2017-10-24T09:29:04-05:00 2016-12-31 930743240 HOFFMAN STEWART & SCHMIDT PC 4900 MEADOWS ROAD STE 200 LAKE OSWEGO OR 970353295 990 2016-01-01 910896241 COWLITZ FAMILY HEALTH CENTER COWL 3606363892 1057 12TH AVENUE LONGVIEW WA 986322509 DIAN COOPER EXECUTIVE DIRECTOR 3606363892 2017-10-09 1 ROBERT M PRILL P00236613 5032205900 2016 2022-09-23 18:48:47Z DIAN COOPER 1057 12TH AVENUE LONGVIEW WA 986322509 23661887 0 X WWW.COWLITZFAMILYHEALTH.ORG X 1972 WA 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. 12 12 295 17 0 0 4299952 4577613 15298632 19080420 3501 3854 0 0 19602085 23661887 0 0 0 0 11139983 12263423 0 0 0 6463613 8002893 17603596 20266316 1998489 3395571 16109540 18374915 4135674 3005478 11973866 15369437 X 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. 0 0 8943189 12956015 TO PROVIDE MEDICAL SERVICES TO LOW INCOME INDIVIDUALS. THE TOTAL MEDICAL ENCOUNTERS DURING THE YEAR WERE 53,858. 2924354 2954765 TO PROVIDE DENTAL SERVICES TO LOW INCOME INDIVIDUALS. THE TOTAL DENTAL ENCOUNTERS DURING THE YEAR WERE 21,548. 630322 TO PROVIDE SUPPLEMENTAL NUTRITION SERVICES FOR PREGNANT AND BREASTFEEDING WOMEN AND THEIR CHILDREN TO AGE 5. DURING 2016, THE CENTER SERVED 5,799 WOMEN, INFANTS AND CHILDREN. 4027592 3169640 TO PROVIDE MEDICAL RELATED SERVICES TO LOW INCOME INDIVIDUALS. ENABLING SERVICE ENCOUNTERS AND MENTAL HEALTH ENCOUNTERS TOTALED 6,097 AND 5,938 RESPECTIVELY. 4027592 3169640 16525457 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 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 57 0 1 295 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X DIAN COOPER 3066363892 1057 12TH AVENUE LONGVIEW WA 98632 RICK HUCKABY PRESIDENT 2.00 X X 0 0 0 MELISSA TAYLOR TREASURER 2.00 X X 0 0 0 WANDA MCBEE SECRETARY 2.00 X X 0 0 0 CARLEEN WOLGAMOTT DIRECTOR 2.00 X 0 0 0 CYNTHIA WASHINGTON-MATTSON VICE PRESIDENT 2.00 X X 0 0 0 ALISABETH BUCK DIRECTOR 2.00 X 0 0 0 SANDRA BENBROOK RIEDER DIRECTOR 2.00 X 0 0 0 EM HOYHTYA DIRECTOR 2.00 X 0 0 0 WAYNE CAIN DIRECTOR 2.00 X 0 0 0 ELIZABETH CATTIN DIRECTOR 2.00 X 0 0 0 JEFFREY KEDDIE DIRECTOR 2.00 X 0 0 0 JOHN PAUL PRADO DIRECTOR 2.00 X 0 0 0 DIAN COOPER EXECUTIVE DIRECTOR 40.00 X 188346 0 7754 PAM SPEARS FINANCE DIRECTOR 40.00 X 107471 0 7304 JAMES COFFEE COO 40.00 X 102798 0 8284 GERARDO MELGAR MEDICAL DIRECTOR 40.00 X 252575 0 7304 GAIL CONWAY PHYSICIAN 40.00 X 168417 0 7304 ANTHONY REYES PHYSICIAN 40.00 X 172135 0 7304 DAVID MEYERS DENTIST 40.00 X 152462 0 7304 TRESHA CARROLL PHYSICIAN 40.00 X 161806 0 7754 TATIANNA TROTT DENTIST 40.00 X 141896 0 8284 1447906 0 68596 20 0 1 0 OCHIN INC 1881 SW NAITO PARKWAY PORTLAND OR 972015195 EMR AND PRACTICE MANAGEMENT FEES 1237367 STAFF CARE 5001 STATESMAN DRIVE IRVING TX 75063 LOCUM TENENS 963272 MCKESSON PO BOX 933027 ATLANTA GA 31193 MEDICAL PRODUCT DISTRIBUTOR 609523 POLAR SYSTEMS 21890 WILLAMETTE DRIVE WEST LINN OR 97068 COMPUTER CONSULTING 462207 ABM JANITORIAL SERVICES PO BOX 742049 LOS ANGELES CA 90074 JANITORIAL SERVICES 276954 14 4573783 3830 4577613 PATIENT SERVICE REVENUE 624100 9820487 9820487 PREMIUM REVENUE AND INCENTIVE 624100 8259621 8259621 PHARMACY FEES 624100 910035 910035 PROGRAM SERVICE REVENUE 624100 72678 72678 OTHER 624100 17599 17599 19080420 3854 3854 23661887 19080420 0 3854 X 681836 259879 421957 9366914 8173359 1193555 1344958 1149676 195282 869715 731492 138223 209957 209957 30866 30866 3403011 2242049 1160962 13518 12868 650 521186 431353 89833 1433943 1338691 95252 70741 56700 14041 49014 39285 9729 25466 25459 7 443093 406003 37090 107381 80978 26403 MEDICAL SUPPLIES 1038724 1038724 BAD DEBT 338050 338050 RECRUITMENT & RETENTION 101919 78528 23391 TAXES AND LICENSES 88039 87559 480 127985 34804 93181 20266316 16525457 3740859 0 2588350 2038597 5776464 4800696 518956 338730 1509377 5044792 113289 126883 322446 714443 9934051 4623277 5280658 5310774 16109540 18374915 1426566 1328735 2709108 1676743 4135674 3005478 X 11937940 15338185 35926 31252 11973866 15369437 16109540 18374915 3395571 0 X X 0 1 X 1 1 1 X 2967414 3426912 3408144 4299952 4577613 18680035 2967414 3426912 3408144 4299952 4577613 18680035 18680035 4814 2452 2158 3501 3854 16779 2533 5677 11167 17599 36976 18733790 63659517 0.99710 0.99700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 559980 559980 3642121 329784 3312337 2364800 1805745 559055 3025843 2469979 555864 341307 17769 323538 5310774 X 23323837 0 23323837 338050 338050 23661887 19928266 0 19928266 338050 338050 20266316 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 DEBTS 338,050. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 338,050. X X 0 0 0 0 0 0 0 0 0 DIAN COOPER EXECUTIVE DIRECTOR 188146 0 200 0 0 0 0 0 7754 0 196100 0 0 0 GERARDO MELGAR MEDICAL DIRECTOR 252375 0 200 0 0 0 0 0 7304 0 259879 0 0 0 GAIL CONWAY PHYSICIAN 165191 0 3226 0 0 0 0 0 7304 0 175721 0 0 0 ANTHONY REYES PHYSICIAN 169835 0 2300 0 0 0 0 0 7304 0 179439 0 0 0 DAVID MEYERS DENTIST 149795 0 2667 0 0 0 0 0 7304 0 159766 0 0 0 TRESHA CARROLL PHYSICIAN 157966 0 3840 0 0 0 0 0 7754 0 169560 0 0 0 TATIANNA TROTT DENTIST 140759 0 1137 0 0 0 0 0 8284 0 150180 0 0 0 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 15 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 IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,242,049. MANAGEMENT AND GENERAL EXPENSES 1,160,962. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,403,011. 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.