2024-05-10T09:02:43-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 100 BELLEVUE WA 98004 990 2022-07-01 930628804 SISKIYOU COMMUNITY HEALTH CENTER INC SISK 5414724777 1701 NW HAWTHORNE AVENUE GRANTS PASS OR 97526 DAWN WEBER RN MHA ACTING CEO 5414724777 2024-05-02 1 DAWN WEBER RN MHA XXX-XX-XXXX 0 KURT BENNION CPA P01469618 4252506100 2024-05-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAWN WEBER RN MHA 1701 NW HAWTHORNE AVENUE GRANTS PASS OR 97526 32042101 0 X WWW.SISKIYOUHEALTHCENTER.COM X 1975 OR TO IDENTIFY AND PROVIDE CARE FOR PRIMARY HEALTH NEEDS OF OUR COMMUNITY IN A PROFESSIONAL AND COMPASSIONATE MANNER. 11 11 274 17 0 0 6887662 7945241 15867747 17702748 48227 8447 4074783 4902598 26878419 30559034 0 83460 0 0 18699285 20030823 0 0 0 7062983 7573046 25762268 27687329 1116151 2871705 31762019 35105296 13440075 13911647 18321944 21193649 TO IDENTIFY AND PROVIDE CARE FOR PRIMARY HEALTH NEEDS OF OUR COMMUNITY IN A PROFESSIONAL AND COMPASSIONATE MANNER. 0 0 19020593 83460 22581121 HEALTHCARE: OUTPATIENT MEDICAL, DENTAL, MENTAL HEALTH, 340B PHARMACY, AND CASE MANAGEMENT SERVICES PROVIDED TO INDIVIDUAL PATIENTS. 1445245 0 0 OUTREACH: OUTREACH, EDUCATION, AND HOME VISITS TO AT-RISK CHILDREN AND THEIR FAMILIES. THIS INCLUDES PARENTING EDUCATION AND HEALTHY START SERVICES TO THESE FAMILIES. OUTPATIENT MEDICAL CARE AND HEALTH EDUCATION AND PROMOTION TO STUDENTS AT THE SCHOOL-BASED CARE CENTER AT THE SCHOOLS IN THE COMMUNITY IT SERVES. 20465838 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 48 0 274 1 0 0 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 0 0 OR X X GREGORY BALL 5414724777 1701 NW HAWTHORNE AVENUE GRANTS PASS OR 97526 KRISTIN MILLER CHIEF MEDICAL DIRECTOR 47.00 X 435253 0 118322 JOE DUNN CHIEF ADMINISTRATIVE & DENTAL OFFICER 47.00 X 396166 0 97780 DUSTIN DURHAM PHYSICIAN 40.00 X 400224 0 91151 CHRISTIAN HOLLAND PHYSICIAN 41.00 X 302319 0 91941 RICHARD BOOTH CHIEF EXECUTIVE OFFICER 48.00 X 295229 0 45392 LINFORD BEACHY PHYSICIAN 32.00 X 244266 0 75008 AMY WILLS TREATING PRACTITIONER 45.00 X 236892 0 54032 BRIAN LAUBSCHER CHIEF COMPLIANCE OFFICER 40.00 X 201436 0 86284 GREGORY BALL CHIEF FINANCIAL OFFICER 42.00 X 209030 0 65505 DANIEL MCDONNELL BEHAVIORAL HEALTH DIRECTOR 40.00 X 196772 0 67777 WARREN KENDALL MD CHAIR 2.00 X X 0 0 0 BRAD LAMONT VICE CHAIR 2.00 X X 0 0 0 GARY RUSS DUNHAM TREASURER 2.00 X X 0 0 0 DENISE TERRELL SECRETARY 2.00 X X 0 0 0 RICHARD COHEN MD DIRECTOR 2.00 X 0 0 0 ROBIN HAUSEN DIRECTOR 2.00 X 0 0 0 LYLE JACKSON MD DIRECTOR 2.00 X 0 0 0 DERRICK KLEINER DIRECTOR (THROUGH MAY 2023) 2.00 X 0 0 0 MONICA MCFADDEN JD DIRECTOR 2.00 X 0 0 0 JENNIFER ROBERTS PHD DIRECTOR 2.00 X 0 0 0 JOHN SEIDEL EDM DIRECTOR 2.00 X 0 0 0 WILLIAM WARD DIRECTOR 2.00 X 0 0 0 2917587 0 793192 43 0 1 0 SCRIBE-X LLC PO BOX 6590 PORTLAND OR 97228 TRANSCRIPTION SERVICES 215126 DIAMOND MEDICAL MAINTENANCE INC PO BOX 3071 CENTRAL POINT OR 97502 CLEANING SERVICES 162449 BARTON & ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 LOCUMS MEDICAL PROVIDER 158287 3 30438 7109397 805406 7945241 NET PATIENT SERVICES 621300 16734176 16734176 MEDICAL INCENTIVE REVENUE 621300 968572 968572 17702748 32609 32609 7738 0 7738 7738 7738 24162 -24162 -24162 -24162 15117 30438 23591 -8474 -8474 6313687 1435314 4878373 4878373 MISCELLANEOUS REVENUE 900099 24961 24961 24961 30559034 22581121 0 32672 83460 83460 1847380 