2016-10-14T21:26:32-05:00 2016-05-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2015-06-01 911349657 COMMUNITY HEALTH CARE COMM 2535974550 1019 PACIFIC AVENUE NO 300 TACOMA WA 98402 DAVID FLENTGE CEO 2537221502 2016-10-14 1 KURT BENNION P01469618 4252506100 2015 2017-02-10 21:41:12Z DAVID FLENTGE 1019 PACIFIC AVENUE NO 300 TACOMA WA 98402 43191294 0 X WWW.COMMHEALTH.ORG X 1987 WA TO PROVIDE THE HIGHEST QUALITY HEALTH CARE WITH COMPASSIONATE AND ACCESSIBLE SERVICE FOR ALL. 15 15 485 29 0 0 4976893 6040011 37400576 36819697 210169 199650 26166 93221 42613804 43152579 0 0 0 0 27096105 29264359 42488 45966 98552 12075482 13075599 39214075 42385924 3399729 766655 47231438 49404365 11638212 13044486 35593226 36359879 X COMMUNITY HEALTH CARE PROVIDES COMPREHENSIVE PRIMARY MEDICAL AND DENTAL CARE THROUGH A CLINIC SYSTEM THAT INCLUDES SEVEN MEDICAL AND THREE DENTAL CLINICS. IN ADDITION, CARE IS ALSO PROVIDED THROUGH A WOMEN'S HEALTH CLINIC. 1 0 19454803 0 15732441 COMMUNITY HEALTH CARE (CHC) MEDICAL CLINICS OFFER MEDICAL SERVICES AND URGENT CARE CENTER SERVICES IN VARIOUS LOCATIONS IN PIERCE COUNTY ACCORDING TO A SLIDING FEE SCALE BASED ON INCOME AND FAMILY SIZE. CHC CONTINUES TO SUPPORT TWO RESIDENCY PROGRAMS: 1. A FAMILY PHYSICIAN RESIDENCY PROGRAM THAT ACCEPTS 6 RESIDENTS EACH YEAR FOR A TOTAL OF 18 RESIDENTS DURING A 3 YEAR PROGRAM; AND 2. A FAMILY ADVANCED REGISTERED NURSE PRACTIONER RESIDENCY PROGRAM. DURING THE FISCAL YEAR ENDED 5/31/16, CHC PROVIDED 31,315 PATIENTS WITH MEDICAL CARE FROM 120,975 PATIENT VISITS AT 7 MEDICAL CLINICS.EFFECTIVE APRIL 2016, COMMUNITY HEALTH CARE ADDED BEHAVIORAL HEALTH SERVICES AT 5 MEDICAL CLINICS. DURING THE FISCAL YEAR ENDED 5/31/16, COMMUNITY HEALTH CARE HAD A TOTAL OF 192 VISITS AND 155 PATIENTS. 8392121 0 8037190 COMMUNITY HEALTH CARE (CHC) DENTAL CLINICS OFFER PRIMARY CARE DENTAL SERVICES IN VARIOUS PIERCE COUNTY LOCATIONS ACCORDING TO THE SAME FEE STRUCTURE. CHC DENTAL CLINICS INCLUDE A DENTAL RESIDENCY PROGRAM THAT LAUNCHED IN JULY 2013. DURING THE FISCAL YEAR ENDED 5/31/16, CHC PROVIDED 55,179 DENTAL VISITS TO 20,691 PATIENTS AT 3 DENTAL CLINICS. 6222439 0 11530048 FIVE PHARMACIES OFFER PHARMACEUTICAL SERVICES TO PATIENTS IN VARIOUS LOCATIONS IN PIERCE COUNTY ACCORDING TO THE SAME FEE STRUCTURE NOTED ABOVE. THE PHARMACY SERVED 18,576 PATIENTS THROUGH 150,649 MEDICATION FILLS. 