2023-10-12T14:59:32-05:00 2022-11-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2021-12-01 910896701 COLUMBIA BASIN HEALTH ASSOCIATION COLU 5094885256 1515 E COLUMBIA STREET OTHELLO WA 99344 NIEVES GOMEZ CEO 5094885256 2023-10-11 1 NIEVES GOMEZ 999009999 KURT BENNION CPA P01469618 4252506100 2023-10-09 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z NIEVES GOMEZ 1515 E COLUMBIA STREET OTHELLO WA 99344 88100181 0 X WWW.CBHA.ORG X 1973 WA TO PROVIDE EQUAL ACCESS TO QUALITY HEALTH CARE TO ALL PERSONS. 11 11 516 12 0 0 14593115 16292978 48351619 50664738 1544838 1123780 0 -34703 64489572 68046793 0 23155 0 0 34626765 38962417 0 0 0 17310026 19213044 51936791 58198616 12552781 9848177 104325193 110075194 11624350 10897434 92700843 99177760 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 26797881 23155 28251495 MEDICAL CARE - COLUMBIA BASIN HEALTH ASSOCIATION (CBHA) SERVED A TOTAL OF 36,687 INDIVIDUALS IN OUR SERVICE AREA - INCLUDING OTHELLO, MATTAWA, AND CONNELL - FOR THE YEAR ENDED NOVEMBER 30, 2022. THE ORGANIZATION ALSO HAS A POLICY OF PROVIDIED CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS REDUCED FEE PROGRAM WITHOUT A CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. DURING THE YEAR THE ORGANIZATION PROVIDED $2,118,993 OF DISCOUNTED MEDICAL SERVICES. 10407287 0 10029153 DENTAL CARE - CBHA SERVED A TOTAL OF 17,995 INDIVIDUALS IN OUR SERVICE AREA - INCLUDING OTHELLO, MATTAWA, AND CONNELL - FOR THE YEAR ENDED NOVEMBER 30, 2022. THE ORGANIZATION ALSO HAS A POLICY OF PROVIDIED CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS REDUCED FEE PROGRAM WITHOUT A CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. DURING THE YEAR THE ORGANIZATION PROVIDED $1,823,498 OF DISCOUNTED DENTAL SERVICES. 5663657 0 8506448 PHARMACY SERVICES - CBHA DISPENSED 249,142 SCRIPTS TO PATIENTS DURING THE YEAR ENDED NOVEMBER 30, 2022. 3268373 0 3877642 OTHER HEALTH PROGRAMS INCLUDE VISION SERVICES, WHICH PROVIDES EYE CARE FOR PATIENTS OF ALL AGES, AS WELL REVENUE FROM OUR CAFE OPERATIONS. 3268373 0 3877642 46137198 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 34 0 516 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 11 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 550 0 0 DEBORAH BUSS BOARD VICE CHAIR 1.00 X X 500 0 0 JOE MONTEMAYOR BOARD TREASURER 1.00 X X 550 0 0 MARTHA HOLT BOARD SECRETARY 1.00 X X 400 0 0 JANELLE ANDERSON BOARD MEMBER 1.00 X 500 0 0 DORA BERAZA BOARD MEMBER 1.00 X 550 0 0 EVERETT COLE BOARD MEMBER (THROUGH 12/2021) 1.00 X 50 0 0 MARTIN GALLARDO BOARD MEMBER 1.00 X 350 0 0 SCOTT HARRIS BOARD MEMBER 1.00 X 500 0 0 ENRIQUE MIRON BOARD MEMBER 1.00 X 250 0 0 MARIA QUEZADA BOARD MEMBER 1.00 X 400 0 0 MARIA ROSALES BOARD MEMBER 1.00 X 500 0 0 NIEVES GOMEZ CEO 50.00 X 597456 0 39032 JOSHUA BUNCH CFO 50.00 X 202446 0 37704 DR HUNG MIU CMO 40.00 X 692969 0 51006 DR JI H CHOI CDO 50.00 X 331880 0 33862 RANDEL STEVENS CIO 40.00 X 216969 0 41594 KELLY CARLSON CAO 40.00 X 150195 0 43436 BASHAR ELALI PHYSICIAN 40.00 X 530858 0 27390 SYED GILLANI PHYSICIAN 40.00 X 426372 0 17065 CATHERINE DINGLASAN PHYSICIAN 40.00 X 