2020-05-12T12:00:03-05:00 2019-06-30 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2018-07-01 911255170 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY COMM 4257893700 8609 EVERGREEN WAY NO NA EVERETT WA 98208 JOSEPH VESSEY CHIEF EXECUTIVE OFFICER 4257893700 2020-05-11 1 COLLEEN RAMIRES P01251320 4252597227 2020-05-11 73.59.64.75 2020-05-11 17:02:53 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C6DE56114614F097EFEFA27A1F452A96C82E7D93 2018 2020-11-19 02:30:22Z NA JOSEPH VESSEY 8609 EVERGREEN WAY NO NA EVERETT WA 98208 66360678 0 X WWW.CHCSNO.ORG X 1986 WA TO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE 10 10 624 147 0 0 6025147 6911782 41311822 48915727 535360 566662 1545026 2580520 49417355 58974691 10000 6700 0 0 35860934 41205150 0 0 0 14642792 15966876 50513726 57178726 -1096371 1795965 77496626 78068014 11306674 9584098 66189952 68483916 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, 2019, CHC PROVIDED $3,855,826 OF CHARITY CARE SERVICES UNDER THIS POLICY. 0 0 27984034 6700 28015876 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 140,845 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $2,427,982. IN ADDITION, CHC PROVIDED PRIMARY CARE OUTREACH SERVICES FOR HOMELESS INDIVIDUALS AND FAMILIES AT THREE TRANSITIONAL HOUSING AGENCIES IN SNOHOMISH COUNTY. 13992017 0 17743397 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 81,811 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $1,427,844. 4664005 0 5652018 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. 139,568 TOTAL PRESCRIPTIONS WERE FILLED FOR THIS FISCAL YEAR. 46640056 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 44 0 1 624 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOSEPH VESSEY 4257893700 8609 EVERGREEN WAY EVERETT WA 98208 ED ROGAN CHAIR 2.00 X X 0 0 0 OLIVIA MATHISEN-HOLLOMAN VICE CHAIR 2.00 X X 0 0 0 SAM HOLTZMAN TREASURER 2.00 X X 0 0 0 REBECCA PRATT VICE CHAIR / SECRETARY 2.00 X X 0 0 0 BICH-NGA NGUYEN BOARD MEMBER 2.00 X 0 0 0 COURTNEY MILLER 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 MIKE SHAW BOARD MEMBER 2.00 X 0 0 0 DOLORES BLUEFORD BOARD MEMBER (THROUGH 9/18) 2.00 X 0 0 0 LINDA INGLIN BOARD MEMBER (THROUGH 9/18) 2.00 X 0 0 0 SORRIE DANSO BOARD MEMBER (THROUGH 2/19) 2.00 X 0 0 0 ROBERT FARRELL CEO (THROUGH 6/19) 45.00 X 234395 0 22196 JOSEPH VESSEY CHIEF FINANCIAL OFFICER 45.00 X 136225 0 6539 THOMAS TOCHER CHIEF CLINICAL OFFICER 45.00 X 317757 0 24538 DION KAPETANOV CHIEF ADMINISTRATIVE OFFIC 45.00 X 179135 0 18814 LISA MILLER CHIEF OPERATING OFFICER 45.00 X 171072 0 17528 TOVE SKAFTUN CHIEF NURSING OFFICER 45.00 X 154170 0 17581 SUE YOON CHIEF DENTAL OFFICER 45.00 X 194781 0 20588 SCOTT MCAFEE CLINICAL DIRECTOR MEDICAL 45.00 X 260974 0 14926 RUTH ANN PARISH CLINICAL DIRECTOR MEDICAL 45.00 X 236967 0 21973 CARMEN OPREA PHYSICIAN WITH OB 45.00 X 234950 0 21866 TESS MOORE CLINICAL DIRECTOR MEDICAL 45.00 X 224216 0 21922 AMY RODRIGUEZ CLINICAL DIRECTOR MEDICAL 45.00 X 222861 0 21148 2567503 0 229619 84 0 1 0 JR ABBOT 3408 1ST AVE SOUTH STE 101 SEATTLE WA 98124 CONSTRUCTION OF FACILITIES 1435408 TECHHEADS 7070 FIR LOOP PORTLAND OR 97223 TECHNOLOGY SUPPORT SERVICES 545993 LANGUAGE LINE SERVICES PO BOX 202564 DALLAS TX 753202572 TRANSLATION SERVICES 277644 COMMUNITY CLINIC CONTRACTING NETWORK 18 S MISSION ST STE 300 WENATCHEE WA 98801 CONSULTING SERVICES 257326 COMPHEALTH PO BOX 972670 DALLAS TX 