CTR066198_Debarment_Check.pdf

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Attached to
Master Agreement AZ|CTR066198
Contract number
CTR066198
Issued by
Arizona

About this file

The document is a compilation of official registration and compliance records for Mariposa Community Health Center, Inc., a nonprofit healthcare organization based in Nogales, Arizona. The records include entity information from the Arizona Corporations Commission, an Office of Inspector General (OIG) exclusions search result, a System for Award Management (SAM.gov) registration, and a State Procurement Office (SPO) debarred and suspended firms list.

Mariposa Community Health Center is a tax-exempt, non-profit organization incorporated on July 22, 1985, with an active registration for government awards. The organization is classified under NAICS code 621498 for "All Other Outpatient Care Centers" and is located in Arizona's 7th Congressional District. Its primary business address is 825 N Grand Ave, Suite 100, in Nogales, Arizona. The entity has an active SAM.gov registration expiring on July 23, 2024, with a unique entity ID of T7KJKFWEKNR9. The organization has no active exclusions records, is not on any debarment lists, and accepts credit card payments. Key leadership includes Dan Prevost (CEO/COO) and Humberto Duran (CFO), with the organization's fiscal year ending on May 31.

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4/16/24, 8:55 AM Arizona Corporations Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01773351 1/3

ENTITY INFORMATION

Search Date and Time: 4/16/2024 8:55:03 AM

Entity Details

Entity Name:

MARIPOSA COMMUNITY HEALTH CENTER, INC.

Entity ID:

01773351

Entity Type:

Domestic Nonprofit Corporation

Entity Status:

Active

Formation Date:

7/22/1985

Reason for Status:

In Good Standing

Approval Date:

7/25/1985

Status Date:

Original Incorporation Date:

7/22/1985

Life Period:

Perpetual

Business Type:

Health Care and Social Assistance

Last Annual Report Filed:

Domicile State:

Arizona

Annual Report Due Date:

9/22/2024

Years Due:

Original Publish Date:Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts http://azcc.gov/corporations/corporation-contacts https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01773351 2/3

Title Name Attention Address Date of Taking Office

Last Updated

CEO (Chief Executive Officer)

Dan Prevost 825 N. Grand Avenue, Suite

100, NOGALES, AZ, 85621,

Santa Cruz County, USA

10/26/2022 2/6/2023

Director

JUDITH

CLAREMON

825 N. Grand Avenue, Suite

100, NOGALES, AZ, 85621,

Santa Cruz County, USA

8/5/2005 9/21/2018

Director LOU JEONG 825 N. Grand Avenue, Suite

100, NOGALES, AZ, 85621,

Santa Cruz County, USA

8/16/2001 9/17/2021

Director RUDY PINA 825 N. Grand Avenue, Suite

100, NOGALES, AZ, 85621,

Santa Cruz County, USA

2/28/1988 9/21/2018

8/26/1985

Statutory Agent Information

Name:

Dan Prevost

Appointed Status:

Active 11/7/2022

Attention:

Address:

825 N Grand Ave., Suite 100, NOGALES, AZ 85621, USA

Agent Last Updated:

9/15/2023

E-mail:

Attention:

Mailing Address:

County:

Santa Cruz

Principal Information

Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01773351 3/3

< Previous ... 1 2 ... Next > Page 1 of 2, records 1 to 5 of 10 Go to Page

Title Name Attention Address Date of Taking Office

Last Updated

Director

ROBERT

LINEIRO

825 N. Grand Avenue, Suite

100, NOGALES, AZ, 85621,

Santa Cruz County, USA

4/12/2017 9/17/2021

Back Return to Search

Return to Results

Document History Name/Restructuring History

Pending Documents Microfilm History

Address

Attention: Dan Prevost

Address: 825 N Grand Ave., Suite 100, NOGALES, AZ, 85621, USA

County: Santa Cruz

Last Updated: 9/15/2023

Entity Principal Office Address

Attention:

Address:

County:

Last Updated:

Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) javascript:$xhtml.paging(2) javascript:$xhtml.paging(2) http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts

4/16/24, 8:54 AM OIG Search Results https://exclusions.oig.hhs.gov/SearchResults.aspx 1/1

Visit our tips page to learn how to best use the Exclusions Database. If you experience technical difficulties, please email the webmaster at webmaster@oig.hhs.gov.

Exclusions Search Results: Exclusions Search Results: EntitiesEntities

No Results were found for

Mariposa Community Health Center

If no results are found, this individual or entity (if it is an entity search) is not currently excluded. Print this Web page for your documentation

Search Again

Search conducted 4/16/2024 11:54:30 AM EST on OIG LEIE Exclusions database.

Source data updated on 4/10/2024 9:00:00 AM EST

Return to Search

An official website of the United States government. Here's how you know > https://oig.hhs.gov/exclusions/exclusions-help.asp#generalSearch mailto:webmaster@oig.hhs.gov https://oig.hhs.gov/exclusions/exclusions-help.asp#entitySearch https://oig.hhs.gov/exclusions/exclusions-help.asp#entitySearch javascript:__doPostBack('ctl00$cpExclusions$lbGridBackToSearch','') javascript:__doPostBack('ctl00$cpExclusions$lbBackToSearch','') https://oig.hhs.gov/notices/official-site.asp

MARIPOSA COMMUNITY HEALTH CENTER, INC.

