2023-05-15T14:08:19-05:00 2022-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 100 BELLEVUE WA 98004 990 2021-07-01 930628804 SISKIYOU COMMUNITY HEALTH CENTER INC SISK 5414724777 1701 NW HAWTHORNE AVENUE GRANTS PASS OR 97526 RICHARD BOOTH CEO 5414724777 2023-05-15 1 RICHARD BOOTH XXX-XX-XXXX KURT BENNION CPA P01469618 4252506100 2023-05-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z RICHARD BOOTH 1701 NW HAWTHORNE AVENUE GRANTS PASS OR 97526 28033905 0 X WWW.SISKIYOUHEALTHCENTER.COM X 1975 OR TO IDENTIFY AND PROVIDE CARE FOR PRIMARY HEALTH NEEDS OF OUR COMMUNITY IN A PROFESSIONAL AND COMPASSIONATE MANNER 12 12 274 17 0 0 9747760 6887662 14425552 15867747 20118 48227 3505967 4074783 27699397 26878419 0 0 0 0 17387679 18699285 0 0 0 5690204 7062983 23077883 25762268 4621514 1116151 24133203 31762019 6927410 13440075 17205793 18321944 TO IDENTIFY AND PROVIDE CARE FOR PRIMARY HEALTH NEEDS OF OUR COMMUNITY IN A PROFESSIONAL AND COMPASSIONATE MANNER. 0 0 18925129 0 19884740 HEALTHCARE: OUTPATIENT MEDICAL, DENTAL, MENTAL HEALTH, 340B PHARMACY, AND CASE MANAGEMENT SERVICES PROVIDED TO INDIVIDUAL PATIENTS. 1211239 0 0 OUTREACH: OUTREACH, EDUCATION, AND HOME VISITS TO AT RISK CHILDREN AND THEIR FAMILIES. THIS INCLUDES PARENTING EDUCATION AND HEALTHY START SERVICES TO THESE FAMILIES. OUTPATIENT MEDICAL CARE AND HEALTH EDUCATION AND PROMOTION TO STUDENTS AT THE SCHOOL BASED CARE CENTER AT THE SCHOOLS IN THE COMMUNITY IT SERVES. 20136368 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 48 0 274 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X X X GREG BALL 5414724777 1701 NW HAWTHORNE AVENUE GRANTS PASS OR 97526 KRISTIN MILLER CHIEF MEDICAL DIRECTOR 40.00 X 392432 0 61626 DUSTIN DURHAM PHYSICIAN 40.00 X 352978 0 62871 JOE DUNN CHIEF ADMINISTRATIVE & DENTAL OFFICER 40.00 X 331349 0 64240 CHRISTIAN HOLLAND PHYSICIAN 40.00 X 293018 0 38310 LINFORD BEACHY PHYSICIAN 30.00 X 281449 0 45957 RICHARD BOOTH CHIEF EXECUTIVE OFFICER 40.00 X 262347 0 43512 BRUCE TOWERS MEDICAL PROVIDER 40.00 X 211658 0 47532 DANIEL MCDONNELL BEHAVIORAL HEALTH DIRECTOR 40.00 X 198180 0 46838 BRUCE MCKEE CO-CFO (THROUGH MARCH 2022) 40.00 X 186194 0 48020 BRIAN LAUBSCHER CHIEF COMPLIANCE OFFICER 40.00 X 192773 0 33960 GREGORY BALL CO-CFO & CFO 40.00 X 152819 0 40869 WARREN KENDALL MD CHAIR 2.00 X X 0 0 0 BRAD LAMONT VICE CHAIR 2.00 X X 0 0 0 DERRICK KLEINER TREASURER 2.00 X X 0 0 0 DENISE TERRELL SECRETARY 2.00 X X 0 0 0 RICHARD COHEN MD DIRECTOR 2.00 X 0 0 0 RUSS DUNHAM DIRECTOR 2.00 X 0 0 0 ROBIN HAUSEN DIRECTOR 2.00 X 0 0 0 LYLE JACKSON MD DIRECTOR 2.00 X 0 0 0 MONICA MCFADDEN JD DIRECTOR 2.00 X 0 0 0 JENNIFER ROBERTS PHD DIRECTOR 2.00 X 0 0 0 JOHN SEIDEL EDM DIRECTOR 2.00 X 0 0 0 WILLIAM WARD DIRECTOR 2.00 X 0 0 0 2855197 0 533735 36 0 1 0 DIAMOND MEDICAL MAINTENANCE INC PO BOX 3071 CENTRAL POINT OR 97502 CLEANING SERVICES 330535 CENTERLOGIC INC 7414 NE HAZEL DELL AVE STE B VANCOUVER WA 98665 IT CONSULTING 307102 BARTON & ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 LOCUMS MEDICAL PROVIDER 273779 J AND J THOMAS INC 897 ROYAL AVE STE B MEDFORD OR 97502 SECURITY 144276 4 27098 5200381 1660183 6887662 NET