2018-09-26T19:27:40-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2017-01-01 910947084 INTERNATIONAL COMMUNITY HEALTH SERVICES INTE 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 TERESITA BATAYOLA PRESIDENT/CEO 2067883618 2018-09-24 1 KURT BENNION P01469618 4252506100 2018-09-24 67.137.57.251 2018-09-24 15:10:19 PD P B1033B006BFCD7423EE2E3AB54E3E8445E45BF8B F0F62AA6298128500262D125680EAF6D2D38659B 2017 2018-06-14 16:35:46Z TERESITA BATAYOLA 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 44267462 0 X WWW.ICHS.COM X 1973 WA PROVIDE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES. 16 16 614 40 0 0 6511898 6616050 34678290 37152888 14347 10840 398897 468795 41603432 44248573 0 35000 0 0 29819877 34528696 0 0 264939 12718655 14385320 42538532 48949016 -935100 -4700443 49416514 47993046 19155700 22432679 30260814 25560367 X DEEPLY ROOTED IN THE ASIAN PACIFIC ISLANDER COMMUNITY, ICHS PROVIDES CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND WELLNESS SERVICES AND PROMOTES HEALTH EQUITY FOR ALL. 1 0 18161901 35000 18032314 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 2017, ICHS PROVIDED 75,042 PRIMARY HEALTH CARE VISITS TO PATIENTS AND $273,629 OF CHARITY CARE. 11208817 11664184 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 2017, ICHS PROVIDED 53,247 DENTAL CARE VISITS TO PATIENTS AND $862,616 OF CHARITY CARE. 11036611 7456390 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 2017, ICHS PROVIDED 8,511 HEALTH CARE VISITS TO PATIENTS AND $129,190 OF CHARITY CARE. 40407329 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 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 50 0 614 1 0 0 0 0 0 0 0 0 0 0 X 16 16 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 PRESIDENT 3.00 2.00 X X 0 0 0 CRIS KRISOLOGO-ELLIOTT 2ND VICE PRESIDENT 3.00 0.00 X X 0 0 0 KELLI NOMURA 3RD VICE PRESIDENT 3.00 0.00 X X 0 0 0 CATHERINE JOHNSON SECRETARY 3.00 0.00 X X 0 0 0 RICHARD MELLON TREASURER 3.00 0.00 X X 0 0 0 MARIAM ABARIENTOS DIRECTOR 1.50 0.00 X 0 0 0 JOYCE CHIN DIRECTOR 1.50 2.00 X 0 0 0 JENNY FANG 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 LEE MARCHISIO 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 3.00 X 255911 0 20348 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 40.00 2.00 X 194472 0 15529 RAYBURN LEWIS CHIEF MEDICAL OFFICER 20.00 0.00 X 28958 0 3109 SHERMAN LOHN CHIEF OPERATING OFFICER 40.00 0.00 X 158352 0 16888 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 258847 0 20646 ALAN CHUN ASSISTANT MEDICAL DIRECTOR 36.00 0.00 X 209729 0 16302 UYENVY PHAM ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 206680 0 16044 DAVID CHEN ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 193455 0 18035 HARVEY WU ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 194894 0 18129 GRANDY AU ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 188188 0 17953 HAMED SAHARI-RASHTI ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 180148 0 17119 STEPANIE KANG ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 172717 0 14812 YUN HEE JO ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 162306 0 7190 NANCY SNAPP MD/PROVIDER 32.00 0.00 X 186367 0 15484 TIMOTHY LAM DDS/PROVIDER 40.00 0.00 X 168588 0 16941 JON SONODA PHARMACY MANAGER 40.00 0.00 X 165965 0 14323 CHINDA ROACH MD/PROVIDER 36.00 0.00 X 165563 0 17130 CHRISTOPHER YEE MD/PROVIDER & MED RESIDENCY DIRECTOR 40.00 0.00 X 162026 0 13673 GRACE WANG FORMER CMO 36.00 0.00 X 153408 0 14087 3406574 0 293742 54 1 1 0 INDEMAND INTERPRETING 555 ANDOVER PARK WEST SUITE 201 TUKWILA WA 98188 INTERPRETING SERVICES 338200 COLVOS CONSTRUCTION 711 COURT C TACOMA WA 98042 VISION CLINIC CONSTRUCTION 309665 QUALITY SYSTEMS INC PO BOX 511449 LOS ANGELES CA 90051 NEXTGEN MAINTENANCE & BILLING 307002 DENTAL PROFESSIONALS 4200 42ND AVE SW SEATTLE WA 98116 DENTAL TEMP SERVICES 183665 KELLER ROHRBACK LLP 1201 THIRD AVE SUITE 3200 SEATTLE WA 98101 LEGAL SERVICES 128578 7 204419 5649469 762162 826503 6616050 PATIENT SERVICE FEES 624100 35789948 35789948 POOL SAVINGS REVENUE 900099 1342688 1342688 OTHER MEDICAL REVENUE 900099 20252 20252 37152888 18132 18132 21470 11597 9873 9873 9873 7292 -7292 -7292 -7292 MANAGEMENT FEES 900099 273894 273894 MISCELLANEOUS REVENUE 900099 185028 185028 458922 44248573 37152888 0 479635 35000 35000 2606763 1532653 1074110 24899910 21316545 3368591 214774 973343 833790 131351 8202 3641733 3073622 544108 24003 