2012-07-30T15:43:59-05:00 2011-12-31 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2011-01-01 910893287 NEIGHBORCARE HEALTH NEIG 2064616935 905 SPRUCE STREET NO 300 SEATTLE WA 981042474 MARK SECORD 2064616935 2012-07-30 1 SARA ELIZABETH J HYRE P00235495 4254544919 2011 2016-02-24 21:20:13Z MARK SECORD 905 SPRUCE STREET NO 300 SEATTLE WA 981042474 48625535 0 X WWW.NEIGHBORCARE.ORG X 1969 WA THE MISSION OF NEIGHBORCARE HEALTH IS TO PROVIDE COMPREHENSIVE HEALTH CARE TO FAMILIES AND INDIVIDUALS WHO HAVE DIFFICULTY ACCESSING CARE; RESPOND WITH SENSITIVITY TO THE NEEDS OF OUR CULTURALLY DIVERSE PATIENTS; AND ADVOCATE AND WORK WITH OTHERS TO IMPROVE THE OVERALL HEALTH STATUS OF THE COMMUNITIES WE SERVE. 14 14 537 88 0 0 16152894 14862504 24738660 24105520 247362 124659 64210 1371693 41203126 40464376 0 0 0 0 25335657 25896632 0 0 91208 11581125 12162964 36916782 38059596 4286344 2404780 59074182 59699791 28373418 26611840 30700764 33087951 X THE ORGANIZATION IS A COMMUNITY-BASED, NON-PROFIT AGENCY THAT OPERATES 20 MEDICAL, DENTAL, AND SCHOOL-BASED HEALTH CENTERS THROUGHOUT SEATTLE AND PROVIDES SERVICES TO OVER 49,600 PEOPLE EACH YEAR. OUR CLINICS ARE LOCATED THROUGHOUT AREAS OF KING COUNTY THAT HAVE THE HIGHEST RATES OF UNINSURED FAMILIES AND THE GREATEST ETHNIC DIVERSITY. INTEGRATED HEALTHCARE SERVICES ARE PROVIDED ON A SLIDING FEE SCALE FOR THE UNINSURED, AND NO ONE IS EVER TURNED AWAY DUE TO INABILITY TO PAY.WE ARE UNIQUELY SKILLED IN PROVIDING CULTURALLY RESPONSIVE SERVICES TO OUR DIVERSE PATIENT POPULATION, WHICH INCLUDES PATIENTS WHO SPEAK MORE THAN 100 DIFFERENT LANGUAGES AND DIALECTS AND REPRESENT MANY CULTURAL GROUPS.WE PROVIDE SERVICES TO RESIDENTS OF URBAN SEATTLE AND SURROUNDING AREAS. OUR TARGET POPULATION CONSISTS OF THE URBAN POOR, UNINSURED, MEDICAID ELIGIBLE, HOMELESS, RECENT IMMIGRANTS, NON-ENGLISH SPEAKING, AS WELL THOSE WHO ARE ISOLATED FROM SERVICES DUE TO TRANSPORTATION OR CULTURAL BARRIERS. 0 0 20098263 18203018 PRIMARY MEDICAL CARE SERVICES INCLUDE THE DIAGNOSIS AND TREATMENT OF ILLNESS AND INJURY, CHRONIC DISEASE MANAGEMENT, HEALTH EDUCATION AND PREVENTIVE CARE (SUCH AS WELL-CHILD EXAMS, SCREENING SERVICES AND IMMUNIZATIONS), SOCIAL WORK, MENTAL HEALTH AND CHEMICAL DEPENDENCYSERVICES. NEIGHBORCARE HEALTH ALSO PROVIDES NUTRITION EDUCATION, MATERNITY SUPPORT SERVICES (INCLUDING MIDWIFERY SERVICES), WIC (WOMEN, INFANT AND CHILDREN PROGRAM) SERVICES AND OUTREACH, AND PUBLIC INSURANCE APPLICATION ASSISTANCE. NEIGHBORCARE HEALTH PROVIDES SPECIALIZED PROGRAMS SUCH AS WOMEN'S HEALTH, TB, HIV AND PROGRAMS FOCUSED ON CARING FOR HOMELESS YOUTH AND FAMILIES. THE MEDICAL PROGRAM ENCOURAGES PATIENT INVOLVEMENT IN IMPROVING AND MAINTAINING GOOD HEALTH. IN 2011, NEIGHBORCARE HEALTH PROVIDED 143,716 VISITS TO 36,848 PATIENTS. NEIGHBORCARE HEALTH PROVIDED $8,838,394 OF CHARITY CARE IN 2011. 8094253 5492358 GENERAL DENTISTRY SERVICES INCLUDE ORAL HEALTH EXAMS, HYGIENE AND RESTORATIVE SERVICES TO CONTAIN THE DISEASE PROCESS. PERIODONTAL AND ENDODONTIC CARE IS ALSO PROVIDED. IN 2011, NEIGHBORCARE PROVIDED 48,225 DENTAL VISITS TO 18,793 CHILDREN AND ADULTS. 