2021-08-30T17:59:30-05:00 2020-11-30 410746749 CLIFTONLARSONALLEN LLP 1202 N 16TH AVE STE 100 YAKIMA WA 98902 990 2019-12-01 910896701 COLUMBIA BASIN HEALTH ASSOCIATION COLU 5094885256 1515 E COLUMBIA STREET OTHELLO WA 99344 NIEVES GOMEZ CEO 5094885256 2021-08-03 1 STACY SHORT P00837115 5098232910 2021-07-28 2019 2022-09-23 18:48:47Z NIEVES GOMEZ 1515 E COLUMBIA STREET OTHELLO WA 99344 79357100 0 X WWW.CBHA.ORG X 1973 WA TO PROVIDE EQUAL ACCESS TO QUALITY HEALTH CARE TO ALL PERSONS. 13 13 465 22 0 0 8851298 10230894 41092153 41970003 1721738 1417205 0 0 51665189 53618102 35187 4000 0 0 30554224 31720657 0 0 0 15076191 15211920 45665602 46936577 5999587 6681525 88237752 98253412 16456633 19033155 71781119 79220257 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 22029258 4000 25928128 MEDICAL CARE - FOR PROFESSIONAL CARE OF PATIENTS COLUMBIA BASIN HEALTH ASSOCIATION (CBHA) SERVED A TOTAL OF 32,821 INDIVIDUALS IN OUR SERVICE AREA INCLUDING OTHELLO, MATTAWA, AND CONNELL FOR THE YEAR ENDED NOVEMBER 30, 2020. 7351804 7720282 DENTAL CARE - FOR DENTAL SERVICES CBHA SERVED A TOTAL OF 15,591 INDIVIDUALS IN OUR SERVICE AREA INCLUDING OTHELLO, MATTAWA, AND CONNELL FOR THE YEAR ENDED NOVEMBER 30, 2020. 4722709 6237232 PHARMACY SERVICES PROVIDED TO CBHA PATIENTS, DURING THE YEAR ENDED NOVEMBER 30, 2020 THERE WAS 234,739 SCRIPTS DISPENSED. 2263196 2084361 OTHER HEALTH PROGRAMS 2263196 2084361 36366967 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 42 0 465 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 13 13 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 DR HUNG MIU CMO 50.00 X 897759 0 48534 GREG BANDENBURG FORMER CEO (THRU 2/2019) 0.00 X 397865 0 73220 DR BASHAR ELALI PHYSICIAN 40.00 X 603409 0 31129 DR CATHERINE DINGLASAN PHYSICIAN 40.00 X 427384 0 25523 DR MONIQUE SMALL-GLASGOW PHYSICIAN 40.00 X 351263 0 19334 DR ALAA ATFEH PHYSICIAN 40.00 X 309082 0 38156 DR GABRIEL W BARRIO PHYSICIAN 40.00 X 314932 0 30464 NIEVES GOMEZ CEO 50.00 X 269136 0 39430 RANDEL STEVENS CIO 40.00 X 205256 0 39803 JOSHUA BUNCH CFO 50.00 X 165505 0 35176 DULCYE FIELD CCO (THRU 8/2019) 40.00 X 185193 0 12663 DR JI H CHOI CDO 40.00 X 173557 0 9920 BLAKE BARTHLEMESS COO (THRU 8/2019) 40.00 X 148412 0 17566 MAXINE TAYLOR BOARD MEMBER 1.00 X 750 0 0 MIKE GARZA BOARD CHAIR 1.00 X X 700 0 0 EVERETT COLE BOARD MEMBER 1.00 X 700 0 0 MARIA QUEZADA BOARD MEMBER 1.00 X 700 0 0 DORA BERAZA BOARD SECRETARY 1.00 X X 650 0 0 DEBORAH BUSS BOARD MEMBER 1.00 X 650 0 0 MARTHA HOLT BOARD MEMBER 1.00 X 650 0 0 JOE MONTEMAYOR BOARD TREASURER 1.00 X X 600 0 0 MARTIN GALLARDO BOARD MEMBER 1.00 X 550 0 0 ENRIQUE MIRON BOARD MEMBER 1.00 X 500 0 0 MARIA ROSALES BOARD MEMBER 1.00 X 500 0 0 JANELLE ANDERSEN BOARD VICE CHAIR 1.00 X X 400 0 0 SCOTT HARRIS BOARD MEMBER 1.00 X 300 0 0 4456403 0 420918 56 1 1 0 INTERPATH LABORATORY INC PO BOX 1208 PENDELTON OR 97801 LABORATORY TESTING SERVICES 252665 LARRY LOVERIDGE PEDIATRIC DENTRISTRY 1921 S ARTHUR STREET KENNEWICK WA 99338 DENTAL SERVICES 172689 VVC HOLDING CORP 925 FOURTH AVENUE SUITE 600 SEATTLE WA 98104 ELECTRONIC MEDICAL HEALTH RECORDS 172582 INLAND IMAGING BUSINESS ASSOCIATES LLC 801 S STEVENS ST SPOKANE WA 99204 RADIOLOGY SERVICES 133557 GAMACHE LANDSCAPING INC 1212 COLUMBIA PARK TRAIL RICHLAND WA 99352 LANDSCAPING SERVICES 130117 7 10230894 10230894 PATIENT SERVICES 621400 25928125 25928125 DENTAL 621400 7720282 7720282 PHARMACY 621400 6237232 6237232 OTHER HEALTH PROGRAMS 621400 2084364 2084364 41970003 1272543 1272543 25794468 89192 25638133 100865 156335 -11673 144662 144662 