2015-08-13T13:21:41-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2014-01-01 910947084 INTERNATIONAL COMMUNITY HEALTH SERVICES INTE 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 2067883618 2015-06-11 1 KYLA J DELGADO P01874220 4252506100 2014 2016-03-07 17:11:31Z TERESITA BATAYOLA 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 27328198 0 X WWW.ICHS.COM X 1973 WA PROVIDE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES 16 16 416 26 0 0 5483445 5264053 18233715 21709649 29887 38870 317407 297889 24064454 27310461 0 0 0 0 15296893 18771481 0 0 253089 6662787 8569236 21959680 27340717 2104774 -30256 47870443 49538613 18021058 19719485 29849385 29819128 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. 0 0 9641843 0 11066772 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 2014, ICHS PROVIDED 54,133 PRIMARY HEALTH CARE VISITS TO PATIENTS AND $337,318 OF CHARITY CARE. 5205425 0 6198470 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 2014, ICHS PROVIDED 30,644 DENTAL CARE VISITS TO PATIENTS AND $441,294 OF CHARITY CARE. 6967347 0 4444407 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 2014, ICHS PROVIDED 6,264 HEALTH CARE VISITS TO PATIENTS AND $156,370 OF CHARITY CARE. 21814615 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 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 44 0 1 416 1 0 0 0 0 0 0 0 0 0 0 X 16 16 1 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 SUITE 100 SEATTLE WA 98104 GILDAS CHEUNG PRESIDENT 3.00 0.00 X X 0 0 0 HIROSHI NAKANO SECRETARY 2.00 2.00 X X 0 0 0 JOHN FOZ 1ST VICE PRESIDENT 2.00 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 RICHARD MELLON TREASURER 1.50 0.00 X 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 CATHERINE JOHNSON 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 ARMILITO PANGILINAN DIRECTOR 1.50 0.00 X 0 0 0 ARIGIN SAKDA DIRECTOR 1.50 2.00 X 0 0 0 NHAN THAI DIRECTOR 1.50 0.00 X 0 0 0 JENNIFER VONG DIRECTOR 1.50 0.00 X 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 47.00 3.00 X 218186 0 6531 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 38.00 2.00 X 149622 0 11435 GRACE WANG CHIEF MEDICAL OFFICER 50.00 0.00 X 223297 0 13101 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 237369 0 12868 AI-KHUE NGUYEN ASSISTANT MEDICAL DIRECTOR 36.00 0.00 X 194345 0 11640 ALAN CHUN ASSISTANT MEDICAL DIRECTOR 34.00 0.00 X 179668 0 11775 UYENVY PHAM ASSISTANT MEDICAL DIRECTOR 40.00 0.00 X 187860 0 11822 JI CHOI DENTAL DIRECTOR 40.00 0.00 X 214761 0 12109 GRANDY AU DDS/PROVIDER 40.00 0.00 X 182060 0 11183 HARVEY WU DDS/PROVIDER 40.00 0.00 X 182502 0 11282 TIMOTHY LAM DDS/PROVIDER 40.00 0.00 X 160695 0 10977 CHRISTOPHER YEE MD/PROVIDER 39.00 0.00 X 208194 0 12209 NANCY SNAPP MD/PROVIDER 32.00 0.00 X 152059 0 11051 2490618 0 147983 13 0 1 0 LEASE CRUTCHER LEWIS WA LLC 107 SPRING ST SEATTLE WA 98104 CONSTRUCTION 14484029 MILLER HAYASHI ARCHITECTS LLC 118 N 35TH ST 200 SEATTLE WA 98103 ARCHITECTURE 430486 QUALITY SYSTEMS INC PO BOX 511449 LOS ANGELES CA 90051 NEXTGEN 423572 SEMAPHORE CORPORATION 9675 SE 36ST ST SUITE 110 MERCER ISLAND WA 98040 NETWORK ENGINEERING 192190 SEATTLE CHINATOWN INTERNATIONAL DISTRICT 409 MAYNARD AVE S 200 SEATTLE WA 98104 SHORELINE CONST. DEVELOPER FEES 185601 5 1256591 2939333 1068129 536280 5264053 PATIENT SERVICE FEES 624100 19202652 19202652 POOL SAVINGS REVENUE 900099 2490846 2490846 OTHER MEDICAL REVENUE 900099 16151 16151 21709649 15186 15186 22800 17737 5063 5063 5063 23684 0 23684 23684 23684 MANAGEMENT FEES 900099 262869 262869 MISCELLANEOUS REVENUE 900099 29957 29957 292826 27310461 21709649 0 336759 1696391 967874 728517 13661031 11157045 2294121 209865 400372 326503 67590 6279 1786159 1432901 333122 20136 1227528 969414 241305 16809 75018 13817 61201 67466 67466 1394010 1099606 294404 36711 26546 10165 278507 213051 65456 132635 104927 27708 1177245 1000143 177102 82871 49786 33085 44173 18028 26145 174558 162028 12530 1249441 899253 350188 92531 62669 29862 MEDICAL SUPPLIES 2347360 2302539 44821 PATIENT EXPENSE 702797 702678 119 EQUIPMENT 326772 180751 146021 LICENSE AND TAXES 141041 83074 57967 246100 41982 204118 27340717 21814615 5273013 253089 24844892 9064175 540827 154924 800730 484778 1652958 2143063 87530 154797 619383 694175 42525130 6762089 18402170 35763041 921953 1079660 47870443 49538613 3162322 4523406 623083 663619 10126031 9918424 2766504 3003345 1343118 1610691 18021058 19719485 X 28939712 29069179 909673 749949 29849385 29819128 47870443 49538613 -30256 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 3550 0 0 3550 0 PART II-B, LINE 1: ATTENDED CHC/API LEGISLATIVE DAY 3528037 3528037 26342873 1287122 25055751 4918866 1712372 3206494 7735354 3762595 3972759 35763041 CONSTRUCTION PAYABLE 1610691 1610691 X 24817522 26654 17737 44391 24773131 2537330 2537330 27310461 27385109 26654 17737 44391 27340718 0 27340718 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. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT EVALUATED ICHS'S TAX POSITION AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE CONSOLIDATED FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. THE ORGANIZATION IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS PRIOR TO 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 17,737. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF EQUIPMENT 23,684. RENTAL INCOME 22,800. POOL SAVINGS REVENUE 2,490,846. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 17,737. X X X X X 0 0 0 1 0 0 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 199009 0 13636 0 5541 0 5834 0 697 0 224717 0 0 0 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 146737 0 500 0 2385 0 4799 0 6636 0 161057 0 0 0 GRACE WANG CHIEF MEDICAL OFFICER 213693 0 8600 0 1004 0 6465 0 6636 0 236398 0 0 0 KIMO HIRAYAMA ASSISTANT MEDICAL DIRECTOR 206624 0 12766 0 17979 0 6232 0 6636 0 250237 0 0 0 AI-KHUE NGUYEN ASSISTANT MEDICAL DIRECTOR 167016 0 9911 0 17418 0 5004 0 6636 0 205985 0 0 0 ALAN CHUN ASSISTANT MEDICAL DIRECTOR 169675 0 8989 0 1004 0 5139 0 6636 0 191443 0 0 0 UYENVY PHAM ASSISTANT MEDICAL DIRECTOR 172643 0 14213 0 1004 0 5186 0 6636 0 199682 0 0 0 JI CHOI DENTAL DIRECTOR 178208 0 18200 0 18353 0 5473 0 6636 0 226870 0 0 0 GRANDY AU DDS/PROVIDER 150190 0 15200 0 16670 0 4547 0 6636 0 193243 0 0 0 HARVEY WU DDS/PROVIDER 155000 0 15950 0 11552 0 4646 0 6636 0 193784 0 0 0 TIMOTHY LAM DDS/PROVIDER 144491 0 15200 0 1004 0 4341 0 6636 0 171672 0 0 0 CHRISTOPHER YEE MD/PROVIDER 183028 0 9739 0 15427 0 5573 0 6636 0 220403 0 0 0 NANCY SNAPP MD/PROVIDER 144150 0 6905 0 1004 0 4415 0 6636 0 163110 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 10160000 1316561 185641 131346 10160000 1316561 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 3 536280 COST X USB MICROPHONE 1 50 FMV 0 0 1 0 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 A, LINE 2 JOHN FOZ AND JOYCE KO FISHER - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF THE FORM 990 IS REVIEWED BY THE CFO AND DESIGNATED STAFF INCLUDING ACCOUNTING MANAGER. THE ORGANIZATION'S FINANCE DEPARTMENT THEN REVIEWS AND SUBMITS A DRAFT COPY OF THE FORM 990 TO THE THREE COMMITTEES OF THE BOARD OF DIRECTORS: HUMAN RESOURCE COMMITTEES, FINANCE AND AUDIT COMMITTEE, EXECUTIVE COMMITTEE. ONCE APPROVED BY THE COMMITTEES, THE FORM 990 IS 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. SCHEDULE O - ADDITIONAL INFORMATION INTERNATIONAL COMMUNITY HEALTH SERVICES COMPLETED CONSTRUCTION OF TWO NEW CLINICS IN THE WASHINGTON CITIES OF BELLEVUE AND SHORELINE TO PROVIDE ACCESS TO COMPREHENSIVE HEALTH CARE TO COMMUNITIES OUTSIDE OF SEATTLE. 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 1256591 ICHS FOUNDATION L 1256591 ICHS FOUNDATION O 262869