INTERNATIONAL COMMUNITY HEALTH SERVICES: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- INTERNATIONAL COMMUNITY HEALTH SERVICES (EIN 91-0947084)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-07
- IRS object ID
- 202233119349301653
- Schema version
- 2021v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule I
- Schedule J
- Schedule K
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-07T09:10:25-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910947084 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERNATIONAL COMMUNITY HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INTE | BusinessNameControlTxt |
| Phone | 2067883618 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 8TH AVENUE SOUTH 100 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98104 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERESITA BATAYOLA | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 2067883618 | PhoneNum |
| Signature | 2022-10-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TERESITA | PersonFirstNm |
| Person Last | BATAYOLA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2022-10-21 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TERESITA BATAYOLA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 8TH AVENUE SOUTH 100 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98104 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $77,380,242 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ICHS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 17 | VotingMembersIndependentCnt |
| Total Employee | 718 | TotalEmployeeCnt |
| Total Volunteers | 94 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $14,144,165 | PYContributionsGrantsAmt |
| CY Contributions Grants | $21,917,145 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $47,420,516 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $55,033,379 | CYProgramServiceRevenueAmt |
| PY Investment Income | $80,770 | PYInvestmentIncomeAmt |
| CY Investment Income | -$118,555 | CYInvestmentIncomeAmt |
| PY Other Revenue | $597,406 | PYOtherRevenueAmt |
| CY Other Revenue | $372,041 | CYOtherRevenueAmt |
| PY Total Revenue | $62,242,857 | PYTotalRevenueAmt |
| CY Total Revenue | $77,204,010 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $120,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $50,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $37,622,190 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $42,774,508 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $262,059 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,484,619 | PYOtherExpensesAmt |
| CY Other Expenses | $25,507,183 | CYOtherExpensesAmt |
| PY Total Expenses | $57,226,809 | PYTotalExpensesAmt |
| CY Total Expenses | $68,331,691 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,016,048 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,872,319 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $70,510,972 | TotalAssetsBOYAmt |
| Total Assets EOY | $68,689,108 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $45,469,283 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $34,775,100 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,041,689 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $33,914,008 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | DEEPLY ROOTED IN THE ASIAN PACIFIC ISLANDER COMMUNITY, ICHS PROVIDES CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND WELLNESS SERVICES AND PROMOTES HEALTH EQUITY FOR ALL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,226,091 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $22,165,411 | RevenueAmt |
| Desc | ICHS PROVIDES MEDICAL SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY. THESE SERVICES INCLUDE PHYSICAL EXAMS, IMMUNIZATIONS, MINOR SURGERY, HOME VISITS, INFANT AND WELL-CHILD CHECK-UPS, OBSTETRIC AND GERIATRIC CARE. DURING 2021, ICHS PROVIDED 66,812 PRIMARY HEALTH CARE VISITS TO PATIENTS AND $225,508 OF CHARITY CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $9,574,265 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $10,186,334 | RevenueAmt |