53618102 41970003 0 1417205 4000 4000 509247 509247 22906821 18905059 4001762 1606000 1361847 244153 4735681 3355361 1380320 1962908 1589955 372953 47394 32225 15169 112409 76431 35978 189568 189568 1822627 1239265 583362 427246 184966 242280 1577042 1104831 472211 350538 238343 112195 1843308 1223832 619476 113692 73607 40085 210969 146344 64625 260065 167826 92239 2023427 1669182 354245 239103 133242 105861 PROGRAM SUPPLIES 1968462 1842115 126347 REPAIRS AND MAINTENANCE 1653853 1188913 464940 PHARMACEUTICAL SUPPLIES 1541467 1541467 BAD DEBT 400674 400674 430076 288156 141920 46936577 36366967 10569610 0 6052100 14624108 8584772 7009574 2477188 2625336 21724625 21724625 444417 385853 784167 737567 37817183 23312549 15237914 14504634 30738351 34394506 1376419 1367071 817799 880138 88237752 98253412 8001582 8864366 1123384 8455051 4888463 0 3987085 0 169857 16456633 19033155 X 71781119 79220257 71781119 79220257 88237752 98253412 X 6681525 927470 -169857 X X 0 1 X 1 1 1 X 8386045 7854457 7696577 8851298 10230894 43019271 31993832 34154875 42992694 41092153 41970003 192203557 40379877 42009332 50689271 49943451 52200897 235222828 0 0 0 235222828 935700 1073924 1158634 1238790 1272543 5679591 935700 1073924 1158634 1238790 1272543 5679591 41315577 43083256 51847905 51182241 53473440 240902419 0.97640 0.97610 0.02360 0.02390 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3000 3000 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO WACH AND NWRPCA, A PORTION OF WHICH IS USED BY THOSE ORGANIZATIONS TO LOBBY ON BEHALF OF THEIR MEMBERS. 2094762 2094762 25762983 16485547 9277436 9228867 6827002 2401865 730571 730571 14504634 FAIR VALUE OF INTEREST RATE SWAP 169857 169857 X 53785473 927470 -570531 356939 53428534 189568 189568 53618102 46346335 0 46346335 189568 400674 590242 46936577 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, 2020 AND 2019, 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: BAD DEBT -400,674. LOSS ON INTEREST RATE SWAP -169,857. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 400,674. X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 DR HUNG MIU CMO 323925 0 245220 0 328614 0 41787 0 6747 0 946293 0 0 0 GREG BANDENBURG FORMER CEO (THRU 2/2019) 84572 0 31230 0 282063 0 66265 0 6955 0 471085 0 217500 0 DR BASHAR ELALI PHYSICIAN 218356 0 334810 0 50243 0 12625 0 18504 0 634538 0 0 0 DR CATHERINE DINGLASAN PHYSICIAN 219590 0 172340 0 35454 0 11860 0 13663 0 452907 0 0 0 DR MONIQUE SMALL-GLASGOW PHYSICIAN 296220 0 37003 0 18040 0 8501 0 10833 0 370597 0 0 0 DR ALAA ATFEH PHYSICIAN 203430 0 74968 0 30684 0 12959 0 25197 0 347238 0 0 0 DR GABRIEL W BARRIO PHYSICIAN 184757 0 129175 0 1000 0 12592 0 17872 0 345396 0 0 0 NIEVES GOMEZ CEO 196220 0 61400 0 11516 0 28500 0 10930 0 308566 0 0 0 RANDEL STEVENS CIO 169456 0 34300 0 1500 0 33178 0 6625 0 245059 0 0 0 JOSHUA BUNCH CFO 136555 0 26700 0 2250 0 24428 0 10748 0 200681 0 0 0 DULCYE FIELD CCO (THRU 8/2019) 93810 0 54810 0 36573 0 5503 0 7160 0 197856 0 0 0 DR JI H CHOI CDO 102981 0 35830 0 34746 0 9500 0 420 0 183477 0 0 0 BLAKE BARTHLEMESS COO (THRU 8/2019) 97098 0 30600 0 20714 0 6108 0 11458 0 165978 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, 2020 INCLUDED $96,223 TO KELLY CARLSON. MYRNA GOMEZ SPOUSE OF NIEVES GOMEZ 29960 EMPLOYEE COMPENSATION 0 JUDE ALSARRAJ SPOUSE OF DR. BASHAR ELALI 66206 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 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: LOSS ON INTEREST RATE SWAP -169,857. 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