COWLITZ FAMILY HEALTH CENTER: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- COWLITZ FAMILY HEALTH CENTER (EIN 91-0896241)
- Tax period
- 2018-01-01 to 2018-12-31
- Filed
- 2019-10-10
- IRS object ID
- 201932839349301603
- Schema version
- 2018v3.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-10-10T14:02:49-05:00 | ReturnTs |
| Tax Period End | 2018-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 930743240 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOFFMAN STEWART & SCHMIDT PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 CENTERPOINTE DRIVE SUITE 300 | AddressLine1Txt |
| City | LAKE OSWEGO | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 970358663 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910896241 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COWLITZ FAMILY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COWL | BusinessNameControlTxt |
| Phone | 3606363892 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1057 12TH AVENUE | AddressLine1Txt |
| City | LONGVIEW | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 986322509 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DIAN COOPER | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 3606363892 | PhoneNum |
| Signature | 2019-10-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ROBERT M PRILL | PreparerPersonNm |
| PTIN | P00236613 | PTIN |
| Phone | 5032205900 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 74.95.39.225 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-10-10 | IPDt |
| IP Tm | 10:05:00 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 95D5054A00A45A836EB4D2778BC8CF1E5F41815C | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 76E610E35C372A61DBF352CE270A820F287984D1 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-01-14 16:20:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DIAN COOPER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1057 12TH AVENUE | AddressLine1Txt |
| City | LONGVIEW | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 986322509 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $29,150,905 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.COWLITZFAMILYHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | EVERYONE DESERVES HIGH-QUALITY COMPASSIONATE CARE. WE PROVIDE COMPREHENSIVE HEALTH SERVICES AND EDUCATION, REGARDLESS OF CIRCUMSTANCES OR INCOME. TOGETHER WE IMPROVE QUALITY OF LIFE AND TRANSFORM OUR COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 297 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,776,617 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,801,227 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,821,956 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,312,213 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,479 | PYInvestmentIncomeAmt |
| CY Investment Income | $9,429 | CYInvestmentIncomeAmt |
| PY Other Revenue | $24,369 | PYOtherRevenueAmt |
| CY Other Revenue | $28,036 | CYOtherRevenueAmt |
| PY Total Revenue | $20,627,421 | PYTotalRevenueAmt |
| CY Total Revenue | $29,150,905 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,596,836 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,590,977 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,502,266 | PYOtherExpensesAmt |
| CY Other Expenses | $8,854,143 | CYOtherExpensesAmt |
| PY Total Expenses | $22,099,102 | PYTotalExpensesAmt |
| CY Total Expenses | $23,445,120 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,471,681 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,705,785 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $17,941,244 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,788,434 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,043,488 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,184,893 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,897,756 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $19,603,541 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | EVERYONE DESERVES HIGH-QUALITY COMPASSIONATE CARE. WE DO THIS BY PROVIDING COMPREHENSIVE HEALTH SERVICES AND EDUCATION, REGARDLESS OF CIRCUMSTANCES OR INCOME. TOGETHER WE IMPROVE QUALITY OF LIFE AND TRANSFORM OUR COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,379,070 | ExpenseAmt |
| Revenue | $17,369,713 | RevenueAmt |
| Desc | TO PROVIDE MEDICAL SERVICES TO LOW INCOME INDIVIDUALS. THE TOTAL MEDICAL ENCOUNTERS DURING THE YEAR WERE 57,570. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,394,926 | ExpenseAmt |
| Revenue | $2,750,867 | RevenueAmt |
| Desc | TO PROVIDE DENTAL SERVICES TO LOW INCOME INDIVIDUALS. THE TOTAL DENTAL ENCOUNTERS DURING THE YEAR WERE 19,179. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $569,207 | ExpenseAmt |
| Desc | TO PROVIDE SUPPLEMENTAL NUTRITION SERVICES FOR PREGNANT AND BREASTFEEDING WOMEN AND THEIR CHILDREN TO AGE 5. DURING 2018, THE CENTER SERVED 5,067 WOMEN, INFANTS, AND CHILDREN. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,166,743 | ExpenseAmt |
