2014-12-08T17:36:12-06:00 2014-03-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2013-04-01 911537371 MOSES LAKE COMMUNITY HEALTH CENTER MOSE 5097650674 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 AMANDA DUZON CHIEF FINANCIAL OFFICER 5097650674 2014-12-02 1 KATHRYN J ONG P00746598 4254544919 2014-12-02 2013 2015-11-30 17:44:51Z SHEILA CHILSON 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 29500932 0 X WWW.MLCHC.ORG X 1991 WA TO PROVIDE HIGH QUALITY, COMPASSIONATE AND COMPREHENSIVE PRIMARY HEALTH SERVICES FOR THE ENTIRE FAMILY, WITH A SPECIAL FOCUS ON THE UNDERSERVED AND MIGRANT FARM-WORKERS IN THE COMMUNITY. 12 12 280 12 0 0 3891803 4307074 16153106 17428170 351053 256389 84360 2786 20480322 21994419 0 139518 0 0 14182515 14482208 0 0 0 5126689 5860787 19309204 20482513 1171118 1511906 27073486 26351986 6961393 4977848 20112093 21374138 TO PROVIDE HIGH QUALITY, COMPASSIONATE AND COMPREHENSIVE PRIMARY HEALTH SERVICES FOR THE ENTIRE FAMILY, WITH A SPECIAL FOCUS ON THE UNDERSERVED AND MIGRANT FARM-WORKERS IN THE COMMUNITY. 0 0 9649579 13358786 MEDICAL SERVICES - THIS PROGRAM INCLUDES MEDICAL, BEHAVIORAL HEALTH AND PHARMACY SERVICES PROVIDED TO PATIENTS OF THE HEALTH CENTER. MOSES LAKE COMMUNITY HEALTH CENTER (MLCHC) PROVIDES PRIMARY CARE SERVICES INCLUDING OBSTETRICS CARE WITH 9 PHYSICIANS AND 10 MID-LEVEL PHYSICIANS ON STAFF. IN 2013, 20,495 MEDICAL PATIENTS WERE SEEN WITH A TOTAL OF 72,313 VISITS. 2896990 3033758 DENTAL SERVICES - MLCHC HAS 7 DENTISTS AND 3 DENTAL HYGIENISTS ON STAFF TO PROVIDE PREVENTATIVE, RESTORATIVE AND EMERGENCY CARE TO THE HEALTH CENTER'S INSURED AND UNINSURED PATIENTS. IN 2013, 9,245 PATIENTS WERE SEEN IN THE DENTAL DEPARTMENT WITH A TOTAL OF 24,584 VISITS PROVIDED. 2066302 139518 1035626 OTHER HEALTH PROGRAMS - MLCHC PROVIDES MATERNITY SUPPORT SERVICES, WIC, INFANT TODDLER EARLY INTERVENTION AND DEVELOPMENTAL DISABILITY PARENT TRAINING PROGRAMS. THE MATERNITY SUPPORT SERVICES DEPARTMENT PROVIDED 6,802 VISITS TO APPROXIMATELY 1,350 PATIENTS. THE WIC PROGRAM SERVICES ELIGIBLE CLIENTS THROUGHOUT GRANT COUNTY IN MULTIPLE LOCATIONS. 14612871 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 35 0 1 280 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X AMANDA DUZON 5097650674 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 AMY RAYMOND VICE CHAIR 2.00 0.00 X X 0 0 0 SCOTT CAMPBELL BOARD CHAIR 2.00 1.00 X X 0 0 0 MATTHEW BENSON TREASURER 1.50 1.00 X X 0 0 0 JUAN CARLOS MAGALLANES-MORALES SECRETARY 1.00 0.00 X X 0 0 0 SHERRY DELGADO DIRECTOR 1.00 0.00 X 0 0 0 SHARON LANGE DIRECTOR 1.00 0.00 X 0 0 0 DANIEL JOSE CHAVEZ DIRECTOR 1.00 0.00 X 0 0 0 CAROL SCHIMKE DIRECTOR 1.00 0.00 X 0 0 0 JACINTO VALVERDE DIRECTOR 1.00 0.00 X 0 0 0 LYNN MACKEY DIRECTOR 1.00 0.00 X 0 0 0 AMALIA EMILY CAMPOS DIRECTOR 1.00 0.00 X 0 0 0 PEDRO DAVALOS DIRECTOR 1.00 0.00 X 0 0 0 ORALIA CERRILLO DIRECTOR 1.00 0.00 X 0 0 0 SHEILA A CHILSON CEO 40.00 1.00 X 159881 0 18312 SHIRLEY J MERKLE DEPUTY