EXECUTIVE DIRECTOR

2012-11-14T15:05:13-06:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 980041446 990 2011-01-01 237100868 COUNTRY DOCTOR COMMUNITY CLINIC COUN 2062991937 2101 EAST YESLER WAY NO 210 SEATTLE WA 981225900 LINDA MCVEIGH EXECUTIVE DIRECTOR 2062991937 2012-11-12 1 PAUL MBAILEY P00292653 4252506100 2012-11-09 2011 2016-02-24 21:20:13Z LINDA MCVEIGH 500 19TH AVENUE EAST SEATTLE WA 98112 12350106 0 X WWW.COUNTRYDOCTOR.ORG X 1971 WA THE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. 15 15 162 16 0 0 5556179 4792780 5616085 5393367 60346 14210 136860 646771 11369470 10847128 0 0 0 0 7969816 8070734 0 0 127074 3475088 3098796 11444904 11169530 -75434 -322402 7442954 7032258 2998470 2898251 4444484 4134007 THE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. 0 0 8552165 5393367 IN 2011 COUNTRY DOCTOR COMMUNITY CLINIC PROVIDED 52,984 MEDICAL VISITS. 84% OF THE PATIENTS SEEN IN 2011 HAD INCOME LESS THAN 200% OF THE FEDERAL POVERTY (FPL). ALL UNINSURED PATIENTS (57% OF THE TOTAL PATIENTS SEEN) EARNING LESS THAN 200% OF FPL WERE SEEN ON A SLIDING SCALE DISCOUNT. 72028 DENTAL CARE IS PROVIDED TO COUNTRY DOCTOR COMMUNITY CLINC (CDCC) PATIENTS THROUGH A CONTRACTUAL ARRANGEMENT WITH A COMMUNITY DENTAL PROVIDER. IN 2011, 178 DENTAL VISITS WERE PROVIDED TO LOW INCOME, UNINSURED PATIENTS. THERE IS NO REVENUE GENERATE BY CDCC THROUGH THIS CONTRACT. 1122445 THE OTHER HEALTH SERVICES PROGRAM PROVIDED 15,226 ANCILLARY HEALTH VISITS (EG NUTRITION, MENTAL HEALTH, WIC, ELIGIBILITY) TO LOW INCOME PATIENTS. 9746638 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 162 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X SUSANA TANTICO 2062991937 2101 EAST YESLER WAY SUITE 210 SEATTLE WA 98122 AUGUST PIPER DIRECTOR 1.00 X 0 0 0 CHERYL ANDERSON DIRECTOR 1.00 X 0 0 0 COLT DEWOLF DIRECTOR 1.00 X 0 0 0 JERRET SALE TREASURER 1.00 X 0 0 0 JOAN KLEINBERG SECRETARY 1.00 X X 0 0 0 LY SIENG NGO DIRECTOR 1.00 X X 0 0 0 PAMELA DUNN CHAIRPERSON 1.00 X 0 0 0 PATRICK FERGUSON VICE CHAIRPERSON 1.00 X X 0 0 0 RIK WYMAN DIRECTOR 1.00 X 0 0 0 SARA THOMPSON DIRECTOR 1.00 X 0 0 0 WINNIE SPERRY DIRECTOR 1.00 X 0 0 0 ROBERT LESKO DIRECTOR 1.00 X 0 0 0 ROBERT STRAIT DIRECTOR 1.00 X 0 0 0 LINDA MCVEIGH EXECUTIVE DIRECTOR 35.00 X 145175 0 13993 SUSANA TANTICO DIRECTOR OF FINANCE 40.00 X 91333 0 15063 RICHARD KOVAR MD MEDICAL DIRECTOR 32.00 X 154864 0 18398 HAROLD MOORE PHYSICIAN/SITE DIRECTOR 35.00 X 138283 0 14700 CARRIE RUBENSTEIN MD PHYSICIAN/CLINICAL DIRECTOR 28.00 X 107424 0 12004 MEGAN DEBELL MD PHYSICIAN/CLINICAL DIRECTOR 28.00 X 108395 0 11443 BESSIE CHI PHARMACIST 40.00 X 104909 0 13023 JUSTIN PAT IT SPECIALIST 40.00 X 102983 0 15597 953366 0 114221 7 0 1 0 PTSO OF WASHINGTON 710 OLIVE WAY SUITE 300 SEATTLE WA 98101 INFO TECH SUPPORT 282340 1 111472 769365 3911943 234295 4792780 THIRD PARTY PAYMENTS 900099 2315342 2315342 PATIENT FEES 621400 1725670 1725670 MEDICARE/MEDICAID PAYM 900099 1352355 1352355 5393367 16364 16364 41008 0 41008 41008 41008 1447733 1449887 -2154 -2154 -2154 133403 769365 53091 80312 80312 OTHER REVENUE 900099 525451 525451 525451 10847128 5918818 0 135530 438826 173262 265564 5977768 5714398 182905 80465 260210 237335 18854 4021 927204 740754 178190 8260 466726 424330 36241 6155 41010 41010 81786 81786 735188 681869 53203 116 412698 331650 56815 24233 442406 227112 212899 2395 38359 30091 8028 240 457000 