2015-12-10T19:54:29-06:00 2015-05-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2014-06-01 911349657 COMMUNITY HEALTH CARE COMM 2535974550 1019 PACIFIC AVENUE NO 300 TACOMA WA 98402 DAVID FLENTGE CEO 2537221502 2015-10-12 1 KYLA DELGADO CPA P01874220 4252506100 2014 2016-04-25 22:37:26Z DAVID FLENTGE 1019 PACIFIC AVENUE NO 300 TACOMA WA 98402 42651899 0 X WWW.COMMHEALTH.ORG X 1987 WA TO PROVIDE THE HIGHEST QUALITY HEALTH CARE WITH COMPASSIONATE AND ACCESSIBLE SERVICE FOR ALL. 18 18 453 47 0 0 7267521 4976893 25556468 37400576 212177 210169 755245 26166 33791411 42613804 0 0 0 0 25002534 27096105 71931 42488 125895 10797977 12075482 35872442 39214075 -2081031 3399729 47464197 47231438 15270700 11638212 32193497 35593226 X COMMUNITY HEALTH CARE PROVIDES COMPREHENSIVE PRIMARY MEDICAL AND DENTAL CARE THROUGH A CLINIC SYSTEM THAT INCLUDES SEVEN MEDICAL AND THREE DENTAL CLINICS. IN ADDITION, CARE IS ALSO PROVIDED THROUGH A WOMEN'S HEALTH CLINIC. 0 0 18318758 0 18041644 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. CHC CONTINUES TO SUPPORT TWO RESIDENCY PROGRAMS: 1. A FAMILY PHYSICIAN RESIDENCY PROGRAM THAT ACCEPTS 6 RESIDENTS EACH YEAR FOR A TOTAL OF 18 RESIDENTS DURING A 3 YEAR PROGRAM; AND 2. A FAMILY ADVANCED REGISTERED NURSE PRACTIONER RESIDENCY PROGRAM. DURING THE FISCAL YEAR ENDED 5/31/15, CHC PROVIDED 29,081 PATIENTS WITH MEDICAL CARE FROM 113,486 PATIENT VISITS AT 7 MEDICAL CLINICS. 7868418 0 7829570 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 5/31/15, CHC PROVIDED 54,649 DENTAL VISITS TO 19,456 PATIENTS AT 3 DENTAL CLINICS. 5381340 0 10210147 FIVE PHARMACIES OFFER PHARMACEUTICAL SERVICES TO PATIENTS IN VARIOUS LOCATIONS IN PIERCE COUNTY ACCORDING TO THE SAME FEE STRUCTURE NOTED ABOVE. THE PHARMACY SERVED 11,372 PATIENTS THROUGH 139,397 MEDICATION FILLS. 1106512 0 1319215 OTHER PROGRAMS INCLUDE VISION, NUTRITION AND MATERNITY SUPPORT SERVICES THAT OFFER PRENATAL CARE, DELIVERY AND CONTINUED POSTNATAL CARE THROUGH A BABY'S 1ST YEAR. 1106512 0 1319215 32675028 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 39 0 453 1 0 0 0 0 0 1 1 0 0 0 0 X 18 18 0 0 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 CHAIR 2.00 2.00 X X 0 0 0 BOWE RICHARD VICE CHAIR 2.00 0.00 X X 0 0 0 IZANT PHYLLIS TREASURER 2.00 0.00 X X 0 0 0 SLOAN DAN SECRETARY 2.00 0.00 X X 0 0 0 BARBANO LYSA BOARD MEMBER 2.00 0.00 X 0 0 0 BOWMAN LINDA BOARD MEMBER 2.00 0.00 X 0 0 0 BUCHANAN BRUCE BOARD MEMBER 2.00 0.00 X 0 0 0 CATHESAL LES BOARD MEMBER 2.00 0.00 X 0 0 0 DASCH ANN BOARD MEMBER 2.00 0.00 X 0 0 0 DEMPSEY PEG BOARD MEMBER 2.00 2.00 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 JOHNSON RIA BOARD MEMBER 2.00 0.00 X 0 0 0 MAGANA MARTHA BOARD MEMBER 2.00 0.00 X 0 0 0 SWANBERG DOUG BOARD MEMBER 2.00 2.00 X 0 0 0 VELEZ ANTHONY BOARD MEMBER 2.00 0.00 X 0 0 0 WALMER GARY 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 150000 0 32379 TONIA CAMPBELL CFO 40.00 2.00 X 125000 0 29775 JEFFREY SMITH MEDICAL DIRECTOR 40.00 0.00 X 279358 0 45929 ALBERT KIM MD FP W/OB 40.00 0.00 X 265865 0 74843 RALPH NEIGHBOR MD OBGYN 40.00 0.00 X 244440 0 57050 JOHNNY ERKINS MD OBGYN 40.00 0.00 X 241041 0 27516 GARY REICHARD MD/DO ASST RESIDENCY DIRECTOR 40.00 0.00 X 224905 0 51347 JEAN RIQUELME MD FP W/O OB 40.00 0.00 X 223253 0 27848 1753862 0 346687 47 0 1 0 OPENWORKS 4742 N 24TH ST STE 450 PHOENIX AZ 85016 JANITORIAL SERVICES 285508 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 222241 DR TAREK BAGHDADI 1802 S YAKIMA 300 TACOMA WA 98405 AFTER HOURS INFANT DELIVERIES 144917 NUWEST GROUP HOLDINGS LLC PO BOX 40285 BELLEVUE WA 98015 TEMP STAFFING SERVICES 140467 4 38800 4247816 690277 553903 4976893 PATIENT FEES 621400 28133593 