1523544 470416 SCHOOL BASED HEALTH SERVICES INCLUDE PRIMARY MEDICAL SERVICES, MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING, TOBACCO PREVENTION AND CESSATION PROGRAMS AND A VARIETY OF SUPPORT GROUPS FOR YOUTH, ALL WITHIN SEATTLE PUBLIC SCHOOLS. EMPHASIS IS PLACED ON AGE-APPROPRIATE HEALTH EDUCATION AND SKILL-BUILDING TO HELP YOUTH MAKE HEALTHY LIFESTYLE CHOICES SO THAT THEY MAY THRIVE AT SCHOOL AND TO BUILD STRONG RELATIONSHIPS AT SCHOOL, HOME AND IN THEIR COMMUNITY. IN 2011, NEIGHBORCARE HEALTH PROVIDED 12,050 VISITS TO 3,858 SCHOOL-BASED PATIENTS. 1358228 73965 SERVICES FOR HOMELESS PATIENTS INCLUDE PROGRAMS OPERATED IN PARTNERSHIP WITH THE CITY OF SEATTLE'S HEALTH CARE FOR THE HOMELESS INITIATIVE, FAMILY TEAM FOCUSES ON CRISIS INTERVENTION THERAPY, MENTAL HEALTH COUNSELING, CHILD GROWTH AND DEVELOPMENT, IMMUNIZATION SCREENING, PARENTING SKILLS, SELF-CARE SKILLS, CHRONIC AND ACUTE DISEASE MANAGEMENT AND REFERRALS FOR LONG-TERM CARE. THE HOMELESS YOUTH CLINIC PROVIDES SERVICES TO HOMELESS AND STREET INVOLVED YOUTH, INCLUDING: PRIMARY MEDICAL CARE, DENTAL CARE, SOCIAL SERVICES, MENTAL HEALTH COUNSELING, ACUPUNCTURE, NATUROPATHY, YOGA, AND OUTREACH, AS WELL AS A RANGE OF ALLOPATHIC COMPLEMENTARY AND ALTERNATIVE HEALTH CARE SERVICES. 1358228 73965 31074288 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 69 0 1 537 1 0 0 0 0 0 1 1 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 X JANINE CHILDS 2065483034 905 SPRUCE STREET STE 300 SEATTLE WA 98104 JOYCE LAMMERT 4.00 X X 0 0 0 RICK RUBIN 1.00 X X 0 0 0 TONY BOZZUTI 3.00 X X 0 0 0 ANDREA DAHL 1.00 X X 0 0 0 FARIBA ALAMDARI 1.00 X 0 0 0 DICK BARBIERI 2.00 X 0 0 0 ALLY BROWN 1.00 X 0 0 0 NANCY DOUTY 0.50 X 0 0 0 OCTAVIA EDWARDS 3.00 X 0 0 0 SANTOKH GILL 1.00 X 0 0 0 BOB GREENLEE 1.00 X 0 0 0 ROM LEE 1.50 X 0 0 0 JOHN MASON 2.00 X 0 0 0 TAMIKO MIYANO 2.00 X 0 0 0 GEORGE PARKER 1.00 X 0 0 0 TIM RANDALL 1.00 X 0 0 0 MARK SECORD 50.00 X 164812 0 10880 KATIE BELL 50.00 X 135396 0 9734 JANINE CHILDS 45.00 X 123965 0 9378 MARCUS REMPEL 50.00 X 186914 0 12228 MARTIN LIEBERMAN 40.00 X 175976 0 10880 THOMAS P SCOTT 40.00 X 167676 0 10767 ALLISON A FITZGERALD 40.00 X 166260 0 10637 DIANA RYBAKOV 50.00 X 156910 0 10857 BEVERLY J SIMPSON 40.00 X 151268 0 10290 JOHN CHARLES OLSON 40.00 X 138684 0 4427 1567861 0 100078 31 0 1 0 JONES BOYS MAINTENANCE CO 1813 130TH AVE NE SUITE 110 BELLEVUE WA 98005 JANITORIAL 321987 UNIVERSAL LANGUAGE SERVICES INC PO BOX 4147 BELLEVUE WA 98009 INTERPRETATION SERVICES 231002 THE GUIDANCE CORPORATION PO BOX 823473 PHILIDELPHIA PA 19182 TEMP STAFFING 230160 OLYMPIC SECURITY SERVICES INC 631 STRANDER BLVD SUITE A TUKWILA WA 98188 SECURITY SERVICES 143272 4 81312 88549 11138057 3554586 821869 14862504 MEDICARE/MEDICAID PMT 621400 9274310 9274310 CAPITATED PLAN 621400 6403736 6403736 PATIENT FEES 621400 5878869 5878869 OTHER SERVICE REVENUE 621400 2548605 2548605 24105520 119128 119128 8133126 8127595 