2022-02-08T18:12:07-06:00 2020-11-17 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2020-04-01 463517778 MLCHC COMMUNITY SERVICES MLCH 5097646102 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 AMANDA BARTA CHIEF FINANCIAL OFFICER 5097646102 2022-02-02 1 AMANDA BARTA 999009999 KATHRYN J OKIMOTO P00746598 4254544919 2022-02-02 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X SHEILA BERSCHAUER 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 2613056 0 X WWW.MLCHC.ORG X 2013 WA MLCHC COMMUNITY SERVICES WAS CREATED FOR THE NEW MARKET TAX CREDIT TRANSACTION. THIS ALLOWED FOR THE CONSTRUCTION OF A NEW QUINCY FACILITY. X 5 4 0 4 0 0 0 0 133200 66600 0 0 0 2546456 133200 2613056 0 0 0 0 0 0 0 0 0 421108 247322 421108 247322 -287908 2365734 6375366 0 8741100 0 -2365734 0 X MLCHC COMMUNITY SERVICES WAS CREATED FOR THE NEW MARKET TAX CREDIT TRANSACTION. THIS ALLOWED FOR THE CONSTRUCTION OF A NEW QUINCY FACILITY. 0 1 66600 MLCHC COMMUNITY SERVICES IS ORGANIZED AND OPERATED EXCLUSIVELY TO BENEFIT MOSES LAKE COMMUNITY HEALTH CENTER (MLCHC), A WASHINGTON NONPROFIT CORPORATION, BY PERFORMING THE FUNCTIONS OF, OR CARRYING OUT THE PURPOSES OF MLCHC; SUCH PURPOSES BEING TO PROVIDE HEALTH SERVICES TO, IMPROVE HEALTH SERVICES OF, AND OTHERWISE IMPROVE THE HEALTH CONDITIONS OF MIGRATORY AGRICULTURAL WORKERS, RESIDENT SEASONAL AGRICULTURAL WORKERS, RURAL AND COMMUNITY POOR AND THEIR FAMILIES. THE ORGANIZATION WAS DISSOLVED IN FY21. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 X AMANDA BARTA 5097650674 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 SHEILA BERSCHAUER CHAIR 1.00 40.00 X X 0 303519 21042 JOHN BROWNE SECRETARY 1.00 0.00 X X 0 0 0 MATTHEW BENSON TREASURER 1.00 2.00 X X 0 0 0 SHERRY DELGADO DIRECTOR 1.00 1.00 X 0 0 0 LEANNE PARTON DIRECTOR 1.00 0.00 X 0 0 0 AMANDA BARTA CFO 1.00 40.00 X 0 202992 24036 0 506511 45078 0 0 1 0 0 RENTAL INCOME 531120 66600 66600 66600 DEBT FORGIVENESS 900099 2546456 2546456 2546456 2613056 66600 0 2546456 33453 33453 61143 61143 152726 152726 247322 0 247322 0 105445 0 0 0 0 0 0 0 0 0 0 0 6231564 0 0 0 0 38357 0 0 6375366 0 11100 0 8730000 0 8741100 0 X -2365734 0 -2365734 0 6375366 0 2365734 0 X 0 1 X 0 0 X X X 1 MOSES LAKE COMMUNITY HEALTH CENTER 911537371 7 1 0 247322 1 0 247322 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 45784235 43171179 43171179 2613056 0 2613056 35429842 35182520 35182520 247322 0 247322 PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM AFFILIATE 43,171,179. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM AFFILIATE 35,182,520. 