2011-03-09T21:51:58-06:00 2010-06-30 Clark Nuber PS 10900 NE 4th Street Suite 1700 Bellevue WA 98004 990 2009-07-01 911255170 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY COMM 4257893700 PO BOX 13060 EVERETT WA 98206 ROBERT FARRELL 4257893700 2011-03-09 1 Sara Elizabeth J Hyre 4254544919 2009 2016-02-24 21:20:13Z ROBERT C FARRELL PO BOX 13060 EVERETT WA 98206 35849314 0 X WWW.CHCSNO.ORG X 1986 WA TO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE. 8 8 262 30 0 0 3663947 5174039 18461990 17971765 379726 403669 1262699 1284941 23768362 24834414 0 0 12843731 12579469 0 117475 9341259 7993625 22184990 20573094 1583372 4261320 46973685 53491446 2182318 3339908 44791367 50151538 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, 2010, CHC PROVIDED $1,397,451 OF CHARITY CARE SERVICES UNDER THIS POLICY. 0 0 9364858 10416248 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 63,880 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $1,052,408. IN ADDITION, CHC PROVIDED PRIMARY CARE OUTREACH SERVICES FOR HOMELESS INDIVIDUALS AND FAMILIES AT THREE TRANSITIONAL HOUSING AGENCIES IN SNOHOMISH COUNTY. 4966770 7067291 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 41,081 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $345,043. 1535254 1626404 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. 65,690 TOTAL PRESCRIPTIONS FILLED FOR THIS FISCAL YEAR. 15866882 1 1 0 0 0 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 1 0 0 0 0 0 0 0 0 1 33 0 1 262 1 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 WA X BOB FARRELL 4257893700 PO BOX 13060 EVERETT WA 98206 LENA MILLER 2.00 X X 0 0 0 JAMIE DUKE 2.00 X X 0 0 0 LARRY WARNER 2.00 X X 0 0 0 LINDA INGLIN 2.00 X X 0 0 0 NAZAR SAYED 2.00 X 0 0 0 PAUL WOLTZ 2.00 X 0 0 0 BRENT THOMPSON 2.00 X 0 0 0 SCOTT ELY 2.00 X 0 0 0 KAREN LINDSEY 2.00 X 0 0 0 JOHN GRANBERG 2.00 X 0 0 0 JULIYYA VANDENBURG 2.00 X 0 0 0 KENNETH GREEN 45.00 X 145385 0 13559 MARY ALBERT 40.00 X 94231 0 4828 CHARLES FAUST 40.00 X 118662 0 3267 ROBERT FARRELL 40.00 X 0 0 0 THOMAS TOCHER 40.00 X 197308 0 14526 RORY LAUGHERY 40.00 X 169038 0 16373 CHIYANG WU 40.00 X 160808 0 12094 ALLISON COLE 40.00 X 156808 0 8558 DAVID JIMENEZ-CELI 40.00 X 155948 0 7908 TINA LIU 40.00 X 142962 0 15041 1341150 0 96154 23 0 1 0 JR ABBOTT CONSTRUCTION 3408 1ST AVE SOUTH SEATTLE WA 98134 CONSTRUCTION 2884112 COMPHEALTH INC PO BOX 972670 DALLAS TX 753972670 TEMP. HEALTHCARE STAFFING 193471 LANGUAGE LINE SERVICES PO BOX 202564 DALLAS TX 753202572 INTERPRETER SERVICES 169268 TECHHEADS 16869 SW 65TH AVE 166 LAKE OSWEGO OR 97035 IT SUPPORT SERVICES 138552 MAXIM HEALTHCARE SERVICES 12558 COLLECTIONS CENTER DR CHICAGO IL 60693 TEMP. HEALTHCARE STAFFING 134712 6 7824 5156828 9387 872866 5174039 MEDICARE/MEDICAID 621400 13260721 13260721 PATIENT FEES 621110 4107928 4107928 CAPITATED REVENUE 900099 603116 603116 17971765 689086 689086 10221158 4220 10153221 357574 67937 -353354 -285417 -285417 1642283 504105 1138178 1138178 PATIENT RECORDS 561000 96820 96820 OTHER FEES COLLECTED 900099 49943 49943 146763 24834414 19109943 