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COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY (EIN 91-1255170)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-03-15
IRS object ID
201310749349300531
Schema version
2011v1.5
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)
Timestamp2013-03-15T11:54:38-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN911194016EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLARK NUBER PSBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line110900 NE 4TH STREET SUITE 1700AddressLine1
CityBELLEVUECity
StateWAState
ZIP Code98004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN911255170EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone4257893700Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 13060AddressLine1
CityEVERETTCity
StateWAState
ZIP Code98206ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameVICTORIA M RINGNESSName
TitleDIRECTOR OF FINANCETitle
Phone4257893700Phone
Date Signed2013-03-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSARA ELIZABETH J HYREName
PTINP00235495PTIN
Phone4254544919Phone
Date Prepared2013-03-15DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonROBERT C FARRELLNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 13060AddressLine1
CityEVERETTCity
StateWAState
ZIP Code98206ZIPCode
FieldValueIRS element (for citing)
Gross Receipts34551301GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHCSNO.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1986YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees272TotalNbrEmployees
Total Nbr Volunteers68TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3633432ContributionsGrantsPriorYear
Contributions Grants Current Year3472657ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17568679ProgramServiceRevenuePriorYear
Program Service Revenue CY20123168ProgramServiceRevenueCY
Investment Income Prior Year757543InvestmentIncomePriorYear
Investment Income Current Year775548InvestmentIncomeCurrentYear
Other Revenue Prior Year1642459OtherRevenuePriorYear
Other Revenue Current Year2369726OtherRevenueCurrentYear
Total Revenue Prior Year23602113TotalRevenuePriorYear
Total Revenue Current Year26741099TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY250GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year13683865SalariesEtcPriorYear
Salaries Etc Current Year15507252SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year202503TotalFundrsngExpCurrentYear
Other Expense Prior Year8437744OtherExpensePriorYear
Other Expenses Current Year8122874OtherExpensesCurrentYear
Total Expenses Prior Year22121609TotalExpensesPriorYear
Total Expenses Current Year23630376TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1480504RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3110723RevenuesLessExpensesCY
Total Assets BOY54143248TotalAssetsBOY
Total Assets EOY57569294TotalAssetsEOY
Total Liabilities BOY2243258TotalLiabilitiesBOY
Total Liabilities EOY2638736TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY51899990NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY54930558NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCOMMUNITY 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, 2012, CHC PROVIDED $3,818,024 OF CHARITY CARE SERVICES UNDER THIS POLICY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense12580993Expense
Grants250Grants
Revenue13616648Revenue
DescriptionMEDICAL 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 76,904 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $3,252,756. IN ADDITION, CHC PROVIDED PRIMARY CARE OUTREACH SERVICES FOR HOMELESS INDIVIDUALS AND FAMILIES AT THREE TRANSITIONAL HOUSING AGENCIES IN SNOHOMISH COUNTY.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense5117078Expense
Revenue6503126Revenue
DescriptionDENTAL 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 38,793 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $565,269.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1181594Expense
Revenue1619389Revenue
DescriptionPHARMACY 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. 90,016 TOTAL PRESCRIPTIONS FILLED FOR THIS FISCAL YEAR.Description
FieldValueIRS element (for citing)
Total Program Service Expense18879665TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109626NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees272NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1VICTORIA M RINGNESSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4257893700TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 13060AddressLine1
CityEVERETTCity
StateWAState
ZIP Code98206ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
LARRY WARNER
CHAIR2.00XX000
BICH-NGA NGUYEN
VICE CHAIR/SECRETARY2.00XX000
JASON HAMLIN
TREASURER2.00XX000
KATHERINE GANTER
BOARD MEMBER2.00X000
LINDA INGLIN
BOARD MEMBER2.00X000
TAMIKO LEWIS
BOARD MEMBER2.00X000
TAMMY MARTIN
BOARD MEMBER2.00X000
LARRY MCLYNNE
BOARD MEMBER2.00X000
NAZAR SAYED
BOARD MEMBER2.00X000
PAUL WOLTZ
BOARD MEMBER2.00X000
JAMIE DUKE
VICE CHAIR2.00XX000
BRENT THOMPSON
BOARD MEMBER THRU 10/112.00X000
SHERYL SLEEPER
BOARD MEMBER THRU 04/122.00X000
MALCOM BELL
BOARD MEMBER THRU 03/122.00X000
ROBERT FARRELL CPA
CHIEF EXECUTIVE OFFICER45.00X137714018831
TOVE SKAFTUN RN
CHIEF OPERATING OFFICER45.00X103164020753
VICTORIA RINGNESS
DIRECTOR OF FINANCE45.00X40047010923
KISHORE SHETTY
DENTAL DIRECTOR45.00182195029895X
ANDREW PERRY
PHYSICIAN45.00194454041830X
YVONNE MA
DENTIST45.00165920026589X
SANJAY RAJ
PHYSICIAN45.00162558033112X
RALPH HAVENS
PHYSICIAN45.0016173100X
TINA LIU
DENTIST45.00151464032586X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1299247TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation214519TotalOtherCompensation
Number Individuals GT100 K30NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
JR ABBOTT CONSTRUCTION
3408 1ST AVE SOUTHSEATTLEWA98134CONSTRUCTION1268546
COMPHEALTH INC
PO BOX 972670DALLASTX753972670TEMP. HEALTHCARE STAFFING359554
STAFF CARE
PO BOX 281923ATLANTAGA303841923TEMP. HEALTHCARE STAFFING206061
LANGUAGE LINE SERVICES
PO BOX 202564DALLASTX753202572INTERPRETER SERVICES195866
TECHHEADS
16869 SW 65TH AVE 166LAKE OSWEGOOR97035IT SUPPORT SERVICES102363
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Federated Campaigns5206FederatedCampaigns
Government Grants3426913GovernmentGrants
All Other Contributions40538AllOtherContributions
Noncash Contributions1005631NoncashContributions
