2020-07-15T15:30:34-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-07-01 930853709 THE WALLACE MEDICAL CONCERN WALL 5034891760 124 NE 181ST AVENUE NO 103 PORTLAND OR 97230 CARRIE HARRIS MBA CFO 5034891760 2020-07-13 1 KURT BENNION CPA P01469618 4252506100 2020-07-13 67.137.57.251 2020-07-13 15:31:04 PD P E96CBB44222ACDC560A6014B0E6D421AE2EAC7C3 18C6E0845578268445159EE3FC712DACCB5F4F97 2018 2021-01-29 14:40:06Z LISA CLINE 124 NE 181ST AVENUE NO 103 PORTLAND OR 97230 6567129 0 X WWW.WALLACEMEDICAL.ORG X 1984 OR PROVIDE HEALTH SERVICES TO THOSE IN NEED IN THE PORTLAND AND GRESHAM METROPOLITAN AREA. 8 8 88 22 0 0 2931945 2669341 3867466 3774493 1032 -10388 222778 121759 7023221 6555205 5890 85992 0 0 3460277 4129476 0 25400 174320 2577972 1785053 6044139 6025921 979082 529284 2587375 3116852 278020 278292 2309355 2838560 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 4339411 85992 3774493 THE WALLACE MEDICAL CONCERN (WMC) PROVIDES AN OPEN DOOR TO EXCEPTIONAL HEALTH SERVICES AND CONNECTIONS THAT SUPPORT INDIVIDUALS AND THEIR FAMILIES IN HEALTHY LIVING. WMC HAS DISTINGUISHED ITSELF FOR OVER THIRTY YEARS AS A PATIENT-FOCUSED, INNOVATIVE HEALTH CARE ORGANIZATION OFFERING A WIDE ARRAY OF SERVICES. SINCE RECEIVING DESIGNATION AS A FEDERALLY QUALIFIED HEALTH CENTER IN 2012, WMC HAS EXPANDED SERVICES TO INCLUDE COMPREHENSIVE PRIMARY CARE, BEHAVIORAL/MENTAL HEALTH AND ORAL HEALTH CARE. WE OFFER OUR PATIENTS AND THEIR FAMILIES A COMPREHENSIVE HEALTH HOME PROVIDING CONTINUITY OF CARE AND FULL INTEGRATION OF MEDICAL AND DENTAL SERVICES. CONTINUED ON SCHEDULE O.WMC'S INCREASING CAPACITY TO DELIVER HIGH-QUALITY, MULTI-DISCIPLINARY CARE IS THE RESULT OF ITS SUCCESS AT ATTRACTING AND RETAINING SKILLED AND COMMITTED HEALTH PROFESSIONALS, A CULTURALLY-APPROPRIATE APPROACH, INNOVATIVE PARTNERSHIPS, AND ONGOING COMMUNITY INVESTMENT.OUR PROGRAMS ADDRESS SOCIAL DETERMINANTS OF HEALTH SUCH AS NUTRITION/FOOD ACCESS AND ORAL HEALTH, WHICH PLAY A PIVOTAL ROLE IN CHILDREN'S DEVELOPMENT. OUR COMPREHENSIVE PRIMARY CARE SERVICES INCLUDE WELL CHILD, WOMEN'S HEALTH, BEHAVIORAL HEALTH AND CHRONIC DISEASE MANAGEMENT. WE OFFER SPECIALTY CLINICS IN DERMATOLOGY, PODIATRY, OPTOMETRY, CHIROPRACTIC AND DENTAL. WE ALSO PLAY A CRITICAL ROLE AS A GATEWAY TO THE LARGER HEALTH CARE SYSTEM, SECURING REFERRALS FOR NO-COST SPECIALTY AND HOSPITAL CARE. WITH BILINGUAL STAFF, PROFESSIONAL INTERPRETER VOLUNTEERS, AND AN EMPHASIS ON HEALTH LITERACY, HEALTH EDUCATION AND PREVENTION, WMC IS ABLE TO PROVIDE CULTURALLY APPROPRIATE CARE TO NON-ENGLISH SPEAKING PATIENTS. THE HEALTH ACCESS WINDOW AT THE MEXICAN CONSULATE OFFERS HEALTH PROMOTION AND DISEASE PREVENTION ASSISTANCE. THE MOBILE MEDICAL CLINIC AND THE NEW ROCKWOOD CLINIC LOCATED OFF THE MAX LINE OFFER ACCESSIBILITY TO THOSE WITH LIMITED TRANSPORTATION OPTIONS. WMC PROVIDES AN OPEN DOOR TO EXCEPTIONAL HEALTH SERVICES AND CONNECTIONS THAT SUPPORT INDIVIDUALS AND THEIR FAMILIES IN HEALTHY LIVING. WMC HAS A 34-YEAR RECORD OF PROVIDING MEDICAL SERVICES AND HAS DISTINGUISHED ITSELF AS A PATIENT-FOCUSED, INNOVATIVE HEALTH CARE ORGANIZATION. WMC BECAME A FEDERALLY QUALIFIED HEALTH CENTER IN JUNE OF 2012, ALLOWING FOR EXPANSION OF SERVICES AND IMPLEMENTATION OF PRIMARY CARE THAT OFFERS A COMPREHENSIVE MEDICAL HOME AND CONTINUITY OF CARE FOR PATIENTS AND THEIR FAMILIES. WMC'S INCREASING CAPACITY TO PROVIDE HIGH QUALITY HEALTH SERVICES IS THE RESULT OF ITS SUCCESS AT ATTRACTING AND MAINTAINING SKILLED AND COMMITTED MEDICAL PROFESSIONALS, ITS INNOVATIVE PARTNERSHIPS, AND THE HIRING OF BILINGUAL, BICULTURAL CARE PROVIDERS AND CLINIC STAFF. 4339411 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 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 0 0 0 0 0 1 26 0 88 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 OR X CARRIE HARRIS 5037666038 124 NE 181ST AVENUE NO 103 PORTLAND OR 97230 LISA GOREN PRESIDENT & DIRECTOR 1.00 X X 0 0 0 LYNN KETCH VICE PRESIDENT & PRESIDENT 1.00 X X 0 0 0 JOHN ENGLE DDS DIRECTOR & SECRETARY 1.00 X X 0 0 0 SUZANNE SIMMONS TREASURER 1.00 X X 0 0 0 EDITH ARRIAGA-FLORES DIRECTOR 1.00 X 0 0 0 EMMANUEL BARRERA DIRECTOR 1.00 X 0 0 0 ANDREW BROWN DIRECTOR 1.00 X 0 0 0 VANESSA CHAMBERS DIRECTOR 1.00 X 0 0 0 VIRGINIA CORNYN DIRECTOR (THROUGH SEPTEMBER 2018) 1.00 X 0 0 0 CARLOS GALEANA DIRECTOR (THROUGH MAY 2019) 1.00 X 0 0 0 SHAY MCCAW DIRECTOR (THROUGH MAY 2019) 1.00 X 0 0 0 MAUREEN WRIGHT MD DIRECTOR (THROUGH MAY 2019) 1.00 X 0 0 0 LISA CLINE CEO 40.00 X 147934 0 16150 CARRIE HARRIS CFO 40.00 X 109392 0 3329 STUART CURRIE MD CMO 40.00 X 261523 0 28744 KYLE GEELAN DMD DENTAL DIRECTOR 40.00 X 144625 0 18263 JULIA FREY PA PHYSICIAN'S ASSISTANT 40.00 X 112705 0 10904 BETHANY STAIRS FNP NURSE PRACTITIONER 40.00 X 111504 0 11523 887683 0 88913 6 0 1 0 OCHIN 1881 SW NAITO PARKWAY PORTLAND OR 97201 I.T. SERVICES 117693 LINGUAVA INTERPRETERS 12106 NE MARX STREET PORTLAND OR 97220 INTERPRETATION SERVICES 108142 2 2479223 190118 2669341 PATIENT BILLING 621110 3527022 3527022 CCO INCENTIVE 621110 247471 247471 3774493 1536 1536 11924 -11924 -11924 -11924 MEANINGFUL USE REVENUE 900099 85000 85000 OTHER INCOME 900099 36759 36759 121759 6555205 3774493 0 111371 85992 85992 568223 568223 2927719 2717046 104334 106339 81380 77834 496 3050 264031 230505 24469 9057 288123 225399 54280 8444 27602 8460 19142 3765 3765 73900 73900 25400 25400 507592 320990 182972 3630 16321 4791 10780 750 117186 5694 110299 1193 8252 1994 6258 342624 219464 114016 9144 4968 3667 1301 74076 27749 39471 6856 171146 74905 95784 457 44855 44855 CLINICAL SUPPLIES 197745 197721 24 BAD DEBT EXPENSE 86510 86510 SMALL EQUIPMENT 45397 13961 31436 OTHER EXPENSES 19502 8503 10999 43612 28226 15386 6025921 4339411 1512190 174320 852621 935389 485159 1085658 55000 74125 315370 341212 75767 57918 1335052 712502 803458 622550 2587375 3116852 256481 254391 21539 23901 278020 278292 X 2028085 2538678 281270 299882 2309355 2838560 2587375 3116852 529284 -79 0 X 0 1 X 1 1 1 X 2114329 2749641 2755689 2931945 2669341 13220945 2114329 2749641 2755689 2931945 2669341 13220945 13220945 2350 4910 6476 605 1536 15877 205759 99320 125048 222778 121759 774664 14011486 15443467 0.94360 0.94780 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 377229 293405 664418 335273 329145 622550 X 6433073 -79 -79 6433152 122053 122053 6555205 6025808 0 6025808 113 113 6025921 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 121,940. REVENUES NETTED AGAINST EXPENSES IN THE FINANCIAL STATEMENTS 113. PART XII, LINE 4B - OTHER ADJUSTMENTS: REVENUES NETTED AGAINST EXPENSES IN THE FINANCIAL STATEMENTS 113. X X X X 1 DANA BROWN CONSULTING 2606 NE 30TH AVENUE PORTLAND OR 97212 GRANT WRITING 0 14000 5500 8500 SCOTT LANGEN 1823 NE 11TH AVENUE PORTLAND OR 97212 MARKETING, BRANDING AND GRANT WRITING 0 4750 19900 -15150 18750 25400 -6650 OR 1 PATIENT HOUSING ASSISTANCE 8 83514 PATIENT NON-MEDICAL FINANCIAL ASSISTANCE 56 2478 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 LISA CLINE CEO 147934 0 0 0 0 0 4512 0 11638 0 164084 0 0 0 STUART CURRIE MD CMO 261523 0 0 0 0 0 10911 0 17833 0 290267 0 0 0 KYLE GEELAN DMD DENTAL DIRECTOR 144625 0 0 0 0 0 6012 0 12251 0 162888 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 2019. 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 2019. 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.