PATIENT SERVICES 621300 15187150 15187150 MEDICAL INCENTIVE REVENUE 621300 680597 680597 15867747 22784 22784 39912 0 39912 39912 39912 25443 0 25443 25443 25443 13407 27098 16728 -3321 -3321 5155751 1138758 4016993 4016993 MISCELLANEOUS REVENUE 900099 21199 21199 21199 26878419 19884740 0 106017 1853373 476750 1376623 13250568 11853187 1397381 458713 346434 112279 2013815 1654590 359225 1122816 881901 240915 8958 8958 50645 50645 1329754 1054513 275241 192256 28505 163751 125072 124303 769 1142116 1136684 5432 148644 101637 47007 223668 202118 21550 1305391 484729 820662 106075 42682 63393 MEDICAL SUPPLIES 784605 772784 11821 REPAIRS & MAINTENANCE 761988 346083 415905 MISCELLANEOUS 453550 291698 161852 RECRUITMENT & PROVIDER 324783 268120 56663 105478 69650 35828 25762268 20136368 5625900 0 2976252 2803814 5687354 2643614 103812 335996 3166572 3416007 334680 361287 247280 264269 30648799 9026987 11163565 21621812 453688 315220 24133203 31762019 2211446 1797600 73670 150000 4332832 11172657 309462 319818 6927410 13440075 X 17205793 18321944 0 17205793 18321944 24133203 31762019 1116151 0 X 0 1 X 1 1 1 X 4767860 4942572 5909482 9747760 6887662 32255336 4767860 4942572 5909482 9747760 6887662 32255336 32255336 56862 94463 86396 57289 62696 357706 28784 22248 41705 49469 34606 176812 32789854 88485035 0.98370 0.98180 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME FUNDRAISING EVENT INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1246527 1246527 17686721 2312995 15373726 4067098 1488494 2578604 6514537 4277233 2237304 1133916 948265 185651 21621812 DEFERRED COMPENSATION 319818 319818 X 27901554 1155486 1155486 26746068 132351 132351 26878419 26894741 1155486 1155486 25739255 23013 23013 25762268 PART X, LINE 2: THE CENTER IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) EXCEPT ON NET INCOME DERIVED FROM UNRELATED BUSINESS ACTIVITIES. MANAGEMENT BELIEVES THERE WAS NO UNRELATED BUSINESS INCOME DURING THE YEAR ENDED JUNE 30, 2022; THEREFORE, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT ANY PROVISION FOR INCOME TAXES. THE CENTER HAS BEEN CLASSIFIED AS AN ENTITY THAT IS NOT A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) AND QUALIFIES FOR DEDUCTIBLE CONTRIBUTIONS AS PROVIDED IN SECTION 170(B)(1)(A)(III). THE CENTER IS EXEMPT FROM PROPERTY TAX ON DEVELOPED LAND UNDER OREGON REVISED STATUTE (ORS) 307.130. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 16,728. COST OF GOODS SOLD 1,138,758. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER NONOPERATING INCOME 109,338. BAD DEBT EXPENSE 23,013. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 16,728. COST OF GOODS SOLD 1,138,758. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 23,013. TEE OFF FOR KIDS 40505 27098 13407 300 4407 6180 308 5533 40505 27098 13407 300 4407 6180 308 5533 16728 -3321 X X X X 0 0 0 0 0 0 0 0 0 KRISTIN MILLER CHIEF MEDICAL DIRECTOR 324656 0 7187 0 60589 0 11848 0 49778 0 454058 0 0 0 DUSTIN DURHAM PHYSICIAN 262452 0 20757 0 69769 0 11848 0 51023 0 415849 0 0 0 JOE DUNN CHIEF ADMINISTRATIVE & DENTAL OFFICER 311286 0 14407 0 5656 0 11848 0 52392 0 395589 0 0 0 CHRISTIAN HOLLAND