2016-03-14T16:29:42-05:00 2015-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2014-07-01 911255170 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY COMM 4257893700 8609 EVERGREEN WAY EVERETT WA 98208 VICTORIA M RINGNESS CHIEF FINANCIAL OFFICER 4257893700 2016-03-09 1 SARA ELIZABETH J HYRE P00235495 4254544919 2016-03-09 2014 2016-08-17 19:52:53Z ROBERT C FARRELL 8609 EVERGREEN WAY EVERETT WA 98208 40272370 0 X WWW.CHCSNO.ORG X 1986 WA TO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE. 10 10 383 85 0 0 8403906 5057685 27503811 29550009 581348 505130 611600 1159779 37100665 36272603 0 0 0 0 20697761 24004503 0 0 251780 10380442 10705999 31078203 34710502 6022462 1562101 69057131 71529045 7426069 8601195 61631062 62927850 X COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY ("CHC") PROVIDES MEDICAL AND DENTAL CARE TO LOW-INCOME/HOMELESS INDIVIDUALS WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES ON A SLIDING FEE BASIS. ALL PATIENTS ARE REQUIRED TO PAY A MINIMUM FEE, AND NO PATIENT IS DENIED SERVICES DUE TO AN INABILITY TO PAY. SINCE MANAGEMENT DOES NOT EXPECT PAYMENT FOR THE DISCOUNTED PORTION OF CARE, THE DISCOUNTED SERVICES ARE EXCLUDED FROM REVENUE. DURING THE YEAR ENDED JUNE 30, 2015, CHC PROVIDED $2,517,647 OF CHARITY CARE SERVICES UNDER THIS POLICY. 0 0 16640362 16622415 MEDICAL CARE - TO PROVIDE MEDICAL SERVICES IN PEDIATRICS, ACUTE GENERAL CARE AND OBSTETRICAL CARE TO LOW-INCOME/ HOMELESS PEOPLE AT FIVE DIFFERENT CLINIC LOCATIONS. COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY ALSO OFFERS PRENATAL CARE, BEHAVIORAL HEALTH SERVICES, IMMUNIZATIONS, AND CHRONIC DISEASE MANAGEMENT TO INDIVIDUALS AND FAMILIES FROM A WIDE VARIETY OF ETHNIC AND CULTURAL BACKGROUNDS. COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY EMPLOYS A MULTI-LINGUAL STAFF, PROVIDES EXTENDED HOURS AND SAME-DAY APPOINTMENTS FOR COMMUNITY RESIDENTS. FEES ARE PAID ON A SLIDING FEE SCALE AND BY THIRD-PARTY INSURANCE, MEDICARE AND MEDICAID. THERE WAS A TOTAL OF 98,325 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $1,572,599. IN ADDITION, CHC PROVIDED PRIMARY CARE OUTREACH SERVICES FOR HOMELESS INDIVIDUALS AND FAMILIES AT THREE TRANSITIONAL HOUSING AGENCIES IN SNOHOMISH COUNTY. 9711031 11252149 DENTAL CARE - TO PROVIDE DENTAL SERVICES TO LOW-INCOME/HOMELESS PEOPLE ON A SLIDING FEE BASIS AND BY THIRD-PARTY INSURANCE AND MEDICAID AT FIVE DIFFERENT CLINICS. THERE WAS A TOTAL OF 65,374 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $945,048. 1981752 2799404 PHARMACY SERVICES - TO PROVIDE PHARMACY SERVICES TO LOW-INCOME PEOPLE ON A SLIDING FEE BASIS AND BY THIRD-PARTY INSURANCE AND MEDICAID AT FIVE DIFFERENT CLINICS. 106,991 TOTAL PRESCRIPTIONS WERE FILLED FOR THIS FISCAL YEAR. 28333145 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 29 0 1 383 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X VICTORIA M RINGNESS 4257893703 8609 EVERGREEN WAY EVERETT WA 98208 BICH-NGA NGUYEN CHAIR 2.00 X X 0 0 0 COURTNEY MILLER VICE CHAIR/SECRETARY 2.00 X X 0 0 0 REBECCA PRATT TREASURER 2.00 X X 0 0 0 CHARLES JEREMIAH BOARD MEMBER 2.00 X 0 0 0 LARRY MCLYNNE BOARD MEMBER 2.00 X 0 0 0 LINDA INGLIN BOARD MEMBER 2.00 X 0 0 0 LARRY D WARNER BOARD MEMBER THRU 06/15 2.00 X 0 0 0 BRYTFIRTH BRYT HASAPHONGSE BOARD MEMBER 2.00 X 0 0 0 TAMIKO LEWIS BOARD MEMBER 2.00 X 0 0 0 ANNE VAN LEYNSEELE BOARD MEMBER 2.00 X 0 0 0 DOLORES BLUEFORD BOARD MEMBER 2.00 X 0 