2019-10-10T14:02:49-05:00 2018-12-31 930743240 HOFFMAN STEWART & SCHMIDT PC 3 CENTERPOINTE DRIVE SUITE 300 LAKE OSWEGO OR 970358663 990 2018-01-01 910896241 COWLITZ FAMILY HEALTH CENTER COWL 3606363892 1057 12TH AVENUE LONGVIEW WA 986322509 DIAN COOPER EXECUTIVE DIRECTOR 3606363892 2019-10-10 1 ROBERT M PRILL P00236613 5032205900 74.95.39.225 2019-10-10 10:05:00 PD P 95D5054A00A45A836EB4D2778BC8CF1E5F41815C 76E610E35C372A61DBF352CE270A820F287984D1 2018 2020-01-14 16:20:31Z DIAN COOPER 1057 12TH AVENUE LONGVIEW WA 986322509 29150905 0 X WWW.COWLITZFAMILYHEALTH.ORG X 1972 WA EVERYONE DESERVES HIGH-QUALITY COMPASSIONATE CARE. WE PROVIDE COMPREHENSIVE HEALTH SERVICES AND EDUCATION, REGARDLESS OF CIRCUMSTANCES OR INCOME. TOGETHER WE IMPROVE QUALITY OF LIFE AND TRANSFORM OUR COMMUNITIES. 11 11 297 18 0 0 4776617 4801227 15821956 24312213 4479 9429 24369 28036 20627421 29150905 0 0 0 0 13596836 14590977 0 0 0 8502266 8854143 22099102 23445120 -1471681 5705785 17941244 22788434 4043488 3184893 13897756 19603541 X EVERYONE DESERVES HIGH-QUALITY COMPASSIONATE CARE. WE DO THIS BY PROVIDING COMPREHENSIVE HEALTH SERVICES AND EDUCATION, REGARDLESS OF CIRCUMSTANCES OR INCOME. TOGETHER WE IMPROVE QUALITY OF LIFE AND TRANSFORM OUR COMMUNITIES. 0 0 10379070 17369713 TO PROVIDE MEDICAL SERVICES TO LOW INCOME INDIVIDUALS. THE TOTAL MEDICAL ENCOUNTERS DURING THE YEAR WERE 57,570. 3394926 2750867 TO PROVIDE DENTAL SERVICES TO LOW INCOME INDIVIDUALS. THE TOTAL DENTAL ENCOUNTERS DURING THE YEAR WERE 19,179. 569207 TO PROVIDE SUPPLEMENTAL NUTRITION SERVICES FOR PREGNANT AND BREASTFEEDING WOMEN AND THEIR CHILDREN TO AGE 5. DURING 2018, THE CENTER SERVED 5,067 WOMEN, INFANTS, AND CHILDREN. 5166743 4219669 TO PROVIDE MEDICAL RELATED SERVICES TO LOW INCOME INDIVIDUALS. ENABLING SERVICE ENCOUNTERS AND MENTAL HEALTH ENCOUNTERS (INCLUDING SUBSTANCE USE DISORDER SERVICES) TOTALED 9,081 AND 9,144, RESPECTIVELY. 5166743 4219669 19509946 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 48 0 1 297 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WA X DIAN COOPER 3066363892 1057 12TH AVENUE LONGVIEW WA 98632 RICK HUCKABY PRESIDENT 2.00 X X 0 0 0 MELISSA TAYLOR TREASURER 2.00 X X 0 0 0 WANDA MCBEE SECRETARY 2.00 X X 0 0 0 CARLEEN WOLGAMOTT DIRECTOR 2.00 X 0 0 0 CYNTHIA WASHINGTON-MATTSON VICE PRESIDENT 2.00 X X 0 0 0 ALISABETH BUCK DIRECTOR 2.00 X 0 0 0 SANDRA BENBROOK-RIEDER DIRECTOR 2.00 X 0 0 0 EM HOYHTYA DIRECTOR 2.00 X 0 0 0 WAYNE CAIN DIRECTOR 2.00 X 0 0 0 ELIZABETH CATTIN DIRECTOR 2.00 X 0 0 0 JOHN PAUL PRADO DIRECTOR 2.00 X 0 0 0 MARK GAITHER DIRECTOR 2.00 X 0 0 0 DIAN COOPER EXECUTIVE DIRECTOR 40.00 X 184486 0 10070 PAM SPEARS FINANCE DIRECTOR 40.00 X 120805 0 9251 JAMES COFFEE COO 40.00 X 122050 0 10324 GERALDO MELGAR MEDICAL DIRECTOR 40.00 X 264873 0 10476 GAIL CONWAY PHYSICIAN 40.00 X 186605 0 9642 ANTHONY REYES PHYSICIAN 40.00 X 197109 0 9669 DAVID MEYERS DENTIST 40.00 X 165029 0 8673 TRESHA CARROLL PHYSICIAN 40.00 X 176649 0 9152 ERIC GURRAD DENTIST 40.00 X 162361 0 9957 1579967 0 87214 19 0 1 0 OCHIN INC 1881 SW NAITO PARKWAY PORTLAND OR 972015195 EMR AND PRACTICE MANAGEMENT FEES 1090088 STAFF CARE 5001 STATESMAN DRIVE IRVING TX 75063 LOCUM TENENS 1017950 MCKESSON PO BOX 933027 ATLANTA GA 31193 MEDICAL PRODUCT DISTRIBUTOR 870062 POLAR SYSTEMS 21890 WILLAMETTE DRIVE WEST LINN OR 97068 IT SERVICES 439582 BURKHART DENTAL 2502 SOUTH 78TH STREET TACOMA WA 98409 MEDICAL PRODUCT DISTRIBUTOR 398259 10 X 4626326 174901 4801227 PATIENT SERVICE REVENUE 624100 11729823 11729823 PREMIUM REVENUE AND INCENTIVE 624100 11297258 11297258 PHARMACY FEES 624100 1175292 1175292 PROGRAM