2013-12-19T16:26:32-06:00 2013-03-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2012-04-01 911537371 MOSES LAKE COMMUNITY HEALTH CENTER MOSE 5097650674 605 COOLIDGE DRIVE MOSES LAKE WA 98837 MIKE HARRELL 5097650674 2013-12-19 1 SARA ELIZABETH J HYRE P00235495 4254544919 2013-12-20 2012 2016-02-25 16:41:14Z SHEILA CHILSON 605 COOLIDGE DRIVE MOSES LAKE WA 98837 28775701 0 X WWW.MLCHC.ORG X 1991 WA TO PROVIDE HIGH QUALITY, COMPASSIONATE AND COMPREHENSIVE PRIMARY HEALTH SERVICES FOR THE ENTIRE FAMILY, WITH A SPECIAL FOCUS ON THE UNDERSERVED AND MIGRANT FARM-WORKERS IN THE COMMUNITY. 12 12 277 12 0 0 3939664 3891803 16837428 16153106 330379 351053 197524 84360 21304995 20480322 0 0 0 0 13082310 14182515 0 0 16291 5751150 5126689 18833460 19309204 2471535 1171118 25734565 27073486 6501730 6961393 19232835 20112093 TO PROVIDE HIGH QUALITY, COMPASSIONATE AND COMPREHENSIVE PRIMARY HEALTH SERVICES FOR THE ENTIRE FAMILY, WITH A SPECIAL FOCUS ON THE UNDERSERVED AND MIGRANT FARM-WORKERS IN THE COMMUNITY. 0 0 9198922 12366930 MEDICAL SERVICES - THIS PROGRAM INCLUDES MEDICAL, BEHAVIORAL HEALTH AND PHARMACY SERVICES PROVIDED TO PATIENTS OF THE HEALTH CENTER. MOSES LAKE COMMUNITY HEALTH CENTER (MLCHC) PROVIDES PRIMARY CARE SERVICES INCLUDING OBSTETRICS CARE WITH 7 PHYSICIANS AND 12 MID-LEVEL PHYSICIANS ON STAFF. IN 2012, 20,456 MEDICAL PATIENTS WERE SEEN WITH A TOTAL OF 73,925 VISITS. 2748038 2722284 DENTAL SERVICES - MLCHC HAS 6 DENTISTS AND 3 DENTAL HYGIENISTS ON STAFF TO PROVIDE PREVENTATIVE, RESTORATIVE AND EMERGENCY CARE TO THE HEALTH CENTER'S INSURED AND UNINSURED PATIENTS. IN 2012, 8,866 PATIENTS WERE SEEN IN THE DENTAL DEPARTMENT WITH A TOTAL OF 23,533 VISITS PROVIDED. 1810653 1063895 OTHER HEALTH PROGRAMS - MLCHC PROVIDES MATERNITY SUPPORT SERVICES, WIC, INFANT TODDLER EARLY INTERVENTION AND DEVELOPMENTAL DISABILITY PARENT TRAINING PROGRAMS. THE MATERNITY SUPPORT SERVICES DEPARTMENT PROVIDED 6,445 VISITS TO APPROXIMATELY 1,400 PATIENTS. THE WIC PROGRAM SERVICES ELIGIBLE CLIENTS THROUGHOUT GRANT COUNTY IN MULTIPLE LOCATIONS. 13757613 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 26 0 1 277 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X MIKE HARRELL 5097650674 605 COOLIDGE DRIVE MOSES LAKE WA 98837 SCOTT CAMPBELL 1.00 X X 0 0 0 SHERRY DELGADO 1.00 X X 0 0 0 SHARON LANGE 1.00 X X 0 0 0 AMY RAYMOND 1.00 X X 0 0 0 CAROL SCHIMKE 1.00 X 0 0 0 LYNN MACKEY 1.00 X 0 0 0 DANIEL CHAVEZ 1.00 X 0 0 0 MATTHEW BENSON 1.00 X 0 0 0 JACINTO VALVERDE 1.00 X 0 0 0 AMELIA CAMPOS 1.00 X 0 0 0 ORALIA CERRILLO 1.00 X 0 0 0 JUAN CARLOS MAGALLANES-MORALES 1.00 X 0 0 0 SHEILA CHILSON 40.00 X 153907 0 24358 SHIRLEY MERKLE 40.00 X 121159 0 9362 CAROLYN BRANDENBURG 40.00 X 98128 0 9679 MIKE HARRELL 40.00 X 0 0 0 LARRY VERHAGE 40.00 X 316733 0 36344 BRETT PACK 40.00 X 215976 0 30962 ANDRE NYE 40.00 X 349070 0 36344 RYAN TOLLEY 40.00 X 317339 0 36344 KRISTY THOMPSON 40.00 X 238144 0 33072 COLE HEMMERLING 40.00 X 287311 0 28305 ANDREA CARTER 40.00 X 232307 0 26103 2330074 0 270873 23 0 1 0 NUVODIA LLC 801 SOUTH STEVENS STREET SPOKANE WA 99204 INFORMATION TECHNOLOGY SERVICE 384676 TROI IT SOLUTIONS 801 SOUTH STEVENS STREET SPOKANE WA 99204 INFORMATION TECHNOLOGY SERVICE 266747 QUEST DIAGNOSTICS LOCK BOX 91514 QUEST DIAGNOSTICS LOS ANGELES CA 90074 OUTSIDE LAB SERVICE 216139 CLEANPROS POST OFFICE BOX 305 MOSES LAKE WA 98837 JANITORIAL 192110 4 3876520 15283 3891803 PATIENT SERVICES 624100 10185170 10185170 MANAGED CARE 624100 5671724 5671724 CONTRACT SERVICES 624100 296212 296212 16153106 256737 256737 8383450 6245 8283768 11611 99682 -5366 94316 94316 EHR INCENTIVE PAYMENTS 900099 63750 63750 MEDICAL RECORDS FEES 561000 3319 3319 UNDERGRAD STIPENDS 611710 2100 2100 15191 15191 84360 20480322 16153106 0 435413 953310 300399 636620 16291 10621951 8706259 1915692 288694 225789 62905 1402467 1099473 302994 916093 712111 203982 155828 29366 126462 2899 1623 1276 48796 48796 54732 54732 26231 26231 51386 9028 42358 295640 150221 145419 507446 209997 297449 216018 54299 161719 122581 88660 33921 50294 35054 15240 73981 73981 795135 108689 686446 84829 36394 48435 MED & PHARM SUPPLIES 1262490 1262490 PURCHASED SERVICES 680868 313624 367244 REPAIRS AND MAINTENANCE 257987 44964 213023 439548 342942 96606 19309204 13757613 5535300 16291 1972993 1151305 1473609 2460738 295523 262680 2984041 2392370 322374 300876 163329 309150 16049386 6131643 9859162 9917743 8557886 10175807 47648 44817 58000 58000 25734565 27073486 3248807 3972506 2021626 1921639 1231297 1067248 6501730 6961393 X 19097835 20018006 135000 94087 19232835 20112093 25734565 27073486 1171118 -291860 0 X 0 1 X 1 1 1 X 4170422 4537962 4660479 3939664 3891803 21200330 4170422 4537962 4660479 3939664 3891803 21200330 21200330 148603 211755 198349 227236 256737 1042680 86478 4274 20610 111362 193250 63750 257000 22611372 77151756 0.93760 0.94410 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: INCENTIVE PAYMENTS - 2011 AMOUNT: $ 193,250. 2012 AMOUNT: $ 63,750. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 362467 362467 7862635 1873749 5988886 2945351 1286939 1658412 4393246 2970955 1422291 485687 485687 9917743 20188462 -291860 -291860 20480322 0 20480322 19309204 0 19309204 0 19309204 X X X X 0 0 0 0 0 0 0 0 0 SHEILA CHILSON 153592 0 100 0 215 0 5253 0 19105 0 178265 0 0 0 LARRY VERHAGE 316033 0 460 0 240 0 10000 0 26344 0 353077 0 0 0 BRETT PACK 173691 0 42046 0 239 0 8218 0 22744 0 246938 0 0 0 ANDRE NYE 347530 0 1300 0 240 0 10000 0 26344 0 385414 