2014-04-09T11:19:02-05:00 2013-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2012-07-01 911255170 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY COMM 4257893700 8609 EVERGREEN WAY EVERETT WA 98208 VICTORIA M RINGNESS 4257893700 2014-04-09 1 SARA ELIZABETH J HYRE P00235495 4254544919 2014-04-09 2012 2015-11-30 17:44:51Z ROBERT C FARRELL 8609 EVERGREEN WAY EVERETT WA 98208 33885459 0 X WWW.CHCSNO.ORG X 1986 WA TO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE. 11 11 285 45 0 0 3472657 3689631 20123168 20764218 775548 870639 2369726 2213009 26741099 27537497 250 0 0 0 15507252 17918384 0 0 222105 8122874 8692438 23630376 26610822 3110723 926675 57569294 58358078 2638736 2954454 54930558 55403624 X COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY 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, 2013, CHC PROVIDED $4,359,859 OF CHARITY CARE SERVICES UNDER THIS POLICY. 0 0 14269230 14174236 MEDICAL CARE - TO PROVIDE MEDICAL SERVICES IN PEDIATRICS, ACUTE GENERAL CARE AND OBSTETRICAL CARE TO LOW-INCOME/ HOMELESS PEOPLE AT FOUR 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 81,577 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $3,426,621. IN ADDITION, CHC PROVIDED PRIMARY CARE OUTREACH SERVICES FOR HOMELESS INDIVIDUALS AND FAMILIES AT THREE TRANSITIONAL HOUSING AGENCIES IN SNOHOMISH COUNTY. 5673708 6589982 DENTAL CARE - TO PROVIDE DENTAL SERVICES TO LOW-INCOME/HOMELESS PEOPLE ON A SLIDING FEE BASIS AND BY THIRD-PARTY INSURANCE AND MEDICAID AT THREE DIFFERENT CLINICS. THERE WAS A TOTAL OF 39,322 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $933,238. 1431429 1816276 PHARMACY SERVICES - TO PROVIDE PHARMACY SERVICES TO LOW-INCOME PEOPLE ON A SLIDING FEE BASIS AND BY THIRD-PARTY INSURANCE AND MEDICAID AT THREE DIFFERENT CLINICS. 93,752 TOTAL PRESCRIPTIONS FILLED FOR THIS FISCAL YEAR. 21374367 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 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 22 0 1 285 1 0 0 0 0 0 0 0 0 0 0 X 11 11 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 JASON HAMLIN 2.00 X X 0 0 0 LARRY WARNER 2.00 X X 0 0 0 BICH-NGA NGUYEN 2.00 X X 0 0 0 KATHERINE GANTER 2.00 X X 0 0 0 JAMIE DUKE 2.00 X X 0 0 0 CHARLES JEREMIAH 2.00 X 0 0 0 COURTNEY MILLER 2.00 X 0 0 0 LARRY MCLYNN 2.00 X 0 0 0 LINDA INGLIN 2.00 X 0 0 0 NAZAR SAYED 2.00 X 0 0 0 PAUL WOLTZ 2.00 X 0 0 0 TAMIKO LEWIS 2.00 X 0 0 0 TAMMY MARTIN 2.00 X 0 0 0 ROBERT FARRELL CPA 45.00 X 149656 0 16403 VICTORIA RINGNESS 45.00 X 94078 0 13214 TOVE SKAFTUN RN 45.00 X 117155 0 14489 DION KAPETANOV 45.00 X 115902 0 11340 THOMAS TOCHER 45.00 X 227954 0 20359 KISHORE SHETTY 45.00 X 186593 0 18140 ANDREW PERRY 45.00 X 184907 0 18449 YVONNE MA 45.00 X 170494 0 17390 HEIDI FINUCANE 45.00 X 156028 0 16841 SANJAY RAJ 45.00 X 164315 0 17048 TESS MOORE 39.00 X 162965 0 16792 1730047 0 180465 35 0 1 0 STAFF CARE PO BOX 281923 ATLANTA GA 303841923 TEMP. HEALTHCARE STAFFING 361923 SUMMIT BUILDING MAINTENANCE INC 2366 EASTLAKE AVE E SEATTLE WA 98102 JANITORIAL SERVICES 192260 COMPHEALTH INC PO BOX 972670 DALLAS TX 753972670 TEMP. HEALTHCARE STAFFING 145804 TECHHEADS 16869 SW 65TH AVE 166 LAKE OSWEGO OR 97035 IT SUPPORT SERVICES 142632 4 4922 3592103 92606 1028012 3689631 MEDICARE/MEDICAID 621400 17108762 17108762 CAPITATED REVENUE 621110 1960233 1960233 PATIENT FEES 621110 1695223 1695223 20764218 566492 