DIRECTOR 40.00 0.00 X 123310 0 7044 MICHAEL L HARRELL CFO (THRU 02/2014) 40.00 0.00 X 93233 0 8477 AMANDA DUZON CFO (FROM 03/2014) 40.00 0.00 X 65292 0 6582 LARRY W VERHAGE MEDICAL DIRECTOR 40.00 0.00 X 304513 0 24810 BRETT L PACK DENTAL DIRECTOR 40.00 0.00 X 208412 0 23230 COLE Q HEMMERLING PHYSICIAN 40.00 0.00 X 280046 0 24784 MICHAEL R TOLLEY PHYSICIAN 40.00 0.00 X 269969 0 24787 KRISTY M THOMPSON PHYSICIAN 40.00 0.00 X 158678 0 11786 JILL K SIMON PHYSICIAN 40.00 0.00 X 165573 0 17466 JAMIE M BOWERS PHARMACIST 40.00 0.00 X 154391 0 17480 1983298 0 184758 23 0 1 0 ALDRICH & ASSOCIATES 810 240TH STREET SE BOTHELL WA 980219397 GENERAL CONTRACTOR 853239 NUVODIA LLC 801 SOUTH STEVENS STREET SPOKANE WA 99204 INFORMATION TECHNOLOGY SERVICE 476502 INTERPATH PO BOX 1208 PENDLETON OR 97801 OUTSIDE LAB SERVICES 252809 LOOFBURROW WETCH ARCHITECTS PS 201 W YAKIMA AVENUE YAKIMA WA 989023405 ARCHITECTURAL SERVICES 242679 CLEANPROS PO BOX 305 MOSES LAKE WA 98837 JANITORIAL SERVICES 199690 6 4288102 18972 11900 4307074 PATIENT SERVICES 624100 11629322 11629322 MANAGED CARE 624100 5485868 5485868 CONTRACT SERVICES 624100 312980 312980 17428170 260631 260631 7502271 7435279 71234 66992 -71234 -4242 -4242 2786 2786 2786 21994419 17428170 0 259175 139518 139518 1055913 441348 614565 10770471 8711253 2059218 254301 197980 56321 1435257 1108031 327226 966266 719989 246277 43763 14758 29005 11458 6337 5121 51456 51456 47332 47332 137259 101907 35352 55683 3856 51827 230113 111179 118934 852169 154213 697956 224222 62079 162143 115060 66580 48480 59971 43419 16552 84935 84935 794064 137685 656379 89915 33592 56323 MED & PHARM SUPPLIES 1065132 1051886 13246 BAD DEBT EXPENSE 627506 627506 PURCHASED SERVICES 589567 438702 150865 REPAIRS AND MAINTENANCE 247173 38710 208463 534009 402343 131666 20482513 14612871 5869642 0 1151305 685025 2460738 740608 262680 242880 2392370 1244068 0 6315900 300876 381397 309150 311888 16121762 6894451 9917743 9227311 10175807 7173213 44817 29696 58000 0 27073486 26351986 3972506 4337756 1921639 0 1067248 640092 6961393 4977848 X 20018006 21374138 94087 0 20112093 21374138 27073486 26351986 1511906 -249861 0 X 0 1 X 1 1 1 X 4537962 4660479 3939664 3891803 4307074 21336982 4537962 4660479 3939664 3891803 4307074 21336982 21336982 211755 198349 227236 256737 260631 1154708 86478 4274 20610 2786 114148 193250 63750 257000 22862838 80794652 0.93330 0.93760 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: INCENTIVE PAYMENTS - 2011 AMOUNT: $ 193,250. 2012 AMOUNT: $ 63,750. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 222949 222949 7862635 2073714 5788921 2963028 1455956 1507072 4531568 3364781 1166787 541582 541582 9227311 21744558 -249861 -249861 21994419 0 21994419 20397935 -84578 -84578 20482513 0 20482513 PART XII, LINE 2D - OTHER ADJUSTMENTS: NET INCOME OF SUBSIDIARY -84,578. 1 MLCHC COMMUNITY SERVICES 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 463517778 501(C)(3) 0 139518 COST LAND CONSTRUCTION OF NEW QUINCY FACILITY. 