2014-11-13T18:34:41-06:00 2013-12-31 910189318 MOSS ADAMS LLP 1301 A STREET SUITE 600 TACOMA WA 984024205 990 2013-01-01 201082052 PTSO OF WASHINGTON PTSO 2064542811 2101 FOURTH AVENUE NO 320 SEATTLE WA 98121 ROY O LA CROIX CEO 2064542811 2014-11-13 1 NANCY J SCHAUER P01326437 2535724100 2013 2015-11-30 17:44:51Z ROY O LA CROIX 2101 FOURTH AVENUE 320 SEATTLE WA 98121 6631669 0 X WWW.PTSOWA.ORG X 2004 WA SEE FORM 990 PART III, QUESTION 1. 7 7 39 7 0 0 718722 529102 4103452 6102555 110 12 0 0 4822284 6631669 3036107 3439667 0 0 169919 435828 0 0 20653 1492231 2839608 4698257 6715103 124027 -83434 3322081 3491134 635410 887897 2686671 2603237 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. 0 0 5734931 3439667 6102555 CUSTOMIZED AND UPGRADED NEXTGEN EHR, EPM AND EDR APPLICATIONS TO MEET THE UNIQUE NEEDS OF OUR FQHC CUSTOMERS AND HELP THEM REALIZE AIU FUNDS. PREPARED FOR MEANINGFUL USE (MU STAGE1)THROUGH MULTIPLE SYSTEM UPGRADES AND COMMENCED WORK ON MU STAGE 2 AND ICD10 UPGRADES. CONTINUED FORUMS FOR BEST PRACTICES AND LESSONS LEARNED.HRSA HEALTH CENTER CONTROLLED NETWORKS - HCCN GRANT - PTSO, E NET,HCHN NETWORKS PROVIDING BEST PRACTICES, OPTIMIZATION AND TRAINING AROUND PATIENT CENTERED MEDICAL HOME, MEANINGFUL USE AND EHR IMPLEMENTATION AND ADOPTION. 5734931 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 1 0 1 18 0 1 39 1 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 WA X GRACE E GRIFFIN 2064542818 2101 FOURTH AVENUE 320 SEATTLE WA 98121 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 ME 1.00 X 0 0 0 ROY O LA CROIX CEO 40.00 X 163782 42068 23462 JULIE COLIN CHIEF MEDICAL INFORMATION OFFICER 40.00 X 161570 70510 8367 SHELLEY YOUNGS DIRECTOR OF CLIENT SERVICES 40.00 X 99611 35456 15307 HENRY PIASKOWSKI DIRECTOR OF DEVELOPMENT & INTEGRATION 40.00 X 97559 34094 18884 522522 182128 66020 2 0 1 0 0 529102 529102 SERVICE FEE REVENUE 518210 6102555 6102555 6102555 12 12 6631669 6102555 0 12 3439667 3439667 435828 423525 12303 81654 56740 24914 18219 18219 42600 42600 486716 398208 80158 8350 119997 119997 214281 214281 141037 26600 114437 227564 110116 117448 776766 776766 23302 23302 CONTRACT SALARIES 3186810 2826969 359841 MAINTENANCE - SOFTWARE/ 880339 880339 TAXES 58603 58603 SUPPLIES 21387 21387 -3439667 -3439667 6715103 5734931 959519 20653 661100 1417111 147315 54102 532254 688379 159548 201249 6995099 5877201 1788501 1117898 33363 12395 3322081 3491134 103328 230187 19312 20667 512770 637043 635410 887897 X 2686671 2603237 2686671 2603237 3322081 3491134 -83434 0 X X 0 1 X 1 1 1 X X X 0 0 0 COUNTRY DOCTOR COMMUNITY HEALTH CENTERS 237100868 7 1 307773 FAMILY HEALTH CENTERS 911275011 7 1 312260 CHC OF KING COUNTY DBA HEALTHPOINT 910884412 7 1 1202235 YAKIMA NEIGHBORHOOD HEALTH SERVICES 910928817 7 1 622358 NEIGHBORCARE HEALTH 910893287 7 1 995041 5 3439667 6995099 5877201 1117898 1117898 DUE TO CHNW 624 MEMBER DEPOSITS 417733 WAGES PAYABLE 218686 637043 X 6631669 0 6631669 0 6631669 6715103 0 6715103 0 6715103 PART X, LINE 2: 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, 2013 AND 2012. 