2014-06-02T18:31:54-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2013-01-01 910947084 INTERNATIONAL COMMUNITY HEALTH SERVICES INTE 2067883618 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 2067883618 2014-05-15 1 PAUL MBAILEY CPA P00292653 4252506100 2013 2015-11-30 17:44:51Z TERESITA BATAYOLA 720 8TH AVENUE SOUTH NO 100 SEATTLE WA 98104 30348518 0 X WWW.ICHS.COM X 1973 WA PROVIDE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES 15 15 337 32 0 0 3598669 5483445 16070228 18233715 618362 29887 3306616 317407 23593875 24064454 0 0 0 0 13632040 15296893 0 0 253903 6439465 6662787 20071505 21959680 3522370 2104774 34167962 47870443 6423351 18021058 27744611 29849385 X INTERNATIONAL COMMUNITY HEALTH SERVICES (ICHS) IS A COMMUNITY-BASED HEALTH CARE CENTER COMMITTED TO PROVIDING CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES. ICHS ALSO PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE ORGANIZATION'S POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THE ORGANIZATION'S ESTABLISHED RATES. A MULTI-ETHNIC HEALTH CARE TEAM APPROACH AND A COMBINATION OF FUNDING SOURCES ENABLES ICHS TO PROVIDE AFFORDABLE COMPREHENSIVE HEALTH CARE, WHICH ADDRESS THE GAPS AND BARRIERS THAT PREVENT THE LOW-INCOME, NON-ENGLISH SPEAKING, ASIAN/PACIFIC ISLANDER POPULATION FROM AVAILING THEMSELVES OF ADEQUATE HEALTH SERVICES. 0 0 7639305 0 8819178 ICHS PROVIDES MEDICAL SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY. THESE SERVICES INCLUDE PHYSICAL EXAMS, IMMUNIZATIONS, MINOR SURGERY, HOME VISITS, AND INFANT AND WELL-CHILD CHECK-UPS. DURING 2013 ICHS PROVIDED 52,681 PRIMARY HEALTH CARE VISITS TO PATIENTS AND $725,817 OF CHARITY CARE. 3634860 0 3527671 ICHS PROVIDES FULL DENTAL CARE FOR THE ENTIRE FAMILY. ICHS PROVIDES EXTENSIVE DENTURE WORK, FULL CLEAING FOR ADULTS AND CHILDREN, PREVENTIVE DENTISTRY, MINOR ORAL SURGERY, RESTORATIVE SERVICES, ORTHODONTIA, AND EMERGENCY CARE. THE STAFF ALSO PROVIDES ORAL HEALTH EDUCATION IN THE COMMUNITY. DURING 2013, ICHS PROVIDED 22,957 DENTAL CARE VISITS TO PATIENTS AND $1,018,047 OF CHARITY CARE. 5789341 0 3688020 ICHS PROVIDES A VARIETY OF OTHER HEALTH CARE SERVICES TO THE COMMUNITY. THESE SERVICES INCLUDE CHINESE TRADITIONAL MEDICINE TECHNIQUES, DISEASE PREVENTION, HEALTH EDUCATION, BEHAVIORAL HEALTH, NUTRITION SERVICES, AND FAMILY PLANNING FOR TEENS AND ADULTS. DURING 2013, ICHS PROVIDED 6,112 HEALTH CARE VISITS TO PATIENTS AND $114,996 OF CHARITY CARE. 17063506 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 34 0 1 337 1 0 0 0 0 0 0 0 0 0 0 X 15 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X HERMES SHAHBAZIAN 2067883618 720 8TH AVENUE SOUTH SUITE 100 SEATTLE WA 98104 CRIS KRISOLOG-ELLIOTT PRESIDENT 3.00 0.00 X X 0 0 0 HIROSHI NAKANO SECRETARY 2.00 2.00 X X 0 0 0 JOHN FOZ 1ST VICE PRESIDENT 3.00 2.00 X X 0 0 0 JANYCE KO FISHER 2ND VICE PRESIDENT 2.00 0.00 X X 