2021-11-22T11:50:17-06:00 2020-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2020-01-01 201056268 COLUMBIA RIVER COMMUNITY HEALTH SERVICES COLU 5414817212 PO BOX 397 BOARDMAN OR 97818 DAVID AYALA EXECUTIVE DIRECTOR 5414817212 2021-11-22 1 DAVID AYALA 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2021-11-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DAVID AYALA PO BOX 397 BOARDMAN OR 97818 6897689 0 X WWW.CRHCLINIC.NET X 2005 OR EMPOWERING MEMBERS OF OUR COMMUNITY TO IMPROVE THEIR QUALITY OF LIFE, ONE PATIENT AT A TIME. 10 9 85 10 0 0 1679912 2301210 2768669 2305395 1739 1953 1014042 1273500 5464362 5882058 0 0 0 0 3832908 4044352 0 0 0 1332020 1479586 5164928 5523938 299434 358120 6067617 7435785 473004 1483052 5594613 5952733 X COLUMBIA RIVER HEALTH EXISTS TO PROVIDE EXCEPTIONAL HEALTHCARE FOR EVERYONE IN OUR COMMUNITY. 0 0 4605062 2305395 THE PURPOSE OF COLUMBIA RIVER HEALTH (CRH) IS TO PROTECT AND IMPROVE THE QUALITY OF LIFE FOR ALL PEOPLE, PARTICULARLY THE MEDICALLY UNDERSERVED AND VULNERABLE PEOPLE, BY PROVIDING ACCESS TO HIGH QUALITY PRIMARY AND PREVENTATIVE HEALTHCARE. IN ADDITION, CRH UTILIZES A SLIDING FEES SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY, BASED ON INCOME AND FAMILY SIZE, A PORTION OF THEIR CHARGES WIL BE FOREGONE FOR A NOMINAL OR FLAT FEE. OUR DENTAL PROGRAM IS IN PLACE FOR THOSE WHO ARE QUALIFIED AS LOW INCOME AND HAVE NO DENTAL INSURANCE. MOST FOR EMERGENCY EXTRACTIONS AND RESTORATIVE WORK AS WELL AS PREVENTIVE APPOINTMENTS. WE WORK WITH ADVANTAGE DENTAL CLINICS FOR EMERGENCY AND PREVENTIVE TREATMENTS AND MEDICAL TEAMS INTERNATIONAL FOR RESTORATIVE TREATMENT. WE HAVE A 1.0 FTE X-RAY TECH WITH DIGITAL X-RAY TECHNOLOGY AVAILABLE. A LANGUAGE LINE IS AVAILABLE FOR ANY NON-ENGLISH SPEAKING PATIENT. THE LANGUAGE LINE SERVICE IS USED ANYWHERE FROM 15 TO 180 MINUTES PER MONTH. IT VARIES FROM MONTH TO MONTH, BUT WE ARE GLAD IT IS AVAILABLE FOR THE PATIENT, WHEN IT IS NEEDED. BEHAVIORAL HEALTH IN THE CLINIC INCLUDES SUBSTANCE USE DISORDER TREATMENT. ALL PROVIDERS ARE X- WAIVERED, TO TREAT OPIATED USE DISORDER WITH MEDICATION. THE PHARMACY IS LOCATED IN THE GROCERY STORE IN TOWN, THE MOST CONVIENEINT LOCATION AVAILABLE CURRENTLY. ADDITIONALLY, CRH IS CONTRACTED WITH CAPTURE RX, WHO CONTRACTS WITH PHARMACIES IN THE REGION TO DISPENSE 340B DRUGS. THIS PROGRAM IS CONTROLLED BY CAPTURE RX AND ALL OF OUR PATIENTS ARE ELIGIBLE. A COMPUTER PROGRAM SCRUBS THE PRESCRIPTIONS, AND GIVES THEM THE BETTER PRICING OF THE PHARMACIST STOCK AND THE 340B PRICING. THE MEDS ARE DISPENSED BY THE CONTRACTED PHARMACIES, AND RESTOCKED BY CAPTURE RX. THEY BILL US FOR THE MEDS RESTOCKED