2013-03-15T11:54:38-05:00 2012-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2011-07-01 911255170 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY COMM 4257893700 PO BOX 13060 EVERETT WA 98206 VICTORIA M RINGNESS 4257893700 2013-03-15 1 SARA ELIZABETH J HYRE P00235495 4254544919 2013-03-15 2011 2016-03-07 17:11:31Z ROBERT C FARRELL PO BOX 13060 EVERETT WA 98206 34551301 0 X WWW.CHCSNO.ORG X 1986 WA TO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE. 11 11 272 68 0 0 3633432 3472657 17568679 20123168 757543 775548 1642459 2369726 23602113 26741099 0 250 0 0 13683865 15507252 0 0 202503 8437744 8122874 22121609 23630376 1480504 3110723 54143248 57569294 2243258 2638736 51899990 54930558 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, 2012, CHC PROVIDED $3,818,024 OF CHARITY CARE SERVICES UNDER THIS POLICY. 0 0 12580993 250 13616648 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 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. 5117078 6503126 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 38,793 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $565,269. 1181594 1619389 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. 90,016 TOTAL PRESCRIPTIONS FILLED FOR THIS FISCAL YEAR. 18879665 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 0 1 26 0 1 272 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X VICTORIA M RINGNESS 4257893700 PO BOX 13060 EVERETT WA 98206 LARRY WARNER 2.00 X X 0 0 0 BICH-NGA NGUYEN 2.00 X X 0 0 0 JASON HAMLIN 2.00 X X 0 0 0 KATHERINE GANTER 2.00 X 0 0 0 LINDA INGLIN 2.00 X 0 0 0 TAMIKO LEWIS 2.00 X 0 0 0 TAMMY MARTIN 2.00 X 0 0 0 LARRY MCLYNNE 2.00 X 0 0 0 NAZAR SAYED 2.00 X 0 0 0 PAUL WOLTZ 2.00 X 0 0 0 JAMIE DUKE 2.00 X X 0 0 0 BRENT THOMPSON 2.00 X 0 0 0 SHERYL SLEEPER 2.00 X 0 0 0 MALCOM BELL 2.00 X 0 0 0 ROBERT FARRELL CPA 45.00 X 137714 0 18831 TOVE SKAFTUN RN 45.00 X 103164 0 20753 VICTORIA RINGNESS 45.00 X 40047 0 10923 KISHORE SHETTY 45.00 X 182195 0 29895 ANDREW PERRY 45.00 X 194454 0 41830 YVONNE MA 45.00 X 165920 0 26589 SANJAY RAJ 45.00 X 162558 0 33112 RALPH HAVENS 45.00 X 161731 0 0 TINA LIU 45.00 X 151464 0 32586 1299247 0 214519 30 0 1 0 JR ABBOTT CONSTRUCTION 3408 1ST AVE SOUTH SEATTLE WA 98134 CONSTRUCTION 1268546 COMPHEALTH INC PO BOX 972670 DALLAS TX 753972670 TEMP. HEALTHCARE STAFFING 359554 STAFF CARE PO BOX 281923 ATLANTA GA 303841923 TEMP. HEALTHCARE STAFFING 206061 LANGUAGE LINE SERVICES PO BOX 202564 DALLAS TX 753202572 INTERPRETER SERVICES 195866 TECHHEADS 16869 SW 65TH AVE 166 LAKE OSWEGO OR 97035 IT SUPPORT SERVICES 102363 5 5206 3426913 40538 1005631 3472657 MEDICARE/MEDICAID 621400 14099883 14099883 PATIENT FEES 621110 3299668 3299668 CAPITATED REVENUE 621110 2723617 2723617 20123168 598703 598703 7484479 3853 7311487 0 172992 3853 176845 176845 2114710 498715 1615995 1615995 INCENTIVE PAYMENTS 900099 658750 658750 PATIENT RECORDS 561000 68894 68894 REFUNDS & REBATES 900099 15875 15875 10212 10212 753731 26741099 21739163 0 1529279 250 250 728897 728897 12014095 9949742 1993349 71004 241360 200351 37774 3235 1570776 1268996 293130 8650 952124 748344 198154 5626 75447 75447 57710 57710 82160 82160 1008610 814190 193403 1017 73369 73369 448199 300777 125738 21684 128959 90392 38567 781556 650225 129413 1918 17776 8242 9202 332 113964 80574 31879 1511 50752 21987 28765 1472183 1260978 207626 3579 105214 77353 27636 225 CLINICAL SUPPLIES 1541669 1540511 1158 BAD DEBT EXPENSE 1149110 1149110 EQUIPMENT RENTAL/ MAINT 482580 355363 126523 694 533616 362280 162835 8501 23630376 18879665 4548208 202503 2873483 5416133 1692576 2063380 14662 18322 1552017 2945673 278800 306938 497701 348968 35279177 6983421 29333250 28295756 17900759 18174124 54143248 57569294 2198592 2538065 7159 70737 37507 29934 2243258 2638736 X 51794990 54827309 105000 103249 51899990 54930558 54143248 57569294 X 3110723 -80155 X 0 1 1 X 1 1 X 3496292 3663947 5174039 3633432 3472657 19440367 20465282 20370396 19614048 19529566 22237878 102217170 14631 31541 96820 86430 743519 972941 23976205 24065884 24884907 23249428 26454054 122630478 0 0 0 122630478 893286 681932 689086 733990 598703 3596997 893286 681932 689086 733990 598703 3596997 71591 21303 49943 88405 10212 241454 24941082 24769119 25623936 24071823 27062969 126468929 0.96960 0.96490 0.02840 0.03270 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6436883 6436883 24003091 4026794 19976297 330653 52215 278438 4283049 2900735 1382314 225501 3677 221824 28295756 CAPITAL LEASE 29934 29934 26741099 23630376 3110723 -80155 -80155 3030568 27077499 -80155 -80155 27157654 82160 -498715 -416555 26741099 24046931 498715 498715 23548216 82160 82160 23630376 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. X X X X 0 0 0 0 0 0 0 0 0 ROBERT FARRELL CPA 137714 0 0 0 0 0 10202 0 8629 0 156545 0 0 0 KISHORE SHETTY 181195 0 1000 0 0 0 20749 0 9146 0 212090 0 0 0 ANDREW PERRY 193454 0 1000 0 0 0 25248 0 16582 0 236284 0 0 0 YVONNE MA 164920 0 1000 0 0 0 16500 0 10089 0 192509 0 0 0 SANJAY RAJ 161558 0 1000 0 0 0 23022 0 10090 0 195670 0 0 0 RALPH HAVENS 160731 0 1000 0 0 0 0 0 0 0 161731 0 0 0 TINA LIU 150464 0 1000 0 0 0 23086 0 9500 0 184050 0 0 0 X 20485 975713 COST OR SELLING PRICE X SOFTWARE 1 29918 FAIR MARKET VALUE 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: 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 A, LINE 4 BY-LAWS WERE REVISED TO REMOVE THE BOARD COMMITTEES. 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 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 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST ONLY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -80,155.