2019-09-30T16:15:10-05:00 2018-11-30 410746749 CLIFTONLARSONALLEN LLP 610 NORTH 39TH AVENUE YAKIMA WA 98902 990 2017-12-01 910896701 COLUMBIA BASIN HEALTH ASSOCIATION COLU 5094885256 1515 E COLUMBIA STREET OTHELLO WA 99344 NIEVES GOMEZ CEO 5094885256 2019-09-26 1 STACY SHORT P00837115 5098232910 2019-09-23 67.137.57.251 2019-09-26 12:34:52 PD P EB0BBDEF6E86ED143E3AB707D06A90C6F6839315 2EFE7395B36462363DC3F040B8FE6F147F29F868 2017 2020-01-14 16:20:31Z NIEVES GOMEZ 1515 E COLUMBIA STREET OTHELLO WA 99344 60229828 0 X WWW.CBHA.ORG X 1973 WA TO PROVIDE EQUAL ACCESS TO QUALITY HEALTH CARE TO ALL PERSONS. 12 12 429 14 0 21251 7854457 7696577 34154875 42992694 1311349 1345135 0 -1353831 43320681 50680575 449303 37611 0 0 27995649 30024682 0 0 0 14430752 15426231 42875704 45488524 444977 5192051 90610796 85273819 30204565 20760089 60406231 64513730 X TO PROVIDE EQUAL ACCESS TO QUALITY HEALTH CARE TO ALL PERSONS REGARDLESS OF AGE, SEX, COLOR, ETHNICITY, NATIONAL ORIGIN, OR THE ABILITY TO PAY.PRIMARY ACTIVITIES: MEDICAL, DENTAL, VISION AND RELATED HEALTHCARE SERVICES. 0 0 20731253 0 25116313 MEDICAL CARE - FOR PROFESSIONAL CARE OF PATIENTS COLUMBIA BASIN HEALTH ASSOCIATION (CBHA) SERVED A TOTAL OF 30,011 INDIVIDUALS DURING FISCAL YEAR 2018 IN OUR SERVICE AREA INCLUDING OTHELLO, MATTAWA, AND CONNELL. 8468251 0 8339114 DENTAL CARE - FOR DENTAL SERVICES CBHA SERVED A TOTAL OF 15,276 INDIVIDUALS DURING FISCAL YEAR 2018 IN OUR SERVICE AREA INCLUDING OTHELLO, MATTAWA, AND CONNELL. 4475236 0 7082176 PHARMACY SERVICES PROVIDED TO CBHA PATIENTS 2067675 37611 2455091 OTHER HEALTH PROGRAMS 2067675 37611 2455091 35742415 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 55 0 1 429 1 1 1 0 0 0 0 1 1 0 0 0 0 X 12 12 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X JOSHUA BUNCH 5094885256 1515 E COLUMBIA STREET OTHELLO WA 99344 MIKE GARZA BOARD CHAIR 1.00 X X 600 0 0 JANELLE ANDERSON BOARD VICE CHAIR 1.00 X X 400 0 0 JOE MONTEMAYOR BOARD TREASURER 1.00 X X 600 0 0 DORA BERAZA BOARD SECRETARY 1.00 X X 500 0 0 DEBORAH BUSS BOARD MEMBER 1.00 X 550 0 0 EVERETT COLE BOARD MEMBER 1.00 X 550 0 0 MARTIN GALLARDO BOARD MEMBER 1.00 X 500 0 0 MARTHA HOLT BOARD MEMBER 1.00 X 400 0 0 ENRIQUE MIRON BOARD MEMBER 1.00 X 300 0 0 PETE PEREZ BOARD MEMBER (THROUGH 3/2018) 1.00 X 500 0 0 MARIA QUEZADA BOARD MEMBER 1.00 X 350 0 0 MARIA ROSALES BOARD MEMBER 1.00 X 450 0 0 MAXINE TAYLOR BOARD MEMBER 1.00 X 500 0 0 GREG BRANDENBURG CEO (THROUGH 2/2018) 40.00 X 321466 0 58457 NIEVES GOMEZ CEO 40.00 X 104118 0 47269 KENT MOSBRUCKER CFO (THROUGH 8/2018) 40.00 X 197437 0 27713 JOSHUA BUNCH VP OF FINANCE 40.00 X 79845 0 23035 DULCYE FIELD CCO 40.00 X 163333 0 50869 DR HUNG MIU CMO 40.00 X 766370 0 52516 RANDEL STEVENS CIO 40.00 X 150633 0 40870 DR ALVIN THIEN CDO (THROUGH 4/2018) 40.00 X 462968 0 27036 DR RANDEL BUNCH PHYSICIAN 40.00 X 301711 0 17087 DR CATHERINE DINGLASAN