2013-08-15T18:23:10-05:00 2013-03-31 910189318 MOSS ADAMS LLP PO BOX 22650 YAKIMA WA 989072650 990 2012-04-01 237297657 COLUMBIA VALLEY COMMUNITY HEALTH COLU 5096644575 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 PATRICK BUCKNUM 5096644575 2013-07-25 1 CHRISTOPHER E RIVARD P00022321 5092487750 2012 2016-02-24 21:20:13Z PATRICK BUCKNUM 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 22216941 0 X WWW.CVCH.ORG X 1972 WA THE MISSION OF COLUMBIA VALLEY COMMUNITY HEALTH IS TO PROVIDE ACCESS TO IMPROVED HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 11 11 265 14 0 0 4538005 4878203 16898735 17172221 51630 48477 20112 4053 21508482 22102954 37373 38133 0 0 14016213 14816601 5958 9260 141104 5222226 5418955 19281770 20282949 2226712 1820005 24105356 26860293 9634433 10580012 14470923 16280281 THE MISSION OF COLUMBIA VALLEY COMMUNITY HEALTH IS TO PROVIDE ACCESS TO IMPROVED HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 0 0 14745784 38133 16448356 PROVIDE COMPREHENSIVE MEDICAL, MENTAL HEALTH AND DENTAL CARE TO SEASONAL AND MIGRANT FARM WORKERS AND THE MEDICALLY UNDERSERVED POPULATION OF THE AREA. THIS INCLUDES GENERAL MEDICINE, DENTAL, PRENATAL, AND OBSTETRIC CARE ON AN OUTPATIENT BASIS. AN ON SITE PHARMACY PROVIDES PATIENT PRESCRIPTION SERVICES TO ENSURE PATIENTS OBTAIN NEEDED MEDICATIONS. 723865 723865 INTERMEDIARY FOR PROVIDING SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN. INCLUDES NUTRITION EDUCATION, REFERRAL FOR HEALTH CARE FOR LOW-INCOME WOMEN AS WELL AS INFANTS AND CHILDREN UNDER AGE FIVE. PROGRAM FOCUS IS FOR BOTH INFANTS AND CHILDREN IN THE CRITICAL PERIODS OF GROWTH AND DEVELOPMENT UNDER AGE FIVE. 15469649 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 59 0 1 265 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X KRISTAL ALBRECHT 5096626000 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 RICH WATSON 2.00 X X 0 0 0 JOANNE HILL 2.00 X X 0 0 0 RICHARD BLIGGENSTORFER 2.00 X X 0 0 0 MARGARITO RODRIGUEZ 2.00 X X 0 0 0 LOLY LARSON 2.00 X 0 0 0 ROBERT SCOTT JR 2.00 X 0 0 0 DOUGLAS HEAD 2.00 X 0 0 0 IRENE BAZAN UNTIL 71712 2.00 X 0 0 0 JUAN VALLE 2.00 X 0 0 0 MARY HUNT 2.00 X 0 0 0 BERTHA SANCHEZ 2.00 X 0 0 0 JOAN ALWAY 2.00 X 0 0 0 PATRICK BUCKNUM 40.00 X 215163 0 30759 CAROL DIEDE 40.00 X 141234 0 27516 KRISTAL ALBRECHT 40.00 X 152011 0 14992 MALCOLM BUTLER 40.00 X 260846 0 32751 SCOTT BIBBENS 40.00 X 199179 0 27926 BRUCE V WILCOX 40.00 X 91991 0 12621 LORINDA PARKS 40.00 X 235385 0 31821 KENNETH SHERMER 40.00 X 214810 0 30744 JOHN DAME 40.00 X 180077 0 29297 JEFFERY HINCKLEY 40.00 X 168853 0 29062 BRENDA BAUMEISTER 40.00 X 155068 0 26940 2014617 0 294429 28 0 1 0 NEXTGEN HEALTHCARE PO BOX 511449 LOS ANGELES CA 900518004 SOFTWARE MAINTENANCE 167782 ALLIED PACIFIC BUILDERS 404 W ROLLING HILLS LANE WENATCHEE WA 98801 CONSTRUCTION AND REMODEL 146990 KDF ARCHITECTURE 1310 NORTH 16TH AVE YAKIMA WA 989021354 ARCHITECTURE FEES 135284 ALDRICH & ASSOCIATES 810 - 240TH ST SE BOTHELL WA 98021 CONSTRUCTION 131329 ERIC WULF LANDSCAPE CONSTRUCTION PO BOX 4252 WENATCHEE WA 98801 LANDSCAPING 101821 5 7194 4799508 71501 76 4878203 NET PATIENT SERVICE RE 621400 