2021-05-14T15:53:49-05:00 2020-06-30 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2019-07-01 911255170 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY COMM 4257893700 8609 EVERGREEN WAY NO NA EVERETT WA 98208 JOSEPH VESSEY CHIEF EXECUTIVE OFFICER 4257893700 2021-04-13 1 COLLEEN RAMIRES P01251320 4252597227 2021-04-13 2019 2022-09-23 18:48:47Z NA JOSEPH VESSEY 8609 EVERGREEN WAY NO NA EVERETT WA 98208 68932663 0 X WWW.CHCSNO.ORG X 1986 WA TO PROVIDE OUR DIVERSE COMMUNITY WITH ACCESS TO HIGH QUALITY, AFFORDABLE PRIMARY HEALTH CARE 11 11 638 147 0 0 6911782 10177919 48915727 45495484 566662 656189 2580520 2482295 58974691 58811887 6700 0 0 0 41205150 42022051 0 0 0 15966876 15171643 57178726 57193694 1795965 1618193 78068014 83410001 9584098 12865253 68483916 70544748 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, 2020, CHC PROVIDED $4,322,012 OF CHARITY CARE OF UNDER THIS POLICY. 0 0 30926500 31141094 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 MULTILINGUAL 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 152,102 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $2,746,975. IN ADDITION, CHC PROVIDED PRIMARY CARE OUTREACH SERVICES FOR HOMELESS INDIVIDUALS AND FAMILIES AT THREE TRANSITIONAL HOUSING AGENCIES IN SNOHOMISH COUNTY. 13254214 14654632 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 64,575 PATIENT ENCOUNTERS FOR THIS FISCAL YEAR. CHARITY CARE SERVICES FOR THE YEAR TOTALED $1,575,037. 2559723 2093120 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. 150,135 TOTAL PRESCRIPTIONS WERE FILLED FOR THIS FISCAL YEAR. 46740437 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 39 0 1 638 1 0 0 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 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 REBECCA PRATT VICE CHAIR / SECRETARY 2.00 X X 0 0 0 SAM HOLTZMAN TREASURER 2.00 X X 0 0 0 ANGELICA MONTANARI BOARD MEMBER 2.00 X 0 0 0 BICH-NGA NGUYEN BOARD MEMBER 2.00 X 0 0 0 CHARLES MISTER BOARD MEMBER (START 9/2019) 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 MIKE SHAW BOARD MEMBER 2.00 X 0 0 0 TRACY CUAJAO BOARD MEMBER 2.00 X 0 0 0 THOMAS TOCHER CHIEF CLINICAL OFFICER 45.00 X 326117 0 21680 SUE YOON CHIEF DENTAL OFFICER 45.00 X 205970 0 19006 LISA MILLER CHIEF OPERATING OFFICER 45.00 X 203154 0 10610 DION KAPETANOV CHIEF ADMINISTRATIVE OFFICER 45.00 X 193216 0 16510 JOSEPH VESSEY CHIEF EXECUTIVE OFFICER 45.00 X 190449 0 17965 TOVE SKATFUN CHIEF NURSING OFFICER 45.00 X 175220 0 17210 RUTH ANN PERISH CLINICAL DIRECTOR MEDICAL 45.00 X 247979 0 20319 SCOTT MCAFEE CLINICAL DIRECTOR MEDICAL 45.00 X 251734 0 15426 CARMEN OPREA PHYSICIAN 45.00 X 237892 0 19889 SUZANNE POWELL PHYSICIAN WITH OB 45.00 X 218917 0 19465 ANDREW PERRY PHYSICIAN 45.00 X 216000 0 19489 2466648 0 197569 104 0 1 0 JR ABBOT 3408 1ST AVE SOUTH SUITE 101 SEATTLE WA 98124 CONSTRUCTION OF FACILITIES 401474 LANGUAGE LINE SERVICES PO BOX 202564 DALLAS TX 753202572 TRANSLATION SERVICES 387929 MILLER HAYASHI ARCHITECT 118 N 35TH ST 200 SEATTLE WA 98103 ARCHITECTURAL SERVICES 274042 TECHHEADS 7070 FIR LOOP PORTLAND OR 97223 TECHNOLOGY SUPPORT SERVICES 225443 COMMUNITY CLINIC CONTRACTING NETWORK LL 18 S MISSION STREET SUITE 300 WENATCHEE WA 98801 CONSULTING SERVICES 142427 8 200 9799479 378240 1798982 10177919 MEDICARE/MEDICAID 621400 20011077 20011077 CAPITATED REVENUE 621110 19050634 19050634 PATIENT FEES 