2016-11-01T15:53:14-05:00 2015-12-31 910189318 Moss Adams LLP 1301 A Street Suite 600 Tacoma WA 984024205 990 2015-01-01 201082052 PTSO of Washington PTSO 2064542816 2101 Fourth Avenue No 850 Seattle WA 98121 Dr Julie Colin Interim CEO 2064542816 2016-11-01 1 Angela M Fidler P01254538 2535724100 2016-11-01 2015 2017-02-10 21:41:12Z Dr Julie Colin 2101 Fourth Avenue 850 Seattle WA 98121 6069299 0 X www.ptsowa.org X 2004 WA SEE FORM 990 PART III, QUESTION 1. 5 5 34 5 0 0 667942 749372 6173142 5319927 0 0 0 0 6841084 6069299 3718615 4440070 0 0 3551950 3193416 0 0 7567 -242589 -1432274 7027976 6201212 -186892 -131913 3218043 3014365 801697 729932 2416346 2284433 PTSO of Washington is established to improve access and the level and quality of healthcare for the medically underserved through the improvements of information technology services available to community health centers. 0 0 5130767 4440070 5319927 Customized and Upgraded Nextgen EHR, EPM and EDR applications to meet the unique needs of our FQHC customers and help them realize AIU funds. Prepared for meaningful use (MU stage1) through multiple system upgrades and commenced work on MU stage 2 and ICD10 upgrades. Continued forums for Best Practices and Lessons Learned.HRSA Health Center Controlled Networks - HCCN Grant - PTSO, E Net, HCHN Networks Providing best practices, optimization and training around Patient Centered Medical Home, Meaningful Use and EHR Implementation and Adoption. 5130767 1 0 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 1 34 1 0 0 0 0 0 0 0 0 X 5 5 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 0 1 0 0 WA X GRACE E GRIFFIN 2064542818 2101 Fourth Avenue 850 Seattle WA 98121 Linda McVeigh Board Member 1.00 X 0 0 0 Katie Bell Board Member 1.00 X 0 0 0 Tom Trompeter Board Member 1.00 X 0 0 0 Anita Monoian Board Member 1.00 X 0 0 0 Heather Findlay Board Member 1.00 X 0 0 0 Roy La Croix CEO (left 10/22/15) 40.00 X 218191 0 16854 Julie Colin Interim CEO 40.00 X 246087 0 14728 Eric Grendell Chief Technology Officer 40.00 X 131954 0 15187 Roger Head Technology Manager 40.00 X 101030 0 11117 Shelley Youngs Dir. Client Services (left 10/10/15) 40.00 X 146228 0 9746 843490 0 67632 5 0 1 0 0 749372 749372 Service fee revenue 518210 5319927 5319927 5319927 6069299 5319927 0 0 4440070 4440070 464279 355183 109096 2145336 1858446 286890 385523 326700 58823 198278 168025 30253 2454 2454 49596 49596 33799 33799 194076 39253 147256 7567 2750 2750 160985 138364 22621 563792 563792 224576 109796 114780 85392 26963 58429 58717 39163 19554 519489 519489 26996 26996 Maintenance - Software/ 985593 985593 Taxes 82444 82444 Miscellaneous Expenses 17137 17137 Grants to Supporting Or -4440070 -4440070 6201212 5130767 1062878 7567 1125122 1061879 42106 48033 1066446 948912 257216 198161 7496649 6739269 724840 757380 2313 0 3218043 3014365 106738 243193 31301 34871 663658 451868 801697 729932 X 2416346 2284433 2416346 2284433 3218043 3014365 -131913 0 X 0 1 X 1 1 1 X X 5 Country Doctor Community Clinic 237100868 7 1 342636 0 FAMILY HEALTH CENTERS IN OKANOGAN 911275011 7 1 333000 0 Healthpoint 910884412 9 1 1657647 0 Yakima Neighborhood Health Services 910928817 9 1 735599 0 Neighborcare Health 910893287 7 1 1371188 0 5 4440070 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART IV, SECTION A, LINE 1 SUPPORTING ORGANIZATIONS ARE NOTIFIED AT BOARD MEETINGS AS THEY REVIEW THE 990 AND UPDATE GOVERNING DOCUMENTS. Part IV, Section D, Line 3 THE MANAGEMENT OF ALL AFFAIRS OF THE PTSO ARE VESTED IN THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS COMPRISED OF BOARD MEMBERS ELECTED BY THE SUPPORTED ORGANIZATIONS. Part IV, Section E, Line 2a PTSO IS ORGANIZED TO IMPROVE ACCESS AND THE LEVEL AND QUALITY OF HEALTH CARE FOR THE MEDICALLY UNDERSERVED THROUGH THE IMPROVEMENT OF INFORMATION TECHNOLOGY SERVICES AVAILABLE TO COMMUNITY HEALTH CENTERS. CURRENTLY PTSO HAS 5 MEMBERS. SEE SCHEDULE I FOR DETAILS ON GRANT RECIPIENTS AND INTENDED USE OF GRANTS. Part IV, Section E, Line 2b PTSO IS ORGANIZED TO SECURE AND MANAGE INFORMATION SYSTEMS WHICH ARE A NECESSARY AND INTEGRAL PART OF THE DELIVERY OF HEALTH CARE. WITHOUT PTSO'S INVOLVEMENT, EACH MEMBER WOULD BE RESPONSIBLE WITH THE PURCHASE, MAINTENANCE AND IMPLEMENTATION OF THEIR OWN INFORMATION SYSTEMS. 