2021-05-17T20:05:46-05:00 2020-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-07-01 930853709 THE WALLACE MEDICAL CONCERN WALL 2034891760 18633 SE STARK STREET NO 401 PORTLAND OR 97233 LISA CLINE CEO 2034891760 2021-05-12 1 KURT BENNION CPA P01469618 4252506100 2021-05-12 2019 2022-09-23 18:48:47Z X LISA CLINE 18633 SE STARK STREET NO 401 PORTLAND OR 97233 7438988 0 X WWW.WALLACEMEDICAL.ORG X 1984 OR PROVIDE HEALTH SERVICES TO THOSE IN NEED IN THE PORTLAND AND GRESHAM METROPOLITAN AREA. 9 9 89 43 0 0 2669341 2899925 3774493 4343725 -10388 11892 121759 183446 6555205 7438988 85992 59622 0 0 4129476 5102613 25400 13271 170896 1785053 2176559 6025921 7352065 529284 86923 3116852 4100357 278292 1174874 2838560 2925483 X THE WALLACE MEDICAL CONCERN ("WMC") PROVIDES AN OPEN DOOR TO EXCEP- TIONAL HEALTH SERVICES THAT SUPPORT INDIVIDUALS AND THEIR FAMILIES IN HEALTHY LIVING. WMC SERVES INDIVIDUALS AND FAMILIES WHO FACE BARRIERS TO CARE THROUGHOUT THE PORTLAND AND GRESHAM METROPOLITAN AREA. 0 0 5482972 59622 4343725 THE WALLACE MEDICAL CONCERN (WALLACE) PROVIDES AN OPEN DOOR TO EXCEPTIONAL HEALTH SERVICES AND CONNECTIONS THAT SUPPORT INDIVIDUALS AND THEIR FAMILIES IN HEALTHY LIVING. WALLACE HAS A 35-YEAR RECORD OF PROVIDING MEDICAL SERVICES AND HAS DISTINGUISHED ITSELF AS A PATIENT-CENTERED, INNOVATIVE HEALTH CARE ORGANIZATION. WALLACE BECAME A FEDERALLY QUALIFIED HEALTH CENTER IN JUNE OF 2012, ALLOWING FOR EXPANDED SERVICES AND IMPLEMENTATION OF PRIMARY CARE THAT OFFERS A COMPREHENSIVE MEDICAL HOME AND CONTINUITY OF CARE FOR PATIENTS AND THEIR FAMILIES. WE OFFER INTEGRATED MEDICAL, DENTAL, AND BEHAVIORAL/ MENTAL HEALTH SERVICES. MEDICAL SERVICES INCLUDE PEDIATRIC CARE, WOMEN'S HEALTH, AND CHRONIC DISEASE MANAGEMENT. OUR CARE TEAMS ADDRESS SOCIAL DETERMINANTS OF HEALTH SUCH AS FOOD SECURITY AND HOUSING. WALLACE'S INCREASING CAPACITY TO PROVIDE HIGH-QUALITY HEALTH SERVICES IS DUE TO ITS SUCCESS IN ATTRACTING SKILLS AND COMMITTED MEDICAL PROFESSIONALS, ITS INNOVATIVE PARTNERSHIPS, AND ITS MULTI-CULTURAL, MULTI-LINGUAL STAFF. 5482972 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 24 0 89 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 OR X AMY BRISSON 6515384869 18633 SE STARK STREET NO 401 PORTLAND OR 97233 STUART CURRIE MD CMO 40.00 X 277265 0 32127 LISA CLINE CEO 40.00 X 162042 0 18238 KYLE GEELAN DMD DENTAL DIRECTOR 40.00 X 151179 0 22819 BRITTA MARTINEZ DENTIST 40.00 X 137107 0 12560 CARRIE HARRIS CFO 40.00 X 128040 0 5570 MARY CAITLYN WELLS FAMILY NURSE PRACTITIONER 40.00 X 117248 0 16270 LORI-ANN LIMA FAMILY NURSE PRACTITIONER 40.00 X 112245 0 13726 JULIA FREY PA PHYSICIAN ASSISTANT 40.00 X 112733 0 11974 BETHANY STAIRS ASSISTANT MEDICAL DIRECTOR 40.00 X 105258 0 12906 LYNN KETCH PRESIDENT 1.00 X X 0 0 0 EDITH ARRIAGA-FLORES VICE PRESIDENT 1.00 X X 0 0 0 JOHN ENGLE DDS SECRETARY 1.00 X X 0 0 0 SUZANNE SIMMONS TREASURER (THROUGH DEC 2019) 1.00 X X 0 0 0 ANDREW BROWN DIRECTOR & TREASURER 1.00 X X 0 0 0 EMMANUEL BARRERA DIRECTOR 1.00 X 0 0 0 VANESSA CHAMBERS DIRECTOR 1.00 X 0 0 0 RHONDA COMBS DIRECTOR 1.00 X 0 0 0 LISA GOREN DIRECTOR (THROUGH FEB 2020) 1.00 X X 0 0 0 THERESA MASSONG DIRECTOR 1.00 X 0 0 0 MOLLY ROBERTS DIRECTOR 1.00 X 0 0 0 1303117 0 146190 9 0 1 0 OCHIN 1881 SW NAITO PARKWAY PORTLAND OR 97201 IT SERVICES 196434 LIFEWORKS NW 14600 NW CORNELL ROAD PORTLAND OR 97229 MENTAL HEALTH SERVICES 155342 2 2701754 198171 2899925 PATIENT BILLING 621110 3640498 3640498 CCO INCENTIVE 621110 703227 703227 4343725 11861 11861 31 0 31 31 31 OTHER INCOME 900099 166446 166446 MEANINGFUL USE REVENUE 900099 17000 17000 183446 7438988 4343725 0 195338 59622 59622 831360 278732 552628 3506811 2958129 426844 121838 117109 87267 25768 4074 346288 287203 46652 12433 301045 