621110 6021138 6021138 RESEARCH & CLINICAL STUDIES INCOM 621110 412635 412635 45495484 501549 501549 6584118 6429478 154640 154640 154640 6084660 3691298 2393362 2393362 MISCELLANEOUS INCOME 561000 51241 51241 PATIENT RECORD 561000 37692 37692 88933 58811887 47888846 0 745122 1418246 1418246 33211090 28728930 4482160 937700 789549 148151 3695151 3081458 613693 2759864 2283120 476744 39423 39423 88445 88445 66307 66307 2625754 1200053 1425701 5651 34 5617 584041 465866 118175 720391 438248 282143 1123391 934664 188727 66064 31967 34097 287421 229285 58136 146255 146255 3106054 2588880 517174 157488 109853 47635 CLINICAL SUPPLIES 3663042 3663042 BAD DEBT 1284428 1284428 EQUIP. RENTAL & MAINT. 380354 348548 31806 MINOR EQUIPMENT 231695 202039 29656 595439 360473 234966 57193694 46740437 10453257 0 4918638 9895227 4286210 2385171 496555 657722 2957611 2533636 715996 821400 367960 362700 72636983 26404643 44696254 46232340 19628790 20521805 78068014 83410001 5274149 7641814 71044 1390675 4238905 3832764 9584098 12865253 X 68483916 70544748 68483916 70544748 78068014 83410001 1618193 442639 0 X 0 1 X 1 1 1 X 6171222 6130235 6025147 6911782 10177919 35416305 38646415 45564578 45732883 54485411 51580144 236009431 25948 24554 47812 26195 37692 162201 44843585 51719367 51805842 61423388 61795755 271587937 0 0 0 271587937 442210 421776 413617 441192 501549 2220344 442210 421776 413617 441192 501549 2220344 22842 5493 43097 58761 51241 181434 45308637 52146636 52262556 61923341 62348545 273989715 0.99120 0.99060 0.00810 0.00880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100456 6460336 6560792 51276570 17661855 33614715 3079 3079 0 10349355 8738406 1610949 4447187 1303 4445884 46232340 X 61595089 442639 3691298 4133937 57461152 66307 1284428 1350735 58811887 59534257 3691298 3691298 55842959 66307 1284428 1350735 57193694 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 3,691,298. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS BAD DEBT 1,284,428. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS COST OF GOODS SOLD 3,691,298. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS BAD DEBT 1,284,428. X X X X 0 0 0 0 0 0 0 0 0 THOMAS TOCHER CHIEF CLINICAL OFFICER 314321 0 11796 0 0 0 11200 0 10480 0 347797 0 0 0 SUE YOON CHIEF DENTAL OFFICER 204796 0 1174 0 0 0 8639 0 10367 0 224976 0 0 0 LISA MILLER CHIEF OPERATING OFFICER 199254 0 3900 0 0 0 4622 0 5988 0 213764 0 0 0 DION KAPETANOV CHIEF ADMINISTRATIVE OFFICER 189211 0 4005 0 0 0 6209 0 10301 0 209726 0 0 0 JOSEPH VESSEY CHIEF EXECUTIVE OFFICER 190139 0 310 0 0 0 7635 0 10330 0 208414 0 0 0 TOVE SKATFUN CHIEF NURSING OFFICER 171215 0 4005 0 0 0 6990 0 10220 0 192430 0 0 0 RUTH ANN PERISH CLINICAL DIRECTOR MEDICAL 236526 0 11453 0 0 0 9904 0 10415 0 268298 0 0 0 SCOTT MCAFEE CLINICAL DIRECTOR MEDICAL 245150 0 6584 0 0 0 10032 0 5394 0 267160 0 0 0 CARMEN OPREA PHYSICIAN 223270 0 14622 0 0 0 9497 0 10392 0 257781 0 0 0 SUZANNE POWELL PHYSICIAN WITH OB 206647 0 12270 0 0 0 9062 0 10403 0 238382 0 0 0 ANDREW PERRY PHYSICIAN 208531 0 7469 0 0 0 9088 0 10401 0 235489 0 0 0 A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2013-09-20 6000000 BUILDING CONSTRUCTION 0 0 0 A 1634034 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 29681 1798982 COST 0 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 2020. 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.