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LEWIS COUNTY COMMUNITY HEALTH SERVICES: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
LEWIS COUNTY COMMUNITY HEALTH SERVICES (EIN 42-1599749)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-10-08
IRS object ID
201812819349300961
Schema version
2017v2.3
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

FieldValueIRS element (for citing)
Return2018-10-08T12:39:17-07:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN200079326PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DINGUS ZARECOR & ASSOCIATES PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line112015 E MAIN AVEAddressLine1Txt
CitySPOKANE VALLEYCityNm
State AbbreviationWAStateAbbreviationCd
ZIP99206ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN421599749EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LEWIS COUNTY COMMUNITY HEALTHBusinessNameLine1Txt
Business Name Line2SERVICESBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlLEWIBusinessNameControlTxt
Phone3603309595PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12690 NE KRESKY AVENUEAddressLine1Txt
CityCHEHALISCityNm
State AbbreviationWAStateAbbreviationCd
ZIP98532ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSTEVEN CLARKPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone3603309595PhoneNum
Signature2018-08-30SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTHOMAS DINGUSPreparerPersonNm
PTINP00951009PTIN
Phone5092420874PhoneNum
Preparation2018-10-08PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address63.131.236.90IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-10-08IPDt
IP Tm14:39:17IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id4E47AE817102BDCE7527071ECCD14AD9DFD4CEB5AtSubmissionCreationDeviceId
At Submission Filing Device Id2474EFBFE268E1323248D70D812BABF32F861C74AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2018-06-14 16:35:46ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1VALLEY VIEW HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerSTEVEN CLARKPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12690 NE KRESKY AVENUEAddressLine1Txt
CityCHEHALISCityNm
State AbbreviationWAStateAbbreviationCd
ZIP98532ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$19,554,738GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.VVHC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2004FormationYr
Legal Domicile StateWALegalDomicileStateCd
Activity Or MissionTO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY BY PROVIDING QUALITY AND COMPASSIONATE HEALTH CARE SERVICES IN A PATIENT-CENTERED ATMOSPHERE, RESPECTING INDIVIDUAL AND CULTURAL DIVERSITY.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee231TotalEmployeeCnt
Total Volunteers7TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$3,434,450PYContributionsGrantsAmt
CY Contributions Grants$3,451,704CYContributionsGrantsAmt
PY Program Service Revenue$12,157,920PYProgramServiceRevenueAmt
CY Program Service Revenue$15,615,217CYProgramServiceRevenueAmt
PY Investment Income$14,265PYInvestmentIncomeAmt
CY Investment Income$72,971CYInvestmentIncomeAmt
PY Other Revenue$178,512PYOtherRevenueAmt
CY Other Revenue$414,846CYOtherRevenueAmt
PY Total Revenue$15,785,147PYTotalRevenueAmt
CY Total Revenue$19,554,738CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$10,718,679PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,977,989CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,450,544PYOtherExpensesAmt
CY Other Expenses$5,035,512CYOtherExpensesAmt
PY Total Expenses$15,169,223PYTotalExpensesAmt
CY Total Expenses$18,013,501CYTotalExpensesAmt
PY Revenues Less Expenses$615,924PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,541,237CYRevenuesLessExpensesAmt
Total Assets BOY$14,613,197TotalAssetsBOYAmt
Total Assets EOY$17,440,080TotalAssetsEOYAmt
Total Liabilities BOY$6,761,559TotalLiabilitiesBOYAmt
