2016-05-04T12:30:31-05:00 2015-06-30 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2014-07-01 930853709 THE WALLACE MEDICAL CONCERN WALL 5034891760 124 NORTHEAST 181ST AVENUE NO 103 PORTLAND OR 97230 MARILYNN WEBER TREASURER 5034891760 2016-05-03 1 KYLA DELGADO CPA P01874220 4252506100 2014 2016-08-17 19:52:53Z LISA CLINE 124 NORTHEAST 181ST AVENUE NO 103 PORTLAND OR 97230 4197671 0 X WWW.WALLACEMEDICAL.ORG X 1984 OR PROVIDE HEALTH SERVICES TO THOSE IN NEED IN THE PORTLAND AND GRESHAM METROPOLITAN AREA. 10 10 47 101 0 0 1664756 2114329 503389 1875233 -23496 250 4977 207859 2149626 4197671 0 0 0 0 1652975 2128421 48546 36012 185321 647626 1419642 2349147 3584075 -199521 613596 556378 1314429 152848 297506 403530 1016923 X THE WALLACE MEDICAL CONCERN ("WMC") PROVIDES AN OPEN DOOR TO EXCEP- TIONAL HEALTH SERVICES THAT SUPPORT INDIVIDUALS AND THEIR FAMILIES IN HEALTHY LIVING. WMC SERVES INDIVIDUALS AND FAMILIES WHO FACE BARRIERS TO CARE THROUGHOUT THE PORTLAND AND GRESHAM METROPOLITAN AREA.WMC PROVIDES AN OPEN DOOR TO EXCEPTIONAL HEALTH SERVICES AND CONNECTIONS THAT SUPPORT INDIVIDUALS AND THEIR FAMILIES IN HEALTHY LIVING. WMC HAS A 31-YEAR RECORD OF PROVIDING MEDICAL SERVICES AND HAS DISTINGUISHED ITSELF AS A PATIENT-FOCUSED, INNOVATIVE HEALTH CARE ORGANIZATION. WMC BECAME A FEDERALLY QUALIFIED HEALTH CENTER IN JUNE OF 2012, ALLOWING FOR EXPANSION OF SERVICES AND IMPLEMENTATION OF PRIMARY CARE THAT OFFERS A COMPREHENSIVE MEDICAL HOME AND CONTINUITY OF CARE FOR PATIENTS AND THEIR FAMILIES. WMC'S INCREASING CAPACITY TO PROVIDE HIGH QUALITY HEALTH SERVICES IS THE RESULT OF ITS SUCCESS AT ATTRACTING AND MAINTAINING SKILLED AND COMMITTED MEDICAL PROFESSIONALS, ITS INNOVATIVE PARTNERSHIPS, AND THE HIRING OF BIL 0 0 2813481 0 1875233 THE WALLACE MEDICAL CONCERN ("WMC") PROVIDES AN OPEN DOOR TO EXCEPTIONAL HEALTH SERVICES AND CONNECTIONS THAT SUPPORT INDIVIDUALS AND THEIR FAMILIES IN HEALTHY LIVING. WMC HAS A 31-YEAR RECORD OF PROVIDING PATIENT-CENTERED, CULTURALLY ADEPT HEALTH SERVICES. WE HAVE SERVED TENS OF THOUSANDS OF CHILDREN AND ADULTS IN NEED. OUR MULTI-CULTURAL STAFF AND VOLUNTEERS PROMOTE POSITIVE HEALTH OUTCOMES WHILE OFFERING RESPECT AND DIGNITY TO OUR PATIENTS. OUR CLINICS ARE OPEN AT STRATEGIC (AND MOBILE) LOCATIONS. A PRIORITY FOCUS IS TO ADDRESS HEALTH DISPARITIES EXPERIENCED BY FAMILIES LIVING IN POVERTY. WE PRIORITIZE PREVENTION AND WELLNESS SERVICES WHILE TREATING ACUTE AND CHRONIC PROBLEMS. CONTINUED ON SCHEDULE O.OUR PROGRAMS ADDRESS SOCIAL DETERMINANTS OF HEALTH SUCH AS NUTRITION/FOOD ACCESS AND ORAL HEALTH, WHICH PLAY A PIVOTAL ROLE IN CHILDREN'S DEVELOPMENT. OUR COMPREHENSIVE PRIMARY CARE SERVICES INCLUDE WELL CHILD, WOMEN'S HEALTH, BEHAVIORAL