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COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY (EIN 91-1255170)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-03-05
IRS object ID
201240659349301139
Schema version
2010v3.4
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)
Timestamp2012-03-05T18:27:56-06:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-07-01TaxPeriodBeginDate

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 Signed2012-03-05DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSARA ELIZABETH J HYREName
Phone4254544919Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts26340453GrossReceipts
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 Employees268TotalNbrEmployees
Total Nbr Volunteers83TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year5174039ContributionsGrantsPriorYear
Contributions Grants Current Year3633432ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17971765ProgramServiceRevenuePriorYear
Program Service Revenue CY17568679ProgramServiceRevenueCY
Investment Income Prior Year403669InvestmentIncomePriorYear
Investment Income Current Year757543InvestmentIncomeCurrentYear
Other Revenue Prior Year1284941OtherRevenuePriorYear
Other Revenue Current Year1642459OtherRevenueCurrentYear
Total Revenue Prior Year24834414TotalRevenuePriorYear
Total Revenue Current Year23602113TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12579469SalariesEtcPriorYear
Salaries Etc Current Year13683865SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year152718TotalFundrsngExpCurrentYear
Other Expense Prior Year7993625OtherExpensePriorYear
Other Expenses Current Year8437744OtherExpensesCurrentYear
Total Expenses Prior Year20573094TotalExpensesPriorYear
Total Expenses Current Year22121609TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4261320RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1480504RevenuesLessExpensesCY
Total Assets BOY53491446TotalAssetsBOY
Total Assets EOY54143248TotalAssetsEOY
Total Liabilities BOY3339908TotalLiabilitiesBOY
Total Liabilities EOY2243258TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY50151538NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY51899990NetAssetsOrFundBalancesEOY
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, 2011, CHC PROVIDED $2,105,683 OF CHARITY CARE SERVICES UNDER THIS POLICY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10738742Expense
Revenue10950641Revenue
DescriptionMEDICAL CARE - TO PROVIDE MEDICAL SERVICES IN PEDIATRICS, ACUTE GENERAL CARE AND OBSTETRICAL CARE TO LOW-INCOME/ HOMELESS PEOPLE AT THREE 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 63,331 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $1,434,181. 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)
Expense5617765Expense
Revenue6618038Revenue
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 40,194 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $671,502.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1262205Expense
Revenue1467624Revenue
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. 81,163 TOTAL PRESCRIPTIONS FILLED FOR THIS FISCAL YEAR.Description
FieldValueIRS element (for citing)
Total Program Service Expense17618712TotalProgramServiceExpense
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 With109620NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees268NumberOfEmployees
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 Docs0ChangesToOrganizingDocs
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 Line1VICKI 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 (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JAMIE DUKE
CHAIR2.00XX000
KATHERINE GANTER
VICE CHAIR2.00XX000
LINDA INGLIN
SECRETARY2.00XX000
LARRY D WARNER
TREASURER2.00XX000
PAUL WOLTZ
BOARD MEMBER2.00X000
NAZAR SAYED
BOARD MEMBER2.00X000
BRENT THOMPSON
BOARD MEMBER2.00X000
TAMMY MARTIN
BOARD MEMBER2.00X000
LARRY MCLYNNE
BOARD MEMBER2.00X000
MALCOM BELL
BOARD MEMBER2.00X000
SHERYL SLEEPER
BOARD MEMBER2.00X000
LENA MILLER
BOARD CHAIR2.00XX000
SCOTT ELY
BOARD MEMBER2.00X000
KENNETH GREEN
EXECUTIVE DIRECTOR45.00X16448808385
ROBERT FARRELL
CFO45.00X9959105803
KIMBRA WELLS-METZ
COO45.00X10094406011
KISHORE SHETTY
DENTAL DIRECTOR40.0011114704318X
LONNIE FULLER
MEDICAL DIRECTOR40.009431802809X
THOMAS TOCHER
MEDICAL DIRECTOR40.00207440662X
ANDREW PERRY
PHYSICIAN40.0017049808220X
ELENA COTULBEA
PHYSICIAN40.0013955606826X
RORY LAUGHERY
PHYSICIAN40.0013109307870X
SANJAY RAJ
PHYSICIAN40.0015245708202X
TINA LIU
DENTIST40.0014258108164X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1101208TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation59481TotalOtherCompensation
Number Individuals GT100 K28NumberIndividualsGT100K
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 SOUTHSEATTLEWA98134CONSTRUCTION5552011
COMPHEALTH INC
PO BOX 972670DALLASTX753972670TEMP. HEALTHCARE STAFFING611937
STAFF CARE
PO BOX 281923ATLANTAGA303841923TEMP. HEALTHCARE STAFFING305086
TECHHEADS
16869 SW 65TH AVE 166LAKE OSWEGOOR97035IT SUPPORT SERVICES248687
LANGUAGE LINE SERVICES
PO BOX 202564DALLASTX753202572INTERPRETER SERVICES189374
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Federated Campaigns5165FederatedCampaigns
Government Grants3611893GovernmentGrants
All Other Contributions16374AllOtherContributions
Noncash Contributions1006441NoncashContributions
Total Contributions3633432TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE/MEDICAID6214001319115813191158
CAPITATED REVENUE62111025684182568418
PATIENT FEES62111018091031809103
FieldValueIRS element (for citing)
Total Program Service Revenue17568679TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column733990TotalRevenueColumn
Exclusion$733,990ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2268630Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2241431Securities
Other3646Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities27199Securities
Other-3646Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column23553TotalRevenueColumn
Exclusion$23,553ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory1960887GrossSalesOfInventory
Cost Of Goods Sold493263CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1467624TotalRevenueColumn
