2011-04-18T14:10:33-05:00 2010-05-31 Clark Nuber PS 10900 NE 4th Street Suite 1700 Bellevue WA 98004 990 2009-06-01 911349657 COMMUNITY HEALTH CARE COMM 2535974550 101 EAST 26TH STREET No 100 TACOMA WA 984211108 DAVID FLENTGE 2535974550 2011-04-14 1 Sara Elizabeth J Hyre 4254544919 2009 2016-02-24 21:20:13Z DAVID FLENTGE 101 EAST 26TH STREET No 100 TACOMA WA 984211108 31808991 0 X WWW.COMMHEALTH.ORG X 1987 WA TO PROVIDE THE HIGHEST QUALITY HEALTH CARE WITH COMPASSIONATE AND ACCESSIBLE SERVICE FOR ALL. 15 15 406 60 0 0 9314479 6331802 26220493 25019678 66235 -229272 291287 -12239 35892494 31109969 9125 4603 0 22243992 21331213 39438 60635 228441 8722471 8548619 31015026 29945070 4877468 1164899 35706915 37560574 6854457 7543217 28852458 30017357 COMMUNITY HEALTH CARE PROVIDES COMPREHENSIVE PRIMARY MEDICAL AND DENTAL CARE THROUGH A CLINIC SYSTEM THAT INCLUDES SIX MEDICAL AND TWO DENTAL CLINICS. IN ADDITION CARE IS ALSO PROVIDED THROUGH A WOMEN'S HEALTH CLINIC. 0 0 15791440 15800860 COMMUNITY HEALTH CARE (CHC) MEDICAL CLINICS OFFER MEDICAL SERVICES AND URGENT CARE CENTER SERVICES IN VARIOUS LOCATIONS IN PIERCE COUNTY ACCORDING TO A SLIDING FEE SCALE BASED ON INCOME AND FAMILY SIZE. DURING THE FISCAL YEAR ENDED 05/31/10, COMMUNITY HEALTH CARE PROVIDED 22,226 PATIENTS WITH MEDICAL CARE FROM 103,337 PATIENT VISITS AT 6 MEDICAL CLINICS WITH 45 MEDICAL PROVIDERS. 63% OF PATIENTS ARE AT POVERTY LEVEL OR BELOW. 85% OF PATIENTS ARE LOW-INCOME. CHC PROVIDED $1,700,023 IN TOTAL CHARITY CARE FOR FISCAL YEAR ENDING 5/31/10. 4421589 5062994 COMMUNITY HEALTH CARE DENTAL CLINICS OFFER PRIMARY CARE DENTAL SERVICES IN VARIOUS PIERCE COUNTY LOCATIONS ACCORDING TO THE SAME FEE STRUCTURE. DURING THE FISCAL YEAR ENDED 05/31/10 COMMUNITY HEALTH CARE PROVIDED 38,359 DENTAL ENCOUNTERS TO 14,388 PATIENTS AT TWO DENTAL CLINICS WITH 13 DENTAL PROVIDERS. 2836724 3276878 SIX PHARMACIES OFFER PHARMACEUTICAL SERVICES TO PATIENTS IN VARIOUS LOCATIONS IN PIERCE COUNTY ACCORDING TO THE SAME FEE STRUCTURE NOTED ABOVE. THE PHARMACY SERVED 11,901 PATIENTS THROUGH 95,226 MEDICATION FILLS. 1013625 891626 COMMUNITY HEALTH CARE PROVIDES EXTENSIVE MATERNITY SUPPORT SERVICES TO HIGH RISK PREGNANT MOTHERS. THIS INCLUDES IN-OFFICE AND IN-HOME CARE BY NURSES, SOCIAL WORKERS, AND NUTRITIONISTS. THE ORGANIZATION ALSO PROVIDES SERVICES OF AN OPHTHALMOLOGIST, PARTICULARLY FOR DIABETIC PATIENTS. 1,951 PATIENTS RECEIVED 7,632 PATIENT VISITS FROM COMMUNITY HEALTH CARE'S MATERNITY SUPPORT SERVICES, NUTRITION PROGRAM, AND ANITCOAGULATION PROGRAM. 1013625 891626 24063378 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 19 0 1 406 1 0 0 0 0 0 0 0 0 0 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X DAVID FLENTGE 2535974550 101 EAST 26TH STREET SUITE 100 TACOMA WA 98421 LINDA BOWMAN 0.50 X 0 0 0 LUIS CAIRE 2.00 X 0 0 0 OLGA GRIBBLE 2.00 X 0 0 0 FIDEL PINO 1.00 X 0 0 0 PETER SETO 2.00 X 0 0 0 ARTURO BIBLARZ 2.00 X 0 0 0 DAN SLOAN 6.00 X 0 0 0 GEORGE TANBARA 2.00 X 0 0 0 SHAMAY THOMAS 2.00 X 0 0 0 DOUG SWANBERG 2.50 X X 0 0 0 DAVE KIMBERLING 2.00 X X 0 0 0 PEG DEMPSEY 2.00 