| Desc | ICHS PROVIDES FULL DENTAL CARE FOR THE ENTIRE FAMILY, INCLUDING EXTENSIVE DENTURE WORK, FULL CLEANING FOR ADULTS AND CHILDREN, PREVENTATIVE DENTISTRY, MINOR ORAL SURGERY, RESTORATIVE SERVICES, ORTHODONTIA, AND EMERGENCY CARE. ICHS ALSO BRINGS DENTAL SERVICES INTO KING COUNTY COMMUNITIES AND SCHOOLS WITH ITS MOBILE DENTAL CLINIC, AS WELL AS ORAL HEALTH EDUCATION IN THE COMMUNITY. DURING 2021, ICHS PROVIDED 39,615 DENTAL CARE VISITS TO PATIENTS AND $518,506 OF CHARITY CARE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $12,854,819 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $14,250,915 | RevenueAmt |
| Desc | ICHS PROVIDES A VARIETY OF OTHER HEALTH CARE SERVICES TO THE COMMUNITY INCLUDING ACUPUNCTURE, VISION, DISEASE PREVENTION, HEALTH EDUCATION, BEHAVIORAL HEALTH, NUTRITION SERVICES, AND FAMILY PLANNING FOR TEENS AND ADULTS. DURING 2021, ICHS PROVIDED 13,418 HEALTH CARE VISITS TO PATIENTS AND $43,785 OF CHARITY CARE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $12,135,733 | ExpenseAmt |
| Grant | $50,000 | GrantAmt |
| Revenue | $8,430,719 | RevenueAmt |
| Desc | ICHS' HEALTHY AGING & WELLNESS PROGRAM (HAWP) MEETS THE UNIQUE NEEDS OF ADULTS AGE 55 AND OLDER. SERVICES INCLUDE:- PACE (PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY) - INDIVIDUALIZED SERVICES TO KEEP NURSING-HOME ELIGIBLE ELDERS LIVING INDEPENDENTLY AT HOME OR IN THE COMMUNITY. PACE HAD 1,011 MEMBER MONTHS IN 2021.- ASSISTED LIVING AT LEGACY HOUSE SENIOR-FRIENDLY LIVING SPACE WITH 24/7 SERVICES TO SUPPORT RESIDENTS TO LIVE INDEPENDENTLY AND SAFELY IN CULTURALLY-FAMILIAR SURROUNDINGS. - ADULT DAY SERVICES FOR SENIORS WITH CHANGING PHYSICAL OR COGNITIVE ABILITIES THRIVE AND CAREGIVERS WITH RESPITE. SERVICES INCLUDE FITNESS, SOCIAL AND RECREATIONAL GROUP ACTIVITIES, NUTRITIOUS, ASIAN-STYLE LUNCHES, TRANSPORTATION COORDINATION, RN OVERSIGHT, REHABILITATIVE OCCUPATIONAL THERAPY, PERSONAL CARE SERVICES, RESPITE FOR CAREGIVERS, ADULT NUTRITION- EBSHP (EVIDENCE-BASED SENIOR HEALTH PROMOTION) SUCH AS TAI JI QUAN: MOVING FOR BETTER BALANCE (WEEKLY CLASSES TO HELP SENIORS IMPROVE MUSCLE STRENGTH, BALANCE, FLEXIBILITY, MOBILITY, AND REDUCE RISK OF FALLS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $12,135,733 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $50,000 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $8,430,719 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $57,790,908 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| 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 | 0 | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | 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 | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 59 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 718 | 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 |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 17 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| 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 | Yes (1) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HERMES SHAHBAZIAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2067883618 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 8TH AVENUE SOUTH 100 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98104 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (43 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|---|---|
| TERESITA BATAYOLA | ||||||||||
| CHIEF EXECUTIVE OFFICER | 50.00 | 2.00 | Yes (X) | $380,014 | $0 | $34,454 | ||||
| ASQUAL GETANEH | ||||||||||
| CMO (THROUGH JUNE 2021) | 40.00 | 0.00 | Yes (X) | $310,720 | $0 | $18,126 | ||||
| KIMO HIRAYAMA | ||||||||||
| ASSISTANT MEDICAL DIRECTOR | 40.00 | 0.00 | $276,363 | $0 | $37,756 | Yes (X) | ||||
| LAKSHMI DEEPA YERRAM | ||||||||||
| CHIEF MEDICAL OFFICER | 40.00 | 0.00 | Yes (X) | $264,101 | $0 | $26,947 | ||||
| KANNIE CHIM | ||||||||||
