2016-06-17T18:35:45-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2015-01-01 910947084 INTERNATIONAL COMMUNITY HEALTH SERVICES INTE 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 2067883618 2016-06-15 1 KYLA J DELGADO P01874220 4252506100 2015 2016-09-27 15:27:22Z TERESITA BATAYOLA 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 37041204 0 X WWW.ICHS.COM X 1973 WA PROVIDE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES 14 14 509 39 0 0 5264053 9471332 21709649 27149925 38870 9364 297889 394390 27310461 37025011 0 0 0 0 18771481 24058738 0 0 206927 8569236 11589487 27340717 35648225 -30256 1376786 49538613 51628284 19719485 20432370 29819128 31195914 X INTERNATIONAL COMMUNITY HEALTH SERVICES (ICHS) IS A COMMUNITY-BASED HEALTH CARE CENTER COMMITTED TO PROVIDING CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES. ICHS ALSO PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE ORGANIZATION'S POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THE ORGANIZATION'S ESTABLISHED RATES. A MULTI-ETHNIC HEALTH CARE TEAM APPROACH AND A COMBINATION OF DIVERSE FUNDING SOURCES ENABLES ICHS TO PROVIDE AFFORDABLE COMPREHENSIVE HEALTH CARE, WHICH ADDRESS THE GAPS AND BARRIERS THAT PREVENT THE LOW-INCOME, NON-ENGLISH SPEAKING, ASIAN/PACIFIC ISLANDER POPULATION FROM AVAILING THEMSELVES OF ADEQUATE HEALTH SERVICES. 1 0 13607789 0 11682497 ICHS PROVIDES MEDICAL SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY. THESE SERVICES INCLUDE PHYSICAL EXAMS, IMMUNIZATIONS, MINOR SURGERY, HOME VISITS, AND INFANT AND WELL-CHILD CHECK-UPS. DURING 2015, ICHS PROVIDED 66,295 PRIMARY HEALTH CARE VISITS TO PATIENTS AND $292,616 OF CHARITY CARE. 7623558 0 9244239 ICHS PROVIDES FULL DENTAL CARE FOR THE ENTIRE FAMILY. ICHS PROVIDES EXTENSIVE DENTURE WORK, FULL CLEANING FOR ADULTS AND CHILDREN, PREVENTIVE DENTISTRY, MINOR ORAL SURGERY, RESTORATIVE SERVICES, ORTHODONTIA, AND EMERGENCY CARE. THE STAFF ALSO PROVIDES ORAL HEALTH EDUCATION IN THE COMMUNITY. DURING 2015, ICHS PROVIDED 45,145 DENTAL CARE VISITS TO PATIENTS AND $712,371 OF CHARITY CARE. 8030116 0 6223189 ICHS PROVIDES A VARIETY OF OTHER HEALTH CARE SERVICES TO THE COMMUNITY. THESE SERVICES INCLUDE CHINESE TRADITIONAL MEDICINE TECHNIQUES, DISEASE PREVENTION, HEALTH EDUCATION, BEHAVIORAL HEALTH, NUTRITION SERVICES, AND FAMILY PLANNING FOR TEENS AND ADULTS. DURING 2015, ICHS PROVIDED 6,362 HEALTH CARE VISITS TO PATIENTS AND $171,587 OF CHARITY CARE. 29261463 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 37 0 509 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 WA X HERMES SHAHBAZIAN 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 GILDAS CHEUNG PRESIDENT 5.00 0.00 X X 0 0 0 JOHN FOZ 1ST VICE PRESIDENT 3.00 2.00 X X 0 0 0 CRIS KRISOLOG-ELLIOTT 2ND VICE PRESIDENT 3.00 0.00 X X 0 0 0 KELLI NOMURA 3RD VICE PRESIDENT 3.00 0.00 X X 0 0 0 CATHERINE JOHNSON SECRETARY 3.00 0.00 X X 0 0 0 RICHARD MELLON TREASURER 3.00 0.00 X X 0 0 0 HIROSHI NAKANO DIRECTOR 1.50 0.00 X 0 0 0 RANA AMINI DIRECTOR 1.50 0.00 X 0 0 0 JANYCE KO FISHER DIRECTOR 1.50 2.00 X 0 0 0 JENNY FANG DIRECTOR 1.50 0.00 X 0 0 0 ARMILITO PANGILINAN DIRECTOR 1.50 0.00 X 0 0 0 