SERVICE REVENUE 624100 109840 109840 24312213 9429 9429 OTHER REVENUE 900099 28036 28036 28036 29150905 24340249 0 9429 X 732335 275349 456986 11166314 9903065 1263249 20736 19439 1297 1680412 1463113 217299 991180 849874 141306 203880 203880 65100 65100 3411124 2136162 1274962 10886 10736 150 455453 360540 94913 1481554 1397082 84472 55466 47789 7677 43558 37529 6029 39495 39450 45 477927 447878 30049 128759 118062 10697 MEDICAL SUPPLIES 970022 970022 CLIENT ASSISTANCE 646577 646577 BAD DEBT 593177 593177 DUES & SUBSCRIPTIONS 88781 41378 47403 182384 152724 29660 23445120 19509946 3935174 0 1919473 2657073 6756408 5288359 468258 371157 2558702 8170723 150910 158187 213626 291623 11388609 5537297 5873867 5851312 17941244 22788434 2391510 1558855 1651978 1626038 4043488 3184893 X 13868155 19575555 29601 27986 13897756 19603541 17941244 22788434 5705785 0 X X 0 1 X 1 1 1 X 3408144 4299952 4577613 4776617 4801227 21863553 3408144 4299952 4577613 4776617 4801227 21863553 21863553 2158 3501 3854 4479 9429 23421 5677 11167 17599 24369 28036 86848 21973822 87535930 0.99500 0.99630 X 559980 559980 4491324 542487 3948837 2718423 2091688 626735 3531779 2858627 673152 87103 44495 42608 5851312 X 28557728 0 28557728 593177 593177 29150905 22851943 0 22851943 593177 593177 23445120 PART X, LINE 2: MANAGEMENT OF COWLITZ FAMILY HEALTH CENTER DOES NOT BELIEVE THE CENTER HAS ANY UNCERTAIN TAX POSITIONS. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT EXPENSE 593,177. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT EXPENSE 593,177. X X 0 0 0 0 0 0 0 0 0 DIAN COOPER EXECUTIVE DIRECTOR 184486 0 0 0 0 0 0 0 10070 0 194556 0 0 0 GERALDO MELGAR MEDICAL DIRECTOR 264873 0 0 0 0 0 0 0 10476 0 275349 0 0 0 GAIL CONWAY PHYSICIAN 184242 0 2363 0 0 0 0 0 9642 0 196247 0 0 0 ANTHONY REYES PHYSICIAN 195709 0 1400 0 0 0 0 0 9669 0 206778 0 0 0 DAVID MEYERS DENTIST 163253 0 1776 0 0 0 0 0 8673 0 173702 0 0 0 TRESHA CARROLL PHYSICIAN 174049 0 2600 0 0 0 0 0 9152 0 185801 0 0 0 ERIC GURRAD DENTIST 161076 0 1285 0 0 0 0 0 9957 0 172318 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE AND THE FULL BOARD OF DIRECTORS MUST REVIEW THE DRAFT FORM 990 PRIOR TO SUBMITTAL. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION INQUIRES ABOUT CONFLICTS OF INTEREST AT INITIAL INTERVIEWS WITH CANDIDATES FOR EMPLOYMENT AND BOARD MEMBERS ARE REQUIRED TO SIGN A STATEMENT OF DECLARATION OF ANY CONFLICTS OF INTEREST. BOARD MEMBERS ARE REQUIRED TO FILL OUT AN ANNUAL CONFLICT OF INTEREST FORM. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE CEO'S PAY BASED ON PERFORMANCE AND COMPARABLE MARKET SALARIES. COMPENSATION FOR KEY EMPLOYEES ARE REVIEWED AND APPROVED BY THE CEO BASED ON PERFORMANCE AND COMPARABLE MARKET SALARIES. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST. FORM 990, PART VIII, LINE 2B: COWLITZ FAMILY HEALTH CENTER (THE CENTER) RECORDED PREMIUM REVENUE AND INCENTIVE REVENUE OF $4,293,328, IN THE YEAR ENDING DECEMBER 31, 2018, AS A RESULT OF A ONE-TIME RECOGNITION OF REVENUE FOR AN ENHANCEMENT RECONCILIATION PROCESS WITH THE STATE OF WASHINGTON, ADJUSTMENTS TO THE RISK POOL WITH CHPW, AND INCENTIVE REVENUE. MANAGEMENT DOES NOT ANTICIPATE THIS LEVEL OF FUNDING TO REPEAT IN THE FUTURE. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,136,162. MANAGEMENT AND GENERAL EXPENSES 1,274,962. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,411,124. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN THE PROCESS FROM THE PRIOR YEAR REGARDING THE OVERSIGHT OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANTS' THAT AUDIT THE FINANCIAL STATEMENTS OF THE ORGANIZATION.