| PACE MEDICAL DIRECTOR | 40.00 | 0.00 | $234,789 | $0 | $38,803 | Yes (X) | ||||
| BETH WEITENSTEINER ARNP | ||||||||||
| RESIDENCY DEPUTY DIRECTOR & PROVIDER | 40.00 | 0.00 | $239,064 | $0 | $26,381 | Yes (X) | ||||
| HERMES SHAHBAZIAN | ||||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 2.00 | Yes (X) | $233,038 | $0 | $17,763 | ||||
| HIEU PHAM PROVIDER | ||||||||||
| MEDICAL RESIDENCY DIRECTOR | 40.00 | 0.00 | $227,976 | $0 | $17,917 | Yes (X) | ||||
| SAMANTHA LEE-CHIU | ||||||||||
| CHIEF DENTAL OFFICER | 40.00 | 0.00 | Yes (X) | $203,730 | $0 | $34,852 | ||||
| GRANDY AU | ||||||||||
| ASSISTANT DENTAL DIRECTOR | 40.00 | 0.00 | $196,974 | $0 | $40,173 | Yes (X) | ||||
| CHINDA ROACH MD | ||||||||||
| PROVIDER | 36.00 | 0.00 | $206,169 | $0 | $25,546 | Yes (X) | ||||
| UYENVY PHAM MD | ||||||||||
| PROVIDER | 36.00 | 0.00 | $204,194 | $0 | $17,526 | Yes (X) | ||||
| TIMOTHY LAM | ||||||||||
| PROVIDER | 40.00 | 0.00 | $164,930 | $0 | $47,704 | Yes (X) | ||||
| HARVEY WU | ||||||||||
| ASSISTANT DENTAL DIRECTOR | 40.00 | 0.00 | $180,005 | $0 | $25,293 | Yes (X) | ||||
| LAUREN LAWLER | ||||||||||
| ASSISTANT MEDICAL DIRECTOR | 40.00 | 0.00 | $159,894 | $0 | $38,109 | Yes (X) | ||||
| WINNIE LEE | ||||||||||
| ASSISTANT MEDICAL DIRECTOR | 40.00 | 0.00 | $153,130 | $0 | $36,719 | Yes (X) | ||||
| HAMED SAHARI-RASHTI | ||||||||||
| PROVIDER | 40.00 | 0.00 | $165,459 | $0 | $23,571 | Yes (X) | ||||
| LILI SPERRY MD | ||||||||||
| PROVIDER | 36.00 | 0.00 | $162,388 | $0 | $21,904 | Yes (X) | ||||
| JU HUI LEE | ||||||||||
| PHARMACY DIRECTOR | 40.00 | 0.00 | $158,928 | $0 | $20,173 | Yes (X) | ||||
| HYELIM PARK PROVIDER | ||||||||||
| CLINICAL INFORMATICS DIRECTOR | 40.00 | 0.00 | $157,375 | $0 | $14,799 | Yes (X) | ||||
| SOLOMUNA HABTU | ||||||||||
| ASSISTANT DENTAL DIRECTOR | 40.00 | 0.00 | $156,035 | $0 | $14,857 | Yes (X) | ||||
| TERESA LEE | ||||||||||
| FORMER KEY EMPLOYEE | 36.00 | 0.00 | $156,337 | $0 | $6,949 | Yes (X) | ||||
| JESSICA GUH MD FAMILY | ||||||||||
| FORMER KEY EMPLOYEE | 40.00 | 0.00 | $100,654 | $0 | $19,800 | Yes (X) | ||||
| RACHEL KOH | ||||||||||
| CHIEF OPERATING OFFICER | 40.00 | 0.00 | Yes (X) | $122,599 | $0 | $8,234 | ||||
| GILDAS CHEUNG | ||||||||||
| CHAIR | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| JOHN FOZ | ||||||||||
| 1ST VICE CHAIR | 3.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| MARVIN ENG | ||||||||||
| 2ND VICE CHAIR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| KELLI NOMURA | ||||||||||
| 3RD VICE CHAIR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| LEE MARCHISIO | ||||||||||
| 4TH VICE CHAIR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| CATHERINE JOHNSON | ||||||||||
| SECRETARY | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| MARIAM ABARIENTOS | ||||||||||
| TREASURER | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| TRISH BUSTOS | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| NICOLE CHU | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| TESSA CHU | ||||||||||
| DIRECTOR | 1.50 | 0.50 | $0 | $0 | $0 | Yes (X) | ||||
| CHENGZHEN DAI | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| AMANDA KIMURA | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| CRIS KRISOLOG-ELLIOTT | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| WILMA LAM | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| KRISTINA LAUBNER SMITH | ||||||||||
| DIRECTOR (THROUGH NOVEMBER 2021) | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| TED LEW | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| HIROSHI NAKANO | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| BARBARA OBENA | ||||||||||
| DIRECTOR (THROUGH JUNE 2021) | 1.50 | 0.50 | $0 | $0 | $0 | Yes (X) | ||||
| JOHN PARK | ||||||||||
| DIRECTOR | 1.50 | 0.00 | $0 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,814,866 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $614,356 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 65 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BAYLEY CONSTRUCTION | |||||