1 0 PART I, LINE 2: MOSES LAKE COMMUNITY HEALTH CENTER MADE A ONE-TIME DONATION OF LAND TO MLCHC COMMUNITY SERVICES, A RELATED ORGANIZATION. THE ORGANIZATION DOES NOT MAKE OTHER GRANTS. X X X X 0 0 0 0 0 0 0 0 0 SHEILA A CHILSON CEO 159479 0 100 0 302 0 5540 0 12772 0 178193 0 0 0 LARRY W VERHAGE MEDICAL DIRECTOR 303782 0 425 0 306 0 10200 0 14610 0 329323 0 0 0 BRETT L PACK DENTAL DIRECTOR 161666 0 46434 0 312 0 8646 0 14584 0 231642 0 0 0 COLE Q HEMMERLING PHYSICIAN 243974 0 35760 0 312 0 10200 0 14584 0 304830 0 0 0 MICHAEL R TOLLEY PHYSICIAN 269357 0 300 0 312 0 10200 0 14587 0 294756 0 0 0 KRISTY M THOMPSON PHYSICIAN 158483 0 0 0 195 0 3305 0 8481 0 170464 0 0 0 JILL K SIMON PHYSICIAN 163801 0 1460 0 312 0 6934 0 10532 0 183039 0 0 0 JAMIE M BOWERS PHARMACIST 134005 0 20100 0 286 0 6352 0 11128 0 171871 0 0 0 FORM 990, PART I, LINE 6 THE BOARD OF DIRECTORS PER MLCHC BYLAWS REQUIRES A BOARD COMPOSITION OF 9 TO 15 MEMBERS. ALL VOLUNTEER POSITIONS ARE RELATED TO INVOLVEMENT ON THE BOARD, EITHER AS AN ELECTED MEMBER OR ADVISORY MEMBER. THESE INDIVIDUALS CONTRIBUTE A MINIMUM OF 3 HOURS A MONTH IN THIS CAPACITY. FORM 990, PART VI, SECTION B, LINE 11 UPON COMPLETION OF THE FORM 990, THE RETURN WILL BE REVIEWED IN DETAIL WITH THE BOARD FINANCE COMMITTEE AND THEN IN SUMMARY WITH THE BOARD OF DIRECTORS. UPON APPROVAL BY THE BOARD OF DIRECTORS, THE FINAL FORM 990 WILL BE SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED ON A CONTINUOUS BASIS TO COMPLY WITH THE CONFLICT OF INTEREST POLICY AND REQUIRED TO DISCLOSE TO THE BOARD OF DIRECTORS OR COMPLIANCE OFFICER ANY ISSUES OR CONCERNS. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING AND REPORTING ANY CONFLICTS OF INTEREST BROUGHT TO THE ATTENTION OF THE ORGANIZATION. A BOARD MEMBER WHO HAS A CONFLICT OF INTEREST, IN ANY MATTER BROUGHT BEFORE THE BOARD, SHALL DECLARE SUCH CONFLICT AND MAY BE INCLUDED IN, OR OFFER INFORMATION TO THE DISCUSSION, BUT SHALL ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 FOR THE CEO, THE BOARD OF DIRECTORS REVIEWS SALARY SURVEYS AND REGIONAL MARKET COMPARISONS TO DETERMINE APPROPRIATE COMPENSATION LEVELS. THE CONTRACT IS REVIEWED BY THE BOARD OF DIRECTORS EVERY THREE YEARS AND APPROVED BY THE ENTIRE BOARD. OTHER OFFICERS AND KEY EMPLOYEES ARE REVIEWED UTILIZING SALARY SURVEYS AND REGIONAL MARKET COMPARISONS AS WELL. THIS PROCESS IS LED BY THE CEO WITH THE ASSISTANCE OF THE HR DIRECTOR. COMPENSATION INFORMATION IS REVIEWED WITH THE BOARD CHAIR BY THE CEO. THE LAST COMPENSATION REVIEW WAS PERFORMED IN 2014. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST FOR VIEWING AT THE ORGANIZATION'S MAIN BUSINESS OFFICE IN THE PRESENCE OF THE CFO OR CEO. MLCHC COMMUNITY SERVICES 605 SOUTH COOLIDGE STREET MOSES LAKE WA 98837 463517778 INVESTMENT WA 501(C)(3) LINE 11A, I MOSES LAKE COMMUNITY HEALTH CENTER 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 MLCHC COMMUNITY SERVICES B 139518 COST