2021-11-15T10:42:35-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-01-01 237100868 COUNTRY DOCTOR COMMUNITY CLINIC COUN 2062991941 2101 EAST YESLER WAY NO 210 SEATTLE WA 98122 MARGARET M TAYLOR CFO 2062991941 2021-11-12 1 MARGARET TAYLOR 999009999 KURT BENNION CPA P01469618 4252506100 2021-11-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z BRANDY TAYLOR 2101 EAST YESLER WAY NO 210 SEATTLE WA 98122 37231657 0 X WWW.COUNTRYDOCTOR.ORG X 1971 WA TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HEALTH CARE REGARDLESS OF ABILITY TO PAY. 12 12 316 16 0 0 7048419 9290166 20874650 25258250 53189 31874 520877 2468771 28497135 37049061 32394 5358 0 0 16156557 18357210 0 0 180506 12114325 13397154 28303276 31759722 193859 5289339 21865768 30444919 10421807 13711619 11443961 16733300 THE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. 0 0 25880321 0 25258250 IN 2020, COUNTRY DOCTOR COMMUNITY CLINIC PROVIDED 50,400 MEDICAL VISITS, 4,336 DENTAL VISITS AND 1,471 MENTAL HEALTH VISITS. 65% OF THE PATIENTS SEEN IN 2020 HAD INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL (FPL). 13% WERE UNINSURED. 2092659 5358 0 THE OTHER HEALTH SERVICES PROGRAMS PROVIDED 2,177 ANCILLARY VISITS (NUTRITION, WIC, ELIGIBILITY) TO LOW-INCOME PATIENTS. 27972980 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 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 34 0 316 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 0 X MARGARET M TAYLOR 2062991941 2101 EAST YESLER WAY SUITE 210 SEATTLE WA 98122 MATT LOGALBO MEDICAL DIRECTOR 40.00 X 213470 0 20028 KRISTIN ANDERSON PHYSICIAN RESIDENCY PROGRAM DIRECTOR 36.00 X 209181 0 17093 RICHARD KOVAR PHYSICIAN 32.00 X 180852 0 24155 BESSIE CHI PHARMACY DIRECTOR 40.00 X 181387 0 22117 JANE KING PHYSICIAN 40.00 X 183697 0 9463 LAURA ADLER PHYSICIAN 40.00 X 183434 0 9601 RALEIGH WATTS EXECUTIVE DIRECTOR 40.00 X 175079 0 15621 MARGARET M TAYLOR CFO 40.00 X 169007 0 10716 RIK WYMAN CHAIR 1.00 X X 0 0 0 MARY DOWNS VICE CHAIR 1.00 X X 0 0 0 JOAN KLEINBERG SECRETARY 1.00 X X 0 0 0 JUSTIN MARTIN TREASURER 1.00 X X 0 0 0 CHERYL ANDERSON DIRECTOR 1.00 X 0 0 0 RAYMOND ANGEL DIRECTOR 1.00 X 0 0 0 MARLON BROWN DIRECTOR 1.00 X 0 0 0 ROI-MARTIN BROWN DIRECTOR 1.00 X 0 0 0 ALEX CURRY DIRECTOR (THROUGH OCTOBER 2020) 1.00 X 0 0 0 COLT DEWOLF DIRECTOR 1.00 X 0 0 0 MORGAN DUTTON DIRECTOR (THROUGH MARCH 2020) 1.00 X 0 0 0 LORI FREE DIRECTOR (THROUGH MARCH 2020) 1.00 X 0 0 0 LY SIENG NGO DIRECTOR 1.00 X 0 0 0 ROB ROCHE DIRECTOR 1.00 X 0 0 0 GRANT SCULL DIRECTOR 1.00 X 0 0 0 NICK UREN DIRECTOR (THROUGH MARCH 2020) 1.00 X 0 0 0 1496107 0 128794 32 0 1 0 ADJ INTEGRATION SOLUTIONS 19409 99TH STREET COURT E BONNEY LAKE WA 98391 I.T. SUPPORT 761504 OCHIN 1881 SW NAITO PARKWAY PORTLAND OR 97201 I.T. SERVICES 447684 CHILDREN'S HOSPITAL & REGIONAL MEDICAL C PO BOX 24728 SEATTLE WA 98124 FACILITIES MANAGEMENT 435726 