Total Liabilities EOY$8,548,318TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,851,638NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,891,762NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY BY PROVIDING QUALITY AND COMPASSIONATE HEALTH CARE SERVICES IN A PATIENT-CENTERED ATMOSPHERE, RESPECTING INDIVIDUAL AND CULTURAL DIVERSITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$8,711,856ExpenseAmt
Revenue$9,102,876RevenueAmt
DescVALLEY VIEW HEALTH CENTER (THE CENTER) PROVIDES MEDICAL SERVICES PRIMARILY TO LOW INCOME INDIVIDUALS. IN 2017, THE CENTER PROVIDED 48,577 MEDICAL ENCOUNTERS, TO 18,199 PATIENTS. THE UNREIMBURSED VALUE OF PROVIDING CHARITY CARE TO THESE PATIENTS WAS APPROXIMATELY 474,000.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$3,861,130ExpenseAmt
Revenue$3,942,250RevenueAmt
DescTHE CENTER PROVIDES DENTAL RELATED SERVICES PRIMARILY TO LOW INCOME INDIVIDUALS. IN 2017, THE CENTER PROVIDED 21,151 DENTAL ENCOUNTERS TO 7,003 PATIENTS.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$1,073,255ExpenseAmt
Revenue$509,095RevenueAmt
DescTHE CENTER PROVIDES BEHAVIORAL HEALTH AND RELATED SERVICES PRIMARILY TO LOW INCOME INDIVIDUALS. IN 2017, THE CENTER PROVIDED 2,595 BEHAVIORAL HEALTH ENCOUNTERS TO 551 PATIENTS.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$1,194,847ExpenseAmt
Revenue$2,060,996RevenueAmt
DescTHE CENTER PROVIDES PHARMACY RELATED SERVICES TO LOW INCOME INDIVIDUALS. IN 2017, THE CENTER'S PHARMACY FILLED OVER 37,472 PRESCRIPTIONS AND SERVED 3,455 PATIENTS.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$1,194,847TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$2,060,996TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$14,841,088TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document38IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld CompliancefalseBackupWthldComplianceInd
Employee231EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersYes (true)LocalChaptersInd
Policies Reference ChaptersYes (true)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonHOLLY SLIVAPersonNm
Phone3603309595PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12690 NE KRESKY AVENUEAddressLine1Txt
CityCHEHALISCityNm
State AbbreviationWAStateAbbreviationCd
ZIP98532ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
JOHN BURTON
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
GREG MARTIN
VICE PRESIDE1.00Yes (X)Yes (X)$0$0$0
JEREMY GERMANN
TREASURER1.00Yes (X)Yes (X)$0$0$0
DAVID PAVLETICH
SECRETARY1.00Yes (X)Yes (X)$0$0$0
MARIANNE SCHUMACHER
BOARD MEMBER1.00Yes (X)$0$0$0
KIANDRE BRASHER
BOARD MEMBER1.00Yes (X)$0$0$0
BRUCE BINDER
BOARD MEMBER1.00Yes (X)$0$0$0
LYNDA NANNEY
BOARD MEMBER1.00Yes (X)$0$0$0
TONI GWIN
BOARD MEMBER1.00Yes (X)$0$0$0
PATRICIA SNYDER
BOARD MEMBER1.00Yes (X)$0$0$0
ANDY SKINNER
BOARD MEMBER1.00Yes (X)$0$0$0
DR MICHAEL LECLAIR
BOARD MEMBER1.00Yes (X)$0$0$0
GRICELDA SANCHEZ
BOARD MEMBER1.00Yes (X)$0$0$0
STEVE ENDERS
BOARD MEMBER1.00Yes (X)$0$0$0
STEVEN CLARK
EXECUTIVE DI40.00Yes (X)$236,068$0$18,848
HOLLY SLIVA
CFO40.00Yes (X)$121,068$0$660
DAVID LITTLE
MEDICAL DIRE40.00$208,797$0$17,614Yes (X)
LOU ANN MERCIER
DENTAL DIREC40.00$188,785$0$17,253Yes (X)
STEPHEN HENNESSEY
ASSISTANT MD40.00$201,291$0$17,912Yes (X)
SUNDY HOLLAND
PHYSICIAN40.00$189,086$0$12,807Yes (X)
SARAH LANDRUM
ASSISTANT MD40.00$175,225$0$17,887Yes (X)
JON WILEY
PHARMACIST40.00$154,657$0$14,362Yes (X)
LAWRENCE LI
DENTIST40.00$153,876$0$6,155Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,628,853TotalReportableCompFromOrgAmt
Total Other Compensation$123,498TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K28IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
BOWERS CONSTRUCTION
320 SW RIVERSIDE DRIVECHEHALISWA98532CONSTRUCTION$739,430
COMPUTER CONNECTIONS
213 E MAIN STCENTRALIAWA98531IT SERVICES$362,300
UNIVERSITY OF WASHINGTON
1959 NE PACIFIC STSEATTLEWA98195PYSCHIATRIC$155,437
STAFF CARE
PO BOX 281923ATLANTAGA30384LOCUM PROVIDER$153,344
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Government Grants$3,439,092GovernmentGrantsAmt
All Other Contributions$12,612AllOtherContributionsAmt
Noncash Contributions$9,520NoncashContributionsAmt
