PTSO OF WASHINGTON: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PTSO OF WASHINGTON (EIN 20-1082052)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2014-01-13
- IRS object ID
- 201400139349303215
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-01-13T17:45:05-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910189318 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 A STREET SUITE 600 | AddressLine1 |
| City | TACOMA | City |
| State | WA | State |
| ZIP Code | 984024205 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201082052 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PTSO OF WASHINGTON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PTSO | NameControl |
| Phone | 2064542811 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 FOURTH AVENUE NO 320 | AddressLine1 |
| City | SEATTLE | City |
| State | WA | State |
| ZIP Code | 98121 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROY O LA CROIX | Name |
| Title | CEO | Title |
| Phone | 2064542811 | Phone |
| Date Signed | 2014-01-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NANCY J SCHAUER | Name |
| PTIN | P01326437 | PTIN |
| Phone | 2535724100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | X | AmendedReturn |
| Name Of Principal Officer Person | ROY O LA CROIX | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 FOURTH AVENUE 320 | AddressLine1 |
| City | SEATTLE | City |
| State | WA | State |
| ZIP Code | 98121 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4822284 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PTSOWA.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2004 | YearFormation |
| State Legal Domicile | WA | StateLegalDomicile |
| Activity Or Mission Description | SEE FORM 990 PART III, QUESTION 1. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 7 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 770491 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 718722 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2736901 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 4103452 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 179 | InvestmentIncomePriorYear |
| Investment Income Current Year | 110 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3507571 | TotalRevenuePriorYear |
| Total Revenue Current Year | 4822284 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2961142 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 3036107 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 169355 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 169919 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 36169 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 629809 | OtherExpensePriorYear |
| Other Expenses Current Year | 1492231 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3760306 | TotalExpensesPriorYear |
| Total Expenses Current Year | 4698257 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -252735 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 124027 | RevenuesLessExpensesCY |
| Total Assets BOY | 3805944 | TotalAssetsBOY |
| Total Assets EOY | 3322081 | TotalAssetsEOY |
| Total Liabilities BOY | 1243300 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 635410 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2562644 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2686671 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4032508 | Expense |
| Grants | 3036106 | Grants |
| Revenue | 4103452 | Revenue |
| Description | STANDARDIZED TRAINING OF NEXTGEN BEST PRACTICES, DATA CENTER TECHNOLOGY MOVE AND EQUIPMENT REFRESH, NEXTGEN 5.6 SP1 AND 5.7 UPGRADES FOR MEANINGFUL USE. 2011 UDS REPORTING, ICD 9 UPDATES AND ICD 10 DISCOVERY AND PREPARATION. ANALYSIS AND ADOPTION OF MEANINGFUL USE MEASURES. HRSA (ARRA) CONTRIBUTION OF GRANT TO FUND INTEGRATED HEALTHCARE HOME PROJECT, CONSISTING OF THREE INTERRELATED PHASES, CDS - CUSTOMIZED CLINICAL DECISION SUPPORT WITH SUPPORTIVE REPORTING CAPABILITIES, EDR -ELECTRONIC DENTAL RECORD AND PORTAL - AN ON LINE PATIENT PORTAL. WIREC (ARRA) HEALTH INFORMATION TECHNOLOGY REGIONAL EXTENSION CENTER PROGRAM FOR WASHINGTON AND IDAHO. PASSED THROUGH QUALIS HEALTH. WORKED ON MILESTONE 3 OF AGREEMENT WITH QUALIS TO MEET STAGE 1 MEANINGFUL USE REQUIREMENTS - ALL 15 CORE OBJECTIVES PLUS 5 CHOSEN OBJECTIVES FOR A TOTAL OF 20 MEANINGFUL USE OBJECTIVES. | Description |
| Total Program Service Expense | 4032508 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 1 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 15 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicy |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRACE E GRIFFIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2064542818 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 FOURTH AVENUE 320 | AddressLine1 |
| City | SEATTLE | City |
| State | WA | State |
| ZIP Code | 98121 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (9 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| TOM TROMPETER | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| LINDA MCVEIGH | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| MIKE HASSING | ||||||
| SECRETARY/ TREASURER | 1.00 | X | 0 | 0 | 0 | |
| ANITA MONOIAN | ||||||
| CHAIRPERSON | 1.00 | X | 0 | 0 | 0 | |
