2016-04-18T17:37:18-05:00 2015-05-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2014-06-01 911138675 TRI-CITIES COMMUNITY HEALTH TRI- 5055472204 PO BOX 1452 PASCO WA 99301 JUAN CORDOVA CEO 5092420874 2016-04-15 1 KYLA DELGADO CPA P01874220 4252506100 2014 2016-08-17 19:52:53Z JUAN CORDOVA PO BOX 1452 PASCO WA 99301 23863325 0 X WWW.MYTCCH.ORG X 1981 WA OUR MISSION IS IMPROVING OUR COMMUNITY'S HEALTH. 10 10 289 10 0 0 8999685 9092398 11743372 14403840 29941 39371 360465 325423 21133463 23861032 0 0 0 0 15345766 16446553 0 0 0 5768450 6154637 21114216 22601190 19247 1259842 17706206 21915864 4882052 7829091 12824154 14086773 X OUR MISSION IS IMPROVING OUR COMMUNITY'S HEALTH. 1 0 14427196 0 10728792 THE CLINIC PROVIDES MEDICAL, DENTAL, VISION AND URGENT CARE TO MIGRANT AND LOW INCOME PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY.THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS $572,300 FOR CHARITY CARE, $62,954 FOR MEDICARE, $3,187,661 FOR MEDICAID, AND $2,678,770 FOR OTHER THIRD PARTY PAYORS FOR THE YEAR.THE CLINIC PROVIDED 55,223 MEDICAL ENCOUNTERS AND 20,333 DENTAL ENCOUNTERS FOR THE YEAR. 3665961 0 2726194 THE CLINIC PROVIDES MENTAL AND SUBSTANCE ABUSE COUNSELING, THERAPY AND PSYCHIATRIC SERVICES TO MIGRANT AND LOW INCOME PERSONS THROUGHOUT BENTON AND FRANKLIN COUNTIES. 1275941 0 948854 THE CLINIC OFFERS MATERNITY SUPPORT SERVICES (MSS), INFANT CASE MANAGEMENT (ICM), SOCIAL SERVICES (OUTREACH) AND WIC NUTRITION EDUCATION APPOINTMENTS, AND CLASSES TO HIGH RISK MOMS DURING AND POST-DELIVERY. A LARGE PERCENTAGE OF THOSE TCH SERVES ARE MIGRANT AND SEASONAL FARMER WORKERS. TCCH SERVES WELL OVER 4,750 CLIENTS PER MONTH THROUGH THESE PROGRAMS. THESE PROGRAMS IMPROVE ACCESS TO CARE AND PROMOTE PROACTIVE HEALTH CARE MESSAGES TO IMPROVE HEALTHY DELIVERIES AND LIVING. 19369098 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 40 0 1 289 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JIM MAIN 5055472204 515 WEST COURT STREET PO BOX 1452 PASCO WA 99301 JOHN INTRAVARTOLO CHAIR 1.00 X X 0 0 0 RON WEED VICE CHAIR 1.00 X X 0 0 0 RUDY MENDOZA TREASURER 1.00 X X 0 0 0 BEVERLY HERRIN SECRETARY 1.00 X X 0 0 0 LILLIAN PARRA SERGEANT AT ARMS 1.00 X X 0 0 0 DOROTEO CHAVEZ MEMBER 1.00 X 0 0 0 ANA RUIZ PERALTA MEMBER 1.00 X 0 0 0 MARK MORRISSETTE MEMBER 1.00 X 0 0 0 JOSE ROJAS MEMBER 1.00 X 0 0 0 MICHAEL TUOHY MEMBER 1.00 X 0 0 0 JUAN CORDOVA CEO 40.00 X 185382 0 15043 ESLEEN FULTZ CFO 40.00 X 145254 0 6111 BRIAN SCHUR CDO 40.00 X 155058 0 15043 JENNIFER ROBINSON COO 40.00 X 99038 0 11282 RICHARD WILLIAMS PHYSICIAN 40.00 X 296131 0 17304 SERGIO FLORES PHYSICIAN 40.00 X 252240 0 9537 ANA MADARIYA PHYSICIAN 40.00 X 236245 0 11157 LEONEL ZOLESSI PHYSICIAN 40.00 X 220955 0 10437 CHERYL HIPOLITO PHYSICIAN 40.00 X 195839 0 5974 1786142 0 101888 18 0 1 0 LCR CONSTRUCTION 8382 GAGE BOULEVARD SUITE J KENNEWICK WA 99336 CONSTRUCTION SERVICES 531142 I-CLEAN BUILDING SERVICES PO BOX 4836 PASCO WA 99301 JANITORIAL SERVICES 256393 EXPRESS SERVICES INC 9701 BOARDWALK BOULEVARD OKLAHOMA CITY OK 73162 TEMPORARY LABOR 114559 SMITH COVE PARTNERSHIP 552 NORTH COLORADO SUITE 101 KENNEWICK WA 99336 CONSTRUCTION SERVICES 108024 4 8583249 509149 508649 9092398 PATIENT SERVICE REVENUE, NET 624100 10439430 10439430 CAPITATION REVENUE 624100 3847254 3847254 ELECTRONIC HEALTH RECORDS INCENTI 624100 117156 117156 14403840 41664 41664 2293 -2293 -2293 -2293 RISK POOL REVENUE 900099 252650 252650 OTHER REVENUE 900099 72773 72773 325423 23861032 14403840 0 364794 631156 631156 12606213 11798946 807267 113972 100387 13585 3095212 2726272 368940 87726 52144 35582 53016 31513 21503 1353387 855215 498172 143160 54515 88645 109128 70931 38197 244204 92993 151211 532891 351294 181597 45046 17154 27892 35864 13657 22207 894541 773695 120846 113482 22086 91396 MEDICAL SUPPLIES 2006813 1957160 49653 BAD DEBT 357945 357945 EQUIPMENT LEASE, REPAIR 96484 62342 34142 MISCELLANEOUS 80950 30849 50101 22601190 19369098 3232092 0 207475 4220768 7820395 388931 442946 602497 559578 895558 828058 83439 150485 89429 158267 15545161 6451250 8674469 9093911 903656 926436 1847459 1728313 17706206 21915864 2351982 3296135 211705 2318509 2164118 2181302 154247 33145 4882052 7829091 X 12824154 14086773 12824154 14086773 17706206 21915864 1259842 2777 0 X 0 1 X 1 1 1 X 1 10044 116281 118300 8025 1 X 219289 219289 10842564 3320966 7521598 54797 16846 37951 4153438 3113438 1040000 275073 275073 9093911 SELF-FUNDED INSURANCE ASSET 73844 ESTIMATED RISK POOL SETTLEMENT RECEIVABLE 169000 ENHANCEMENT RECEIVABLE 120955 ASSETS LIMITED AS TO USE FOR HOUSING PROGRAM 1353636 SECURITY DEPOSITS 10878 1728313 ESTIMATED THIRD-PARTY SETTLEMENTS 33145 33145 X 23566718 0 23566718 294314 294314 23861032 22601190 0 22601190 0 22601190 PART IV, LINE 1B: CHECK BOOKS ARE HELD FOR A NUMBER OF PATIENTS. THE BANK ACCOUNT IS UNDER THE PATIENT'S NAME. TCCH MAKES SURE BILLS ARE PAID BUT THE MONEY IS NOT PROVIDED TO TCCH DIRECTLY. PART IV, LINE 2B: STATE DEPARTMENT OF COMMERCE- THESE FUNDS ARE AVAILABLE TO THE CLINIC FOR 50 YEARS. HOUSING ASSISTANCE COUNCIL- THESE FUNDS ARE FOR THE PURCHASE OF LOTS FOR SELF-HELP HOUSING PROGRAM. THE FUNDS ARE DRAWN DOWN AT THE TIME OF PURCHASE AND WHEN THE LOTS ARE SOLD, 75 PERCENT OF THE FUNDS ARE HELD IN A REVOLVING FUND FOR FUTURE LOT PURCHASES WITH THE REMAINING 25 PERCENT RETURNED TO THE HOUSING ASSISTANCE COUNCIL. HOUSING AND URBAN DEVELOPMENT- THESE FUNDS ARE ALLOCATED FOR USE AS SPECIFIED BY THE GRANT AGREEMENTS. FUNDS RECEIVED BY THE CLINIC ARE FOR THE PURCHASE OF LOTS TO BE SOLD TO FAMILIES IN THE SELF-HELP PROGRAM AND ARE INCLUDED IN A REVOLVING ACCOUNT UNTIL IT IS NO LONGER USED FOR LOT PURCHASES OR SUBSIDIES AT WHICH TIME IT IS TO BE RETURNED TO HOUSING AND URBAN DEVELOPMENT. COMMUNITY HOUSING DEVELOPMENT ORGANIZATION- THESE FUNDS ARE TO BE RETURNED SHOULD THE HOME BE SOLD OR FORECLOSED BEFORE THE MINIMUM AFFORDIBILITY PERIOD ENDS, WHICH VARIES BETWEEN 5 AND 15 YEARS BASED ON THE COST OF THE UNIT. AFTER THE MINIMUM AFFORDIBILITY PERIOD HAS BEEN ACHIEVED, THE ASSOCIATED DEBT IS FORGIVEN AND THE FUNDS ARE RECOGNIZED AS REVENUE BY THE CLINIC. PART X, LINE 2: THE CLINIC HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE CLINIC'S TAX POSITIONS AND CONCLUDED THAT THE CLINIC HAD TAKEN NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. PART XI, LINE 4B - OTHER ADJUSTMENTS: RISK POOL SAVINGS 252,650. INTEREST INCOME 41,664. X X X 0 0 0 0 0 0 0 0 0 JUAN CORDOVA CEO 162382 0 0 0 23000 0 0 0 15043 0 200425 0 0 0 ESLEEN FULTZ CFO 145254 0 0 0 0 0 0 0 6111 0 151365 0 0 0 BRIAN SCHUR CDO 155058 0 0 0 0 0 0 0 15043 0 170101 0 0 0 RICHARD WILLIAMS PHYSICIAN 278631 0 0 0 17500 0 0 0 17304 0 313435 0 0 0 SERGIO FLORES PHYSICIAN 252240 0 0 0 0 0 0 0 9537 0 261777 0 0 0 ANA MADARIYA PHYSICIAN 221013 0 0 0 15232 0 0 0 11157 0 247402 0 0 0 LEONEL ZOLESSI PHYSICIAN 220955 0 0 0 0 0 0 0 10437 0 231392 0 0 0 CHERYL HIPOLITO PHYSICIAN 195839 0 0 0 0 0 0 0 5974 0 201813 0 0 0 X 3 508649 COST 0 0 1 0 FORM 990, PART I, LINE 6: VOLUNTEERS FOR THE CLINIC PROVIDE SUPPORT IN ADMINISTRATION, FACILITY, AND SUPPORT SERVICE DEPARTMENTS. FORM 990, PART III, LINE 2 AN EYE CLINIC AND VISION PROGRAM WERE OPENED IN MARCH OF 2015. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE GOVERNING BOARD AND ONE OTHER BOARD MEMBER TO BE DESIGNATED BY THE BOARD. THE EXECUTIVE COMMITTEE IS AUTHORIZED TO REVIEW AND TAKE ANY NECESSARY ACTION, WHICH, IN THE OPINION OF A MAJORITY OF THE COMMITTEE UPON VOTE WHERE FOUR MEMBERS ARE PRESENT, CANNOT WAIT FOR THE NEXT REGULARLY SCHEDULED BOARD MEETING OR WHERE CALLING A SPECIAL BOARD MEETING IS NOT PRACTICAL. THE EXECUTIVE COMMITTEE CHAIRPERSON MUST REPORT TO THE BOARD AT THE NEXT REGULAR MEETING ALL ACTIONS TAKEN BY THE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE 99O WAS PROVIDED TO THE CEO AND CONTROLLER, WHO REVIEWED THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS WERE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT WAS PRESENTED TO THE CEO, WHO THEN APPROVED THE 990. ONCE MANAGEMENT WAS SATISFIED WITH THE 990, IT WAS DISTRIBUTED TO ALL BOARD MEMBERS FOR REVIEW. AFTER BOARD REVIEW, THE CEO SIGNED THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST AT THE TIME OF APPOINTMENT TO THE BOARD OR THROUGH SELF-DISCLOSURE IN THE INTERIM. DISCLOSURES ARE REVIEWED BY THE FULL BOARD. IF A CONFLICT OF INTEREST EXISTS, THE BOARD MEMBER IS EXCUSED FROM ALL DISCUSSIONS AND ANY VOTING THAT RELATES TO THE MATTER IN QUESTION. IT IS UNDERSTOOD THAT ALL BOARD MEMBERS HAVE AN OBLIGATION TO REPORT ANY MATTERS OR ISSUES THAT MAY GIVE RISE TO A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE HUMAN RESOURCE DEPARTMENT REGULARY CONDUCTS SALARY REVIEWS AND SURVEYS FOR ALL POSITIONS, INCLUDING KEY EMPLOYEES AND OFFICERS, AND ADVISES THE BOARD OF DIRECTORS OF THEIR FINDINGS UPON REQUEST. THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE CEO'S COMPENSATION. THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES WHEN THEY ARE HIRED, BUT THE CEO REVIEWS AND APPROVES THEIR COMPENSATION IN SUBSEQUENT YEARS. FORM 990, PART VI, SECTION C, LINE 19 THE CLINIC MAKES ITS GOVERINING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.