2023-09-11T15:22:40-05:00 2022-10-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY STE 200 BELLEVUE WA 98004 990 2021-11-01 263084386 LA PINE COMMUNITY HEALTH CENTER LAPI 5415363435 PO BOX 3300 LA PINE OR 97739 ERIN TRAPP CHIEF EXECUTIVE OFFICER 5415363435 2023-09-11 1 ERIN TRAPP 999009999 KURT BENNION P01469618 4252506100 2023-09-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ERIN TRAPP PO BOX 3300 LA PINE OR 97739 10977859 0 X WWW.LAPINECC.COM X 2008 OR LA PINE COMMUNITY HEALTH CENTER IMPROVES LIVES IN OUR COMMUNITY THROUGH ACCESSIBLE AND AFFORDABLE HEALTHCARE PROVIDED WITH KINDNESS, INTEGRITY, AND RESPECT. 11 11 86 15 0 0 2909918 3164094 6740637 6225635 185 1273 504653 544211 10155393 9935213 3720 22595 0 0 5012517 5306465 0 0 3100 2341285 2481492 7357522 7810552 2797871 2124661 14022573 19196978 6018444 9068188 8004129 10128790 LA PINE COMMUNITY HEALTH CENTER IMPROVES LIVES IN OUR COMMUNITY THROUGH ACCESSIBLE AND AFFORDABLE HEALTHCARE PROVIDED WITH KINDNESS, INTEGRITY, AND RESPECT. 0 0 5565230 22595 6616502 LA PINE COMMUNITY HEALTH CENTER (LCHC), A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) FORMED IN 2009, SERVES THE GENERAL POPULATION WITH AN EMPHASIS ON DISADVANTAGED AND MEDICALLY UNDER-SERVED RESIDENTS. LCHC PROVIDES PATIENT-CENTERED, COMPREHENSIVE, AFFORDABLE PRIMARY MEDICAL, BEHAVIORAL/MENTAL HEALTH AND ANCILLARY (OUTREACH) CARE TO PATIENTS LIVING IN THE SERVICE AREA WHICH INCLUDES SOUTH DESCHUTES COUNTY, NORTHERN KLAMATH, AND NORTHWESTERN LAKE COUNTIES. OUR SERVICES INCLUDE PREVENTION, DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC ILLNESS, CHRONIC DISEASE MANAGEMENT, REFERRALS, AND FOLLOW-UP FOR SPECIALTY DIAGNOSTIC TREATMENT. 5565230 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 15 0 86 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 OR X X ERIN TRAPP 5415363435 PO BOX 3300 LA PINE OR 97739 CHARLA DEHATE CHIEF EXECUTIVE OFFICER 60.00 X 173927 0 9607 JOAN FRIDERICI MD PHYSICIAN 40.00 X 164949 0 10159 MICHAEL ALLEN DO FORMER KEY EMPLOYEE 0.00 X 167255 0 5147 RITA GOEHRING NP NURSE PRACTITIONER 40.00 X 138272 0 8844 MEGAN LEWIS NP NURSE PRACTITIONER 40.00 X 133225 0 9533 DENISE GRIFFITHS FNP FAMILY NURSE PRACTITIONER 40.00 X 126276 0 9834 REBECCA BREWER PA-C PHYSICIAN ASSISTANT 40.00 X 125570 0 9863 DAVID GOSSER CHAIR 1.00 X X 0 0 0 RELINDA REYNOLDS VICE CHAIR 1.00 X X 0 0 0 JOAN WALTER SECRETARY (THROUGH APRIL 2022) 1.00 X X 0 0 0 SHELLEY MIESEN BOARD MEMBER & SECRETARY 1.00 X X 0 0 0 HANNAH OLMSTEAD TREASURER (THROUGH JAN 2022) 1.00 X X 0 0 0 MARY DOUGLAS BOARD MEMBER & TREASURER 1.00 X X 0 0 0 LINDA BAUMAN BOARD MEMBER 1.00 X 0 0 0 DONNY BURKLOW BOARD MEMBER (THROUGH MARCH 2022) 1.00 X 0 0 0 RICK DAVIS BOARD MEMBER 1.00 X 0 0 0 FRANK HERNANDEZ BOARD MEMBER (THROUGH MAY 2022) 1.00 X 0 0 0 ANDREA HINE BOARD MEMBER 1.00 X 0 0 0 TAMMY LESUEUR BOARD MEMBER 1.00 X 0 0 0 RYAN MACIEJ BOARD MEMBER 1.00 X 0 0 0 MARIAN MENGEL BOARD MEMBER 1.00 X 0 0 0 PAMELA PERRINE BOARD MEMBER 1.00 X 0 0 0 1029474 0 62987 13 1 1 0 WESTON TECHNOLOGY SOLUTIONS 19795 VILLAGE OFFICE COURT BEND OR 97702 IT SUPPORT 232167 OCHIN PO BOX 5426 PORTLAND OR 97228 EMR SUPPORT 230962 COMMUNITY LINK CONSULTING INC PO BOX 276 NEWMAN LAKE WA 99052 ACCOUNTING SUPPORT 115859 3 2736745 427349 25970 3164094 PATIENT SERVICE REVENUE 621300 5681443 5681443 PAYOR INCENTIVE REVENUE 621300 544192 544192 6225635 1273 1273 134564 0 134564 134564 134564 1433513 1042646 390867 390867 MISCELLANEOUS INCOME 900099 18780 18780 18780 9935213 6616502 0 154617 3620 3620 18975 18975 442159 64657 377502 3808312 3338643 469669 103395 84559 18836 575750 471475 104275 376849 302675 74174 12123 12123 45792 45792 658896 356989 298807 3100 56735 56735 107833 86266 21567 201733 