PHYSICIAN 40.00 X 443512 0 34506 DR BASHAR ELALI PHYSICIAN 40.00 X 502923 0 38923 DR CHRIS SCHULER PHYSICIAN 40.00 X 326748 0 23357 DR MONIQUE SMALL-GLASGOW PHYSICIAN 40.00 X 324725 0 31846 4151989 0 473484 51 0 1 0 THE NEENAN COMPANY LLLP 2607 MIDPOINT DRIVE FORT COLLINS CO 80525 ARCHITECTURE 352878 VISION TECHNOLOGIES INC PO BOX 64240 BALTIMORE MD 21264 IT SERVICES 333605 ATS FACILITY SYSTEMS PO BOX 8567 KALLISPELL MT 59901 WORKFLOW ANALYSIS 278035 COMPUNET INC PO BOX 410802 SALT LAKE CITY UT 84141 IT SERVICES 258543 GE HEALTHCARE IITS USA CORP 15724 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 IT SERVICES 156612 6 7696577 7696577 PATIENT SERVICES 621400 25116313 25116313 DENTAL 621400 8339114 8339114 PHARMACY 621400 7082176 7082176 OTHER HEALTH PROGRAMS 621400 2455091 2455091 42992694 1158634 1158634 9727153 8601 9457601 91652 269552 -83051 186501 186501 IMPAIRMENT LOSS 900099 -1353831 -1353831 -1353831 50680575 42992694 0 -8696 31611 31611 6000 6000 2916900 987670 1929230 21475736 19469824 2005912 1432630 1134759 297871 4199416 3090179 1109237 51374 38262 13112 69059 69059 2933911 1782728 1151183 591510 110601 480909 1981199 1422363 558836 301500 231844 69656 193818 72937 120881 86677 50447 36230 421620 23898 397722 2096034 1743913 352121 188824 109929 78895 PROGRAM SUPPLIES 2073693 1950638 123055 PHARMACEUTICAL SUPPLIES 1675671 1675671 0 REPAIRS AND MAINTENANCE 1287383 911694 375689 UBI TAXES 4534 4534 1469424 897447 571977 45488524 35742415 9746109 0 5908929 2832291 6765239 7189364 3958908 2325004 21724625 21724625 300682 412255 708428 572052 36460711 19889598 18858351 16571113 28402064 30898724 3177481 1908809 806089 839582 90610796 85273819 17964767 9360068 12239798 11400021 30204565 20760089 X 60406231 64513730 60406231 64513730 90610796 85273819 5192051 -1084552 0 X X 0 1 X 1 1 1 X 5694466 6251179 8386045 7854457 7696577 35882724 27697304 32437348 31993832 34154875 42992694 169276053 33391770 38688527 40379877 42009332 50689271 205158777 0 0 0 205158777 906531 1023536 935700 1073924 1158634 5098325 906531 1023536 935700 1073924 1158634 5098325 34298301 39712063 41315577 43083256 51847905 210257102 0.97580 0.97590 0.02420 0.02410 X 0 0 0 0 0 0 0 0 1 3300 3300 0 PART II-B, LINE 1: DUES TO WACMHC AND NWRPCA 2013415 2013415 25726571 14338188 11388383 8464596 5551410 2913186 256129 256129 16571113 X 49678722 -1084552 1436882 352330 49326392 1354183 1354183 50680575 45100391 0 45100391 388133 388133 45488524 PART X, LINE 2: UNDER PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, THE ASSOCIATION IS EXEMPT FROM FEDERAL INCOME TAXES, EXCEPT FOR NET INCOME FROM UNRELATED BUSINESS ACTIVITIES. AS OF NOVEMBER 30, 2018 AND 2017, THE ASSOCIATION HAD NO UNRELATED BUSINESS ACTIVITIES SUBJECT TO FEDERAL INCOME TAXES. MANAGEMENT EVALUATED THE ASSOCIATION'S TAX POSITIONS AND CONCLUDED THAT THE ASSOCIATION HAD TAKEN NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. THE ASSOCIATION'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 83,051. IMPAIRMENT LOSS 1,353,831. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER REVENUE 622,416. INVESTMENT INCOME 343,634. BAD DEBT EXPENSE 388,133. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 388,133. 1 COLUMBIA BASIN CIRCLE OF CARE 1515 E COLUMBIA STREET OTHELLO WA 99344 811037696 501(C)(3) 31611 THE ASSOCIATION CONTINUES TO FACILITATE FINANCING FOR THE NEW BUILDING CONSTRUCTION PROJECT. 1 0 SCHOLARSHIPS 3 6000 PART I, LINE 2: GRANTS TO A RELATED ORGANIZATION ARE MONITORED THROUGH COMMON MANAGEMENT. GRANTS TO OTHER ORGANIZATIONS ARE MONITORED THROUGH FOLLOW-UP CONVERSATIONS AND REPORTING. SCHOLARSHIP PAYMENTS ARE MADE DIRECTLY TO THE EDUCATIONAL INSTITUTION. X X X X X X 0 1 0 0 0 0 0 0 0 GREG BRANDENBURG CEO (THROUGH 2/2018) 231570 0 76500 0 13396 0 45457 0 13000 0 379923 0 0 0 NIEVES GOMEZ CEO 91546 0 10880 0 1692 0 37293 0 9976 0 151387 0 0 0 KENT MOSBRUCKER CFO (THROUGH 8/2018) 157197 0 33380 0 6860 0 10800 0 16913 0 225150 0 0 0 DULCYE FIELD CCO 123197 0 26430 0 13706 0 34096 0 16773 0 214202 0 0 0 DR HUNG MIU CMO 319376 0 194930 0 252064 0 46100 0 6416 0 818886 0 0 89758 RANDEL STEVENS CIO 128428 0 21080 0 1125 0 34654 0 6216 0 191503 0 0 0 DR ALVIN THIEN CDO (THROUGH 4/2018) 197390 0 71545 0 194033 0 10800 0 16236 0 490004 0 0 0 DR RANDEL BUNCH PHYSICIAN 211757 0 59438 0 30516 0 5668 0 11419 0 318798 0 0 0 DR CATHERINE DINGLASAN PHYSICIAN 204466 0 202781 0 36265 0 21600 0 12906 0 478018 0 0 0 DR BASHAR ELALI PHYSICIAN 214469 0 227556 0 60898 0 21600 0 17323 0 541846 0 0 0 DR CHRIS SCHULER PHYSICIAN 206620 0 93890 0 26238 0 6461 0 16896 0 350105 0 0 0 DR MONIQUE SMALL-GLASGOW PHYSICIAN 266546 0 38145 0 20034 0 21600 0 10246 0 356571 0 0 0 PART I, LINE 4B THE DEFERRED COMPENSATION PLAN WAS ORIGINALLY SETUP AS A 457(B) PLAN. IRS REQUIREMENTS AND THE PLAN ADMINISTRATION REQUIRED THE PLAN TO BE CONVERTED TO A 457(F) PLAN. THIS CHANGE REQUIRED PARTICIPANTS TO TAKE PAYOUTS FROM THE PLAN ON THE VESTING SCHEDULE OF 5 YEARS. REQUIRED 457(F) DISTRIBUTIONS DURING THE TWELVE MONTHS ENDED NOVEMBER 30, 2018 INCLUDED $89,758 TO DR. HUNG MIU. MYRNA GOMEZ SPOUSE OF NIEVES GOMEZ 41450 EMPLOYEE COMPENSATION 0 JUDE ALSARRAJ SPOUSE OF DR. BASHAR ELALI 60419 EMPLOYEE COMPENSTATION 0 FORM 990, PART VI, SECTION A, LINE 6 EVERY PERSON INTERESTED IN THE PURPOSE AND OBJECTIVES OF THE ASSOCIATION SHALL BE ELIGIBLE FOR MEMBERSHIP. EVERY PERSON ELIGIBLE FOR MEMBERSHIP SHALL BECOME A MEMBER UPON PROPERLY REGISTERING AS A PATIENT OF THE ASSOCIATION. ANY PERSON EIGHTEEN YEARS OF AGE OR OLDER WHO HAS WITHIN THE IMMEDIATELY PRECEDING EIGHTEEN MONTHS OBTAINED SERVICES FROM THE ASSOCIATION FOR HIMSELF/HERSELF OR FOR ANY MEMBER OF HIS/HER HOUSEHOLD DEPENDENT ON HIM/HER FOR SUPPORT. ACTIVE MEMBERS SHALL NOT HAVE VOTING PRIVILEGES. FORM 