753972670 TEMPORARY HEALTHCARE STAFFING 153739 25 690 6441122 469970 1596318 6911782 MEDICARE/MEDICAID 621400 39186268 39186268 PATIENT FEES 621110 6045955 6045955 CAPITATED REVENUE 621110 3683504 3683504 48915727 441192 441192 4437337 4305637 6230 131700 -6230 125470 125470 5569684 3074120 2495564 2495564 MISC INCOME 561000 58761 58761 PATIENT RECORD 561000 26195 26195 84956 58974691 51411291 0 651618 6700 6700 1594704 1594704 32609404 28404531 4204873 866747 724981 141766 3651179 3000436 650743 2483116 2068381 414735 95659 95659 95549 95549 60882 60882 2035614 774669 1260945 24688 220 24468 619830 488809 131021 787206 500842 286364 1172838 987320 185518 59911 34073 25838 337080 256167 80913 168996 168996 3334991 2682839 652152 147146 103806 43340 CLINICAL SUPPLIES 3727864 3727864 BAD DEBT 1458854 1458854 MINOR EQUIPMENT 429088 396304 32784 EQUIPMENT RENTAL & MAIN 410825 359556 51269 999855 663704 336151 57178726 46640056 10538670 0 5468322 4918638 2221779 4286210 510412 496555 2610418 2957611 832037 715996 214344 367960 67994845 23298591 47161093 44696254 18478221 19628790 77496626 78068014 4672334 5274149 16288 71044 4618052 4238905 2000000 0 11306674 9584098 X 66121788 68483916 68164 0 66189952 68483916 77496626 78068014 1795965 497999 0 X 0 1 X 1 1 1 X 5057685 6171222 6130235 6025147 6911782 30296071 31983068 38646415 45564578 45732883 54485411 216412355 37849 25948 24554 47812 26195 162358 37078602 44843585 51719367 51805842 61423388 246870784 0 0 0 246870784 482688 442210 421776 413617 441192 2201483 482688 442210 421776 413617 441192 2201483 -1506 22842 5493 43097 58761 128687 37559784 45308637 52146636 52262556 61923341 249200954 0.99060 0.98920 0.00880 0.01010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100456 6436883 6537339 51237654 15447371 35790283 3079 3079 0 10067296 7848141 2219155 149477 149477 44696254 X 62485930 497999 3074122 3572121 58913809 60882 60882 58974691 60191966 3074122 3074122 57117844 60882 60882 57178726 PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT CHC IS A TAX EXEMPT 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 3,074,122. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS COST OF GOODS SOLD 3,074,122. X X X X 0 0 0 0 0 0 0 0 0 ROBERT FARRELL CEO (THROUGH 6/19) 216795 0 17600 0 0 0 12072 0 10124 0 256591 0 0 0 THOMAS TOCHER CHIEF CLINICAL OFFICER 306009 0 11748 0 0 0 14326 0 10212 0 342295 0 0 0 DION KAPETANOV CHIEF ADMINISTRATIVE OFFIC 172547 0 6588 0 0 0 8842 0 9972 0 197949 0 0 0 LISA MILLER CHIEF OPERATING OFFICER 164589 0 6483 0 0 0 8603 0 8925 0 188600 0 0 0 TOVE SKAFTUN CHIEF NURSING OFFICER 150425 0 3745 0 0 0 7700 0 9881 0 171751 0 0 0 SUE YOON CHIEF DENTAL OFFICER 169600 0 25181 0 0 0 10533 0 10055 0 215369 0 0 0 SCOTT MCAFEE CLINICAL DIRECTOR MEDICAL 241748 0 19226 0 0 0 13020 0 1906 0 275900 0 0 0 RUTH ANN PARISH CLINICAL DIRECTOR MEDICAL 227500 0 9467 0 0 0 11852 0 10121 0 258940 0 0 0 CARMEN OPREA PHYSICIAN WITH OB 215887 0 19063 0 0 0 11733 0 10133 0 256816 0 0 0 TESS MOORE CLINICAL DIRECTOR MEDICAL 189839 0 34377 0 0 0 11874 0 10048 0 246138 0 0 0 AMY RODRIGUEZ CLINICAL DIRECTOR MEDICAL 192371 0 30490 0 0 0 11156 0 9992 0 244009 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 23598 1596319 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 CONFLICT 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 2019. 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.