Total Contributions$3,451,704TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PROGRAM SERVICE REVENUE, NET624100$15,117,003$15,117,003
CAPITATION REVENUE624100$498,214$498,214
FieldValueIRS element (for citing)
Total Program Service Revenue$15,615,217TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$72,971TotalRevenueColumnAmt
Exclusion$72,971ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$39,998RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$39,998RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$39,998TotalRevenueColumnAmt
Exclusion$39,998ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
INSURANCE PROCEEDS900099$124,124$124,124
SHARED RISK POOLS900099$114,085$114,085
OTHER REVENUE900099$110,020$110,020

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$26,619TotalRevenueColumnAmt
Exclusion$26,619ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$374,848OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,554,738TotalRevenueColumnAmt
Related Or Exempt Func Income$15,615,217RelatedOrExemptFuncIncomeAmt
Exclusion$487,817ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$809,094TotalAmt
Program Services$432,449ProgramServicesAmt
Management And General$376,645ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,097,855TotalAmt
Program Services$8,750,521ProgramServicesAmt
Management And General$1,347,334ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$276,365TotalAmt
Program Services$239,942ProgramServicesAmt
Management And General$36,423ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$971,716TotalAmt
Program Services$843,651ProgramServicesAmt
Management And General$128,065ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$822,959TotalAmt
Program Services$519,342ProgramServicesAmt
Management And General$303,617ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$2,241TotalAmt
Management And General$2,241ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$55,637TotalAmt
Program Services$1,828ProgramServicesAmt
Management And General$53,809ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,405,696TotalAmt
Program Services$1,045,448ProgramServicesAmt
Management And General$360,248ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$13,221TotalAmt
Management And General$13,221ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$809,572TotalAmt
Program Services$608,570ProgramServicesAmt
Management And General$201,002ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$406,386TotalAmt
Program Services$332,740ProgramServicesAmt
Management And General$73,646ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$44,072TotalAmt
Program Services$22,368ProgramServicesAmt
Management And General$21,704ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$133,010TotalAmt
Program Services$82,349ProgramServicesAmt
Management And General$50,661ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$180,442TotalAmt
Program Services$180,442ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$633,226TotalAmt
Program Services$613,240ProgramServicesAmt
Management And General$19,986ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$58,668TotalAmt
Program Services$58,668ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$953,854$953,854
MISCELLANEOUS EXPENSES$193,567$123,230$70,337
B&O TAXES$60,628$370$60,258
DUES & SUBSCRIPTIONS$56,247$11,571$44,676

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$29,045TotalAmt
Program Services$20,505ProgramServicesAmt
Management And General$8,540ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$18,013,501TotalAmt
Program Services$14,841,088ProgramServicesAmt
Management And General$3,172,413ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$466,998BOYAmt
EOY$431,194EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,821,415BOYAmt
EOY$2,620,619EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$193,835BOYAmt
EOY$465,510EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$707,954BOYAmt
EOY$708,618EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$87,393BOYAmt
