2026-07-20T15:10:58-05:00 2025-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2025-01-01 260493856 INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION INTE 2067883585 720 8TH AVENUE SOUTH 100 SEATTLE WA 98104 KELLI NOMURA ICHS CEO 2067883585 2026-07-11 1 KURT BENNION P01469618 4252506100 2026-06-26 2025 2025-03-06 01:10:19Z ICHS FOUNDATION KELLI NOMURA 720 8TH AVENUE SOUTH 100 SEATTLE WA 98104 1473596 0 X WWW.ICHS.COM/ICHS-FOUNDATION X 2007 WA TO RAISE FUNDS FOR AND PROVIDE PHILANTHROPIC SUPPORT TO INTERNATIONAL COMMUNITY HEALTH SERVICES. 13 12 0 40 0 0 4817559 1452113 0 0 0 0 6794 -18133 4824353 1433980 407330 728291 0 0 0 0 0 0 288725 731583 732879 1138913 1461170 3685440 -27190 207634 209702 11697 40955 195937 168747 X TO RAISE FUNDS FOR AND PROVIDE PHILANTHROPIC SUPPORT TO INTERNATIONAL COMMUNITY HEALTH SERVICES (ICHS). 0 0 728291 728291 0 ICHS FOUNDATION GENERATES FINANCIAL RESOURCES FOR CHARITY CARE PROVIDED BY INTERNATIONAL COMMUNITY HEALTH SERVICES (ICHS) THROUGH FUNDRAISING EVENTS, DIRECT APPEALS, GRANTS, AND ONLINE FUNDRAISING CAMPAIGNS. CHARITY CARE INCLUDES ANY UNCOMPENSATED MEDICAL, DENTAL, AND OTHER HEALTH SERVICES PROVIDED BY ICHS. IN 2025, ICHS FOUNDATION RAISED $786,628 OF PHILANTHROPIC SUPPORT FOR UNCOMPENSATED CARE. INTERNATIONAL COMMUNITY HEALTH SERVICES (ICHS) IS A FEDERALLY QUALIFIED HEALTH CENTER SERVING KING COUNTY, WA. DEEPLY ROOTED IN THE ASIAN PACIFIC ISLANDER COMMUNITY, ICHS PROVIDES CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND WELLNESS SERVICES AND PROMOTES HEALTH EQUITY FOR ALL.(CONTINUED IN SCHEDULE O)ICHS CURRENTLY OPERATES 12 SERVICE SITES ACROSS KING COUNTY, WHICH INCLUDES:- FOUR FULL-SERVICE MEDICAL AND DENTAL CLINICS, A VISION CLINIC IN SEATTLE, HOLLY PARK, SHORELINE AND BELLEVUE, WA;- TWO SCHOOL-BASED HEALTH CENTERS IN SEATTLE AND BELLEVUE;- A PRIMARY CARE CLINIC AT A HUMAN SERVICES PROVIDER IN SOUTH SEATTLE;- A MOBILE DENTAL AND MEDICAL CLINIC WHICH VISITS SCHOOLS AND COMMUNITY SITES IN KING COUNTY;- AN ASSISTED LIVING FACILITY, LEGACY HOUSE, WITH ADULT DAY SERVICES;- A CONGREGATE MEAL PROGRAM IN THE INTERNATIONAL DISTRICT; AND- A PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY AT LEGACY HOUSE.ICHS FOUNDATION GENERATES FINANCIAL RESOURCES FOR ICHS CAPITAL IMPROVEMENTS AND EXPANSION EFFORTS, INCLUDING BUT NOT LIMITED TO EQUIPMENT UPGRADES, FACILITY EXPANSION, ACQUISITION, AND CONSTRUCTION.ICHS FOUNDATION WORKS WITH THE MARKETING AND COMMUNICATIONS DEPARTMENT TO DISSEMINATE HEALTH RELATED INFORMATION AND EVENTS TO THE COMMUNITY. 728291 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 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 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 13 12 0 1 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X HERMES SHAHBAZIAN 2067883618 720 8TH AVENUE SOUTH 100 SEATTLE WA 98104 X KELLI NOMURA DIRECTOR 2.00 42.00 X 0 353409 30894 HERMES SHAHBAZIAN CFO 2.00 42.00 X 0 264307 19738 ALICE BRAVERMAN EXECUTIVE DIR. (THRU JAN '25 & AS OF OCT '25) 30.00 0.00 X 0 95516 4447 MELISSA JOHNSON EXECUTIVE DIRECTOR (MAR - JULY 2025) 40.00 0.00 X 0 97410 2849 JENNY SHIN PRESIDENT 2.00 0.00 X X 0 0 0 MATT HOPKINS VICE PRESIDENT 1.00 0.00 X X 0 0 0 HANNAH WONG VICE PRESIDENT 1.00 0.00 X X 0 0 0 RAJ SIDHU SECRETARY (THROUGH DECEMBER 2025) 1.00 0.00 X X 0 0 0 LUIS BARBERO TREASURER 1.00 0.00 X X 0 0 0 CAMILLE BIGGINS DIRECTOR 