335377 0 25563 MATTHEW PAINTER PHYSICIAN 40.00 X 328112 0 6871 LEO GAETA VP OF PROGRAMS 40.00 X 148386 0 39322 3966120 0 362845 56 0 1 0 INTERPATH LABORATORY INC PO BOX 1208 PENDLETON OR 97801 LABORATORY TESTING SERVICES 238991 NUVODIA LLC 2818 N SULLIVAN ROAD SUITE 120 SPOKANE VALLEY WA 99216 RADIOLOGY SERVICES 134767 GAMACHE LANDSCAPING INC 1212 COLUMBIA PARK TRAIL RICHLAND WA 99352 LANDSCAPING SERVICES 133682 INLAND NORTHWEST IMAGING PS 801 S STEVENS ST SPOKANE WA 99204 RADIOLOGY SERVICES 132575 LARRY LOVERIDGE PEDIATRIC DENTISTRY 1921 S ARTHUR STREET KENNEWICK WA 99338 CONTRACTED DENTAL SERVICES 131966 6 51878 14921130 1319970 16292978 PATIENT SERVICES 621400 28251495 28251495 DENTAL 621400 10029153 10029153 PHARMACY 621400 8506448 8506448 OTHER HEALTH PROGRAMS 621400 3877642 3877642 50664738 1202401 1202401 19919444 16000 19999891 14174 -80447 1826 -78621 -78621 0 51878 37823 -37823 -37823 4620 1500 3120 3120 68046793 50664738 0 1089077 20000 20000 3155 3155 2438549 858427 1580122 26569219 24589876 1979343 1796229 1430041 366188 5793328 4231183 1562145 2365092 832568 1532524 57891 39113 18778 136260 92061 44199 168987 168987 2059547 1391494 668053 697162 196542 500620 2368331 1587516 780815 719799 486319 233480 1951395 1281279 670116 194317 89387 104930 633637 473455 160182 2252940 1835188 417752 262541 148928 113613 PROGRAM SUPPLIES 2860114 2651778 208336 PHARMACEUTICAL SUPPLIES 2210117 2210117 REPAIRS AND MAINTENANCE 1971693 1590524 381169 BAD DEBT 470902 470902 197411 98247 99164 58198616 46137198 12061418 0 10496550 16395239 5372358 5429513 1024082 2997351 2799382 21724625 21724625 452871 531497 1020846 1256154 49143851 25413938 22140750 23729913 37700398 34518601 1510792 1768609 908652 897579 104325193 110075194 10246856 10775413 1377494 122021 11624350 10897434 X 92700843 99177760 92700843 99177760 104325193 110075194 9848177 -3371260 0 X X 0 1 X 1 1 1 X 7696577 8851298 10230894 14593115 16292978 57664862 42992694 41092153 41970003 48351619 50664738 225071207 50689271 49943451 52200897 62944734 66957716 282736069 0 0 0 282736069 1158634 1238790 1272543 1039370 1202401 5911738 1158634 1238790 1272543 1039370 1202401 5911738 4620 4620 51847905 51182241 53473440 63984104 68164737 288652427 0.97950 0.97810 0.02050 0.02190 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: RAFFLE TICKET SALES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12720 12720 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO WACH, ACH, AND NWRPCA A PORTION OF WHICH IS USED BY THOSE ORGANIZATIONS TO LOBBY ON BEHALF OF THEIR MEMBERS. NWRPCA HAD NO LOBBYING FOR 2022. 7106198 7106198 30020163 16921472 13098691 11663281 8492466 3170815 354209 354209 23729913 X 65745025 -3371260 2729174 -642086 66387111 168987 1490695 1659682 68046793 57598050 39323 39323 57558727 168987 470902 639889 58198616 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, 2022 AND 2021, 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: FUNDRAISING EVENT EXPENSES 39,323. INVESTMENT LOSSES 2,689,851. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 271,558. GAIN ON DISPOSAL OF ASSETS 1,826. OTHER REVENUE 746,409. BAD DEBT EXPENSE 470,902. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 39,323. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 470,902. COLOR RUN 51878 51878 1372 2788 33663 51878 51878 1372 2788 33663 37823 -37823 1 PART I, LINE 2: BEFORE CBHA DONATES MONEY TO ANOTHER ORGANIZATION, CBHA CONFIRMS THAT THE RECIPIENT ORGANIZATION IS A 501(C)(3) ORGANIZATION. X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 DR HUNG MIU CMO 329220 0 198772 0 164977 0 43975 0 7031 0 743975 0 0 0 NIEVES GOMEZ CEO 263600 0 107500 0 226356 0 27544 0 11488 0 636488 0 213594 0 BASHAR ELALI PHYSICIAN 241456 0 241696 0 47706 0 13177 0 14213 0 558248 0 0 0 SYED GILLANI PHYSICIAN 225374 0 158085 0 42913 0 10194 0 6871 0 443437 0 0 0 DR JI H CHOI CDO 200250 0 27500 0 104130 0 32775 0 1087 0 365742 0 0 0 CATHERINE DINGLASAN PHYSICIAN 244410 0 70647 0 20320 0 11263 0 14300 0 360940 0 0 0 MATTHEW PAINTER PHYSICIAN 247297 0 62146 0 18669 0 0 0 6871 0 334983 0 0 0 RANDEL STEVENS CIO 177969 0 37500 0 1500 0 34650 0 6944 0 258563 0 0 0 JOSHUA BUNCH CFO 162446 0 33500 0 6500 0 26354 0 11350 0 240150 0 0 0 KELLY CARLSON CAO 119332 0 27000 0 3863 0 24489 0 18947 0 193631 0 0 0 LEO GAETA VP OF PROGRAMS 118354 0 27500 0 2532 0 31937 0 7385 0 187708 0 0 0 PART I, LINE 1A GYM MEMBERSHIP MONTHLY FEE IS PAID IF EMPLOYEE VISITS 12 A MONTH, OTHERWISE THE FEE IS DEDUCTED FROM THEIR PAYROLL. PART I, LINE 4B THE DEFERRED COMPENSATION PLAN WAS ORIGINALLY CREATED 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) CONTRIBUTIONS AND DISTRIBUTIONS DURING THE TWELVE MONTHS ENDED NOVEMBER 30, 2022 INCLUDED THE FOLLOWING EMPLOYEES: IN CALENDAR YEAR 2021, THE FOLLOWING WERE CONTRIBUTED INTO THE PLAN: NIEVES GOMEZ, CEO - $19,500 JOSHUA BUNCH, CFO - $19,500 HUNG MIU, CMO - $26,000 JI CHOI, CDO - $19,500 LEO GAETA, VP OF PROGRAMS - $26,000 KELLY CARLSON, VP OF ADMINISTRATIVE SERVICES - $19,500 RANDEL STEVENS, CIO - $26,000 IN CALENDAR YEAR 2021, THE FOLLOWING WERE DISTRIBUTED OUT OF THE PLAN: NIEVES GOMEZ, CEO - $213,594 MYRNA GOMEZ SPOUSE OF NIEVES GOMEZ 27833 EMPLOYEE COMPENSATION 0 KRISTEN STEVENS SPOUSE OF RANDEL STEVENS 72505 EMPLOYEE COMPENSATION 0 JUDE ALSARRAJ SPOUSE OF DR. BASHAR ELALI 63591 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSIST OF THE BOARD'S OFFICERS, PLUS TWO BOARD MEMEBERS-AT-LARGE APPOINTED BY THE PRESIDENT AND APPROVED BY THE BOARD. THE BOARD OF DIRECTORS HAS RESPONSBILITY AND THE AUTHORITY TO DELEGATE ALL OR A PORTION OF ITS POWERS TO THE EXECUTIVE COMMITTEE FROM TIME TO TIME. SUCH DELEGATION IS ACCOMPLISHED EITHER BY RESOLUTION OR BY MOTION OF THE BOARD. 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 CEO 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. PART XII, LINE 2C THE PROCESS OF, AND RESPONSIBILITIES FOR, SELECTING THE FINANCIAL STATEMENT AUDITOR AND OVERSEEING THE FINANCIAL STATEMENT AUDIT DID NOT CHANGE DURING THE FISCAL 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 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 COLUMBIA BASIN CIRCLE OF CARE D 21724625 CASH COLUMBIA BASIN CIRCLE OF CARE K 1200000 CASH