2015-11-13T19:43:02-06:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2014-01-01 237100868 COUNTRY DOCTOR COMMUNITY CLINIC COUN 2062991937 2101 EAST YESLER WAY NO 210 SEATTLE WA 981225900 LINDA MCVEIGH EXECUTIVE DIRECTOR 2062991937 2015-11-11 1 KYLA DELGADO P01874220 4252506100 2014 2016-04-25 22:37:26Z LINDA MCVEIGH 500 19TH AVENUE EAST SEATTLE WA 98112 19247357 0 X WWW.COUNTRYDOCTOR.ORG X 1971 WA TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HEALTH CARE REGARDLESS OF ABILITY TO PAY. 17 17 206 19 0 0 4785356 5043959 8239425 12303517 -3063 630 347968 1037105 13369686 18385211 0 0 0 0 8925952 10211218 0 0 127908 4657564 7151068 13583516 17362286 -213830 1022925 7386484 7846869 3962072 3392561 3424412 4454308 THE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. 0 0 14356769 0 12303517 IN 2014, COUNTRY DOCTOR COMMUNITY CLINIC PROVIDED 58,459 MEDICAL VISITS. 79% OF THE PATIENTS SEEN IN 2014 HAD INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL (FPL). ALL UNINSURED PATIENTS (28% OF THE TOTAL PATIENTS SEEN) EARNING LESS THAN 200% OF FPL WERE SEEN ON A SLIDING SCALE DISCOUNT. 1369458 0 0 THE OTHER HEALTH SERVICES PROGRAMS PROVIDED 18,827 ANCILLARY HEALTH VISITS (EG NUTRITION, WIC, ELIGIBILITY) TO LOW-INCOME PATIENTS. 74395 0 0 DENTAL CARE IS PROVIDED TO COUNTRY DOCTOR COMMUNITY CLINIC (CDCC) PATIENTS THROUGH A CONTRACTUAL ARRANGEMENT WITH A COMMUNITY DENTAL PROVIDER. 15800622 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 32 0 206 1 0 0 0 0 0 1 1 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 WA X SUSANA TANTICO 2062991937 2101 EAST YESLER WAY SUITE 210 SEATTLE WA 98122 JERRY SALE CHAIR 1.00 X X 0 0 0 RIK WYMAN VICE-PRESIDENT VICE CHAIR 1.00 X X 0 0 0 JOAN KLEINBERG SECRETARY 1.00 X X 0 0 0 MORGAN DUTTON TREASURER 1.00 X X 0 0 0 GRANT SCULL DIRECTOR 1.00 X 0 0 0 WINNIE SPERRY DIRECTOR 1.00 X 0 0 0 CHRISTINE JONES DIRECTOR 1.00 X 0 0 0 COLT DE WOLF DIRECTOR 1.00 X 0 0 0 RAYMOND ANGEL DIRECTOR 1.00 X 0 0 0 CHERYL ANDERSON DIRECTOR 1.00 X 0 0 0 MARY BYRD DIRECTOR 1.00 X 0 0 0 LY SIENG NGO DIRECTOR 1.00 X 0 0 0 CHRIS SALAZAR DIRECTOR 1.00 X 0 0 0 LINDA MCVEIGH EXECUTIVE DIRECTOR 35.00 X 163665 0 16452 SUSANA TANTICO DIRECTOR OF FINANCE 40.00 X 104514 0 20896 RICHARD KOVAR MEDICAL DIRECTOR 35.00 X 175888 0 22678 SARAH HUFBAUER PHYSICIAN, CLINICL SITE DIRECTOR 35.00 X 154980 0 9278 JUSTIN PAT IT COORDINATOR 35.00 X 126947 0 19960 KATHRYN MAYER PHYSICIAN 35.00 X 116344 0 13564 CARRIE RUBENSTEIN PHYSICIAN / RESIDENCY DIRECTOR 35.00 X 118209 0 3236 960547 0 106064 13 0 1 0 PTSO OF WASHINGTON 3101 4TH AVENUE SUITE 320 SEATTLE WA 98101 I.T. SUPPORT 369783 SEATTLE CHILDREN'S 4800 SAND POINT WAY NE SEATTLE WA 98105 BUILDING MAINTENANCE 168301 2 150588 4640590 252781 256782 5043959 PATIENT SERVICES 621400 7478950 7478950 PHARMACY 621400 4824567 4824567 12303517 10126 10126 98209 0 98209 98209 98209 779275 788771 -9496 -9496 -9496 22950 150588 73375 -50425 -50425 GAIN ON DEBT FORGIVENESS 900099 755749 755749 OTHER REVENUE 900099 201523 201523 RISK POOL REVENUE 900099 32049 32049 989321 18385211 12303517 0 1037735 305527 305527 7978119 7587964 312628 77527 10711 9104 1500 107 1916513 1793057 112582 10874 348 296 49 3 10711 10711 100960 100960 1488711 1391211 95469 2031 376730 288489 66913 21328 453398 318613 125785 9000 46206 36938 7672 1596 412490 379111 30187 3192 105294 33327 71967 PHARMACEUTICALS 3308094 3308094 BAD DEBT 373659 373659 MISCELLANEOUS 328814 134758 191806 2250 OTHER HEALTHCARE SUPPLI 146001 146001 17362286 15800622 1433756 127908 65562 201911 861784 941304 731585 872479 1142643 1585247 9279 8937 428623 594648 9449137 5806794 3875132 3642343 271876 0 7386484 7846869 1269378 1527144 2692694 1865417 3962072 3392561 X 3341357 4371253 83055 83055 3424412 4454308 7386484 7846869 1022925 6971 0 