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TRI CITIES COMMUNITY HEALTH: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
TRI CITIES COMMUNITY HEALTH (EIN 91-1138675)
Tax period
2009-06-01 to 2010-05-31
Filed
2011-01-14
IRS object ID
201130149349301118
Schema version
2009v1.7
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)
Timestamp2011-01-14T15:50:49-06:00Timestamp
Tax Period End Date2010-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DINGUS ZARECOR & ASSOCIATESBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line112015 E MAIN STE AAddressLine1
CitySPOKANE VALLEYCity
StateWAState
ZIP Code99206ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN911138675EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LA CLINICA-SOUTH COLUMBIA RURALBusinessNameLine1
Business Name Line2HEALTH CLINICBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlLACLNameControl
Phone5055472204Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1515 WEST COURT ST PO BOX 1452AddressLine1
CityPASCOCity
StateWAState
ZIP Code99301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCARL I WALTERS IIName
TitleCHIEF EXECUTIVE OFFICERTitle
Phone5055472204Phone
Date Signed2011-01-12DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTOM DINGUSName
Phone5092420874Phone
Date Prepared2011-01-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH CENTER LA CLINICABusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCARL I WALTERS IINameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1515 WEST COURT STAddressLine1
CityPASCOCity
StateWAState
ZIP Code99301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts19344879GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.TCC-HEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1981YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HIGH QUALITY, EFFECTIVE, AND AFFORDABLE HEALTH CARE AND OTHER ASSOCIATED SERVICES IN A COMPASSIONATE AND CULTURALLY SENSITIVE MANNER TO ALL PEOPLE WITHOUT PREJUDICE TO RACE, COLOR, CREED, GENDER OR ECONOMIC STATUS.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees240TotalNbrEmployees
Total Nbr Volunteers25TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year4088481ContributionsGrantsPriorYear
Contributions Grants Current Year7854066ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13947870ProgramServiceRevenuePriorYear
Program Service Revenue CY10759171ProgramServiceRevenueCY
Investment Income Prior Year66565InvestmentIncomePriorYear
Investment Income Current Year468446InvestmentIncomeCurrentYear
Other Revenue Prior Year37293OtherRevenuePriorYear
Other Revenue Current Year140723OtherRevenueCurrentYear
Total Revenue Prior Year18140209TotalRevenuePriorYear
Total Revenue Current Year19222406TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year13223045SalariesEtcPriorYear
Salaries Etc Current Year12033420SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3995121OtherExpensePriorYear
Other Expenses Current Year4497653OtherExpensesCurrentYear
Total Expenses Prior Year17218166TotalExpensesPriorYear
Total Expenses Current Year16531073TotalExpensesCurrentYear
Revenues Less Expenses Prior Year922043RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2691333RevenuesLessExpensesCY
Total Assets BOY8734693TotalAssetsBOY
Total Assets EOY11999543TotalAssetsEOY
Total Liabilities BOY3160942TotalLiabilitiesBOY
Total Liabilities EOY4069525TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5573751NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7930018NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HIGH QUALITY, EFFECTIVE, AND AFFORDABLE HEALTH CARE AND OTHER ASSOCIATED SERVICES IN A COMPASSIONATE AND CULTURALLY SENSITIVE MANNER TO ALL PEOPLE WITHOUT PREJUDICE TO RACE, COLOR, CREED, GENDER OR ECONOMIC STATUS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense9228360Expense
Revenue9884927Revenue
DescriptionTHE CLINIC PROVIDES MEDICAL, DENTAL, AND URGENT CARE TO MIGRANT AND LOW INCOME PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 1,216,699 FOR CHARITY CARE, 457,107 FOR MEDICARE, 1,528,296 FOR MEDICAID, AND 3,232,650 FOR OTHER THIRD PARTY PAYORS FOR THE YEAR. THE CLINIC PROVIDED 49,805 MEDICAL, 13,469 DENTAL, AND 14,023 URGENT CARE ENCOUNTERS FOR THE YEAR.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2306065Expense
Revenue127662Revenue
DescriptionTHE CLINIC PROVIDES MENTAL AND SUBSTANCE ABUSE COUNSELING, THERAPY AND PSYCHIATRIC SERVICES TO MIGRANT AND LOW INCOME PERSONS THROUGOUT THE BENTON AND FRANKLIN COUNTIES. THE PROGRAM SERVES APPROXIMATE 215 CHILDREN, 235 ADOLESCENTS, AND 1,103 ADULTS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1178877Expense
Revenue746582Revenue
DescriptionTHE CLINIC PROVIDES NUTRITIONAL AND EARLY DEVELOPMENT SERVICES TO OVER 4,000 MIGRANT AND LOW INCOME INDIVIDUALS. OUR SOCIAL SERVICES DEPARTMENT ASSISTS FAMILIES THROUGH COMMUNITY EDUCATION, WIC NUTRITIONAL PROGRAMS AND MANAGED CARE.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
DescriptionTHE CLINIC PARTICIPATED IN A PROGRAM TO PROVIDE FINANCING FOR LAND ACQUISITION AND MORTGAGE SUBSIDIES FOR VERY LOW-INCOME FAMILIES IN BENTON, FRANKLIN, AND WALLA WALLA COUNTIES OF WASHINGTON STATE. THE CLINIC HAS CHOSEN NOT TO CONTINUE THE HOUSING PROGRAM. NO NEW SUBSIDIES OR LOT PURCHASES ARE BEING MADE. ACTIVITY IS LIMITED TO THE SALE OF EXISTING LOTS AND REPAYMENT OF SUBSIDIES, WHICH WILL BE USED TO REPAY THE ACCRUED HOUSING COSTS.Description
