2012-03-05T18:27:56-06:00 2011-06-30 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2010-07-01 911255170 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY COMM 4257893700 PO BOX 13060 EVERETT WA 98206 VICTORIA M RINGNESS 4257893700 2012-03-05 1 SARA ELIZABETH J HYRE 4254544919 2010 2016-02-24 21:20:13Z ROBERT C FARRELL PO BOX 13060 EVERETT WA 98206 26340453 0 X WWW.CHCSNO.ORG X 1986 WA TO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE. 11 11 268 83 0 0 5174039 3633432 17971765 17568679 403669 757543 1284941 1642459 24834414 23602113 0 0 0 0 12579469 13683865 0 0 152718 7993625 8437744 20573094 22121609 4261320 1480504 53491446 54143248 3339908 2243258 50151538 51899990 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, 2011, CHC PROVIDED $2,105,683 OF CHARITY CARE SERVICES UNDER THIS POLICY. 0 0 10738742 10950641 MEDICAL 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. 5617765 6618038 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 40,194 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $671,502. 1262205 1467624 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. 81,163 TOTAL PRESCRIPTIONS FILLED FOR THIS FISCAL YEAR. 17618712 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 20 0 1 268 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X VICKI RINGNESS 4257893700 PO BOX 13060 EVERETT WA 98206 JAMIE DUKE 2.00 X X 0 0 0 KATHERINE GANTER 2.00 X X 0 0 0 LINDA INGLIN 2.00 X X 0 0 0 LARRY D WARNER 2.00 X X 0 0 0 PAUL WOLTZ 2.00 X 0 0 0 NAZAR SAYED 2.00 X 0 0 0 BRENT THOMPSON 2.00 X 0 0 0 TAMMY MARTIN 2.00 X 0 0 0 LARRY MCLYNNE 2.00 X 0 0 0 MALCOM BELL 2.00 X 0 0 0 SHERYL SLEEPER 2.00 X 0 0 0 LENA MILLER 2.00 X X 0 0 0 SCOTT ELY 2.00 X 0 0 0 KENNETH GREEN 45.00 X 164488 0 8385 ROBERT FARRELL 45.00 X 99591 0 5803 KIMBRA WELLS-METZ 45.00 X 100944 0 6011 KISHORE SHETTY 40.00 X 111147 0 4318 LONNIE FULLER 40.00 X 94318 0 2809 THOMAS TOCHER 40.00 X 20744 0 662 ANDREW PERRY 40.00 X 170498 0 8220 ELENA COTULBEA 40.00 X 139556 0 6826 RORY LAUGHERY 40.00 X 131093 0 7870 SANJAY RAJ 40.00 X 152457 0 8202 TINA LIU 40.00 X 142581 0 8164 1101208 0 59481 28 0 1 0 JR ABBOTT CONSTRUCTION 3408 1ST AVE SOUTH SEATTLE WA 98134 CONSTRUCTION 5552011 COMPHEALTH INC PO BOX 972670 DALLAS TX 753972670 TEMP. HEALTHCARE STAFFING 611937 STAFF CARE PO BOX 281923 ATLANTA GA 303841923 TEMP. HEALTHCARE STAFFING 305086 TECHHEADS 16869 SW 65TH AVE 166 LAKE OSWEGO OR 97035 IT SUPPORT SERVICES 248687 LANGUAGE LINE SERVICES PO BOX 202564 DALLAS TX 753202572 INTERPRETER SERVICES 189374 5 5165 3611893 16374 1006441 3633432 MEDICARE/MEDICAID 621400 13191158 13191158 CAPITATED REVENUE 621110 2568418 2568418 PATIENT FEES 621110 1809103 1809103 17568679 733990 733990 2268630 2241431 3646 27199 -3646 23553 23553 1960887 493263 1467624 1467624 PATIENT RECORDS 561000 86430 86430 REFUNDS & REBATES 900099 82763 82763 OTHER FEES COLLECTED 900099 5642 5642 174835 23602113 19036303 0 932378 513345 513345 10724148 8687788 1966240 70120 93359 77016 14727 1616 1401035 1121192 271533 8310 951978 744587 201445 5946 42985 42985 57589 57589 93782 93782 1566674 1260312 306155 207 38881 38881 455973 305396 135334 15243 143666 108974 34692 716645 586291 128123 2231 14365 6419 7559 387 91726 54557 36812 357 41574 18422 23152 1391187 1149542 237895 3750 104155 74936 29017 202 CLINICAL SUPPLIES 1499062 1495875 3187 BAD DEBT EXPENSE 1200444 1200444 MISCELLANEOUS EXPENSE 516160 406736 108508 916 EQUIPMENT RENTAL/ MAINT 462876 320225 141286 1365 22121609 17618712 4350179 152718 3174650 2873483 3594064 1692576 887019 14662 3534488 1552017 346321 278800 329088 497701 34844486 5511236 20411980 29333250 17063989 17900759 4149847 0 53491446 54143248 3234068 2198592 61173 7159 44667 37507 3339908 2243258 X 50039538 51794990 112000 105000 50151538 51899990 53491446 54143248 X 1480504 267948 X 0 1 1 X 1 1 X 2917990 3496292 3663947 5174039 3633432 18885700 21590178 20465282 20370396 19614048 19529566 101569470 9587 14631 31541 96820 86430 239009 24517755 23976205 24065884 24884907 23249428 120694179 0 0 0 120694179 1095571 893286 681932 689086 733990 4093865 1095571 893286 681932 689086 733990 4093865 66710 71591 21303 49943 88405 297952 25680036 24941082 24769119 25623936 24071823 125085996 0.96490 0.96290 0.03270 0.03390 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2220085 4216798 6436883 24061555 3074019 20987536 3079 3079 0 4222781 2431687 1791094 120188 2451 117737 29333250 CAPITAL LEASE - ST PORTION 8304 CAPITAL LEASE - LT PORTION 29203 37507 23602113 22121609 1480504 267948 267948 1748452 24269542 267948 267948 24001594 93782 -493263 -399481 23602113 22521090 493263 493263 22027827 93782 93782 22121609 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. X X X X 1 0 0 0 0 0 0 0 0 KENNETH GREEN 164488 0 0 0 0 0 0 0 8385 0 172873 0 0 0 ANDREW PERRY 160498 0 10000 0 0 0 0 0 8220 0 178718 0 0 0 SANJAY RAJ 152457 0 0 0 0 0 0 0 8202 0 160659 0 0 0 TINA LIU 141958 0 623 0 0 0 0 0 8164 0 150745 0 0 0 PART I, LINE 4A RORY LAUGHERY RECEIVED $44,135 AND KIMBRA WELLS-METZ RECEIVED $8,630 IN SEVERANCE PAYMENTS DURING THE YEAR. X 21483 1006441 COST OR SELLING PRICE 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 BUT THERE WERE ALSO 10 NON-EMPLOYEE VOLUNTEERS OVER THE COURSE OF THE YEAR. MEMBERS OF THE BOARD OF DIRECTORS ARE ALSO VOLUNTEERS. FORM 990, PART VI, SECTION B, LINE 11 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 12C CHC 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 15 THE 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 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 GAINS ON INVESTMENTS: 267,948.