2021-10-01T09:57:27-05:00 2021-03-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-04-01 237297657 COLUMBIA VALLEY COMMUNITY HEALTH COLU 5096626000 600 ORONDO AVENUE NO 1 WENATCHEE WA 98801 DAVID OLSON CEO 5096626000 2021-09-29 1 DAVID OLSON 999009999 KURT BENNION CPA P01469618 4252506100 2021-09-29 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DAVID OLSON 600 ORONDO AVENUE NO 1 WENATCHEE WA 98801 49091528 0 X WWW.CVCH.ORG X 1972 WA PARTNERING TO ACHIEVE OPTIMAL HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 11 11 399 11 0 0 9082241 16509181 34884235 31418314 322634 574931 346688 589102 44635798 49091528 31681 6773 0 0 26526096 29664544 0 0 0 12537182 13133783 39094959 42805100 5540839 6286428 61216299 72024454 13082291 16887767 48134008 55136687 THE MISSION OF COLUMBIA VALLEY COMMUNITY HEALTH IS PARTNERING TO ACHIEVE OPTIMAL HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 0 0 33947230 6773 31418314 PROVIDE COMPREHENSIVE MEDICAL, MENTAL HEALTH AND DENTAL CARE TO SEASONAL AND MIGRANT FARM WORKERS AND THE MEDICALLY UNDERSERVED POPULATION OF THE AREA. THIS INCLUDES GENERAL MEDICINE, DENTAL, PRENATAL, AND OBSTETRIC CARE ON AN OUTPATIENT BASIS. AN ON SITE PHARMACY PROVIDES PATIENT PRESCRIPTION SERVICES TO ENSURE PATIENTS OBTAIN NEEDED MEDICATIONS. 506115 0 0 INTERMEDIARY FOR PROVIDING SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN. INCLUDES NUTRITION EDUCATION, REFERRAL FOR HEALTH CARE FOR LOWINCOME WOMEN AS WELL AS INFANTS AND CHILDREN UNDER AGE FIVE. PROGRAM FOCUS IS FOR BOTH INFANTS AND CHILDREN IN THE CRITICAL PERIODS OF GROWTH AND DEVELOPMENT UNDER AGE FIVE. 34453345 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 53 0 399 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 0 1 1 1 1 1 1 1 0 0 X MIKE ROMINE 5096626000 600 ORONDO AVENUE NO 1 WENATCHEE WA 98801 MALCOLM BUTLER CMO 40.00 X 361952 0 37904 DAVID OLSON CEO 40.00 X 336786 0 37904 KENNETH SHERMER MEDICAL DIRECTOR 40.00 X 317916 0 37904 TOBE HARBERD PHYSICIAN 40.00 X 277976 0 37897 KERI BERGESON MEDICAL DIRECTOR 40.00 X 274095 0 37722 JERRY CRAWFORD PHYSICIAN 40.00 X 266165 0 30780 JEFFERY HINCKLEY DENTIST & DENTAL DIRECTOR 40.00 X 241631 0 36518 JOSHUA BURNELL PHYSICIAN 40.00 X 242585 0 25145 MICHAEL ROMINE CFO 40.00 X 201703 0 27836 MANUEL NAVARRO COO 40.00 X 165732 0 32662 BLAKE EDWARDS BEHAVIORAL HEALTH DIRECTOR 40.00 X 134724 0 31206 KRISTINA STEPPER PRESIDENT 2.00 X X 0 0 0 JOHN SWENSON VICE PRESIDENT 2.00 X X 0 0 0 LOLY LARSON SECRETARY 2.00 X X 0 0 0 ROBERT SCOTT JR TREASURER 2.00 X X 0 0 0 JOAN ALWAY BOARD MEMBER 2.00 X 0 0 0 JR CANO BOARD MEMBER 2.00 X 0 0 0 LAURA LEON BOARD MEMBER 2.00 X 0 0 0 MICHAEL MACHADO BOARD MEMBER 2.00 X 0 0 0 DUSTY MAHONEY BOARD MEMBER 2.00 X 0 0 0 ALFREDO ORTIZ BOARD MEMBER 2.00 X 0 0 0 TERESA ZEPEDA BOARD MEMBER 2.00 X 0 0 0 2821265 0 373478 45 0 1 0 BOUTEN CONSTRUCTION CO PO BOX 3507 SPOKANE WA 99220 CONSTRUCTION SERVICES 1902881 ATHENAHEALTH PO BOX 415615 BOSTON MA 02241 BILLING & COLLECTION SERVICES 936600 ABM JANITORIAL SERVICES PO BOX 419860 BOSTON MA 02241 JANITORIAL SERVICES 345162 ACCESS NURSE PM LLC PO BOX 635013 CINCINNATI OH 45263 TELEPHONE TRIAGE 252215 COMMUNITY CLINIC CONTRACTING NETWORK IN 18 S MISSION ST 300 WENATCHEE WA 98801 DATA WAREHOUSING SERVICES 168318 7 16460371 48810 1347118 16509181 PATIENT SERVICE REVENUE 621400 18941253 18941253 ENHANCEMENTS REVENUE 621400 10225174 