| Revenue | $4,219,669 | RevenueAmt |
| Desc | TO PROVIDE MEDICAL RELATED SERVICES TO LOW INCOME INDIVIDUALS. ENABLING SERVICE ENCOUNTERS AND MENTAL HEALTH ENCOUNTERS (INCLUDING SUBSTANCE USE DISORDER SERVICES) TOTALED 9,081 AND 9,144, RESPECTIVELY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,166,743 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $4,219,669 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $19,509,946 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 48 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 297 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | 0 | LocalChaptersInd |
| 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DIAN COOPER | PersonNm |
| Phone | 3066363892 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1057 12TH AVENUE | AddressLine1Txt |
| City | LONGVIEW | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98632 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| RICK HUCKABY | ||||||||
| PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MELISSA TAYLOR | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| WANDA MCBEE | ||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| CARLEEN WOLGAMOTT | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| CYNTHIA WASHINGTON-MATTSON | ||||||||
| VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ALISABETH BUCK | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| SANDRA BENBROOK-RIEDER | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| EM HOYHTYA | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| WAYNE CAIN | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| ELIZABETH CATTIN | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN PAUL PRADO | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| MARK GAITHER | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| DIAN COOPER | ||||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $184,486 | $0 | $10,070 | |||
| PAM SPEARS | ||||||||
| FINANCE DIRECTOR | 40.00 | Yes (X) | $120,805 | $0 | $9,251 | |||
| JAMES COFFEE | ||||||||
| COO | 40.00 | Yes (X) | $122,050 | $0 | $10,324 | |||
| GERALDO MELGAR | ||||||||
| MEDICAL DIRECTOR | 40.00 | $264,873 | $0 | $10,476 | Yes (X) | |||
| GAIL CONWAY | ||||||||
| PHYSICIAN | 40.00 | $186,605 | $0 | $9,642 | Yes (X) | |||
| ANTHONY REYES | ||||||||
| PHYSICIAN | 40.00 | $197,109 | $0 | $9,669 | Yes (X) | |||
| DAVID MEYERS | ||||||||
| DENTIST | 40.00 | $165,029 | $0 | $8,673 | Yes (X) | |||
| TRESHA CARROLL | ||||||||
| PHYSICIAN | 40.00 | $176,649 | $0 | $9,152 | Yes (X) | |||
| ERIC GURRAD | ||||||||
| DENTIST | 40.00 | $162,361 | $0 | $9,957 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,579,967 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $87,214 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| OCHIN INC | |||||
| 1881 SW NAITO PARKWAY | PORTLAND | OR | 972015195 | EMR AND PRACTICE MANAGEMENT FEES | $1,090,088 |
| STAFF CARE | |||||
| 5001 STATESMAN DRIVE | IRVING | TX | 75063 | LOCUM TENENS | $1,017,950 |
| MCKESSON | |||||
| PO BOX 933027 | ATLANTA | GA | 31193 | MEDICAL PRODUCT DISTRIBUTOR | $870,062 |
| POLAR SYSTEMS | |||||
| 21890 WILLAMETTE DRIVE | WEST LINN | OR | 97068 | IT SERVICES | $439,582 |
| BURKHART DENTAL | |||||
| 2502 SOUTH 78TH STREET | TACOMA | WA | 98409 | MEDICAL PRODUCT DISTRIBUTOR | $398,259 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Government Grants | $4,626,326 | GovernmentGrantsAmt |
| All Other Contributions | $174,901 | AllOtherContributionsAmt |
| Total Contributions | $4,801,227 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 624100 | $11,729,823 | $11,729,823 |
| PREMIUM REVENUE AND INCENTIVE | 624100 | $11,297,258 | $11,297,258 |
| PHARMACY FEES | 624100 | $1,175,292 | $1,175,292 |
| PROGRAM SERVICE REVENUE | 624100 | $109,840 | $109,840 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,312,213 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,429 | TotalRevenueColumnAmt |
| Exclusion | $9,429 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $28,036 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,036 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $28,036 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,150,905 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,340,249 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $9,429 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $732,335 | TotalAmt |
| Program Services | $275,349 | ProgramServicesAmt |
| Management And General | $456,986 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,166,314 | TotalAmt |
| Program Services | $9,903,065 | ProgramServicesAmt |
| Management And General | $1,263,249 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,736 | TotalAmt |
| Program Services | $19,439 | ProgramServicesAmt |
| Management And General | $1,297 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,680,412 | TotalAmt |
| Program Services | $1,463,113 | ProgramServicesAmt |
