2017-10-02T11:28:57-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2016-01-01 421599749 LEWIS COUNTY COMMUNITY HEALTH SERVICES LEWI 3603309595 2690 NE KRESKY AVENUE CHEHALIS WA 98532 STEVEN CLARK EXECUTIVE DIRECTOR 3603309595 2017-07-25 1 KURT BENNION P01469618 4252506100 67.137.57.251 2017-07-25 14:23:57 PD P 757A344A9F492B99F4DBC36D20E5EEF65915C547 9AD29FA46B8615F2777C89FEDEB19E0AFF07ACA7 2016 2021-01-29 14:40:06Z VALLEY VIEW HEALTH CENTER STEVEN CLARK 2690 NE KRESKY AVENUE CHEHALIS WA 98532 15832400 0 X WWW.VVHC.ORG X 2004 WA IMPROVE THE HEALTH & WELL-BEING OF THE COMMUNITY BY PROVIDING QUALITY & COMPASSIONATE HEALTH CARE. 9 9 223 10 0 0 2228563 3434450 12673485 12157920 45822 14265 131723 178512 15079593 15785147 0 0 0 0 10348211 10718679 0 0 0 3551521 4450544 13899732 15169223 1179861 615924 13164258 14613197 5944348 6761559 7219910 7851638 X TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITY BY PROVIDING QUALITY AND COMPASSIONATE HEALTH CARE SERVICES IN A PATIENT CENTERED ATMOSPHERE, RESPECTING INDIVIDUAL AND CULTURAL DIVERSITY. 1 0 12857088 0 12157920 VALLEY VIEW HEALTH CENTER ("THE CENTER") PROVIDES MEDICAL, DENTAL, BEHAVIORAL HEALTH AND RELATED SERVICES PRIMARILY TO LOW INCOME INDIVIDUALS. IN 2016, THE CENTER PROVIDED 42,606 MEDICAL, 18,112 DENTAL AND 561 BEHAVIORAL HEALTH ENCOUNTERS. THE UNREIMBURSED VALUE OF PROVIDING CHARITY CARE TO THESE PATIENTS WAS $490,345. IN 2016, VVHC'S NEWLY OPENED 340B PHARMACY FILLED OVER 9,000 PRESCRIPTIONS AND SERVED 1,841 PATIENTS. 12857088 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 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 42 0 223 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X HOLLY SLIVA 3603309595 2690 NE KRESKY AVENUE CHEHALIS WA 98532 JOHN BURTON PRESIDENT 1.00 X X 0 0 0 GREG MARTIN VICE PRESIDENT 1.00 X X 0 0 0 MARIA GRAHAM SECRETARY 1.00 X X 0 0 0 CHERYL MILLMAN TREASURER 1.00 X X 0 0 0 LYNDA NANNEY IMMEDIATE PAST PRESIDENT 1.00 X X 0 0 0 DR ROBERT ENDERS DIRECTOR 1.00 X 0 0 0 TONI GWIN DIRECTOR 1.00 X 0 0 0 DR MICHAEL LECLAIR DIRECTOR 1.00 X 0 0 0 JANICE SMITH DIRECTOR 1.00 X 0 0 0 STEVEN CLARK EXECUTIVE DIRECTOR 40.00 X 214712 0 16985 HOLLY SLIVA CFO 40.00 X 117043 0 10304 DAVID LITTLE MEDICAL DIRECTOR 40.00 X 197800 0 16100 LOU ANN MERCIER DENTAL DIRECTOR 40.00 X 184380 0 16084 STEPHEN HENNESSEY ASSISTANT MEDICAL DIRECTOR 40.00 X 195054 0 16542 DANIEL KOWALS DENTIST 40.00 X 180806 0 10888 SARAH LANDRUM PHYSICIAN 40.00 X 171489 0 16363 LAWRENCE LI DENTIST 40.00 X 145338 0 5813 CHARLOTTE CLARK-NEITZEL PHYSICIAN 40.00 X 142043 0 5646 1548665 0 114725 19 0 1 0 LEWISCUTLER CONSTRUCTION PO BOX 11879 OLYMPIA WA 98506 CONSTRUCTION 922593 COMPUTER CONNECTIONS 213 EAST MAIN STREET CENTRALIA WA 98531 IT SERVICES 414281 INTEGRITY HEALTHCARE LOCUMS 8877 SANDY CREST LANE BOYNTON BEACH FL 33437 LOCUM PROVIDER SERVICES 214865 UNIVERSITY OF WASHINGTON 1959 NE