RACHEL KOH DIRECTOR 1.50 0.00 X 0 0 0 BENJAMIN LEE DIRECTOR 1.50 0.00 X 0 0 0 TED LEW DIRECTOR 1.50 0.00 X 0 0 0 ARIGIN SAKDA DIRECTOR 0.50 2.00 X 0 0 0 NHAN THAI DIRECTOR 0.50 0.00 X 0 0 0 JOYCE CHIN DIRECTOR 1.50 2.00 X 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 50.00 3.00 X 217435 0 7123 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 40.00 2.00 X 166540 0 11674 GRACE WANG CHIEF MEDICAL OFFICER 50.00 0.00 X 239439 0 13884 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 241985 0 13811 ALAN CHUN ASSISTANT MEDICAL DIRECTOR 34.00 0.00 X 205578 0 12816 UYENVY PHAM ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 197305 0 12531 JI CHOI DENTAL DIRECTOR 40.00 0.00 X 185338 0 12309 JOSEPH YOO ASSISTANT DENTAL DIRECTOR 40.00 0.00 X 168697 0 11686 CHRISTOPHER YEE MD/PROVIDER & MED RES TRNG DIRECTOR 40.00 0.00 X 200604 0 12805 NANCY SNAPP MD/PROVIDER 32.00 0.00 X 175924 0 11984 HARVEY WU DDS/PROVIDER 40.00 0.00 X 175423 0 11879 GRANDY AU DDS/PROVIDER 40.00 0.00 X 167097 0 11674 TIMOTHY LAM DDS/PROVIDER 40.00 0.00 X 164238 0 11516 2505603 0 155692 34 0 1 0 LEASE CRUTCHER LEWIS WA LLC 107 SPRING ST SEATTLE WA 98104 CONSTRUCTION SERVICES 1602808 QUALITY SYSTEMS INC PO BOX 511449 LOS ANGELES CA 90051 NEXTGEN SERVICES 411885 INDEMAND INTERPRETING 555 ANDOVER PARK WEST SUITE 201 SEATTLE WA 98188 INTERPRETING SERVICES 173163 DENTAL PROFESSIONALS 4200 42ND AVE SW SEATTLE WA 98116 DENTAL SERVICES 133702 4 5274658 3772502 424172 605511 9471332 PATIENT SERVICE FEES 624100 25357874 25357874 POOL SAVINGS REVENUE 900099 1775667 1775667 OTHER MEDICAL REVENUE 900099 16384 16384 27149925 12322 12322 41003 13235 27768 27768 27768 2958 -2958 -2958 -2958 MANAGEMENT FEES 900099 217383 217383 MISCELLANEOUS REVENUE 900099 149239 149239 366622 37025011 27149925 0 403754 1718151 939562 778589 18057243 14990938 2892359 173946 523033 434657 83248 5128 2183758 1766993 402696 14069 1576553 1268437 294332 13784 92038 29713 62325 55114 55114 1756081 1368854 387227 23703 15117 8586 309610 245751 63859 164945 130484 34461 1290827 1089029 201798 98974 62705 36269 83022 49734 33288 445884 424552 21332 2326524 1895347 431177 107809 68047 39762 MEDICAL SUPPLIES 3338751 3272928 65823 PATIENT EXPENSE 765589 764614 975 EQUIPMENT 187158 158216 28942 LICENSE AND TAXES 161231 111546 49685 382227 174239 207988 35648225 29261463 6179835 206927 9064175 6711694 484778 693782 2143063 2087203 154797 171901 694175 691211 42461651 8565738 35763041 33895913 154924 103579 1200000 1079660 6073001 49538613 51628284 4523406 7178830 663619 734394 9918424 9704161 3003345 2814985 1610691 0 19719485 20432370 X 29069179 30355684 749949 840230 29819128 31195914 49538613 51628284 1376786 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 1 302 0 0 0 1 2611 0 1 50 2963 0 PART II-B, LINE 1: ATTENDED CHC/API LEGISLATIVE DAY, PLACED NACHC CAMPAIGN ADS, AND PAID MEMBERSHIP TO LOBBYING ORGANIZATION. 3528037 3528037 26387699 2486459 23901240 4903224 2026051 2877173 7633626 4053228 3580398 9065 9065 33895913 RECEIVABLE FROM RELATED ORGANIZATION 6073001 6073001 X 35138183 26790 16193 42983 35095200 1929811 1929811 37025011 35575109 26790 13235 40025 35535084 113141 113141 35648225 PART X, LINE 2: THE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED ICHS'S TAX POSITION 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 13,235. LOSS ON DISPOSAL OF EQUIPMENT 2,958. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL INCOME 41,003. POOL SAVINGS REVENUE 1,775,667. BAD DEBT 113,141. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 13,235. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 113,141. X X X X X 0 0 0 1 0 0 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 189436 0 22376 0 5623 0 6426 0 697 0 224558 0 0 0 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 163453 0 500 0 2587 0 5049 0 6625 0 178214 0 0 0 GRACE WANG CHIEF MEDICAL OFFICER 231689 0 7750 0 0 0 7259 0 6625 0 253323 0 0 0 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 223144 0 2813 0 16028 0 7186 0 6625 0 255796 0 0 0 ALAN CHUN ASSISTANT MEDICAL DIRECTOR 197129 0 8449 0 0 0 6191 0 6625 0 218394 0 0 0 UYENVY PHAM ASSISTANT MEDICAL DIRECTOR 184788 0 11875 0 642 0 5906 0 6625 0 209836 0 0 0 JI CHOI DENTAL DIRECTOR 151984 0 18500 0 14854 0 5684 0 6625 0 197647 0 0 0 JOSEPH YOO ASSISTANT DENTAL DIRECTOR 140361 0 15250 0 13086 0 5061 0 6625 0 180383 0 0 0 CHRISTOPHER YEE MD/PROVIDER & MED RES TRNG DIRECTOR 177257 0 11049 0 12298 0 6180 0 6625 0 213409 0 0 0 NANCY SNAPP MD/PROVIDER 167569 0 8355 0 0 0 5359 0 6625 0 187908 0 0 0 HARVEY WU DDS/PROVIDER 150913 0 15500 0 9010 0 5254 0 6625 0 187302 0 0 0 GRANDY AU DDS/PROVIDER 136855 0 15500 0 14742 0 5049 0 6625 0 178771 0 0 0 TIMOTHY LAM DDS/PROVIDER 145339 0 15500 0 3399 0 4891 0 6625 0 175754 0 0 0 PART I, LINE 5 THE CEO RECEIVES A BONUS BASED ON FIVE STRATEGIC GOALS, ONE OF WHICH IS DIVERSIFYING REVENUE. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2013-10-18 10160000 CONSTRUCTION 0 0 0 A 455839 10160000 1316561 185641 131346 10160000 0 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 X 2 605511 COST 0 0 1 0 FORM 990, PART III, LINE 2 ARNP INITIATIVE - IN ORDER TO MEET ON-GOING SHORTAGE OF EXPERIENCED PROVIDERS, DURING 2015, ICHS STARTED HIRING NEW ADVANCED REGISTERED NURSE PRACTITIONER (ARNP) GRADUATES WITH THE OBJECTIVE OF HAVING AVAILABILITY OF EXPERIENCED PROVIDERS TO MEET THE PROVIDER VACANCIES. THIS INITIATIVE ACCEPTS THREE GRADUATES EVERY YEAR FOR A TWO YEAR INITIATIVE THAT INCLUDES A COMBINATION OF CLINICAL CLASSROOM TRAININGS WITH A PANEL OF VARIOUS EXPERTS AND PATIENT VISITS UNDER SUPERVISION OF PRECEPTOR. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS CHAIRED BY THE PRESIDENT OF THE BOARD AND ONLY CONSISTS OF THE ELECTED OFFICERS OF THE BOARD AND THE CHIEF EXECUTIVE OFFICER OF ICHS AS AN EX OFFICIO MEMBER. THE EXECUTIVE COMMITTEE IS EXCLUSIVELY AUTHORIZED TO ACT FOR THE BOARD IN URGENT SITUATIONS DURING THE INTERIM PERIOD BETWEEN MEETINGS OF THE BOARD IN A MANNER CONSISTENT WITH ESTABISHED BOARD POLICIES AND/OR DIRECTION, AND SHALL REPORT ALL ACTIVITIES AND ACTIONS AT THE NEXT MEETING OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF THE FORM 990 WAS REVIEWED BY THE CFO AND DESIGNATED STAFF INCLUDING ACCOUNTING MANAGER. THE ORGANIZATION'S FINANCE DEPARTMENT THEN REVIEWED AND