X X 0 0 0 GARY WALMER 5.00 X X 0 0 0 IRENE MAZER 5.00 X 0 0 0 KYLE SHIMAMOTO 2.00 X 0 0 0 DEBRA YOUNG 1.50 X X 0 0 0 LORI ENGELKING 1.50 X 0 0 0 LYSA BARBANO 2.00 X 0 0 0 THOMAS DUKE 2.00 X 0 0 0 DAVID FLENTGE 40.00 X 154400 0 17334 JEFFREY SMITH 40.00 X 231735 0 33040 DEARL OLSEN 40.00 X 163600 0 24296 KATHRYN TONDER 40.00 X 171709 0 26572 RALPH NEIGHBOR 40.00 X 222713 0 26922 CHUCK SAMUELS 40.00 X 179311 0 16801 ENRIQUE LEON 40.00 X 171189 0 37578 SUSAN POWELL 40.00 X 164527 0 31095 1459184 0 213638 31 0 1 0 RUSHFORTH CONSTRUCTION 6021 12TH STREET TACOMA WA 98424 GENERAL CONSTRUCTION 933211 OPENWORKS 4742 N 24TH STREET SUITE 300 PHOENIX WA 85016 JANITORIAL SERVICES 180901 NORTHWEST CUSTOM ROOFING POBOX 111851 TACOMA WA 98411 GENERAL CONSTRUCTION 167745 JOHNSON ARCHITECTURE 2124 THIRD AVENUE SUITE 200 SEATTLE WA 98121 ARCHITECTURAL SERVICES 143636 VISTA STAFFING 275 EAST 200 SOUTH SALT LAKE CITY UT 84111 TEMPORARY STAFFING 120896 5 66885 59771 5161607 1043539 839302 6331802 PATIENT FEES 621400 20070334 20070334 PHARMACY REVENUE 621300 2841054 2841054 GOVERNMENT AGENCY FEES 621400 2108290 2108290 25019678 79027 79027 358404 666703 358404 -666703 -308299 -308299 7400 59771 32319 -24919 -24919 REIMBURSEMENTS 623990 10682 10682 MISCELLANEOUS 900099 1163 1163 MEDICAL RECORDS 623990 835 835 12680 31109969 25032358 0 -254191 4603 4603 655008 431914 223094 16088548 13020750 2978392 89406 665598 550500 110710 4388 2737953 2123959 609372 4622 1184106 953665 223853 6588 16738 16738 69368 69368 60635 60635 122697 18014 104235 448 1618185 1425019 175946 17220 887626 486296 398580 2750 68380 40982 27169 229 44974 26954 17869 151 95861 79363 16498 1430394 1267954 162440 129930 90783 39147 PHARMACY 1306929 1300688 6241 BAD DEBT 723785 714410 9375 CONTRACT SERVICES 625490 393685 231805 CONTRACT PROVIDERS 362857 362419 438 LABORATORY FEES 205930 205930 839475 565490 241356 32629 29945070 24063378 5653251 228441 5660462 7425948 1817201 1501424 2830693 341406 3158890 5425030 279773 263219 484406 251131 28004277 6482786 20754102 21521491 721388 830925 35706915 37560574 5264457 2724445 1590000 1525000 3293772 6854457 7543217 X 28852458 30017357 28852458 30017357 35706915 37560574 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 1 0 0 1 2056 0 0 2056 0 3423354 3423354 16014607 1554643 14459964 2113265 767506 1345759 6356777 4064897 2291880 96274 95740 534 21521491 31109969 29945070 1164899 0 1164899 31158522 16234 16234 31142288 -32319 -32319 31109969 29993623 16234 32319 48553 29945070 0 29945070 PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES: $-32,319 PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES: $32,319 X X X X X X X 1 RICHARD OLDENBURG CONSULTING 0 796610 60635 735975 796610 60635 735975 WA LUNCHEON 67171 59771 7400 25 4000 7347 12201 8746 67171 59771 7400 25 4000 7347 12201 8746 32319 -24919 X X X X X 0 0 0 0 0 0 0 0 0 DAVID FLENTGE 143791 0 0 0 10609 0 7251 0 10083 0 171734 0 0 0 JEFFREY SMITH 214605 0 16866 0 264 0 11049 0 21991 0 264775 0 0 0 DEARL OLSEN 149712 0 12022 0 1866 0 7687 0 16609 0 187896 0 0 0 