FieldValueIRS element (for citing)
Total Program Service Expense12713302TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109639NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees240NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledtrueForm1098CFiled
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCARL I WALTERS IINamePerson
Telephone Number5095472204TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1452AddressLine1
CityPASCOCity
StateWAState
ZIP Code99301ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
LINDA GUSTAFSON
PRESIDENT1.00X000
RAMPUR VISWANATH
VICE PRESIDE1.00X000
AVIGAIL SANCHEZ
TREASURER1.00X000
BEVERLY HERRIN
SECRETARY1.00X000
JOSE A ROJAS
MEMBER1.00X000
RON WEED
MEMBER1.00X000
DOROTEO CHAVEZ
MEMBER1.00X000
JOHN INTRAVARTOLO
MEMBER1.00X000
LILLIAN PARRA
MEMBER1.00X000
RUDY MENDOZA
MEMBER1.00X000
SERGIO FLORES
CMO40.00270489016492X
CARL I WALTERS II
CEO40.00189531013171X
DIANN KUMMER
COO40.001167150399X
ROBERT WILKINSON
INTERIM CFO40.004803808236X
AMY LEMMONS
INTERIM CFO40.003438305990X
MICHEL DEWITT
CFO40.00000X
LEONEL ZOLESSI
PHYSICIAN40.00290493012080X
ZIBA IRAEE
PHYSICIAN40.00222335016317X
RICHARD WILLIAMS
PHYSICIAN40.0019160006833X
LAURIE ZIMMERMAN
PHYSICIAN40.00188131017322X
JAVIER HUERTA
PHYSICIAN AS40.00148560017322X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1700275TotalReportableCompFromOrg
Total Other Compensation114162TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MEIER ENTERPRISES INC
8697 W GAGE BLVDKENNEWICKWA99336ARCHITECT273104
COMMUNITY LINK CONSULTING INC
25011 E TRENT AVE CNEWMAN LAKEWA99025FINANCIAL257777
PERKINS COIE
1201 3RD AVE SUITE 4800SEATTLEWA98101LEGAL COUNSEL116249
STAFF CARE INC
4021 SOUTH 700 EAST STE 220SALT LAKE CITYUT84107PHYSICIAN SRVS112868
SILVER BOW ROOFING INC
3718 W 15TH AVEKENNEWICKWA99338CONSTRUCTION101814
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants4111341GovernmentGrants
All Other Contributions3742725AllOtherContributions
Noncash Contributions387464NoncashContributions
Total Contributions7854066TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENUE, NET62410070311297031129
CAPITATION REVENUE62410037280423728042
FieldValueIRS element (for citing)
Total Program Service Revenue10759171TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column38255TotalRevenueColumn
Exclusion$38,255ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities474918Securities
Other77746Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other122473Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities474918Securities
Other-44727Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column430191TotalRevenueColumn
Exclusion$430,191ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
OTHER90009987962$87,962
MEDICAL RECORDS90009952761$52,761
FieldValueIRS element (for citing)
Total Other Revenue140723TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column19222406TotalRevenueColumn
Related Or Exempt Function Income10759171RelatedOrExemptFunctionIncome
Exclusion$609,169ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total712775Total
Program Services63984ProgramServices
Management And General648791ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8884519Total
Program Services7804851ProgramServices
Management And General1079668ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total91487Total
Program Services64448ProgramServices
Management And General27039ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1344411Total
Program Services1080479ProgramServices
Management And General263932ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1000228Total
Program Services791838ProgramServices
Management And General208390ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total453064Total
Program Services3408ProgramServices
Management And General449656ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total89656Total
Management And General89656ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total887275Total
Program Services700159ProgramServices
Management And General187116ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total116398Total
Program Services17787ProgramServices
Management And General98611ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1354832Total
Program Services1141164ProgramServices
Management And General213668ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total85472Total
Program Services28696ProgramServices
Management And General56776ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total494106Total
Program Services317593ProgramServices
Management And General176513ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total78714Total
Program Services32618ProgramServices
Management And General46096ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total34058Total
Program Services26662ProgramServices
Management And General7396ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total8948Total
Management And General8948ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total234963Total
Program Services123733ProgramServices
Management And General111230ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total72509Total
Program Services45134ProgramServices
Management And General27375ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
OTHER EXPENSE28766822484862820
BAD DEBT179510179510
DUES AND SUBSCRIPTIONS657981337052428
LICENSES AND TAXES54682530201662