990, PART VI, SECTION A, LINE 7A AN ANNUAL MEETING SHALL BE HELD ON A DATE AND AT A TIME CONSIDERED BY THE BOARD OF DIRECTORS TO BE SO CONSISTENT WITH THE FISCAL YEAR UNDER WHICH THE ASSOCIATION IS OPERATED. SAID MEETING WILL BE AT THE PRINCIPAL PLACE OF BUSINESS, OR AT SUCH OTHER PLACE DESIGNATED BY THE BOARD OF DIRECTORS AND OPEN TO ALL MEMBERS. PRINCIPAL PURPOSE OF THE ANNUAL MEETING SHALL BE ELECTION OF DIRECTORS TO FILL VACANT POSITIONS ON THE BOARD. APPROXIMATELY ONE-THIRD (1/3) OF THE BOARD POSITIONS WILL BE ELIGIBLE FOR ELECTION AT EACH ANNUAL MEETING. IF OTHER POSITIONS ARE VACANT AT THE DATE OF THE ANNUAL MEMBERSHIP MEETING, THESE POSITIONS WILL ALSO BE ELIGIBLE TO BE FILLED BY ELECTION. THE ORDER OF BUSINESS SHALL BE DETERMINED BY THE PRESIDING OFFICER AND SHALL INCLUDE THE ELECTION OF DIRECTORS, PRESENTATION OF THE ANNUAL FINANCIAL REPORT, AND ANY COMMITTEE REPORTS THE PRESIDING OFFICER MAY DEEM APPROPRIATE. EACH BOARD MEMBER SHALL BE ENTITLED TO ONE VOTE. THERE SHALL BE NO PROXIES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY THE INDEPENDENT AUDITOR AND PRESENTED TO SENIOR MANAGEMENT, THE FINANCE COMMITTEE, AND THE BOARD OF DIRECTORS FOR FINAL REVIEW AND APPROVAL BEFORE FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND ENFORCED WHEN DISCLOSURES ARISE. SUBJECT TO SECTION 2 SUBSECTION F OF THIS ARTICLE ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF A BOARD MEMBER SHALL BE DISCLOSED TO THE BOARD. WHEN ANY SUCH INTEREST BECOMES A MATTER OF BOARD ACTION, SUCH MEMBER SHALL NOT VOTE OR USE PERSONAL INFLUENCE ON THE MATTER, AND SHALL NOT BE COUNTED IN THE QUORUM FOR A MEETING AT WHICH BOARD ACTION IS TO BE TAKEN ON THE INTEREST. THE MEMBER MAY, HOWEVER, BRIEFLY STATE A POSITION ON THE MATTER, AND ANSWER PERTINENT QUESTIONS OF BOARD MEMBERS. THE MINUTES OF ALL ACTIONS TAKEN ON SUCH MATTERS SHALL CLEARLY REFLECT THAT THESE REQUIREMENTS HAVE BEEN MET. FORM 990, PART VI, SECTION B, LINE 15A A CONSULTING FIRM (MERCES, INC) HAS HELPED ESTABLISH A PAY STRUCTURE OF PAY GRADES WITHIN THE ORGANIZATION. ALL POSITIONS EXCLUDING PROVIDERS ARE EVALUATED ON A VARIETY OF MEASURES TO CREATE THE PAY GRADES. THERE ARE 3 PAY RANGES IN EACH SCALE AND ARE REVIEWED ANNUALLY FOR ADJUSTMENT. PAY WITHIN A GRADE IS DETERMINED FROM PERFORMANCE EVALUATIONS. IN ADDITION, CBHA PARTICIPATES IN THE MILLIMAN USA COMPENSATION SURVEYS ANNUALLY FOR THE 50TH PERCENTILE COMPENSATION COMPARISONS AND/OR CALCULATIONS. THE CEO'S COMPENSATION IS SET BY THE BOARD OF DIRECTORS. OTHER OFFICERS' COMPENSATION IS SET BY THE CEO. THE MOST RECENT COMPENSATION REVIEW WAS CONDUCTED IN 2018. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED SINCE PRIOR YEAR COLUMBIA BASIN CIRCLE OF CARE 1515 E COLUMBIA STREET OTHELLO WA 99344 811037696 SUPPORTING ORGANIZATION WA 501(C)(3) LINE 12C, III-FI N/A 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0