2018-11-13T10:52:38-06:00 2018-03-31 910189318 MOSS ADAMS LLP PO BOX 22650 YAKIMA WA 989072650 990 2017-04-01 237297657 COLUMBIA VALLEY COMMUNITY HEALTH COLU 5096643528 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 DAVID OLSON CEO 5096643528 2018-11-07 1 EMINA O CRESSWELL CPA P01217304 5092487750 2018-09-06 12.129.7.100 2018-11-07 10:21:20 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C96F15E91551BFB057D7740D910768FE520FD508 2017 2019-02-21 02:37:17Z DAVID OLSON 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 34986484 0 X WWW.CVCH.ORG X 1972 WA TO PROVIDE ACCESS TO IMPROVED HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 11 11 366 11 0 0 7797611 8348276 21732748 26538595 -464625 20091 0 0 29065734 34906962 50340 483397 0 0 19614799 21304998 8502 3400 18885 7929540 9047828 27603181 30839623 1462553 4067339 47922519 53583335 14571154 15931623 33351365 37651712 THE MISSION OF COLUMBIA VALLEY COMMUNITY HEALTH IS TO PROVIDE ACCESS TO IMPROVED HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 0 0 23445630 483397 25837018 PROVIDE COMPREHENSIVE MEDICAL, MENTAL HEALTH AND DENTAL CARE TO SEASONAL AND MIGRANT FARM WORKERS AND THE MEDICALLY UNDERSERVED POPULATION OF THE AREA. THIS INCLUDES GENERAL MEDICINE, DENTAL, PRENATAL, AND OBSTETRIC CARE ON AN OUTPATIENT BASIS. AN ON SITE PHARMACY PROVIDES PATIENT PRESCRIPTION SERVICES TO ENSURE PATIENTS OBTAIN NEEDED MEDICATIONS. 593889 701577 INTERMEDIARY FOR PROVIDING SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN. INCLUDES NUTRITION EDUCATION, REFERRAL FOR HEALTH CARE FOR LOW-INCOME WOMEN AS WELL AS INFANTS AND CHILDREN UNDER AGE FIVE. PROGRAM FOCUS IS FOR BOTH INFANTS AND CHILDREN IN THE CRITICAL PERIODS OF GROWTH AND DEVELOPMENT UNDER AGE FIVE. 24039519 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 66 0 1 366 1 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 1 0 X MIKE ROMINE 5096626000 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 MICHAEL MACHADO BOARD MEMBER 2.00 X 0 0 0 LOLY LARSON BOARD MEMBER 2.00 X 0 0 0 ROBERT SCOTT JR BOARD MEMBER 2.00 X 0 0 0 JOHN SWENSON BOARD MEMBER 2.00 X 0 0 0 TERESA ZEPEDA BOARD MEMBER 2.00 X 0 0 0 RICH WATSON BOARD MEMBER 2.00 X 0 0 0 RUTH CABRERA DE ALPIRE BOARD MEMBER 2.00 X 0 0 0 ERIN TOFTE-NORDVIK BOARD MEMBER THROUGH 6/17 2.00 X 0 0 0 JOAN ALWAY PRESIDENT 2.00 X X 0 0 0 KRISTINA STEPPER VICE PRESIDENT 2.00 X X 0 0 0 JOANNE HILL SECRETARY 2.00 X X 0 0 0 SHAUN KOOS TREASURER 2.00 X X 0 0 0 DAVID OLSON CEO 40.00 X 235652 0 25090 MICHAEL ROMINE CFO 40.00 X 170041 0 26108 CAROL DIEDE COO 40.00 X 174360 0 22630 MALCOLM BUTLER CHIEF MEDICAL OFFICER 40.00 X 301825 0 30138 BRUCE V WILCOX DENTAL DIRECTOR 40.00 X 274606 0 30362 KENNETH SHERMER MEDICAL DIRECTOR 40.00 X 283467 0 30340 KERI BERGESON MEDICAL DIRECTOR 40.00 X 262147 0 21583 JENNIFER SNYDER PHYSICIAN 40.00 X 257653 0 28456 JEFFERY HINCKLEY DENTIST 40.00 X 201732 0 27783 BRENDA BAUMEISTER PHYSICIAN 40.00 X 200483 0 27535 2361966 0 270025 37 0 1 0 ALDRICH & ASSOCIATES 810 240TH ST SE BOTHELL WA 98021 CONSTRUCTION 5708676 ATHENAHEALTH INC PO BOX 415615 BOSTON MA 02241 BILLING AND COLLECTION SERVICE 474831 COMMUNITY CLINIC CONTRACTING NETWORK IN 18 S MISSION ST SUITE 300 WENATCHEE WA 98801 DATA WAREHOUSE 384107 ABM JANITORIAL SERVICES PO