0 550432 389262 389262 9840159 8221095 1553756 65308 102406 81017 19656 1733 1358211 1103130 247201 7880 889431 719530 164286 5615 24497 24497 51575 51575 92073 92073 1194448 561518 630380 2550 13008 13008 521050 357435 152546 11069 349429 7249 341986 194 688253 565009 121083 2161 15509 6804 8197 508 102572 58335 44222 15 40868 14874 25994 1741590 1437949 299914 3727 108482 83450 24801 231 CLINICAL SUPPLIES 1260047 1258964 1083 BAD DEBT EXPENSE 1130598 1130598 EQUIPMENT RENTAL/ MAINT 352194 109827 241717 650 MISCELLANEOUS EXPENSE 307432 150098 155591 1743 20573094 15866882 4588737 117475 1391913 3174650 6822620 3594064 27249 887019 3188928 3534488 327101 346321 145978 329088 25919221 5507241 22219551 20411980 12657859 17063989 192486 4149847 46973685 53491446 2036420 3234068 145898 61173 0 44667 2182318 3339908 X 44672367 50039538 119000 112000 44791367 50151538 46973685 53491446 X 0 1 1 X 1 1 X 2698702 2917990 3496292 3663947 5174039 17950970 19477607 21590178 20465282 20370396 19614048 101517511 22176309 24508168 23961574 24034343 24788087 119468481 0 0 0 119468481 844507 1095571 893286 681932 689086 4204382 844507 1095571 893286 681932 689086 4204382 35299 76297 86222 52844 146763 397425 23056115 25680036 24941082 24769119 25623936 124070288 0.96290 0.96280 0.03390 0.03480 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3711163 2725720 6436883 16175107 2775870 13399237 229347 221247 8100 3059500 2508898 550602 18384 1226 17158 20411980 CONSTRUCTION IN PROGRESS 4148906 DEPOSITS 941 4149847 CAPITAL LEASE - ST PORTION 7161 CAPITAL LEASE - LT PORTION 37506 44667 24834414 20573094 4261320 1098851 1098851 5360171 26345297 1098851 1098851 25246446 92073 -504105 -412032 24834414 20985126 504105 504105 20481021 92073 92073 20573094 Part XII, Line 4b - Other Adjustments: COST OF GOODS SOLD INCLUDED IN REVENUE ON FINANCIAL STATEMENTS: -504105. Part XIII, Line 2d - Other Adjustments: COST OF GOODS SOLD INCLUDED IN REVENUE ON FINANCIAL STATEMENTS: 504105. X X X X X 0 0 0 0 0 0 0 0 0 KENNETH GREEN 145385 0 0 0 0 0 5510 0 8049 0 158944 0 0 0 THOMAS TOCHER 197308 0 0 0 0 0 9865 0 4661 0 211834 0 0 0 RORY LAUGHERY 169038 0 0 0 0 0 8452 0 7921 0 185411 0 0 0 CHIYANG WU 160808 0 0 0 0 0 4173 0 7921 0 172902 0 0 0 ALLISON COLE 156808 0 0 0 0 0 7840 0 718 0 165366 0 0 0 DAVID JIMENEZ-CELI 155948 0 0 0 0 0 0 0 7908 0 163856 0 0 0 TINA LIU 142962 0 0 0 0 0 7148 0 7893 0 158003 0 0 0 X 19973 872866 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 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 INVESTIGATE AND RESOLVE THE CONFLICT OF INTEREST COMPLAINT. 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 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. Form 990, Part VI, Section C, line 19 THESE WOULD BE AVAILABLE UPON REQUEST ONLY. 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 VII ROBERT FARRELL'S (CFO) IS REPORTED AS HAVING NO INCOME BECAUSE HE STARTED WORKING FOR COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY IN FEBRUARY 2010 AND PART VII COMPENSATION IS BASED ON COMPENSATION FOR THE 2009 CALENDAR YEAR.