12756185 12756185 ENHANCEMENT REVENUE 621400 2829574 2829574 CAPITATION REVENUE 621400 1013908 1013908 MEANINGFUL USE INCENTIVE REVENUE 621400 323000 323000 CONTRACT SERVICES 621400 228165 228165 21389 21389 17172221 57991 57991 75111 69183 5928 5928 5928 9514 -9514 -9514 -9514 33415 7194 35290 -1875 -1875 22102954 17172221 0 52530 38133 38133 1222096 654238 567858 10652407 8646769 1955806 49832 564536 462831 101301 404 1442788 1215277 219367 8144 934774 741368 189490 3916 105598 105598 34755 34755 9260 9260 308100 176858 131242 122150 36366 16639 69145 312632 144978 167654 710827 399364 311463 490006 340028 149978 249548 198658 50890 1179309 916244 263065 107640 70387 37253 PATIENT & PHARMACEUTICA 1021764 1021764 CONTINUING EDUCATION 239770 118640 121018 112 OTHER 171463 19555 151908 DUES & LICENSE 151373 95772 55601 214020 172419 41310 291 20282949 15469649 4672196 141104 1984145 2413780 6396220 7844720 128083 467899 1135248 1019363 205876 161810 122062 137490 22811459 7996228 14133722 14815231 24105356 26860293 1975178 1941930 7070124 6670494 589131 1967588 9634433 10580012 X 14440789 16239533 30134 40748 14470923 16280281 24105356 26860293 1820005 -10647 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1807466 1807466 14521344 4247745 10273599 967917 668220 299697 4297007 3015553 1281454 1217725 64710 1153015 14815231 OTHER LIABILITIES 1967588 1967588 X 22196780 -10647 104473 93826 22102954 0 22102954 20387422 104473 104473 20282949 0 20282949 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. EFFECTIVE JANUARY 1, 2009, THE ORGANIZATION ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. AS OF MARCH 31, 2013 AND 2012, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AUTHORITIES FOR FISCAL YEARS 2010 AND LATER. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 35,290. RENTAL EXPENSES 69,183. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 35,290. RENTAL EXPENSES 69,183. 40TH ANNIVERSARY EVENT 40609 7194 33415 4962 7443 6589 16296 40609 7194 33415 4962 7443 6589 16296 35290 -1875 1 PAYMENT OF MEDICAL BILLS FOR INDIVIDUALS WHO NEED ASSISTANCE. 256 38133 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: PER THE CLIENTS FUNDING POLICY TO BE CONSIDERED FOR THE HELPING HANDS FUND, THE PATIENT'S HOUSEHOLD INCOME SHOULD NOT EXCEED TWO HUNDRED PERCENT (200%) OF THE POVERTY GUIDELINES. AS THE HELPING HANDS FUND IS THE PAYER OF LAST RESORT, ALL OUTSIDE FUNDING SOURCES (INCLUDING, BUT NOT LIMITED TO, GRANTS, GOVERNMENT ASSISTANCE, PRIVATE FOUNDATIONS, AND PATIENT ASSISTANCE PROGRAMS) WILL BE REVIEWED AND UTILIZED BEFORE DETERMINING HELPING HANDS FUND ELIGIBILITY. THE COMMITTEE WILL REVIEW AND VOTE ON ELIGIBLE APPLICATIONS ON A CASE BY CASE BASIS. FOR APPLICATIONS REFERRED BY PROVIDERS, AN URGENT NEED REQUEST FORM WILL BE COMPLETED BY THE PROVIDER AND SIGNED BY A COMMITTEE MEMBER. IF THE ESTIMATED COST IS BETWEEN $200 AND $299, A MANAGEMENT TEAM MEMBER'S SIGNATURE IS ALSO REQUIRED. URGENT NEED REQUEST EQUAL TO OR GREATER THAN $300 MUST BE APPROVED BY THE COMMITTEE VIA EMAIL VOTE BEFORE FUNDING CAN OCCUR. NON URGENT NEED APPLICATIONS WILL BE REVIEWED AT MONTHLY COMMITTEE MEETINGS. IN