BOX 951864 DALLAS TX 75395 JANITORIAL SERVICES 212806 OGDEN MURPHY WALLACE PLLC 901 FIFTH AVE SUITE 3500 SEATTLE WA 981642008 LEGAL 114586 5 8295965 52311 8348276 NET PATIENT SERVICE REVENUE 621400 18020263 18020263 ENHANCEMENT REVENUE 621400 5914648 5914648 CAPITATION REVENUE 621400 1672453 1672453 CONTRACT SERVICES 621400 661469 661469 MEANINGFUL USE INCENTIVE REVENUE 621400 191250 191250 78512 78512 26538595 99613 99613 79522 -79522 -79522 -79522 34906962 26538595 0 20091 450000 450000 33397 33397 1305751 351233 954518 15759643 13959080 1788162 12401 658839 518348 139977 514 2124049 1783694 339018 1337 1456716 1221105 234761 850 204807 204807 68765 68765 3400 3400 872812 186009 686803 117745 19739 98006 246390 134426 111741 223 1270604 787310 483294 768991 578500 190491 21933 17941 3992 283481 141734 141587 160 167015 106832 60183 2059718 1191374 868344 129410 70608 58802 PATIENT & PHARMACEUTICA 2103043 2102074 969 OTHER EQUIPMENT 140373 132748 7625 STAFF RECRUITING 107554 91480 16074 DUES & LICENSE 55722 53890 1832 429465 107997 321468 30839623 24039519 6781219 18885 5517611 8411648 5022858 4394464 672528 224393 2839387 1370750 115760 142523 272765 350254 47421100 13075672 29433166 34345428 2848444 3143875 1200000 1200000 47922519 53583335 3996777 3324414 275533 35000 4909953 9864378 5388891 2707831 14571154 15931623 X 33295814 37611707 55551 40005 33351365 37651712 47922519 53583335 4067339 233009 0 X 0 1 X 1 1 1 X 4066966 4066966 37149351 8810946 28338405 129171 83068 46103 5771237 4033709 1737528 304375 147949 156426 34345428 MANAGED CARE RECONCILIATION 2233660 BEHAVIORAL HEALTH FFS TAKEBACKS 384410 OTHER LIABILITIES 89761 2707831 X 34769492 233009 79521 312530 34456962 450000 450000 34906962 30469145 79521 79521 30389624 450000 450000 30839624 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS USING A STANDARD THAT PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. AS OF MARCH 31, 2018 AND 2017, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 79,521. PART XI, LINE 4B - OTHER ADJUSTMENTS: GRANT EXPENSE 450,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 79,521. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANT EXPENSE 450,000. 1 THE TRUST FOR PUBLIC LAND 18 N WENATCHEE AVE WENATCHEE WA 98801 237222333 501(C)(3) 450000 TO HELP FUND THE BUILDING OF A PARK NEXT TO THE CLINIC IN EAST WENATCHEE 1 0 PAYMENT OF MEDICAL BILLS FOR INDIVIDUALS WHO NEED ASSISTANCE - HELPING HANDS 102 33397 PART I, LINE 2: PER THE CLIENTS FUNDING POLICY TO BE CONSIDERED FOR THE HELPING HANDS FUND, THE PATIENT'S HOUSEHOLD INCOME SHOULD NOT EXCEED TWO HUNDRED PERCENT (200%) OF THE POVERTY GUIDELINES. AS THE HELPING HANDS FUND IS THE PAYER OF LAST RESORT, ALL OUTSIDE FUNDING SOURCES (INCLUDING, BUT NOT LIMITED TO, GRANTS, GOVERNMENT ASSISTANCE, PRIVATE FOUNDATIONS, AND PATIENT ASSISTANCE PROGRAMS) WILL BE REVIEWED AND UTILIZED BEFORE DETERMINING HELPING HANDS FUND ELIGIBILITY. THE COMMITTEE WILL REVIEW AND VOTE ON ELIGIBLE APPLICATIONS ON A CASE BY CASE BASIS. FOR APPLICATIONS REFERRED BY PROVIDERS, AN URGENT NEED REQUEST FORM WILL BE COMPLETED BY THE PROVIDER AND SIGNED BY A COMMITTEE MEMBER. IF THE ESTIMATED COST IS BETWEEN $200 AND $299, A MANAGEMENT TEAM MEMBER'S SIGNATURE IS ALSO REQUIRED. URGENT NEED REQUEST