| Management And General | $217,299 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $991,180 | TotalAmt |
| Program Services | $849,874 | ProgramServicesAmt |
| Management And General | $141,306 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,880 | TotalAmt |
| Management And General | $203,880 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,100 | TotalAmt |
| Management And General | $65,100 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,411,124 | TotalAmt |
| Program Services | $2,136,162 | ProgramServicesAmt |
| Management And General | $1,274,962 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,886 | TotalAmt |
| Program Services | $10,736 | ProgramServicesAmt |
| Management And General | $150 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,453 | TotalAmt |
| Program Services | $360,540 | ProgramServicesAmt |
| Management And General | $94,913 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,481,554 | TotalAmt |
| Program Services | $1,397,082 | ProgramServicesAmt |
| Management And General | $84,472 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,466 | TotalAmt |
| Program Services | $47,789 | ProgramServicesAmt |
| Management And General | $7,677 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,558 | TotalAmt |
| Program Services | $37,529 | ProgramServicesAmt |
| Management And General | $6,029 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,495 | TotalAmt |
| Program Services | $39,450 | ProgramServicesAmt |
| Management And General | $45 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $477,927 | TotalAmt |
| Program Services | $447,878 | ProgramServicesAmt |
| Management And General | $30,049 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,759 | TotalAmt |
| Program Services | $118,062 | ProgramServicesAmt |
| Management And General | $10,697 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $970,022 | $970,022 | |
| CLIENT ASSISTANCE | $646,577 | $646,577 | |
| BAD DEBT | $593,177 | $593,177 | |
| DUES & SUBSCRIPTIONS | $88,781 | $41,378 | $47,403 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,384 | TotalAmt |
| Program Services | $152,724 | ProgramServicesAmt |
| Management And General | $29,660 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,445,120 | TotalAmt |
| Program Services | $19,509,946 | ProgramServicesAmt |
| Management And General | $3,935,174 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,919,473 | BOYAmt |
| EOY | $2,657,073 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,756,408 | BOYAmt |
| EOY | $5,288,359 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $468,258 | BOYAmt |
| EOY | $371,157 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,558,702 | BOYAmt |
| EOY | $8,170,723 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,910 | BOYAmt |
| EOY | $158,187 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $213,626 | BOYAmt |
| EOY | $291,623 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,388,609 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,537,297 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,873,867 | BOYAmt |
| EOY | $5,851,312 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,941,244 | BOYAmt |
| EOY | $22,788,434 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,391,510 | BOYAmt |
| EOY | $1,558,855 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,651,978 | BOYAmt |
| EOY | $1,626,038 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,043,488 | BOYAmt |
| EOY | $3,184,893 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,868,155 | BOYAmt |
| EOY | $19,575,555 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,601 | BOYAmt |
| EOY | $27,986 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,897,756 | BOYAmt |
| EOY | $19,603,541 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,941,244 | BOYAmt |
| EOY | $22,788,434 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,705,785 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,408,144 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,299,952 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,577,613 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,776,617 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,801,227 | CurrentTaxYearAmt |
| Total | $21,863,553 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,408,144 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,299,952 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,577,613 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,776,617 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,801,227 | CurrentTaxYearAmt |
| Total | $21,863,553 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $21,863,553 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,158 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,501 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,854 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,479 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,429 | CurrentTaxYearAmt |