227269 65173 8603 12345 12345 25926 826 25100 84277 84277 13271 13271 668797 443696 221551 3550 9175 5053 4122 161781 126794 32564 2423 348789 270105 78684 5773 3843 1930 44756 21959 20894 1903 148038 110292 37289 457 22627 9514 12854 259 CLINICAL SUPPLIES 324448 324433 15 BAD DEBT EXPENSE 167429 151745 15684 SMALL EQUIPMENT 101899 83000 18899 OTHER EXPENSES 50499 21145 27269 2085 7352065 5482972 1698197 170896 935389 1481451 1085658 1570547 74125 103424 341212 319820 57918 76228 1409797 860910 622550 548887 3116852 4100357 254391 249818 23901 925056 278292 1174874 X 2538678 2653895 299882 271588 2838560 2925483 3116852 4100357 86923 0 X 0 1 X 1 1 1 X 2749641 2755689 2931945 2669341 2899925 14006541 2749641 2755689 2931945 2669341 2899925 14006541 14006541 4910 6476 605 1536 11861 25388 99320 125048 222778 121759 183446 752351 14784280 17911959 0.94740 0.94360 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME MEANINGFUL USE INSURANCE REIMBURSEMENTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 670634 445265 225369 672942 415645 257297 66221 66221 548887 X 7296940 0 7296940 142048 142048 7438988 7352065 0 7352065 0 7352065 PART X, LINE 2: WMC IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND COMPARABLE STATE LAW. IN ADDITION, WMC HAS BEEN RECOGNIZED AS A PUBLIC CHARITY UNDER SECTIONS 170(B)(1)(A)(VI) AND 509(A)(1) OF THE IRC. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED WMC'S TAX POSITIONS AND CONCLUDED THAT WMC HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 142,048. 1 PATIENT NON-MEDICAL FINANCIAL ASSISTANCE 59 11950 PATIENT HOUSING ASSISTANCE 18 47672 PART I, LINE 2: FINANCIAL ASSISTANCE IS RECOMMENDED AND REQUESTED BY A WALLACE MEDICAL CONCERN EMPLOYEE ON BEHALF OF A PATIENT WHEN THE EMPLOYEE SEES A NEED. PAYMENTS ARE MADE DIRECTLY TO THIRD PARTIES TO ASSIST PATIENTS, ENSURING THAT ALL FUNDS ARE USED FOR THE INTENDED PURPOSE. X X 0 0 0 0 0 0 0 0 0 STUART CURRIE MD CMO 259856 0 17409 0 0 0 11607 0 20520 0 309392 0 0 0 LISA CLINE CEO 153066 0 4798 0 4178 0 4798 0 13440 0 180280 0 0 0 KYLE GEELAN DMD DENTAL DIRECTOR 146365 0 4814 0 0 0 6419 0 16400 0 173998 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE OFFICERS OF THE BOARD OF DIRECTORS AND ONE ADDITIONAL DIRECTOR SERVE AS THE MEMBERS OF THE EXECUTIVE COMMITTEE. THE CEO SITS ON THE EXECUTIVE COMMITTEE AS AN ADVISOR, BUT DOES NOT HAVE A VOTE. THE EXECUTIVE COMMITTEE HAS ALL OF THE POWERS AND AUTHORITY OF THE BOARD OF DIRECTORS WHEN ACTING IN A REASONABLE MANNER DURING AN EMERGENCY AS DELEGATED BY THE BOARD, IF IT IS IMPRACTICAL TO CONVENE A MEETING OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY MANAGEMENT AND THE FINANCE COMMITTEE. A COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD-DELEGATED POWERS IS REQUIRED TO SIGN AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT FOR CONSIDERATION BY THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD-DELEGATED POWERS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, THE INTERESTED PERSON IS REQUIRED TO LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POTENTIAL CONFLICT. IN ADDITION, A PERIODIC REVIEW IS PERFORMED BY THE GOVERNING BOARD AND, AT A MINIMUM, INCLUDES WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. FORM 990, PART VI, SECTION B, LINE 15A THE SALARY OF THE CHIEF EXECUTIVE OFFICER IS DETERMINED BY THE BOARD OF DIRECTORS AFTER A REVIEW OF THE NON-PROFIT AND HEALTH CENTER SALARY SURVEY FOR THE REGION. THIS PROCESS WAS LAST COMPLETED IN 2020. THE SALARY OF THE CHIEF FINANCIAL OFFICER IS DETERMINED BY THE CHIEF EXECUTIVE OFFICER AFTER A REVIEW OF THE NON-PROFIT AND HEALTH CENTER SALARY SURVEY FOR THE REGION. THE PROCESS WAS LAST COMPLETED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.