| KATIE BELL | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| LARRY MCCULLEY | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| KIM MITROKA | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| BRUCE JOHNSON | ||||||
| EX OFFICIO - NON-VOTING MEMBER | 1.00 | X | 0 | 0 | 0 | |
| ROY O LA CROIX | ||||||
| CEO | 40.00 | 0 | 169919 | 22216 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 169919 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 22216 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Government Grants | 718722 | GovernmentGrants |
| Total Contributions | 718722 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | SERVICE FEE REVENUE | Description |
| Business Code | 812900 | BusinessCode |
| Total Revenue Column | 4103452 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4103452 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 4103452 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 110 | TotalRevenueColumn |
| Exclusion | $110 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4822284 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4103452 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $110 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3036107 | Total |
| Program Services | 3036107 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169919 | Total |
| Program Services | 153650 | ProgramServices |
| Fundraising | 16269 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65913 | Total |
| Program Services | 50473 | ProgramServices |
| Management And General | 15440 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26613 | Total |
| Management And General | 26613 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30646 | Total |
| Management And General | 30646 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 362044 | Total |
| Program Services | 305070 | ProgramServices |
| Management And General | 37074 | ManagementAndGeneral |
| Fundraising | 19900 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 159470 | Total |
| Management And General | 159470 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 238666 | Total |
| Program Services | 238666 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101065 | Total |
| Program Services | 101065 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43438 | Total |
| Program Services | 11897 | ProgramServices |
| Management And General | 31541 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 715130 | Total |
| Program Services | 715130 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19840 | Total |
| Management And General | 19840 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| CONTRACT SALARIES | 1875109 | 1622779 | 252330 |
| MAINTENANCE - SOFTWARE/ | 833778 | 833778 | |
| TAXES | 56626 | 56626 | |
| GRANTS TO SUPPORTING OR | -3036107 | -3036107 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4698257 | Total |
| Program Services | 4032508 | ProgramServices |
| Management And General | 629580 | ManagementAndGeneral |
| Fundraising | 36169 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1587517 | BOY |
| EOY | 661100 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 357664 | BOY |
| EOY | 147315 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76650 | BOY |
| EOY | 532254 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 164390 | BOY |
| EOY | 159548 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 6897275 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5108774 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1555949 | BOY |
| EOY | 1788501 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63774 | BOY |
| EOY | 33363 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3805944 | BOY |
| EOY | 3322081 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 148493 | BOY |
| EOY | 103328 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2305 | BOY |
| EOY | 19312 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1092502 | BOY |
| EOY | 512770 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1243300 | BOY |
| EOY | 635410 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2562644 | BOY |
| EOY | 2686671 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2562644 | BOY |
| EOY | 2686671 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3805944 | BOY |
| EOY | 3322081 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 124027 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (5 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | AmountAmount |
|---|---|---|---|
| COUNTRY DOCTOR COMMUNITY HEALTH CENTERS | |||
| 237100868 | 7 | 1 | $304,729 |
| FAMILY HEALTH CENTERS | |||
| 911275011 | 7 | 1 | $290,082 |
| CHC OF KING COUNTY DBA HEALTHPOINT | |||
| 910884412 | 7 | 1 | $1,053,442 |
| YAKIMA NEIGHBORHOOD HEALTH SERVICES | |||
| 910928817 | 7 | 1 | $487,879 |
| NEIGHBORCARE HEALTH | |||
| 910893287 | 7 | 1 | $899,975 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 5 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 3036107 | SumOfAmounts |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6897275 | OtherCostOrOtherBasis |
| Depreciation | 5108774 | Depreciation |
| Book Value | 1788501 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1788501 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO CHNW | $176,145 |
| MEMBER DEPOSITS | $336,163 |
