COLUMBIA VALLEY COMMUNITY HEALTH: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COLUMBIA VALLEY COMMUNITY HEALTH (EIN 23-7297657)
Tax period
2011-04-01 to 2012-03-31
Filed
2012-08-15
IRS object ID
201212299349300526
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-15T11:47:21-05:00Timestamp
Tax Period End Date2012-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN910189318EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MOSS ADAMS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 22650AddressLine1
CityYAKIMACity
StateWAState
ZIP Code989072650ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237297657EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLUMBIA VALLEY COMMUNITY HEALTHBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLUNameControl
Phone5096644575Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 ORONDO AVE SUITE 1AddressLine1
CityWENATCHEECity
StateWAState
ZIP Code98801ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePATRICK BUCKNUMName
TitleCEOTitle
Phone5096644575Phone
Date Signed2012-08-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCHRISTOPHER E RIVARDName
PTINP00022321PTIN
Phone5092487750Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPATRICK BUCKNUMNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1600 ORONDO AVE SUITE 1AddressLine1
CityWENATCHEECity
StateWAState
ZIP Code98801ZIPCode
FieldValueIRS element (for citing)
Gross Receipts21508482GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CVCH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1972YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF COLUMBIA VALLEY COMMUNITY HEALTH IS TO PROVIDE ACCESS TO IMPROVED HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees251TotalNbrEmployees
Total Nbr Volunteers12TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4414911ContributionsGrantsPriorYear
Contributions Grants Current Year4538005ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17212541ProgramServiceRevenuePriorYear
Program Service Revenue CY16898735ProgramServiceRevenueCY
Investment Income Prior Year-17666InvestmentIncomePriorYear
Investment Income Current Year51630InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year20112OtherRevenueCurrentYear
Total Revenue Prior Year21609786TotalRevenuePriorYear
Total Revenue Current Year21508482TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year32602GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY37373GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year13727397SalariesEtcPriorYear
Salaries Etc Current Year14016213SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY5958TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year121610TotalFundrsngExpCurrentYear
Other Expense Prior Year5300311OtherExpensePriorYear
Other Expenses Current Year5222226OtherExpensesCurrentYear
Total Expenses Prior Year19060310TotalExpensesPriorYear
Total Expenses Current Year19281770TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2549476RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2226712RevenuesLessExpensesCY
Total Assets BOY19408553TotalAssetsBOY
Total Assets EOY24105356TotalAssetsEOY
Total Liabilities BOY7171986TotalLiabilitiesBOY
Total Liabilities EOY9634433TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY12236567NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY14470923NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF COLUMBIA VALLEY COMMUNITY HEALTH IS TO PROVIDE ACCESS TO IMPROVED HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense13820295Expense
Grants37373Grants
Revenue16132279Revenue
DescriptionPROVIDE 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense786563Expense
Revenue786568Revenue
DescriptionINTERMEDIARY 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.Description
FieldValueIRS element (for citing)
Total Program Service Expense14606858TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109649NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees251NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKRISTAL ALBRECHTNamePerson
Telephone Number5096626000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1600 ORONDO AVE SUITE 1AddressLine1
CityWENATCHEECity
StateWAState
ZIP Code98801ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JOANNE HILL
VICE PRESIDENT2.00XX000
LOLY LARSON
BOARD MEMBER2.00X000
RICH WATSON
PRESIDENT2.00XX000
ROBERT SCOTT
BOARD MEMBER2.00X000
RICHARD BLIGGENSTORFER
TREASURER2.00XX000
DOUGLAS HEAD
BOARD MEMBER2.00X000
MARGARITO RODRIGUEZ
SECRETARY2.00XX000
IRENE BAZAN
BOARD MEMBER2.00X000
JUAN VALLE
BOARD MEMBER2.00X000
NICK COVEY
BOARD MEMBER2.00X000
CHRISTOPHER ERIC HUGHES
BOARD MEMBER2.00X000
BERTHA SANCHEZ
BOARD MEMBER2.00X000
PATRICK BUCKNUM
CEO40.00X195575027458
CAROL DIEDE
COO40.00X123728024140
MALCOLM BUTLER
CHIEF MEDICAL OFFICER40.00X279610030187
SCOTT BIBBENS
CHIEF DENTAL OFFICER40.00X230443028942
KRISTAL ALBRECHT
CFO40.00X125066012247
LORINDA PARKS
PHYSICIAN40.00239690028472X
KENNETH SHERMER
PHYSICIAN40.00223707028276X
JOHN DAME
PHYSICIAN40.00204652028204X
JEFFERY HINCKLEY
DENTIST40.00174486027190X
ERIC OLSON
PHYSICIAN40.00151418026542X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1948375TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation261658TotalOtherCompensation
Number Individuals GT100 K20NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ALDRICH & ASSOCIATES
810 240TH ST SEBOTHELLWA98021CONSTRUCTION4334172
KDF ARCHITECT
1310 N 16TH AVEYAKIMAWA98902ARCHITECTURAL SERVICES268602
ALLEGIANCE BENEFIT PLAN MANAGEMENT
PO BOX 4346MISSOULAMT59806CAFETERIA PLAN ADMINISTRATION117804
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants4374804GovernmentGrants
All Other Contributions163201AllOtherContributions
Noncash Contributions7509NoncashContributions
Total Contributions4538005TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE RE6214001228319712283197
ENHANCEMENT REVENUE62140026963502696350
CAPITATION REVENUE62140012726141272614
MEANINGFUL USE INCENTI621400467500467500
CONTRACT SERVICES621400114035114035