518883 1328497 14256038 11900147 2355891 419371 325114 94257 2295523 1802350 493173 1212511 898587 313924 5907 5907 51912 51912 1453807 1143398 310409 304609 47770 256839 142173 138265 3908 986606 878044 108562 258240 146119 112121 364079 359514 4565 1320258 430800 889458 110286 39852 70434 MEDICAL SUPPLIES 851406 788552 62854 REPAIRS & MAINTENANCE 837692 361014 476678 RECRUITMENT & PROVIDER 419182 359076 60106 MISCELLANEOUS 241068 85004 156064 225821 159889 65932 27687329 20465838 7221491 0 2803814 5535188 2643614 1095399 335996 161233 3416007 5333269 361287 329380 264269 415935 30615785 9205318 21621812 21410467 315220 824425 31762019 35105296 1797600 2353970 150000 49960 11172657 10609354 319818 898363 13440075 13911647 X 18321944 21193649 18321944 21193649 31762019 35105296 2871705 0 X 0 1 X 1 1 1 X 4942572 5909482 9747760 6887662 7960358 35447834 4942572 5909482 9747760 6887662 7960358 35447834 35447834 94463 86396 57289 62696 40347 341191 22248 41705 49469 34606 24961 172989 35962014 97414818 0.98570 0.98370 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME FUNDRAISING EVENT INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1246527 1246527 17828561 2785303 15043258 4453445 1694038 2759407 6015761 4020520 1995241 1071491 705457 366034 21410467 DEFERRED COMPENSATION 424271 RIGHT-OF-USE LEASE LIABILITIES 474092 898363 X 31868435 1482562 1482562 30385873 173161 173161 30559034 29062554 1482562 1482562 27579992 107337 107337 27687329 PART X, LINE 2: THE CENTER IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) EXCEPT ON NET INCOME DERIVED FROM UNRELATED BUSINESS ACTIVITIES. MANAGEMENT BELIEVES THERE WAS NO UNRELATED BUSINESS INCOME DURING THE YEAR ENDED JUNE 30, 2023; THEREFORE, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT ANY PROVISION FOR INCOME TAXES. THE CENTER HAS BEEN CLASSIFIED AS AN ENTITY THAT IS NOT A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) AND QUALIFIES FOR DEDUCTIBLE CONTRIBUTIONS AS PROVIDED IN SECTION 170(B)(1)(A)(III). THE CENTER IS EXEMPT FROM PROPERTY TAX ON DEVELOPED LAND UNDER OREGON REVISED STATUTE (ORS) 307.130. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 23,591. COST OF GOODS SOLD 1,435,314. LOSS ON DISPOSAL OF FIXED ASSETS 23,657. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER NONOPERATING INCOME 65,824. BAD DEBT EXPENSE 107,337. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 23,591. COST OF GOODS SOLD 1,435,314. LOSS ON DISPOSAL OF FIXED ASSETS 23,657. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 107,337. TEE OFF FOR KIDS 45555 30438 15117 4917 7100 189 11385 45555 30438 15117 4917 7100 189 11385 23591 -8474 1 GRANTS PASS ACTIVE CLUB PO BOX 961 GRANTS PASS OR 97528 930883280 501(C)(3) 16183 0 2022 4 THE KIDS LIVESTOCK AUCTION 1 0 PART I, LINE 2: ALL DONATIONS ARE GIVEN TO CHARITABLE ORGANIZATIONS FOR WHOLESOME EVENTS FOR KIDS, FAMILIES AND THOSE IN NEED. AS DONATIONS ARE MADE TO CHARITABLE ORGANIZATIONS FOR GENERAL OPERATING SUPPORT, NO SPECIFIC FOLLOW-UP IS CONDUCTED REGARDING THE USE OF THE FUNDS. X X X X 0 0 0 1 0 0 0 1 0 KRISTIN MILLER CHIEF MEDICAL DIRECTOR 322181 0 6039 0 107033 0 12200 0 106122 0 553575 0 0 0 JOE DUNN CHIEF ADMINISTRATIVE & DENTAL OFFICER 359596 0 10243 0 26327 0 12200 0 85580 0 493946 0 0 0 DUSTIN DURHAM PHYSICIAN 274430 0 400 0 125394 0 12200 0 78951 0 491375 0 0 0 CHRISTIAN HOLLAND PHYSICIAN 262869 0 