0 0 ROBERT C FARRELL CPA CHIEF EXECUTIVE OFFICER 45.00 X 164530 0 16490 VICTORIA RINGNESS CHIEF FINANCIAL OFFICER 45.00 X 116899 0 13185 LISA M MILLER CHIEF OPERATING OFFICER 45.00 X 110326 0 11608 DION C KAPETANOV CHIEF ADMIN OFFICER 45.00 X 125211 0 10223 THOMAS M TOCHER CHIEF CLINICAL OFFICER 45.00 X 254265 0 21451 STEVEN D AGUILU PHYSICIAN 45.00 X 178207 0 8172 SCOTT R MCAFEE PHYSICIAN 45.00 X 177188 0 7669 ALEX H KOSLOFF PHYSICIAN 45.00 X 181109 0 18563 ANDREW K PERRY DIRECTOR, CLINICAL 45.00 X 187329 0 17833 TESS T MOORE DIRECTOR, CLINICAL 45.00 X 180184 0 17206 TOVE R SKAFTUN FORMER OFFICER 45.00 X 124665 0 14246 1799913 0 156646 42 1 1 0 JR ABBOTT CONSTRUCTION INC 3408 1ST AVE S SUITE 101 SEATTLE WA 981248448 CONSTRUCTION 5685101 COMPHEALTH INC PO BOX 972670 DALLAS TX 753976270 TEMP. HEALTHCARE STAFFING 261095 SUMMIT BUILDING MAINTENANCE INC 2366 EASTLAKE AVE E SEATTLE WA 98102 JANITORIAL SERVICES 189023 LANGUAGE LINE SERVICES PO BOX 202564 DALLAS TX 753202572 TRANSLATION SERVICES 167137 TECHHEADS 16869 SW 65TH AVE 166 LAKE OSWEGO OR 97035 IT SUPPORT SERVICES 160530 7 89289 4512168 456228 1024505 5057685 MEDICARE/MEDICAID 621400 24634843 24634843 PATIENT FEES 621110 2588882 2588882 CAPITATED REVENUE 621110 2272786 2272786 QUALITY CARE PAYMENTS 621110 53498 53498 29550009 482688 482688 2713109 2640106 50561 73003 -50561 22442 22442 2433059 1309100 1123959 1123959 PATIENT RECORDS 561000 37849 37849 VARIOUS INCENTIVES 561000 9876 9876 INSURANCE STLMT ADJ 900099 -20046 -20046 8141 8141 35820 36272603 30673968 0 540950 1034474 1034474 19041462 16426449 2552197 62816 422292 346411 73552 2329 1986780 1649866 329455 7459 1519495 1253124 261426 4945 8312 8312 61827 61827 67431 67431 728308 389194 316202 22912 102408 102408 410484 331253 65442 13789 221777 176321 45373 83 1024713 737901 284732 2080 50620 22255 27430 935 213154 144632 68403 119 197680 11902 185778 2529569 2224355 301795 3419 150468 114365 35848 255 CLINICAL SUPPLIES 1984457 1984457 BAD DEBT EXPENSE 831067 831067 EQUIPMENT RENTAL/ MAINT 762562 590114 172261 187 MINOR EQUIPMENT 354902 340721 8911 5270 1006260 758758 224728 22774 34710502 28333145 6125577 251780 1283030 2971868 2086943 2235741 420097 361595 4925105 4269185 371910 439027 437516 332088 55456130 11927189 42095579 43528941 17245426 17390600 191525 0 69057131 71529045 3656970 2681138 116870 63960 3643815 5853915 8414 2182 7426069 8601195 X 61540628 62849467 90434 78383 61631062 62927850 69057131 71529045 1562101 -265313 0 X 0 1 X 1 1 1 X 3633432 3472657 4021131 8403906 5057685 24588811 19529566 22237878 23039999 28662623 31983068 125453134 86430 68894 30849 39485 37849 263507 23249428 25779429 27091979 37106014 37078602 150305452 0 0 0 150305452 733990 598703 566492 509108 482688 2890981 733990 598703 566492 509108 482688 2890981 88405 26087 34384 80956 -1506 228326 24071823 26404219 27692855 37696078 37559784 153424759 0.97970 0.97610 0.01880 0.02190 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: INSURANCE SETTLEMENT - 2013 AMOUNT: $ 54,482. 2014 AMOUNT: $ -20,046. REFUNDS AND REBATES - 2010 AMOUNT: $ 82,763. 2011 AMOUNT: $ 15,875. 2012 AMOUNT: $ 24,916. 2013 AMOUNT: $ 18,930. 2014 AMOUNT: $ 4,218. VARIOUS INCENTIVES - 2014 AMOUNT: $ 9,876. MISCELLANEOUS - 2010 AMOUNT: $ 5,642. 2011 AMOUNT: $ 10,212. 2012 AMOUNT: $ 9,468. 2013 AMOUNT: $ 7,544. 2014 AMOUNT: $ 4,446. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6555723 6555723 41406913 7620162 33786751 330653 248759 81894 6738683 4050914 2687769 424158 7354 416804 43528941 CAPITAL LEASE 2182 2182 37248959 -265313 -265313 37514272 67431 -1309100 -1241669 36272603 35952171 1309100 1309100 34643071 67431 67431 34710502 PART XI, LINE 4B - OTHER ADJUSTMENTS: COST OF GOODS SOLD INCLUDED IN EXPENSE ON FINANCIAL STATEMENTS -1,309,100. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD INCLUDED IN EXPENSE ON FINANCIAL STATEMENTS 1,309,100. X X X X 0 0 0 0 0 0 0 0 0 ROBERT C FARRELL CPA CHIEF EXECUTIVE OFFICER 154530 0 10000 0 0 0 8356 0 8135 0 181021 0 0 0 THOMAS M TOCHER CHIEF CLINICAL OFFICER 252102 0 2163 0 0 0 13232 0 8219 0 275716 0 0 0 STEVEN D AGUILU PHYSICIAN 176728 0 1479 0 0 0 0 0 8172 0 186379 0 0 0 SCOTT R MCAFEE PHYSICIAN 171162 0 6026 0 0 0 6932 0 736 0 184856 0 0 0 ALEX H KOSLOFF PHYSICIAN 178893 0 2216 0 0 0 10413 0 8150 0 199672 0 0 0 ANDREW K PERRY DIRECTOR, CLINICAL 185500 0 1829 0 0 0 9658 0 8175 0 205162 0 0 0 TESS T MOORE DIRECTOR, CLINICAL 167530 0 12654 0 0 0 9254 0 7952 0 197390 0 0 0 TOVE R SKAFTUN FORMER OFFICER 120521 0 4144 0 0 0 6422 0 7824 0 138911 0 0 0 A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2013-09-20 6000000 BUILDING CONSTRUCTION 0 0 0 A 146085 6000000 110061 5889939 2014 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 0 0 1 A 1 X 18982 936044 COST OR SELLING PRICE X SOFTWARE 6 88461 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN B IS BASED ON THE NUMBER OF ITEMS CONTRIBUTED. FORM 990, PART I, LINE 6 VOLUNTEERS STAFFED SEVERAL HEALTH FAIRS AND PATIENT EVENTS. THESE VOLUNTEERS WERE PREDOMINANTLY EMPLOYEES WHO VOLUNTEERED THEIR TIME. MEMBERS OF THE BOARD OF DIRECTORS ARE ALSO VOLUNTEERS. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS REVIEWS AND APPROVES CHC'S FORM 990 PRIOR TO ITS FILING WITH THE IRS. THE APPROVAL PROCESS IS AS FOLLOWS: THE BOARD OF DIRECTORS RECEIVE A COPY OF FORM 990 AND MAKE A MOTION AND VOTE TO APPROVE THE FORM 990. UPON THE BOARD OF DIRECTORS' APPROVAL, THE FORM 990 IS ELECTRONICALLY FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CHC OF SNOHOMISH COUNTY EMPLOYEE HANDBOOK CONTAINS THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. EACH EMPLOYEE AND BOARD MEMBER IS REQUIRED TO SIGN OFF AS HAVING READ THE HANDBOOK AND HAVING UNDERSTOOD THIS CONFLICT OF INTEREST POLICY. PER THIS POLICY, ALL EMPLOYEES AND BOARD MEMBERS ARE REQUIRED TO AVOID AND REPORT SITUATIONS THAT COULD CREATE OR RESULT IN A REAL OR PERCEIVED CONFLICT OF INTEREST BY DISCLOSING THE RELATIONSHIP, ACTIVITY OR ASSOCIATION TO THEIR MANAGER OR HUMAN RESOURCES. BOARD MEMBERS WHO BELIEVE THAT A CONFLICT OF INTEREST EXISTS NEED TO INFORM THE CHAIR OF THE BOARD, WHO WOULD WORK WITH THE CEO TO INQUIRE INTO THE FACTS AND DETERMINE WHETHER A CONLICT OF INTEREST EXISTS. WHERE A CONFLICT OF INTEREST OCCURS, THE INDIVIDUAL IS RECUSED FROM ANY DECISION MAKING PROCESS OR MEETINGS RELATED TO THAT SITUATION. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE CHIEF EXECUTIVE OFFICER COMPENSATION AND PERFORMS A PERFORMANCE EVALUATION TO SET COMPENSATION. THE HUMAN RESOURCES MANAGER MAY ASSIST AS NECESSARY. ALL OTHER OFFICERS' COPMENSATION IS SET BY HUMAN RESOURCES. THE SALARY RANGE IS BASED ON COMMUNITY COMPENSATION DATA AND YEARS OF PROFESSIONAL EXPERIENCE AND QUALIFICATIONS. ANNUAL REVIEWS WERE LAST PERFORMED IN MARCH 2015. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST ONLY.