Total Contributions3472657TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE/MEDICAID6214001409988314099883
PATIENT FEES62111032996683299668
CAPITATED REVENUE62111027236172723617
FieldValueIRS element (for citing)
Total Program Service Revenue20123168TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column598703TotalRevenueColumn
Exclusion$598,703ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities7484479Securities
Other3853Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities7311487Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities172992Securities
Other3853Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column176845TotalRevenueColumn
Exclusion$176,845ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory2114710GrossSalesOfInventory
Cost Of Goods Sold498715CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1615995TotalRevenueColumn
Related Or Exempt Function Income1615995RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
INCENTIVE PAYMENTS900099658750$658,750
PATIENT RECORDS56100068894$68,894
REFUNDS & REBATES90009915875$15,875

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column10212TotalRevenueColumn
Exclusion$10,212ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue753731TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column26741099TotalRevenueColumn
Related Or Exempt Function Income21739163RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,529,279ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total250Total
Program Services250ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total728897Total
Management And General728897ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total12014095Total
Program Services9949742ProgramServices
Management And General1993349ManagementAndGeneral
Fundraising71004Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total241360Total
Program Services200351ProgramServices
Management And General37774ManagementAndGeneral
Fundraising3235Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1570776Total
Program Services1268996ProgramServices
Management And General293130ManagementAndGeneral
Fundraising8650Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total952124Total
Program Services748344ProgramServices
Management And General198154ManagementAndGeneral
Fundraising5626Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total75447Total
Management And General75447ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total57710Total
Management And General57710ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total82160Total
Management And General82160ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1008610Total
Program Services814190ProgramServices
Management And General193403ManagementAndGeneral
Fundraising1017Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total73369Total
Fundraising73369Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total448199Total
Program Services300777ProgramServices
Management And General125738ManagementAndGeneral
Fundraising21684Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total128959Total
Program Services90392ProgramServices
Management And General38567ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total781556Total
Program Services650225ProgramServices
Management And General129413ManagementAndGeneral
Fundraising1918Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total17776Total
Program Services8242ProgramServices
Management And General9202ManagementAndGeneral
Fundraising332Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total113964Total
Program Services80574ProgramServices
Management And General31879ManagementAndGeneral
Fundraising1511Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total50752Total
Program Services21987ProgramServices
Management And General28765ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1472183Total
Program Services1260978ProgramServices
Management And General207626ManagementAndGeneral
Fundraising3579Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total105214Total
Program Services77353ProgramServices
Management And General27636ManagementAndGeneral
Fundraising225Fundraising

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraisingManagement And GeneralManagementAndGeneral
CLINICAL SUPPLIES154166915405111158
BAD DEBT EXPENSE11491101149110
EQUIPMENT RENTAL/ MAINT482580355363694126523

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total533616Total
Program Services362280ProgramServices
Management And General162835ManagementAndGeneral
Fundraising8501Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total23630376Total
Program Services18879665ProgramServices
Management And General4548208ManagementAndGeneral
Fundraising202503Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2873483BOY
EOY5416133EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1692576BOY
EOY2063380EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY14662BOY
EOY18322EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1552017BOY
EOY2945673EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY278800BOY
EOY306938EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY497701BOY
EOY348968EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis35279177LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6983421LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY29333250BOY
EOY28295756EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17900759BOY
EOY18174124EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY54143248BOY
EOY57569294EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2198592BOY
EOY2538065EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY7159BOY
EOY70737EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY37507BOY
EOY29934EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2243258BOY
EOY2638736EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY51794990BOY
EOY54827309EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY105000BOY
EOY103249EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY51899990BOY
EOY54930558EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY54143248BOY
EOY57569294EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3110723ReconcilationRevenueExpenses
Reconcilation Other Changes-80155ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3496292CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3663947CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5174039CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3633432CurrentTaxYearMinus1Year