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 2010. 0 COUNTRY DOCTOR CHC 500 19TH AVE EAST SEATTLE WA 98112 237100868 501 C (3) 307773 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) 312260 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) 1202235 VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. SUPPORTIVE ASSISTANCE YAKIMA NEIGHBORHOOD HEALTH SERVICES PO BOX 2605 YAKIMA WA 98907 910928817 501 C (3) 622358 VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. SUPPORTIVE ASSISTANCE NEIGHBORCARE HEALTH 905 SPRUCE STREET SUITE 300 SEATTLE WA 98104 910893287 501 C (3) 995041 VARIOUS OPERATING SERVICES, DATA CENTER, SOFTWARE AND SUPPORT. SUPPORTIVE ASSISTANCE 5 0 X X X 0 0 0 0 0 0 0 0 0 ROY O LA CROIX CEO 148742 40491 15040 0 0 1577 0 0 19303 4159 183085 46227 0 0 JULIE COLIN CHIEF MEDICAL INFORMATION OFFICER 160024 66626 1526 3814 20 70 0 0 4041 4326 165611 74836 0 0 SHELLEY YOUNGS DIRECTOR OF CLIENT SERVICES 94591 34221 5000 1235 20 0 0 0 11476 3831 111087 39287 0 0 HENRY PIASKOWSKI DIRECTOR OF DEVELOPMENT & INTEGRATIO 97549 31736 0 2358 10 0 0 0 14284 4600 111843 38694 0 0 SCHEDULE J PART II LINE 1 DURING 2013, COMMUNITY HEALTH NETWORK OF WASHINGTON, A SUPPORTED ORGANIZATION, PAID PART OF THE SALARY OF ROY LACROIX, CEO OF PTSO OF WASHINGTON, JULIE COLIN, CHIEF MEDICAL INFORMATION OFFICER FOR PTSO OF WASHINGTON, SHELLEY YOUNGS, DIRECTOR OF CLIENT SERVICES FOR PTSO OF WASHINGTON AND HENRY PIASKOWSKI, DIRECTOR OF DEVELOPMENT & INTEGRATION FOR PTSO OF WASHINGTON. 4/1/13 PTSO TOOK ON ITS OWN PAYROLL FUNCTION AND HAS USED THE SAME METHODOLOGY OF COMPENSATION SURVEY, COMPENSATION CONSULTANT AND BOARD APPROVAL OF THE CEO COMPENSATION. 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 FOR PART OF THE YEAR THE CEO WAS 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. 4/1/13 PTSO TOOK ON ITS OWN PAYROLL FUNCTION AND HAS USED THE SAME METHODOLOGY OF COMPENSATION SURVEY, COMPENSATION CONSULTANT AND BOARD APPROVAL OF THE CEO COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND GOVERNING/ORGANIZING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PTSO FINANCE COMMITTE MAINTAINS OVERSIGHT OF THE PTSO FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR. 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) 170(B)(1)(A)(VI) 0 FAMILY HEALTH CENTERS IN OKANOGAN PO BOX 1340 OKANOGAN WA 98840 911275011 FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER WA 501 C (3) 170(B)(1)(A)(VI) 0 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) 170(B)(1)(A)(III) 0 YAKIMA NEIGHBORHOOD HEALTH SERVICES PO BOX 2605 YAKIMA WA 98907 910928817 FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER WA 501 C (3) 170(B)(1)(A)(VI) 0 NEIGHBORCARE HEALTH 905 SPRUCCE STREET SUITE 300 SEATTLE WA 98104 910893287 FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER WA 501 C (3) 170(B)(1)(A)(III) 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 1 COMMUNITY HEALTH NETWORK OF WASHINGTON I 10414 FMV COMMUNITY HEALTH NETWORK OF WASHINGTON R 7488 FMV COMMUNITY HEALTH NETWORK OF WASHINGTON O 591383 FMV