Related Or Exempt Function Income1467624RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
PATIENT RECORDS56100086430$86,430
REFUNDS & REBATES90009982763$82,763
OTHER FEES COLLECTED9000995642$5,642
FieldValueIRS element (for citing)
Total Other Revenue174835TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column23602113TotalRevenueColumn
Related Or Exempt Function Income19036303RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$932,378ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total513345Total
Management And General513345ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10724148Total
Program Services8687788ProgramServices
Management And General1966240ManagementAndGeneral
Fundraising70120Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total93359Total
Program Services77016ProgramServices
Management And General14727ManagementAndGeneral
Fundraising1616Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1401035Total
Program Services1121192ProgramServices
Management And General271533ManagementAndGeneral
Fundraising8310Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total951978Total
Program Services744587ProgramServices
Management And General201445ManagementAndGeneral
Fundraising5946Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total42985Total
Management And General42985ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total57589Total
Management And General57589ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total93782Total
Management And General93782ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1566674Total
Program Services1260312ProgramServices
Management And General306155ManagementAndGeneral
Fundraising207Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total38881Total
Fundraising38881Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total455973Total
Program Services305396ProgramServices
Management And General135334ManagementAndGeneral
Fundraising15243Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total143666Total
Program Services108974ProgramServices
Management And General34692ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total716645Total
Program Services586291ProgramServices
Management And General128123ManagementAndGeneral
Fundraising2231Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total14365Total
Program Services6419ProgramServices
Management And General7559ManagementAndGeneral
Fundraising387Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total91726Total
Program Services54557ProgramServices
Management And General36812ManagementAndGeneral
Fundraising357Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total41574Total
Program Services18422ProgramServices
Management And General23152ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1391187Total
Program Services1149542ProgramServices
Management And General237895ManagementAndGeneral
Fundraising3750Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total104155Total
Program Services74936ProgramServices
Management And General29017ManagementAndGeneral
Fundraising202Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraisingManagement And GeneralManagementAndGeneral
CLINICAL SUPPLIES149906214958753187
BAD DEBT EXPENSE12004441200444
MISCELLANEOUS EXPENSE516160406736916108508
EQUIPMENT RENTAL/ MAINT4628763202251365141286

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22121609Total
Program Services17618712ProgramServices
Management And General4350179ManagementAndGeneral
Fundraising152718Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3174650BOY
EOY2873483EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3594064BOY
EOY1692576EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY887019BOY
EOY14662EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3534488BOY
EOY1552017EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY346321BOY
EOY278800EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY329088BOY
EOY497701EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis34844486LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5511236LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY20411980BOY
EOY29333250EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17063989BOY
EOY17900759EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4149847BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY53491446BOY
EOY54143248EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3234068BOY
EOY2198592EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY61173BOY
EOY7159EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY44667BOY
EOY37507EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3339908BOY
EOY2243258EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY50039538BOY
EOY51794990EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY112000BOY
EOY105000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY50151538BOY
EOY51899990EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY53491446BOY
EOY54143248EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1480504ReconcilationRevenueExpenses
Reconcilation Other Changes267948ReconcilationOtherChanges
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 Years2917990CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3496292CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3663947CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5174039CurrentTaxYearMinus1Year
Current Tax Year3633432CurrentTaxYear
Total18885700Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years21590178CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20465282CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20370396CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19614048CurrentTaxYearMinus1Year
Current Tax Year19529566CurrentTaxYear
Total101569470Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9587CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14631CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years31541CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year96820CurrentTaxYearMinus1Year
Current Tax Year86430CurrentTaxYear
Total239009Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years24517755CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years23976205CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24065884CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year24884907CurrentTaxYearMinus1Year