PHYSICIAN 254631 0 8166 0 30221 0 11848 0 26462 0 331328 0 0 0 LINFORD BEACHY PHYSICIAN 238684 0 6491 0 36274 0 11682 0 34275 0 327406 0 0 0 RICHARD BOOTH CHIEF EXECUTIVE OFFICER 227615 0 1500 0 33232 0 248 0 43264 0 305859 0 0 0 BRUCE TOWERS MEDICAL PROVIDER 159802 0 7384 0 44472 0 8815 0 38717 0 259190 0 0 0 DANIEL MCDONNELL BEHAVIORAL HEALTH DIRECTOR 186759 0 4610 0 6811 0 8276 0 38562 0 245018 0 0 0 BRUCE MCKEE CO-CFO (THROUGH MARCH 2022) 185709 0 1700 0 -1215 0 7970 0 40050 0 234214 0 0 0 BRIAN LAUBSCHER CHIEF COMPLIANCE OFFICER 190553 0 1700 0 520 0 8121 0 25839 0 226733 0 0 0 GREGORY BALL CO-CFO & CFO 143846 0 12355 0 -3382 0 6497 0 34372 0 193688 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE COMPRISED OF THE OFFICERS OF THE BOARD. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS IN EMERGENCY SITUATIONS WHEN AN IMMEDIATE DECISION MUST BE MADE TO AVOID A DELETERIOUS OUTCOME. ANY EMERGENCY ACTION TAKEN BY THE EXECUTIVE COMMITTEE MUST BE RATIFIED BY A MAJORITY VOTE OF THE BOARD AT ITS NEXT REGULAR MEETING. THE EXECUTIVE COMMITTEE'S RESPONSIBILITIES ALSO INCLUDE (A) COORDINATING ACTIVITIES OF THE BOARD; (B) CONDUCTING AN ANNUAL PERFORMANCE EVALUATION OF THE CEO AND RECOMMENDING ADJUSTMENTS TO THE CEO'S COMPENSATION PACKAGE CONSISTENT WITH THE RESULTS OF THE EVALUATION; (C) OVERSEEING THE RESEARCH, DEVELOPMENT AND RECOMMENDATION OF A LONG-RANGE PLAN; (D) MAKING SPECIFIC FISCAL GOALS AND OBJECTIVE RECOMMENDATIONS FOR ADOPTION BY THE BOARD BASED ON THE STRATEGIC PLAN; (E) REVIEWING AND RECOMMENDING CONTRACTUAL RELATIONSHIPS FOR OUTSIDE SERVICES WITH CONSULTANTS AND SPECIALISTS; (F) REVIEWING, DEVELOPING AND RECOMMENDING THE ORGANIZATION'S HUMAN RESOURCES POLICIES; AND (G) ANNUALLY REVIEWING EMPLOYMENT CLASSIFICATIONS, SALARIES AND BENEFITS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE EXECUTIVE STAFF AND WAS MADE AVAILABLE TO MEMBERS OF THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EMPLOYEES, DIRECTORS, CONSULTANTS, AND THOSE WHO PROVIDE SERVICES OR FURNISH GOODS TO THE CORPORATION SHALL AVOID ANY CONFLICT OF INTEREST OR THE APPEARANCE OF CONFLICT OF INTEREST BY EXEMPTING THEMSELVES FROM CONSIDERING ANY INDIVIDUAL ISSUES ON WHICH THEY HAVE AN ACTUAL OR APPARENT CONFLICT OF INTEREST. THE BOARD REQUIRES THAT EACH MEMBER FILL OUT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE DOCUMENTING ALL COMPANIES OWNED BY BOARD MEMBERS OR OTHER BOARDS THAT THE MEMBER MAY BELONG TO. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE CONDUCTS AN ANNUAL PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER AND RECOMMENDS ADJUSTMENTS TO THE CHIEF EXECUTIVE OFFICER'S COMPENSATION PACKAGE CONSISTENT WITH THE RESULTS OF THE ANNUAL EVALUATION AND THE MOST RECENT MGMA SALARY SURVEY STANDARDS. EACH YEAR A MARKET REVIEW OF KEY EMPLOYEES' COMPENSATION IS PREPARED USING THE NORTHWEST REGIONAL PRIMARY CARE ASSOCIATIONS EVALUATIONS FOR REGION X, SPECIFIC TO FQHC'S.. COMPENSATION COMPARISONS ARE ALSO EVALUATED USING THE NATIONAL MGMA AND THE OREGON CHAPTER OF THE MGMA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATMEENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.