1244626 0 1520018 OTHER PROGRAMS INCLUDE VISION, NUTRITION AND MATERNITY SUPPORT SERVICES THAT OFFER PRENATAL CARE, DELIVERY AND CONTINUED POSTNATAL CARE THROUGHA BABY'S 1ST YEAR. 1244626 0 1520018 35313989 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 30 0 485 1 0 0 0 0 0 1 1 0 0 0 0 X 15 15 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X TONIA CAMPBELL 2535691510 1019 PACIFIC AVENUE STE 300 TACOMA WA 98402 SHIMAMOTO KYLE CHAIR 2.00 2.00 X X 0 0 0 BOWE RICHARD VICE CHAIR 2.00 0.00 X X 0 0 0 SLOAN DAN SECRETARY 2.00 2.00 X X 0 0 0 CATHERSAL LES TREASURER 2.00 0.00 X X 0 0 0 BOWMAN LINDA BOARD MEMBER 2.00 0.00 X 0 0 0 BUCHANON BRUCE BOARD MEMBER 2.00 0.00 X 0 0 0 DASCH ANN BOARD MEMBER 2.00 0.00 X 0 0 0 DEMPSEY PEG BOARD MEMBER 2.00 2.00 X 0 0 0 GRIFFIN-STALLWORTH LADEDRIA BOARD MEMBER 2.00 0.00 X 0 0 0 HANSEN PAUL BOARD MEMBER 2.00 0.00 X 0 0 0 IZANT PHYLLIS BOARD MEMBER 2.00 0.00 X 0 0 0 JOHNSON RIA BOARD MEMBER 2.00 0.00 X 0 0 0 REPP KEN BOARD MEMBER 2.00 0.00 X 0 0 0 SMART ANDY BOARD MEMBER 2.00 0.00 X 0 0 0 SWANBERG DOUG BOARD MEMBER 2.00 2.00 X 0 0 0 TIEMAN LINDA BOARD MEMBER 2.00 0.00 X 0 0 0 VELEZ ANTHONY BOARD MEMBER 2.00 0.00 X 0 0 0 WALMER GARY BOARD MEMBER 2.00 0.00 X 0 0 0 WEISS SHELLY BOARD MEMBER 2.00 0.00 X 0 0 0 YOUNG DEBRA BOARD MEMBER 2.00 0.00 X 0 0 0 DAVID FLENTGE CEO 40.00 2.00 X 153549 0 18355 TONIA CAMPBELL CFO 40.00 2.00 X 124803 0 27270 JEFFREY SMITH MEDICAL DIRECTOR 40.00 0.00 X 305336 0 42778 ALBERT KIM MD FP W/OB 40.00 0.00 X 307744 0 47388 JOHNNY ERKINS MD OBGYN 40.00 0.00 X 264390 0 22702 JAMES LENHART MD FP W/OB 40.00 0.00 X 249091 0 17791 GARY REICHARD MD/DO ASST RESIDENCY DIRECTOR 40.00 0.00 X 240806 0 30395 SANDRA WERNER MD FP W/O OB 40.00 0.00 X 218207 0 9396 1863926 0 216075 54 0 1 0 OPENWORKS 4742 N 24TH ST STE 450 PHOENIX AZ 85016 JANITORIAL SERVICES 284511 NUWEST GROUP HOLDINGS LLC PO BOX 40285 BELLEVUE WA 98015 TEMPORARY STAFFING 271580 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 27216 LABORATORY SERVICES 219483 DR TAREK BAGHDADI OBGYN 1802 S YAKIMA 300 TACOMA WA 98405 AFTER-HOUR INFANT DELIVERIES 159149 4 14000 22500 5890961 112550 454316 6040011 PATIENT FEES 621400 25969041 25969041 PHARMACY REVENUE 621300 10850656 10850656 36819697 199650 199650 35071 0 35071 35071 35071 74357 22500 38715 35642 35642 MISCELLANEOUS REVENUE 900099 22508 22508 22508 43152579 36819697 0 292871 678272 678272 22367580 18989828 3352136 25616 801618 669692 129021 2905 3846860 3154749 678424 13687 1570029 1270815 293701 5513 23741 2163 21578 52358 4770 47588 45966 45966 1630329 1389079 241216 34 148926 80230 68696 868519 543032 323831 1656 762347 612695 149247 405 775402 614444 160627 331 318843 218255 98740 1848 272533 157875 114612 46 1151922 955779 195773 370 141245 97817 43422 6 MEDICAL AND DENTAL SUPP 5528620 5526381 2239 MISCELLANEOUS 529353 242693 286491 169 BAD DEBT 353291 353291 REPAIRS AND MAINTENANCE 294302 253908 40394 223868 176493 47375 42385924 35313989 6973383 98552 3582734 5694373 2135799 1943375 452531 438948 2936886 3649333 14303 170630 206582 685159 963168 31000082 13999518 17728721 17000564 163126 146473 19361549 19361549 47231438 49404365 5127393 6706265 67854 98658 1190000 1115000 5252965 5124563 11638212 13044486 X 35593226 36359879 35593226 36359879 47231438 49404365 766655 0 X 0 1 X 1 1 1 X 5639201 14867928 7267521 4976893 6040011 38791554 5639201 14867928 7267521 4976893 6040011 38791554 38791554 47426 90758 212177 244377 234721 829459 29793 15447 25064 16703 22509 109516 39730529 145633898 0.97640 0.98060 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 4001 0 0 4001 0 PART II-B, LINE 1: THE ORGANIZATION'S EMPLOYEES, INCLUDING THE CEO, CFO, AND DIRECTOR OF OPERATIONS, SPENT APPROXIMATELY 52 HOURS LOBBYING. 3642530 3642530 14623865 4443384 10180481 2311127 1396772 914355 10298187 8159362 2138825 124373 124373 17000564 BOND RESERVE FUND 185000 RECEIVABLE FROM HILLTOP CHC INVESTMENT FUND, LLC 19176549 19361549 X 42507682 63735 38715 102450 42405232 747347 747347 43152579 42135083 63735 38715 102450 42032633 353291 353291 42385924 PART X, LINE 2: NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS BECAUSE THE ORGANIZATION IS A NONPROFIT ORGANIZATION, EXEMPT FROM INCOME TAXES UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE. MANAGEMENT EVALUATED THE ORGANIZATION'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 (ASC). PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 38,715. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER INCOME 234,722. CAPITAL CAMPAIGN CONTRIBUTIONS 159,334. BAD DEBT EXPENSE 353,291. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 38,715. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 353,291. X X X X X X X 1 RICHARD OLDENBURG 6825 RAINIER AVE GIG HARBOR WA 98335 MAJOR & PLANNED GIFT CONSULTING 0 260149 45966 214183 260149 45966 214183 WA ANNUAL LUNCHEON 96857 22500 74357 14943 2000 21772 96857 22500 74357 14943 2000 21772 38715 35642 X X X X X 0 0 0 0 0 0 0 0 0 DAVID FLENTGE CEO 153549 0 0 0 0 0 7788 0 10567 0 171904 0 0 0 TONIA CAMPBELL CFO 124803 0 0 0 0 0 5250 0 22020 0 152073 0 0 0 JEFFREY SMITH MEDICAL DIRECTOR 277939 0 26412 0 985 0 24391 0 18387 0 348114 0 0 0 ALBERT KIM MD FP W/OB 260865 0 46879 0 0 0 25724 0 21664 0 355132 0 0 0 JOHNNY ERKINS MD OBGYN 244691 0 19699 0 0 0 10739 0 11963 0 287092 0 0 0 JAMES LENHART MD FP W/OB 229615 0 19476 0 0 0 1782 0 16009 0 266882 0 0 0 GARY REICHARD MD/DO ASST RESIDENCY DIRECTOR 228353 0 12453 0 0 0 11634 0 18761 0 271201 0 0 0 SANDRA WERNER MD FP W/O OB 212324 0 512 0 5371 0 732 0 8664 0 227603 0 0 0 A WA HEALTH CARE FACILITIES AUTHORITY 911108929 93978EUWO 2003-01-23 3320000 TO FUND BUILDING 0 0 1 A 2205000 3320000 96667 185620 3088333 2003 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WA HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/23/2013 X 1 1950 DONOR VALUED X 24 430116 CDC PRICING X EQUIP MAINTENANCE 10 18000 INVOICE X DENTAL EQUIPMENT 1 4250 COST 0 0 1 0 FORM 990, PART III, LINE 2 EFFECTIVE APRIL 2016, COMMUNITY HEALTH CARE ADDED BEHAVIORAL HEALTH SERVICES AT 5 MEDICAL CLINICS. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF BOARD (CHAIR OR CO-CHAIRS, VICE CHAIR, SECRETARY AND TREASURER) AND THE CHAIRS OF EACH STANDING COMMITTEE. THE EXECUTIVE COMMITTEE HAS THE POWERS AND AUTHORITY OF THE BOARD TO MAKE DECISIONS WHEN THE BOARD IS NOT IN SESSION. THE EXECUTIVE COMMITTEE ALSO OVERSEES THE RECRUITMENT AND HIRING OF THE CEO. FORM 990, PART VI, SECTION A, LINE 4 COMMUNITY HEALTH CARE'S BYLAWS WERE AMENDED IN FEBRUARY 2016. AMONG THE AMENDMENTS MADE, THE PERSONNEL AND EMPLOYEE INVESTMENT COMMITTEE WAS GIVEN OVERSIGHT OF THE PRESIDENT/CEO'S COMPENSATION PROCESS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PROVIDED TO THE BOARD PRIOR TO FILING. THE BOARD WAS GIVEN THE OPPORTUNITY TO FORWARD QUESTIONS AND OR CONCERNS TO THE FINANCE COMMITTEE SO THEY COULD BE ADDRESSED. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND MANAGEMENT TEAM MEMBERS ARE ASKED TO SIGN A CONFLICT OF INTEREST STATEMENT AT INITIAL ORIENTATION AND AGAIN ANNUALLY. RECORDS ARE MAINTAINED BY EITHER THE HUMAN RESOURCES DIRECTOR OR THE ASSISTANT TO THE CEO. REPORTED OR POTENTIAL CONFLICTS ARE REVIEWED BY EITHER THE HUMAN RESOURCES DIRECTOR OR THE CEO. IF A CONFLICT OF INTEREST EXISTS, THE BOARD MEMBER OR MANAGEMENT TEAM MEMBER MUST EXCUSE THEMSELVES FROM THE DISCUSSION OR VOTING. IF A CONFLICT IS PERVASIVE WITH A BOARD MEMBER THEN THE CO-CHAIRS CAN PROCEED TO REMOVE THE BOARD MEMBER. IF A CONFLICT IS PERVASIVE WITH A MANAGEMENT TEAM MEMBER THEN THEY MAY BE TERMINATED. FORM 990, PART VI, SECTION B, LINE 15 COMMUNITY HEALTH CARE USES NORTHWEST REGIONAL PRIMARY CARE ASSOCIATION, NATIONAL ASSOCIATION FOR COMMUNITY HEALTH CENTERS, AND MILLIMAN SALARY SURVEYS AND DATA FROM THE PACIFIC NORTHWEST REGION AS COMPARATIVE DATA. AN OUTSOURCED INDEPENDENT CONSULTANT IS ALSO USED TO DETERMINE SALARY EXPECTATION. THE BOARD REVIEWS THE CEO'S COMPENSATION AND APPROVES. THIS PROCESS WAS LAST COMPLETED IN 2015. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS REVIEWED BY THE CEO AND THEN THE BOARD OF DIRECTORS FOR FINAL APPROVAL. THIS PROCESS WAS LAST COMPLETED IN 2015. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. HILLTOP REGIONAL HEALTH CENTER 1019 PACIFIC AVENUE SUITE 300 TACOMA WA 98402 455494488 HEALTHCARE WA 501(C)(3) LINE 11D, III-O COMMUNITY HEALTH CARE 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 HILLTOP REGIONAL HEALTH CENTER K 231001 FMV BASED ON LOW-COST FINANCING