HEALTH AND CHRONIC DISEASE MANAGEMENT. WE OFFER SPECIALTY CLINICS IN DERMATOLOGY, PODIATRY, OPTOMETRY, CHIROPRACTIC AND DENTAL. WE ALSO PLAY A CRITICAL ROLE AS A GATEWAY TO THE LARGER HEALTH CARE SYSTEM, SECURING REFERRALS FOR NO-COST SPECIALTY AND HOSPITAL CARE. WITH BILINGUAL STAFF, PROFESSIONAL INTERPRETER VOLUNTEERS, AND AN EMPHASIS ON HEALTH LITERACY, HEALTH EDUCATION AND PREVENTION, WMC IS ABLE TO PROVIDE CULTURALLY APPROPRIATE CARE TO NON-ENGLISH SPEAKING PATIENTS. THE HEALTH ACCESS WINDOW AT THE MEXICAN CONSULATE OFFERS HEALTH PROMOTION AND DISEASE PREVENTION ASSISTANCE. THE MOBILE MEDICAL CLINIC AND THE NEW ROCKWOOD CLINIC LOCATED OFF THE MAX LINE OFFER ACCESSIBILITY TO THOSE WITH LIMITED TRANSPORTATION OPTIONS. 0 2813481 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 18 0 47 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 0 1 0 0 OR X AMY BRISSON 5039070594 124 NE 181ST AVE STE 103 PORTLAND OR 97230 VIRGINIA CORNYN PRESIDENT & DIRECTOR 1.00 X X 0 0 0 MAUREEN WRIGHT MD DIRECTOR & PRESIDENT 1.00 X X 0 0 0 DAVID WOLF VICE PRESIDENT & DIRECTOR 1.00 X X 0 0 0 LISA GOREN DIRECTOR & VICE PRESIDENT 1.00 X X 0 0 0 DEBORAH HEDGES SECRETARY & DIRECTOR 1.00 X X 0 0 0 MARILYNN WEBER TREASURER & SECRETARY 1.00 X X 0 0 0 ADELE ATWOOD DIRECTOR 1.00 X 0 0 0 CARLOS GALEANA DIRECTOR 1.00 X 0 0 0 PATRICIA HICKS DIRECTOR 1.00 X 0 0 0 MARVA MITCHELL DIRECTOR 1.00 X 0 0 0 ANA LUCIA VALENCIA DIRECTOR 1.00 X 0 0 0 LISA CLINE CHIEF EXECUTIVE OFFICER 50.00 X 97496 0 4514 AMY BRISSON DIRECTOR OF FINANCE 43.00 X 37152 0 2944 ANNA JIMINEZ MD MEDICAL DIRECTOR 40.00 X 153185 0 8967 287833 0 16425 1 0 1 0 0 1192563 921766 1830 2114329 PATIENT BILLING 621110 1875233 1875233 1875233 250 250 2100 0 2100 2100 2100 OTHER INCOME 900099 184509 184509 MEANINGFUL USE REVENUE 900099 21250 21250 205759 4197671 1875233 0 208109 182030 182030 1596523 1329783 164599 102141 22916 19018 2453 1445 157962 128917 20052 8993 168990 127635 31585 9770 17923 16450 1473 5165 5165 82847 82847 36012 36012 290994 267378 19130 4486 1712 1600 112 30932 17657 7096 6179 26974 20150 4234 2590 89189 67837 15415 5937 10256 6753 3480 23 31683 19643 11012 1028 1171 1171 37510 29103 6170 2237 20476 13930 5427 1119 BAD DEBT EXPENSE 594043 594043 CLINICAL SUPPLIES 119150 118836 314 SMALL EQUIPMENT 26533 25474 144 915 VOLUNTEER MANAGEMENT 11567 11329 180 58 21517 14395 6633 489 3584075 2813481 585273 185321 9015 33406 95809 168422 88061 54491 146791 413026 35190 23444 746800 125160 181512 621640 556378 1314429 138174 196832 14674 100674 152848 297506 X 213338 834170 190192 182753 403530 1016923 556378 1314429 613596 -203 0 X 0 1 X 1 1 1 X 764456 1062396 1540932 1664756 2114329 7146869 764456 1062396 1540932 