2016-11-08T18:19:22-06:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2015-01-01 237100868 COUNTRY DOCTOR COMMUNITY CLINIC COUN 2062991937 2101 EAST YESLER WAY NO 210 SEATTLE WA 98122 LINDA MCVEIGH EXECUTIVE DIRECTOR 2062991937 2016-11-08 1 KYLA DELGADO P01874220 4252506100 2015 2017-02-10 21:41:12Z LINDA MCVEIGH 2101 EAST YESLER WAY NO 210 SEATTLE WA 98122 19952326 0 X WWW.COUNTRYDOCTOR.ORG X 1971 WA TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HEALTH CARE REGARDLESS OF ABILITY TO PAY. 12 12 226 16 0 0 5043959 4710371 12303517 14560425 630 366822 1037105 82776 18385211 19720394 0 0 0 0 10211218 11847969 0 0 155655 7151068 6766315 17362286 18614284 1022925 1106110 7846869 8798488 3392561 3252604 4454308 5545884 THE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. 0 0 15268863 0 14560425 IN 2015, COUNTRY DOCTOR COMMUNITY CLINIC PROVIDED 53,367 MEDICAL VISITS. 83% OF THE PATIENTS SEEN IN 2015 HAD INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL (FPL). ALL UNINSURED PATIENTS (24% OF THE TOTAL PATIENTS SEEN) EARNING LESS THAN 200% OF FPL WERE SEEN ON A SLIDING SCALE DISCOUNT. 1475137 0 0 THE OTHER HEALTH SERVICES PROGRAMS PROVIDED 17,890 ANCILLARY HEALTH VISITS (EG NUTRITION, WIC, ELIGIBILITY) TO LOW-INCOME PATIENTS. 16744000 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 27 0 226 1 0 0 0 0 0 1 1 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 WA X SUSANA TANTICO 2062991937 2101 EAST YESLER WAY SUITE 210 SEATTLE WA 98122 JERRY SALE CHAIR 1.00 X X 0 0 0 RIK WYMAN VICE-PRESIDENT VICE CHAIR 1.00 X X 0 0 0 JOAN KLEINBERG SECRETARY 1.00 X X 0 0 0 MORGAN DUTTON TREASURER 1.00 X X 0 0 0 CHERYL ANDERSON DIRECTOR 1.00 X 0 0 0 RAYMOND ANGEL DIRECTOR 1.00 X 0 0 0 MARY BYRD DIRECTOR 1.00 X 0 0 0 COLT DE WOLF DIRECTOR 1.00 X 0 0 0 CHRISTINE JONES DIRECTOR 1.00 X 0 0 0 CHRIS SALAZAR DIRECTOR 1.00 X 0 0 0 GRANT SCULL DIRECTOR 1.00 X 0 0 0 LY SIENG NGO DIRECTOR 1.00 X 0 0 0 WINNIE SPERRY DIRECTOR 1.00 X 0 0 0 STEVE WILKINS DIRECTOR 1.00 X 0 0 0 LINDA MCVEIGH EXECUTIVE DIRECTOR 35.00 X 166147 0 15411 SUSANA TANTICO DIRECTOR OF FINANCE 40.00 X 111984 0 17707 RICHARD KOVAR MEDICAL DIRECTOR 35.00 X 179874 0 36930 SARAH HUFBAUER PHYSICIAN, CLINICAL SITE DIRECTOR 35.00 X 153743 0 35576 KRISTIN ANDERSON PHYSICIAN, RESIDENCY DIRECTOR 35.00 X 157757 0 5623 MATT LOGALBO PHYSICIAN 35.00 X 143210 0 25019 JUSTIN PAT IT SPECIALIST 40.00 X 119816 0 15952 1032531 0 152218 13 0 1 0 PTSO OF WASHINGTON 3101 4TH AVENUE SUITE 320 SEATTLE WA 98101 I.T. SUPPORT 284990 SEATTLE CHILDREN'S 4800 SAND POINT WAY NE SEATTLE WA 98105 BUILDING MAINTENANCE 201472 2 146375 4408284 155712 288189 4710371 PATIENT SERVICES 621400 8060106 8060106 PHARMACY 621400 6500319 6500319 14560425 6366 6366 83970 0 83970 83970 83970 530000 169544 360456 360456 360456 0 146375 62388 -62388 -62388 OTHER REVENUE 900099 49058 49058 RISK POOL REVENUE 900099 12136 12136 61194 19720394 14560425 0 449598 X 311249 311249 9251860 8720077 432403 99380 330042 309255 18270 2517 1293959 1190830 93436 9693 660859 598234 57756 4869 17213 17213 88537 88537 2166397 2011626 150503 4268 33211 2114 30872 225 247968 170318 60004 17646 573659 433622 134070 5967 61895 50988 10868 39 8601 547 7996 58 410598 376652 30774 3172 110859 23365 87494 PHARMACEUTICALS 2210125 2210125 BAD DEBT 420483 420483 MISCELLANEOUS 184082 11831 170989 1262 OTHER HEALTHCARE SUPPLI 154407 154407 78280 59526 12195 6559 18614284 16744000 1714629 155655 201911 412676 941304 413665 872479 1237171 1585247 3057716 8937 594648 319851 9568059 6210650 3642343 3357409 7846869 8798488 1527144 1397055 1865417 1855549 3392561 3252604 X 4371253 5462829 83055 83055 4454308 5545884 7846869 8798488 1106110 -14534 0 X 0 1 X 1 1 1 X 4792780 4856236 4785356 5043959 4711212 24189543 4792780 4856236 4785356 5043959 4711212 24189543 24189543 57372 96147 113859 108335 90336 466049 525451 220307 312659 1012271 61194 2131882 26787474 46488075 0.90300 0.90550 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE RISK POOL REVENUE DEBT FORGIVENESS SPECIAL FUNDRAISING EVENTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 83055 83055 83055 83055 83055 83055 83055 83055 83055 