2015-02-25T20:30:45-06:00 2014-05-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2013-06-01 911349657 COMMUNITY HEALTH CARE COMM 2535974550 1019 PACIFIC AVENUE NO 300 TACOMA WA 98402 DAVID FLENTGE CEO 2537221502 2015-02-23 1 DANIEL M FREIN CPA P00856532 4252506100 2013 2016-02-25 16:41:14Z DAVID FLENTGE 1019 PACIFIC AVENUE NO 300 TACOMA WA 98402 33835877 0 X WWW.COMMHEALTH.ORG X 1987 WA TO PROVIDE THE HIGHEST QUALITY HEALTH CARE WITH COMPASSIONATE AND ACCESSIBLE SERVICE FOR ALL. 14 14 394 25 0 0 14867928 7267521 22467821 25556468 90758 212177 301367 755245 37727874 33791411 0 0 0 0 20931711 25002534 0 71931 934881 8351232 10797977 29282943 35872442 8444931 -2081031 52241806 47464197 16436950 15270700 35804856 32193497 X COMMUNITY HEALTH CARE PROVIDES COMPREHENSIVE PRIMARY MEDICAL AND DENTAL CARE THROUGH A CLINIC SYSTEM THAT INCLUDES SIX MEDICAL AND THREE DENTAL CLINICS. IN ADDITION, CARE IS ALSO PROVIDED THROUGH A WOMEN'S HEALTH CLINIC. 0 0 18209671 0 13673183 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. IN 2014, CHC LAUNCHED A FAMILY PHYSICIAN RESIDENCY PROGRAM THAT ACCEPTS 6 RESIDENTS EACH YEAR FOR A TOTAL OF 18 RESIDENTS DURING A 3 YEAR PROGRAM AND CONTINUES TO SUPPORT A FAMILY ADVANCED REGISTERED NURSE PRACTIONER RESIDENCY PROGRAM THAT BEGAN IN 2012. DURING THE FISCAL YEAR ENDED 5/31/14, CHC PROVIDED 33,214 PATIENTS WITH MEDICAL CARE FROM 96,888 PATIENT VISITS AT 7 MEDICAL CLINICS. 6190407 0 5519182 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 5/31/14, CHC PROVIDED 41,294 DENTAL VISITS TO 6,927 PATIENTS AT 3 DENTAL CLINICS. 3535190 0 5417518 FOUR PHARMACIES OFFER PHARMACEUTICAL SERVICES TO PATIENTS IN VARIOUS LOCATIONS IN PIERCE COUNTY ACCORDING TO THE SAME FEE STRUCTURE NOTED ABOVE. THE PHARMACY SERVED 14,646 PATIENTS THROUGH 104,145 MEDICATION FILLS. 439357 0 946585 OTHER PROGRAMS INCLUDE VISION, NUTRITIONAL AND MATERNITY SUPPORT SERVICES WHICH OFFER PRENATAL CARE, DELIVERY AND CONTINUED POSTNATAL CARE WHICH CONTINUE THROUGH A BABY'S 1ST YEAR. 439357 0 946585 28374625 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 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 42 0 394 1 0 0 0 0 0 1 1 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 WA X TONIA CAMPBELL 2535691510 1019 PACIFIC AVENUE STE 300 TACOMA WA 98402 SHIMAMOTO KYLE CO-CHAIR 2.00 2.00 X X 0 0 0 SWANBERG DOUG CO-CHAIR 2.00 2.00 X X 0 0 0 BARBANO LYSA VICE CHAIR 2.00 0.00 X X 0 0 0 DEMPSEY PEG TREASURER 2.00 2.00 X X 0 0 0 MAGANA MARTHA SECRETARY 2.00 0.00 X X 0 0 0 BABULA RAY BOARD MEMBER 2.00 0.00 X 0 0 0 BOWE RICHARD BOARD MEMBER 2.00 0.00 X 0 0 0 BOWMAN LINDA BOARD MEMBER 2.00 0.00 X 0 0 0 DASCH ANN BOARD MEMBER 2.00 0.00 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 HOGAN NAN 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 SETO PETER BOARD MEMBER 2.00 0.00 X 0 0 0 SLOAN DAN 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 158817 0 42041 LEE PODOLL INTERIM CEO 40.00 0.00 X 0 0 0 TONIA CAMPBELL CFO 40.00 2.00 X 29769 0 4659 SMITH JEFFREY MEDICAL DIRECTOR 40.00 0.00 X 286519 0 56011 HIGGINBOTHAM BRUCE MD FP W/O OB 40.00 0.00 X 189320 0 44350 KIM ALBERT MD FP W/O OB 41.90 0.00 X 231976 0 64380 NEIGHBOR RALPH MD OBGYN 37.50 0.00 X 254857 0 54278 RIQUELME JEAN MD FP W/O OB 40.00 0.00 X 202749 0 25360 SAMUELS CHUCK DENTIST 43.20 0.00 X 185529 0 32038 1539536 0 323117 23 0 1 0 SEMAPHORE CORPORATION 9675 SE 36TH STREET SUITE 110 MERCER ISLAND WA 98040 NETWORK ENGINEERING 230813 DR TAREK BAGHDADI OBGYN 1802 SOUTH YAKIMA 300 TACOMA WA 98405 AFTER-HOURS INFANT DELIVERIES 193085 OPENWORKS 4742 N 24TH STREET SUITE 450 PHOENIX AZ 85016 JANITORIAL SERVICES 188939 COMMUNITY LINK CONSULTING INC PO BOX 276 NEWMAN LAKE WA 99025 FISCAL CONSULTING SERVICES 168824 VISTA STAFFING SOLUTIONS FILE 50834 LOS ANGELES CA 90074 TEMP MEDICAL STAFFING 161844 8 30200 6096063 1141258 642191 7267521 PATIENT