| ACCRUED PAYABLES | $462 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 512770 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 4822284 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 4822284 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 4822284 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 4698257 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 4698257 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 4698257 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| 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 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, 2012 AND 2011. THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION 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 2009. | Explanation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|
| COUNTRY DOCTOR CHC | ||||||||
| 500 19TH AVE EAST | SEATTLE | WA | 98112 | 237100868 | 501 C (3) | 304729 | 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) | 290082 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| CHC OF KING COUNTY DBA HEALTHPOINT | ||||||||
| 955 POWELL AVE SE SUITE A | RENTON | WA | 98057 | 910884412 | 501 C (3) | 1053442 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| YAKIMA NEIGHBORHOOD HEALTH SERVICES | ||||||||
| PO BOX 2605 | YAKIMA | WA | 98907 | 910928817 | 501 C (3) | 487879 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| NEIGHBORCARE HEALTH | ||||||||
| 905 SPRUCE STREET SUITE 300 | SEATTLE | WA | 98104 | 910893287 | 501 C (3) | 899975 | VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. | SUPPORTIVE ASSISTANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 5 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ROY O LA CROIX | NamePerson |
| Title | CEO | Title |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 150296 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 14461 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 5162 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 9885 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 12331 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 192135 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | DURING 2012, COMMUNITY HEALTH NETWORK OF WASHINGTON, A SUPPORTED ORGANIZATION, PAID SALARY OF ROY LACROIX, CEO OF PTSO OF WASHINGTON. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| AMENDED RETURN | FORM 990 | THE ORGANIZATION IS AMENDING ITS 2012 FORM 990 TO REFLECT THE FOLLOWING CHANGES: FORM 990, PART VI, SECTION A, LINE 4 - CHANGE TO "YES" WITH EXPLANATION ON SCHEDULE O. FORM 990, PART VII, SECTION A, COLUMN B - CHANGE TO HOURS FOR BRUCE JOHNSON FROM 40 TO 1. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE ORGANIZATION AMENDED ITS BYLAWS TO REFLECT A CHANGE IN THE NUMBER OF THE BOARD MEMBERS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE DRAFT COPY OF THE PTSO TAX FORM 990 WILL BE SENT TO THE FINANCE COMMITTEE FOR REVIEW. AFTER REVIEW BY THE FINANCE COMMITTEE, THE PTSO TAX FORM 990 WILL GO TO THE PTSO BOARD FOR REVIEW. | |
| FORM 990, PART VI, SECTION B, LINE 12 | PTSO OF WASHINGTON DOES NOT HAVE A WRITTEN CONFLICT OF INTEREST POLICY, BUT ITS SUPPORTED ORGANIZATIONS HAVE THOSE POLICIES. | |
| FORM 990, PART VI, SECTION B, LINE 15A | THE CEO IS COMPENSATED BY A RELATED ORGANIZATION. THIS RELATED ORGANIZATION USES THE FOLLOWING METHODS TO DETERMINE THE CEO'S COMPENSATION: APPROVAL BY THE BOARD, COMPENSATION STUDY/SURVEY, AND 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. | |
| THE PTSO FINANCE COMMITTE MAINTAINS OVERSIGHT OF THE PTSO FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Controlled OrgControlledOrg | Public Charity StatusPublicCharityStatus |
|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HEALTH PLAN OF WASHINGTON | |||||||||
| 720 OLIVE WAY STE 300 | SEATTLE | WA | 98101 | 911729710 | PROVIDE HEALTH CARE SERVICES INSURANCE COVERAGE TO WASHINGTON STATE PROGRAMS | WA | 501 C (4) | 0 | |
| COMMUNITY HEALTH NETWORK OF WASHINGTON | |||||||||
| 720 OLIVE WAY STE 300 | SEATTLE | WA | 98101 | 911577184 | PROMOTION OF ACCESSIBLE, AFFORDABLE AND QUALITY HEALTHCARE FOR WASHINGTON. | WA | 501 C (4) | 0 | |
| COUNTRY DOCTOR CHC | |||||||||
| 500 19TH AVE EAST | SEATTLE | WA | 98112 | 237100868 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501 C (3) | 0 | 170(B)(1)(A)(VI) |
| FAMILY HEALTH CENTERS IN OKANOGAN | |||||||||
| PO BOX 1340 | OKANOGAN | WA | 98840 | 911275011 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501 C (3) | 0 | 170(B)(1)(A)(VI) |
| CHC OF KING COUNTY DBA HEALTHPOINT | |||||||||
| 955 POWELL AVE SW SUITE A | RENTON | WA | 98057 | 910884412 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501 C (3) | 0 | 170(B)(1)(A)(III) |
| YAKIMA NEIGHBORHOOD HEALTH SERVICES | |||||||||
| PO BOX 2605 | YAKIMA | WA | 98907 | 910928817 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501 C (3) | 0 | 170(B)(1)(A)(VI) |
| NEIGHBORCARE HEALTH | |||||||||
| 905 SPRUCCE STREET SUITE 300 | SEATTLE | WA | 98104 | 910893287 | FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER | WA | 501 C (3) | 0 | 170(B)(1)(A)(III) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| COMMUNITY HEALTH NETWORK OF WASHINGTON | ||
| I | 56477 | FMV |
| COMMUNITY HEALTH NETWORK OF WASHINGTON | ||
| R | 7440 | FMV |
| COMMUNITY HEALTH NETWORK OF WASHINGTON | ||
| O | 2011024 | FMV |
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