0 0 0 RYAN TOLLEY 296999 0 20100 0 240 0 10000 0 26344 0 353683 0 0 0 KRISTY THOMPSON 237684 0 220 0 240 0 9028 0 24044 0 271216 0 0 0 COLE HEMMERLING 266463 0 20608 0 240 0 5561 0 22744 0 315616 0 0 0 ANDREA CARTER 231967 0 100 0 240 0 3359 0 22744 0 258410 0 0 0 A WASHINGTON HEALTH CARE FACILITIES 911108929 93978EUWO 2003-01-23 943250 SEE PART VI 0 0 1 B WASHINGTON HEALTH CARE FACILITIES 911108929 NONEAVAIL 2006-07-21 1550000 CONSTRUCTION OF FACILITIES 0 0 0 A 226584 943250 52580 18866 19476 852363 2003 0 0 1 1 B 345027 1550000 1550000 2006 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 1 B 1 SCHEDULE K, PART I, LINE A, COLUMN F BOND ISSUE A WAS PART OF A POOLED FINANCING ISSUE, AND THE AMOUNTS REPORTED ARE THE ALLOCATED PORTIONS OF THE ISSUE. THE PURPOSE OF THE BOND ISSUE WAS FOR ACQUISITION, CONSTRUCTION, AND/OR RENOVATION OF THE HEALTHCARE CLINIC IN QUINCY, WA. FORM 990, PART I, LINE 6 THE BOARD OF DIRECTORS PER MLCHC BYLAWS REQUIRES A BOARD COMPOSITION OF 9 TO 15 MEMBERS. ALL VOLUNTEER POSITIONS ARE RELATED TO INVOLVEMENT ON THE BOARD, EITHER AS AN ELECTED MEMBER OR ADVISORY MEMBER. THESE INDIVIDUALS CONTRIBUTE A MINIMUM OF 3 HOURS A MONTH IN THIS CAPACITY. FORM 990, PART VI, SECTION B, LINE 11 UPON COMPLETION OF THE FORM 990, THE RETURN WILL BE REVIEWED IN DETAIL WITH THE BOARD FINANCE COMMITTEE AND THEN IN SUMMARY WITH THE BOARD OF DIRECTORS. UPON APPROVAL BY THE BOARD OF DIRECTORS, THE FINAL FORM 990 WILL BE SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED ON A CONTINUOUS BASIS TO COMPLY WITH THE CONFLICT OF INTEREST POLICY AND REQUIRED TO DISCLOSE TO THE BOARD OF DIRECTORS OR COMPLIANCE OFFICER ANY ISSUES OR CONCERNS. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING AND REPORTING ANY CONFLICTS OF INTEREST BROUGHT TO THE ATTENTION OF THE ORGANIZATION. A BOARD MEMBER WHO HAS A CONFLICT OF INTEREST, IN ANY MATTER BROUGHT BEFORE THE BOARD, SHALL DECLARE SUCH CONFLICT AND MAY BE INCLUDED IN, OR OFFER INFORMATION TO THE DISCUSSION, BUT SHALL ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 FOR THE CEO, THE BOARD OF DIRECTORS REVIEWS SALARY SURVEYS AND REGIONAL MARKET COMPARISONS TO DETERMINE APPROPRIATE COMPENSATION LEVELS. THE CONTRACT IS REVIEWED BY THE BOARD OF DIRECTORS EVERY THREE YEARS AND APPROVED BY THE ENTIRE BOARD. OTHER OFFICERS AND KEY EMPLOYEES ARE REVIEWED UTILIZING SALARY SURVEYS AND REGIONAL MARKET COMPARISONS AS WELL. THIS PROCESS IS LED BY THE CEO WITH THE ASSISTANCE OF THE HR DIRECTOR. COMPENSATION INFORMATION IS REVIEWED WITH THE BOARD CHAIR BY THE CEO. THE LAST COMPENSATION REVIEW WAS PERFORMED IN 2013. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST FOR VIEWING AT THE ORGANIZATION'S MAIN BUSINESS OFFICE IN THE PRESENCE OF THE CFO OR CEO.