| Total | $23,421 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,677 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,167 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,599 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,369 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $28,036 | CurrentTaxYearAmt |
| Total | $86,848 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $21,973,822 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $87,535,930 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99500 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99630 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $559,980 | OtherCostOrOtherBasisAmt |
| Book Value | $559,980 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,491,324 | OtherCostOrOtherBasisAmt |
| Depreciation | $542,487 | DepreciationAmt |
| Book Value | $3,948,837 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,718,423 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,091,688 | DepreciationAmt |
| Book Value | $626,735 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,531,779 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,858,627 | DepreciationAmt |
| Book Value | $673,152 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $87,103 | OtherCostOrOtherBasisAmt |
| Depreciation | $44,495 | DepreciationAmt |
| Book Value | $42,608 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,851,312 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $28,557,728 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $28,557,728 | RevenueSubtotalAmt |
| Other Revenues Not Included | $593,177 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $593,177 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $29,150,905 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,851,943 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $22,851,943 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $593,177 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $593,177 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $23,445,120 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | MANAGEMENT OF COWLITZ FAMILY HEALTH CENTER DOES NOT BELIEVE THE CENTER HAS ANY UNCERTAIN TAX POSITIONS. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT EXPENSE 593,177. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT EXPENSE 593,177. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DIAN COOPER | ||||||||||||||
| EXECUTIVE DIRECTOR | $184,486 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,070 | $0 | $194,556 | $0 | $0 | $0 |
| GERALDO MELGAR | ||||||||||||||
| MEDICAL DIRECTOR | $264,873 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,476 | $0 | $275,349 | $0 | $0 | $0 |
| GAIL CONWAY | ||||||||||||||
| PHYSICIAN | $184,242 | $0 | $2,363 | $0 | $0 | $0 | $0 | $0 | $9,642 | $0 | $196,247 | $0 | $0 | $0 |
| ANTHONY REYES | ||||||||||||||
| PHYSICIAN | $195,709 | $0 | $1,400 | $0 | $0 | $0 | $0 | $0 | $9,669 | $0 | $206,778 | $0 | $0 | $0 |
| DAVID MEYERS | ||||||||||||||
| DENTIST | $163,253 | $0 | $1,776 | $0 | $0 | $0 | $0 | $0 | $8,673 | $0 | $173,702 | $0 | $0 | $0 |
| TRESHA CARROLL | ||||||||||||||
| PHYSICIAN | $174,049 | $0 | $2,600 | $0 | $0 | $0 | $0 | $0 | $9,152 | $0 | $185,801 | $0 | $0 | $0 |
| ERIC GURRAD | ||||||||||||||
| DENTIST | $161,076 | $0 | $1,285 | $0 | $0 | $0 | $0 | $0 | $9,957 | $0 | $172,318 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FINANCE COMMITTEE AND THE FULL BOARD OF DIRECTORS MUST REVIEW THE DRAFT FORM 990 PRIOR TO SUBMITTAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION INQUIRES ABOUT CONFLICTS OF INTEREST AT INITIAL INTERVIEWS WITH CANDIDATES FOR EMPLOYMENT AND BOARD MEMBERS ARE REQUIRED TO SIGN A STATEMENT OF DECLARATION OF ANY CONFLICTS OF INTEREST. BOARD MEMBERS ARE REQUIRED TO FILL OUT AN ANNUAL CONFLICT OF INTEREST FORM. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE CEO'S PAY BASED ON PERFORMANCE AND COMPARABLE MARKET SALARIES. COMPENSATION FOR KEY EMPLOYEES ARE REVIEWED AND APPROVED BY THE CEO BASED ON PERFORMANCE AND COMPARABLE MARKET SALARIES. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST. |
| FORM 990, PART VIII, LINE 2B: | COWLITZ FAMILY HEALTH CENTER (THE CENTER) RECORDED PREMIUM REVENUE AND INCENTIVE REVENUE OF $4,293,328, IN THE YEAR ENDING DECEMBER 31, 2018, AS A RESULT OF A ONE-TIME RECOGNITION OF REVENUE FOR AN ENHANCEMENT RECONCILIATION PROCESS WITH THE STATE OF WASHINGTON, ADJUSTMENTS TO THE RISK POOL WITH CHPW, AND INCENTIVE REVENUE. MANAGEMENT DOES NOT ANTICIPATE THIS LEVEL OF FUNDING TO REPEAT IN THE FUTURE. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,136,162. MANAGEMENT AND GENERAL EXPENSES 1,274,962. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,411,124. |
| FORM 990, PART XII, LINE 2C: | THERE HAS BEEN NO CHANGE IN THE PROCESS FROM THE PRIOR YEAR REGARDING THE OVERSIGHT OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANTS' THAT AUDIT THE FINANCIAL STATEMENTS OF THE ORGANIZATION. |