5531 5531 5531 46485 88549 33564 12921 12921 EHR INCENTIVE PMT 900099 998750 998750 SETTLEMENT PMT 900099 128164 128164 HRSA PMT 900099 84161 84161 147697 147697 1358772 40464376 24105520 0 1634409 840164 259627 580537 20485571 17688449 2748262 48860 426838 358047 68166 625 2605551 2101653 501902 1996 1538508 1300465 234332 3711 103539 52375 51164 67170 33978 33192 1524620 672746 851874 14498 8651 5847 1651238 1480990 170248 734802 371701 363101 709468 607228 102240 70145 23408 46737 180620 98768 81852 260553 226135 34418 1707214 1207200 500014 148521 103626 44895 BAD DEBT EXPENSE 2210320 2210320 PHARMACEUTICALS 1551538 1551538 DUES & TAXES 286224 47021 239203 LABORATORY FEES 227099 227099 715395 443263 236116 36016 38059596 31074288 6894100 91208 643776 1039748 2090984 3374992 2784431 1516750 3123457 3598795 3253686 2170535 162309 171220 735428 927261 35123775 9772347 25784586 25351428 6983671 8037793 13511854 13511269 59074182 59699791 4095986 5182536 198678 202488 23783704 20866704 295050 360112 28373418 26611840 X 29969687 32326421 731077 761530 30700764 33087951 59074182 59699791 X 2404780 -17593 X 0 1 1 X 1 1 X 13316945 14265187 15745847 16152894 14862504 74343377 13316945 14265187 15745847 16152894 14862504 74343377 74343377 575052 552266 410434 263749 119128 1920629 44579 35732 3119 8904 12921 105255 38719 37202 98420 55306 1358772 1588419 77957680 118623063 0.95360 0.96520 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: EHR INCENTIVE PROGRAM SETTLEMENT REIMBURSEMENT 501C AGENCY TRUST MISCELLANEOUS INSURANCE REIMBURSEMENT REBATES & INCENTIVES BOARD MEETING REIMBURSEMENT HRSA PAYMENT RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1000000 1000000 2000000 3000000 11000 4000 15000 250000 250000 500000 750000 2592380 2592380 22735344 4749808 17985536 3450762 1469746 1981016 6274030 3552793 2721237 71259 71259 25351428 FACILITY CONTRIBUTION RECEIVABLE 700492 NEIGHBORCARE HEALTH LENDER RECEIVABLE 12810777 13511269 INTEREST RATE SWAP 360112 360112 40464376 38059596 2404780 47469 -65062 -17593 2387187 40989267 47469 412384 65038 524891 40464376 0 40464376 38472648 412384 668 413052 38059596 0 38059596 PART XI, LINE 8 - OTHER ADJUSTMENTS: INTEREST RATE SWAP AGREEMENT -65,062. PART XII, LINE 2D - OTHER ADJUSTMENTS: INDIRECT SPECIAL EVENTS EXPESNE 668. INTEREST RATE SWAP AGREEMENT -65,062. NEIGHBORCARE LENDER, LLC INTEREST REVENUE 129,432. PART XIII, LINE 2D - OTHER ADJUSTMENTS: INDIRECT SPECIAL EVENTS EXPENSE 668. PUMPKIN PUSH 94631 63764 30867 9770 21128 FEAST AT THE MARKET 40403 24785 15618 2666 135034 88549 46485 9770 2666 21128 33564 12921 X X X 0 0 0 0 0 0 0 0 0 MARK SECORD 164812 0 0 0 0 0 5238 0 5642 0 175692 0 0 0 MARCUS REMPEL 186914 0 0 0 0 0 6449 0 5779 0 199142 0 0 0 MARTIN LIEBERMAN 175976 0 0 0 0 0 5238 0 5642 0 186856 0 0 0 THOMAS P SCOTT 167676 0 0 0 0 0 5125 0 5642 0 178443 0 0 0 ALLISON A FITZGERALD 166260 0 0 0 0 0 4991 0 5646 0 176897 0 0 0 DIANA RYBAKOV 156910 0 0 0 0 0 5082 0 5775 0 167767 0 0 0 BEVERLY J SIMPSON 151268 0 0 0 0 0 4648 