83055 0.00000 1.00000 0.00000 0 0 184000 184000 6780574 4061862 2718712 182047 172287 9760 2411010 1976501 434509 10428 10428 3357409 X 19701970 20823 62388 83211 19618759 101635 101635 19720394 18697495 20823 62388 83211 18614284 0 18614284 PART V, LINE 4: THE ENDOWMENT FUNDS ARE ASSETS SET ASIDE AND RESTRICTED BY DONORS. THE INCOME GENERATED FROM THESE ASSETS IS USED TO FUND OPERATIONS OF THE ORGANIZATION. PART X, LINE 2: CDCHC'S ACTIVITIES ARE GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; HOWEVER, UNRELATED BUSINESS ACTIVITIES WOULD BE SUBJECT TO INCOME TAX. SINCE CDCHC IS EXEMPT FROM FEDERAL INCOME TAX LIABILITY, NO PROVISION IS MADE FOR CURRENT OR DEFERRED INCOME TAX EXPENSE. FOR THE YEARS DECEMBER 31, 2015 AND 2014, MANAGEMENT EVALUATED CDCHC'S TAX POSITIONS AND CONCLUDED THAT CDCHC HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS. ALL TAX-EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE AND OTHER APPLICABLE STATE STATUTES. WITH FEW EXCEPTIONS, CDCHC IS NO LONGER SUBJECT TO FEDERAL INCOME TAX EXAMINATIONS FOR YEARS BEFORE 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 62,388. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL INCOME 83,970. REALIZED GAIN ON INVESTMENTS 5,529. RISK POOL REVENUE 12,136. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 62,388. FUNDRAISING DINNER 146375 146375 0 9730 37868 6200 8590 146375 146375 0 9730 37868 6200 8590 62388 -62388 X X X X 0 0 0 0 0 1 0 0 0 LINDA MCVEIGH EXECUTIVE DIRECTOR 166047 0 100 0 0 0 7063 0 8348 0 181558 0 0 0 RICHARD KOVAR MEDICAL DIRECTOR 179784 0 90 0 0 0 9182 0 27748 0 216804 0 0 0 SARAH HUFBAUER PHYSICIAN, CLINICAL SITE DIRECTOR 153663 0 80 0 0 0 7077 0 28499 0 189319 0 0 0 KRISTIN ANDERSON PHYSICIAN, RESIDENCY DIRECTOR 157667 0 90 0 0 0 4756 0 867 0 163380 0 0 0 MATT LOGALBO PHYSICIAN 143120 0 90 0 0 0 7019 0 18000 0 168229 0 0 0 PART I, LINE 6 ALL EMPLOYEES RECEIVE A SMALL END-OF-YEAR BONUS BASED ON THE ORGANIZATION'S PERFORMANCE, INCLUDING FINANCIAL PERFORMANCE. X 12 288189 COST OR SELLING PRICE 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD CHAIR AND AT LEAST THREE OTHER BOARD MEMBERS. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY AS EXPRESSLY DELEGATED TO IT BY RESOLUTION OF THE BOARD IN THE GOVERNANCE OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE BOTH REVIEWED A DRAFT OF THE RETURN BEFORE IT WAS PRESENTED TO THE FINANCE COMMITTEE FOR FURTHER REVIEW. AFTER REVIEW BY THE FINANCE COMMITTEE AND DISTRIBUTION TO THE FULL BOARD THE FORM 990 WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE AND NON-COMPLIANCE WERE REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED DURING THE MONTHLY MEETINGS. BOARD MEMBERS SIGN A CONFLICT OF INTEREST FORM ANNUALLY. ANY MEMBER WITH A STATED CONFLICT OF INTEREST IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD CHAIRPERSON DETERMINES THE EXTENT OF THE CONFLICT AND WHETHER THE CONFLICTED BOARD MEMBER SHOULD NOT VOTE ON AN ISSUE OR SHOULD RECUSE HIM OR HERSELF FROM THE DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. EVERY TWO YEARS THIS PROCESS IS ASSISTED BY AN INDEPENDENT COMPENSATION CONSULTANT AS WELL AS A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE LAST REVIEW PROCESS OF THE EXECUTIVE DIRECTOR'S COMPENSATION WAS DONE IN 2014. THE DIRECTOR OF FINANCE'S COMPENSATION IS REVIEWED BY THE EXECUTIVE DIRECTOR BASED ON A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE BOARD THEN REVIEWS IT ALONG WITH ALL OTHER EMPLOYEES AS A GROUP. THE REVIEW OF THE DIRECTOR OF FINANCE'S COMPENSATION WAS DONE IN 2014. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G I.T. SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 101,751. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 101,751. INTERPRETIVE SERVICES: PROGRAM SERVICE EXPENSES 75,219. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,219. HEALTHCARE SERVICES: PROGRAM SERVICE EXPENSES 1,884,040. MANAGEMENT AND GENERAL EXPENSES 293. FUNDRAISING EXPENSES 4,268. TOTAL EXPENSES 1,888,601. OTHER SERVICES: PROGRAM SERVICE EXPENSES 52,367. MANAGEMENT AND GENERAL EXPENSES 48,459. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100,826.