7496649 6739269 757380 757380 Member Deposits 156570 WAGES PAYABLE 295298 451868 X 6069299 0 6069299 0 6069299 6201212 0 6201212 0 6201212 Part X, Line 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C) (3) OF THE INTERNAL REVENUE CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE ORGANIZATION DID NOT ENGAGE IN AN ACTIVITY UNRELATED TO ITS TAX EXEMPT PURPOSE; ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ACCORDANCE WITH REQUIREMENTS RELATED TO ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES, THE ORGANIZATION HAS DETERMINED THEY HAVE NO UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014. THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A)(VIII) AND HAS BEEN FURTHER CLASSIFIED AS A SUPPORTING ORGANIZATION UNDER SECTION 509(A)(3). 1 Healthpoint 955 powell ave se suite a renton WA 98057 910884412 501 c (3) 1657647 Various operating services, data center, software and support. Supportive Assistance Neighborcare Health 905 Spruce Street Suite 300 Seattle WA 98104 910893287 501 c (3) 1371188 Various operating services, data center, software and support. Supportive Assistance Yakima Neighborhood Health Services po box 2605 yakima WA 98907 910928817 501 c (3) 735599 Various operating services, data center, software and support. Supportive Assistance Country Doctor Community Clinic 500 19th Ave East Seattle WA 98112 237100868 501 c (3) 342636 Various operating services, data center, software and support. Supportive Assistance Family Health Centers in Okanogan PO Box 1340 Okanogan WA 98840 911275011 501 c (3) 333000 Various operating services, data center, software and support. Supportive Assistance 5 Part I, Line 2: THE ORGANIZATIONS RECEIVING ASSISTANCE ARE CLASS A MEMBERS AS IDENTIFIED IN PTSO'S GOVERNING DOCUMENTS. AS A SUPPORTING ORGANIZATION, PTSO MONITORS ITS SUPPORT TO ITS SUPPORTED ORGANIZATIONS. X X X 1 0 0 0 0 0 0 1 0 Roy La Croix CEO (left 10/22/15) 186499 0 0 0 31692 0 11294 0 5560 0 235045 0 0 0 Julie Colin Interim CEO 232395 0 13692 0 0 0 14016 0 712 0 260815 0 0 0 Shelley Youngs Dir. Client Services (left 10/10/15) 116429 0 3463 0 26336 0 6723 0 3023 0 155974 0 0 0 Part I, Line 4a ROY LA CROIX WAS PAID $31,692 FOR SEVERANCE DUE TO TERMINATION. SHELLEY YOUNGS WAS PAID $26,336 FOR SEVERANCE DUE TO TERMINATION. Part I, Line 7 Bonuses were determined by the CEO on a discretionary basis according to budgeted salary increases for 2015. Form 990, Part VI, Section A, line 2 PTSO'S BOARD CONSISTS OF REPRESENTATIVES OF ITS MEMBERS. AS SUCH BOARD MEMBERS MAY HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. Form 990, Part VI, Section A, line 6 THE MEMBERSHIP OF PTSO CONSISTS OF TWO CLASSES OF MEMBERS. CLASS A MEMBERS ARE COMMUNITY HEALTH CENTERS AND CURRENTLY CONSIST OF THE SUPPORTED ORGANIZATIONS REPORTED ON SCHEDULE A. Form 990, Part VI, Section A, line 7a EACH CLASS A MEMBER MAY APPOINT ONE OF ITS SENIOR EXECUTIVE OR MANAGEMENT STAFF TO SERVE AS A DIRECTOR. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the finance committee and then provided to the full board prior to filing with the IRS. Form 990, Part VI, Section B, line 12c IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND/OR MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. ALL AFFECTED PERSONS SHALL COMPLETE THE ANNUAL AFFIRMATION AND DISCLOSURE STATEMENT ON AN ANNUAL BASIS AND SUBMIT SUCH COMPLETED ANNUAL DISCLOSURE STATEMENTS TO THE SECRETARY OF THE BOARD OF DIRECTORS. THE SECRETARY SHALL BE RESPONSIBLE FOR FILING ALL COPIES OF THE ANNUAL AFFIRMATION AND DISCLOSURE STATEMENTS WITH THE OFFICIAL CORPORATE RECORDS OF THE ORGANIZATION AND SHALL BRING ANY POTENTIAL CONFLICTS OF INTEREST DISCLOSED IN THE ANNUAL AFFIRMATION AND DISCLOSURE STATEMENTS TO THE ATTENTION OF THE BOARD OF DIRECTORS AT THE NEXT MEETING OF THE BOARD DIRECTORS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE INTERESTED PERSON SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. Form 990, Part VI, Section B, line 15a THE BOARD OF DIRECTORS REVIEWS AND DETERMINES CEO COMPENSATION USING COMPARABILITY DATA AND AN INDEPENDENT COMPENSATION CONSULTANT. Form 990, Part VI, Section C, line 19 The Organization's audited financial statements and governing/organizing documents are available upon request. COUNTRY DOCTOR COMMUNITY CLINIC 500 19th Ave east Seattle WA 98112 237100868 Federally Qualified Community Health Center WA 501(c)(3) Line 7 0 Family Health Centers in Okanogan po box 1340 Okanogan WA 98840 911275011 Federally Qualified Community Health Center WA 501(c)(3) Line 7 0 HealthPoint 955 Powell Ave SW Suite A Renton WA 98057 910884412 Federally Qualified Community Health Center WA 501(c)(3) Line 9 0 YAKIMA NEIGHBORHOOD HEALTH SERVICES po Box 2605 Yakima WA 98907 910928817 Federally Qualified Community Health Center WA 501(c)(3) Line 9 0 NEIGHBORCARE HEALTH 905 Spruce Street Suite 300 Seattle WA 98104 910893287 Federally Qualified Community Health Center WA 501(c)(3) Line 7 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 1