FEES 621400 20827345 20827345 PHARMACY REVENUE 621300 4729123 4729123 25556468 212177 212177 75884 30200 44466 31418 31418 MEANINGFUL USE REVENUE 711300 357000 357000 MANAGED CARE POOLED SAVINGS 900099 341763 341763 MISCELLANEOUS REVENUE 900099 25064 25064 723827 33791411 25556468 0 967422 439903 439903 19037053 15935293 2987694 114066 636230 511926 122099 2205 4889348 3934081 938319 16948 145161 17278 122153 5730 76230 9074 64147 3009 71931 71931 1744911 1451825 232556 60530 294923 50727 236928 7268 908300 541577 340746 25977 575383 452425 122785 173 771627 407986 361276 2365 246562 135358 107015 4189 418327 114028 173990 130309 1256330 665905 102951 487474 134150 86060 48090 MEDICAL AND DENTAL SUPP 2967148 2965027 2121 BAD DEBT 614373 614373 REPAIRS AND MAINTENANCE 214269 192544 21723 2 ASSOCIATION DUES 201448 156510 44802 136 228835 132628 93638 2569 35872442 28374625 6562936 934881 8690610 2190164 1328047 3011221 3192816 993749 16710910 2260552 28574 105443 121360 194798 193224 502035 30453867 11712090 19921631 18741777 192215 179778 1785550 19361549 52241806 47464197 7437488 7505422 40381 47847 1330000 1260000 7629081 6457431 16436950 15270700 X 35804856 32193497 35804856 32193497 52241806 47464197 -2081031 -1530328 0 X 0 1 X 1 1 1 X 6331802 4257171 5639201 14867928 7267521 38363623 6331802 4257171 5639201 14867928 7267521 38363623 38363623 -229272 27717 47426 90758 212177 148806 -12239 24041 902814 319676 723827 1958119 40470548 117915733 0.94790 0.96400 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE MANAGED CARE POOLED SAVINGS MEANINGFUL USE REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 3526 3526 0 PART II-B, LINE 1: CEO SPENT APPROXIMATELY TEN HOURS LOBBYING. 3642530 3642530 14599140 3785542 10813598 2308465 1156983 1151482 9842661 6769565 3073096 61071 61071 18741777 BOND RESERVE FUND 185000 RECEIVABLE FROM HILLTOP CHC INVESTMENT FUND, LLC 19176549 19361549 X 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). THE ORGANIZATION IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2011. X X X X X X X 1 RICHARD OLDENBURG 6825 RAINIER AVE GIG HARBOR WA 98335 MAJOR & PLANNED GIFT CONSULTING 0 661839 71931 589908 661839 71931 589908 WA ANNUAL LUNCHEON 106084 30200 75884 6150 13720 6000 18596 106084 30200 75884 6150 13720 6000 18596 44466 31418 X X X X X 0 0 0 0 0 0 0 0 0 DAVID FLENTGE CEO 158817 0 0 0 0 0 10000 0 32041 0 200858 0 0 0 SMITH JEFFREY MEDICAL DIRECTOR 264111 0 22408 0 0 0 12000 0 44011 0 342530 0 0 0 HIGGINBOTHAM BRUCE MD FP W/O OB 189320 0 0 0 0 0 0 0 44350 0 233670 0 0 0 KIM ALBERT MD FP W/O OB 218912 0 13064 0 0 0 15651 0 48729 0 296356 0 0 0 NEIGHBOR RALPH MD OBGYN 234691 0 20166 0 0 0 23000 0 31278 0 309135 0 0 0 RIQUELME JEAN MD FP W/O OB 201732 0 1017 0 0 0 0 0 25360 0 228109 0 0 0 SAMUELS CHUCK DENTIST 166902 0 18627 0 0 0 23000 0 9038 0 217567 0 0 0 A WA HEALTH CARE FACILITIES AUTHORITY 911108929 93978EUWO 2003-01-23 3320000 TO FUND BUILDING 0 0 1 A 2060000 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 JEFF SMITH CURRENT HIGHEST COMPENSATED EMPLOYEE STAFF PHYSICIAN AGREEMENT X 30000 11620 0 0 1 ALBERT KIM CURRENT HIGHEST COMPENSATED EMPLOYEE STAFF PHYSICIAN AGREEMENT X 30000 16954 0 0 1 28574 X 48 607198 CDC PRICING X EQUIPMENT MAI 14 19315 INVOICE X DENTAL EQUIPM 1 12722 COST X ANNUAL LUNCH 6 2956 COST 0 0 1 0 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 3 LEE PODOLL, AN EMPLOYEE OF COMMUNITY LINK CONSULTING, WAS ENGAGED AS TEMPORARY CFO THROUGH SEPTEMBER 2013. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING. THE BOARD IS GIVEN THE OPPORTUNITY TO FORWARD QUESTIONS AND OR CONCERNS TO THE FINANCE COMMITTEE SO THEY CAN 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 2014. 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 2014. 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 154001 FMV BASED ON LOW-COST FINANCING