF THE APPOINTED DIRECTORS ARE PERSONS WHO ARE NOT EMPLOYEES OF MARINHEALTH MEDICAL CENTER AND ARE SELECTED BY MARINHEALTH MEDICAL CENTER FROM CANDIDATES IDENTIFIED BY THE NOMINATING COMMITTEE OF MARINHEALTH MEDICAL NETWORK; THE ADDITIONAL 5 APPOINTED DIRECTORS MAY BE EMPLOYEES OF MARINHEALTH MEDICAL CENTER AND ARE SELECTED BY MARINHEALTH MEDICAL CENTER WITHOUT ANY NOMINATION PROCESS. IN ADDITION, PRIMA MEDICAL GROUP HAS THE POWER TO APPOINT 2 DIRECTORS, WHO ARE FULL-TIME PHYSICIAN EMPLOYEES OF PRIMA MEDICAL GROUP. LASTLY, THE MEDICAL STAFF OF MARIN HEALTHCARE DISTRICT MEDICAL CARE CENTERS ALSO HAS THE POWER TO APPOINT 2 DIRECTORS WHO ARE MARIN HEALTHCARE DISTRICT MEDICAL CARE CENTER-BASED PHYSICIANS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD OF MARINHEALTH MEDICAL NETWORK SHALL NOT, WITHOUT PRIOR WRITTEN APPROVAL OF THE MARINHEALTH MEDICAL CENTER (THE ORGANIZATION'S SOLE MEMBER, PER THE BYLAWS), PERFORM OR COMMIT OR AUTHORIZE OR DIRECT ANY OFFICER OF MARINHEALTH MEDICAL NETWORK TO PERFORM OR COMMIT ANY OF THE FOLLOWING ACTIONS: (I) FILE FOR BANKRUPTCY, MAKE A GENERAL ASSIGNMENT FOR THE BENEFIT OF CREDITORS, OR TAKE ANY SIMILAR ACTION; (II) MAKE ANY MATERIAL CHANGE IN THE NATURE OF THE MARINHEALTH MEDICAL NETWORK'S BUSINESS; (III) SELL, EXCHANGE, OR OTHERWISE DISPOSE OF ANY ASSETS OUTSIDE THE ORDINARY COURSE OF BUSINESS; (IV) ENGAGE IN ANY DISSOLUTION, LIQUIDATION, MERGER, CONSOLIDATION, CONVERSION, OR REORGANIZATION OR ISSUE ANY CORPORATE MEMBERS; (V) AMEND MARINHEALTH MEDICAL NETWORK'S ARTICLES OF INCORPORATION OR BYLAWS; (VI) BORROW MONEY IN THE NAME OF MARINHEALTH MEDICAL NETWORK OR UTILIZE PROPERTY (REAL OR PERSONAL) OWNED BY MARINHEALTH MEDICAL NETWORK AS SECURITY FOR SUCH LOANS; (VII) ENTER INTO A MANAGEMENT AGREEMENT WITH ANY PERSON OR ENTITY PURSUANT TO WHICH IT WOULD REASONABLE BE INTERPRETED THAT MARINHEALTH MEDICAL NETWORK IS TRANSFERRING MANAGEMENT CONTROL OF ITS OPERATIONS TO A THIRD PARTY; (VIII) ACQUIRE, PURCHASE, DEVELOP, IMPROVE, SELL, LEASE, OR MORTGAGE ANY CORPORATE REAL ESTATE OR ANY INTEREST THEREIN OR ENTER INTO ANY CONTRACT FOR ANY SUCH PURPOSES; (IX) MAKE ANY LOAN, INVESTMENT, TRANSFER, OR DISPOSITION OF ANY ASSETS OF MARINHEALTH MEDICAL NETWORK OR ENTER INTO ANY CONTRACT OR INCUR ANY LIABILITIES ON BEHALF OF MARINHEALTH MEDICAL NETWORK OTHER THAN FOR FAIR CONSIDERATION AND IN THE ORDINARY COURSE OF BUSINESS RELATING TO ITS NORMAL DAILY OPERATION; (X) ESTABLISH CAPITAL AND OPERATING BUDGETS FOR MARINHEALTH MEDICAL NETWORK OR ADOPT MATERIAL CHANGES THERETO; AND (XI) ANY OTHER ACTION THAT COULD REASONABLY BE EXPECTED TO HAVE A MATERIAL ADVERSE EFFECT ON THE 501(C)(3) STATUS OR TAX-EXEMPT BONDS OF MARINHEALTH MEDICAL NETWORK OR MARINHEALTH MEDICAL CENTER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE DEPARTMENT. THE FORM 990 IS THEN REVIEWED BY THE ORGANIZATION'S CFO AND CEO 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 THEREOF, 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 REVIEW AS NEEDED. |