Current Tax Year3472657CurrentTaxYear
Total19440367Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years20465282CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20370396CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years19614048CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19529566CurrentTaxYearMinus1Year
Current Tax Year22237878CurrentTaxYear
Total102217170Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14631CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years31541CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years96820CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year86430CurrentTaxYearMinus1Year
Current Tax Year743519CurrentTaxYear
Total972941Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years23976205CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years24065884CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24884907CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year23249428CurrentTaxYearMinus1Year
Current Tax Year26454054CurrentTaxYear
Total122630478Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509122630478PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years893286CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years681932CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years689086CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year733990CurrentTaxYearMinus1Year
Current Tax Year598703CurrentTaxYear
Total3596997Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years893286CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years681932CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years689086CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year733990CurrentTaxYearMinus1Year
Current Tax Year598703CurrentTaxYear
Total3596997Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years71591CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years21303CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years49943CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year88405CurrentTaxYearMinus1Year
Current Tax Year10212CurrentTaxYear
Total241454Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years24941082CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years24769119CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years25623936CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year24071823CurrentTaxYearMinus1Year
Current Tax Year27062969CurrentTaxYear
Total126468929Total
FieldValueIRS element (for citing)
Public Support Percentage5090.96960PublicSupportPercentage509
Prior Year Support Percentage0.96490PriorYearSupportPercentage
Investment Income Percentage0.02840InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.03270PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis6436883OtherCostOrOtherBasis
Book Value6436883BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis24003091OtherCostOrOtherBasis
Depreciation4026794Depreciation
Book Value19976297BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis330653OtherCostOrOtherBasis
Depreciation52215Depreciation
Book Value278438BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4283049OtherCostOrOtherBasis
Depreciation2900735Depreciation
Book Value1382314BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis225501OtherCostOrOtherBasis
Depreciation3677Depreciation
Book Value221824BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings28295756TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCAPITAL LEASEDescription
Amount$29,934Amount
FieldValueIRS element (for citing)
Total Of Amounts29934TotalOfAmounts
Total Revenue26741099TotalRevenue
Total Expenses23630376TotalExpenses
Excess Or Deficit For Year3110723ExcessOrDeficitForYear
Net Unrealized GL On Investments-80155NetUnrealizedGLOnInvestments
Total Adjustments-80155TotalAdjustments
Excess Or Deficit Per FS3030568ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt27077499TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-80155NetUnrealizedGainsInvestments
Revenue Not Rptd F990-80155RevenueNotRptdF990
Revenue Subtotal27157654RevenueSubtotal
Investment Expenses Not Included82160InvestmentExpensesNotIncluded
Other Revenues Not Included-498715OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-416555RevenueNotRptdOnFinStmt
Total Revenue Per Form99026741099TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt24046931TotExpensesEtcAuditedFinclStmt
Other Expenses Included498715OtherExpensesIncluded
Expenses Not Rptd F990498715ExpensesNotRptdF990
Expenses Subtotal23548216ExpensesSubtotal
Investment Expenses Not Included282160InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt82160ExpensesNotRptdOnFinStmt
Total Expenses Per Form99023630376TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
PART XII, LINE 4B - OTHER ADJUSTMENTS:COST OF GOODS SOLD INCLUDED IN EXPENSE ON FINANCIAL STATEMENTS -498,715.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:COST OF GOODS SOLD INCLUDED IN EXPENSE ON FINANCIAL STATEMENTS 498,715.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ROBERT FARRELL CPA
1377140000010202086290156545000
KISHORE SHETTY
1811950100000020749091460212090000
ANDREW PERRY
19345401000000252480165820236284000
YVONNE MA
16492001000000165000100890192509000
SANJAY RAJ
16155801000000230220100900195670000
RALPH HAVENS
160731010000000000161731000
TINA LIU
1504640100000023086095000184050000

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions20485NumberOfContributions
Noncash Contribs Rptd F990975713NoncashContribsRptdF990
Method Of Determining RevenuesCOST OR SELLING PRICEMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionSOFTWAREDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99029918NoncashContribsRptdF990
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierMETHOD FOR DETERMINING NUMBER OF CONTRIBUTORS:Identifier
Return ReferencePART I, COLUMN (B):ReturnReference
ExplanationCONTRIBUTIONS ARE BASED ON THE NUMBER OF ITEMS CONTRIBUTED.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART I, LINE 6VOLUNTEERS 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 A, LINE 4BY-LAWS WERE REVISED TO REMOVE THE BOARD COMMITTEES.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15THE 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 DIRECTOR OF FINANCE, CAO, 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 2012.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST ONLY.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -80,155.CHANGES IN NET ASSETS OR FUND BALANCES: