2012-08-15T11:47:21-05:00 2012-03-31 910189318 MOSS ADAMS LLP PO BOX 22650 YAKIMA WA 989072650 990 2011-04-01 237297657 COLUMBIA VALLEY COMMUNITY HEALTH COLU 5096644575 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 PATRICK BUCKNUM 5096644575 2012-08-15 1 CHRISTOPHER E RIVARD P00022321 5092487750 2011 2016-02-24 21:20:13Z PATRICK BUCKNUM 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 21508482 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. 12 12 251 12 0 0 4414911 4538005 17212541 16898735 -17666 51630 0 20112 21609786 21508482 32602 37373 0 0 13727397 14016213 0 5958 121610 5300311 5222226 19060310 19281770 2549476 2226712 19408553 24105356 7171986 9634433 12236567 14470923 THE MISSION OF COLUMBIA VALLEY COMMUNITY HEALTH IS TO PROVIDE ACCESS TO IMPROVED HEALTH AND WELLNESS WITH COMPASSION AND RESPECT FOR ALL. 0 0 13820295 37373 16132279 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. 786563 786568 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. 14606858 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 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 49 0 1 251 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 KRISTAL ALBRECHT 5096626000 600 ORONDO AVE SUITE 1 WENATCHEE WA 98801 JOANNE HILL 2.00 X X 0 0 0 LOLY LARSON 2.00 X 0 0 0 RICH WATSON 2.00 X X 0 0 0 ROBERT SCOTT 2.00 X 0 0 0 RICHARD BLIGGENSTORFER 2.00 X X 0 0 0 DOUGLAS HEAD 2.00 X 0 0 0 MARGARITO RODRIGUEZ 2.00 X X 0 0 0 IRENE BAZAN 2.00 X 0 0 0 JUAN VALLE 2.00 X 0 0 0 NICK COVEY 2.00 X 0 0 0 CHRISTOPHER ERIC HUGHES 2.00 X 0 0 0 BERTHA SANCHEZ 2.00 X 0 0 0 PATRICK BUCKNUM 40.00 X 195575 0 27458 CAROL DIEDE 40.00 X 123728 0 24140 MALCOLM BUTLER 40.00 X 279610 0 30187 SCOTT BIBBENS 40.00 X 230443 0 28942 KRISTAL ALBRECHT 40.00 X 125066 0 12247 LORINDA PARKS 40.00 X 239690 0 28472 KENNETH SHERMER 40.00 X 223707 0 28276 JOHN DAME 40.00 X 204652 0 28204 JEFFERY HINCKLEY 40.00 X 174486 0 27190 ERIC OLSON 40.00 X 151418 0 26542 1948375 0 261658 20 0 1 0 ALDRICH & ASSOCIATES 810 240TH ST SE BOTHELL WA 98021 CONSTRUCTION 4334172 KDF ARCHITECT 1310 N 16TH AVE YAKIMA WA 98902 ARCHITECTURAL SERVICES 268602 ALLEGIANCE BENEFIT PLAN MANAGEMENT PO BOX 4346 MISSOULA MT 59806 CAFETERIA PLAN ADMINISTRATION 117804 3 4374804 163201 7509 4538005 NET PATIENT SERVICE RE 621400 12283197 12283197 ENHANCEMENT REVENUE 621400 2696350 2696350 CAPITATION REVENUE 621400 1272614 1272614 MEANINGFUL USE INCENTI 621400 467500 467500 CONTRACT SERVICES 621400 114035 114035 65039 65039 16898735 51630 51630 OTHER INCOME 900099 20112 20112 20112 21508482 16918847 0 51630 37373 37373 1077399 310430 766969 10340332 8592201 1730171 17960 360877 300667 60210 1347952 1169553 174039 4360 889653 705097 184556 54975 54975 39655 39655 5958 5958 284889 150657 134232 180001 86669 93332 1183174 990184 192990 484898 339429 145469 488902 350614 138288 12607 8696 3911 230124 129710 100414 212317 147407 64910 1108596 786232 322364 102145 102108 37 REPAIR & MAINENTANCE 429220 300454 128766 OTHER EXPENSES 198223 76773 121450 STAFF RECRUITING 113544 65663 47881 BUSINESS TAXES 58510 6076 52434 40446 37534 2912 19281770 14606858 4553302 121610 2623455 1984145 5458381 6396220 214759 128083 1017064 1135248 84496 205876 72741 122062 20950979 6914208 5894299 14036771 86569 3956789 96951 19408553 24105356 3636210 1975178 125382 2968298 7070124 84542 357554 589131 7171986 9634433 X 12199830 14440789 36737 30134 12236567 14470923 19408553 24105356 X 2226712 7644 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1366672 1366672 14457435 3589254 10868181 967917 589090 378827 4094245 2671154 1423091 64710 64710 0 14036771 OTHER LONG TERM LIABILITIES 589131 589131 21508482 19281770 2226712 7646 -2 7644 2234356 21516128 7646 7646 21508482 0 21508482 19281770 0 19281770 0 19281770 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. 1 PAYMENT OF MEDICAL BILLS FOR INDIVIDUALS WHO NEED ASSISTANCE. 208 37373 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 175866 0 20000 0 -291 0 5557 0 21901 0 223033 0 0 0 MALCOLM BUTLER 226548 0 15132 0 37930 0 8154 0 22033 0 309797 0 0 0 SCOTT BIBBENS 148047 0 67811 0 14585 0 6909 0 22033 0 259385 0 0 0 LORINDA PARKS 142116 0 62929 0 34645 0 6444 0 22028 0 268162 0 0 0 KENNETH SHERMER 119616 0 93012 0 11079 0 6249 0 22027 0 251983 0 0 0 JOHN DAME 149615 0 31583 0 23454 0 6185 0 22019 0 232856 0 0 0 JEFFERY HINCKLEY 136572 0 28131 0 9783 0 5197 0 21993 0 201676 0 0 0 ERIC OLSON 107654 0 43077 0 687 0 4633 0 21909 0 177960 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. WA HEALTHCARE FACILITIES 911108929 2010-12-16 7200000 REMODELING & RENOVATION 0 0 0 2910096 7200000 29142 58202 4231702 2012 1 0 0 1 0 1 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. FORM 990, PART VIII, LINE 2C: NO CHANGE FROM PRIOR YEAR.