2406947 2029008 359979 17960 160187 10563 149624 65614 65614 3361910 2085754 1276156 51356 8879 42477 313226 249462 63764 212738 170798 41940 1460647 1226032 234615 98862 59237 39625 124464 73180 51284 400917 385444 15473 2415117 2021365 393752 119588 78202 41386 MEDICAL SUPPLIES 3341932 3276735 65197 PATIENT EXPENSE 1094263 1092526 1737 EQUIPMENT 279638 254062 25576 BAD DEBT EXPENSE 278496 278496 606365 315976 290389 48949016 40407329 8276748 264939 7774289 7652621 2264905 2255124 3334194 3017155 210878 212449 712955 942994 44122174 13115932 32280175 31006242 5000 2053 1200000 1200000 1634118 1704408 49416514 47993046 6179785 10078196 789168 668840 9483028 9254801 2703719 2430842 19155700 22432679 X 29246132 24893566 1014682 666801 30260814 25560367 49416514 47993046 -4700443 -4 0 X 0 1 X 1 1 1 X 1 1 0 0 0 0 1 4628 1 810 1 550 5988 0 PART II-B, LINE 1: INTERNATIONAL COMMUNITY HEALTH SERVICES ("ICHS") STAFF ATTENDED THE CHC/API LEGISLATIVE DAY AND ICHS PAID MEMBERSHIP DUES TO ASSOCIATIONS THAT LOBBIED ON BEHALF OF ALL MEMBERS, INCLUDING ICHS. WENT TO WASHINGTON D.C. TO LOBBY FOR HEPATITIS B. CEO WENT TO WASHINGTON D.C. TO MEET WITH LEGISLATORS. 3528037 3528037 26609901 4907060 21702841 5223810 2664004 2559806 8760426 5544868 3215558 31006242 X 44160322 -4 293219 42300 335515 43824807 423766 423766 44248573 48975336 293219 11597 304816 48670520 278496 278496 48949016 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: RENTAL EXPENSE 11,597. LOSS ON DISPOSAL OF EQUIPMENT 7,292. CAPITAL GRANT 23,411. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL INCOME 21,470. CAPITAL CONTRIBUTIONS 123,800. BAD DEBT 278,496. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 11,597. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 278,496. 1 AGING IN PACE WASHINGTON PO BOX 3007 SEATTLE WA 981143007 810856014 501(C)(3) 35000 INITIAL FUNDING TO SUPPORT OPERATIONS 1 0 PART I, LINE 2: THE ONLY TRANSFER WAS TO AN ORGANIZATION ON WHICH INTERNATIONAL COMMUNITY HEALTH SERVICES' PRESIDENT/CEO SERVES AS BOARD PRESIDENT. SHE ENSURES THAT TRANSFERRED FUNDS ARE USED FOR APPROPRIATE PURPOSES THROUGH HER POSITION ON THE BOARD OF DIRECTORS. X X X X X 0 0 0 1 0 0 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 204302 0 33516 0 18093 0 10051 0 10297 0 276259 0 0 0 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 190800 0 0 0 3672 0 7632 0 7897 0 210001 0 0 0 SHERMAN LOHN CHIEF OPERATING OFFICER 158352 0 0 0 0 0 6591 0 10297 0 175240 0 0 0 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 236027 0 10250 0 12570 0 10349 0 10297 0 279493 0 0 0 ALAN CHUN ASSISTANT MEDICAL DIRECTOR 205004 0 4725 0 0 0 8405 0 7897 0 226031 0 0 0 UYENVY PHAM ASSISTANT MEDICAL DIRECTOR 192088 0 11250 0 3342 0 8147 0 7897 0 222724 0 0 0 DAVID CHEN ASSISTANT DENTAL DIRECTOR 163005 0 18000 0 12450 0 7738 0 10297 0 211490 0 0 0 HARVEY WU ASSISTANT DENTAL DIRECTOR 172726 0 15750 0 6418 0 7832 0 10297 0 213023 0 0 0 GRANDY AU ASSISTANT DENTAL DIRECTOR 153428 0 16750 0 18010 0 7656 0 10297 0 206141 0 0 0 HAMED SAHARI-RASHTI ASSISTANT DENTAL DIRECTOR 158380 0 5750 0 16018 0 6822 0 10297 0 197267 0 0 0 STEPANIE KANG ASSISTANT DENTAL DIRECTOR 158092 0 14625 0 0 0 6915 0 7897 0 187529 0 0 0 YUN HEE JO ASSISTANT DENTAL DIRECTOR 145806 0 16500 0 0 0 6493 0 697 0 169496 0 0 0 NANCY SNAPP MD/PROVIDER 177367 0 9000 0 0 0 7587 0 7897 0 201851 0 0 0 TIMOTHY LAM DDS/PROVIDER 133330 0 15000 0 20258 0 6644 0 10297 0 185529 0 0 0 JON SONODA PHARMACY MANAGER 160641 0 0 0 5324 0 6426 0 7897 0 180288 0 0 0 CHINDA ROACH MD/PROVIDER 154591 0 4350 0 6622 0 6833 0 10297 0 182693 0 0 0 CHRISTOPHER YEE MD/PROVIDER & MED RESIDENCY DIRECTOR 127895 0 7250 0 26881 0 5950 0 7723 0 175699 0 0 0 GRACE WANG FORMER CMO 150408 0 3000 0 0 0 6190 0 7897 0 167495 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 905195 10160000 1316561 185641 131346 10160000 0 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 X 6163 DONOR VALUED X 3 696440 COST X EQUIPMENT 1 123800 DONOR VALUED X GIFT CARDS 1 100 FMV 0 0 1 0 FORM 990, PART III, LINE 2 VISION CLINIC AND SCHOOL-BASED HEALTH CENTER-BELLEVUE OPENED IN 2018. 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 204419 CASH INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION L 273894 FAIR MARKET VALUE INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION M 204419 CASH INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION O 273894 FAIR MARKET VALUE