X 0 1 X 1 1 1 X 5556179 4792780 4856236 4785356 5043959 25034510 5556179 4792780 4856236 4785356 5043959 25034510 25034510 84668 57372 96147 113859 108335 460381 81853 525451 220307 312659 1012271 2152541 27647432 37543735 0.90550 0.94000 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE RISK POOL REVENUE DEBT FORGIVENESS SPECIAL FUNDRAISING EVENTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 83055 83055 83055 83055 83055 83055 83055 83055 83055 83055 0.00000 1.00000 0.00000 0 0 184000 184000 6780574 3804845 2975729 182047 171993 10054 2302516 1829956 472560 3642343 X 17605437 23362 82871 106233 17499204 886007 886007 18385211 17459023 23362 73375 96737 17362286 0 17362286 PART V, LINE 4: THE ENDOWMENT FUNDS ARE ASSETS SET ASIDE AND RESTRICTED BY DONORS. THE INCOME GENERATED FROM THESE ASSETS IS USED TO FUND OPERATIONS OF THE ORGANIZATION. PART X, LINE 2: CDCHC'S ACTIVITIES ARE GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; HOWEVER, UNRELATED BUSINESS ACTIVITIES WOULD BE SUBJECT TO INCOME TAX. SINCE CDCHC IS EXEMPT FROM FEDERAL INCOME TAX LIABILITY, NO PROVISION IS MADE FOR CURRENT OR DEFERRED INCOME TAX EXPENSE. FOR THE YEARS DECEMBER 31, 2014 AND 2013, MANAGEMENT EVALUATED CDCHC'S TAX POSITIONS AND CONCLUDED THAT CDCHC HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS. ALL TAX-EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE AND OTHER APPLICABLE STATE STATUTES. WITH FEW EXCEPTIONS, CDCHC IS NO LONGER SUBJECT TO FEDERAL INCOME TAX EXAMINATIONS FOR YEARS BEFORE 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 73,375. REALIZED LOSS ON INVESTMENTS 9,496. PART XI, LINE 4B - OTHER ADJUSTMENTS: RISK POOL REVENUE 32,049. RENTAL INCOME 98,209. GAIN ON DEBT FORGIVENESS 755,749. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 73,375. FUNDRAISING DINNER 173538 150588 22950 40799 14440 3647 14489 173538 150588 22950 40799 14440 3647 14489 73375 -50425 X X X 0 0 0 0 0 0 0 0 0 LINDA MCVEIGH EXECUTIVE DIRECTOR 163565 0 100 0 0 0 0 0 16452 0 180117 0 0 0 RICHARD KOVAR MEDICAL DIRECTOR 175788 0 100 0 0 0 0 0 22678 0 198566 0 0 0 SARAH HUFBAUER PHYSICIAN, CLINICL SITE DIRECTOR 154880 0 100 0 0 0 0 0 9278 0 164258 0 0 0 X 12 256782 COST OR SELLING PRICE 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD CHAIR AND AT LEAST THREE OTHER BOARD MEMBERS. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY AS EXPRESSLY DELEGATED TO IT BY RESOLUTION OF THE BOARD IN THE GOVERNANCE OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE BOTH REVIEW A DRAFT OF THE RETURN BEFORE IT IS PRESENTED TO THE FINANCE COMMITTEE FOR FURTHER REVIEW. AFTER REVIEW BY THE FINANCE COMMITTEE AND DISTRIBUTION TO THE FULL BOARD THE FORM 990 IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE AND NON-COMPLIANCE WERE REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED DURING THE MONTHLY MEETINGS. BOARD MEMBERS SIGN A CONFLICT OF INTEREST FORM ANNUALLY. ANY MEMBER WITH A STATED CONFLICT OF INTEREST IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD CHAIRPERSON DETERMINES THE EXTENT OF THE CONFLICT AND WHETHER THE CONFLICTED BOARD MEMBER SHOULD NOT VOTE ON AN ISSUE OR SHOULD RECUSE HIM OR HERSELF FROM THE DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. EVERY TWO YEARS THIS PROCESS IS ASSISTED BY AN INDEPENDENT COMPENSATION CONSULTANT AS WELL AS A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE LAST REVIEW PROCESS OF THE EXECUTIVE DIRECTOR'S COMPENSATION WAS DONE IN 2014. THE DIRECTOR OF FINANCE'S COMPENSATION IS REVIEWED BY THE EXECUTIVE DIRECTOR BASED ON A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE BOARD THEN REVIEWS IT ALONG WITH ALL OTHER EMPLOYEES AS A GROUP. THE REVIEW OF THE DIRECTOR OF FINANCE'S COMPENSATION WAS DONE IN 2014. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.