2019-11-11T16:14:36-06:00 2019-03-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-04-01 237297657 COLUMBIA VALLEY COMMUNITY HEALTH COLU 5096626000 600 ORONDO AVENUE NO 1 WENATCHEE WA 98801 DAVID OLSON CEO 5096626000 2019-11-06 1 KURT BENNION CPA P01469618 4252506100 2019-11-06 67.137.57.251 2019-11-06 21:46:11 PS P D393EE94A1B818777A7285D28D1C1E92A392F7EC AFCD7F9A41873079145CE562B0D1596B0D4DEB3A 2018 2020-03-31 21:24:44Z DAVID OLSON 600 ORONDO AVENUE NO 1 WENATCHEE WA 98801 41797193 0 X WWW.CVCH.ORG X 1972 WA PARTNERING TO ACHIEVE OPTIMAL HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 9 9 377 11 0 313 8348276 9264751 26538595 32158662 20091 275309 0 92191 34906962 41790913 483397 7723 0 0 21304998 24320585 3400 0 0 9047828 12108684 30839623 36436992 4067339 5353921 53583335 56567792 15931623 13585514 37651712 42982278 THE MISSION OF COLUMBIA VALLEY COMMUNITY HEALTH IS PARTNERING TO ACHIEVE OPTIMAL HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 0 0 28545875 7723 32158662 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. 557534 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. 29103409 1 1 0 0 0 0 0 0 0 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 0 0 1 0 0 0 0 0 0 0 0 1 65 0 377 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 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 JOAN ALWAY PRESIDENT 2.00 X X 0 0 0 KRISTINA STEPPER VICE PRESIDENT 2.00 X X 0 0 0 JOANNE HILL SECRETARY 2.00 X X 0 0 0 SHAUN KOOS TREASURER 2.00 X X 0 0 0 RUTH CABRERA DE ALPIRE BOARD MEMBER (THROUG APRIL 2018) 2.00 X 0 0 0 LOLY LARSON BOARD MEMBER 2.00 X 0 0 0 MICHAEL MACHADO BOARD MEMBER 2.00 X 0 0 0 ROBERT SCOTT JR BOARD MEMBER 2.00 X 0 0 0 JOHN SWENSON BOARD MEMBER 2.00 X 0 0 0 RICH WATSON BOARD MEMBER (THROUGH APRIL 2018) 2.00 X 0 0 0 TERESA ZEPEDA BOARD MEMBER 2.00 X 0 0 0 DAVID OLSON CEO 40.00 X 259870 0 36336 MICHAEL ROMINE CFO 40.00 X 169174 0 32895 CAROL DIEDE COO 40.00 X 185463 0 27052 MALCOLM BUTLER CMO 40.00 X 337655 0 36313 BRUCE WILCOX DENTAL DIRECTOR (THROUGH JUNE 2018) 40.00 X 58807 0 4759 MICHAEL HAN DENTAL DIRECTOR (JUNE - NOV 2018) 40.00 X 195871 0 29905 JEFFERY HINCKLEY DENTIST & DENTAL DIRECTOR 40.00 X 200594 0 34583 KENNETH SHERMER MEDICAL DIRECTOR 40.00 X 295696 0 37413 KERI BERGESON MEDICAL DIRECTOR 40.00 X 280546 0 22163 JENNIFER SNYDER PHYSICIAN 40.00 X 261680 0 35571 BROOKE JARDINE PHYSICIAN 40.00 X 217274 0 19565 LAUREN KENDALL PHYSICIAN 40.00 X 215246 0 28507 2677876 0 345062 43 0 1 0 ATHENAHEALTH PO BOX 415615 BOSTON MA 02241 BILLING & COLLECTION SERVICES 668318 COMMUNITY CLINIC CONTRACTING NETWORK 18 S MISSION ST STE 300 WENATCHEE WA 98801 DATA WAREHOUSING SERVICES 203828 ABM JANITORIAL SERVICES PO BOX 951864 DALLAS TX 75395 JANITORIAL SERVICES 198052 3 9204796 59955 923581 9264751 PATIENT SERVICE REVENUE 621400 20927930 20927930 ENHANCEMENTS REVENUE 621400 8735341 8735341 CAPITATION REVENUE 621400 2327559 2327559 MEANINGFUL USE REVENUE 621400 144500 144500 MEDICAL RECORD REVENUE 621400 23332 23332 32158662 245529 245529 36060 0 6280 36060 -6280 29780 29780 MISCELLANEOUS INCOME 