EOY$140,607EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$13,640BOYAmt
EOY$65,232EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$12,531,893LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,113,338LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$7,282,785BOYAmt
EOY$8,418,555EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$4,037,523BOYAmt
EOY$4,099,178EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,654BOYAmt
EOY$490,567EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$14,613,197BOYAmt
EOY$17,440,080EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$981,356BOYAmt
EOY$1,108,033EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$14,401BOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$4,380,901BOYAmt
EOY$4,283,379EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,384,901BOYAmt
EOY$3,156,906EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,761,559BOYAmt
EOY$8,548,318EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,851,638BOYAmt
EOY$8,891,762EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,851,638BOYAmt
EOY$8,891,762EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,613,197BOYAmt
EOY$17,440,080EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,541,237ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$8,668NetUnrlzdGainsLossesInvstAmt
Prior Period Adjustments-$492,445PriorPeriodAdjustmentsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,168,316OtherCostOrOtherBasisAmt
Book Value$1,168,316BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,993,021OtherCostOrOtherBasisAmt
Depreciation$2,340,832DepreciationAmt
Book Value$6,652,189BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,370,556OtherCostOrOtherBasisAmt
Depreciation$1,772,506DepreciationAmt
Book Value$598,050BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$8,418,555TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescESTIMATED THIRD-PARTY SETTLEMENTSDesc
Amt$3,156,906Amt
FieldValueIRS element (for citing)
Total Liability$3,156,906TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$19,546,070TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$8,668NetUnrealizedGainsInvstAmt
Revenue Not Reported-$8,668RevenueNotReportedAmt
Revenue Subtotal$19,554,738RevenueSubtotalAmt
Total Revenue Per Form990$19,554,738TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$18,013,501TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$18,013,501ExpensesSubtotalAmt
Total Expenses Per Form990$18,013,501TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PAGE 3, PART XFormAndLineReferenceDesc
ExplanationTHE CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSRY. THE CENTER 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, 2017, AND 2016, THE CENTER HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgYes (true)CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (true)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
STEVEN CLARK
EXECUTIVE DIRECTOR$214,515$21,553$8,767$10,081$254,916
DAVID LITTLE
MEDICAL DIRECTOR$205,064$3,733$8,352$9,262$226,411
LOU ANN MERCIER
DENTAL DIRECTOR$182,756$6,029$7,201$10,052$206,038
STEPHEN HENNESSEY
ASSISTANT MD$194,253$7,038$8,052$9,860$219,203
SUNDY HOLLAND
PHYSICIAN$188,086$1,000$3,545$9,262$201,893
SARAH LANDRUM
ASSISTANT MD$171,768$3,457$7,009$10,878$193,112
JON WILEY
PHARMACIST$133,457$21,200$3,175$11,187$169,019
LAWRENCE LI
DENTIST$141,353$12,523$6,155$160,031

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 5ATHE EXECUTIVES AND PHYSICIANS ARE EVALUATED BASED ON MULTIPLE MEASURES OF PERFORMANCE. MEASURES INCLUDE QUALITY OF PATIENT CARE METRICS AND PRODUCTIVITY STANDARDS. THESE METRICS ARE EVALUATED QUARTERLY AND ANNUALLY, AND HAVE AN IMPACT ON PAY-FOR-PERFORMANCE AND PAY INCREASES.
SCHEDULE J, PAGE 1, PART I, LINE 6ASEE NARRATIVE FOR SCHEDULE J, PART I, LINE 5A.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4DTHE CENTER PROVIDES PHARMACY RELATED SERVICES TO LOW INCOME INDIVIDUALS. IN 2017, THE CENTER'S PHARMACY FILLED OVER 37,472 PRESCRIPTIONS AND SERVED 3,455 PATIENTS.