0 0 0 KELLI NOMURA 3RD VICE PRESIDENT 2.00 0.00 X X 0 0 0 GILDAS CHEUNG TREASURER 2.00 0.00 X X 0 0 0 JENNY FANG DIRECTOR 1.50 0.00 X 0 0 0 CATHERINE JOHNSON DIRECTOR 1.50 0.00 X 0 0 0 RACHEL KOH DIRECTOR 1.50 0.00 X 0 0 0 BENJAMIN LEE DIRECTOR 1.50 0.00 X 0 0 0 TED LEW DIRECTOR 1.50 0.00 X 0 0 0 RICHARD MELLON DIRECTOR 1.50 0.00 X 0 0 0 ROBERT MULL DIRECTOR 1.50 0.00 X 0 0 0 ARMILITO PANGILINAN DIRECTOR 1.50 0.00 X 0 0 0 ARIGIN SAKDA DIRECTOR 1.50 2.00 X 0 0 0 JENNIFER VONG DIRECTOR 1.50 0.00 X 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 47.00 3.00 X 190496 0 6244 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 38.00 2.00 X 132740 0 10411 GRACE WANG MEDICAL DIRECTOR 50.00 0.00 X 209200 0 12421 KIMO HIRAYAMA ASST MEDICAL DIRECTOR 36.00 0.00 X 197680 0 12068 AI-KHUE NGUYEN ASST MEDICAL DIRECTOR 36.00 0.00 X 167308 0 11176 JI CHOI DENTAL DIRECTOR 40.00 0.00 X 153964 0 10769 ALAN CHUN MD/PROVIDER 36.00 0.00 X 162990 0 11016 HARVEY WU DDS/PROVIDER 40.00 0.00 X 151724 0 10608 DANIEL COPP MD/PROVIDER 40.00 0.00 X 155338 0 10755 CHRISTOPHER YEE MD/PROVIDER 39.00 0.00 X 149092 0 10651 UYENVY PHAM MD/PROVIDER 40.00 0.00 X 160859 0 10959 1831391 0 117078 23 0 1 0 LEASE CRUTCHER LEWIS WA LLC 107 SPRING ST SEATTLE WA 98104 CONSTRUCTION 2952611 MILLER HAYASHI ARCHITECTS LLC 118 N 35TH ST 200 SEATTLE WA 98103 ARCHITECTURE 1093586 BAYLEY CONSTRUCTION 8005 SE 28TH ST MERCER ISLAND WA 98040 CONSTRUCTION 614000 QUALITY SYSTEMS INC PO BOX 511449 LOS ANGELES CA 90051 NEXTGEN 192547 KELLER ROHRBACK LLP 1201 THIRD AVE SUITE 3200 SEATTLE WA 98101 LEGAL 110501 5 603452 3705544 1174449 648741 5483445 PATIENT SERVICE FEES 624100 16034869 16034869 POOL SAVINGS REVENUE 900099 2184132 2184132 OTHER MEDICAL REVENUE 900099 14714 14714 18233715 38046 38046 48700 24809 23891 23891 23891 6251096 6254111 5144 -3015 -5144 -8159 -8159 MANAGEMENT FEES 900099 266800 266800 MISCELLANEOUS REVENUE 900099 26716 26716 293516 24064454 18233715 0 347294 1114477 525250 589227 11428194 9182440 2032924 212830 337049 270780 60026 6243 1424458 1128724 260904 34830 992715 780254 212461 59714 2804 56910 40315 40315 889145 579429 309716 8527 3750 4777 182143 148678 33465 89355 73456 15899 1085854 922130 163724 54202 29695 24507 32414 13997 18417 159934 146693 13241 868909 603971 264938 101437 75798 25639 MEDICAL SUPPLIES 2224487 2206697 17790 DUES AND SUBSCRIPTION 260355 13060 247295 EQUIPMENT 230945 107491 123454 LICENSE AND TAXES 146335 96956 49379 228716 151453 77263 21959680 17063506 4642271 253903 10853916 24844892 6791923 540827 721452 800730 1990139 1652958 1059193 706913 24252164 5849994 12225427 18402170 525912 921953 34167962 47870443 2936827 3162322 571233 623083 10126031 2915291 2766504 0 1343118 6423351 18021058 X 27043437 28681057 701174 1168328 27744611 29849385 34167962 47870443 2104774 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 