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column65039TotalRevenueColumn
Related Or Exempt Function Income65039RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue16898735TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column51630TotalRevenueColumn
Exclusion$51,630ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column20112TotalRevenueColumn
Related Or Exempt Function Income20112RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue20112TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column21508482TotalRevenueColumn
Related Or Exempt Function Income16918847RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$51,630ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total37373Total
Program Services37373ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1077399Total
Program Services310430ProgramServices
Management And General766969ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10340332Total
Program Services8592201ProgramServices
Management And General1730171ManagementAndGeneral
Fundraising17960Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total360877Total
Program Services300667ProgramServices
Management And General60210ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1347952Total
Program Services1169553ProgramServices
Management And General174039ManagementAndGeneral
Fundraising4360Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total889653Total
Program Services705097ProgramServices
Management And General184556ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total54975Total
Management And General54975ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total39655Total
Management And General39655ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total5958Total
Fundraising5958Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total284889Total
Program Services150657ProgramServices
Management And General134232ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total180001Total
Management And General86669ManagementAndGeneral
Fundraising93332Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1183174Total
Program Services990184ProgramServices
Management And General192990ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total484898Total
Program Services339429ProgramServices
Management And General145469ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total488902Total
Program Services350614ProgramServices
Management And General138288ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total12607Total
Program Services8696ProgramServices
Management And General3911ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total230124Total
Program Services129710ProgramServices
Management And General100414ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total212317Total
Program Services147407ProgramServices
Management And General64910ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1108596Total
Program Services786232ProgramServices
Management And General322364ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total102145Total
Program Services102108ProgramServices
Management And General37ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
REPAIR & MAINENTANCE429220300454128766
OTHER EXPENSES19822376773121450
STAFF RECRUITING1135446566347881
BUSINESS TAXES58510607652434

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total40446Total
Program Services37534ProgramServices
Management And General2912ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19281770Total
Program Services14606858ProgramServices
Management And General4553302ManagementAndGeneral
Fundraising121610Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2623455BOY
EOY1984145EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5458381BOY
EOY6396220EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY214759BOY
EOY128083EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1017064BOY
EOY1135248EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY84496BOY
EOY205876EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY72741BOY
EOY122062EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis20950979LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6914208LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5894299BOY
EOY14036771EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY86569BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3956789BOY
EOY96951EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY19408553BOY
EOY24105356EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3636210BOY
EOY1975178EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY125382BOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY2968298BOY
EOY7070124EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY84542BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY357554BOY
EOY589131EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7171986BOY
EOY9634433EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY12199830BOY
EOY14440789EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY36737BOY
EOY30134EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12236567BOY
EOY14470923EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19408553BOY
EOY24105356EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2226712ReconcilationRevenueExpenses
Reconcilation Other Changes7644ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1366672OtherCostOrOtherBasis
Book Value1366672BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis14457435OtherCostOrOtherBasis
Depreciation3589254Depreciation
Book Value10868181BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis967917OtherCostOrOtherBasis
Depreciation589090Depreciation
Book Value378827BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4094245OtherCostOrOtherBasis
Depreciation2671154Depreciation
Book Value1423091BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis64710OtherCostOrOtherBasis
Depreciation64710Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings14036771TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionOTHER LONG TERM LIABILITIESDescription
Amount$589,131Amount
FieldValueIRS element (for citing)
Total Of Amounts589131TotalOfAmounts
Total Revenue21508482TotalRevenue
Total Expenses19281770TotalExpenses
Excess Or Deficit For Year2226712ExcessOrDeficitForYear
Net Unrealized GL On Investments7646NetUnrealizedGLOnInvestments
Other-$2OtherAmount
Total Adjustments7644TotalAdjustments
Excess Or Deficit Per FS2234356ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt21516128TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments7646NetUnrealizedGainsInvestments
Revenue Not Rptd F9907646RevenueNotRptdF990
Revenue Subtotal21508482RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99021508482TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt19281770TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal19281770ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99019281770TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X: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, 2012 AND 2011, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL.
PART XI, LINE 8 - OTHER ADJUSTMENTS:ROUNDING -2.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantPAYMENT OF MEDICAL BILLS FOR INDIVIDUALS WHO NEED ASSISTANCE.TypeOfGrant
Number Of Recipients208NumberOfRecipients
Amount Of Cash Grant37373AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
PATRICK BUCKNUM
1758660200000-291055570219010223033000
MALCOLM BUTLER
226548015132037930081540220330309797000
SCOTT BIBBENS
148047067811014585069090220330259385000
LORINDA PARKS
142116062929034645064440220280268162000
KENNETH SHERMER
119616093012011079062490220270251983000
JOHN DAME
149615031583023454061850220190232856000
JEFFERY HINCKLEY
13657202813109783051970219930201676000
ERIC OLSON
1076540430770687046330219090177960000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationHOUSING ALLOWANCES ARE CONSIDERED TO BE TAXABLE EARNINGS IN ACCORDANCE WITH PAYROLL LAWS. THE INTERNAL COMPENSATION POLICY GOVERNS COMPENSATION FOR AGENCY POSITIONS.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1WA HEALTHCARE FACILITIESBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN911108929IssuerEIN
Date Issued2010-12-16DateIssued
Issue Price7200000IssuePrice
Description Of PurposeREMODELING & RENOVATIONDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired2910096AmountRetired
Total Proceeds7200000TotalProceeds
Capitalized Interest29142CapitalizedInterest
Issuance Costs From Proceeds58202IssuanceCostsFromProceeds
Capital Expenditures4231702CapitalExpenditures
Year Of Subst Completion2012YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements1AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS REVIEWED EITHER BY THE BOARD OR FINANCE COMMITTEE PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CCOMPLIANCE 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 15DATA 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 19CONFLICT 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 XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 7,646. ROUNDING -2. TOTAL TO FORM 990, PART XI, LINE 5: 7,644.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART VIII, LINE 2C:NO CHANGE FROM PRIOR YEAR.

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