2019-05-20T12:38:09-05:00 2018-06-30 930900579 MCDONALD JACOBS PC 520 SW YAMHILL ST STE 500 PORTLAND OR 97204 990 2017-07-01 462164971 SOUTHWEST WASHINGTON REGIONAL HEALTH ALLIANCE SOUT 3608287319 2404 E MILL PLAIN BLVD VANCOUVER WA 98661 JOHN HERSEN PRESIDENT 3608287319 2019-05-17 1 KARIN S WANDTKE P00172715 5032270581 50.204.228.78 2019-05-17 10:17:20 PD P 16E3360C8D28A2C498A262D79CEC4CD768A9D895 FA9676FDB5E3B5CC3D00C9F643EA12EB39A2C68D 2017 2019-02-21 02:37:17Z SOUTHWEST WASHINGTON ACCOUNTABLE COMMUNITY OF HEALTH JON HERSEN 2404 E MILL PLAIN BLVD VANCOUVER WA 98661 32143319 0 X WWW.SOUTHWESTACH.ORG X 2013 WA PARTNERING TO BUILD A HEALTHIER FUTURE IN SOUTHWEST WASHINGTON - FOR EVERYONE. 14 14 14 70 0 0 3399 32110068 1071769 0 18 29168 0 4083 1075186 32143319 0 3506410 0 0 150958 1633020 0 0 0 397204 1159982 548162 6299412 527024 25843907 1270307 27853009 64954 681909 1205353 27171100 X SOUTHWEST WASHINGTON ACCOUNTABLE COMMUNITY OF HEALTH (SWACH) IS A LOCAL NONPROFIT WORKING TO IMPROVE HEALTH IN SOUTHWEST WASHINGTON. WE BRING TOGETHER COMMUNITY MEMBERS AND OTHER EXPERTS TO ADDRESS OUR REGION'S MAJOR HEALTH CHALLENGES. THROUGH INNOVATIVE PARTNERSHIPS AND LOCAL RESOURCES, WE'RE WORKING TO CREATE LASTING CHANGES AND A HEALTHIER FUTURE FOR EVERYONE. 0 0 1621215 227267 SOUTHWEST WASHINGTON REGIONAL HEALTH ALLIANCE CONFIRMED PARTNERSHIPS WITH TWENTY CLINICAL ORGANIZATIONS IN CLARK, SKAMANIA AND KLICKITAT COUNTIES, COORDINATED HEALTH INFORMATION ASSESSMENTS WITH EACH ORGANIZATION, AND DEFINED A PROCESS TO CREATE TRANSFORMATION PLANS TO IMPROVE CARE AND SERVICE FOR MEDICAID MEMBERS. 454231 411880 THE HEALTHY LIVING COLLABORATIVE (HLC) SUPPORTS CROSS SECTOR WORK WITH A FOCUS ON COMMUNITY ENGAGEMENT AND HEALTH POLICY AND SYSTEMS WORK. COMMUNITY ENGAGEMENT EFFORTS PRIMARILY FOCUS ON FIVE COMMUNITY HEALTH WORKER PROGRAMS. HLC SUPPORTS POLICY AND SYSTEMS WORK AT THE ORGANIZATIONAL, LOCAL, AND STATE LEVEL. 2867263 2867263 INTERGOVERNMENTAL TRANSFER (IGT) CONTRIBUTION TO THE STATEWIDE SHARED INVESTMENT POOL TO SUPPORT SPECIFIC DOMAIN 1 SERVICES FROM DESIGNATED PROVIDERS ACROSS ALL NINE ACCOUNTABLE COMMUNITY OF HEALTH (ACH) REGIONS. 4942709 1 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 5 0 14 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X X SUSAN CRANDALL 3608287319 2404 E MILL PLAIN BLVD VANCOUVER WA 98661 JOH HERSEN PRESIDENT 2.00 X X 0 0 0 SHARON CROWELL VICE PRESIDENT 2.00 X X 0 0 0 KAREN STRAL SECRETARY 2.00 X X 0 0 0 KEVIN WITTE TREASURER 2.00 X X 0 0 0 LAUREL LEE PAST SECRETARY 1.00 X X 0 0 0 LES BURGER MEMBER 1.00 X 0 0 0 SHONA CARTER MEMBER 1.00 X 0 0 0 DAVID EDWARDS MEMBER 1.00 X 0 0 0 DAVID KELLY MEMBER 1.00 X 0 0 0 ROBB KIMMES MEMBER 1.00 X 0 0 0 STEVE KUTZ MEMBER 1.00 X 0 0 0 CRAIG PRIDEMORE MEMBER 1.00 X 0 0 0 KIRBY RICHARDS MEMBER 1.00 X 0 0 0 ROXANNE WOLFE MEMBER 1.00 X 0 0 0 DAWN BONDER THROUGH 42518 CEO 40.00 X 146731 0 8744 JANICE