28133593 PHARMACY REVENUE 621300 9266983 9266983 37400576 210169 210169 34208 0 34208 34208 34208 13350 38800 38095 -24745 -24745 MISCELLANEOUS REVENUE 900099 16703 16703 16703 42613804 37400576 0 236335 659299 659299 20756031 18038592 2671930 45509 713719 586887 123947 2885 3497619 2968175 514852 14592 1469437 1208310 255187 5940 43993 9340 34653 82725 17563 65162 42488 42488 1329527 969101 349460 10966 344324 148740 195534 50 799730 493821 304849 1060 646287 500792 145223 272 689910 445970 243903 37 260673 145316 113437 1920 341976 230507 111469 1168806 987527 181177 102 149424 93583 55841 MEDICAL AND DENTAL SUPP 4587312 4582032 5280 BAD DEBT 574445 574445 MISCELLANEOUS 550539 230605 319871 63 REPAIRS AND MAINTENANCE 233634 210841 22793 272177 232881 39285 11 39214075 32675028 6413152 125895 2190164 3582734 3011221 2135799 993749 452531 2260552 2936886 28574 14303 194798 170630 502035 685159 30592968 12864247 18741777 17728721 179778 163126 19361549 19361549 47464197 47231438 7505422 5127393 47847 67854 1260000 1190000 6457431 5252965 15270700 11638212 X 32193497 35593226 32193497 35593226 47464197 47231438 3399729 0 X 0 1 X 1 1 1 X 4257171 5639201 14867928 7267521 4976893 37008714 4257171 5639201 14867928 7267521 4976893 37008714 37008714 27717 47426 90758 212177 244377 622455 24041 29793 15447 25064 16703 111048 37742217 132261878 0.98060 0.94790 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 2488 0 0 2488 0 PART II-B, LINE 1: CEO AND CFO SPENT APPROXIMATELY THIRTY SIX HOURS LOBBYING. 3642530 3642530 14599140 4113793 10485347 2308465 1276866 1031599 9983600 7473588 2510012 59233 59233 17728721 BOND RESERVE FUND 185000 RECEIVABLE FROM HILLTOP CHC INVESTMENT FUND, LLC 19176549 19361549 X 41098187 57380 38095 95475 41002712 1611092 1611092 42613804 38504104 57380 38095 95475 38408629 805446 805446 39214075 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). PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 38,095. PART XI, LINE 4B - OTHER ADJUSTMENTS: MANAGED CARE POOLED SAVINGS 411,545. OTHER INCOME 244,377. CAPITAL CAMPAIGN CONTRIBUTIONS 149,724. BAD DEBT EXPENSE 574,445. MISCELLANEOUS EXPENSES 231,001. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 38,095. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 574,445. MISCELLANEOUS EXPENSES 231,001. X X X X X X X 1 RICHARD OLDENBURG 6825 RAINIER AVE GIG HARBOR WA 98335 MAJOR & PLANNED GIFT CONSULTING 0 259951 42488 217463 259951 42488 217463 WA ANNUAL LUNCHEON 52150 38800 13350 16312 2000 19783 52150 38800 13350 16312 2000 19783 38095 -24745 X X X X X 0 0 0 0 0 0 0 0 0 DAVID FLENTGE CEO 150000 0 0 0 0 0 7500 0 24879 0 182379 0 0 0 TONIA CAMPBELL CFO 125000 0 0 0 0 0 1154 0 28621 0 154775 0 0 0 JEFFREY SMITH MEDICAL DIRECTOR 252342 0 13815 0 13201 0 11174 0 34755 0 325287 0 0 0 ALBERT KIM MD FP W/OB 206574 0 31483 0 27808 0 12924 0 61919 0 340708 0 0 0 RALPH NEIGHBOR MD OBGYN 244440 0 0 0 0 0 12128 0 44922 0 301490 0 0 0 JOHNNY ERKINS MD OBGYN 238770 0 2271 0 0 0 367 0 27149 0 268557 0 0 0 GARY REICHARD MD/DO ASST RESIDENCY DIRECTOR 223972 0 933 0 0 0 2649 0 48698 0 276252 0 0 0 JEAN RIQUELME MD FP W/O OB 200091 0 3250 0 19912 0 8263 0 19585 0 251101 0 0 0 A WA HEALTH CARE FACILITIES AUTHORITY 911108929 93978EUWO 2003-01-23 3320000 TO FUND BUILDING 0 0 1 A 2130000 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 ALBERT KIM CURRENT HIGHEST COMPENSATED EMPLOYEE STAFF PHYSICIAN AGREEMENT X 30000 14303 0 0 1 14303 X 24 535902 CDC PRICING X EQUIP MAINTENANCE 10 15000 INVOICE X DENTAL EQUIPMENT 2 3000 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 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 231001 FMV BASED ON LOW-COST FINANCING