0.50 0.00 X 0 0 0 JOHN FOZ DIRECTOR 0.50 1.50 X 0 0 0 ARIGIN SAKDA DIRECTOR 0.50 0.00 X 0 0 0 LEECHING TRAN DIRECTOR 0.50 0.00 X 0 0 0 JOANNA VALDERRAMA DIRECTOR 0.50 0.00 X 0 0 0 BETTY WONG DIRECTOR 0.50 0.00 X 0 0 0 CHARLES WU DIRECTOR 0.50 0.00 X 0 0 0 GRACE YU DIRECTOR 0.50 0.00 X 0 0 0 0 810642 57928 0 0 1 0 INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVENUE S 100 SEATTLE WA 98104 MANAGEMENT SERVICES 444154 1 48393 637735 765985 12206 1452113 20206 48393 39616 -19410 -19410 MISCELLANEOUS INCOME 900099 1277 1277 1277 1433980 0 0 -18133 X 728291 728291 444154 444154 29600 29600 4200 4200 160477 160477 16988 16988 27915 27915 35 35 22386 22386 690 690 22237 22237 62 62 2116 2116 MISCELLANEOUS 907 907 DUES & SUBSCRIPTIONS 864 864 LICENSES & TAXES 155 155 EQUIPMENT 93 93 1461170 728291 444154 288725 47634 43572 160000 80750 5755 2221 2221 0 0 0 79625 207634 209702 11697 11165 29790 11697 40955 X 195937 168747 195937 168747 207634 209702 -27190 0 X X 0 1 X 1 0 X X X 1 INTERNATIONAL COMMUNITY HEALTH SERVICES 910947084 3 1 728291 0 1 728291 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2221 2221 0 0 RECEIVABLE FROM RELATED ORGANIZATIONS 64000 DEPOSITS 15625 79625 X PART X, LINE 2: THE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT EVALUATED ICHS, THE FOUNDATION, AND AIPACE'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE CONSOLIDATED FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION (ASC). LUNAR NEW YR. LUNCHEON 68599 48393 20206 5493 20828 13295 68599 48393 20206 5493 20828 13295 39616 -19410 1 INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVENUE S 100 SEATTLE WA 98104 910947084 501(C)(3) 728291 0 TO SUPPORT CLINICAL OPERATIONS 1 0 PART I, LINE 2: INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION ONLY GRANTS MONEY TO INTERNATIONAL COMMUNITY HEALTH SERVICES, ITS SUPPORTED ORGANIZATION. BOTH ORGANIZATIONS ARE UNDER COMMON CONTROL. 1 0 0 0 0 0 1 0 0 KELLI NOMURA DIRECTOR 0 283802 0 55700 0 13907 0 13796 0 17098 0 384303 0 0 HERMES SHAHBAZIAN CFO 0 264307 0 0 0 0 0 10590 0 9148 0 284045 0 0 PART I, LINE 3 THE CEO OF INTERNATIONAL COMMUNITY HEALTH SERVICES ("ICHS") IS A MEMBER OF THE BOARD OF DIRECTORS. THEIR COMPENSATION IS DETERMINED BY ICHS, THE SUPPORTED ORGANIZATION. ICHS USES THE FOLLOWING TO DETERMINE THE CEO'S COMPENSATION: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A IN 2025, MELISSA JOHNSON - EXECUTIVE DIRECTOR - RECEIVED SEVERANCE PAYMENTS OF $28,464 FROM INTERNATIONAL COMMUNITY HEALTH SERVICES. PART I, LINE 6 AT THE DISCRETION OF THE ICHS BOARD, THE CEO MAY RECEIVE A PERFORMANCE BONUS NOT TO EXCEED 20% OF THE CEO'S ANNUAL SALARY FOR THE CALENDAR YEAR. THE PERFORMANCE BONUS CRITERIA INCLUDE THE FIVE FOLLOWING EQUALLY WEIGHTED AREAS: FINANCIAL, STRATEGIC, COMMUNITY, EMPLOYEE/PATIENT SATISFACTION, AND QUALITY. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT SERVICES ARE PROVIDED BY INTERNATIONAL COMMUNITY HEALTH SERVICES. FORM 990, PART VI, SECTION A, LINE 7A THE CEO OF INTERNATIONAL COMMUNITY HEALTH SERVICES IS A BOARD MEMBER OF THE FOUNDATION. THE BOARD OF DIRECTORS OF INTERNATIONAL COMMUNITY HEALTH SERVICES APPOINTS ALL OTHER BOARD MEMBERS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE THE APPROVAL OF THE INTERNATIONAL COMMUNITY HEALTH SERVICES BOARD OF DIRECTORS: (A) A DECISION TO SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE FOUNDATION OUTSIDE THE ORDINARY COURSE OF ITS OPERATIONS; (B) THE ADOPTION AND AMENDING OF THE FOUNDATION'S INVESTMENT POLICIES; (C) THE ADOPTION AND AMENDING OF THE FOUNDATION'S MISSION STATEMENT; AND (D) A DECISION TO DISSOLVE THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF THE FORM 990 WAS REVIEWED BY THE CFO AND DESIGNATED STAFF, INCLUDING THE CONTROLLER, OF ICHS. THE ICHS FINANCE DEPARTMENT THEN SUBMITTED A DRAFT COPY OF THE FORM 990 TO THE ORGANIZATION'S BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C ICHS REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICIES WITH ICHS FOUNDATION. ICHS HAS TWO CONFLICT OF INTEREST POLICIES. THE FIRST POLICY IS AN OVERARCHING POLICY FOR THE ENTIRE AGENCY, WHICH WORKS TO ENSURE EFFECTIVE MANAGEMENT OF CONFLICTS OF INTEREST AT ICHS. THE SECOND POLICY IS SET TO ENSURE ALL BOARD-RELATED ACTIVITIES ARE CONDUCTED IN A WAY THAT ENSURES COMPLIANCE WITH APPLICABLE LAWS, PRESERVES THE PUBLIC'S TRUST, ENSURES GOOD STEWARDSHIP OF ICHS RESOURCES, AND UPHOLDS HIGH STANDARDS OF CONDUCT AND PERSONAL INTEGRITY AMONG ALL BOARD DIRECTORS AND BOARD ASSOCIATES. THE CONFLICT OF INTEREST POLICY REQUIRES ALL EMPLOYEES AND NON-EMPLOYEE REPRESENTATIVES TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MAY COMPROMISE THEIR JUDGMENT OR IF PERSONAL INTERESTS ARE IN SUBSTANTIAL CONFLICT WITH THE BEST INTERESTS OF ICHS. SIMILARLY, INDIVIDUALS ARE EXPECTED TO REMOVE THEMSELVES FROM A POSITION OF DECISION-MAKING AUTHORITY OR SIGNIFICANT INFLUENCE WITH RESPECT TO ANY CONFLICT SITUATION THAT ARISES. A SITUATION IS CONSIDERED A CONFLICT OF INTEREST IF AN INTEREST OR ACTIVITY INFLUENCES OR APPEARS TO INFLUENCE THE ABILITY OF AN INDIVIDUAL TO EXERCISE OBJECTIVITY OR IMPAIRS THE INDIVIDUAL'S ABILITY TO PERFORM HIS OR HER EMPLOYMENT OR REPRESENTATIVE WORK RESPONSIBILITIES IN THE BEST INTEREST OF ICHS. ANY UNETHICAL ABUSE OF EMPLOYEES OR NON-EMPLOYEE REPRESENTATIVES CAN RESULT IN DISCIPLINARY ACTION (INCLUDING TERMINATION OF EMPLOYMENT). THE CONFLICT OF INTEREST POLICY FOR BOARD DIRECTORS AND BOARD ASSOCIATES REQUIRES BOARD DIRECTORS AND ASSOCIATES TO DISCLOSE ANY REAL OR APPARENT CONFLICT OF INTEREST TO THE BOARD AND EXCUSE HIMSELF OR HERSELF FROM VOTING, AS APPROPRIATE. ADDITIONALLY, NO BOARD MEMBER CAN ALSO BE AN EMPLOYEE OR RELATED TO AN EMPLOYEE OF ICHS. IF A CONFLICT OF INTEREST IS PERCEIVED TO EXIST BUT IS NOT DISCLOSED, THE BOARD MAY VOTE WHETHER THERE IS A REAL CONFLICT OF INTEREST. IF THE VOTE IS AFFIRMATIVE, THE BOARD MEMBER IN QUESTION IS NOT ENTITLED TO VOTE ON THAT ISSUE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A: ALL COMPENSATION REPORTED IN FORM 990, PART VII, SECTION A IS PAID BY INTERNATIONAL COMMUNITY HEALTH SERVICES, A RELATED ORGANIZATION. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 160,477. TOTAL EXPENSES 160,477. FORM 990, PART XII, LINE 2C: THE AUTHORITY TO SELECT THE FINANCIAL STATEMENT AUDITOR AND TO OVERSEE THE FINANCIAL STATEMENT AUDIT DID NOT CHANGE DURING THE FISCAL YEAR. INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVE S SUITE 100 SEATTLE WA 98104 910947084 MEDICAL AND DENTAL CLINICS WA 501(C)(3) LINE 3 N/A 0 AGING IN PACE WASHINGTON PO BOX 3007 SEATTLE WA 98114 810856014 PROGRAM FOR ALL-INCLUSIVE CARE FOR THE ELDERLY WA 501(C)(3) LINE 12A, I INTERNATIONAL COMMUNITY HEALTH SERVICES 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0