10225174 CAPITATION REVENUE 621400 2207407 2207407 MEANINGFUL USE REVENUE 621400 34000 34000 MEDICAL RECORD REVENUE 621400 10480 10480 31418314 73912 73912 501019 0 501019 501019 501019 MISCELLANEOUS INCOME 900099 448745 448745 BAD DEBT RECOVERY 900099 140357 140357 589102 49091528 31418314 0 1164033 6773 6773 1645553 227566 1417987 22202987 19470583 2732404 838615 753212 85403 3524089 3151270 372819 1453300 1266819 186481 46827 46827 65000 65000 28333 28333 1227929 542878 685051 98532 74001 24531 1213179 787787 425392 1910234 993649 916585 1177551 978698 198853 14136 8824 5312 267362 209582 57780 2158470 1582026 576444 66284 66284 MEDICAL SUPPLIES 4044540 4042628 1912 MISCELLANEOUS EXPENSES 485944 162701 323243 CONTINUING EDUCATION 188658 120464 68194 DUES & LICENSES 82500 73884 8616 58304 58304 42805100 34453345 8351755 0 11890441 16095714 9241001 10302417 340220 903827 2253241 4199694 173969 361665 666558 813299 52216804 19324709 32089881 32892095 3199051 5157599 1200000 1200000 161937 98144 61216299 72024454 3914915 5788558 28125 20250 8620280 8013228 0 1018026 518971 2047705 13082291 16887767 X 48044567 55019361 89441 117326 48134008 55136687 61216299 72024454 6286428 716251 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 3013200 3013200 40739857 13359178 27380679 129171 117131 12040 8034218 5848400 2185818 300358 300358 32892095 OTHER LIABILITIES 2047705 2047705 X 49751561 716251 8160 724411 49027150 28333 36045 64378 49091528 42776767 0 42776767 28333 28333 42805100 PART IV, LINE 2B: DURING THE FISCAL YEAR, THE ORGANIZATION RECEIVED A LARGE PAYMENT FROM ONE OF OUR VENDORS WITH NO EXPLANATION ABOUT THE PURPOSE OF THE PAYMENT. WE ARE REPORTING A LIABILITY IN THE BALANCE TO REFLECT THE FACT THAT THIS MONEY MAY BE REPAID TO THE VENDOR. PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS USING A STANDARD THAT PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. AS OF MARCH 31, 2021 AND 2020, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 8,160. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 36,045. 1 HELPING HANDS FUND 50 6773 PART I, LINE 2: PER THE FUNDING POLICY, TO BE CONSIDERED FOR THE HELPING HANDS FUND, THE PATIENT'S HOUSEHOLD INCOME SHOULD NOT EXCEED TWO HUNDRED PERCENT (200%) OF THE POVERTY GUIDELINES. THE COMMITTEE WILL REVIEW AND VOTE ON ELIGIBLE APPLICATIONS ON A CASE BY CASE BASIS. FOR APPLICATIONS REFERRED BY PROVIDERS, AN URGENT NEED REQUEST FORM WILL BE COMPLETED BY THE PROVIDER AND SIGNED BY A COMMITTEE MEMBER. IF THE ESTIMATED COST IS BETWEEN $200 AND $299, A MANAGEMENT TEAM MEMBER'S SIGNATURE IS ALSO REQUIRED. URGENT NEED REQUEST EQUAL TO OR GREATER THAN $300 MUST BE APPROVED BY THE COMMITTEE VIA EMAIL VOTE BEFORE FUNDING CAN OCCUR. NON URGENT NEED APPLICATIONS WILL BE REVIEWED AT MONTHLY COMMITTEE MEETINGS. PAYMENTS ARE MADE DIRECTLY TO CREDITORS TO ENSURE PROPER USE OF ALL FUNDS. X 1 1 X X X X X 0 0 0 0 0 1 0 1 0 MALCOLM BUTLER CMO 297396 0 62854 0 1702 0 12825 0 25079 0 399856 0 0 0 DAVID OLSON CEO 254053 0 63125 0 19608 0 12825 0 25079 0 374690 0 0 0 KENNETH SHERMER MEDICAL DIRECTOR 285282 0 12332 0 20302 0 12825 0 25079 0 355820 0 0 0 TOBE HARBERD PHYSICIAN 224360 0 125 0 53491 0 12818 0 25079 0 315873 0 0 0 KERI BERGESON MEDICAL DIRECTOR 245675 0 10024 0 18396 0 12643 0 25079 0 311817 0 0 0 JERRY CRAWFORD PHYSICIAN 242586 0 20261 0 3318 0 12155 0 18625 0 296945 0 0 0 JEFFERY