900099 92191 92191 92191 41790913 32158662 0 367500 7723 7723 1463269 383407 1079862 18282813 16117663 2165150 682396 600671 81725 2585867 2246112 339755 1306240 1104672 201568 62175 62175 45150 45150 20742 20742 960798 213035 747763 107955 91749 16206 503699 332293 171406 1649784 1124520 525264 994410 796969 197441 26277 14893 11384 303368 206260 97108 2147647 1320548 827099 168757 21385 147372 UBI TAXES 66 66 MEDICAL SUPPLIES 3333905 3321461 12444 BAD DEBT EXPENSE 779016 779016 MISCELLANEOUS EXPENSES 636214 190599 445615 368721 230433 138288 36436992 29103409 7333583 0 8411648 10066110 4394464 4617348 224393 282210 1370750 4016419 142523 192662 350254 674528 47357634 15218422 34052722 32139212 3143875 3158479 1200000 1200000 292706 220824 53583335 56567792 3324414 3324272 35000 356550 9864378 9209679 2707831 695013 15931623 13585514 X 37611707 42926501 40005 55777 37651712 42982278 53583335 56567792 5353921 -23355 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4077504 4077504 37035999 10417591 26618408 129171 100072 29099 6008792 4700759 1308033 106168 106168 32139212 OTHER LIABILITIES 695013 695013 X 40975382 15703 15703 40959679 20742 810492 831234 41790913 35637234 0 35637234 20742 779016 799758 36436992 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE 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, 2019 AND 2018, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 15,703. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 31,476. PROVISION FOR BAD DEBT 779,016. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 779,016. 1 HELPING HANDS FUND 53 7723 PART I, LINE 2: PER THE CLIENTS 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 0 0 0 0 DAVID OLSON CEO 222512 0 36644 0 714 0 11298 0 25038 0 296206 0 0 0 MICHAEL ROMINE CFO 145642 0 23072 0 460 0 7921 0 24974 0 202069 0 0 0 CAROL DIEDE COO 147105 0 37894 0 464 0 8524 0 18528 0 212515 0 0 0 MALCOLM BUTLER CMO 274050 0 52006 0 11599 0 12304 0 24009 0 373968 0 0 0 MICHAEL HAN DENTAL DIRECTOR (JUNE - NOV 2018) 164745 0 24412 0 6714 0 9040 0 20865 0 225776 0 0 0 JEFFERY HINCKLEY DENTIST & DENTAL DIRECTOR 174750 0 14063 0 11781 0 9575 0 25008 0 235177 0 0 0 KENNETH SHERMER MEDICAL DIRECTOR 259731 0 17554 0 18411 0 12375 0 25038 0 333109 0 0 0 KERI BERGESON MEDICAL DIRECTOR 247293 0 5794 0 27459 0 12375 0 9788 0 302709 0 0 0 JENNIFER SNYDER PHYSICIAN 241807 0 6493 0 13380 0 10533 0 25038 0 297251 0 0 0 BROOKE JARDINE PHYSICIAN 216641 0 0 0 633 0 9777 0 9788 0 236839 0 0 0 LAUREN KENDALL PHYSICIAN 211410 0 3286 0 550 0 9909 0 18598 0 243753 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. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2017-06-22 9911965 NEW CONSTRUCTION AND REFINANCE SERIES 2010 BONDS 0 0 0 A 579457 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 X 15852 923581 INVOICE PRICE 0 0 0 0 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 A DRAFT OF THE FORM 990 WAS PROVIDED BY THE EXTERNAL TAX PRACTITIONER AND 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 2018. 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.