2014-11-17T13:22:19-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2013-01-01 237100868 COUNTRY DOCTOR COMMUNITY CLINIC COUN 2062991937 2101 EAST YESLER WAY NO 210 SEATTLE WA 981225900 LINDA MCVEIGH EXECUTIVE DIRECTOR 2062991937 2014-11-17 1 PAUL M BAILEY CPA P00292653 4252506100 2013 2015-11-30 17:44:51Z LINDA MCVEIGH 500 19TH AVENUE EAST SEATTLE WA 98112 13776299 0 X WWW.COUNTRYDOCTOR.ORG X 1971 WA TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HEALTH CARE REGARDLESS OF ABILITY TO PAY. 12 12 217 23 0 0 4856236 4785356 5991341 8239425 37684 -3063 301808 347968 11187069 13369686 0 0 0 0 8291100 8925952 0 0 135627 3362624 4657564 11653724 13583516 -466655 -213830 7923410 7386484 4265446 3962072 3657964 3424412 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 10480379 0 8209425 IN 2013 COUNTRY DOCTOR COMMUNITY CLINIC PROVIDED 48,065 MEDICAL VISITS. 90% OF THE PATIENTS SEEN IN 2013 HAD INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL (FPL). ALL UNINSURED PATIENTS (44% OF THE TOTAL PATIENTS SEEN) EARNING LESS THAN 200% OF FPL WERE SEEN ON A SLIDING SCALE DISCOUNT. 1261877 0 0 THE OTHER HEALTH SERVICES PROGRAMS PROVIDED 13,746 ANCILLARY HEALTH VISITS (EG NUTRITION, MENTAL HEALTH, WIC, ELIGIBILITY) TO LOW INCOME PATIENTS. 73816 0 30000 DENTAL CARE IS PROVIDED TO COUNTRY DOCTOR COMMUNITY CLINC (CDCC) PATIENTS THROUGH A CONTRACTUAL ARRANGEMENT WITH A COMMUNITY DENTAL PROVIDER. IN 2013, 204 DENTAL VISITS WERE PROVIDED TO LOW INCOME, UNINSURED PATIENTS. 11816072 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 25 0 217 1 0 0 0 0 0 1 1 0 0 0 0 X 12 12 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 PAMELA DUNN CHAIRPERSON 1.00 X X 0 0 0 JOAN KLEINBERG INTERIM CHAIRPERSON/SECRETARY 1.00 X X 0 0 0 PATRICK FERGUSON VICE CHAIRPERSON 1.00 X X 0 0 0 JERRET SALE TREASURER 1.00 X X 0 0 0 CHERYL ANDERSON DIRECTOR 1.00 X 0 0 0 MARY BYRD DIRECTOR 1.00 X 0 0 0 COLT DEWOLF DIRECTOR 1.00 X 0 0 0 MORGAN DUTTON DIRECTOR 1.00 X 0 0 0 ALLAN GUIDEN DIRECTOR 1.00 X 0 0 0 CHRISTINE JONES DIRECTOR 1.00 X 0 0 0 CARLA KROEZE DIRECTOR 1.00 X 0 0 0 LY SIENG NGO DIRECTOR 1.00 X 0 0 0 AUGUST PIPER DIRECTOR 1.00 X 0 0 0 CHRISTOPHER SALAZAR DIRECTOR 1.00 X 0 0 0 WINNIE SPERRY DIRECTOR 1.00 X 0 0 0 SARA THOMPSON DIRECTOR 1.00 X 0 0 0 RIK WYMAN DIRECTOR 1.00 X 0 0 0 LINDA MCVEIGH EXECUTIVE DIRECTOR 35.00 X 149017 0 7845 SUSANA TANTICO DIRECTOR OF FINANCE 35.00 X 97716 0 3289 RICHARD KOVAR MEDICAL DIRECTOR 35.00 X 145155 0 22439 HAROLD MOORE PHYSICIAN / CLINICAL DIRECTOR 35.00 X 138497 0 23000 JUSTIN PAT IT COORDINATOR 35.00 X 109106 0 5965 SARAH HUFBAUER PHYSICIAN 35.00 X 105198 0 23173 JEFFERY WARNER MD PHYSICIAN 35.00 X 103416 0 0 848105 0 85711 6 0 1 0 PTSO OF WASHINGTON 3101 FOURTH AVE SUITE 320 SEATTLE WA 98101 INFO TECH SUPPORT 231280 1 144708 4102535 538113 288189 4785356 THIRD PARTY PAYMENTS 900099 2547322 2547322 PATIENT FEES 621400 2294936 2294936 PHARMACY 900099 1977864 1977864 MEDICARE/MEDICAID PAYMENTS 900099 1419303 1419303 8239425 20725 20725 93134 0 93134 93134 93134 325000 348788 -23788 -23788 -23788 0 144708 57825 -57825 -57825 RISK POOL REVENUE 900099 242168 242168 OTHER REVENUE 900099 70491 70491 312659 13369686 8239425 0 344905 257867 257867 6932803 6535419 312483 84901 291359 247655 40790 2914 837136 738112 90929 8095 606787 515769 84950 6068 26845 26845 83201 83201 968635 934821 33661 153 277232 212147 45993 19092 418603 272587 137384 8632 41248 28174 11952 1122 425641 387846 34679 3116 102834 35629 67205 PHARMACEUTICALS 1585846 1297657 288189 BAD DEBT 383442 383442 MISCELLANEOUS 193391 76168 115689 1534 OTHER HEALTHCARE SUPPLI 150646 150646 13583516 11816072 1631817 135627 284735 65562 931563 861784 597017 731585 923118 1142643 9279 469121 428623 9297302 5422170 4167307 3875132 550549 271876 7923410 7386484 1205977 1269378 2772336 2692694 287133 0 4265446 3962072 X 3574909 3341357 83055 83055 3657964 3424412 7923410 7386484 -213830 -19722 0 X 0 1 X 1 1 1 X 4928394 5556179 4792780 4856236 4785356 24918945 4928394 5556179 4792780 4856236 4785356 24918945 24918945 95365 84668 57372 96147 113859 447411 3841 81853 525451 220307 312659 1144111 26510467 30528834 0.94000 0.97240 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE RISK POOL REVENUE 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 3544440 3236134 182047 171698 10349 2150681 1706032 444649 3875132 X 13123501 7504 57825 65329 13058172 311514 311514 13369686 13648845 7504 57825 65329 13583516 0 13583516 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 HAS RECEIVED A DETERMINATION LETTER FROM THE IRS THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS BECAUSE CDCHC IS A NONPROFIT ORGANIZATION, EXEMPT FROM INCOME TAXES. MANAGEMENT EVALUATED CDCHC'S TAX POSITIONS AND CONCLUDED THAT CDCHC 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. CDCHC IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 57,825. PART XI, LINE 4B - OTHER ADJUSTMENTS: REALIZED LOSS ON INVESTMENTS -23,788. RISK POOL REVENUE 242,168. RENTAL INCOME 93,134. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 57,825. FUNDRAISING DINNER 144708 144708 39837 17988 144708 144708 39837 17988 57825 -57825 X X X 0 0 0 0 0 1 0 0 0 LINDA MCVEIGH EXECUTIVE DIRECTOR 149017 0 0 0 0 0 0 0 7845 0 156862 0 0 0 RICHARD KOVAR MEDICAL DIRECTOR 145155 0 0 0 0 0 0 0 22439 0 167594 0 0 0 HAROLD MOORE PHYSICIAN / CLINICAL DIRECTOR 138497 0 0 0 0 0 0 0 23000 0 161497 0 0 0 PART I, LINE 6 ALL EMPLOYEES RECEIVE A SMALL END OF YEAR BONUS BASED ON THE ORGANIZATION'S PERFORMANCE, INCLUDING FINANCIAL PERFORMANCE. X 12 288189 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 HERSELFT 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 2013. 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 2013. 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.