2019-09-23T15:56:50-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-05-21 830597273 NORTH WHATCOM CLINIC NORT 3607882620 1616 CORNWALL AVENUE NO 205 BELLINGHAM WA 98225 DESMOND SKUBI EXECUTIVE DIRECTOR 3607882620 2019-08-15 1 KURT BENNION P01469618 4252506100 2019-08-15 67.137.57.251 2019-08-15 21:54:02 PD P 1163F2703C142B8AEA81BE89D0CF340018EA0271 BF9991DD2DB12812CD4D00877CE6B9F0AB9EA94D 2018 2019-02-21 02:37:17Z X DESMOND SKUBI 1616 CORNWALL AVENUE NO 205 BELLINGHAM WA 98225 651096 0 X N/A X 2018 WA CONSTRUCT AND HOLD REAL ESTATE TO SUPPORT UNITY CARE NORTHWEST. 5 5 0 5 0 0 651096 0 0 0 651096 0 0 0 0 0 408 408 650688 17281865 16631177 650688 THE ORGANIZATION IS ORGANIZED FOR THE PURPOSE OF HOLDING TITLE TO (OR ENTERING INTO A LONG-TERM LEASE OF) REAL ESTATE, COLLECTING INCOME THEREFROM, AND TURNING OVER THE ENTIRE AMOUNT THEREOF, LESS EXPENSES, TO UNITY CARE NORTHWEST. 0 0 THE ORGANIZATION IS ORGANIZED FOR THE PURPOSE OF HOLDING TITLE TO (OR ENTERING INTO A LONG-TERM LEASE OF) REAL ESTATE, COLLECTING INCOME THEREFROM, AND TURNING OVER THE ENTIRE AMOUNT THEREOF, LESS EXPENSES, TO UNITY CARE NORTHWEST. 0 1 0 0 0 1 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X DIAHANN BARRERA 3607882654 1616 CORNWALL AVENUE SUITE 205 BELLINGHAM WA 98225 DANIEL WHITTLE PRESIDENT 0.10 2.00 X X 0 0 0 MICHAEL BATES VICE PRESIDENT 0.10 0.00 X X 0 0 0 JON MARTIN SECRETARY 0.10 0.00 X X 0 0 0 JENNIFER MOLDVER TREASURER 0.10 2.00 X X 0 0 0 MELVIN DE JONG DIRECTOR 0.10 2.00 X 0 0 0 DESMOND SKUBI EXECUTIVE DIRECTOR 4.00 46.00 X 0 242189 12291 0 242189 12291 0 0 1 0 ALDRICH & ASSOCIATES INC 810 240TH STREET SE BOTHELL WA 98021 GENERAL CONTRACTOR 2594924 1 651096 651096 651096 0 0 0 LICENSES & PERMITS 408 408 408 0 408 0 10213281 7068584 0 0 7068584 0 17281865 2574281 14056896 0 16631177 X 650688 0 650688 0 17281865 650688 0 X 0 1 X 0 0 X X 2 2.08 0 2 0 1 1 0.00 102400 0 210000 210000 6858584 6858584 7068584 X 0 0 0 651096 651096 651096 408 0 408 0 408 PART II, LINE 9: THE CONSERVATION EASEMENT, WHICH IS UNDEVELOPED LAND, IS INCLUDED WITH FIXED ASSETS ON THE BALANCE SHEET. THERE ARE NO REVENUES ASSOCIATED WITH THE EASEMENT. EXPENSES FOR THE EASEMENT ARE LIMITED TO FEES FOR THIRD PARTIES TO MONITOR AND ENFORCE THE EASEMENT AND ARE INCLUDED IN PURCHASED SERVICES. PART X, LINE 2: NORTH WHATCOM CLINIC RECEIVED A DETERMINATION LETTER FROM THE IRS THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(2) OF THE IRC. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT RELATED TO THE CLINIC'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE CLINIC EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2018, THE CLINIC HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. ALL TAX-EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE, AND OTHER APPLICABLE STATE STATUTES. PART XI, LINE 4B - OTHER ADJUSTMENTS: TRANSFER FROM AFFILIATE 651,096. 0 0 0 DESMOND SKUBI EXECUTIVE DIRECTOR 0 242189 0 0 0 0 0 4675 0 7616 0 254480 0 0 PART I, LINE 3 THE EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED BY UNITY CARE NORTHWEST, A RELATED ORGANIZATION. UNITY CARE NORTHWEST USES THE FOLLOWING METHODS TO DETERMINE THE EXECUTIVE DIRECTOR'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. FORM 990 OF OTHER ORGANIZATIONS 4. WRITTEN EMPLOYMENT CONTRACT 5. COMPENSATION SURVEY OR STUDY 6. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT SERVICES ARE PROVIDED BY UNITY CARE NORTHWEST, THE SOLE MEMBER OF NORTH WHATCOM CLINIC. FORM 990, PART VI, SECTION A, LINE 6 UNITY CARE NORTHWEST IS THE SOLE MEMBER OF NORTH WHATCOM CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER, UNITY CARE NORTHWEST, APPOINTS ALL BOARD MEMBERS AND MAY REMOVE A BOARD MEMBER AT ANY TIME. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY UNITY CARE NORTHWEST'S CFO, BY THE EXECUTIVE DIRECTOR, BY UNITY CARE NORTHWEST'S FINANCE COMMITTEE, AND WAS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY FOR APPROVAL PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C WHEN A BOARD MEMBER HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE INDIVIDUAL INFORMS THE BOARD OF THE MATTER. THE BOARD PRESIDENT OR A MAJORITY OF THE BOARD MAY, AT THEIR DISCRETION, EXCLUDE THE INDIVIDUAL FROM ANY OF THE FOLLOWING ACTIVITIES RELATING TO THE CONFLICT: PARTICIPATION IN DISCUSSIONS OF THE ISSUE, PRESENCE FOR VOTES, AND/OR PARTICIPATION IN COMMITTEES. FORM 990, PART VI, SECTION B, LINE 15 ALL COMPENSATION DETERMINATIONS ARE MADE BY UNITY CARE NORTHWEST. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 IS AVAILABLE UPON REQUEST AND ONLINE AT WWW.GUIDESTAR.ORG, A WEBSITE THAT THE PUBLIC CAN ACCESS TO OBTAIN INFORMATION ABOUT NON-PROFITS. THE FORM 1024 IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. UNITY CARE NORTHWEST 1616 CORNWALL AVENUE SUITE 205 BELLIMGHAM WA 98225 912168190 HEALTH CARE WA 501(C)(3) LINE 3 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0