2013-11-13T15:36:23-06:00 2012-12-31 910189318 MOSS ADAMS LLP 1301 A STREET SUITE 600 TACOMA WA 984024205 990 2012-01-01 201082052 PTSO OF WASHINGTON PTSO 2064542811 2101 FOURTH AVENUE NO 320 SEATTLE WA 98121 ROY O LA CROIX 2064542811 2013-11-13 1 NANCY J SCHAUER P01326437 2535724100 2012 2016-02-24 21:20:13Z ROY O LA CROIX 2101 FOURTH AVENUE 320 SEATTLE WA 98121 4822284 0 X WWW.PTSOWA.ORG X 2004 WA SEE FORM 990 PART III, QUESTION 1. 7 0 0 7 0 0 770491 718722 2736901 4103452 179 110 0 0 3507571 4822284 2961142 3036107 0 0 169355 169919 0 0 36169 629809 1492231 3760306 4698257 -252735 124027 3805944 3322081 1243300 635410 2562644 2686671 X 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 4032508 3036106 4103452 STANDARDIZED TRAINING OF NEXTGEN BEST PRACTICES, DATA CENTER TECHNOLOGY MOVE AND EQUIPMENT REFRESH,NEXTGEN 5.7 UPGRADE FOR MEANINGFUL USE, 2012 UDS REPORTING, PREPARATION FOR 2013 UDS REPORTING, ICD 10 PREPARATION, ANALYSIS 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. 4032508 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 15 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 0 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 1.00 X 0 0 0 LINDA MCVEIGH 1.00 X 0 0 0 MIKE HASSING 1.00 X 0 0 0 ANITA MONOIAN 1.00 X 0 0 0 KATIE BELL 1.00 X 0 0 0 LARRY MCCULLEY 1.00 X 0 0 0 KIM MITROKA 1.00 X 0 0 0 BRUCE JOHNSON 40.00 X 0 0 0 ROY O LA CROIX 40.00 X 0 169919 22216 0 169919 22216 0 0 1 0 0 718722 718722 SERVICE FEE REVENUE 812900 4103452 4103452 4103452 110 110 4822284 4103452 0 110 3036107 3036107 169919 153650 16269 65913 50473 15440 26613 26613 30646 30646 362044 305070 37074 19900 159470 159470 238666 238666 101065 101065 43438 11897 31541 715130 715130 19840 19840 CONTRACT SALARIES 1875109 1622779 252330 MAINTENANCE - SOFTWARE/ 833778 833778 TAXES 56626 56626 GRANTS TO SUPPORTING OR -3036107 -3036107 4698257 4032508 629580 36169 1587517 661100 357664 147315 76650 532254 164390 159548 6897275 5108774 1555949 1788501 63774 33363 3805944 3322081 148493 103328 2305 19312 1092502 512770 1243300 635410 X 2562644 2686671 2562644 2686671 3805944 3322081 124027 0 X X 0 1 X 1 1 1 X X X 0 0 0 COMMUNITY HEALTH PLAN OF WASHINGTON 911729710 7 1 0 COMMUNITY HEALTH NETWORK OF WASHINGTON 911577184 7 1 0 COUNTRY DOCTOR COMMUNITY HEALTH CENTERS 237100868 7 1 304729 FAMILY HEALTH CENTERS 911275011 7 1 290082 CHC OF KING COUNTY DBA HEALTHPOINT 910884412 7 1 1053442 YAKIMA NEIGHBORHOOD HEALTH SERVICES 910928817 7 1 487879 NEIGHBORCARE HEALTH 910893287 7 1 899975 7 3036107 6897275 5108774 1788501 1788501 DUE TO CHNW 176145 MEMBER DEPOSITS 336163 ACCRUED PAYABLES 462 512770 X 4822284 0 4822284 0 4822284 4698257 0 4698257 0 4698257 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 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. 0 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 5 0 X X X 0 0 0 0 0 0 0 0 0 ROY O LA CROIX 0 150406 0 14461 0 5052 0 9885 0 12331 0 192135 0 0 SUPPLEMENTAL INFORMATION PART III DURING 2012, COMMUNITY HEALTH NETWORK OF WASHINGTON, A SUPPORTED ORGANIZATION, PAID SALARY OF ROY LACROIX, EXECUTIVE DIRECTOR OF PTSO OF WASHINGTON. 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. 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 1 1 0 0 0 0 1 0 0 1 0 COMMUNITY HEALTH NETWORK OF WASHINGTON I 56477 FMV COMMUNITY HEALTH NETWORK OF WASHINGTON R 7440 FMV COMMUNITY HEALTH NETWORK OF WASHINGTON N 2011024 FMV