FINLEY THROUGH 42518 CFO 40.00 X 104808 0 9679 251539 0 18423 2 0 1 0 0 31472198 637870 32110068 29168 29168 OTHER INCOME 900099 4083 4083 4083 32143319 4083 0 29168 X 3506410 3506410 596238 264380 331858 812035 360068 451967 23447 10397 13050 97916 43417 54499 103384 45842 57542 43470 200 43270 10890 10890 875679 672468 203211 11320 9236 2084 9631 1180 8451 27156 194 26962 52341 3944 48397 39244 24973 14271 6975 6975 2892 2892 LICENSES AND FEES 60361 60361 MISCELLANEOUS 20023 20023 6299412 4942709 1356703 0 1264328 16073235 3864395 167868 7725073 5979 22438 1270307 27853009 64954 681909 64954 681909 X 1205353 27052418 118682 1205353 27171100 1270307 27853009 25843907 121840 0 X X 0 1 X 1 0 X 1014145 225361 526287 3399 32110068 33879260 1014145 225361 526287 3399 32110068 33879260 33879260 1 18 29168 29187 4083 4083 33912530 1071769 0.99900 X 0.95560 0.00000 0 1 0 0 0 0 0 0 1 130 130 0 PART II-B, LINE 1: EMAIL CORRESPONDENCE 0 X 32143319 0 32143319 0 32143319 6299412 0 6299412 0 6299412 PART X, LINE 2: THE ORGANIZATION FOLLOWS THE PROVISIONS OF FASB ASC TOPIC 740 ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. MANAGEMENT HAS EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH PROVISIONS OF THIS TOPIC. 0 211 INFO 7535 NE AMBASSADOR PLACE SUITE B PORTLAND OR 97220 930784586 501(C)(3) 8937 WA STATE DOH SUBGRANTEE CONTRACTED FOR OBESITY, DIABETES, AND HEART DISEASE AND STROKE PREVENTION ACTIVITIES CASCADE PACIFIC ACTION ALLIANCE LLC 1217 4TH AVENUE E SUITE 200 OLYMPIA WA 98506 820799403 LLC (PART OF 501C3 C 10000 WA STATE DOH SUBGRANTEE CONTRACTED FOR OBESITY, DIABETES, AND HEART DISEASE AND STROKE PREVENTION ACTIVITIES CLARK COUNTY PUBLIC HEALTH 1300 FRANKLIN STREET VANCOUVER WA 98660 916001299 LOCAL GOVERNMENT 53932 WA STATE DOH SUBGRANTEE CONTRACTED FOR OBESITY, DIABETES, AND HEART DISEASE AND STROKE PREVENTION ACTIVITIES CONSUMER VOICES ARE BORN 1601 E FOURTH PLAIN BLVD VANCOUVER WA 98661 911727234 501(C)(3) 42181 HEALTHY LIVING COLLABORATIVE ANCHOR ORGANIZATION FOR COMMUNITY HEALTH WORKERS. COWLITZ COUNTY 1952 9TH AVENUE LONGVIEW WA 98632 916001310 LOCAL GOVERNMENT 9382 WA STATE DOH SUBGRANTEE CONTRACTED FOR OBESITY, DIABETES, AND HEART DISEASE AND STROKE PREVENTION ACTIVITIES FOUNDATION FOR HEALTHY GENERATIONS 419 3RD AVENUE WEST SEATTLE WA 98119 916186093 501(C)(3) 8323 WA STATE DOH SUBGRANTEE CONTRACTED FOR OBESITY, DIABETES, AND HEART DISEASE AND STROKE PREVENTION ACTIVITIES FREE CLINIC OF SW WASHINGTON 4100 PLOMONDON STREET VANCOUVER WA 98661 911707542 501(C)(3) 38892 HEALTHY LIVING COLLABORATIVE ANCHOR ORGANIZATION FOR COMMUNITY HEALTH WORKERS. WASHINGTON STATE UNIVERSITY PO BOX 641025 PULLMAN WA 99164 916001108 501(C)(3) 7500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION CHILDRENS HOME SOCIETY OF WASHINGTON 220 EASTMONT AVE SUITE B EAST WENATCHEE WA 98802 910575955 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON 100 