566492 6190110 2494 5881591 6866 308519 -4372 304147 304147 2275781 459505 1816276 1816276 EHR INCENTIVE PAYMENTS 900099 331500 331500 PATIENT RECORDS 561000 30849 30849 REFUNDS & REBATES 900099 24916 24916 9468 9468 396733 27537497 22580494 0 1267372 834711 834711 13834311 11568516 2178069 87726 358271 298212 58005 2054 1741761 1418262 314816 8683 1149330 905043 237116 7171 114714 114714 58344 58344 65084 65084 1106730 894107 207276 5347 74409 74409 479213 312529 145026 21658 169099 130332 38767 789188 670472 115267 3449 20084 9371 10117 596 188018 111720 75655 643 36491 16390 20101 1517395 1319158 194779 3458 128873 102899 25704 270 CLINICAL SUPPLIES 1680189 1678343 1846 BAD DEBT EXPENSE 1268398 1268398 EQUIPMENT RENTAL/ MAINT 569320 430805 137102 1413 426889 239810 183697 3382 26610822 21374367 5014350 222105 5416133 2444165 2063380 1576588 18322 62317 2945673 3229398 306938 332601 348968 253025 38793589 7800098 28295756 30993491 18174124 19466493 57569294 58358078 2538065 2846227 70737 88640 29934 19587 2638736 2954454 X 54827309 55306205 103249 97419 54930558 55403624 57569294 58358078 926675 -453609 0 X 0 1 X 1 1 1 X 3663947 5174039 3633432 3472657 3689631 19633706 20370396 19614048 19529566 22237878 23039999 104791887 31541 96820 86430 743519 387265 1345575 24065884 24884907 23249428 26454054 27116895 125771168 0 0 0 125771168 681932 689086 733990 598703 566492 3270203 681932 689086 733990 598703 566492 3270203 21303 49943 88405 10212 9468 179331 24769119 25623936 24071823 27062969 27692855 129220702 0.97330 0.96960 0.02530 0.02840 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6455267 6455267 24135889 4992827 19143062 330653 117730 212923 4278386 2684639 1593747 3593394 4902 3588492 30993491 CAPITAL LEASE 19587 19587 27478309 -453609 -453609 27931918 65084 -459505 -394421 27537497 27005243 459505 459505 26545738 65084 65084 26610822 PART XI, LINE 4B - OTHER ADJUSTMENTS: COST OF GOODS SOLD INCLUDED IN EXPENSE ON FINANCIAL STATEMENTS -459,505. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD INCLUDED IN EXPENSE ON FINANCIAL STATEMENTS 459,505. X X X X 0 0 0 0 0 0 0 0 0 ROBERT FARRELL CPA 139656 0 10000 0 0 0 7656 0 8747 0 166059 0 0 0 THOMAS TOCHER 225766 0 2188 0 0 0 11437 0 8922 0 248313 0 0 0 KISHORE SHETTY 183937 0 2656 0 0 0 9367 0 8773 0 204733 0 0 0 ANDREW PERRY 182929 0 1978 0 0 0 9665 0 8784 0 203356 0 0 0 YVONNE MA 168516 0 1978 0 0 0 8677 0 8713 0 187884 0 0 0 HEIDI FINUCANE 148662 0 7366 0 0 0 8219 0 8622 0 172869 0 0 0 SANJAY RAJ 163192 0 1123 0 0 0 8379 0 8669 0 181363 0 0 0 TESS MOORE 153026 0 9939 0 0 0 8190 0 8602 0 179757 0 0 0 X 24020 1006370 COST OR SELLING PRICE X SOFTWARE 1 21642 FAIR MARKET VALUE 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS: PART I, COLUMN (B): CONTRIBUTIONS ARE 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 ORGANIZATIONS 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 CEO COMPENSATION AND PERFORMS A PERFORMANCE EVALUATION TO SET COMPENSATION. THE HUMAN RESOURCES MANAGER MAY ASSIST AS NECESSARY. THE CHIEF FINANCIAL OFFICER, CHIEF ADMINISTRATIVE OFFICER, AND COO COMPENSATION IS SET BY HUMAN RESOURCES. THE SALARY RANGE IS BASED ON COMMUNITY COMPENSATION DATA AND THE APPLICANTS' YEARS OF PROFESSIONAL EXPERIENCE AND QUALIFICATIONS. ANNUAL REVIEWS WERE LAST PERFORMED IN MARCH 2013. 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.