| 8005 SE 28TH STREET | MERCER ISLAND | WA | 98040 | CONSTRUCTION | $1,465,539 |
| SCRIBE-X LLC | |||||
| PO BOX 6590 | PORTLAND | OR | 97228 | TEMPORARY STAFFING | $696,640 |
| STRATUS INDEMAND INC | |||||
| PO BOX 675248 | DETROIT | MI | 48267 | INTERPRETATION SERVICES | $589,953 |
| COMMUNITY TECHNOLOGIES | |||||
| PO BOX 735740 | DALLAS | TX | 75373 | I.T. SERVICES | $277,471 |
| ASIAN COUNSELING & REFERRAL SERVICE | |||||
| 3639 MARTIN LUTHER KING JR WAY S | SEATTLE | WA | 98144 | HEALTHCARE SERVICES | $270,117 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $735,135 | RelatedOrganizationsAmt |
| Government Grants | $20,647,597 | GovernmentGrantsAmt |
| All Other Contributions | $534,413 | AllOtherContributionsAmt |
| Noncash Contributions | $2,305,197 | NoncashContributionsAmt |
| Total Contributions | $21,917,145 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE FEES | 624100 | $41,753,909 | $41,753,909 |
| HEALTHY WELLNESS & AGING | 623000 | $8,430,719 | $8,430,719 |
| POOL SAVINGS REVENUE | 900099 | $4,216,719 | $4,216,719 |
| OTHER MEDICAL REVENUE | 900099 | $632,032 | $632,032 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $55,033,379 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $57,677 | TotalRevenueColumnAmt |
| Exclusion | $57,677 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $45,805 | SecuritiesAmt |
| Other | $130,427 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$45,805 | SecuritiesAmt |
| Other | -$130,427 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$176,232 | TotalRevenueColumnAmt |
| Exclusion | -$176,232 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MANAGEMENT FEES | 900099 | $274,359 | $274,359 |
| MISCELLANEOUS REVENUE | 900099 | $97,682 | $97,682 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $372,041 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,204,010 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $55,033,379 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $253,486 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,000 | TotalAmt |
| Program Services | $50,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,105,638 | TotalAmt |
| Program Services | $1,960,689 | ProgramServicesAmt |
| Management And General | $2,144,949 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,629,808 | TotalAmt |
| Program Services | $27,381,852 | ProgramServicesAmt |
| Management And General | $4,024,168 | ManagementAndGeneralAmt |
| Fundraising | $223,788 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,232,341 | TotalAmt |
| Program Services | $1,068,437 | ProgramServicesAmt |
| Management And General | $156,268 | ManagementAndGeneralAmt |
| Fundraising | $7,636 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,268,538 | TotalAmt |
| Program Services | $2,821,993 | ProgramServicesAmt |
| Management And General | $432,783 | ManagementAndGeneralAmt |
| Fundraising | $13,762 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,538,183 | TotalAmt |
| Program Services | $2,099,495 | ProgramServicesAmt |
| Management And General | $421,789 | ManagementAndGeneralAmt |
| Fundraising | $16,899 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,858 | TotalAmt |
| Program Services | $32,074 | ProgramServicesAmt |
| Management And General | $143,784 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,817 | TotalAmt |
| Management And General | $72,817 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,598,984 | TotalAmt |
| Program Services | $3,738,214 | ProgramServicesAmt |
| Management And General | $860,770 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,458 | TotalAmt |
| Program Services | $7,619 | ProgramServicesAmt |
| Management And General | $152,839 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598,673 | TotalAmt |
| Program Services | $482,535 | ProgramServicesAmt |
| Management And General | $116,166 | ManagementAndGeneralAmt |
