2016-09-23T16:42:36-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2015-01-01 421599749 LEWIS COUNTY COMMUNITY HEALTH SERVICES LEWI 3603309595 2690 NE KRESKY AVENUE CHEHALIS WA 98532 STEVEN CLARK EXECUTIVE DIRECTOR 3603309595 2016-09-21 1 KURT BENNION P01469618 4252506100 2015 2017-02-10 21:41:12Z VALLEY VIEW HEALTH CENTER STEVEN CLARK 2690 NE KRESKY AVENUE CHEHALIS WA 98532 15079593 0 X WWW.VVHC.ORG X 2004 WA IMPROVE THE HEALTH & WELL-BEING OF THE COMMUNITY BY PROVIDING QUALITY & COMPASSIONATE HEALTH CARE. 9 9 202 14 0 0 1946329 2228563 10575328 12673485 21303 45822 150685 131723 12693645 15079593 0 0 0 0 8670948 10348211 0 0 0 2826319 3551521 11497267 13899732 1196378 1179861 12081172 13169294 6013588 5949384 6067584 7219910 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. 0 0 11080644 0 12673485 VALLEY VIEW HEALTH CENTER ("THE CENTER") PROVIDES MEDICAL, DENTAL, BEHAVIORAL HEALTH AND RELATED SERVICES PRIMARILY TO LOW INCOME INDIVIDUALS. THE UNREIMBURSED VALUE OF PROVIDING CHARITY CARE TO THESE PATIENTS WAS $366,579. THE CENTER PROVIDED 49,245 MEDICAL, 20,146 DENTAL AND 3,400 BEHAVIORAL HEALTH ENCOUNTERS FOR THE YEAR. 11080644 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 32 0 202 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 LYNDA NANNEY PRESIDENT 1.00 X X 0 0 0 MARIA GRAHAM SECRETARY 1.00 X X 0 0 0 DR ROBERT ENDERS TREASURER 1.00 X X 0 0 0 JOHN BURTON DIRECTOR 1.00 X 0 0 0 SEAN FITZGERALD DIRECTOR 1.00 X 0 0 0 TONI GWIN DIRECTOR 1.00 X 0 0 0 DR MICHAEL J LECLAIR DIRECTOR 1.00 X 0 0 0 GREG MARTIN DIRECTOR 1.00 X 0 0 0 CHERYL MILLMAN DIRECTOR 1.00 X 0 0 0 JANICE SMITH DIRECTOR 1.00 X 0 0 0 STEVEN CLARK EXECUTIVE DIRECTOR 40.00 X 205335 0 19136 HOLLY SLIVA CFO 40.00 X 117128 0 10511 LOU ANN MERCIER DENTAL DIRECTOR 40.00 X 176486 0 15980 DAVID LITTLE MEDICAL DIRECTOR 40.00 X 181541 0 13970 DAVID LUSH PHYSICIAN 40.00 X 167404 0 6615 STEPHEN HENNESSEY ASSISTANT MEDICAL DIRECTOR 40.00 X 165561 0 18097 ELISSA MAYNARD DENTIST 40.00 X 149641 0 16107 LAWRENCE LI DENTIST 40.00 X 147987 0 5911 CHARLOTTE CLARK-NEITZEL PHYSICIAN 40.00 X 141269 0 5644 1452352 0 111971 16 0 1 0 COMPUTER CONNECTIONS 213 EAST MAIN STREET CENTRALIA WA 98531 IT SERVICES 316844 INTEGRITY HEALTHCARE LOCUMS 8877 SANDY CREST LANE BOYNTON BEACH FL 33437 LOCUM SERVICES 205683 2 2053499 175064 2228563 PROGRAM SERVICE REVENUE 624100 11885739 11885739 CAPITATION REVENUE 624100 787746 787746 12673485 45822 45822 35003 0 35003 35003 35003 OTHER REVENUE 900099 69185 69185 MEDICAL RECORDS REVENUE 900099 27535 27535 96720 15079593 12673485 0 177545 740087 242105 497982 7931302 7064479 866823 203280 140017 63263 831181 551518 279663 642361 421458 220903 32362 32362 991783 784383 207400 13097 6817 6280 562042 422692 139350 289351 227767 61584 32986 16438 16548 86406 46412 39994 192132 144779 47353 498779 323209 175570 62099 6408 55691 MEDICAL SUPPLIES 394905 394905 MISCELLANEOUS 158769 145011 13758 RISK POOL SETTLEMENT 109851 109851 DUES & SUBSCRIPTIONS 44355 9092 35263 82604 23303 59301 13899732 11080644 2819088 0 120357 153915 2938076 2159338 87912 366400 869302 722321 43002 61469 5000 12355 9867949 3143381 6518677 6724568 1196200 2962238 5992 5036 296654 1654 12081172 13169294 947875 1266515 73627 46851 4727686 4623294 264400 12724 6013588 5949384 X 6067584 7219910 6067584 7219910 12081172 13169294 1179861 -27535 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1454 402 700 1156 0 1168316 1168316 6786686 1746016 5040670 1912947 1397365 515582 6724568 ESTIMATED THIRD-PARTY SETTLEMENTS 12724 12724 X 15028390 -27535 -27535 15055925 23668 23668 15079593 13789881 0 13789881 109851 109851 13899732 PART IV, LINE 1B: VALLEY VIEW HEALTH CENTER HOLDS THE BANK ACCOUNT FOR A SMALL LOCAL ORGANIZATION THAT IS 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, 2015 AND 2014, THE CENTER HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS 5,381. INTEREST INCOME 18,287. PART XII, LINE 4B - OTHER ADJUSTMENTS: COMMUNITY HEALTH PLAN OF WASHINGTON RISK POOL DISTRIBUTIONS 109,851. X X X 0 0 0 1 0 1 0 0 0 STEVEN CLARK EXECUTIVE DIRECTOR 198925 0 6410 0 0 0 8315 0 10821 0 224471 0 0 0 LOU ANN MERCIER DENTAL DIRECTOR 172586 0 3900 0 0 0 6957 0 9023 0 192466 0 0 0 DAVID LITTLE MEDICAL DIRECTOR 175666 0 5875 0 0 0 7355 0 6615 0 195511 0 0 0 DAVID LUSH PHYSICIAN 150404 0 17000 0 0 0 0 0 6615 0 174019 0 0 0 STEPHEN HENNESSEY ASSISTANT MEDICAL DIRECTOR 157266 0 8295 0 0 0 6792 0 11305 0 183658 0 0 0 ELISSA MAYNARD DENTIST 141248 0 8393 0 0 0 6132 0 9975 0 165748 0 0 0 LAWRENCE LI DENTIST 139754 0 8233 0 0 0 5911 0 0 0 153898 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 VI, SECTION B, LINE 11 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 PREVENT ANY REAL OR PERCEIVED CONFLICTS OF INTERESTS FROM OCCURRING 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 SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON; HAS RECEIVED, REVIEWED, AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. EACH MEMBER OF THE CENTER'S MANAGEMENT TEAM WILL COMPLETE THE CONFLICT OF INTEREST STATEMENT ANNUALLY. POTENTIAL CONFLICTS AT THE BOARD LEVEL ARE REVIEWED BY THE ENTIRE 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, OR MAY INTERFERE WITH YOUR RESPONSIBILITIES TO THE CENTER, OR HAS THE APPEARANCE OF INFLUENCING YOU 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 THE 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 2015. THE COMPENSATION 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 2015, BUT DOES 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.