HINCKLEY DENTIST & DENTAL DIRECTOR 213877 0 27402 0 352 0 11439 0 25079 0 278149 0 0 0 JOSHUA BURNELL PHYSICIAN 222960 0 125 0 19500 0 8890 0 16255 0 267730 0 0 0 MICHAEL ROMINE CFO 164779 0 32983 0 3941 0 9255 0 18581 0 229539 0 0 0 MANUEL NAVARRO COO 132400 0 33125 0 207 0 7767 0 24895 0 198394 0 0 0 BLAKE EDWARDS BEHAVIORAL HEALTH DIRECTOR 112538 0 22325 0 -139 0 6493 0 24713 0 165930 0 0 0 PART I, LINE 1A THE ORGANIZATION PROVIDES HEALTH CLUB MEMBERSHIPS FOR ALL EMPLOYEES, INCLUDING THE INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A. THIS AMOUNT IS NOT INCLUDED IN EMPLOYEES' TAXABLE COMPENSATION. PART I, LINE 6 THE ORGANIZATION'S LEADERSHIP TEAM PARTICIPATES IN AN INCENTIVE-BASED PROGRAM WITH SIX PILLARS, INCLUDING FINANCIAL SUSTAINABILITY (I.E. OPERATING MARGIN), COMMUNITY, GROWTH, PATIENT EXPERIENCE, QUALITY, AND WORKFORCE. EACH PILLAR IS EQUALLY WEIGHTED. PART I, LINE 7 DURING 2020, THE CEO APPROVED A ONE-TIME BONUS FOR EACH MEMBER OF THE EXECUTIVE TEAM, EXCLUDING THE CEO, AS COMPENSATION FOR ADDITIONAL SERVICES PROVIDED DURING THE COVID PANDEMIC RESPONSE. BONUS AMOUNTS RANGED FROM $2,500 TO $7,000. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2017-06-22 9911965 NEW CONSTRUCTION AND REFINANCE SERIES 2010 BONDS 0 0 0 A 1783392 9911965 5080906 4831059 2017 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 MICHELLE NAVARRO SPOUSE OF MANUEL NAVARRO, COO 81381 EMPLOYEE COMPENSATION 0 TOBIAS BUTLER SON OF MALCOM BUTLER, CMO 13291 EMPLOYEE COMPENSATION 0 X 23679 1347118 INVOICE PRICE 0 0 0 0 PART I, COLUMN (B): THE NUMBER REPORTED IN PART I, COLUMN B IS THE NUMBER OF DONATED ITEMS RECEIVED DURING THE FISCAL YEAR. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD AND ONE AT-LARGE BOARD MEMBER. THE EXECUTIVE COMMITTEE IS AUTHORIZED TO REVIEW AND TAKE ANY NECESSARY ACTION THAT, IN THE OPINION OF A MAJORITY OF THE COMMITTEE, CANNOT WAIT FOR THE NEXT REGULARLY SCHEDULED BOARD MEETING OR WHERE THE CALLING OF A SPECIAL BOARD MEETING IS NOT PRACTICAL. THE EXECUTIVE COMMITTEE CHAIR MUST REPORT TO THE BOARD AT ITS NEXT REGULAR MEETING ALL ACTIONS TAKEN BY THE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING WITH THE IRS, A DRAFT OF THE FORM 990 WAS REVIEWED BY THE ACCOUNTING TEAM AND THE CFO, THEN PRESENTED TO THE FINANCE COMMITTEE, A SUBCOMMITTEE OF THE BOARD. THE FINANCE COMMITTEE REVIEWED THE FORM 990 AND THEN PRESENTED ITS RECOMMENDATION TO THE BOARD OF DIRECTORS TO FILE. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER SIGNS THE CONFLICT OF INTEREST STATEMENT WHEN THEY JOIN THE BOARD. IN ADDITION, AT THE ANNUAL BOARD MEETING IN MARCH ALL BOARD MEMBERS SIGN THE STATEMENT AGAIN TO ENSURE NOTHING HAS CHANGED FROM THE PRIOR YEAR OR TO BRING ATTENTION TO SOMETHING THAT HAS. ALSO, BOARD MEMBERS ARE ENCOURAGED TO DISCLOSE NEW INFORMATION THAT MIGHT COME UP AFTER THE STATEMENT WAS SIGNED. IF A CONFLICT EXISTS, THAT BOARD MEMBER DOES NOT VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15A SALARY DATA IS PULLED FROM MULTIPLE SALARY SURVEY SOURCES, IN ADDITION TO INDEPENDENT SALARY SURVEYS CONDUCTED THROUGH HR. THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE CEO'S COMPENSATION. THE CEO REVIEWS AND APPROVES ALL OTHER EMPLOYEES' COMPENSATION. THE PROCESS WAS LAST COMPLETED IN 2021. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST, BUT THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC.