2019-10-23T18:59:53-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-01-01 910947084 INTERNATIONAL COMMUNITY HEALTH SERVICES INTE 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 TERESITA BATAYOLA PRESIDENT/CEO 2067883618 2019-09-18 1 KURT BENNION P01469618 4252506100 2019-09-18 67.137.57.251 2019-09-18 14:42:14 PD P 36FF25BD9C5A7C875D9B7D46C359D3D923ECD097 34EA3E3715EC5C0264D5DE4C291818DF01AF5FF7 2018 2020-01-14 16:20:31Z TERESITA BATAYOLA 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 49401432 0 X WWW.ICHS.COM X 1973 WA PROVIDE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES. 18 18 652 37 0 37731 6616050 6712649 37152888 42250139 10840 11546 468795 410916 44248573 49385250 35000 0 0 0 34528696 35731025 0 0 268902 14385320 14975223 48949016 50706248 -4700443 -1320998 47993046 49327430 22432679 25088061 25560367 24239369 DEEPLY ROOTED IN THE ASIAN PACIFIC ISLANDER COMMUNITY, ICHS PROVIDES CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND WELLNESS SERVICES AND PROMOTES HEALTH EQUITY FOR ALL. 0 0 18744804 0 23493983 ICHS PROVIDES MEDICAL SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY. THESE SERVICES INCLUDE PHYSICAL EXAMS, IMMUNIZATIONS, MINOR SURGERY, HOME VISITS, AND INFANT AND WELL-CHILD CHECK-UPS. DURING 2018, ICHS PROVIDED 83,068 PRIMARY HEALTH CARE VISITS TO PATIENTS AND $234,640 OF CHARITY CARE. 11000476 0 11409112 ICHS PROVIDES FULL DENTAL CARE FOR THE ENTIRE FAMILY. ICHS PROVIDES EXTENSIVE DENTURE WORK, FULL CLEANING FOR ADULTS AND CHILDREN, PREVENTIVE DENTISTRY, MINOR ORAL SURGERY, RESTORATIVE SERVICES, ORTHODONTIA, AND EMERGENCY CARE. THE STAFF ALSO PROVIDES ORAL HEALTH EDUCATION IN THE COMMUNITY. DURING 2018, ICHS PROVIDED 51,998 DENTAL CARE VISITS TO PATIENTS AND $736,455 OF CHARITY CARE. 11938952 0 7347044 ICHS PROVIDES A VARIETY OF OTHER HEALTH CARE SERVICES TO THE COMMUNITY. THESE SERVICES INCLUDE CHINESE TRADITIONAL MEDICINE TECHNIQUES, DISEASE PREVENTION, HEALTH EDUCATION, BEHAVIORAL HEALTH, NUTRITION SERVICES, AND FAMILY PLANNING FOR TEENS AND ADULTS. DURING 2018, ICHS PROVIDED 9,074 HEALTH CARE VISITS TO PATIENTS AND $121,598 OF CHARITY CARE. 41684232 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 68 0 652 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X HERMES SHAHBAZIAN 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 GILDAS CHEUNG CHAIR 5.00 0.00 X X 0 0 0 JOHN FOZ 1ST VICE CHAIR 3.00 2.00 X X 0 0 0 CRIS KRISOLOG-ELLIOTT 2ND VICE CHAIR 3.00 0.00 X X 0 0 0 KELLI NOMURA 3RD VICE CHAIR 3.00 0.00 X X 0 0 0 LEE MARCHISIO 4TH VICE CHAIR 3.00 0.00 X X 0 0 0 CATHERINE JOHNSON SECRETARY 3.00 0.00 X X 0 0 0 JOYCE CHIN TREASURER 3.00 0.00 X X 0 0 0 MARIAM ABARIENTOS DIRECTOR 1.50 0.00 X 0 0 0 TRISH BUSTOS DIRECTOR 1.50 0.00 X 0 0 0 TESSA CHU DIRECTOR 1.50 0.00 X 0 0 0 JENNY FANG DIRECTOR 1.50 0.00 X 0 0 0 AMANDA KIMURA DIRECTOR 1.50 0.00 X 0 0 0 JANYCE KO FISHER DIRECTOR 1.50 2.00 X 0 0 0 TED LEW DIRECTOR 1.50 0.00 X 0 0 0 ANU MADAN DIRECTOR 1.50 0.00 X 0 0 0 HIROSHI NAKANO DIRECTOR 1.50 0.00 X 0 0 0 BARBARA OBENA DIRECTOR 1.50 0.00 X 0 0 0 CHARLES WU DIRECTOR 1.50 2.00 X 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 50.00 4.00 X 269792 0 24143 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 40.00 2.00 X 194763 0 16168 RAYBURN LEWIS CHIEF MEDICAL OFFICER 20.00 0.00 X 127545 0 13490 DAVID CHEN CHIEF DENTAL OFFICER 40.00 0.00 X 197663 0 21443 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 272298 0 24424 UYENVY PHAM ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 222061 0 17268 TERESA LEE ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 187916 0 7894 GRANDY AU ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 194229 0 21472 HARVEY WU ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 199769 0 18072 MOLLY MELBYE ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 160463 0 14810 JESSICA GUH FAMILY MEDICINE RESIDENCY DIRECTOR 40.00 0.00 X 201823 0 16025 BETH WEITENSTEINER ARNP RESIDENCY DEPUTY DIRECTOR 32.00 0.00 X 154528 0 16022 HAMED SAHARI-RASHTI DDS PROVIDER 40.00 0.00 X 174411 0 16650 ALAN CHUN MD PROVIDER 32.00 0.00 X 192251 0 16098 NANCY SNAPP MD PROVIDER 32.00 0.00 X 194728 0 16286 CHINDA ROACH MD PROVIDER 36.00 0.00 X 201462 0 19874 JASON GOV DDS PROVIDER 40.00 0.00 X 175649 0 15019 GRACE WANG FORMER OFFICER 28.00 0.00 X 173045 0 15238 STEPHANIE KANG FORMER KEY EMPLOYEE 40.00 0.00 X 126391 0 9116 3620787 0 319512 56 1 1 0 INDEMAND INTERPRETING 555 ANDOVER PARK W STE 201 TUKWILA WA 98188 INTERPRETING SERVICES 388363 NEXTGEN HEALTHCARE PO BOX 511449 LOS ANGELES CA 90051 NEXTGEN MAINTENANCE & BILLING SERVICES 278836 COMMUNITY CLINIC CONTRACTING NETWORK 18 S MISSION ST STE 300 WENATCHEE WA 98801 ICHS SCORECARDS 204433 NEIGHBORHOOD HOUSE 1225 S WELLER STREET 510 SEATTLE WA 98114 SUBCONTRACTOR FOR SBHC GRANT 148922 DENTAL PROFESSIONALS 4700 42ND AVENUE SW SUITE 460 SEATTLE WA 98116 DENTAL TEMP SERVICES 145078 8 305323 5815567 591759 685580 6712649 PATIENT SERVICE FEES 624100 38205216 38205216 POOL SAVINGS REVENUE 900099 4017668 4017668 OTHER MEDICAL REVENUE 900099 27255 27255 42250139 25675 25675 2053 16182 -14129 -14129 -14129 MANAGEMENT FEES 900099 284384 284384 MISCELLANEOUS REVENUE 900099 126532 126532 410916 49385250 42250139 0 422462 2594082 1449924 1144158 26384730 22691323 3473872 219535 1033910 889904 135328 8678 3189832 2715879 451883 22070 2528471 2135173 374679 18619 130807 53258 77549 56390 56390 4023239 2277419 1745820 61421 7974 53447 340665 272932 67733 205967 167939 38028 1638170 1391448 246722 113032 65701 47331 93757 38245 55512 382552 367556 14996 2430174 2046737 383437 130723 90321 40402 UBI TAXES 7924 7924 MEDICAL SUPPLIES 3407997 3377263 30734 PATIENT EXPENSE 834428 834119 309 BAD DEBT 321528 321528 796449 489589 306860 50706248 41684232 8753114 268902 7652621 11581005 2255124 1784454 3017155 2702950 212449 218406 942994 1029342 44184078 15395845 31006242 28788233 2053 1200000 1200000 1704408 2023040 47993046 49327430 10078196 13163585 668840 776020 9254801 9019265 2430842 2129191 22432679 25088061 X 24893566 23661722 666801 577647 25560367 24239369 47993046 49327430 -1320998 0 X 0 1 X 1 1 1 X 1 1 0 0 0 0 1 278 0 0 278 0 PART II-B, LINE 1: INTERNATIONAL COMMUNITY HEALTH SERVICES ("ICHS") STAFF ATTENDED THE CHC/API LEGISLATIVE DAY. 3528037 3528037 26613277 6122104 20491173 5188392 2988780 2199612 8765090 6284961 2480129 89282 89282 28788233 X 49609833 442828 564797 1007625 48602208 783042 783042 49385250 50827548 442828 442828 50384720 321528 321528 50706248 PART X, LINE 2: THE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED ICHS'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF EQUIPMENT 14,129. NET ASSETS RELEASED FROM RESTRICTIONS 550,668. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 321,528. CONTRIBUTIONS WITH DONOR RESTRICTIONS 461,514. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 321,528. X X X X X 0 0 0 1 0 0 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 213062 0 38516 0 18214 0 10606 0 13537 0 293935 0 0 0 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 194763 0 0 0 0 0 7791 0 8377 0 210931 0 0 0 DAVID CHEN CHIEF DENTAL OFFICER 166343 0 18750 0 12570 0 7906 0 13537 0 219106 0 0 0 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 243357 0 16250 0 12691 0 10887 0 13537 0 296722 0 0 0 UYENVY PHAM ASSISTANT MEDICAL DIRECTOR 204811 0 17250 0 0 0 8891 0 8377 0 239329 0 0 0 TERESA LEE ASSISTANT MEDICAL DIRECTOR 165764 0 14150 0 8002 0 7197 0 697 0 195810 0 0 0 GRANDY AU ASSISTANT DENTAL DIRECTOR 157286 0 18750 0 18193 0 7935 0 13537 0 215701 0 0 0 HARVEY WU ASSISTANT DENTAL DIRECTOR 175481 0 17750 0 6538 0 8015 0 10057 0 217841 0 0 0 MOLLY MELBYE ASSISTANT DENTAL DIRECTOR 148463 0 12000 0 0 0 6433 0 8377 0 175273 0 0 0 JESSICA GUH FAMILY MEDICINE RESIDENCY DIRECTOR 177014 0 13700 0 11109 0 7648 0 8377 0 217848 0 0 0 BETH WEITENSTEINER ARNP RESIDENCY DEPUTY DIRECTOR 130179 0 12400 0 11949 0 5965 0 10057 0 170550 0 0 0 HAMED SAHARI-RASHTI DDS PROVIDER 144606 0 13667 0 16138 0 6593 0 10057 0 191061 0 0 0 ALAN CHUN MD PROVIDER 182651 0 9600 0 0 0 7721 0 8377 0 208349 0 0 0 NANCY SNAPP MD PROVIDER 181528 0 13200 0 0 0 7909 0 8377 0 211014 0 0 0 CHINDA ROACH MD PROVIDER 188043 0 9450 0 3969 0 8137 0 11737 0 221336 0 0 0 JASON GOV DDS PROVIDER 160716 0 5333 0 9600 0 6642 0 8377 0 190668 0 0 0 GRACE WANG FORMER OFFICER 168920 0 4125 0 0 0 6861 0 8377 0 188283 0 0 0 STEPHANIE KANG FORMER KEY EMPLOYEE 111641 0 14750 0 0 0 4229 0 4887 0 135507 0 0 0 PART I, LINE 5 THE PRESIDENT/CEO RECEIVES A BONUS BASED ON FIVE STRATEGIC GOALS, ONE OF WHICH IS DIVERSIFYING REVENUE. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2013-10-18 10160000 CONSTRUCTION 0 0 0 A 1140735 10160000 1316561 185641 131346 10160000 2014 0 0 0 1 A 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WASHINGTON HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/18/2018 X 329 DONOR VALUED X 2 685251 COST 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS CHAIRED BY THE CHAIR OF THE BOARD AND ONLY CONSISTS OF THE ELECTED OFFICERS OF THE BOARD AND THE PRESIDENT/CEO OF ICHS AS AN EX OFFICIO MEMBER. THE EXECUTIVE COMMITTEE IS EXCLUSIVELY AUTHORIZED TO ACT FOR THE BOARD IN URGENT SITUATIONS DURING THE INTERIM PERIOD BETWEEN MEETINGS OF THE BOARD IN A MANNER CONSISTENT WITH ESTABISHED BOARD POLICIES AND/OR DIRECTION, AND SHALL REPORT ALL ACTIVITIES AND ACTIONS AT THE NEXT MEETING OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF THE FORM 990 WAS REVIEWED BY THE CFO AND DESIGNATED STAFF, INCLUDING THE ACCOUNTING MANAGER. THE ORGANIZATION'S FINANCE DEPARTMENT THEN REVIEWED AND SUBMITTED A DRAFT COPY OF THE FORM 990 TO THE FINANCE, AUDIT AND EXECUTIVE COMMITTEES OF THE THE BOARD OF DIRECTORS, WHO RECOMMENDED APPROVAL OF THE FORM TO THE FULL BOARD. THE FORM 990 WAS SUBSEQUENTLY PRESENTED TO THE FULL BOARD AT THE FOLLOWING BOARD MEETING FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C ICHS REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICIES. ICHS HAS TWO CONFLICT OF INTEREST POLICIES. THE FIRST POLICY IS AN OVERARCHING POLICY FOR THE ENTIRE AGENCY, WHICH WORKS TO ENSURE EFFECTIVE MANAGEMENT OF CONFLICTS OF INTEREST AT ICHS. THE SECOND POLICY IS SET TO ENSURE ALL BOARD-RELATED ACTIVITIES ARE CONDUCTED IN A WAY THAT ENSURES COMPLIANCE WITH APPLICABLE LAWS, PRESERVES THE PUBLIC'S TRUST, ENSURES GOOD STEWARDSHIP OF ICHS RESOURCES, AND UPHOLDS HIGH STANDARDS OF CONDUCT AND PERSONAL INTEGRITY AMONG ALL BOARD DIRECTORS AND BOARD ASSOCIATES. THE CONFLICT OF INTEREST POLICY REQUIRES ALL EMPLOYEES AND NON-EMPLOYEE REPRESENTATIVES TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MAY COMPROMISE THEIR JUDGMENT OR IF PERSONAL INTERESTS ARE IN SUBSTANTIAL CONFLICT WITH THE BEST INTERESTS OF ICHS. SIMILARLY, INDIVIDUALS ARE EXPECTED TO REMOVE THEMSELVES FROM A POSITION OF DECISION-MAKING AUTHORITY OR SIGNIFICANT INFLUENCE WITH RESPECT TO ANY CONFLICT SITUATION THAT ARISES. A SITUATION IS CONSIDERED A CONFLICT OF INTEREST IF AN INTEREST OR ACTIVITY INFLUENCES OR APPEARS TO INFLUENCE THE ABILITY OF AN INDIVIDUAL TO EXERCISE OBJECTIVITY OR IMPAIRS THE INDIVIDUAL'S ABILITY TO PERFORM HIS OR HER EMPLOYMENT OR REPRESENTATIVE WORK RESPONSIBILITIES IN THE BEST INTEREST OF ICHS. ANY UNETHICAL ABUSE OF EMPLOYEES OR NON-EMPLOYEE REPRESENTATIVES CAN RESULT IN DISCIPLINARY ACTION (INCLUDING TERMINATION OF EMPLOYMENT). THE CONFLICT OF INTEREST POLICY FOR BOARD DIRECTORS AND BOARD ASSOCIATES REQUIRES BOARD DIRECTORS AND ASSOCIATES TO DISCLOSE ANY REAL OR APPARENT CONFLICT OF INTEREST TO THE BOARD AND EXCUSE HIMSELF OR HERSELF FROM VOTING, AS APPROPRIATE. ADDITIONALLY, NO BOARD MEMBER CAN ALSO BE AN EMPLOYEE OR RELATED TO AN EMPLOYEE OF ICHS. IF A CONFLICT OF INTEREST IS PERCEIVED TO EXIST BUT IS NOT DISCLOSED, THE BOARD MAY VOTE WHETHER THERE IS A REAL CONFLICT OF INTEREST. IF THE VOTE IS AFFIRMATIVE, THE BOARD MEMBER IN QUESTION IS NOT ENTITLED TO VOTE ON THAT ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS PERFORM AN ANNUAL PERFORMANCE EVALUATION OF THE PRESIDENT/CEO WITH ASSISTANCE FROM A THIRD PARTY CONSULTANT. THE EXECUTIVE COMMITTEE OF THE BOARD (CHAIRS OF ALL THE COMMITTEES) MEETS WITH THE PRESIDENT/CEO TO NEGOTIATE COMPENSATION THAT IS CONSISTENT WITH MARKET PAY. THIS PROCESS IS UNDERTAKEN ANNUALLY. THE CHIEF FINANCIAL OFFICER AND OTHER KEY EMPLOYEES' COMPENSATION IS DETERMINED BY PERFOMANCE EVALUATIONS AND A COMPENSATION STUDY THAT IS UNDERTAKEN EVERY TWO YEARS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION 720 8TH AVENUE S SUITE 100 SEATTLE WA 98104 260493856 FUNDRAISING WA 501(C)(3) LINE 12A, I INTERNATIONAL COMMUNITY HEALTH SERVICES 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION C 305323 CASH INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION L 284384 FAIR MARKET VALUE INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION M 305323 CASH INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION O 284384 FAIR MARKET VALUE