400 0 39050 0 12003 0 79938 0 394260 0 0 0 RICHARD BOOTH CHIEF EXECUTIVE OFFICER 234977 0 13051 0 47201 0 0 0 45392 0 340621 0 0 0 LINFORD BEACHY PHYSICIAN 243257 0 500 0 509 0 9946 0 65062 0 319274 0 0 0 AMY WILLS TREATING PRACTITIONER 178869 0 400 0 57623 0 9574 0 44458 0 290924 0 0 0 BRIAN LAUBSCHER CHIEF COMPLIANCE OFFICER 198375 0 2900 0 161 0 8198 0 78086 0 287720 0 0 0 GREGORY BALL CHIEF FINANCIAL OFFICER 182651 0 24650 0 1729 0 8554 0 56951 0 274535 0 0 0 DANIEL MCDONNELL BEHAVIORAL HEALTH DIRECTOR 192884 0 2700 0 1188 0 8085 0 59692 0 264549 0 0 0 PART I, LINE 5 THE ORGANIZATION'S MEDICAL PROVIDERS MAY RECEIVE INCENTIVE COMPENSATION BASED ON THE NUMBER OF PATIENTS SEEN IN A DAY, WHICH IS CLOSELY CONNECTED TO THE ORGANIZATION'S REVENUES. PART I, LINE 7 IN 2022, ALL EMPLOYEES RECEIVED BONUSES. THE AMOUNTS WERE DETERMINED BY THE BOARD OF DIRECTORS AND CEO, BASED ON TYPE OF POSITION AND TENURE. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE COMPRISED OF THE OFFICERS OF THE BOARD. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS IN EMERGENCY SITUATIONS WHEN AN IMMEDIATE DECISION MUST BE MADE TO AVOID A DELETERIOUS OUTCOME. ANY EMERGENCY ACTION TAKEN BY THE EXECUTIVE COMMITTEE MUST BE RATIFIED BY A MAJORITY VOTE OF THE BOARD AT ITS NEXT REGULAR MEETING. THE EXECUTIVE COMMITTEE'S RESPONSIBILITIES ALSO INCLUDE (A) COORDINATING ACTIVITIES OF THE BOARD; (B) CONDUCTING AN ANNUAL PERFORMANCE EVALUATION OF THE CEO AND RECOMMENDING ADJUSTMENTS TO THE CEO'S COMPENSATION PACKAGE CONSISTENT WITH THE RESULTS OF THE EVALUATION; (C) OVERSEEING THE RESEARCH, DEVELOPMENT AND RECOMMENDATION OF A LONG-RANGE PLAN; (D) MAKING SPECIFIC FISCAL GOALS AND OBJECTIVE RECOMMENDATIONS FOR ADOPTION BY THE BOARD BASED ON THE STRATEGIC PLAN; (E) REVIEWING AND RECOMMENDING CONTRACTUAL RELATIONSHIPS FOR OUTSIDE SERVICES WITH CONSULTANTS AND SPECIALISTS; (F) REVIEWING, DEVELOPING AND RECOMMENDING THE ORGANIZATION'S HUMAN RESOURCES POLICIES; AND (G) ANNUALLY REVIEWING EMPLOYMENT CLASSIFICATIONS, SALARIES AND BENEFITS. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 WAS REVIEWED BY THE EXECUTIVE STAFF AND BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C EMPLOYEES, DIRECTORS, CONSULTANTS, AND THOSE WHO PROVIDE SERVICES OR FURNISH GOODS TO THE CORPORATION SHALL AVOID ANY CONFLICT OF INTEREST OR THE APPEARANCE OF CONFLICT OF INTEREST BY EXEMPTING THEMSELVES FROM CONSIDERING ANY INDIVIDUAL ISSUES ON WHICH THEY HAVE AN ACTUAL OR APPARENT CONFLICT OF INTEREST. THE BOARD REQUIRES THAT EACH MEMBER FILL OUT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE DOCUMENTING ALL COMPANIES OWNED BY BOARD MEMBERS OR OTHER BOARDS THAT THE MEMBER MAY BELONG TO. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE CONDUCTS AN ANNUAL PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER AND RECOMMENDS ADJUSTMENTS TO THE CHIEF EXECUTIVE OFFICER'S COMPENSATION PACKAGE CONSISTENT WITH THE RESULTS OF THE ANNUAL EVALUATION AND THE MOST RECENT MGMA SALARY SURVEY STANDARDS. EACH YEAR A MARKET REVIEW OF KEY EMPLOYEES' COMPENSATION IS PREPARED USING THE NORTHWEST REGIONAL PRIMARY CARE ASSOCIATIONS EVALUATIONS FOR REGION X, SPECIFIC TO FQHC'S.. COMPENSATION COMPARISONS ARE ALSO EVALUATED USING THE NATIONAL MGMA AND THE OREGON CHAPTER OF THE MGMA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATMEENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.