| Fundraising | -$28 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414,241 | TotalAmt |
| Program Services | $349,677 | ProgramServicesAmt |
| Management And General | $64,564 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,338,260 | TotalAmt |
| Program Services | $2,775,515 | ProgramServicesAmt |
| Management And General | $562,745 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,941 | TotalAmt |
| Program Services | $20,471 | ProgramServicesAmt |
| Management And General | $24,470 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,228 | TotalAmt |
| Program Services | $79,050 | ProgramServicesAmt |
| Management And General | $61,178 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $443,274 | TotalAmt |
| Program Services | $406,815 | ProgramServicesAmt |
| Management And General | $36,459 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,534,185 | TotalAmt |
| Program Services | $2,011,613 | ProgramServicesAmt |
| Management And General | $522,572 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250,216 | TotalAmt |
| Program Services | $204,162 | ProgramServicesAmt |
| Management And General | $46,054 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| HEALTHCARE ENROLLEES | $4,183,872 | $4,183,872 | |
| MEDICAL SUPPLIES | $7,595,369 | $7,395,756 | $199,613 |
| EQUIPMENT | $211,965 | $197,521 | $14,444 |
| PATIENT EXPENSE | $198,579 | $185,632 | $12,947 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $545,263 | TotalAmt |
| Program Services | $337,916 | ProgramServicesAmt |
| Management And General | $207,345 | ManagementAndGeneralAmt |
| Fundraising | $2 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,331,691 | TotalAmt |
| Program Services | $57,790,908 | ProgramServicesAmt |
| Management And General | $10,278,724 | ManagementAndGeneralAmt |
| Fundraising | $262,059 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,668,532 | BOYAmt |
| EOY | $21,998,926 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,091,141 | BOYAmt |
| EOY | $2,087,198 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,842,741 | BOYAmt |
| EOY | $2,533,966 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,746,620 | BOYAmt |
| EOY | $3,052,605 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $326,264 | BOYAmt |
| EOY | $477,641 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $539,804 | BOYAmt |
| EOY | $277,059 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $45,772,580 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,002,658 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,125,229 | BOYAmt |
| EOY | $26,769,922 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,170,641 | BOYAmt |
| EOY | $11,491,791 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,510,972 | BOYAmt |
| EOY | $68,689,108 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,170,678 | BOYAmt |
| EOY | $13,067,293 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,821,501 | BOYAmt |
| EOY | $787,911 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,520,066 | BOYAmt |
| EOY | $8,228,048 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,957,038 | BOYAmt |
| EOY | $12,691,848 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,469,283 | BOYAmt |
| EOY | $34,775,100 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,117,049 | BOYAmt |
| EOY | $33,541,844 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $924,640 | BOYAmt |
| EOY | $372,164 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,041,689 | BOYAmt |
| EOY | $33,914,008 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,510,972 | BOYAmt |
| EOY | $68,689,108 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $8,872,319 | 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 | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | Yes (1) | VolunteersInd |