1664756 2114329 7146869 7146869 6218 2681 901 77 2350 12227 425 1871 3724 4977 205759 216756 7375852 2505745 0.96900 0.95020 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME MEANINGFUL USE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 475000 475000 191193 87568 103625 80607 37592 43015 621640 X 3287251 -203 158826 158623 3128628 1069043 1069043 4197671 3148858 158826 158826 2990032 594043 594043 3584075 PART X, LINE 2: WMC IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND COMPARABLE STATE LAW. IN ADDITION, WMC HAS BEEN RECOGNIZED AS A PUBLIC CHARITY UNDER SECTIONS 170(B)(1)(A)(VI) AND 509(A)(1) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED WMC'S TAX POSITIONS AND CONCLUDED THAT WMC 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAPITAL CONTRIBUTIONS 475,000. BAD DEBT EXPENSE 594,043. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 594,043. X X X X 1 MEADOW MARTELL PO BOX 2565 CAVE JUNCTION OR 97523 GRANT WRITING 0 718300 17064 0 LAURA RAYMOND 4401 SE 29TH AVE PORTLAND OR 97202 GRANT WRITING 0 205950 4893 0 COMMUNITY LINK CONSULTING PO BOX 276 NEWMAN LAKE WA 99025 GRANT WRITING 0 142427 3383 0 DANA BROWN 2606 NE 30TH AVE PORTLAND OR 97212 GRANT WRITING 0 115000 10672 0 1181677 36012 OR X X 0 0 0 0 0 0 0 0 0 ANNA JIMINEZ MD MEDICAL DIRECTOR 153185 0 0 0 0 0 2536 0 6431 0 162152 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE OFFICERS OF THE BOARD OF DIRECTORS AND ONE ADDITIONAL DIRECTOR SERVE AS THE MEMBERS OF THE EXECUTIVE COMMITTEE. THE CEO SITS ON THE EXECUTIVE COMMITTEE AS AN ADVISOR, BUT DOES NOT HAVE A VOTE. THE EXECUTIVE COMMITTEE HAS ALL OF THE POWERS AND AUTHORITY OF THE BOARD OF DIRECTORS WHEN ACTING IN A REASONABLE MANNER DURING AN EMERGENCY AS DELEGATED BY THE BOARD, IF IT IS IMPRACTICAL TO CONVENE A MEETING OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED BY MANAGEMENT AND THE FINANCE COMMITTEE. A COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD-DELEGATED POWERS IS REQUIRED TO SIGN AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT FOR CONSIDERATION BY THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD-DELEGATED POWERS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, THE INTERESTED PERSON IS REQUIRED TO LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POTENTIAL CONFLICT. IN ADDITION, A PERIODIC REVIEW IS PERFORMED BY THE GOVERNING BOARD AND, AT A MINIMUM, INCLUDES WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. FORM 990, PART VI, SECTION B, LINE 15A THE SALARY OF THE CHIEF EXECUTIVE OFFICER IS DETERMINED BY THE BOARD OF DIRECTORS AFTER A REVIEW OF THE NON-PROFIT AND HEALTH CENTER SALARY SURVEY FOR THE REGION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.