0 5642 0 161558 0 0 0 X 6 17446 SELLING PRICE X 2 0 VALUE OF PROPERTY X 12 804423 SELLING PRICE 0 0 1 1 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): VARIOUS METHODS ARE USED TO MEASURE THE NUMBER OF CONTRIBUTIONS OR ITEMS RECEIVED. FOR PUBLICLY TRADED SECURITIES, THE NUMBER OF CONTRIBUTIONS RECEIVED IS COUNTED. WE RECEIVED TWO PARCELS OF LAND IN BUTTONWILLOW, CALIFORNIA FROM AN ESTATE. THE ORGANIZATION RECEIVES VACCINES AND PHARMACEUTICALS THROUGHOUT THE MONTH FOR ITS VARIOUS CLINICS. IT IS DIFFICULT TO TRACK THE NUMBER OF ITEMS RECEIVED EACH MONTH HOWEVER WE ESTMATED THAT WE RECEIVE AT LEAST ONE CONTRIBUTION PER MONTH THROUGHOUT THE YEAR FOR OUR VACCINES AND PHARMACEUTICALS. WE HAVE BEEN KEEPING TRACK OF THE VALUE OF NON-CASH CONTRIBUTIONS WE RECEIVE. THIRD PARTY USE: PART I, LINE 32B: A REALTOR HAS TRIED TO SELL THE LAND PARCELS. NON REPORTING OF REVENUE: PART I, LINE 33: NO VALUE WAS BOOKED FOR THE LAND PARCELS BECAUSE THE VALUE CAN NOT BE DETERMINED OR IS MINIMAL. FORM 990, PART I, LINE 6: OUR VOLUNTEERS PROVIDE MEDICAL, DENTAL, NATUROPATHIC CARE, AS WELL AS CLERICAL ASSISTANCE IN THE CLINICS, INTERPRETER SERVICES, AND ASSISTANCE WITH FUNDRAISING EVENTS. IN ADDITION, THERE ARE 16 VOLUNTEER BOARD OF DIRECTORS. FORM 990, PART I, LINE 19: PART I, LINE 19 INCLUDE EXCESS OPERATING SUPPORT AND REVENUES OF $1,790,693 IN 2010 AND $938,833 IN 2011. THE REMAINING AMOUNTS REPRESENT CAPITAL CAMPAIGN INCOME FOR THE ORGANIZATION'S RAINIER BEACH MEDICAL AND DENTAL CLINIC. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE, WITH AUTHORITY FROM THE BOARD OF DIRECTORS, REVIEWS THE FORM 990 WITH THE CHIEF FINANCIAL OFFICER. A FULL COPY OF THE TAX RETURN IS MADE AVAILABLE TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR ANNUALLY SIGNS A DECLARATION IDENTIFYING CONFLICTS BETWEEN PERSONAL INTERESTS AND THE INTERESTS OF THE ORGANIZATION OF WHICH HE/SHE IS AWARE. IF A CONFLICT EXISTS, IT SHALL BE FULLY DISCLOSED TO THE BOARD OF DIRECTORS AND IN CASES WHERE THE CONFLICT MIGHT INFLUENCE A DECISION, THE PERSON WITH THE CONFLICT SHALL NOT PARTICIPATE IN THE DISCUSSION OR VOTE RELATING TO THE MATTER IN WHICH THE CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD USES MARKET DATA AVAILABLE FROM MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA) AND NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) TO DETERMINE THE EXECUTIVE DIRECTOR'S SALARY. THE EXECUTIVE DIRECTOR'S SALARY IS REVIEWED ANNUALLY WITH THE LAST REVIEW IN JUNE/JULY 2011, OTHER MANAGEMENT SALARIES ARE REVIEWED BY HUMAN RESOURCES DEPARTMENT AND ARE COMPARED TO MARKET DATA FROM MILLIMAN, ETC. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 47,469. INTEREST RATE SWAP AGREEMENT -65,062. TOTAL TO FORM 990, PART XI, LINE 5: -17,593. NEIGHBORCARE LENDER LLC 905 SPRUCE STREET SUITE 300 SEATTLE WA 98104 271529844 FINANCIAL SERVICES WA NEIGHBORCARE HEALTH C 129432 13061101 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 NEIGHBORCARE LENDER LLC D 12810777 CASH NEIGHBORCARE LENDER LLC Q 129432 CASH