Current Tax Year23249428CurrentTaxYear
Total120694179Total

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 Total509120694179PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1095571CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years893286CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years681932CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year689086CurrentTaxYearMinus1Year
Current Tax Year733990CurrentTaxYear
Total4093865Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1095571CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years893286CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years681932CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year689086CurrentTaxYearMinus1Year
Current Tax Year733990CurrentTaxYear
Total4093865Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years66710CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years71591CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years21303CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year49943CurrentTaxYearMinus1Year
Current Tax Year88405CurrentTaxYear
Total297952Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years25680036CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years24941082CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24769119CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year25623936CurrentTaxYearMinus1Year
Current Tax Year24071823CurrentTaxYear
Total125085996Total
FieldValueIRS element (for citing)
Public Support Percentage5090.96490PublicSupportPercentage509
Prior Year Support Percentage0.96290PriorYearSupportPercentage
Investment Income Percentage0.03270InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.03390PriorYrInvestIncomePercentage
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)
Investment Cost Or Other Basis2220085InvestmentCostOrOtherBasis
Other Cost Or Other Basis4216798OtherCostOrOtherBasis
Book Value6436883BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis24061555OtherCostOrOtherBasis
Depreciation3074019Depreciation
Book Value20987536BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3079OtherCostOrOtherBasis
Depreciation3079Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4222781OtherCostOrOtherBasis
Depreciation2431687Depreciation
Book Value1791094BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis120188OtherCostOrOtherBasis
Depreciation2451Depreciation
Book Value117737BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings29333250TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
CAPITAL LEASE - ST PORTION$8,304
CAPITAL LEASE - LT PORTION$29,203
FieldValueIRS element (for citing)
Total Of Amounts37507TotalOfAmounts
Total Revenue23602113TotalRevenue
Total Expenses22121609TotalExpenses
Excess Or Deficit For Year1480504ExcessOrDeficitForYear
Net Unrealized GL On Investments267948NetUnrealizedGLOnInvestments
Total Adjustments267948TotalAdjustments
Excess Or Deficit Per FS1748452ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt24269542TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments267948NetUnrealizedGainsInvestments
Revenue Not Rptd F990267948RevenueNotRptdF990
Revenue Subtotal24001594RevenueSubtotal
Investment Expenses Not Included93782InvestmentExpensesNotIncluded
Other Revenues Not Included-493263OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-399481RevenueNotRptdOnFinStmt
Total Revenue Per Form99023602113TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt22521090TotExpensesEtcAuditedFinclStmt
Other Expenses Included493263OtherExpensesIncluded
Expenses Not Rptd F990493263ExpensesNotRptdF990
Expenses Subtotal22027827ExpensesSubtotal
Investment Expenses Not Included293782InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt93782ExpensesNotRptdOnFinStmt
Total Expenses Per Form99022121609TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
PART XII, LINE 4B - OTHER ADJUSTMENTS:COST OF GOODS SOLD INCLUDED IN REVENUE ON FINANCIAL STATEMENTS -493,263.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:COST OF GOODS SOLD INCLUDED IN REVENUE ON FINANCIAL STATEMENTS 493,263.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
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 (4 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
KENNETH GREEN
164488000000083850172873000
ANDREW PERRY
1604980100000000082200178718000
SANJAY RAJ
152457000000082020160659000
TINA LIU
14195806230000081640150745000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4AReturnReference
ExplanationRORY LAUGHERY RECEIVED $44,135 AND KIMBRA WELLS-METZ RECEIVED $8,630 IN SEVERANCE PAYMENTS DURING THE YEAR.Explanation

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions21483NumberOfContributions
Noncash Contribs Rptd F9901006441NoncashContribsRptdF990
Method Of Determining RevenuesCOST OR SELLING PRICEMethodOfDeterminingRevenues
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 (6 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 BUT THERE WERE ALSO 10 NON-EMPLOYEE VOLUNTEERS OVER THE COURSE OF THE YEAR. MEMBERS OF THE BOARD OF DIRECTORS ARE ALSO VOLUNTEERS.
THE BOARD OF DIRECTORS REVIEWS AND APPROVE CHC'S FORM 990 PRIOR TO ITS FILING WITH THE IRS. THE APPROVAL PROCESS IS AS FOLLOWS: THE BOARD OF DIRECTORS RECEIVES A COPY OF FORM 990. THE FINANCE COMMITTEE THOROUGHLY REVIEWS FORM 990 AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS TO APPROVE IT. THE BOARD OF DIRECTORS WILL 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 11
FORM 990, PART VI, SECTION B, LINE 12CCHC OF SNOHOMISH EMPLOYEE HANDBOOK CONTAINS THE ORGANIZATIONS CONFLICT OF INTEREST POLICY. EACH EMPLOYEE AND BOARD MEMBER IS REQUIRED TO SIGN OFF AS HAVING READ THE CHC EMPLOYEE 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 EXECUTIVE DIRECTOR 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 EXECUTIVE DIRECTOR'S COMPENSATION AND WITH THE ASSISTANCE OF AN OUTSIDE CONSULTANT, PERFORMS A PERFORMANCE EVALUATION TO SET COMPENSATION. THE HUMAN RESOURCES DIRECTOR MAY ASSIST AS NECESSARY. THE CFO 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 2011.
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 GAINS ON INVESTMENTS: 267,948.CHANGES IN NET ASSETS OR FUND BALANCES: