2016-02-08T10:36:36-06:00 2015-03-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2014-04-01 911537371 MOSES LAKE COMMUNITY HEALTH CENTER MOSE 5097650674 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 AMANDA DUZON CHIEF FINANCIAL OFFICER 5097650674 2016-02-06 1 KATHRYN J ONG P00746598 4254544919 2016-02-06 2014 2016-04-25 22:37:26Z SHEILA CHILSON 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 29129977 0 X WWW.MLCHC.ORG X 1991 WA TO PROVIDE HIGH QUALITY, COMPASSIONATE AND COMPREHENSIVE PRIMARY HEALTH SERVICES FOR THE ENTIRE FAMILY, WITH A SPECIAL FOCUS ON THE UNDERSERVED AND MIGRANT FARM-WORKERS IN THE COMMUNITY. 12 12 290 12 0 0 4307074 5254443 17428170 19635114 256389 -594346 2786 9663 21994419 24304874 139518 0 0 0 14482208 15928145 0 0 0 5860787 6587593 20482513 22515738 1511906 1789136 26351986 29135578 4977848 6175249 21374138 22960329 TO PROVIDE HIGH QUALITY, COMPASSIONATE AND COMPREHENSIVE PRIMARY HEALTH SERVICES FOR THE ENTIRE FAMILY, WITH A SPECIAL FOCUS ON THE UNDERSERVED AND MIGRANT FARM-WORKERS IN THE COMMUNITY. 0 0 10064747 14423805 MEDICAL SERVICES - THIS PROGRAM INCLUDES MEDICAL, BEHAVIORAL HEALTH AND PHARMACY SERVICES PROVIDED TO PATIENTS OF THE HEALTH CENTER. MOSES LAKE COMMUNITY HEALTH CENTER (MLCHC) PROVIDES PRIMARY CARE SERVICES INCLUDING OBSTETRICS CARE WITH 9 PHYSICIANS AND 9 MID-LEVEL PHYSICIANS ON STAFF. IN 2014, 20,035 MEDICAL PATIENTS WERE SEEN WITH A TOTAL OF 68,333 VISITS. 3850623 4543722 DENTAL SERVICES - MLCHC HAS 7 DENTISTS AND 3 DENTAL HYGIENISTS ON STAFF TO PROVIDE PREVENTATIVE, RESTORATIVE AND EMERGENCY CARE TO THE HEALTH CENTER'S INSURED AND UNINSURED PATIENTS. IN 2014, 11,015 PATIENTS WERE SEEN IN THE DENTAL DEPARTMENT WITH A TOTAL OF 29,318 VISITS PROVIDED. 2039021 667587 OTHER HEALTH PROGRAMS - MLCHC PROVIDES MATERNITY SUPPORT SERVICES, WIC, INFANT TODDLER EARLY INTERVENTION AND DEVELOPMENTAL DISABILITY PARENT TRAINING PROGRAMS. THE MATERNITY SUPPORT SERVICES DEPARTMENT PROVIDED 7,204 VISITS TO APPROXIMATELY 1,240 PATIENTS. THE WIC PROGRAM SERVICES ELIGIBLE CLIENTS THROUGHOUT GRANT COUNTY IN MULTIPLE LOCATIONS. 15954391 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 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 1 1 1 0 0 1 33 0 1 290 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X AMANDA DUZON 5091650674 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 AMY RAYMOND BOARD CHAIR 2.00 0.00 X X 0 0 0 SCOTT CAMPBELL BOARD VICE CHAIR 2.00 1.00 X X 0 0 0 MATTHEW BENSON TREASURER 2.00 1.00 X X 0 0 0 JUAN CARLOS MAGALLANES SECRETARY 1.00 0.00 X X 0 0 0 AMELIA CAMPOS DIRECTOR 1.00 0.00 X 0 0 0 ORALIA CERRILLO DIRECTOR THRU 04/14 1.00 0.00 X 0 0 0 DANIEL CHAVEZ DIRECTOR 1.00 0.00 X 0 0 0 PEDRO DAVALOS DIRECTOR 1.00 0.00 X 0 0 0 SHERRY DELGADO DIRECTOR 1.00 0.00 X 0 0 0 EVA HIDALGO DIRECTOR 1.00 0.00 X 0 0 0 SHARON LANGE DIRECTOR 1.00 0.00 X 0 0 0 LYNN MAKCEY DIRECTOR THRU 07/15 1.00 0.00 X 0 0 0 CAROL SCHIMKE DIRECTOR 1.00 0.00 X 0 0 0 JACINTO VALVERDE DIRECTOR 1.00 0.00 X 0 0 0 SHEILA A CHILSON CEO 40.00 1.00 X 167197 0 19110 SHIRLEY J MERKLE DEPUTY DIRECTOR 40.00 0.00 X 135046 0 7972 AMANDA DUZON CFO 40.00 0.00 X 90443 0 10879 LARRY W VERHAGE PHYSICIAN/MEDICAL DIRECTOR 40.00 0.00 X 328922 0 24976 BRETT L PACK DENTIST/DENTAL DIRECTOR 40.00 0.00 X 236887 0 26918 AUGUST KING PHYSICIAN 40.00 0.00 X 293621 0 18081 COLE Q HEMMERLING PHYSICIAN 40.00 0.00 X 293431 0 24876 MICHAEL R TOLLEY PHYSICIAN 40.00 0.00 X 273047 0 24876 SIMRAT SARAN PHYSICIAN 40.00 0.00 X 219846 0 9928 AUSTEN STASIAK PHYSICIAN 40.00 0.00 X 176624 0 14845 2215064 0 182461 22 0 1 0 NUVODIA LLC 801 SOUTH STEVENS STREET SPOKANE WA 99204 INFORMATION TECHNOLOGY SERVICE 1125704 ALDRICH & ASSOCIATES INC 810 240TH STREET SE BOTHELL WA 980219397 GENERAL CONTRACTOR 272160 CLEANPROS PO BOX 305 MOSES LAKE WA 98837 JANITORIAL SERVICE 237510 INTERPATH PO BOX 1208 PENDLETON OR 97801 OUTSIDE LAB SERVICE 156531 4 587045 4530706 136692 5254443 PATIENT SERVICES 624100 12881015 12881015 MANAGED CARE 624100 6405283 6405283 CONTRACT SERVICES 624100 348816 348816 19635114 248972 248972 350 0 350 350 350 3953310 28475 3858309 966794 95001 -938319 -843318 -843318 REIMBURSEMENT 900099 5000 5000 SURPLUS 900099 4313 4313 9313 24304874 19635114 0 -584683 1046972 390731 656241 12023447 9781333 2242114 283166 225557 57609 1646893 1064476 582417 927667 743047 184620 28490 28490 16962 12550 4412 82492 82492 44657 44657 336493 288889 47604 66149 11991 54158 194004 97408 96596 956386 237988 718398 387505 75326 312179 113966 72217 41749 69304 50699 18605 2558 2558 780642 221656 558986 85286 36707 48579 MED & PHARM SUPPLIES 1345461 1328796 16665 PURCHASED SERVICES 707202 379722 327480 BAD DEBT EXPENSE 376622 376622 REPAIRS AND MAINTENANCE 295162 43101 252061 698252 515575 182677 22515738 15954391 6561347 0 685025 1077358 740608 1476526 242880 260532 1244068 2158515 6315900 6314900 381397 444792 311888 352181 15304221 6573296 9227311 8730925 7173213 8291683 29696 28166 26351986 29135578 4337756 6175249 640092 0 4977848 6175249 X 21374138 22960329 21374138 22960329 26351986 29135578 1789136 -202945 0 X 0 1 X 1 1 1 X 4660479 3939664 3891803 4307074 5254443 22053463 4660479 3939664 3891803 4307074 5254443 22053463 22053463 198349 227236 256737 260631 249322 1192275 86478 4274 20610 2786 9313 123461 193250 63750 257000 23626199 86011285 0.93340 0.93330 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: INCENTIVE PAYMENTS - 2011 AMOUNT: $ 193,250. 2012 AMOUNT: $ 63,750. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 497817 497817 6679863 1874181 4805682 2793395 1522691 1270704 5324562 3176424 2148138 8584 8584 8730925 23514884 -202945 -202945 23717829 587045 587045 24304874 22893704 377966 377966 22515738 0 22515738 PART XI, LINE 4B - OTHER ADJUSTMENTS: INTERCOMPANY TRANSFER 587,045. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET INCOME OF SUBSIDIARY 377,966. X X 0 0 0 0 0 0 0 0 0 SHEILA A CHILSON CEO 166997 0 200 0 0 0 6366 0 12744 0 186307 0 0 0 LARRY W VERHAGE PHYSICIAN/MEDICAL DIRECTOR 307222 0 20950 0 750 0 10400 0 14576 0 353898 0 0 0 BRETT L PACK DENTIST/DENTAL DIRECTOR 215287 0 20300 0 1300 0 9766 0 17152 0 263805 0 0 0 AUGUST KING PHYSICIAN 291771 0 200 0 1650 0 3722 0 14359 0 311702 0 0 0 COLE Q HEMMERLING PHYSICIAN 251898 0 39133 0 2400 0 10400 0 14476 0 318307 0 0 0 MICHAEL R TOLLEY PHYSICIAN 272797 0 250 0 0 0 10400 0 14476 0 297923 0 0 0 SIMRAT SARAN PHYSICIAN 218746 0 200 0 900 0 2408 0 7520 0 229774 0 0 0 AUSTEN STASIAK PHYSICIAN 169899 0 5975 0 750 0 7118 0 7727 0 191469 0 0 0 FORM 990, PART I, LINE 6 THE BOARD OF DIRECTORS PER MLCHC BYLAWS REQUIRES A BOARD COMPOSITION OF 9 TO 15 MEMBERS. ALL VOLUNTEER POSITIONS ARE RELATED TO INVOLVEMENT ON THE BOARD, EITHER AS AN ELECTED MEMBER OR ADVISORY MEMBER. THESE INDIVIDUALS CONTRIBUTE A MINIMUM OF 3 HOURS A MONTH IN THIS CAPACITY. FORM 990, PART VI, SECTION B, LINE 11 UPON COMPLETION OF THE FORM 990, THE RETURN WILL BE REVIEWED IN DETAIL WITH THE BOARD FINANCE COMMITTEE AND THEN IN SUMMARY WITH THE BOARD OF DIRECTORS. UPON APPROVAL BY THE BOARD OF DIRECTORS, THE FINAL FORM 990 WILL BE SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED ON A CONTINUOUS BASIS TO COMPLY WITH THE CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO DISCLOSE TO THE BOARD OF DIRECTORS OR COMPLIANCE OFFICER ANY ISSUES OR CONCERNS. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING AND REPORTING ANY CONFLICTS OF INTEREST BROUGHT TO THE ATTENTION OF THE ORGANIZATION. A BOARD MEMBER WHO HAS A CONFLICT OF INTEREST, IN ANY MATTER BROUGHT BEFORE THE BOARD, SHALL DECLARE SUCH CONFLICT AND MAY BE INCLUDED IN, OR OFFER INFORMATION TO THE DISCUSSION, BUT SHALL ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 FOR THE CEO, THE BOARD OF DIRECTORS REVIEWS SALARY SURVEYS AND REGIONAL MARKET COMPARISONS TO DETERMINE APPROPRIATE COMPENSATION LEVELS. THE CONTRACT IS REVIEWED BY THE BOARD OF DIRECTORS EVERY THREE YEARS AND APPROVED BY THE ENTIRE BOARD. OTHER OFFICERS AND KEY EMPLOYEES ARE REVIEWED UTILIZING SALARY SURVEYS AND REGIONAL MARKET COMPARISONS AS WELL. THIS PROCESS IS LED BY THE CEO WITH THE ASSISTANCE OF THE HR DIRECTOR. COMPENSATION INFORMATION IS REVIEWED WITH THE BOARD CHAIR BY THE CEO. THE LAST COMPENSATION REVIEW WAS PERFORMED IN 2014. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE FOR VIEWING UPON REQUEST AT THE ORGANIZATION'S MAIN BUSINESS OFFICE IN THE PRESENCE OF THE CFO OR CEO. MLCHC COMMUNITY SERVICES 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 463517778 CLINIC EXPANSION AND REMODEL WA 501(C)(3) LINE 11A, I MOSES LAKE COMMUNITY HEALTH CENTER 1 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 MLCHC COMMUNITY SERVICES C 587045 COST MLCHC COMMUNITY SERVICES K 133200 COST