3970 0 0 3970 0 PART II-B, LINE 1: ATTENDED 2013 API LEGISLATIVE DAY 3528037 3528037 5381497 999778 4381719 4939368 1401372 3537996 5263111 3448844 1814267 5140151 5140151 18402170 CONSTRUCTION PAYABLE 1343118 1343118 X 20920450 24972 24809 49781 20870669 3193785 3193785 24064454 22009461 24972 24809 49781 21959680 0 21959680 PART X, LINE 2: THE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT EVALUATED ICHS'S TAX POSITION AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE CONSOLIDATED FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. THE ORGANIZATION IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS PRIOR TO 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 24,809. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF EQUIPMENT -5,144. CAPITAL DEVELOPENT GRANT 966,097. RENTAL INCOME 48,700. POOL SAVINGS REVENUE 2,184,132. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 24,809. X X X 0 0 0 1 0 0 0 0 0 TERESITA BATAYOLA CHIEF EXECUTIVE OFFICER 172818 0 12094 0 5584 0 5577 0 667 0 196740 0 0 0 GRACE WANG MEDICAL DIRECTOR 195843 0 12000 0 1357 0 6326 0 6095 0 221621 0 0 0 KIMO HIRAYAMA ASST MEDICAL DIRECTOR 167552 0 12825 0 17303 0 5973 0 6095 0 209748 0 0 0 AI-KHUE NGUYEN ASST MEDICAL DIRECTOR 137080 0 15120 0 15108 0 5081 0 6095 0 178484 0 0 0 JI CHOI DENTAL DIRECTOR 115248 0 18000 0 20716 0 4674 0 6095 0 164733 0 0 0 ALAN CHUN MD/PROVIDER 150878 0 10755 0 1357 0 4921 0 6095 0 174006 0 0 0 HARVEY WU DDS/PROVIDER 120876 0 18000 0 12848 0 4513 0 6095 0 162332 0 0 0 DANIEL COPP MD/PROVIDER 128710 0 10000 0 16628 0 4660 0 6095 0 166093 0 0 0 CHRISTOPHER YEE MD/PROVIDER 125732 0 10435 0 12925 0 4556 0 6095 0 159743 0 0 0 UYENVY PHAM MD/PROVIDER 147502 0 12000 0 1357 0 4864 0 6095 0 171818 0 0 0 PART I, LINE 5 THE CEO RECEIVES A BONUS BASED ON FIVE STRATEGIC GOALS, ONE OF WHICH IS DIVERSIFYING REVENUE. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2013-10-18 10107500 CONSTRUCTION 0 0 0 A 10107621 78846 10028775 0 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 X 3 648291 COST X COMPUTERS 1 450 FMV 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS CHAIRED BY THE PRESIDENT OF THE BOARD AND ONLY CONSISTS OF THE ELECTED OFFICERS OF THE BOARD AND THE CHIEF EXECUTIVE OFFICER OF ICHS. THE EXECUTIVE COMMITTEE IS EXCLUSIVELY AUTHORIZED TO ACT FOR THE BOARD IN URGENT SITUATIONS DURING THE INTERIM PERIOD BETWEEN MEETINGS OF THE BOARD IN A MANNER CONSISTENT WITH ESTABISHED BOARD POLICIES AND/OR DIRECTION, AND SHALL REPORT ALL ACTIVITIES AND ACTIONS AT THE NEXT MEETING OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2 JOHN FOZ AND JOYCE KO FISHER - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FINANCE DEPARTMENT SUBMITS A DRAFT COPY OF THE FORM 990 TO THE BOARD OF DIRECTOR'S FINANCE AND AUDIT COMMITTEE. ONCE APPROVED BY THE COMMITTEE, THE FORM 990 IS SUBMITTED AND PRESENTED TO THE FULL