FORM 990, PAGE 6, PART VI, LINE 11BA COPY OF THE FORM 990 IS PROVIDED TO THE EXECUTIVE DIRECTOR AND CFO WHO REVIEW THE FORM AND SCHEDULES. ALL COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PRESENTED TO THE BOARD OF DIRECTORS WHO THEN APPROVE THE FORM 990. ONCE MANAGEMENT IS SATISFIED WITH THE FORM 990, THE EXECUTIVE DIRECTOR SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN.
FORM 990, PAGE 6, PART VI, LINE 12CIT IS THE POLICY OF THE CENTER TO ENSURE TRANSPARENCY REGARDING ANY CONFLICTS OF INTEREST AND PREVENT ANY REAL OR PERCEIVED CONFLICTS OF INTERESTS FROM OCCURRING WITH RESPECT TO BOARD MEMBERS, EMPLOYEES, CONSULTANTS, AND THOSE WHO FURNISH GOODS OR SERVICES. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON; HAS RECEIVED, REVIEWED, AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. EACH MEMBER OF THE CENTER'S MANAGEMENT TEAM COMPLETES THE CONFLICT OF INTEREST STATEMENT ANNUALLY. POTENTIAL CONFLICTS AT THE BOARD LEVEL ARE REVIEWED BY THE GOVERNING BOARD. ALL EMPLOYEES ARE EXPECTED TO AVOID PLACING THEMSELVES IN A POSITION THAT MAY CREATE OR LEAD TO A CONFLICT OF INTEREST OR THE APPEARANCE OF ONE. THEY ARE PROHIBITED FROM ENGAGING IN ANY OUTSIDE BUSINESS ACTIVITY, FINANCIAL RELATIONSHIP, OR INVESTMENT THAT CONFLICTS WITH THE CENTER'S INTERESTS, COMPETES WITH THE CENTER, OR MAY INTERFERE WITH THEIR RESPONSIBILITIES TO THE CENTER, OR HAS THE APPEARANCE OF INFLUENCING THEM TO ACT OR MAKE DECISIONS IN A BIASED MANNER OR CONTRARY TO THE BEST INTERESTS OF THE CENTER.
FORM 990, PAGE 6, PART VI, LINE 15ATHE BOARD OF DIRECTORS' EXECUTIVE COMMITTEE SETS THE COMPENSATION OF THE EXECUTIVE DIRECTOR EQUAL TO THE FIFTIETH PERCENTILE OF THE CURRENT NATIONAL SALARY SURVEYS FOR THE STATE OF WASHINGTON, SUBJECT TO INCREASES AND DECREASES DUE TO ECONOMIC NECESSITY. THE NATIONAL SURVEY IS OBTAINED ANNUALLY BY HUMAN RESOURCES, AND REVIEWED AND UPDATED ANNUALLY BY THE EXECUTIVE COMMITTEE. PAY FOR PERFORMANCE IS CALCULATED AND ADJUSTED ANNUALLY BASED ON THE DIFFERENCE BETWEEN THE BASE SALARY AND THE SEVENTY- FIFTH PERCENTILE OF THE CURRENT NATIONAL SALARY SURVEYS FOR THE STATE OF WASHINGTON AND BASED ON FINANCIAL AND QUALITY PERFORMANCE METRICS OF THE CENTER. IN THE EVENT THAT THE SALARY LEVEL DECREASES ACCORDING TO THE SURVEY, THE ANNUAL BASE COMPENSATION WILL REMAIN UNCHANGED.
FORM 990, PAGE 6, PART VI, LINE 15BTHE COMPENSATION REVIEW FOR OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED USING NATIONAL SALARY SURVEYS OBTAINED BY HUMAN RESOURCES. THE SALARIES ARE REVIEWED AND UPDATED ANNUALLY OR ON THE EMPLOYEE'S CONTRACT TERMS. THIS PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION IN 2017.
FORM 990, PAGE 6, PART VI, LINE 19THE CENTER MAKES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.