2012-12-21T10:04:55-06:00 2012-03-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2011-04-01 911537371 MOSES LAKE COMMUNITY HEALTH CENTER MOSE 5097650674 605 COOLIDGE DRIVE MOSES LAKE WA 98837 CAROLYN BRANDENBURG 5097650674 2012-12-20 1 SARA ELIZABETH J HYRE P00235495 4254544919 2012-12-21 2011 2016-02-24 21:20:13Z SHEILA CHILSON 605 COOLIDGE DRIVE MOSES LAKE WA 98837 28132083 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. 11 11 272 13 0 0 4660479 3939664 15957467 16837428 219337 330379 86478 197524 20923761 21304995 0 0 0 0 12864690 13082310 0 0 15781 5437481 5751150 18302171 18833460 2621590 2471535 22643445 25734565 5664872 6501730 16978573 19232835 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 9116927 12759488 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 9 PHYSICIANS AND 10 MID-LEVEL PHYSICIANS ON STAFF. IN 2011, 19,286 MEDICAL PATIENTS WERE SEEN WITH A TOTAL OF 69,258 VISITS. 2518657 2864761 DENTAL SERVICES - MLCHC HAS 7 DENTISTS AND 2 DENTAL HYGIENISTS ON STAFF TO PROVIDE PREVENTATIVE, RESTORATIVE AND EMERGENCY CARE TO THE HEALTH CENTER'S INSURED AND UNINSURED PATIENTS. IN 2011, 8,214 PATIENTS WERE SEEN IN THE DENTAL DEPARTMENT WITH A TOTAL OF 22,054 VISITS PROVIDED. 1794995 1213179 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 6,639 VISITS TO APPROXIMATELY 1,600 PATIENTS. THE WIC PROGRAM SERVICES ELIGIBLE CLIENTS THROUGHOUT GRANT COUNTY IN MULTIPLE LOCATIONS. 13430579 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 0 1 33 0 1 272 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X CAROLYN BRANDENBURG 5097650674 605 COOLIDGE DRIVE MOSES LAKE WA 98337 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 FRANCES LEINWEBER 1.00 X 0 0 0 ORALIA CERRILLO 1.00 X 0 0 0 JUAN CARLOS MAGALLANES-MORALES 1.00 X 0 0 0 JUANITA KILPATRICK 1.00 X 0 0 0 JUAN REYES CUIN 1.00 X 0 0 0 SHEILA CHILSON 40.00 X 122257 0 19430 SHIRLEY MERKLE 40.00 X 103835 0 8200 CAROLYN BRANDENBURG 40.00 X 69396 0 18681 LARRY VERHAGE 40.00 X 314432 0 34037 ANDRE NYE 40.00 X 311552 0 32883 MICHAEL TOLLEY 40.00 X 266818 0 30957 KRISTY THOMPSON 40.00 X 234979 0 29275 MARK VANCE 40.00 X 181042 0 28695 GREGG LIEDTKA 40.00 X 149493 0 21300 1753804 0 223458 20 0 1 0 TROI IT SOLUTIONS 801 SOUTH STEVENS STREET SPOKANE WA 99204 INFORMATION TECHNOLOGY SERVICE 608697 QUEST DIAGNOSTICS LOCK BOX 91514 QUEST DIAGNOSTICS LOS ANGELES CA 90074 OUTSIDE LAB SERVICE 196513 CLEANPROS POST OFFICE BOX 305 MOSES LAKE WA 98837 JANITORIAL 189530 3 3918281 21383 3939664 PATIENT SERVICES 624100 11234189 11234189 MANAGED CARE 624100 5283294 5283294 CONTRACT SERVICES 624100 319945 319945 16837428 227236 227236 6930231 6823145 3943 107086 -3943 103143 103143 INCENTIVE PAYMENTS 900099 191250 191250 UNDERGRAD STIPENDS 611710 3300 3300 MEDICAL RECORDS FEES 561000 2000 2000 974 974 197524 21304995 16837428 0 527903 704077 116620 571676 15781 9997014 8237279 1759735 254694 207477 47217 1226519 964229 262290 900006 673430 226576 17536 10396 7140 46981 46981 45032 45032 232458 129682 102776 82587 28000 54587 272255 136996 135259 922417 190176 732241 236193 58769 177424 118682 102819 15863 58332 42071 16261 80467 80467 742407 98977 643430 93939 43045 50894 MED & PHARM SUPPLIES 1091522 1091431 91 PURCHASED SERVICES 495687 412209 83478 BAD DEBTS 489212 489212 REPAIRS AND MAINTENANCE 279807 45196 234611 445636 352565 93071 18833460 13430579 5387100 15781 983470 1972993 2003004 1473609 179905 295523 1993500 2984041 313535 322374 87332 163329 15265976 5406814 10138836 9859162 6835386 8557886 50477 47648 58000 58000 22643445 25734565 2159023 3512849 2113879 2021626 1391970 967255 5664872 6501730 X 16978573 19097835 135000 16978573 19232835 22643445 25734565 X 2471535 -217273 X 0 1 1 X 1 1 X 3582138 4170422 4537962 4660479 3939664 20890665 3582138 4170422 4537962 4660479 3939664 20890665 20890665 166413 148603 211755 198349 227236 952356 86478 4274 90752 193250 193250 22127023 74615969 0.94410 0.95420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 362467 362467 7862635 1673784 6188851 2931245 1111096 1820149 4054551 2621934 1432617 55078 55078 9859162 21304995 18833460 2471535 -217273 -217273 2254262 21087722 -217273 -217273 21304995 0 21304995 18833460 0 18833460 0 18833460 X X X 0 0 0 0 0 0 0 0 0 LARRY VERHAGE 314092 0 100 0 240 0 9800 0 24237 0 348469 0 0 0 ANDRE NYE 311212 0 100 0 240 0 9800 0 23083 0 344435 0 0 0 MICHAEL TOLLEY 266278 0 300 0 240 0 8849 0 22108 0 297775 0 0 0 KRISTY THOMPSON 219639 0 15100 0 240 0 8792 0 20483 0 264254 0 0 0 MARK VANCE 177732 0 3070 0 240 0 6135 0 22560 0 209737 0 0 0 GREGG LIEDTKA 134176 0 15100 0 217 0 6157 0 15143 0 170793 0 0 0 WASHINGTON HEALTH CARE FACILITIES 911108929 93978EUWO 2003-01-23 943250 SEE PART V 0 0 1 186584 943250 52580 18866 19476 852363 2003 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 X SCHEDULE K, PART I, LINE A, COLUMN F THE BOND ISSUE 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -217,273.