430837 26133 30 76040 36764 39276 PHARMACEUTICALS 430758 430758 BAD DEBT 192933 192933 MISCELLANEOUS 190442 94369 94914 1159 FUNDRAISING 176 176 0 11169530 9746638 1295818 127074 635067 308879 91346 91367 712067 734297 498992 778079 342872 460170 7639542 4646678 3261242 2992864 1887283 1653174 14085 13428 7442954 7032258 959032 878509 1724290 1697853 315148 321889 2998470 2898251 X 4361429 4050952 83055 83055 4444484 4134007 7442954 7032258 X -322402 11925 X 0 1 1 X 1 1 X 3939346 4565967 4928394 5556179 4792780 23782666 3939346 4565967 4928394 5556179 4792780 23782666 23782666 171525 134216 95365 84668 57372 543146 140611 94785 74227 30685 78158 418466 3939 1882 3841 9662 24753940 0.96080 0.95900 X 83055 83055 83055 83055 83055 83055 83055 83055 0 0 184000 184000 5377881 3038002 2339879 182047 171363 10684 1895614 1437313 458301 2992864 CAPITAL LEASE 21654 FQHC ENHANCEMENT SETTLEMENT 287133 OTHER LIABILITIES (DEFERRED RENT) 13102 321889 10847128 11169530 -322402 11925 11925 -310477 10974546 11925 62402 74327 10900219 -53091 -53091 10847128 11285023 62402 53091 115493 11169530 0 11169530 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE ASSETS SET ASIDE AND RESTRICTED BY DONORS. THE INCOME GENERATED FROM THESE ASSETS IS USED TO FUND OPERATIONS OF THE ORGANIZATION. PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT SPECIAL EVENT EXPENSES PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT SPECIAL EVENT EXPENSES CDCHC 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. NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS BECAUSE CDCHC IS A NOT-FOR-PROFIT ORGANIZATION, EXEMPT FROM INCOME TAXES. MANAGEMENT EVALUATED CDCHCS TAX POSITIONS AND CONCLUDED THAT CDCHC HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. CDCHC IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2008. FUND RAISING DINNER 902768 769365 133403 35607 17484 902768 769365 133403 35607 17484 53091 80312 X X X 0 0 0 0 0 0 0 0 0 LINDA MCVEIGH 145067 0 108 0 0 0 0 0 13993 0 159168 0 0 0 RICHARD KOVAR MD 154767 0 97 0 0 0 0 0 18398 0 173262 0 0 0 HAROLD MOORE 138175 0 108 0 0 0 0 0 14700 0 152983 0 0 0 X 12 234295 COST OR SELLING PRICE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE BOTH REVIEW A DRAFT OF THE RETURN BEFORE IT IS PRESENTED TO THE FINANCE COMMITTEE FOR FURTHER REVIEW. AFTER REVIEW BY THE FINANCE COMMITTEE AND DISTRIBUTION TO THE FULL BOARD THE FORM 990 IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE AND NON-COMPLIANCE WERE REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED DURING THE MONTHLY MEETINGS. BOARD MEMBERS SIGN A CONFLICT OF INTEREST FORM ANNUALLY. ANY MEMBER WITH A STATED CONFLICT OF INTEREST IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD CHAIRPERSON DETERMINES THE EXTENT OF THE CONFLICT AND WHETHER THE CONFLICTED BOARD MEMBER SHOULD NOT VOTE ON AN ISSUE OR SHOULD RECUSE THEMSELF FROM THE DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. EVERY TWO YEARS THIS PROCESS IS ASSISTED BY AN INDEPENDENT COMPENSATION CONSULTANT. THE LAST REVIEW PROCESS OF THE EXECUTIVE DIRECTOR'S COMPENSATION WAS DONE IN AUGUST 2010. THE DIRECTOR OF FINANCE'S COMPENSATION IS DETERMINED ANNUALLY BY THE BOARD BASED ON A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE REVIEW OF THE DIRECTOR OF FINANCE'S COMPENSATION WAS DONE IN JULY 2010. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 11,925.