2019-05-15T15:51:57-05:00 2018-06-30 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2017-07-01 911255170 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY COMM 4257893700 8609 EVERGREEN WAY EVERETT WA 98208 ROBERT C FARRELL CHIEF EXECUTIVE OFFICER 4257893700 2019-05-15 1 COLLEEN RAMIRES P01251320 4252597227 2019-05-15 12.129.7.100 2019-05-15 12:14:59 PD P 07D962CAD7C2343BC8DC703B9E740CE903356D52 07D962CAD7C2343BC8DC703B9E740CE903356D52 2017 2019-02-21 02:37:17Z ROBERT C FARRELL 8609 EVERGREEN WAY EVERETT WA 98208 54742336 0 X WWW.CHCSNO.ORG X 1986 WA TO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE 11 11 559 108 0 0 6130235 6025147 39006116 41311822 353670 535360 1961732 1545026 47451753 49417355 0 10000 0 0 32073646 35860934 0 0 0 12447152 14642792 44520798 50513726 2930955 -1096371 76970318 77496626 9450731 11306674 67519587 66189952 X COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY ("CHC") 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, 2018, CHC PROVIDED $3,323,578 OF CHARITY CARE SERVICES UNDER THIS POLICY. 0 0 24663622 10000 24461553 MEDICAL CARE - TO PROVIDE MEDICAL SERVICES IN PEDIATRICS, ACUTE GENERAL CARE AND OBSTETRICAL CARE TO LOW-INCOME/ HOMELESS PEOPLE AT FIVE 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 116,448 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $1,827,575. IN ADDITION, CHC PROVIDED PRIMARY CARE OUTREACH SERVICES FOR HOMELESS INDIVIDUALS AND FAMILIES AT THREE TRANSITIONAL HOUSING AGENCIES IN SNOHOMISH COUNTY. 14225614 16850269 DENTAL CARE - TO PROVIDE DENTAL SERVICES TO LOW-INCOME/HOMELESS PEOPLE ON A SLIDING FEE BASIS AND BY THIRD-PARTY INSURANCE AND MEDICAID AT FIVE DIFFERENT CLINICS. THERE WAS A TOTAL OF 82,112 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $1,496,004. 2274417 1454117 PHARMACY SERVICES - TO PROVIDE PHARMACY SERVICES TO LOW-INCOME PEOPLE ON A SLIDING FEE BASIS AND BY THIRD-PARTY INSURANCE AND MEDICAID AT FIVE DIFFERENT CLINICS. 126,723 TOTAL PRESCRIPTIONS WERE FILLED FOR THIS FISCAL YEAR. 41163653 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 36 0 1 559 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 X ROBERT C FARRELL 4257893717 8609 EVERGREEN WAY EVERETT WA 98208 COURTNEY MILLER CHAIR (THRU 4/18) 2.00 X X 0 0 0 OLIVIA MATHISEN-HOLLOMAN CHAIR (FROM 4/18) 2.00 X X 0 0 0 SAM HOLTZMAN TREASURER (FROM 4/18) 2.00 X X 0 0 0 REBECCA PRATT TREASURER (THRU 4/18), SECRETARY 2.00 X X 0 0 0 LINDA INGLIN TREASURER (THRU 4/18), BOARD MEMBER 2.00 X X 0 0 0 BRYTFIRTH HASAPHONGSE SECRETARY (THRU 7/17) 2.00 X X 0 0 0 ED ROGAN SECRETARY (THRU 4/18), VICE CHAIR 2.00 X X 0 0 0 BICH-NGA NGUYEN BOARD MEMBER 2.00 X 0 0 0 DOLORES BLUEFORD BOARD MEMBER 2.00 X 0 0 0 LENORA ROSE BOARD MEMBER 2.00 X 0 0 0 TRACY CUAJAO BOARD MEMBER 2.00 X 0 0 0 ANGELICA MONTANARI BOARD MEMBER 2.00 X 0 0 0 SORRIE DANSO BOARD MEMBER 2.00 X 0 0 0 ROBERT FARRELL CHIEF EXECUTIVE OFFICER 45.00 X 213193 0 21138 VICTORIA RINGNESS CHIEF FINANCIAL OFFICER (THRU 10/17) 45.00 X 144439 0 7319 