69119 132614 164395 121916 42479 70427 26860 43567 131373 131373 248878 248878 45809 37563 8246 MEDICAL SUPPLIES 327652 313252 14400 RECRUITMENT/RETENTION 127282 118332 8950 BAD DEBT EXPENSE 89063 89063 DUES & SUBSCRIPTIONS 87758 14866 72892 105743 46400 59343 7810552 5565230 2242222 3100 5234885 9760717 1851261 1852503 36303 107094 748931 809064 10035 18044 43860 35085 8188075 1577874 6088759 6610201 8539 4270 14022573 19196978 456138 659852 0 3000000 5562306 5408336 6018444 9068188 X 8004129 10128790 8004129 10128790 14022573 19196978 2124661 0 X 0 1 X 1 1 1 X 1564536 1712353 3621234 2909918 3164094 12972135 5921832 6186139 6677459 7676779 7659148 34121357 7486368 7898492 10298693 10586697 10823242 47093492 0 0 0 47093492 25789 27942 27875 131476 135837 348919 25789 27942 27875 131476 135837 348919 14480 18780 33260 7512157 7926434 10326568 10732653 10977859 47475671 0.99200 0.99430 0.00730 0.00540 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 403375 403375 6345032 298022 6047010 1011725 874272 137453 427943 405580 22363 6610201 X 10385625 48000 491475 539475 9846150 89063 89063 9935213 8260964 48000 491475 539475 7721489 89063 89063 7810552 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT ORGANIZATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A)(III) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). PART XI, LINE 2D - OTHER ADJUSTMENTS: PHARMACY 340B SUPPLIES 491,475. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 89,063. PART XII, LINE 2D - OTHER ADJUSTMENTS: PHARMACY 340B SUPPLIES 491,475. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 89,063. 1 DENTAL ASSISTANCE 71 5500 TRANSPORTATION ASSISTANCE 275 10000 RX/DME ASSISTANCE 70 2600 FOOD ASSISTANCE 10 225 DIAPER ASSISTANCE 80 650 PART I, LINE 2: TO ENSURE PROPER USE, INDIVIDUALS ARE GIVEN VOUCHERS FOR ASSISTANCE WITH TRANSPORTATION, FOOD, ETC., OR ARE GIVEN THE ITEMS THEY NEED. X X X 0 0 0 0 0 1 0 1 0 CHARLA DEHATE CHIEF EXECUTIVE OFFICER 173127 0 800 0 0 0 1886 0 7721 0 183534 0 0 0 JOAN FRIDERICI MD PHYSICIAN 164149 0 800 0 0 0 2438 0 7721 0 175108 0 0 0 MICHAEL ALLEN DO FORMER KEY EMPLOYEE 167255 0 0 0 0 0 0 0 5147 0 172402 0 0 0 PART I, LINE 6 OPERATING MARGIN IS ONE OF SEVERAL FACTORS USED BY THE BOARD IN DETERMINING WHETHER TO PROVIDE BONUSES TO ALL EMPLOYEES. OTHER FACTORS INCLUDE QUALITY METRICS, PATIENT SATISFACTION, AND EMPLOYEE SATISFACTION/RETENTION. PART I, LINE 7 DURING 2021, THE BOARD OF DIRECTORS CHOSE TO GIVE ALL EMPLOYEES A ONE-TIME BONUS OF $800. X 1275 25970 INVOICE PRICE 0 0 1 0 PART I, COLUMN (B): THE NUMBER REPORTED IN COLUMN B IS THE NUMBER OF DONATED ITEMS RECEIVED DURING THE FISCAL YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD RECEIVED THE FORM 990 ELECTRONICALLY PRIOR TO THE BOARD MEETING FOR THEM TO REVIEW. THE DOCUMENT WAS REVIEWED BY THE CEO DURING THE BOARD MEETING. ANY QUESTIONS WERE ANSWERED AT THE BOARD MEETING AND IF NECESSARY THE APPROPRIATE CHANGES WERE MADE. THE BOARD VOTED ON THE APPROVAL OF THE FORM 990 AT THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS REVIEWED ANNUALLY WITH THE BOARD MEMBERS, DIRECTORS, MANAGERS AND KEY EMPLOYEES. THE DISCLOSURE STATEMENT AND CONFLICT OF INTEREST ARE SIGNED BY EACH PERSON. A TRANSACTION IN WHICH A BOARD MEMBER HAS A CONFLICT OF INTEREST MAY BE APPROVED BY MAJORITY VOTE OF A QUORUM OF THE BOARD OF DIRECTORS IF THE MATERIAL FACTS OR THE TRANSACTION AND THE DIRECTOR'S INTEREST ARE DISCLOSED OR KNOWN TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S SALARY IS ASSESSED BY THE BOARD BASED ON A SURVEY OF COMMUNITY HEALTH CENTERS IN OUR REGION FROM NORTHWEST REGIONAL PRIMARY CARE. THE LAST COMPENSATION REVIEW OCCURRED IN 2023. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.