| Paid Staff Or Management | Yes (1) | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $2,325 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $2,325 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | DURING THE FISCAL YEAR, SENIOR ICHS STAFF HELD COORDINATED MEETINGS WITH MEMBERS OF CONGRESS. IN ADDITION, SENIOR ICHS STAFF AND BOARD MEMBERS HELD COORDIANTED MEETINGS WITH STATE ELECTED OFFICIALS DURING COMMUNITY HEALTH CENTER LOBBYING DAY. IN ADDITION, ICHS STAFF ATTENDED THE APA LEGISLATIVE DAY AND COALITION MEETINGS WHERE STRATEGIES WERE DISCUSSED TO INFLUENCE PROPOSED OR PENDING HEALTHCARE LEGISLATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,528,037 | OtherCostOrOtherBasisAmt |
| Book Value | $3,528,037 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,043,981 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,818,489 | DepreciationAmt |
| Book Value | $20,225,492 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,178,652 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,921,030 | DepreciationAmt |
| Book Value | $1,257,622 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,000,360 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,263,139 | DepreciationAmt |
| Book Value | $1,737,221 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,550 | OtherCostOrOtherBasisAmt |
| Book Value | $21,550 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $26,769,922 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| RECEIVABLE FROM RELATED ORGANIZATION | $2,830,885 |
| RIGHT OF USE LEASE | $8,403,612 |
| DEPOSITS | $257,294 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $11,491,791 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED ICHS' TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE CONSOLIDATED FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AGING IN PACE WASHINGTON | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3007 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 981143007 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 810856014 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $50,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | GENERAL OPERATING SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ONLY GRANT WAS TO AN ORGANIZATION IN WHICH THE PRESIDENT/CEO SERVES AS A BOARD MEMBER. THROUGH THIS BOARD INVOLVEMENT, ICHS CAN ENSURE ALL TRANSFERRED FUNDS ARE USED APPROPRIATELY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | Yes (1) | 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (23 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TERESITA BATAYOLA | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $331,241 | $0 | $36,259 | $0 | $12,514 | $0 | $15,501 | $0 | $18,953 | $0 | $414,468 | $0 | $0 | $0 |
| ASQUAL GETANEH | ||||||||||||||
| CMO (THROUGH JUNE 2021) | $105,975 | $0 | $2,616 | $0 | $202,129 | $0 | $11,393 | $0 | $6,733 | $0 | $328,846 | $0 | $0 | $0 |
| KIMO HIRAYAMA | ||||||||||||||
| ASSISTANT MEDICAL DIRECTOR | $260,772 | $0 | $2,742 | $0 | $12,849 | $0 | $11,053 | $0 | $26,703 | $0 | $314,119 | $0 | $0 | $0 |
| LAKSHMI DEEPA YERRAM | ||||||||||||||
| CHIEF MEDICAL OFFICER | $248,791 | $0 | $11,023 | $0 | $4,287 | $0 | $10,564 | $0 | $16,383 | $0 | $291,048 | $0 | $0 | $0 |
| KANNIE CHIM | ||||||||||||||
| PACE MEDICAL DIRECTOR | $222,057 | $0 | $9,425 | $0 | $3,307 | $0 | $9,930 | $0 | $28,873 | $0 | $273,592 | $0 | $0 | $0 |
| BETH WEITENSTEINER ARNP | ||||||||||||||
| RESIDENCY DEPUTY DIRECTOR & PROVIDER | $226,298 | $0 | $2,634 | $0 | $10,132 | $0 | $9,428 | $0 | $16,953 | $0 | $265,445 | $0 | $0 | $0 |
| HERMES SHAHBAZIAN | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $226,592 | $0 | $2,088 | $0 | $4,358 | $0 | $9,147 | $0 | $8,616 | $0 | $250,801 | $0 | $0 | $0 |
| HIEU PHAM PROVIDER | ||||||||||||||
| MEDICAL RESIDENCY DIRECTOR | $214,703 | $0 | $13,273 | $0 | $0 | $0 | $9,126 | $0 | $8,791 | $0 | $245,893 | $0 | $0 | $0 |
| SAMANTHA LEE-CHIU | ||||||||||||||
| CHIEF DENTAL OFFICER | $188,124 | $0 | $2,799 | $0 | $12,807 | $0 | $8,149 | $0 | $26,703 | $0 | $238,582 | $0 | $0 | $0 |
| GRANDY AU | ||||||||||||||
| ASSISTANT DENTAL DIRECTOR | $169,608 | $0 | $8,616 | $0 | $18,750 | $0 | $7,865 | $0 | $32,308 | $0 | $237,147 | $0 | $0 | $0 |