STRATUS INDEMAND INC PO BOX 675248 DETROIT MI 48267 INTERPRETATION SERVICES 114239 OUTSTMART OFFICE SOLUTIONS INC PO BOX 170157 SAN FRANCISCO CA 94117 FACILITY RENOVATIONS 110119 5 8269408 1020758 288619 9290166 PHARMACY 621400 12757890 12757890 PATIENT SERVICES 621400 12500360 12500360 25258250 11983 11983 251538 0 251538 251538 251538 202487 182596 19891 19891 19891 RISK POOL & INCENTIVES 900099 2173235 2173235 OTHER REVENUE 900099 43998 43998 2217233 37049061 25258250 0 2500645 5358 5358 603921 116749 487172 14745656 13890460 739102 116094 512630 413590 95670 3370 1446005 1134127 302742 9136 1048998 814991 227464 6543 47128 25091 21761 276 92895 49457 42894 544 3111872 2563918 528521 19433 19293 3525 15669 99 550518 393687 146431 10400 908213 575634 332173 406 15168 10485 3740 943 64497 44586 15903 4008 7177 1311 5829 37 680743 605160 73390 2193 158859 6664 152117 78 MEDICAL SUPPLIES 7145043 7144171 872 TAXES 287590 52547 233569 1474 MISCELLANEOUS 208411 33701 173616 1094 BAD DEBT 47673 47673 52074 40095 7601 4378 31759722 27972980 3606236 180506 2733001 11812499 6566 5118 2794946 2082892 2486296 2984796 160970 150294 21334102 8527237 13217445 12806865 466544 602455 21865768 30444919 2511923 2971246 7909884 7720373 0 3020000 10421807 13711619 X 11360906 16650245 83055 83055 11443961 16733300 21865768 30444919 5289339 0 X 0 1 X 1 1 1 X 6421155 6491795 6490239 7048419 9290166 35741774 6421155 6491795 6490239 7048419 9290166 35741774 35741774 107142 76720 62002 213989 263521 723374 133356 474041 466795 388171 2217233 3679596 40144744 101632299 0.89030 0.93760 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE RISK POOL REVENUE SPECIAL FUNDRAISING EVENTS CHARITABLE GAMING EVENTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 83055 83055 83055 83055 83055 83055 83055 83055 83055 83055 0.00000 1.00000 0.00000 0 0 184000 184000 16601647 5431176 11170471 182047 182047 0 4366408 2914014 1452394 12806865 FORGIVEABLE PPP LOAN 3020000 3020000 X 34878397 0 34878397 2170664 2170664 37049061 31712049 0 31712049 47673 47673 31759722 PART V, LINE 4: THE ENDOWMENT FUNDS ARE ASSETS SET ASIDE AND RESTRICTED BY DONORS. THE INCOME GENERATED FROM THESE ASSETS IS USED TO FUND OPERATIONS OF THE ORGANIZATION. PART X, LINE 2: CDCHC'S ACTIVITIES ARE GENERALLY EXEMPT FROM FEDERAL INCOMES TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; HOWEVER, UNRELATED BUSINESS ACTIVITIES WOULD BE SUBJECT TO INCOME TAX. SINCE CDCHC IS EXEMPT FROM FEDERAL INCOME TAX LIABILITY, NO PROVISION IS MADE FOR CURRENT OR DEFERRED INCOME TAX EXPENSE. FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019, MANAGEMENT EVALUATED CDCHC'S TAX POSITIONS AND CONCLUDED THAT CDCHC HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS. ALL TAX-EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE, AND OTHER APPLICABLE STATE STATUTES, USUALLY FOR THREE YEARS SUBSEQUENT TO THE DATE THE RETURN WAS FILED. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL INCOME 251,538. GRANT FUNDS 1,539,706. REALIZED GAINS ON INVESTMENTS 19,891. BAD DEBT EXPENSE 47,673. CAPITAL GRANTS & CAMPAIGN CONTRIBUTIONS 311,856. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 47,673. 1 TRANSPORTATION ASSISTANCE 191 5358 PART I, LINE 2: THE ORGANIZATION PROVIDES TRANSPORTATION ASSISTANCE TO PATIENTS. IF A PATIENT USES A BUS, TRAIN OR SIMILAR TRANSPORTATION, THEY ARE GIVEN A VOUCHER THAT IS ONLY USEFUL FOR THAT TRANSPORTATION. IF A PATIENT USES A TAXI OR SIMILAR TRANSPORTATION, THE ORGANIZATION ORDERS AND PAYS FOR THE RIDE DIRECTLY. X X X X X 0 0 0 0 0 0 0 0 0 MATT LOGALBO MEDICAL DIRECTOR 213470 0 0 0 0 0 12341 0 7687 0 233498 0 0 0 KRISTIN ANDERSON PHYSICIAN RESIDENCY PROGRAM DIRECTOR 209181 0 0 0 0 0 9316 0 7777 0 226274 0 0 0 RICHARD KOVAR PHYSICIAN 180852 0 0 0 0 0 7984 0 16171 0 205007 0 0 0 BESSIE CHI PHARMACY DIRECTOR 181387 0 0 0 0 0 8355 0 13762 0 203504 0 0 0 JANE KING PHYSICIAN 183697 0 0 0 0 0 9087 0 376 0 193160 0 0 0 LAURA ADLER PHYSICIAN 183434 0 0 0 0 0 9316 0 285 0 193035 0 0 0 RALEIGH WATTS EXECUTIVE DIRECTOR 175079 0 0 0 0 0 7656 0 7965 0 190700 0 0 0 MARGARET M TAYLOR CFO 169007 0 0 0 0 0 7659 0 3057 0 179723 0 0 0 X 12 288619 COST/SELLING PRICE 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD CHAIR AND AT LEAST THREE OTHER BOARD MEMBERS. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY AS EXPRESSLY DELEGATED TO IT BY RESOLUTION OF THE BOARD IN THE GOVERNANCE OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990, THE CFO, THE INTERIM EXECUTIVE DIRECTOR AND THE FINANCE COMMITTEE. THE FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS AT THEIR NEXT MEETING AFTER THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE AND NON-COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY WERE REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED DURING THE MONTHLY MEETINGS. BOARD MEMBERS SIGN A CONFLICT OF INTEREST FORM ANNUALLY. ANY MEMBER WITH A STATED CONFLICT OF INTEREST IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD CHAIRPERSON DETERMINES THE EXTENT OF THE CONFLICT AND WHETHER THE CONFLICTED BOARD MEMBER SHOULD NOT VOTE ON AN ISSUE OR SHOULD RECUSE HIM OR HERSELF FROM THE DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. EVERY TWO YEARS, THIS PROCESS IS ASSISTED BY AN INDEPENDENT COMPENSATION CONSULTANT AS WELL AS A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE LAST REVIEW PROCESS OF THE EXECUTIVE DIRECTOR'S COMPENSATION WAS DONE IN 2020. THE CFO'S COMPENSATION IS REVIEWED BY THE EXECUTIVE DIRECTOR BASED ON A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE BOARD THEN REVIEWS IT ALONG WITH ALL OTHER EMPLOYEES AS A GROUP. THE REVIEW OF THE DIRECTOR OF FINANCE'S COMPENSATION WAS DONE IN 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.