AND ALSO ISSUE US PAYMENTS FROM PROCEEDS FROM THE PROGRAM. WE ARE AN OUT STATIONED OUTREACH WORKER (OSOW) WITH THE STATE OF OREGON. WE PROVIDE ASSISTANCE WITH THE OREGON HEALTH PLAN APPLICATION PROCESS (MEDICAID). FREE TRANSPORTATION IS PROVIDED FOR OUR SERVICE AREA PATIENTS. SPANISH-ENGLISH BILINGUAL STAFF IS THROUGHOUT THE VARIOUS DEPARTMENTS, TO ASSIST WITH OUR HIGH NUMBER OF SPANISH SPEAKING ONLY PATIENTS. IN 2020 WE ALSO STARTED COVID-19 TESTING. 4605062 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 10 0 85 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X DAVID AYALA 5414817212 450 TATONE ST BOARDMAN OR 97818 GEOFFREY THOMAS CHIEF MEDICAL OFFICER 40.00 X 299650 0 35862 ANDREW CREMORE PHARMACIST 40.00 X 153866 0 27456 DAVID AYALA EXECUTIVE DIRECTOR 40.00 X X 138198 0 30556 CHAOFEN TAN PHARMACIST 40.00 X 119559 0 10666 KATHERINE DUNLEVY PHYSICIAN ASSISTANT 40.00 X 114372 0 10259 TERESA LANDRETH DIRECTOR OF BEHAVIORAL HEALTH 40.00 X 101403 0 13841 PAMELA DOCKEN CHAIRMAN 1.00 X X 0 0 0 JAMES SETZER THRU NOVEMBER VICE CHAIR 1.00 X X 0 0 0 ROSIE DELGADO SECRETARY 1.00 X X 0 0 0 TED LIEURANCE TREASURER 1.00 X X 0 0 0 DEANNA CAMP MEMBER 1.00 X 0 0 0 STAN CHAFFIN MEMBER 1.00 X 0 0 0 SHEILA CORPUS MEMBER 1.00 X 0 0 0 SAUL LLAMAS MEMBER 1.00 X 0 0 0 CYNTHIA NAVARRO MEMBER 1.00 X 0 0 0 JUAN REYNA MEMBER 1.00 X 0 0 0 927048 0 128640 6 0 1 0 CARDINAL HEALTH 112 LLC C/O BANK OF AMERICA LOCKBOX 3712 C CHICAGO IL 60693 PHARMACY MEDS 994699 DYNAMIC COMPUTER CONSULTING INC PO BOX 1133 PENDLETON OR 97801 IT CONSULTANT 134458 OCHIN 1881 SW NAITO PARKWAY PORTLAND OR 97201 EHR SOFTWARE 104375 COMMUNITY LINK CONSULTING PO BOX 276 NEWMAN LAKE WA 99025 ACCOUNTING CONSULTANT 104017 4 2282710 18500 2301210 PATIENT REVENUE, NET 621400 2105975 2105975 OTHER REVENUE 621400 199420 199420 2305395 1953 1953 2289131 1015631 1273500 1273500 5882058 2305395 0 1275453 504266 475217 29049 2912945 2745143 167802 61042 57526 3516 262651 247521 15130 303448 285968 17480 53970 53970 38187 38187 4388 4388 206483 159255 47228 89018 52973 36045 47383 28703 18680 253996 253996 34912 34912 REPAIRS & MAINTENANCE 131129 129421 1708 DUES & SUBSCRIPTIONS 81755 81755 BAD DEBT EXPENSE 65009 65009 RECRUITING 3083 3083 470273 146419 323854 5523938 4605062 918876 0 2084539 277 81 3473019 218670 163518 163681 160000 162526 5325876 1908264 3656424 3417612 3055 0 6067617 7435785 473004 527886 0 263606 0 691560 473004 1483052 X 5259998 5614368 334615 338365 5594613 5952733 6067617 7435785 358120 0 X X 0 1 X 1 1 1 X 1431194 1288628 1675098 1679912 2301210 8376042 1431194 1288628 1675098 1679912 2301210 8376042 8376042 3974 9974 4531 1739 1953 22171 8398213 18849838 0.99740 0.99670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 741075 741075 3802663 1225095 2577568 14219 4045 10174 767919 679124 88795 3417612 PPP LOAN 691560 691560 5878975 -3083 -3083 5882058 0 5882058 5520855 0 5520855 3083 3083 5523938 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -3,083. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,083. X X X X 0 0 0 0 0 0 0 0 0 GEOFFREY THOMAS CHIEF MEDICAL OFFICER 299240 0 410 0 0 0 8550 0 27312 0 335512 0 0 0 ANDREW CREMORE PHARMACIST 148459 0 5407 0 0 0 4442 0 23014 0 181322 0 0 0 DAVID AYALA EXECUTIVE DIRECTOR 126724 0 11474 0 0 0 4050 0 26506 0 168754 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE CEO REVIEWS THE 990 PRIOR TO FILING. IT WILL ALSO BE DISTRIBUTED TO EACH BOARD MEMBER BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C COLUMBIA RIVER COMMUNITY HEALTH SERVICES REGULARLY MONITORS AND ENFORCES THEIR CONFLICT OF INTEREST POLICY BY HAVING ALL BOARD MEMBERS AND OFFICERS FILL OUT A DECLARATION OF CONFLICT OF INTEREST DISCLOSURE FORM, WHICH IS REVIEWED AND UPDATED PERIODICALLY AS NEEDED. THE CONFLICT OF INTEREST POLICY COVERS ALL EMPLOYEES AND BOARD MEMBERS. CONFLICTS MAY BE DETERMINED AND REVIEWED AT ALL LEVELS WITHIN THE ORGANIZATION, INCLUDING BOARD MEMBERS, MANAGEMENT, AND EMPLOYEES, BUT THE BOARD IS RESPONSIBLE FOR FINAL DECISIONS AND COURSES OF ACTION REGARDING POTENTIAL OR ACTUAL CONFLICTS. RESTRICTIONS IMPOSED MAY INCLUDE PROHIBITING THE CLINIC FROM ENTERING INTO TRANSACTIONS WHERE A CONFLICT EXISTS. ADDITIONALLY, THE CLINIC EXCLUDES THOSE FOR WHICH A CONFLICT EXISTS FROM PARTICIPATION IN DELIBERATION AND DECISIONS ON SUCH TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE DETERMINED BY USING A SALARY SCALE. THE SALARY SCALE HAS A RATE RANGE. THE EMPLOYEE'S RATE IS SELECTED BY USING THE SALARY SCALE AND TAKING INTO CONSIDERATION EDUCATON AND EXPERIENCE. THE DATA FOR THE SALARY SCALE IS DETERMINED BY COMPARING SALARY SURVEYS IN THE REGION. THE SALARY SCALE IS APPROVED BY THE BOARD. SUPERVISORS AND THE EXECUTIVE DIRECTOR APPROVED ALL EMPLOYEE'S COMPENSATION. THE BOARD OF DIRECTORS APPROVED THE EXECUTIVE DIRECTOR'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 ALL ORGANIZATION GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND APPROVAL OF THE CEO. PART XII, LINE 2C FINANCIAL STATEMENTS ARE PREPARED BY THE ACCOUNTING TEAM AND REVIEWED BY THE CFO AND CEO. THEY ARE THEN PRESENTED MONTHLY TO THE BOARD OF DIRECTORS BY THE CFO. THE ENTIRE BOARD REVIEWS THE FINANCIALS AND ARE RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT FOR AUDITING. THERE HAVE BEEN NO CHANGES FROM PRIOR YEARS.