2013-11-11T12:50:06-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2012-01-01 920146203 KODIAK ISLAND HEALTH CARE FOUNDATION KODI 9074815005 1911 EAST REZANOF DRIVE KODIAK AK 99615 JUDY C RATHJE 9074815005 2013-11-11 1 PAUL MBAILEY P00292653 4252506100 2013-11-08 2012 2016-02-24 21:20:13Z JUDY C RATHJE 1911 EAST REZANOF DRIVE KODIAK AK 99615 2472750 0 X WWW.KODIAKCHC.ORG X 1998 AK TO PROMOTE AND CONTRIBUTE TO A HEALTHY COMMUNITY THROUGH EDUCATION, EXPANSION OF HEALTH CARE SERVICES, AND FACILITATION OF PATIENT CARE THROUGH EXISTING PROVIDERS, REGARDLESS OF A PATIENT'S ABILITY TO PAY FOR SERVICES. 14 13 56 12 0 0 1215075 1201096 1713963 1244822 -603 85 -4834 26747 2923601 2472750 0 0 0 0 1984900 1758207 0 0 0 867967 966132 2852867 2724339 70734 -251589 597302 546093 301818 502198 295484 43895 X TO PROVIDE HIGH QUALITY, ACCCESSIBLE AND SUSTAINABLE PRIMARY AND PREVENTIVE HEALTH SERVICES TO EVERYONE IN THE KODIAK ISLAND BOROUGH. OUR CENTER AND HEALTH CARE PROFESSIONALS STRIVE TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTH CARE TO OUR ENTIRE COMMUNITY BY OFFERING A FULL RANGE OF PRIMARY AND PREVENTATIVE HEALTH SERVICES. WE ALSO PROVIDE REFERRAL ARRANGEMENTS SUCH AS MENTAL HEALTH TREATMENT AND COUNSELING, SUBSTANCE ABUSE SERVICE, SPECIALTY CARE, AND HOSPITALIZATIONS. WE OFFER HEALTHCARE TO EVERYONE IN OUR COMMUNITY - INSURED, UNINSURED AND UNDERINSURED. 0 0 1909009 1244822 THE CLINIC'S MISSION IS TO PROVIDE CARE TO ALL, REGARDLESS OF ABILITY TO PAY, AND TO SPECIALIZE IN PROVIDING CARE FOR THE MEDICALLY UNDERSERVED, LOW INCOME, AND OTHER DISADVANTAGED POPULATIONS OF KODIAK ISLAND. THE CLINIC STRIVES TO IMPROVE THE OVERALL HEALTH OF THE GENERAL POPLULATION THROUGH HEALTH EDUCATION AND PROMOTION OF ACTIVITIES. THE CLINIC'S PHILOSOPHY IS TO PROVIDE ACCESSIBLE, AFFORDABLE, COMPASSIONATE, QUALITY CARE SERVICES FOR KODIAK ISLAND.THE CLINIC PROVIDED CARE FOR 9,062 VISITS IN 2012. 1909009 1 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 13 0 1 56 1 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 AK X X KODIAK ISLAND HEALTH CARE FOUN 9074865000 1911 EAST REZANOF DRIVE KODIAK AK 99615 MONTE HAWVER 0.00 X 0 0 0 SONYA MORTENSON 0.00 X 0 0 0 JEROME SELBY 0.00 X 0 0 0 LARISSA CASEY 0.00 X 0 0 0 JENNIE DE LA FUENTE 0.00 X 0 0 0 PATRICIA KERNAN 0.00 X 0 0 0 VILMA GALLIVAN 0.00 X 0 0 0 AMANDA SWANSON 0.00 X 0 0 0 LESLIE LEYLAND FIELDS 0.00 X 0 0 0 CAROL AUSTERMAN 0.00 X 0 0 0 BARRY HASKELL 0.00 X 0 0 0 JC RATHJE 40.00 X 16827 0 0 16827 0 0 0 0 0 0 COMMUNITY LINK CONSULTING PO BOX 276 NEWMAN LAKE WA 99025 INTERIM CFO/IT SUPPORT 158179 OCHIN 707 SW WASHINGTON ST PORTLAND OR 97205 BILLING/PMS 147363 NWRPCA 6512 23RD AVE STE 305 SEATTLE WA 98199 GRANT MGMT SUPPORT 105363 3 1192763 8333 1201096 PATIENT CHARGES 624100 1244822 1244822 1244822 85 85 OTHER INCOME 624100 26747 26747 26747 2472750 1244822 0 26832 X 16827 16827 1432436 1088100 344336 175125 132219 42906 133819 101033 32786 1035 1035 13811 13811 199875 199875 285774 249633 36141 2803 2803 22014 22014 113550 113550 108159 48615 59544 4421 4421 53530 53530 784 784 MISCELLANEOUS 76968 72352 4616 SUPPLIES 65330 54639 10691 RECRUITMENT & RETENTION 37321 10244 27077 CONTRACT LABOR 35301 31896 3405 -54544 -69600 15056 2724339 1909009 815330 0 178973 169802 63420 14088 151790 131930 400 7363 464656 241746 202719 222910 597302 546093 238113 415571 63705 86627 301818 502198 X 295484 43895 295484 43895 597302 546093 -251589 0 X 0 1 X 0 1 1 X 3813292 2571841 1126977 1205482 1201096 9918688 3813292 2571841 1126977 1205482 1201096 9918688 9918688 8283 653 231 -633 85 8619 -4834 26747 21913 9949220 7593240 0.99690 0.99700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 464656 241746 222910 222910 LEASE OBLIGATION 4899 HEALTHY TOMORROWS FUNDS PAYABLE 81728 86627 X 2472750 0 2472750 0 2472750 2724339 0 2724339 0 2724339 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE CLINIC HAS RECEIVED A DETERMINATION LETTER FROM THE IRS THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MANAGEMENT EVALUATED KODIAK ISLAND HEALTH CARE FOUNDATION'S TAX POSITIONS AND CONCLUDED THAT KODIAK ISLAND HEALTH CARE FOUNDATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQURE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVIDIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. KODIAK ISLAND HEALTH CARE FOUNDATION IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2009. X X X 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 LINE 11A EXPLANATION - ELECTRONIC DISTRIBUTION TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT PRIOR TO FILING OF RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR THE MANAGERS ARE REQUIRED TO DISCLOSE ANY AND ALL INVESTMENTS IN RELATED ENTITIES FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION OF THE EXECUTIVE DIRECTOR AND TOP MANAGEMENT OFFICIALS IS REVIEWED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 108,069. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,069. CONSULTING AND OTHER PROFESSIONAL SERVICES FEES: PROGRAM SERVICE EXPENSES 141,564. MANAGEMENT AND GENERAL EXPENSES 36,141. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 177,705.