BOARD AT THE FOLLOWING BOARD MEETING FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C ICHS REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICIES. ICHS HAS TWO CONFLICT OF INTEREST POLICIES. THE FIRST POLICY IS AN OVERARCHING POLICY FOR THE ENTIRE AGENCY, WHICH WORKS TO ENSURE EFFECTIVE MANAGEMENT OF CONFLICTS OF INTEREST AT ICHS. THE SECOND POLICY IS SET TO ENSURE ALL BOARD-RELATED ACTIVITIES ARE CONDUCTED IN A WAY THAT ENSURES COMPLIANCE WITH APPLICABLE LAWS, PRESERVES THE PUBLIC'S TRUST, ENSURES GOOD STEWARDSHIP OF ICHS RESOURCES, AND UPHOLDS HIGH STANDARDS OF CONDUCT AND PERSONAL INTEGRITY AMONG ALL BOARD DIRECTORS AND BOARD ASSOCIATES. THE CONFLICT OF INTEREST POLICY REQUIRES ALL EMPLOYEES AND NON-EMPLOYEE REPRESENTATIVES TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MAY COMPROMISE THEIR JUDGMENT OR IF PERSONAL INTERESTS ARE IN SUBSTANTIAL CONFLICT WITH THE BEST INTERESTS OF ICHS. SIMILARLY, INDIVIDUALS ARE EXPECTED TO REMOVE THEMSELVES FROM A POSITION OF DECISION-MAKING AUTHORITY OR SIGNIFICANT INFLUENCE WITH RESPECT TO ANY CONFLICT SITUATION THAT ARISES. A SITUATION IS CONSIDERED A CONFLICT OF INTEREST IF AN INTEREST OR ACTIVITY INFLUENCES OR APPEARS TO INFLUENCE THE ABILITY OF AN INDIVIDUAL TO EXERCISE OBJECTIVITY OR IMPAIRS THE INDIVIDUAL'S ABILITY TO PERFORM HIS OR HER EMPLOYMENT OR REPRESENTATIVE WORK RESPONSIBILITIES IN THE BEST INTEREST OF ICHS. ANY UNETHICAL ABUSE OF EMPLOYEES OR NON-EMPLOYEE REPRESENTATIVES CAN RESULT IN DISCIPLINARY ACTION (INCLUDING TERMINATION OF EMPLOYMENT). THE CONFLICT OF INTEREST FOR BOARD DIRECTORS AND BOARD ASSOCIATES REQUIRES BOARD DIRECTORS AND ASSOCIATES TO DISCLOSE ANY REAL OR APPARENT CONFLICT OF INTEREST TO THE BOARD AND EXCUSE HIMSELF OR HERSELF FROM VOTING, AS APPROPRIATE. ADDITIONALLY, NO BOARD MEMBER CAN ALSO BE AN EMPLOYEE OR RELATED TO AN EMPLOYEE OF ICHS. IF A CONFLICT OF INTEREST IS PERCEIVED TO EXIST BUT IS NOT DISCLOSED, THE BOARD MAY VOTE WHETHER THERE IS A REAL CONFLICT OF INTEREST. IF THE VOTE IS AFFIRMATIVE, THE BOARD MEMBER IN QUESTION IS NOT ENTITLED TO VOTE ON THAT ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS PERFORM AN ANNUAL PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER (CEO) WITH A THIRD PARTY CONSULTANT. THE EXECUTIVE COMMITTEE OF THE BOARD (CHAIRS OF ALL THE COMMITTEES) MEETS WITH THE CEO TO NEGOTIATE COMPENSATION THAT IS CONSISTENT WITH MARKET PAY. THIS PROCESS IS UNDERTAKEN ANNUALLY. THE CHIEF FINANCIAL OFFICER AND OTHER KEY EMPLOYEES COMPENSATION IS DETERMINED BY PERFOMANCE EVALUATIONS AND A COMPENSATION STUDY WHICH IS UNDERTAKEN EVERY TWO YEARS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION 720 8TH AVE S SEATTLE WA 98104 260493856 FUNDRAISING WA 501(C)(3) LINE 11A, I ICHS 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 ICHS FOUNDATION C 603452 ICHS FOUNDATION L 603452 ICHS FOUNDATION O 266800