2021-11-15T12:43:42-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-01-01 910947084 INTERNATIONAL COMMUNITY HEALTH SERVICES INTE 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 TERESITA BATAYOLA PRESIDENT/CEO 2067883618 2021-11-09 1 TERESITA BATAYOLA 999009999 KURT BENNION P01469618 4252506100 2021-11-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TERESITA BATAYOLA 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 63428683 0 X WWW.ICHS.COM X 1973 WA PROVIDE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES. 17 17 717 35 0 0 10233357 14144165 42885843 47420516 129578 80770 458374 597406 53707152 62242857 27000 120000 0 0 40695531 37622190 0 0 294505 17198349 19484619 57920880 57226809 -4213728 5016048 48801537 70510972 28775896 45469283 20025641 25041689 X DEEPLY ROOTED IN THE ASIAN PACIFIC ISLANDER COMMUNITY, ICHS PROVIDES CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND WELLNESS SERVICES AND PROMOTES HEALTH EQUITY FOR ALL. 0 0 18766544 0 22896485 ICHS PROVIDES MEDICAL SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY. THESE SERVICES INCLUDE PHYSICAL EXAMS, IMMUNIZATIONS, MINOR SURGERY, HOME VISITS, AND INFANT AND WELL-CHILD CHECK-UPS. DURING 2020, ICHS PROVIDED 68,335 PRIMARY HEALTH CARE VISITS TO PATIENTS AND $350,509 OF CHARITY CARE. 8222518 0 7219037 ICHS PROVIDES FULL DENTAL CARE FOR THE ENTIRE FAMILY. ICHS PROVIDES EXTENSIVE DENTURE WORK, FULL CLEANING FOR ADULTS AND CHILDREN, PREVENTIVE DENTISTRY, MINOR ORAL SURGERY, RESTORATIVE SERVICES, ORTHODONTIA, AND EMERGENCY CARE. THE STAFF ALSO PROVIDES ORAL HEALTH EDUCATION IN THE COMMUNITY. DURING 2020, ICHS PROVIDED 26,664 DENTAL CARE VISITS TO PATIENTS AND $319,983 OF CHARITY CARE. 11970229 0 12555660 ICHS PROVIDES A VARIETY OF OTHER HEALTH CARE SERVICES TO THE COMMUNITY. THESE SERVICES INCLUDE ACUPUNCTURE, VISION, DISEASE PREVENTION, HEALTH EDUCATION, BEHAVIORAL HEALTH, NUTRITION SERVICES, AND FAMILY PLANNING FOR TEENS AND ADULTS. DURING 2020, ICHS PROVIDED 10,159 HEALTH CARE VISITS TO PATIENTS AND $17,447 OF CHARITY CARE. 8726530 120000 4749334 A HEALTH AGING AND WELLNESS PROGRAM (HAWP) INCLUDES PACE (PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY), ASSISTED LIVING, ADULT DAY SERVICES AND ADULT NUTRITION. PACE IS AN INNOVATIVE MODEL OF CARE THAT HELPS SENIORS LIVE INDEPENDENTLY IN THEIR COMMUNITY. PACE HAD 553 MEMBER MONTH IN 2020. 8726530 120000 4749334 47685821 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 59 0 717 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X HERMES SHAHBAZIAN 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 253465 0 24053 ASQUAL GETANEH CHIEF MEDICAL OFFICER 40.00 0.00 X 254810 0 18943 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 50.00 2.00 X 237464 0 19580 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 40.00 2.00 X 227270 0 17559 RACHEL KOH CHIEF OPERATING OFFICER 40.00 0.00 X 204812 0 16832 BETH WEITENSTEINER RESIDENCY DEPUTY DIRECTOR/MEDICAL PROVIDER 32.00 0.00 X 199021 0 17682 UYENVY PHAM MD PROVIDER 36.00 0.00 X 182003 0 15836 KANNIE CHIM PACE MEDICAL DIRECTOR 40.00 0.00 X 179064 0 15363 SAMANTHA LEE-CHIU CHIEF DENTAL OFFICER 40.00 0.00 X 166967 0 20598 CHINDA ROACH MD PROVIDER 36.00 0.00 X 162846 0 20576 GRACE WANG MD FORMER OFFICER 28.00 0.00 X 158401 0 15063 JENNIFER ABRAMS MD PROVIDER 40.00 0.00 X 157639 0 14787 GRANDY AU ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 151437 0 20179 JU HUI LEE PHARMACY DIRECTOR 40.00 0.00 X 155172 0 14846 HARVEY WU ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 152340 0 16253 JESSICA GUH MD FAMILY FORMER KEY EMPLOYEE 40.00 0.00 X 146156 0 17979 LILI SPERRY MD PROVIDER 32.00 0.00 X 138422 0 17682 ANN LU MD PROVIDER 36.00 0.00 X 141055 0 14869 TERESA LEE FORMER KEY EMPLOYEE 32.00 0.00 X 123746 0 5531 GILDAS CHEUNG CHAIR 4.00 0.00 X X 0 0 0 JOHN FOZ 1ST VICE CHAIR 3.00 0.50 X X 0 0 0 MARVIN ENG 2ND VICE CHAIR 3.00 0.00 X X 0 0 0 KELLI NOMURA 3RD VICE CHAIR 3.00 0.00 X X 0 0 0 LEE MARCHISIO 4TH VICE CHAIR 3.00 0.00 X X 0 0 0 CATHERINE JOHNSON SECRETARY 3.00 0.00 X X 0 0 0 MARIAM ABARIENTOS TREASURER 3.00 0.00 X X 0 0 0 TRISH BUSTOS DIRECTOR 1.50 0.00 X 0 0 0 NICOLE CHU DIRECTOR 1.50 0.00 X 0 0 0 TESSA CHU DIRECTOR 1.50 0.00 X 0 0 0 CHENGZHEN DAI DIRECTOR 1.50 0.00 X 0 0 0 AMANDA KIMURA DIRECTOR 1.50 0.00 X 0 0 0 CRIS KRISOLOG-ELLIOTT DIRECTOR 1.50 0.00 X 0 0 0 KRISTINA LAUBNER SMITH DIRECTOR 1.50 0.00 X 0 0 0 TED LEW DIRECTOR 1.50 0.00 X 0 0 0 HIROSHI NAKANO DIRECTOR 1.50 0.00 X 0 0 0 BARBARA OBENA DIRECTOR 1.50 0.50 X 0 0 0 3392090 0 324211 47 1 1 0 STRATUS INDEMAND INC PO BOX 675248 DETROIT MI 48267 INTERPRETATION SERVICES 570609 BAYLEY CONSTRUCTION 8005 SE 28TH STREET MERCER ISLAND WA 98040 CONSTRUCTION 358629 PROVIDENCE HEALTH & SERVICES PO BOX 84392 SEATTLE WA 98124 PRACTICE MANAGEMENT SYSTEM 288270 FELDESMAN TUCKER LEIFER FIDELL LLP 1129 20TH ST NW 400 WASHINGTON DC 20036 LEGAL SERVICES 264549 NUWEST GROUP HOLDINGS LLC PO BOX 940 ROSEVILLE CA 95661 TEMPORARY STAFFING 234441 10 609201 11893605 1641359 479967 14144165 PATIENT SERVICE FEES 624100 38178046 38178046 HEALTHY WELLNESS & AGING 623000 4749334 4749334 POOL SAVINGS REVENUE 900099 4054071 4054071 OTHER MEDICAL REVENUE 900099 439065 439065 47420516 66596 66596 1200000 1163537 22289 36463 -22289 14174 14174 MANAGEMENT FEES 900099 315632 315632 MISCELLANEOUS REVENUE 900099 281774 281774 597406 62242857 47420516 0 678176 120000 120000 2383710 980769 1402941 27572954 23814544 3517553 240857 1054921 912289 134024 8608 4457733 3852368 578238 27127 2152872 1793345 341614 17913 470017 7038 462979 71955 71955 3421075 2594470 826605 100636 7867 92769 361551 278370 83181 198355 154622 43733 3209133 2689213 519920 28460 21343 7117 43454 25192 18262 421812 379175 42637 2474146 1935395 538751 246734 203267 43467 HEALTHCARE ENROLLEES 1845791 1845791 MEDICAL SUPPLIES 4514651 4376954 137697 BAD DEBT 702713 702713 PATIENT EXPENSE 527282 527282 846854 463814 383040 57226809 47685821 9246483 294505 5762950 18668532 2014157 2091141 2651227 3842741 3478930 4746620 314896 326264 1203008 741710 45830841 18705612 29960751 27125229 1200000 0 2215618 12968735 48801537 70510972 15194810 15170678 759262 7821501 8776173 8520066 4045651 13957038 28775896 45469283 X 19413099 24117049 612542 924640 20025641 25041689 48801537 70510972 5016048 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 2364 0 1 2364 0 PART II-B, LINE 1: 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. 3528037 3528037 27958037 8542033 19416004 5168525 3613572 1554953 8456391 6550007 1906384 719851 719851 27125229 RECEIVABLE FROM RELATED ORGANIZATION 2687050 RIGHT OF USE LEASE 10281685 12968735 X PART X, LINE 2: 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 FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. 