0 0 0 0 0 0 0 0 0 SHEILA BERSCHAUER CHAIR 0 303319 0 200 0 0 0 10622 0 10420 0 324561 0 0 AMANDA BARTA CFO 0 202792 0 200 0 0 0 8084 0 15952 0 227028 0 0 PART I, LINE 3 FOR THE CHAIR, THE BOARD OF DIRECTORS OF MOSES LAKE COMMUNITY HEALTH CENTER, A RELATED ORGANIZATION, REVIEWS SALARY SURVEYS AND REGIONAL MARKET COMPARISONS TO DETERMINE APPROPRIATE COMPENSATION LEVELS. ASSETS INCLUDING CASH AND FIXED ASSETS 2020-09-11 6183545 BOOK 911537371 MOSES LAKE COMMUNITY HEALTH CENTER 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 501(C)(3) 1 1 0 0 1 1 1 1 0 PART I, LINE 2E: PERSON(S) INVOLVED: IN REGARDS TO PART I, LINE 2A AND 2B: THIS REFERS TO VARIOUS BOARD MEMBERS, OFFICERS AND EMPLOYEES. PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: THERE ARE SEVERAL COMMON BOARD MEMBERS, OFFICERS AND EMPLOYEES THAT HAVE AND WILL CONTINUE TO SERVE FOR THE SUCCESSOR/TRANSFEREE ORGANIZATION AFTER THE DISSOLUTION. FORM 990, PART I, LINE 6: THE BOARD OF DIRECTORS PER MLCHC COMMUNITY SERVICES BYLAWS REQUIRES A BOARD COMPOSITION OF FIVE MEMBERS. ALL FOUR VOLUNTEER POSITIONS NOTED ARE RELATED TO INVOLVEMENT ON THE BOARD, EITHER AS AN ELECTED MEMBER OR ADVISORY MEMBER. THESE INDIVIDUALS CONTRIBUTE A MINIMUM OF 1 HOUR PER YEAR IN THIS CAPACITY. THE REMAINING BOARD MEMBER IS THE NON-VOLUNTEER CEO. FORM 990, PART III, LINE 3 THE ORGANIZATION WAS DISSOLVED IN FY21 AND ASSETS WERE TRANSFERRED TO ITS SUPPORTED ORGANIZATION, MOSES LAKE COMMUNITY HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7A MOSES LAKE COMMUNITY HEALTH CENTER, A RELATED AND SUPPORTED ORGANIZATION, APPOINTS A MAJORITY OF THE BOARD MEMBERS FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B DUE TO THE SIZE OF THE ORGANIZATION AND THE LOW LEVEL OF ACTIVITY FROM YEAR TO YEAR, COMMITTEES ARE NOT DEEMED NECESSARY. FORM 990, PART VI, SECTION B, LINE 11B UPON COMPLETION OF THE FORM 990, THE RETURN WILL BE REVIEWED IN DETAIL WITH THE BOARD FINANCE COMMITTEE OF MOSES LAKE COMMUNITY HEALTH CENTER (MLCHC), A RELATED ORGANIZATION, AND THEN IN SUMMARY WITH THE BOARD OF DIRECTORS OF MLCHC. UPON APPROVAL BY THE BOARD OF DIRECTORS, THE FINAL FORM 990 WILL BE SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF BOTH OFFICERS IS REVIEWED BY MOSES LAKE COMMUNITY HEALTH CENTER, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE FOR VIEWING UPON REQUEST AT THE ORGANIZATION'S MAIN BUSINESS OFFICE IN THE PRESENCE OF THE CFO OR CEO OF MOSES LAKE COMMUNITY HEALTH CENTER, A RELATED ORGANIZATION. FORM 990, PART VI, LINES 12, 13, AND 14: MLCHC COMMUNITY SERVICES RELIES ON THE CONFLICT OF INTEREST POLICY, WHISTLEBLOWER POLICY AND DOCUMENT RETENTION AND DESTRUCTION POLICY OF MOSES LAKE COMMUNITY HEALTH CENTER, A RELATED ORGANIZATION. MOSES LAKE COMMUNITY HEALTH CENTER 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 911537371 PRIMARY HEALTH SERVICES WA 501(C)(3) LINE 7 N/A 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0