| CHINDA ROACH MD | ||||||||||||||
| PROVIDER | $194,173 | $0 | $4,604 | $0 | $7,392 | $0 | $8,163 | $0 | $17,383 | $0 | $231,715 | $0 | $0 | $0 |
| UYENVY PHAM MD | ||||||||||||||
| PROVIDER | $199,794 | $0 | $4,400 | $0 | $0 | $0 | $8,196 | $0 | $9,330 | $0 | $221,720 | $0 | $0 | $0 |
| TIMOTHY LAM | ||||||||||||||
| PROVIDER | $147,456 | $0 | $4,667 | $0 | $12,807 | $0 | $7,151 | $0 | $40,553 | $0 | $212,634 | $0 | $0 | $0 |
| HARVEY WU | ||||||||||||||
| ASSISTANT DENTAL DIRECTOR | $168,161 | $0 | $4,967 | $0 | $6,877 | $0 | $7,240 | $0 | $18,053 | $0 | $205,298 | $0 | $0 | $0 |
| LAUREN LAWLER | ||||||||||||||
| ASSISTANT MEDICAL DIRECTOR | $140,510 | $0 | $1,831 | $0 | $17,553 | $0 | $6,406 | $0 | $31,703 | $0 | $198,003 | $0 | $0 | $0 |
| WINNIE LEE | ||||||||||||||
| ASSISTANT MEDICAL DIRECTOR | $137,024 | $0 | $3,299 | $0 | $12,807 | $0 | $6,275 | $0 | $30,444 | $0 | $189,849 | $0 | $0 | $0 |
| HAMED SAHARI-RASHTI | ||||||||||||||
| PROVIDER | $155,883 | $0 | $2,799 | $0 | $6,777 | $0 | $6,618 | $0 | $16,953 | $0 | $189,030 | $0 | $0 | $0 |
| LILI SPERRY MD | ||||||||||||||
| PROVIDER | $157,290 | $0 | $2,194 | $0 | $2,904 | $0 | $6,511 | $0 | $15,393 | $0 | $184,292 | $0 | $0 | $0 |
| JU HUI LEE | ||||||||||||||
| PHARMACY DIRECTOR | $156,840 | $0 | $2,088 | $0 | $0 | $0 | $6,557 | $0 | $13,616 | $0 | $179,101 | $0 | $0 | $0 |
| HYELIM PARK PROVIDER | ||||||||||||||
| CLINICAL INFORMATICS DIRECTOR | $144,633 | $0 | $2,134 | $0 | $10,608 | $0 | $5,883 | $0 | $8,916 | $0 | $172,174 | $0 | $0 | $0 |
| SOLOMUNA HABTU | ||||||||||||||
| ASSISTANT DENTAL DIRECTOR | $151,293 | $0 | $4,742 | $0 | $0 | $0 | $6,241 | $0 | $8,616 | $0 | $170,892 | $0 | $0 | $0 |
| TERESA LEE | ||||||||||||||
| FORMER KEY EMPLOYEE | $149,962 | $0 | $2,343 | $0 | $4,032 | $0 | $6,253 | $0 | $696 | $0 | $163,286 | $0 | $0 | $0 |
| JESSICA GUH MD FAMILY | ||||||||||||||
| FORMER KEY EMPLOYEE | $85,294 | $0 | $2,667 | $0 | $12,693 | $0 | $3,877 | $0 | $15,923 | $0 | $120,454 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4A | IN 2021, ASQUAL GETANEH RECEIVED A SEVERANCE PAYMENT OF $146,072. |
| PART I, LINE 5 | THE PRESIDENT/CEO RECEIVES A BONUS BASED ON FIVE STRATEGIC GOALS, ONE OF WHICH IS DIVERSIFYING REVENUE. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WASHINGTON HEALTH CARE FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 911108929 | BondIssuerEIN |
| Bond Issued | 2013-10-18 | BondIssuedDt |
| Issue Price | $10,107,500 | IssuePriceAmt |
| Purpose | CONSTRUCTION | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,931,952 | RetiredAmt |
| Total Proceeds | $10,107,500 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $131,346 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $9,976,154 | CapitalExpendituresAmt |
| Substantial Completion | 2014 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | ISSUER NAME: WASHINGTON HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/18/2018 | ExplanationTxt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 118 | ContributionCnt |
| Noncash Contributions Rpt F990 | $2,305,197 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE IS CHAIRED BY THE CHAIR OF THE BOARD AND ONLY CONSISTS OF THE ELECTED OFFICERS OF THE BOARD AND THE PRESIDENT/CEO OF ICHS AS AN EX OFFICIO MEMBER. THE EXECUTIVE COMMITTEE IS EXCLUSIVELY AUTHORIZED TO ACT FOR THE BOARD IN URGENT SITUATIONS DURING THE INTERIM PERIOD BETWEEN MEETINGS OF THE BOARD IN A MANNER CONSISTENT WITH ESTABISHED BOARD POLICIES AND/OR DIRECTION, AND SHALL REPORT ALL ACTIVITIES AND ACTIONS AT THE NEXT MEETING OF THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | A DRAFT COPY OF THE FORM 990 WAS REVIEWED BY THE CFO AND DESIGNATED STAFF, INCLUDING THE ACCOUNTING MANAGER. THE ORGANIZATION'S FINANCE DEPARTMENT THEN REVIEWED AND SUBMITTED A DRAFT COPY OF THE FORM 990 TO THE FINANCE, AUDIT AND EXECUTIVE COMMITTEES OF THE THE BOARD OF DIRECTORS, WHO RECOMMENDED APPROVAL OF THE FORM