Unique Entity ID

T7KJKFWEKNR9

CAGE / NCAGE

3LPV8

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Jul 23, 2024

Physical Address

825 N Grand AVE

STE 100

Nogales, Arizona 85621-2385

United States

Mailing Address

825 N Grand AVE STE 100

Nogales, Arizona 85621-2385

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 07

State / Country of Incorporation

Arizona / United States

URL

www.mariposachc.net

Registration Dates

Activation Date

Aug 3, 2023

Submission Date

Jul 24, 2023

Initial Registration Date

Nov 12, 2003

Entity Dates

Entity Start Date

Dec 1, 1985

Fiscal Year End Close Date

May 31

Immediate Owner

CAGE

(blank)

Legal Business Name

(blank)

Highest Level Owner

CAGE

(blank)

Legal Business Name

(blank)

Executive Compensation

Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of

P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions.

Proceedings Questions

Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or 2. C.F.R. 200 Appendix XII. Their responses are displayed in the responsibility/qualification section of SAM.gov. Maintaining an active registration in SAM.gov demonstrates the registrant responded to the proceedings questions.

Exclusion Summary

Active Exclusions Records?

No

SAM Search Authorization

I authorize my entity's non-sensitive information to be displayed in SAM public search results:

Yes

Entity Types

Business Types

Entity Structure

Corporate Entity (Tax Exempt)

Entity Type

Business or Organization

Organization Factors

(blank)

Profit Structure

Non-Profit Organization

Last updated by Amanda Webster on Jul 24, 2023 at 02:32 PM MARIPOSA COMMUNITY HEALTH CENTER, INC.

Apr 16, 2024 03:34:41 PM GMT https://sam.gov/entity/T7KJKFWEKNR9/coreData?status=null Page 1 of 2

Socio-Economic Types

Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the

SBA supplemental pages during registration.

Financial Information

Accepts Credit Card Payments

Yes

Debt Subject To Offset

No

EFT Indicator

CAGE Code

3LPV8

Points of Contact

Electronic Business

Humberto Duran, CFO 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Dan Prevost, COO 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Government Business

Dan Prevost, CEO 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Dan Prevost, COO 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Past Performance

Humberto Duran 1852 N. Mastick WAY

Nogales, Arizona 85621

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

621498

NAICS Title

All Other Outpatient Care Centers

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Amanda Webster on Jul 24, 2023 at 02:32 PM MARIPOSA COMMUNITY HEALTH CENTER, INC.

Apr 16, 2024 03:34:41 PM GMT https://sam.gov/entity/T7KJKFWEKNR9/coreData?status=null Page 2 of 2

4/16/24, 9:16 AM Debarred and Suspended Firms | SPO Intranet https://spointra.az.gov/compliance/debarred-and-suspended-firms 1/2

Visit OpenBooks (https://openbooks.az.gov) Ombudsman-Citizens Aide (https://www.azoca.gov)

Register to Vote (https://azsos.gov/elections/voters/register-vote-update-voter-information/registerupdate-vote)

AZ.Gov (https://az.gov/search/) (https://az.gov)

Home (/) » Compliance (/compliance) » Debarred and Suspended Firms (/compliance/debarred-and-suspended-firms)

Debarred and Suspended Firms SPO is responsible for maintaining a list of firms that are suspended or debarred from doing business with the State of Arizona.

THERE ARE NO SUSPENDED OR DEBARRED FIRMS AT THIS TIME.

COMPLIANCE

Agency Procurement Authority (/compliance/agency-procurement-authority)

Control Self-Assessment (CSA) (/compliance/control-self-assessment-csa)

Procurement Compliance Reviews (PCR) (/compliance/procurement-compliance-reviews-pcr)

Compliance Hotline (/compliance/compliance-hotline)

Debarred and Suspended Firms (/compliance/debarred-and-suspended-firms) https://openbooks.az.gov/ https://openbooks.az.gov/ https://www.azoca.gov/ https://www.azoca.gov/ https://azsos.gov/elections/voters/register-vote-update-voter-information/registerupdate-vote https://azsos.gov/elections/voters/register-vote-update-voter-information/registerupdate-vote https://az.gov/search/ https://az.gov/search/ https://az.gov/ https://az.gov/ https://spointra.az.gov/ https://spointra.az.gov/ https://spointra.az.gov/compliance https://spointra.az.gov/compliance https://spointra.az.gov/compliance/debarred-and-suspended-firms https://spointra.az.gov/compliance/debarred-and-suspended-firms https://spointra.az.gov/compliance/agency-procurement-authority https://spointra.az.gov/compliance/control-self-assessment-csa https://spointra.az.gov/compliance/procurement-compliance-reviews-pcr https://spointra.az.gov/compliance/compliance-hotline https://spointra.az.gov/compliance/debarred-and-suspended-firms https://spointra.az.gov/

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