PTSO OF WASHINGTON: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- PTSO OF WASHINGTON (EIN 20-1082052)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-11
- IRS object ID
- 201533159349301628
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-11T09:57:48-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 A STREET SUITE 600 | AddressLine1Txt |
| City | TACOMA | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 984024205 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201082052 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PTSO OF WASHINGTON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PTSO | BusinessNameControlTxt |
| Phone | 2064542811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 FOURTH AVENUE NO 850 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98121 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR JULIE COLIN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2064542811 | PhoneNum |
| Signature | 2015-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NANCY SCHAUER | PreparerPersonNm |
| PTIN | P01326437 | PTIN |
| Phone | 2535724100 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DR JULIE COLIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 FOURTH AVENUE 850 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98121 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,841,084 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PTSOWA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | SEE FORM 990 PART III, QUESTION 1. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 38 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $529,102 | PYContributionsGrantsAmt |
| CY Contributions Grants | $667,942 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,102,555 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,173,142 | CYProgramServiceRevenueAmt |
| PY Investment Income | $12 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $6,631,669 | PYTotalRevenueAmt |
| CY Total Revenue | $6,841,084 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,439,667 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,718,615 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $435,828 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,551,950 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,500 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,839,608 | PYOtherExpensesAmt |
| CY Other Expenses | -$242,589 | CYOtherExpensesAmt |
| PY Total Expenses | $6,715,103 | PYTotalExpensesAmt |
| CY Total Expenses | $7,027,976 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$83,434 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$186,892 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,491,134 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,218,043 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $887,897 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $801,697 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,603,237 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,416,346 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PTSO OF WASHINGTON IS ESTABLISHED TO IMPROVE ACCESS AND THE LEVEL AND QUALITY OF HEALTHCARE FOR THE MEDICALLY UNDERSERVED THROUGH THE IMPROVEMENTS OF INFORMATION TECHNOLOGY SERVICES AVAILABLE TO COMMUNITY HEALTH CENTERS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,954,329 | ExpenseAmt |
| Grant | $3,718,615 | GrantAmt |
| Revenue | $6,173,142 | RevenueAmt |
| Desc | CUSTOMIZED AND UPGRADED NEXTGEN EHR, EPM AND EDR APPLICATIONS TO MEET THE UNIQUE NEEDS OF OUR FQHC CUSTOMERS AND HELP THEM REALIZE AIU FUNDS. PREPARED FOR MEANINGFUL USE (MU STAGE1)THROUGH MULTIPLE SYSTEM UPGRADES AND COMMENCED WORK ON MU STAGE 2 AND ICD10 UPGRADES. CONTINUED FORUMS FOR BEST PRACTICES AND LESSONS LEARNED.HRSA HEALTH CENTER CONTROLLED NETWORKS - HCCN GRANT - PTSO, E NET,HCHN NETWORKS PROVIDING BEST PRACTICES, OPTIMIZATION AND TRAINING AROUND PATIENT CENTERED MEDICAL HOME, MEANINGFUL USE AND EHR IMPLEMENTATION AND ADOPTION. | Desc |
| Total Program Service Expenses | $5,954,329 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 18 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 38 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRACE E GRIFFIN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2064542818 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 FOURTH AVENUE 850 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98121 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TOM TROMPETER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LINDA MCVEIGH | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MIKE HASSING | ||||||||
| SECRETARY/ TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ANITA MONOIAN | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KATIE BELL | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LARRY MCCULLEY | ||||||||
| BOARD MEMBER (DD:02/14) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KIM MITROKA | ||||||||
| BOARD MEMBER (DD:02/14) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BRUCE JOHNSON | ||||||||
| EX OFFICIO-NON-VOTING (DD:02/14) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ROY O LA CROIX | ||||||||
| CEO | 40.00 | $214,881 | $0 | $28,447 | Yes (X) | |||
| DR JULIE COLIN | ||||||||
| CHIEF MEDICAL INFORMATION | 40.00 | $257,613 | $0 | $15,571 | Yes (X) | |||
| SHELLEY YOUNGS | ||||||||
| DIRECTOR OF CLIENT SERVICE | 40.00 | $144,050 | $0 | $16,022 | Yes (X) | |||
| ERIC GRENDELL | ||||||||
| CHIEF TECHNOLOGY OFFICER | 40.00 | $100,556 | $0 | $6,379 | Yes (X) | |||
| ROGER HEAD | ||||||||
| TECHNOLOGY MANAGER | 40.00 | $101,753 | $0 | $21,337 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $818,853 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $87,756 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $667,942 | GovernmentGrantsAmt |
| Total Contributions | $667,942 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SERVICE FEE REVENUE | Desc |
| Business | 518210 | BusinessCd |
| Total Revenue Column | $6,173,142 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,173,142 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,173,142 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,841,084 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,173,142 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,718,615 | TotalAmt |
| Program Services | $3,718,615 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $472,495 | TotalAmt |
| Program Services | $365,054 | ProgramServicesAmt |
| Management And General | $107,441 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,338,926 | TotalAmt |
| Program Services | $2,121,511 | ProgramServicesAmt |
| Management And General | $217,415 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $527,514 | TotalAmt |
| Program Services | $472,612 | ProgramServicesAmt |
| Management And General | $54,902 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $213,015 | TotalAmt |
| Program Services | $190,845 | ProgramServicesAmt |
| Management And General | $22,170 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,488 | TotalAmt |
| Management And General | $7,488 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,831 | TotalAmt |
| Management And General | $50,831 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,823 | TotalAmt |
| Management And General | $111,823 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $351,097 | TotalAmt |
| Program Services | $248,677 | ProgramServicesAmt |
| Management And General | $99,920 | ManagementAndGeneralAmt |
| Fundraising | $2,500 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,500 | TotalAmt |
| Management And General | $2,500 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,136 | TotalAmt |
| Program Services | $474 | ProgramServicesAmt |
| Management And General | $50,662 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $898,958 | TotalAmt |
| Program Services | $898,958 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,162 | TotalAmt |
| Management And General | $141,162 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,096 | TotalAmt |
| Program Services | $39,741 | ProgramServicesAmt |
| Management And General | $85,355 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,385 | TotalAmt |
| Program Services | $42,144 | ProgramServicesAmt |
| Management And General | $28,241 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $705,591 | TotalAmt |
| Program Services | $705,591 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,502 | TotalAmt |
| Management And General | $25,502 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MAINTENANCE - SOFTWARE/ | $868,722 | $868,722 | |
| TAXES | $65,735 | $65,735 | |
| GRANTS TO SUPPORTING OR | -$3,718,615 | -$3,718,615 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,027,976 | TotalAmt |
| Program Services | $5,954,329 | ProgramServicesAmt |
| Management And General | $1,071,147 | ManagementAndGeneralAmt |
| Fundraising | $2,500 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,417,111 | BOYAmt |
| EOY | $1,125,122 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,102 | BOYAmt |
| EOY | $42,106 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $688,379 | BOYAmt |
| EOY | $1,066,446 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $201,249 | BOYAmt |
| EOY | $257,216 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,301,752 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,576,912 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,117,898 | BOYAmt |
| EOY | $724,840 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,395 | BOYAmt |
| EOY | $2,313 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,491,134 | BOYAmt |
| EOY | $3,218,043 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $230,187 | BOYAmt |
| EOY | $106,738 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,667 | BOYAmt |
| EOY | $31,301 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $637,043 | BOYAmt |
| EOY | $663,658 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $887,897 | BOYAmt |
| EOY | $801,697 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,603,237 | BOYAmt |
| EOY | $2,416,346 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,603,237 | BOYAmt |
| EOY | $2,416,346 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,491,134 | BOYAmt |
| EOY | $3,218,043 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$186,892 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| Supported Organizations | 5 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (5 entries)
| EINEIN | Organization TypeOrganizationTypeDesc | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| COUNTRY DOCTOR COMMUNITY CLINIC | ||||
| 237100868 | 7 | Yes (1) | $319,160 | $0 |
| FAMILY HEALTH CENTERS IN OKANOGAN | ||||
| 911275011 | 7 | Yes (1) | $284,908 | $0 |
| HEALTHPOINT | ||||
| 910884412 | 9 | Yes (1) | $1,321,243 | $0 |
| YAKIMA NEIGHBORHOOD HEALTH SERVICES | ||||
| 910928817 | 9 | Yes (1) | $711,742 | $0 |
| NEIGHBORCARE HEALTH | ||||
| 910893287 | 7 | Yes (1) | $1,081,562 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 5 | SupportedOrganizationsTotalCnt |
| Support Sum | $3,718,615 | SupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (1) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | Yes (1) | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | Yes (1) | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Test | Yes (X) | ActivitiesTestInd |
| Activities Further Exempt Prps | Yes (1) | ActivitiesFurtherExemptPrpsInd |
| Activities Engaged Org Invlmnt | Yes (1) | ActivitiesEngagedOrgInvlmntInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, SECTION A, LINE 1 | SUPPORTING ORGANIZATIONS ARE NOTIFIED AT BOARD MEETINGS AS THEY REVIEW THE 990 AND UPDATE GOVERNING DOCUMENTS. |
| PART IV, SECTION D, LINE 3 | THE MANAGEMENT OF ALL AFFAIRS OF THE PTSO ARE VESTED IN THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS COMPRISED OF BOARD MEMBERS ELECTED BY THE SUPPORTED ORGANIZATIONS. |
| PART IV, SECTION E, LINE 2A | PTSO IS ORGANIZED TO IMPROVE ACCESS AND THE LEVEL AND QUALITY OF HEALTH CARE FOR THE MEDICALLY UNDERSERVED THROUGH THE IMPROVEMENT OF INFORMATION TECHNOLOGY SERVICES AVAILABLE TO COMMUNITY HEALTH CENTERS. CURRENTLY PTSO HAS 5 MEMBERS. SEE SCHEDULE I FOR DETAILS ON GRANT RECIPIENTS AND INTENDED USE OF GRANTS. |
| PART IV, SECTION E, LINE 2B | PTSO IS ORGANIZED TO SECURE AND MANAGE INFORMATION SYSTEMS WHICH ARE A NECESSARY AND INTEGRAL PART OF THE DELIVERY OF HEALTH CARE. WITHOUT PTSO'S INVOLVEMENT, EACH MEMBER WOULD BE RESPONSIBLE WITH THE PURCHASE, MAINTENANCE AND IMPLEMENTATION OF THEIR OWN INFORMATION SYSTEMS. |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,301,752 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,576,912 | DepreciationAmt |
| Book Value | $724,840 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $724,840 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO CHNW | $624 |
| MEMBER DEPOSITS | $396,187 |
| WAGES PAYABLE | $266,847 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $663,658 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $6,841,084 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $6,841,084 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $6,841,084 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $7,027,975 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $7,027,975 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $7,027,975 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C) (3) OF THE INTERNAL REVENUE CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE ORGANIZATION DID NOT ENGAGE IN AN ACTIVITY UNRELATED TO ITS TAX EXEMPT PURPOSE; ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ACCORDANCE WITH REQUIREMENTS RELATED TO ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES, THE ORGANIZATION HAS DETERMINED THEY HAVE NO UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2014 AND 2013. THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A)(VIII) AND HAS BEEN FURTHER CLASSIFIED AS A SUPPORTING ORGANIZATION UNDER SECTION 509(A)(3). THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2011. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Non Cash AssistanceNonCashAssistanceAmt | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| HEALTHPOINT | ||||||||
| 955 POWELL AVE SE SUITE A | RENTON | WA | 98057 | 910884412 | 501 C (3) | $1,321,243 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| NEIGHBORCARE HEALTH | ||||||||
| 905 SPRUCE STREET SUITE 300 | SEATTLE | WA | 98104 | 910893287 | 501 C (3) | $1,081,562 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| YAKIMA NEIGHBORHOOD HEALTH SERVICES | ||||||||
| PO BOX 2605 | YAKIMA | WA | 98907 | 910928817 | 501 C (3) | $711,742 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| COUNTRY DOCTOR COMMUNITY CLINIC | ||||||||
| 500 19TH AVE EAST | SEATTLE | WA | 98112 | 237100868 | 501 C (3) | $319,160 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| FAMILY HEALTH CENTERS IN OKANOGAN | ||||||||
| PO BOX 1340 | OKANOGAN | WA | 98840 | 911275011 | 501 C (3) | $284,908 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE I | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATIONS RECEIVING ASSISTANCE ARE CLASS A MEMBERS AS IDENTIFIED IN PTSO'S GOVERNING DOCUMENTS. AS A SUPPORTING ORGANIZATION, PTSO MONITORS ITS SUPPORT TO ITS SUPPORTED ORGANIZATIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROY O LA CROIX | ||||||||||||||
| CEO | $190,151 | $0 | $24,720 | $0 | $10 | $0 | $12,892 | $0 | $15,555 | $0 | $243,328 | $0 | $0 | $0 |
| DR JULIE COLIN | ||||||||||||||
| CHIEF MEDICAL INFORMATION | $247,432 | $0 | $10,171 | $0 | $10 | $0 | $14,859 | $0 | $712 | $0 | $273,184 | $0 | $0 | $0 |
| SHELLEY YOUNGS | ||||||||||||||
| DIRECTOR OF CLIENT SERVICE | $138,500 | $0 | $5,540 | $0 | $10 | $0 | $8,643 | $0 | $7,379 | $0 | $160,072 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART 1, LINE 15: | MANAGEMENT FEES - THE ORGANIZATION HAD A MANAGEMENT SERVICE AGREEMENT WITH THE COMMUNITY HEALTH NETWORK OF WASHINGTON (CHNW) THAT AUTOMATICALLY RENEWED EACH CALENDAR YEAR UNLESS WRITTEN NOTICE WAS DELIVERED BY EITHER PARTY AT LEAST 90 DAYS PRIOR TO YEAR-END. BASED ON THE ORIGINAL AGREEMENT, ALL OF THE EMPLOYEES AND RELATED PAYROLL COSTS, INCLUDING 401 (K) COSTS, ARE PROVIDED TO THE ORGANIZATION BY CHNW, AND THE ORGANIZATION RECEIVES OFFICE SPACE, PURCHASING, ACCOUNTING, AND MANAGEMENT SERVICES. SUBSEQUENT AMENDMENTS TO THE AGREEMENT IN 2013 MODIFIED THE CONTRACT TO EXCLUDE OFFICE SPACE, EMPLOYEES, AND PAYROLL COSTS, INCLUDING 401 (K) COSTS AND SERVICES, WHICH WERE NO LONGER PAID FOR AND PROVIDED BY CHNW. EFFECTIVE MARCH 1, 2015, THE ORGANIZATION TERMINATED THE MASTER SERVICE AGREEMENT WITH CHNW. |
| FORM 990, PART VI, SECTION A, LINE 2 | PTSO'S BOARD CONSISTS OF REPRESENTATIVES OF ITS MEMBERS. AS SUCH BOARD MEMBERS MAY HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS WERE AMENDED DURING 2014 TO CLARIFY THE ROLE OF CLASS A AND CLASS B MEMBERS IN THE APPOINTMENT OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERSHIP OF PTSO CONSISTS OF TWO CLASSES OF MEMBERS. CLASS A MEMBERS ARE COMMUNITY HEALTH CENTERS AND CURRENTLY CONSIST OF THE SUPPORTED ORGANIZATIONS REPORTED ON SCHEDULE A. |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH CLASS A MEMBER MAY APPOINT ONE OF ITS SENIOR EXECUTIVE OR MANAGEMENT STAFF TO SERVE AS A DIRECTOR. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AND THEN PROVIDED TO THE FULL BOARD PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND/OR MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. ALL AFFECTED PERSONS SHALL COMPLETE THE ANNUAL AFFIRMATION AND DISCLOSURE STATEMENT ON AN ANNUAL BASIS AND SUBMIT SUCH COMPLETED ANNUAL DISCLOSURE STATEMENTS TO THE SECRETARY OF THE BOARD OF DIRECTORS. THE SECRETARY SHALL BE RESPONSIBLE FOR FILING ALL COPIES OF THE ANNUAL AFFIRMATION AND DISCLOSURE STATEMENTS WITH THE OFFICIAL CORPORATE RECORDS OF THE ORGANIZATION AND SHALL BRING ANY POTENTIAL CONFLICTS OF INTEREST DISCLOSED IN THE ANNUAL AFFIRMATION AND DISCLOSURE STATEMENTS TO THE ATTENTION OF THE BOARD OF DIRECTORS AT THE NEXT MEETING OF THE BOARD DIRECTORS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE INTERESTED PERSON SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD OF DIRECTORS REVIEWS AND DETERMINES CEO COMPENSATION USING COMPARABILITY DATA AND AN INDEPENDENT COMPENSATION CONSULTANT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND GOVERNING/ORGANIZING DOCUMENTS ARE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| COUNTRY DOCTOR COMMUNITY CLINIC | |||||||||
| 500 19TH AVE EAST | SEATTLE | WA | 98112 | 237100868 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501(C)3 | 7 | 0 |
| FAMILY HEALTH CENTERS IN OKANOGAN | |||||||||
| PO BOX 1340 | OKANOGAN | WA | 98840 | 911275011 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501(C)3 | 7 | 0 |
| HEALTHPOINT | |||||||||
| 955 POWELL AVE SW SUITE A | RENTON | WA | 98057 | 910884412 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501(C)3 | 9 | 0 |
| YAKIMA NEIGHBORHOOD HEALTH SERVICES | |||||||||
| PO BOX 2605 | YAKIMA | WA | 98907 | 910928817 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501(C)3 | 9 | 0 |
| NEIGHBORCARE HEALTH | |||||||||
| 905 SPRUCE STREET SUITE 300 | SEATTLE | WA | 98104 | 910893287 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501(C)3 | 7 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
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