| FORM 990, PART VI, SECTION B, LINE 15B | MARINHEALTH MEDICAL NETWORK DOES NOT DIRECTLY COMPENSATE THE CEO; ACCORDINGLY (AND AS PROVIDED IN THE FORM 990 INSTRUCTIONS), FORM 990, PART VI, SECTION B, LINE 15A HAS BEEN ANSWERED "NO". RATHER, THE CEO IS COMPENSATED BY MARINHEALTH MEDICAL CENTER, A RELATED ORGANIZATION. MARIN HEALTH MEDICAL CENTER'S BOARD OF DIRECTORS DETERMINES THE COMPENSATION OF MARINHEALTH MEDICAL NETWORK'S CEO THROUGH NEGOTIATIONS BASED UPON DUTIES AND GOALS. MARKET COMPARABILITY DATA IS USED TO ESTABLISH PARAMETERS OF COMPENSATION, AND THE DECISION REGARDING THE COMPENSATION ARRANGEMENT IS CONTEMPORANEOUSLY DOCUMENTED IN THE BOARD MINUTES. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION IS SET BY THE CEO, UTILIZING MARKET COMPARABILITY DATA. |
| FORM 990, PART VI, SECTION C, LINE 19 | MARINHEALTH MEDICAL NETWORK MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION DURING REGULAR BUSINESS HOURS AT ITS PRINCIPAL OFFICE. |
| FORM 990, PART VII, SECTION A: | LEE DOMANICO (CEO OF MHMC THROUGH AUGUST 2020), JON FRIEDENBERG (COO OF MHMC THROUGH MAY 2020), LINDA LANG (CHIEF HUMAN RESOURCES OFFICER OF MHMC), ERIC BRETTNER (CFO OF MHMC), DAVID KLEIN, MD (CEO OF MHMC EFFECTIVE SEPTEMBER 2020), MARY FRIEDMAN (VP OF STRATEGY AND BUSINESS DEVELOPMENT OF MHMC), AND RUSS PECKENPAUGH (EXECUTIVE DIRECTOR OF IT OF MHMC) ARE LISTED AS MEMBERS OF THE BOARD OF MARINHEALTH MEDICAL NETWORK; THEY ARE ALSO EMPLOYED AND COMPENSATED BY MARINHEALTH MEDICAL CENTER (MHMC), A RELATED ORGANIZATION. FORM 990, PART VII AND SCHEDULE J, PART II REPORTS 100% OF THESE INDIVIDUALS' COMPENSATION AS FROM A RELATED ORGANIZATION. IN ADDITION TO THEIR DUTIES WITH MHMC, EACH INDIVIDUAL DEVOTED AN AVERAGE OF TWO HOURS PER WEEK TO MARINHEALTH MEDICAL NETWORK RELATING TO THEIR DUTIES ASSOCIATED WITH SERVING ON THE BOARD OF DIRECTORS. THE COMPENSATION REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II IS RELATED TO THEIR SERVICES PROVIDED TO MHMC AND IS UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK FOR THEIR DUTIES AS BOARD MEMBERS OF MARINHEALTH MEDICAL NETWORK. |
| FORM 990, PART IX, LINE 11G | RECRUITING AND TEMPORARY AGENCY FEES: PROGRAM SERVICE EXPENSES 23,397. MANAGEMENT AND GENERAL EXPENSES 1,160,912. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,184,309. TRIAGE SERVICES: PROGRAM SERVICE EXPENSES 28,868. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,868. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 669,600. MANAGEMENT AND GENERAL EXPENSES 4,739,782. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,409,382. PROFESSIONAL SERVICE AGREEMENT FEES: PROGRAM SERVICE EXPENSES 45,709,426. MANAGEMENT AND GENERAL EXPENSES 3,524,695. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,234,121. |
| Software ID: | |
| Software Version: |