ADDITION TO THE APPLICATION, FURTHER INFORMATION MAY BE OBTAINED BY THE COMMITTEE TO AID WITH ELIGIBILITY DETERMINATION. IF THE NEED DICTATES, THE COMMITTEE MAY CONSIDER AN APPLICATION PRIOR TO THE MONTHLY MEETING. APPLICANTS REQUESTING RELIEF ON CVCH ACCOUNTS WILL GENERALLY RECEIVE A DECISION AND NOTIFICATION BY A COMMITTEE REPRESENTATIVE WITHIN 60 DAYS OF COMMITTEE REVIEW. IN MAKING A DETERMINATION OF ELIGIBILITY, THE COMMITTEE MAY CONSIDER WHETHER THE PATIENT HAS NEGOTIATED IN GOOD FAITH WITH THE CVCH BILLING DEPARTMENT, KEPT PATIENT SERVICE APPOINTMENTS, MADE PAYMENTS, AND/OR DEMONSTRATED INTEREST IN CLEARING HIS/HER ACCOUNT. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 PATRICK BUCKNUM 186193 0 10000 0 18970 0 8760 0 21999 0 245922 0 0 0 CAROL DIEDE 124732 0 11677 0 4825 0 5797 0 21719 0 168750 0 0 0 KRISTAL ALBRECHT 128891 0 19279 0 3841 0 6442 0 8550 0 167003 0 0 0 MALCOLM BUTLER 228326 0 26533 0 5987 0 10718 0 22033 0 293597 0 0 0 SCOTT BIBBENS 151494 0 48015 0 -330 0 8227 0 19699 0 227105 0 0 0 LORINDA PARKS 142501 0 52433 0 40451 0 9788 0 22033 0 267206 0 0 0 KENNETH SHERMER 120000 0 86093 0 8717 0 8711 0 22033 0 245554 0 0 0 JOHN DAME 139158 0 33806 0 7113 0 7264 0 22033 0 209374 0 0 0 JEFFERY HINCKLEY 137753 0 15756 0 15344 0 7061 0 22001 0 197915 0 0 0 BRENDA BAUMEISTER 157462 0 0 0 -2394 0 6908 0 20032 0 182008 0 0 0 PART I, LINE 1A HOUSING ALLOWANCES ARE CONSIDERED TO BE TAXABLE EARNINGS IN ACCORDANCE WITH PAYROLL LAWS. THE INTERNAL COMPENSATION POLICY GOVERNS COMPENSATION FOR AGENCY POSITIONS. A WA HEALTHCARE FACILITIES 911108929 2010-12-16 7200000 REMODELING & RENOVATION 0 0 0 A 3039859 7200000 29142 58202 4231702 2012 1 0 0 1 A 0 1 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED EITHER BY THE BOARD OR FINANCE COMMITTEE PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE IS UPDATED ANNUALLY FOR BOARD MEMBERS. FOR STAFF MEMBERS, THE PROCESS FOR EVALUATING CONFLICT OF INTEREST ISSUES IS OUTLINED IN POLICY ADM-CC-02, EMPLOYEE CONFLICT OF INTEREST. EMPLOYEES SUBMIT THEIR REQUEST FOR REVIEW OF OUTSIDE EMPLOYMENT TO THE HUMAN RESOURCES (HR) DIRECTOR, GENERALLY VIA EMAIL. THE HR DIRECTOR REVIEWS THE REQUEST WITH THE EMPLOYEE'S IMMEDIATE SUPERVISOR AND APPROPRIATE MANAGER AND/OR DIRECTOR UP TO THE MANAGEMENT TEAM MEMBER. IF APPROVED VIA THIS CHAIN OF COMMAND, THE REQUEST IS SUBMITTED TO THE CEO FOR FINAL APPROVAL. A WRITTEN RESPONSE IS PROVIDED TO THE EMPLOYEE OUTLINING ANY GUIDELINES. IN THE CASE OF HIGHLY SENSITIVE CONFLICT OF INTEREST ISSUES, EMPLOYEES MAY CONSULT WITH THE CEO DIRECTLY. FORM 990, PART VI, SECTION B, LINE 15 DATA PULLED FROM: 1) NACHC HEALTH CENTER COMPENSATION & BENEFITS REPORT, 2) MILLIMAN NORTHWEST HEALTH CARE INDUSTRY SALARY SURVEY, AND 3) INDEPENDENT SALARY SURVEYS CONDUCTED THROUGH HR. INFORMATION IS REVIEWED BY THE CEO, WHO MAKES RECOMMENDATIONS TO THE BOARD FOR FINAL APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST, BUT NOT PUBLISHED EXTERNALLY. GOVERNING DOCUMENTS ARE NOT SHARED. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST, AND THE FORM 990 IS AVAILABLE ON GUIDESTAR. FORM 990, PART VIII, LINE 2C: NO CHANGE FROM PRIOR YEAR.