TO THE FULL BOARD. THE FORM 990 WAS SUBSEQUENTLY PRESENTED TO THE FULL BOARD AT THE FOLLOWING BOARD MEETING FOR REVIEW AND APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | ICHS REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICIES. ICHS HAS TWO CONFLICT OF INTEREST POLICIES. THE FIRST POLICY IS AN OVERARCHING POLICY FOR THE ENTIRE AGENCY, WHICH WORKS TO ENSURE EFFECTIVE MANAGEMENT OF CONFLICTS OF INTEREST AT ICHS. THE SECOND POLICY IS SET TO ENSURE ALL BOARD-RELATED ACTIVITIES ARE CONDUCTED IN A WAY THAT ENSURES COMPLIANCE WITH APPLICABLE LAWS, PRESERVES THE PUBLIC'S TRUST, ENSURES GOOD STEWARDSHIP OF ICHS RESOURCES, AND UPHOLDS HIGH STANDARDS OF CONDUCT AND PERSONAL INTEGRITY AMONG ALL BOARD DIRECTORS AND BOARD ASSOCIATES. THE CONFLICT OF INTEREST POLICY REQUIRES ALL EMPLOYEES AND NON-EMPLOYEE REPRESENTATIVES TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MAY COMPROMISE THEIR JUDGMENT OR IF PERSONAL INTERESTS ARE IN SUBSTANTIAL CONFLICT WITH THE BEST INTERESTS OF ICHS. SIMILARLY, INDIVIDUALS ARE EXPECTED TO REMOVE THEMSELVES FROM A POSITION OF DECISION-MAKING AUTHORITY OR SIGNIFICANT INFLUENCE WITH RESPECT TO ANY CONFLICT SITUATION THAT ARISES. A SITUATION IS CONSIDERED A CONFLICT OF INTEREST IF AN INTEREST OR ACTIVITY INFLUENCES OR APPEARS TO INFLUENCE THE ABILITY OF AN INDIVIDUAL TO EXERCISE OBJECTIVITY OR IMPAIRS THE INDIVIDUAL'S ABILITY TO PERFORM HIS OR HER EMPLOYMENT OR REPRESENTATIVE WORK RESPONSIBILITIES IN THE BEST INTEREST OF ICHS. ANY UNETHICAL ABUSE OF EMPLOYEES OR NON-EMPLOYEE REPRESENTATIVES CAN RESULT IN DISCIPLINARY ACTION (INCLUDING TERMINATION OF EMPLOYMENT). THE CONFLICT OF INTEREST POLICY FOR BOARD DIRECTORS AND BOARD ASSOCIATES REQUIRES BOARD DIRECTORS AND ASSOCIATES TO DISCLOSE ANY REAL OR APPARENT CONFLICT OF INTEREST TO THE BOARD AND EXCUSE HIMSELF OR HERSELF FROM VOTING, AS APPROPRIATE. ADDITIONALLY, NO BOARD MEMBER CAN ALSO BE AN EMPLOYEE OR RELATED TO AN EMPLOYEE OF ICHS. IF A CONFLICT OF INTEREST IS PERCEIVED TO EXIST BUT IS NOT DISCLOSED, THE BOARD MAY VOTE WHETHER THERE IS A REAL CONFLICT OF INTEREST. IF THE VOTE IS AFFIRMATIVE, THE BOARD MEMBER IN QUESTION IS NOT ENTITLED TO VOTE ON THAT ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD REVIEWS AND DETERMINES THE COMPENSATIONOF THE CEO BY USING EXTERNAL MARKET DATA. 1) NWARPCABIENNIAL REGION X HEALTH CENTER SALARY AND BENEFITS SURVEY; 2) NACHC HEALTH CENTER SALARY AND BENEFITS REPORT; 3) MILLIMAN'S NW HEALTHCARE EXECUTIVE COMPENSATION SURVEY; AND 4) MERCES CONSULTING CEO COMPENSATION FOR FQHCS. ICHS HR SETS PAY LEVELS TO THOSE IN THE EXISTING MARKETPLACE BY USING THE FOLLOWING: 1) NWRPCA BIENNIAL REGION X HEALTH CENTER SALARY AND BENEFITS SURVEY; 2) NACHC HEALTH CENTER SALARY AND BENEFITS REPORT; 3) MILLIMAN'S NW HEALTHCARE EXECUTIVE COMPENSATION SURVEY; AND 4) MILLIMAN'S NW HEALTHCARE COMPENSATION SURVEY. ICHS USES AN INDEPENDENT CONSULTANT TO REVIEW ITS COMPENSATION PHILOSOPHY/STRUCTURE EVERY 5 YEARS TO MAINTAIN A COMPENSATION/BENEFITS PROGRAM THAT REMAINS COMPETITIVE TO ATTRACT AND RETAIN TOP TALENT. THE EXECUTIVE COMPENSATION REVIEW PROCESS MOST RECENTLY INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 8TH AVENUE S SUITE 100 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98104 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 260493856 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERNATIONAL COMMUNITY HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | 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 | 0 | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | 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 |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION | ||
| C | $735,135 | CASH |
| INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION | ||
| L | $274,359 | FAIR MARKET VALUE |
| INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION | ||
| M | $735,135 | CASH |
| INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION | ||
| N | $274,359 | FAIR MARKET VALUE |