2013-06-20T14:11:17-05:00 2012-12-31 930743240 HOFFMAN STEWART & SCHMIDT PC 4900 MEADOWS ROAD STE 200 LAKE OSWEGO OR 970353295 990 2012-01-01 910896241 COWLITZ FAMILY HEALTH CENTER COWL 3606363892 1057 12TH AVENUE LONGVIEW WA 986322509 DIAN COOPER 3606363892 2013-06-13 1 ROBERT M PRILL P00236613 5032205900 2012 2016-02-24 21:20:13Z DIAN COOPER 1057 12TH AVENUE LONGVIEW WA 986322509 11181539 0 X WWW.COWLITZFAMILYHEALTH.ORG X 1972 WA TO PROMOTE, ENCOURAGE AND PROVIDE HEALTH SERVICES IN ORDER TO IMPROVE THE QUALITY OF LIFE THROUGH SOUND NUTRITION, EDUCATION, PREVENTIVE HEALTH CARE, AND THE EMPOWERMENT OF CHOICE. 14 14 154 28 0 0 2240136 2967414 8853319 8206778 14106 4814 2575 2533 11110136 11181539 0 0 0 0 6979917 7376367 0 0 0 3349576 3871871 10329493 11248238 780643 -66699 8327725 8245392 1675181 1659547 6652544 6585845 X TO PROMOTE, ENCOURAGE AND PROVIDE HEALTH SERVICES IN ORDER TO IMPROVE THE QUALITY OF LIFE THROUGH SOUND NUTRITION, EDUCATION, PREVENTIVE HEALTH CARE, AND THE EMPOWERMENT OF CHOICE. 0 0 4897796 5170660 TO PROVIDE MEDICAL SERVICES TO LOW INCOME INDIVIDUALS. THE TOTAL MEDICAL ENCOUNTERS DURING THE YEAR WERE 40,957. 622127 TO PROVIDE SUPPLEMENTAL NUTRITION SERVICES FOR PREGNANT AND BREASTFEEDING WOMEN AND THEIR CHILDREN TO AGE 5. DURING 2012, THE CENTER SERVED 6,286 WOMEN, INFANTS AND CHILDREN. 2199882 1882851 TO PROVIDE DENTAL SERVICES TO LOW INCOME INDIVIDUALS. THE TOTAL DENTAL ENCOUNTERS DURING THE YEAR WERE 23,045. 565605 1160614 TO PROVIDE MEDICAL RELATED SERVICES TO LOW INCOME INDIVIDUALS. ENABLING SERVICE ENCOUNTERS AND MENTAL HEALTH ENCOUNTERS TOTALED 5,225 AND 3,496 RESPECTIVELY. 565605 1160614 8285410 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 20 0 154 1 0 0 0 0 0 0 0 0 0 0 X 14 14 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 2.00 X X 0 0 0 MELISSA TAYLOR 2.00 X X 0 0 0 WANDA MCBEE 2.00 X X 0 0 0 CARLEEN WOLGAMOTT 2.00 X 0 0 0 CYNTHIA WASHINGTON-MATTSON 2.00 X 0 0 0 JOSIAH JOHNSON 2.00 X 0 0 0 GEORGE ROBERTSON 2.00 X 0 0 0 KENDALL RIVERS 2.00 X 0 0 0 QUINCEY SHINNICK 2.00 X 0 0 0 ALISABETH BUCK 2.00 X 0 0 0 ANN SHODDY 2.00 X 0 0 0 DONNA SETTERS 2.00 X 0 0 0 CARLOS CARREON 2.00 X 0 0 0 JOE TITUS 2.00 X 0 0 0 DIAN COOPER 40.00 X 101408 0 7318 ANDREA TRENNER 40.00 X 68700 0 7318 GERARDO MELGAR 40.00 X 166624 0 7318 ROBERT PETERSON 40.00 X 153440 0 7318 ROXANE OSHIRO 40.00 X 147076 0 5489 TRESHA CARROLL 40.00 X 127723 0 7318 PARTHA GONAVARAM 40.00 X 142340 0 7318 DAVID STEVES 40.00 X 150977 0 7318 1058288 0 56715 12 0 1 0 OCHIN INC 1881 SW NAITO PARKWAY PORTLAND OR 972015195 EMR AND PRACTICE MANAGEMENT FEES 485389 POLAR SYSTEMS 21890 WILLAMETTE DRIVE WEST LINN OR 97068 COMPUTER CONSULTING 361442 BOB LARGE CONSTRUCTION LLC 2240 34TH AVENUE LONGVIEW WA 98632 CONSTRUCTION SERVICES 329879 3 2963949 3465 2967414 PATIENT SERVICE REVENU 624100 5980549 5980549 PREMIUM REVENUE 624100 2226229 2226229 8206778 4814 4814 OTHER REVENUE 624100 2533 2533 2533 11181539 8214125 0 0 387419 188160 199259 5742188 5109056 633132 756763 668503 88260 489997 435969 54028 38215 38215 27800 27800 1114322 300453 813869 15728 14648 1080 280564 96563 184001 585983 142794 443189 39533 31243 8290 70362 55606 14756 33711 33711 408984 179048 229936 47987 47987 MEDICAL SUPPLIES 619829 619829 BAD DEBT 318872 318872 TAXES AND LICENSES 73819 49421 24398 TELEPHONE 69818 45860 23958 126344 29385 96959 11248238 8285410 2962828 0 1615159 1425681 3186714 3201070 104997 434853 829243 643158 55288 59309 132752 129180 5281716 2929575 2403572 2352141 8327725 8245392 903903 899053 771278 760494 1675181 1659547 X 6652544 6585845 6652544 6585845 8327725 8245392 -66699 0 X X 0 1 X 1 1 1 X 2411332 2835315 2803464 2240136 2967414 13257661 2411332 2835315 2803464 2240136 2967414 13257661 13257661 65048 33922 23882 14106 4814 141772 8318 4679 2575 2533 18105 13417538 39209777 0.98810 0.97940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 83030 83030 719994 146680 573314 1837143 1273954 563189 2298120 1508941 789179 343429 343429 2352141 X 10862667 -318872 -318872 11181539 0 11181539 10929366 -318872 -318872 11248238 0 11248238 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MANAGEMENT OF COWLITZ FAMILY HEALTH CENTER DOES NOT BELIEVE THE CENTER HAS ANY UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -318,872. PART XII, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -318,872. X X 0 0 0 0 0 0 0 0 0 GERARDO MELGAR 166624 0 0 0 0 0 0 0 7318 0 173942 0 0 0 ROBERT PETERSON 153440 0 0 0 0 0 0 0 7318 0 160758 0 0 0 ROXANE OSHIRO 147076 0 0 0 0 0 0 0 5489 0 152565 0 0 0 DAVID STEVES 150977 0 0 0 0 0 0 0 7318 0 158295 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION SENDS AN EMAIL WITH THE FORM 990 TO ALL BOARD MEMBERS AND SOLICITS COMMENTS PRIOR TO FILING. 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 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.