SUBMITTED A DRAFT COPY OF THE FORM 990 TO THE FINANCE AND AUDIT COMMITTEE OF THE THE BOARD OF DIRECTORS WHICH RECOMMENDED APPROVAL OF THE FORM TO THE OTHER COMMITTEES AND THE FULL BOARD. THE FORM 900 WAS SUBSEQUENTLY SUBMITTED AND PRESENTED TO THE FULL BOARD AT THE FOLLOWING BOARD MEETING FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C ICHS REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICIES. ICHS HAS TWO CONFLICT OF INTEREST POLICIES. THE FIRST POLICY IS AN OVERARCHING POLICY FOR THE ENTIRE AGENCY, WHICH WORKS TO ENSURE EFFECTIVE MANAGEMENT OF CONFLICTS OF INTEREST AT ICHS. THE SECOND POLICY IS SET TO ENSURE ALL BOARD-RELATED ACTIVITIES ARE CONDUCTED IN A WAY THAT ENSURES COMPLIANCE WITH APPLICABLE LAWS, PRESERVES THE PUBLIC'S TRUST, ENSURES GOOD STEWARDSHIP OF ICHS RESOURCES, AND UPHOLDS HIGH STANDARDS OF CONDUCT AND PERSONAL INTEGRITY AMONG ALL BOARD DIRECTORS AND BOARD ASSOCIATES. THE CONFLICT OF INTEREST POLICY REQUIRES ALL EMPLOYEES AND NON-EMPLOYEE REPRESENTATIVES TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MAY COMPROMISE THEIR JUDGMENT OR IF PERSONAL INTERESTS ARE IN SUBSTANTIAL CONFLICT WITH THE BEST INTERESTS OF ICHS. SIMILARLY, INDIVIDUALS ARE EXPECTED TO REMOVE THEMSELVES FROM A POSITION OF DECISION-MAKING AUTHORITY OR SIGNIFICANT INFLUENCE WITH RESPECT TO ANY CONFLICT SITUATION THAT ARISES. A SITUATION IS CONSIDERED A CONFLICT OF INTEREST IF AN INTEREST OR ACTIVITY INFLUENCES OR APPEARS TO INFLUENCE THE ABILITY OF AN INDIVIDUAL TO EXERCISE OBJECTIVITY OR IMPAIRS THE INDIVIDUAL'S ABILITY TO PERFORM HIS OR HER EMPLOYMENT OR REPRESENTATIVE WORK RESPONSIBILITIES IN THE BEST INTEREST OF ICHS. ANY UNETHICAL ABUSE OF EMPLOYEES OR NON-EMPLOYEE REPRESENTATIVES CAN RESULT IN DISCIPLINARY ACTION (INCLUDING TERMINATION OF EMPLOYMENT). THE CONFLICT OF INTEREST FOR BOARD DIRECTORS AND BOARD ASSOCIATES REQUIRES BOARD DIRECTORS AND ASSOCIATES TO DISCLOSE ANY REAL OR APPARENT CONFLICT OF INTEREST TO THE BOARD AND EXCUSE HIMSELF OR HERSELF FROM VOTING, AS APPROPRIATE. ADDITIONALLY, NO BOARD MEMBER CAN ALSO BE AN EMPLOYEE OR RELATED TO AN EMPLOYEE OF ICHS. IF A CONFLICT OF INTEREST IS PERCEIVED TO EXIST BUT IS NOT DISCLOSED, THE BOARD MAY VOTE WHETHER THERE IS A REAL CONFLICT OF INTEREST. IF THE VOTE IS AFFIRMATIVE, THE BOARD MEMBER IN QUESTION IS NOT ENTITLED TO VOTE ON THAT ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS PERFORM AN ANNUAL PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER (CEO) WITH A THIRD PARTY CONSULTANT. THE EXECUTIVE COMMITTEE OF THE BOARD (CHAIRS OF ALL THE COMMITTEES) MEETS WITH THE CEO TO NEGOTIATE COMPENSATION THAT IS CONSISTENT WITH MARKET PAY. THIS PROCESS IS UNDERTAKEN ANNUALLY. THE CHIEF FINANCIAL OFFICER AND OTHER KEY EMPLOYEES COMPENSATION IS DETERMINED BY PERFOMANCE EVALUATIONS AND A COMPENSATION STUDY WHICH IS UNDERTAKEN EVERY TWO YEARS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION 720 8TH AVE S SEATTLE WA 98104 260493856 FUNDRAISING WA 501(C)(3) LINE 11A, I INTERNATIONAL COMMUNITY HEALTH SERVICES 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 ICHS FOUNDATION C 5274658 ICHS FOUNDATION L 5274658 ICHS FOUNDATION O 217383