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total16531073Total
Program Services12713302ProgramServices
Management And General3817771ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY32660BOY
EOY12929EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2500632BOY
EOY4327140EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY385057BOY
EOY1153610EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY913326BOY
EOY1114235EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1478715BOY
EOY1406728EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY9900BOY
EOY8172EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY42942BOY
EOY23414EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis6866445LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4241790LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1998803BOY
EOY2624655EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY596423BOY
EOY659993EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY776235BOY
EOY668667EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8734693BOY
EOY11999543EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1901697BOY
EOY1366774EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1259245BOY
EOY437729EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
EOY2265022EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3160942BOY
EOY4069525EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY5573751BOY
EOY7930018EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5573751BOY
EOY7930018EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8734693BOY
EOY11999543EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

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

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis173983OtherCostOrOtherBasis
Book Value173983BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3200718OtherCostOrOtherBasis
Depreciation1891453Depreciation
Book Value1309265BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2769836OtherCostOrOtherBasis
Depreciation2350337Depreciation
Book Value419499BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis721908OtherCostOrOtherBasis
Book Value721908BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2624655TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
SELF-FUNDED INSURANCE ASSET336492
HOUSING PREDEVELOPMENT COSTS312175
BHP SPONSORSHIP PROGRAM20000
FieldValueIRS element (for citing)
Total Book Value Other Assets668667TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ACCRUED HOUSING COSTS$1,106,000
ESTIMATED POOL SETTLEMENT$948,022
ESTIMATED MEDICAID ENHANCEMENT$211,000
FieldValueIRS element (for citing)
Total Of Amounts2265022TotalOfAmounts
Total Revenue19222406TotalRevenue
Total Expenses16531073TotalExpenses
Excess Or Deficit For Year2691333ExcessOrDeficitForYear
Net Unrealized GL On Investments42175NetUnrealizedGLOnInvestments
Other-$377,241OtherAmount
Total Adjustments-335066TotalAdjustments
Excess Or Deficit Per FS2356267ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt19264581TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments42175NetUnrealizedGainsInvestments
Revenue Not Rptd F99042175RevenueNotRptdF990
Revenue Subtotal19222406RevenueSubtotal
Total Revenue Per Form99019222406TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt16908314TotExpensesEtcAuditedFinclStmt
Other Expenses Included377241OtherExpensesIncluded
Expenses Not Rptd F990377241ExpensesNotRptdF990
Expenses Subtotal16531073ExpensesSubtotal
Total Expenses Per Form99016531073TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
RECONCILIATION OF CHANGES - OTHERSCHEDULE D, PAGE 4, PART XI, LINE 8RISK POOL LOSS -377,241
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHERSCHEDULE D, PAGE 4, PART XIII, LINE 2DRISK POOL LOSS 377,241

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
SERGIO FLORES
27048916492286981
CARL I WALTERS II
18953113171202702
LEONEL ZOLESSI
29049312080302573
ZIBA IRAEE
22233516317238652
RICHARD WILLIAMS
1916006833198433
LAURIE ZIMMERMAN
18813117322205453
JAVIER HUERTA
14856017322165882

Schedule M IRS990ScheduleM

Cars And Other Vehicles CarsAndOtherVehicles

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99016335NoncashContribsRptdF990
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenues

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990315287NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionOFFICE FURNITURDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99055842NoncashContribsRptdF990
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990 - ORGANIZATION'S MISSIONTO PROVIDE HIGH QUALITY, EFFECTIVE, AND AFFORDABLE HEALTH CARE AND OTHER ASSOCIATED SERVICES IN A COMPASSIONATE AND CULTURALLY SENSITIVE MANNER TO ALL PEOPLE WITHOUT PREJUDICE TO RACE, COLOR, CREED, GENDER OR ECONOMIC STATUS.
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITSFORM 990, PAGE 1, PART I, LINE 6VOLUNTEERS FOR THE CLINIC PROVIDE SUPPORT IN ADMINISTRATION, FACILITY, AND SUPPORT SERVICE DEPARTMENTS.
ALL OTHER ACHIEVEMENTS DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4DTHE CLINIC PARTICIPATED IN A PROGRAM TO PROVIDE FINANCING FOR LAND ACQUISITION AND MORTGAGE SUBSIDIES FOR VERY LOW-INCOME FAMILIES IN BENTON, FRANKLIN, AND WALLA WALLA COUNTIES OF WASHINGTON STATE. THE CLINIC HAS CHOSEN NOT TO CONTINUE THE HOUSING PROGRAM. NO NEW SUBSIDIES OR LOT PURCHASES ARE BEING MADE. ACTIVITY IS LIMITED TO THE SALE OF EXISTING LOTS AND REPAYMENT OF SUBSIDIES, WHICH WILL BE USED TO REPAY THE ACCRUED HOUSING COSTS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11A COPY OF THE 990 IS PROVIDED TO THE CEO AND CFO WHO REVIEWS THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PRESENTED TO THE CEO, WHO THEN APPROVES THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. THE BOARD OF DIRECTORS ARE NOTIFIED WHEN THE RETURN HAS BEEN FILED AND THE BOARD OF DIRECTORS REVIEW THE FILED RETURN AT THE NEXT SCHEDULED BOARD FINANCE COMMITTEE MEETING.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CALL BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST AT THE TIME OF APPOINTMENT TO THE BOARD. DISCLOSURES ARE REVIEWED BY THE FULL BOARD. IF A CONFLICT OF INTEREST EXISTS, THE BOARD MEMBER IS EXCUSED FROM ALL DISCUSSIONS AND ANY VOTING THAT RELATES TO THE MATTER IN QUESTION. IT IS UNDERSTOOD THAT ALL BOARD MEMBERS HAVE AN OBLIGATION TO REPORT ANY MATTERS OR ISSUES THAT MAY BE APPLICABLE TO REPORT PURSUANT TO THE CONFLICT OF INTEREST POLICY.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE HUMAN RESOURCES DEPARTMENT REGULARLY CONDUCTS SALARY REVIEWS AND SURVEYS FOR ALL POSITIONS, INCLUDING KEY EMPLOYEES, AND ADVISES THE BOARD OF DIRECTORS THEIR FINDINGS UPON REQUEST.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BTHE COMPENSATION PROCESS FOR OTHER OFFICERS IS THE SAME AS THE COMPENSATION PROCESS DESCRIBED ABOVE.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
ADDITIONAL INFORMATIONSCHEDULE OEFFECTIVE JULY 2010, THE CLINIC CHANGED ITS NAME TO TRI-CITIES COMMUNITY HEALTH. FORM 990, PART X, LINE 10 - DESCRIPTION OF DEPRECIATION EXPENSE COMPUTATION IT IS THE CLINIC'S POLICY TO CAPITALIZE PROPERTY, BUILDINGS AND EQUIPMENT WITH A BASIS GREATER THAN 5,000 AND AN ESTIMATED USEFUL LIFE OF ONE OR MORE YEARS, LESSER AMOUNTS ARE EXPENSED. PROPERTY, BUILDINGS, AND EQUIPMENT ARE STATED AT COST. DONATED PROPERTY, BUILDINGS, AND EQUIPMENT ARE STATED AT THEIR FAIR VALUE AT THE DATE OF DONATION. DEPRECIATION IS CALCULATED USING THE STRAIGHT-LINE METHOD OVER THE ASSETS' USEFUL LIVES RANGING FROM 3 TO 40 YEARS. LEASEHOLD IMPROVEMENTS ARE AMORTIZED OVER THE SHORTER OF THE LIFE OF THE ASSET OR THE LEASE TERM. FORM 990, PART VII SECTION A, MANAGEMENT - OFFICERS LISTING DURING THE FISCAL YEAR, THE CLINIC HAD TURNOVER IN THE CHIEF FINANCIAL OFFICER (CFO) POSITION. THREE SEPERATE INDIVIDUALS PERFORMED CFO DUTIES OVER THE COURSE OF THE FISCAL YEAR.