THOMAS TOCHER CHIEF CLINICAL OFFICER 45.00 X 301326 0 25274 DION KAPETANOV CHIEF ADMINISTRATIVE OFFICER 45.00 X 160283 0 18033 LISA MILLER CHIEF OPERATING OFFICER 45.00 X 158928 0 16862 TOVE SKAFTUN CHIEF NURSING OFFICER 45.00 X 142700 0 16934 SCOTT MCAFEE CLINICAL DIRECTOR MEDICAL 45.00 X 255662 0 14675 RUTH ANN PARISH CLINICAL DIRECTOR MEDICAL 45.00 X 228738 0 21581 SUZANNE POWELL PHYSICIAN WITH OB 45.00 X 215735 0 21405 CARMEN OPREA PHYSICIAN WITH OB 45.00 X 214683 0 18126 DOUGLAS MCMILLEN CLINICAL DIRECTOR MEDICAL 45.00 X 201983 0 20174 2237670 0 201521 79 0 1 0 JR ABBOT 3408 1ST AVE SOUTH STE 101 SEATTLE WA 98124 CONSTRUCTION OF FACILITIES 3790252 TECHHEADS 7070 FIR LOOP PORTLAND OR 97223 TECHNOLOGY SUPPORT SERVICES 546886 LANGUAGE LINE SERVICES PO BOX 202564 DALLAS TX 753202572 TRANSLATION SERVICES 219954 COMMUNITY CLINIC CONTRACTING NETWORK 18 S MISSION ST STE 300 WENATCHEE WA 98801 CONSULTING SERVICES 211515 COMPHEALTH PO BOX 972670 DALLAS TX 753972670 TEMPORARY HEALTHCARE STAFFING 191390 24 728 5896641 127778 1169711 6025147 MEDICARE/MEDICAID 621400 34846100 34846100 PATIENT FEES 621110 4765802 4765802 CAPITATED REVENUE 621110 1699920 1699920 41311822 413617 413617 2479780 2358037 121743 121743 121743 4421061 2966944 1454117 1454117 PATIENT RECORD 561000 47812 47812 VARIOUS STIPENDS/INCENTIVES 561000 32702 32702 REFUNDS AND REBATES 561000 10250 10250 145 145 90909 49417355 42765939 0 626269 10000 10000 1190064 1190064 28825256 24516894 4308362 696279 571282 124997 2958179 2468128 490051 2191156 1786004 405152 25875 4884 20991 98341 98341 70656 70656 1432634 607215 825419 72620 11478 61142 626854 483440 143414 994994 652509 342485 1051654 843140 208514 43019 26543 16476 319149 215960 103189 32619 32619 3174591 2688724 485867 142821 100885 41936 CLINICAL SUPPLIES 2821941 2821264 677 BAD DEBT 1310265 1310265 MINOR EQUIPMENT 818980 728096 90884 CONTRACTED SERVICES 538435 538435 1067344 778507 288837 50513726 41163653 9350073 0 7339331 5468322 2106952 2221779 526685 510412 4312618 2610418 628580 832037 364184 214344 67551445 20390352 43361455 47161093 18330513 18478221 76970318 77496626 4432108 4672334 35094 16288 4983529 4618052 0 2000000 9450731 11306674 X 67445794 66121788 73793 68164 67519587 66189952 76970318 77496626 -1096371 -243238 9974 0 X 0 1 X 1 1 1 X 8403906 5057685 6171222 6130235 6025147 31788195 28662623 31983068 38646415 45564578 45732883 190589567 39485 37849 25948 24554 47812 175648 37106014 37078602 44843585 51719367 51805842 222553410 0 0 0 222553410 509108 482688 442210 421776 413617 2269399 509108 482688 442210 421776 413617 2269399 80956 -1506 22842 5493 43097 150882 37696078 37559784 45308637 52146636 52262556 224973691 0.98920 0.98720 0.01010 0.01210 X 6555723 6555723 50850181 13172542 37677639 3079 3079 0 9844517 7203701 2640816 297945 11030 286915 47161093 X 52070405 -243238 2966944 2723706 49346699 70656 70656 49417355 53400040 -9974 2966944 2956970 50443070 70656 70656 50513726 PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT CHC IS A TAXEXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS NOT CONSIDERED A PRIVATE FOUNDATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: RECLASS COST OF GOODS SOLD 2,966,944. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS COST OF GOODS SOLD 2,966,944. 0 HONORING CHOICES PACIFIC NORTHWEST 2001 SIXTH AVENUE SUITE 2700 SEATTLE WA 98121 916074463 501(C)(3) 10000 GENERAL SUPPORT 1 0 PART I, LINE 2: THE ORGANIZATION KEEPS RECORDS OF THE GRANTS THAT ARE DISPERSED. INFORMATION SUCH AS AUTHORIZATIONS AND AWARD TERMS AND CONDITIONS ARE PART OF THE DOCUMENTATION. THE CFO OR CEO OF THE ORGANIZATION RECEIVES A REIMBURSEMENT REQUEST FOR APPROVAL. X X X X 0 0 0 0 0 0 0 0 0 ROBERT FARRELL CHIEF EXECUTIVE OFFICER 195593 0 17600 0 0 0 11019 0 10119 0 234331 0 0 0 VICTORIA RINGNESS CHIEF FINANCIAL OFFICER (THRU 10/17) 142353 0 2086 0 0 0 0 0 7319 0 151758 0 0 0 THOMAS TOCHER CHIEF CLINICAL OFFICER 289578 0 11748 0 0 0 15099 0 10175 0 326600 0 0 0 DION KAPETANOV CHIEF ADMINISTRATIVE OFFICER 153695 0 6588 0 0 0 8138 0 9895 0 178316 0 0 0 LISA MILLER CHIEF OPERATING OFFICER 152445 0 6483 0 0 0 7992 0 8870 0 175790 0 0 0 TOVE SKAFTUN CHIEF NURSING OFFICER 138955 0 3745 0 0 0 7119 0 9815 0 159634 0 0 0 SCOTT MCAFEE CLINICAL DIRECTOR MEDICAL 239085 0 16577 0 0 0 12755 0 1920 0 270337 0 0 0 RUTH ANN PARISH CLINICAL DIRECTOR MEDICAL 220092 0 8646 0 0 0 11460 0 10121 0 250319 0 0 0 SUZANNE POWELL PHYSICIAN WITH OB 191243 0 24492 0 0 0 11338 0 10067 0 237140 0 0 0 CARMEN OPREA PHYSICIAN WITH OB 202695 0 11988 0 0 0 8050 0 10076 0 232809 0 0 0 DOUGLAS MCMILLEN CLINICAL DIRECTOR MEDICAL 200345 0 1638 0 0 0 10084 0 10090 0 222157 0 0 0 A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2013-09-20 6000000 BUILDING CONSTRUCTION 0 0 0 A 1243474 6000000 110061 5889939 2014 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 X 19183 1169711 COST 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN (B) IS BASED ON THE NUMBER OF ITEMS RECEIVED. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS REVIEWS AND APPROVES CHC'S FORM 990 PRIOR TO ITS FILING WITH THE IRS. THE APPROVAL PROCESS IS AS FOLLOWS: THE BOARD OF DIRECTORS RECEIVE A COPY OF FORM 990 AND 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 THE CHC OF SNOHOMISH COUNTY EMPLOYEE HANDBOOK CONTAINS THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. EACH EMPLOYEE AND BOARD MEMBER IS REQUIRED TO SIGN OFF AS HAVING READ THE 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 CEO 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 CHIEF EXECUTIVE OFFICER'S COMPENSATION AND PERFORMS A PERFORMANCE EVALUATION TO SET COMPENSATION. THE HUMAN RESOURCES MANAGER MAY ASSIST AS NECESSARY. ALL OTHER OFFICERS' COMPENSATION IS SET BY HUMAN RESOURCES. THE SALARY RANGE IS BASED ON COMMUNITY COMPENSATION DATA AND YEARS OF PROFESSIONAL EXPERIENCE AND QUALIFICATIONS. ANNUAL REVIEWS OF COMPENSATION WERE LAST PERFORMED IN MARCH 2018. 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.