KATHRYN TONDER 156595 0 14952 0 162 0 7125 0 19447 0 198281 0 0 0 RALPH NEIGHBOR 189662 0 31825 0 1226 0 9698 0 17224 0 249635 0 0 0 CHUCK SAMUELS 156947 0 22094 0 270 0 7868 0 8933 0 196112 0 0 0 ENRIQUE LEON 138298 0 32634 0 257 0 7549 0 30029 0 208767 0 0 0 SUSAN POWELL 146004 0 18259 0 264 0 2754 0 28341 0 195622 0 0 0 WA HEALTH CARE FACILITIES AUTHORITY 911108929 93978EUW0 2003-01-23 3320000 To fund building 0 0 3320000 96667 135000 3088333 2003 0 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 X 1 4920 AVERAGE HIGH/LOW X 50 834382 COST OR SELLING PRICE 0 0 1 0 Form 990, Part VI, Section B, line 11 THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING. THE BOARD IS GIVEN THE OPPORTUNITY TO FORWARD QUESTIONS AND OR CONCERNS TO THE FINANCE COMMITTEE SO THEY CAN BE ADDRESSED. Form 990, Part VI, Section B, line 12c BOARD MEMBERS AND MANAGEMENT TEAM MEMBERS ARE ASKED TO SIGN STATEMENTS AT INITIAL ORIENTATION AND AGAIN ANNUALLY. EMPLOYEES SIGN STATEMENTS AT INITIAL ORIENTATION AND THEN EVERY THREE YEARS. RECORDS ARE MAINTAINED BY EITHER THE HR DIRECTOR OR THE ASSISTANT TO THE CEO. REPORTED OR POTENTIAL CONFLICTS ARE REVIEWED BY EITHER THE HR DIRECTOR OR THE CEO. IF A CONFLICT OF INTEREST EXISTS, THE BOARD MEMBER OR MANAGEMENT TEAM MEMBER CAN RECUSE THEMSELVES FROM THE DISCUSSION OR VOTING. IF A CONFLICT IS PERVASIVE WITH A BOARD MEMBER THEN THE CO-CHAIRS CAN PROCEED TO REMOVE THE BOARD MEMEBER. IF A CONFLICT IS PERVASIVE WITH A STAFF MEMBER THEN THEY MAY BE TERMINATED. Form 990, Part VI, Section B, line 15 ANNUALLY THE CO-CHAIRS OF THE BOARD ASSIGN AN AD HOC COMMITTEE TO CONDUCT THE ANNUAL EVALUATION OF THE CEO, AS WELL AS DETERMINE ANY COMPENSATION CHANGES. OFTEN THE ENTIRE EXECUTIVE COMMITTEE IS INVOLVED. THE RESULTS OF THE EVALUATION WILL BE USED BY THE BOARD AS A BASIS TO DETERMINE WHETHER AN INCREASE SHOULD BE GIVEN. THE BOARD HAS DETERMINED THAT THEY WILL COMPLETE A COMPREHENSIVE SALARY COMPARISON OF COMPARABLE SIZED COMMUNITY HEALTH CENTERS IN THE NORTHWEST, USING A CONSULTANT, EVERY THREE YEARS. DURING THE OTHER TWO YEARS THE BOARD WILL REVIEW DATA MADE AVAILABLE BY THE NORTHWEST REGIONAL PRIMARY CARE ASSOCIATION AS A REFERENCE POINT IN MAKING A DETERMINATION ABOUT HOW MUCH OF AN INCREASE WOULD BE GRANTED IF ANY. SALARY RANGES FOR ALL OTHER EMPLOYEE SALARIES ARE APPROVED BY THE BOARD BASED ON SURVEY DATA PROVIDED TO THE HR DEPARTMENT AND/OR UNION NEGOTIATIONS. Form 990, Part VI, Section C, line 19 THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART I, LINE 6: VOLUNTEERS SERVED ON COMMUNITY HEALTH CARE'S BOARD AND ITS COMMUNITY RELATIONS, EXECUTIVE, FINANCE, MEMBERSHIP, PERSONNEL, PLANNING AND QUALITY IMPROVEMENT, AND/OR FACILITIES COMMITTEES. ALSO VOLUNTEERS SERVED ON THE MARKETING ADVISORY, DEVELOPMENT ADVISORY, AND/OR THE CAPITAL CAMPAIGN COUNCILS. SCHEDULE A PART I, LINE 3: REASON FOR PUBLIC CHARITY STATUS ALTHOUGH THE ORGANIZATION IS A HOSPITAL AS DESCRIBED IN 170(B)(1)(A)(III), THE ORGANIZATION IS NOT A LICENSED HOSPITAL UNDER STATE LAW. THEREFORE, THE ORGANIZATION DID NOT COMPLETE SCHEDULE H.