PACIFIC STREET SEATTLE WA 98195 PSYCHIATRIC CONSULTATIONS 134418 AUSTIN MAJOR GROUP 545 E JOHN CARPENTER FREEWAY IRVING TX 75062 LOCUM PROVIDER SERVICES 131529 6 3250645 183805 3434450 PROGRAM SERVICE REVENUE 624100 11651502 11651502 CAPITATION REVENUE 624100 506418 506418 12157920 61518 61518 35003 0 35003 35003 35003 47253 -47253 -47253 -47253 OTHER REVENUE 900099 113887 113887 MEDICAL RECORDS REVENUE 900099 29622 29622 143509 15785147 12157920 0 192777 752473 640955 111518 8474457 7218526 1255931 202530 161783 40747 532482 491153 41329 756737 653297 103440 44153 44153 1148094 887855 260239 117054 109234 7820 558439 434328 124111 303338 224388 78950 140078 88171 51907 7778 7778 193955 193955 543332 502500 40832 46160 32561 13599 MEDICAL SUPPLIES 463000 463000 RISK POOL SETTLEMENT 380291 380291 MISCELLANEOUS EXPENSES 210360 177201 33159 BAD DEBT EXPENSE 100951 100951 193561 96939 96622 15169223 12857088 2312135 0 153915 466998 2159338 1821415 366400 193835 722321 707954 61469 87393 12355 13640 10762896 3480111 6724568 7282785 2962238 4037523 1654 1654 13164258 14613197 1266515 981356 46851 14401 4618258 4380901 12724 1384901 5944348 6761559 X 7219910 7851638 7219910 7851638 13164258 14613197 615924 15804 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1156 0 1156 0 0 1168316 1168316 6455951 1884546 4571405 1972624 1595565 377059 1166005 1166005 7282785 ESTIMATED THIRD-PARTY SETTLEMENTS 1384901 1384901 X 15651759 15804 47253 63057 15588702 196445 196445 15785147 14687981 0 14687981 481242 481242 15169223 PART IV, LINE 1B: THROUGH JANUARY 2016, VALLEY VIEW HEALTH CENTER HELD THE BANK ACCOUNT FOR A SMALL LOCAL ORGANIZATION THAT WAS IN THE PROCESS OF OBTAINING ITS OWN TAX-EXEMPT STATUS. PART X, LINE 2: THE CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE CENTER EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINITY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2016 AND 2015, THE CENTER HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS 47,253. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 77,322. BAD DEBT EXPENSE 100,951. CONTRIBUTIONS 18,172. PART XII, LINE 4B - OTHER ADJUSTMENTS: COMMUNITY HEALTH PLAN OF WASHINGTON RISK POOL DISTRIBUTIONS 380,291. BAD DEBT EXPENSE 100,951. X X X 0 0 0 1 0 1 0 0 0 STEVEN CLARK EXECUTIVE DIRECTOR 210101 0 4611 0 0 0 5716 0 11269 0 231697 0 0 0 DAVID LITTLE MEDICAL DIRECTOR 189620 0 8180 0 0 0 7912 0 8188 0 213900 0 0 0 LOU ANN MERCIER DENTAL DIRECTOR 177380 0 7000 0 0 0 7327 0 8757 0 200464 0 0 0 STEPHEN HENNESSEY ASSISTANT MEDICAL DIRECTOR 189866 0 5188 0 0 0 7802 0 8740 0 211596 0 0 0 DANIEL KOWALS DENTIST 180806 0 0 0 0 0 2700 0 8188 0 191694 0 0 0 SARAH LANDRUM PHYSICIAN 168964 0 2525 0 0 0 6860 0 9503 0 187852 0 0 0 LAWRENCE LI DENTIST 141338 0 4000 0 0 0 5813 0 0 0 151151 0 0 0 PART I, LINE 5 THE EXECUTIVES AND PHYSICIANS ARE EVALUATED BASED ON MULTIPLE MEASURES OF PERFORMANCE. MEASURES INCLUDE QUALITY OF PATIENT CARE METRICS AND PRODUCTIVITY STANDARDS. THESE METRICS ARE EVALUATED QUARTERLY AND ANNUALLY, AND HAVE AN IMPACT ON PAY-FOR-PERFORMANCE AND PAY INCREASES. PART I, LINE 6 SEE NARRATIVE FOR SCHEDULE J, PART I, LINE 5A. FORM 990, PART III, LINE 2 VALLEY VIEW HEALTH CENTER OPENED A 340B PHARMACY FOR PATIENTS IN 2016. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE EXECUTIVE DIRECTOR AND CFO WHO REVIEWED THE FORM AND SCHEDULES. ALL COMMENTS AND QUESTIONS WERE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT WAS PRESENTED TO THE BOARD OF DIRECTORS WHO THEN APPROVED THE FORM 990. ONCE MANAGEMENT WAS SATISFIED WITH THE FORM 990, THE EXECUTIVE DIRECTOR SIGNED THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF VALLEY VIEW HEALTH CENTER ("THE CENTER") TO ENSURE TRANSPARENCY REGARDING ANY CONFLICTS OF INTEREST AND TO PREVENT ANY REAL OF PERCEIVED CONFLICTS OF INTEREST FROM OCCURING WITH RESPECT TO BOARD MEMBERS, EMPLOYEES, CONSULTANTS, AND THOSE WHO FURNISH GOODS OR SERVICES. EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD-DELEGATED POWERS ANNUALLY SIGNS A STATEMENT THAT AFFIRMS SUCH PERSON HAS RECEIVED, REVIEWED AND UNDERSTANDS THE POLICY; HAS AGREED TO COMPLY WITH THE POLICY; AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES THAT FURTHER ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. EACH MEMBER OF THE CENTER'S MANAGEMENT TEAM COMPLETES THE CONFLICT OF INTEREST STATEMENT ANNUALLY. POTENTIAL CONFLICTS AT THE BOARD LEVEL ARE REVIEWED BY THE BOARD OF DIRECTORS. ALL EMPLOYEES ARE EXPECTED TO AVOID PLACING THEMSELVES IN A POSITION THAT MAY CREATE OR LEAD TO A CONFLICT OF INTEREST OR THE APPEARANCE OF ONE. THEY ARE PROHIBITED FROM ENGAGING IN ANY OUTSIDE BUSINESS ACTIVITY, FINANCIAL RELATIONSHIP, OR INVESTMENT THAT CONFLICTS WITH THE CENTER'S INTERESTS, COMPETES WITH THE CENTER, MAY INTERFERE WITH THEIR RESPONSIBILITIES TO THE CENTER, OR HAS THE APPEARANCE OF INFLUENCING THEM TO ACT OR MAKE DECISIONS IN A BIASED MANNER OR CONTRARY TO THE BEST INTERESTS OF THE CENTER. FORM 990, PART VI, SECTION B, LINE 15A TTHE BOARD OF DIRECTORS' EXECUTIVE COMMITTEE DETERMINES THE COMPENSATION OF THE EXECUTIVE DIRECTOR USING THEIR PERSONAL EXPERIENCE AND CURRENT NATIONAL SALARY SURVEYS OBTAINED BY HUMAN RESOURCES. THE SALARY IS REVIEWED AND UPDATED ANNUALLY. THIS PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2016. THE COMPENSATION REVIEW FOR OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED USING NATIONAL SALARY SURVEYS OBTAINED BY HUMAN RESOURCES. THE SALARY IS REVIEWED AND UPDATED ANNUALLY OR ON THE EMPLOYEE'S CONTRACT TERMS. THIS PROCESS INCLUDED COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2016, BUT DID NOT INCLUDE REVIEW AND APPROVAL BY INDEPENDENT PERSONS. FORM 990, PART VI, SECTION C, LINE 19 THE CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.