EQUAL TO OR GREATER THAN $300 MUST BE APPROVED BY THE COMMITTEE VIA EMAIL VOTE BEFORE FUNDING CAN OCCUR. NON URGENT NEED APPLICATIONS WILL BE REVIEWED AT MONTHLY COMMITTEE MEETINGS. IN ADDITION TO THE APPLICATION, FURTHER INFORMATION MAY BE OBTAINED BY THE COMMITTEE TO AID WITH ELIGIBILITY DETERMINATION. IF THE NEED DICTATES, THE COMMITTEE MAY CONSIDER AN APPLICATION PRIOR TO THE MONTHLY MEETING. APPLICANTS REQUESTING RELIEF ON CVCH ACCOUNTS WILL GENERALLY RECEIVE A DECISION AND NOTIFICATION BY A COMMITTEE REPRESENTATIVE WITHIN 60 DAYS OF COMMITTEE REVIEW. IN MAKING A DETERMINATION OF ELIGIBILITY, THE COMMITTEE MAY CONSIDER WHETHER THE PATIENT HAS NEGOTIATED IN GOOD FAITH WITH THE CVCH BILLING DEPARTMENT, KEPT PATIENT SERVICE APPOINTMENTS, MADE PAYMENTS, AND/OR DEMONSTRATED INTEREST IN CLEARING HIS/HER ACCOUNT. X X X X X 0 0 0 0 0 0 0 1 0 DAVID OLSON CEO 200800 0 34163 0 689 0 6884 0 18206 0 260742 0 0 0 MICHAEL ROMINE CFO 141600 0 28000 0 441 0 7982 0 18126 0 196149 0 0 0 CAROL DIEDE COO 149045 0 24841 0 474 0 8024 0 14606 0 196990 0 0 0 MALCOLM BUTLER CHIEF MEDICAL OFFICER 265864 0 35354 0 607 0 11925 0 18213 0 331963 0 0 0 BRUCE V WILCOX DENTAL DIRECTOR 204657 0 63210 0 6739 0 12150 0 18212 0 304968 0 0 0 KENNETH SHERMER MEDICAL DIRECTOR 205401 0 51425 0 26641 0 12150 0 18190 0 313807 0 0 0 KERI BERGESON MEDICAL DIRECTOR 201769 0 43925 0 16453 0 11797 0 9786 0 283730 0 0 0 JENNIFER SNYDER PHYSICIAN 202644 0 47897 0 7112 0 10259 0 18197 0 286109 0 0 0 JEFFERY HINCKLEY DENTIST 169793 0 30656 0 1283 0 9601 0 18182 0 229515 0 0 0 BRENDA BAUMEISTER PHYSICIAN 199000 0 0 0 1483 0 9330 0 18205 0 228018 0 0 0 PART I, LINE 7 ANNUAL MERIT AND PERFORMANCE BASED BONUSES ARE AVAILABLE TO DIRECTORS AND DEPARTMENT LEADERS. THE BONUSES AND BONUS STRUCTURE ARE MONITORED BY THE EXECUTIVE TEAM AND APPROVED BY THE BOARD OF DIRECTORS. A WA HEALTHCARE FACILITIES 911108929 2017-06-22 9911965 NEW CONSTRUCTION AND REFINANCE 0 0 0 A 699 9911965 5080906 2017 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE 990 IS PROVIDED BY THE EXTERNAL TAX PRACTITIONER AND PRESENTED TO THE FINANCE COMMITTEE, A SUBCOMMITTEE OF THE BOARD. THE FINANCE COMMITTEE REVIEWS THE 990 AND THEN PRESENTS ITS RECOMMENDATION TO THE BOARD OF DIRECTORS TO FILE. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER SIGNS THE CONFLICT OF INTEREST STATEMENT WHEN THEY ARE ONBOARDED. IN ADDITION, AT THE ANNUAL BOARD MEETING IN MARCH ALL BOARD MEMBERS SIGN THE STATEMENT AGAIN TO ENSURE NOTHING HAS CHANGED FROM THE PRIOR YEAR OR TO BRING ATTENTION TO SOMETHING THAT HAS. ALSO, BOARD MEMBERS ARE ENCOURAGED TO DISCLOSE NEW INFORMATION THAT MIGHT COME UP AFTER THE STATEMENT WAS SIGNED. IF A CONFLICT EXISTS, THAT BOARD MEMBER(S) DOES NOT VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 DATA PULLED FROM: 1) NACHC HEALTH CENTER COMPENSATION & BENEFITS REPORT, 2) MILLIMAN NORTHWEST HEALTH CARE INDUSTRY SALARY SURVEY, AND 3) INDEPENDENT SALARY SURVEYS CONDUCTED THROUGH HR. INFORMATION IS REVIEWED BY THE CEO, WHO MAKES RECOMMENDATIONS TO THE BOARD FOR FINAL APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST, BUT NOT PUBLISHED EXTERNALLY. GOVERNING DOCUMENTS ARE NOT SHARED. AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST, AND THE FORM 990 IS AVAILABLE ON GUIDESTAR.