23RD AVE S SEATTLE WA 98144 911585652 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION LUTHERAN COMMUNITY SERVICES NORTHWEST 4040 S 188TH ST SUITE 300 SEATAC WA 98188 930386860 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION COMPREHENSIVE HEALTHCARE 402 S 4TH AVE PO BOX 959 YAKIMA WA 98907 911043304 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION SEA-MAR COMMUNITY HEALTH CENTERS 1040 SOUTH HENDERSON ST SEATTLE WA 98108 911020139 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION KLICKITAT VALLEY HEALTH 310 S ROOSEVELT GOLDENDALE WA 98620 916001738 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION PUBLIC HOSPITAL DISTRICT NO 2 OF KLICKITAT COUNTY PO BOX 99 WHITE SALMON WA 98672 916000960 LOCAL GOVERNMENT 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION CHILD AND ADOLESCENT CLINIC 971 11TH AVENUE LONGVIEW WA 98632 911139057 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION INSTITUTE FOR FAMILY DEVELOPMENT 34004 16TH AVE SOUTH SUITE 200 FEDERAL WAY WA 98003 911158512 501(C)(3) 7500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION COLUMBIA RIVER MENTAL HEALTH SERVICES 6926 NE FOURTH PLAIN BLVD VANCOUVER WA 98661 910609138 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION COMMUNITY SERVICES NORHTWEST 1601 E FOURTH PLAIN BLVD VANCOUVER WA 98661 141848332 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION DAYBREAK YOUTH SERVICES 960 E 3RD STREET SPOKANE WA 99202 911083936 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST 500 NE MULTNOMAH ST PORTLAND OR 97232 930798039 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION LIFELINE CONNECTIONS PO BOX 1678 VANCOUVER WA 98668 910787084 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION NAMI SOUTHWEST WASHINGTON 5411 E MILL PLAIN BLVD SUITE 4 VANCOUVER WA 98661 911065027 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION MID-COLUMBIA FAMILY PHYSICIANS PS PO BOX 1519 BINGEN WA 98672 911152824 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION ONE COMMUNITY HEALTH 849 PACIFIC AVE HOOD RIVER OR 97031 930910794 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION SKAMANIA COUNTY 710 SW ROCK CREEK DR STEVENSON WA 98648 916001363 LOCAL GOVERNMENT 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION PEACEHEALTH 1115 SE 164TH AVE VANCOUVER WA 98683 916068143 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION PROVIDENCE HEALTH AND SERVICES-WASHINGTON 1801 LIND AVE SW RENTON WA 98057 510216586 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION FAMILY SOLUTIONS INC 1014 MAIN STREET VANCOUVER WA 98660 912171585 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION TELECARE CORPORATION 1601 E 4TH PLAIN BLVD BLDG 17 A142 VANCOUVER WA 98661 270342521 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION THE VANCOUVER CLINIC INC PS 700 NE 87TH AVENUE VANCOUVER WA 98664 910851599 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION CHILDRENS CENTER 13500 SE 7TH ST VANCOUVER WA 98683 911459420 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION KLICKITAT COUNTY 228 W MAIN MS-CH-14 GOLDENDALE WA 98620 916001350 LOCAL GOVERNMENT 7500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION LEGACY SALMON CREEK HOSPITAL 1120 NW 20TH AVE SUITE 108 PORTLAND OR 97209 331065485 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION PLANNED PARENTHOOD OF THE COLUMBIAWILLAMETTE INC 3727 NE MARTIN LUTHER KING JR BLVD PORTLAND OR 97212 936031270 501(C)(3) 17500 PROVIDER ENGAGEMENT, PARTICIPATION AND IMPLEMENTATION ROSE MEDICAL GROUPS PC 18 NW 20 AVE BATTLE GROUND WA 98604 810799249 501(C)(3) 7500 SHARED DOMAIN 1 INCENTIVES UNIVERSITY OF WASHINGTON 1959 PACIFIC STREET SEATTLE WA 98195 916001537 501(C)(3) 2293810 SHARED DOMAIN 1 INCENTIVES KING COUNTY PUBLIC HOSPITAL DISTRICT 2 12040 NE 128TH ST KIRKLAND WA 98034 910844563 LOCAL GOVERNMENT 252319 SHARED DOMAIN 1 INCENTIVES PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY 400 S 43RD STREET RENTON WA 98055 916000986 LOCAL GOVERNMENT 252319 SHARED DOMAIN 1 INCENTIVES ASSOCIATION OF WA PUBLIC HOSPITAL DISTRICTS 999 3RD AVE STE 1400 SEATTLE WA 98104 911467655 LOCAL GOVERNMENT 21000 SHARED DOMAIN 1 INCENTIVES PHD 1 DBA SKAGIT VALLEY HOSPITAL 1415 E KINCAID STREET MOUNT VERNON WA 98273 562392010 LOCAL GOVERNMENT 7982 SHARED DOMAIN 1 INCENTIVES 40 1 PART I, LINE 2: DETAILED INVOICES AND EXPENSE BACK UP REQUIRED FOR PAYMENT. PERIODIC REPORTING REQUIRED AND MONITORED BY PROGRAM DIRECTOR. X 1 0 0 0 0 0 0 0 0 DAWN BONDER THROUGH 42518 CEO 146731 0 0 0 0 0 3638 0 5106 0 155475 0 0 0 PART I, LINE 4A DAWN BONDER: $200,435 PAID DURING FISCAL YEAR; SEVERANCE PAID IN SEVERAL INSTALLMENTS BETWEEN 3/1/18 AND 4/25/18. JANICE FINLEY: $128,258 PAID DURING FISCAL YEAR; SEVERANCE PAID IN SEVERAL INSTALLMENTS BETWEEN 4/16/18 AND 4/25/18. PART OF SEVERANCE IS CASH IN LIEU OF HEALTH/DENTAL INSURANCE FOR EXTENDED TIME. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE 990 IS E-MAILED TO THE BOARD MEMBERS FOR REVIEW BEFORE BEING FINALIZED AND SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO REVIEW POLICY AND DISCLOSE ANY CONFLICTS ANNUALLY IN WRITING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ALL DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 467,604. MANAGEMENT AND GENERAL EXPENSES 139,542. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 607,146. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 12,120. MANAGEMENT AND GENERAL EXPENSES 16,919. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,039. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 192,744. MANAGEMENT AND GENERAL EXPENSES 46,750. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 239,494. PART XII LINE 2C THE PROCESS FOR FINANCIAL STATEMENT OVERSIGHT HAS NOT CHANGED FROM THE PRIOR YEAR. LATE FILE RETURN DUE TO CCH SOFTWARE OUTAGE