1 AGING IN PACE WASHINGTON PO BOX 3007 SEATTLE WA 981143007 810856014 501(C)(3) 120000 EQUITY CONTRIBUTION 1 0 PART I, LINE 2: 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. X X X X X 0 0 0 1 0 0 0 0 0 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 237487 0 3000 0 12978 0 10134 0 13919 0 277518 0 0 0 ASQUAL GETANEH CHIEF MEDICAL OFFICER 252310 0 2500 0 0 0 10304 0 8639 0 273753 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 224988 0 0 0 12476 0 9381 0 10199 0 257044 0 0 0 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 222998 0 0 0 4272 0 8920 0 8639 0 244829 0 0 0 RACHEL KOH CHIEF OPERATING OFFICER 204812 0 0 0 0 0 8193 0 8639 0 221644 0 0 0 BETH WEITENSTEINER RESIDENCY DEPUTY DIRECTOR/MEDICAL PROVIDER 177891 0 2400 0 18730 0 7483 0 10199 0 216703 0 0 0 UYENVY PHAM MD PROVIDER 177008 0 2700 0 2295 0 7197 0 8639 0 197839 0 0 0 KANNIE CHIM PACE MEDICAL DIRECTOR 171564 0 7500 0 0 0 7444 0 7919 0 194427 0 0 0 SAMANTHA LEE-CHIU CHIEF DENTAL OFFICER 154109 0 0 0 12858 0 6679 0 13919 0 187565 0 0 0 CHINDA ROACH MD PROVIDER 148466 0 2700 0 11680 0 6657 0 13919 0 183422 0 0 0 GRACE WANG MD FORMER OFFICER 158401 0 0 0 0 0 6424 0 8639 0 173464 0 0 0 JENNIFER ABRAMS MD PROVIDER 151292 0 2400 0 3947 0 6148 0 8639 0 172426 0 0 0 GRANDY AU ASSISTANT DENTAL DIRECTOR 129826 0 3000 0 18611 0 6260 0 13919 0 171616 0 0 0 JU HUI LEE PHARMACY DIRECTOR 155172 0 0 0 0 0 6207 0 8639 0 170018 0 0 0 HARVEY WU ASSISTANT DENTAL DIRECTOR 141450 0 2000 0 8890 0 6054 0 10199 0 168593 0 0 0 JESSICA GUH MD FAMILY FORMER KEY EMPLOYEE 136896 0 2500 0 6760 0 5860 0 12119 0 164135 0 0 0 LILI SPERRY MD PROVIDER 133371 0 2400 0 2651 0 5563 0 12119 0 156104 0 0 0 ANN LU MD PROVIDER 138546 0 675 0 1834 0 5650 0 9219 0 155924 0 0 0 TERESA LEE FORMER KEY EMPLOYEE 120300 0 0 0 3446 0 4812 0 719 0 129277 0 0 0 PART I, LINE 5 THE PRESIDENT/CEO RECEIVES A BONUS BASED ON FIVE STRATEGIC GOALS, ONE OF WHICH IS DIVERSIFYING REVENUE. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2013-10-18 10107500 CONSTRUCTION 0 0 0 A 1639934 10107500 131346 9976154 2014 0 0 0 1 A 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WASHINGTON HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/18/2018 X 2 479967 COST 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 1 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 OF DIRECTORS PERFORM AN ANNUAL PERFORMANCE EVALUATION OF THE PRESIDENT/CEO BASED ON VARIOUS COMPENSATION SURVEYS. THE EXECUTIVE COMMITTEE OF THE BOARD (CHAIRS OF ALL THE COMMITTEES) MEETS WITH THE PRESIDENT/CEO TO NEGOTIATE COMPENSATION THAT IS CONSISTENT WITH MARKET PAY. THIS PROCESS IS UNDERTAKEN ANNUALLY. THE CHIEF FINANCIAL OFFICER AND OTHER KEY EMPLOYEES' COMPENSATION IS DETERMINED BY PERFOMANCE EVALUATIONS AND VARIOUS COMPENSATION SURVEYS. RECOMMENDATIONS FOR COMPENSATION ADJUSTMENTS ARE REVIEWED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION 720 8TH AVENUE S SUITE 100 SEATTLE WA 98104 260493856 FUNDRAISING WA 501(C)(3) LINE 12A, I INTERNATIONAL COMMUNITY HEALTH SERVICES 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION C 609201 CASH INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION L 315632 FAIR MARKET VALUE INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION M 609201 CASH INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION N 315632 FAIR MARKET VALUE