Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
INTERNATIONAL COMMUNITY HEALTH SERVICES
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
720 8TH AVENUE SOUTH NO 100
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SEATTLE, WA98104
D Employer identification number

91-0947084
E Telephone number

(206) 788-3618
G Gross receipts $ 30,348,518
F Name and address of principal officer:
TERESITA BATAYOLA
720 8TH AVENUE SOUTH NO 100
SEATTLE,WA98104
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.ICHS.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1973
M State of legal domicile: WA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: PROVIDE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 337
6 Total number of volunteers (estimate if necessary) ............. 6 32
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,598,669 5,483,445
9 Program service revenue (Part VIII, line 2g) ......... 16,070,228 18,233,715
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 618,362 29,887
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,306,616 317,407
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 23,593,875 24,064,454
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 13,632,040 15,296,893
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet253,903    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 6,439,465 6,662,787
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 20,071,505 21,959,680
19 Revenue less expenses. Subtract line 18 from line 12....... 3,522,370 2,104,774
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 34,167,962 47,870,443
21 Total liabilities (Part X, line 26)............. 6,423,351 18,021,058
22 Net assets or fund balances. Subtract line 21 from line 20..... 27,744,611 29,849,385
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet 2014-05-15
Signature of officer Date
JumboBullet TERESITA BATAYOLACHIEF EXECUTIVE OFFICER
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
PAUL MBAILEY CPA
Preparer's signature
PAUL MBAILEY CPA
Date
 
PTIN
P00292653
Firm's name MediumBullet
CLIFTONLARSONALLEN LLP
 
Firm's EIN MediumBullet41-0746749
Firm's address MediumBullet
3000 NORTHUP WAY SUITE 200
 
BELLEVUE, WA98004
Phone no. (425) 250-6100
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Page 2
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
..............
1
Briefly describe the organization’s mission: INTERNATIONAL COMMUNITY HEALTH SERVICES (ICHS) IS A COMMUNITY-BASED HEALTH CARE CENTER COMMITTED TO PROVIDING CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH SERVICES TO IMPROVE THE HEALTH OF ASIAN PACIFIC ISLANDER AND OTHER COMMUNITIES. ICHS ALSO PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE ORGANIZATION'S POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THE ORGANIZATION'S ESTABLISHED RATES. A MULTI-ETHNIC HEALTH CARE TEAM APPROACH AND A COMBINATION OF FUNDING SOURCES ENABLES ICHS TO PROVIDE AFFORDABLE COMPREHENSIVE HEALTH CARE, WHICH ADDRESS THE GAPS AND BARRIERS THAT PREVENT THE LOW-INCOME, NON-ENGLISH SPEAKING, ASIAN/PACIFIC ISLANDER POPULATION FROM AVAILING THEMSELVES OF ADEQUATE HEALTH SERVICES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 7,639,305 including grants of $ 0 ) (Revenue $ 8,819,178 )
ICHS PROVIDES MEDICAL SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY. THESE SERVICES INCLUDE PHYSICAL EXAMS, IMMUNIZATIONS, MINOR SURGERY, HOME VISITS, AND INFANT AND WELL-CHILD CHECK-UPS. DURING 2013 ICHS PROVIDED 52,681 PRIMARY HEALTH CARE VISITS TO PATIENTS AND $725,817 OF CHARITY CARE.
4b (Code:   ) (Expenses $ 3,634,860 including grants of $ 0 ) (Revenue $ 3,527,671 )
ICHS PROVIDES FULL DENTAL CARE FOR THE ENTIRE FAMILY. ICHS PROVIDES EXTENSIVE DENTURE WORK, FULL CLEAING FOR ADULTS AND CHILDREN, PREVENTIVE DENTISTRY, MINOR ORAL SURGERY, RESTORATIVE SERVICES, ORTHODONTIA, AND EMERGENCY CARE. THE STAFF ALSO PROVIDES ORAL HEALTH EDUCATION IN THE COMMUNITY. DURING 2013, ICHS PROVIDED 22,957 DENTAL CARE VISITS TO PATIENTS AND $1,018,047 OF CHARITY CARE.
4c (Code:   ) (Expenses $ 5,789,341 including grants of $ 0 ) (Revenue $ 3,688,020 )
ICHS PROVIDES A VARIETY OF OTHER HEALTH CARE SERVICES TO THE COMMUNITY. THESE SERVICES INCLUDE CHINESE TRADITIONAL MEDICINE TECHNIQUES, DISEASE PREVENTION, HEALTH EDUCATION, BEHAVIORAL HEALTH, NUTRITION SERVICES, AND FAMILY PLANNING FOR TEENS AND ADULTS. DURING 2013, ICHS PROVIDED 6,112 HEALTH CARE VISITS TO PATIENTS AND $114,996 OF CHARITY CARE.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet17,063,506
Form 990 (2013)
Page 3
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III
Click to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment.............
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XIIClick to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV..........
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? ...
20b
 
 
Form 990 (2013)
Page 4
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J.......................Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II ....................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2...Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ........
38
Yes
 
Form 990 (2013)
Page 5
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V.........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
34
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
337
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? ......................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? .......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year? ............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
30,348,518
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Page 6
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
WA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletHERMES SHAHBAZIAN720 8TH AVENUE SOUTH SUITE 100   SEATTLE, WA98104 (206) 788-3618
Form 990 (2013)
Page 7
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) CRIS KRISOLOG-ELLIOTT......................................................................
PRESIDENT
3.00
.................
0.00
X   X       0 0 0
(2) HIROSHI NAKANO......................................................................
SECRETARY
2.00
.................
2.00
X   X       0 0 0
(3) JOHN FOZ......................................................................
1ST VICE PRESIDENT
3.00
.................
2.00
X   X       0 0 0
(4) JANYCE KO FISHER......................................................................
2ND VICE PRESIDENT
2.00
.................
0.00
X   X       0 0 0
(5) KELLI NOMURA......................................................................
3RD VICE PRESIDENT
2.00
.................
0.00
X   X       0 0 0
(6) GILDAS CHEUNG......................................................................
TREASURER
2.00
.................
0.00
X   X       0 0 0
(7) JENNY FANG......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(8) CATHERINE JOHNSON......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(9) RACHEL KOH......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(10) BENJAMIN LEE......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(11) TED LEW......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(12) RICHARD MELLON......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(13) ROBERT MULL......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(14) ARMILITO PANGILINAN......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(15) ARIGIN SAKDA......................................................................
DIRECTOR
1.50
.................
2.00
X           0 0 0
(16) JENNIFER VONG......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(17) TERESITA BATAYOLA......................................................................
CHIEF EXECUTIVE OFFICER
47.00
.................
3.00
    X       190,496 0 6,244
Form 990 (2013)
Page 8
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) HERMES SHAHBAZIAN........................................................................
CHIEF FINANCIAL OFFICER
38.00
.......................2.00
    X       132,740 0 10,411
(19) GRACE WANG........................................................................
MEDICAL DIRECTOR
50.00
.......................0.00
      X     209,200 0 12,421
(20) KIMO HIRAYAMA........................................................................
ASST MEDICAL DIRECTOR
36.00
.......................0.00
      X     197,680 0 12,068
(21) AI-KHUE NGUYEN........................................................................
ASST MEDICAL DIRECTOR
36.00
.......................0.00
      X     167,308 0 11,176
(22) JI CHOI........................................................................
DENTAL DIRECTOR
40.00
.......................0.00
      X     153,964 0 10,769
(23) ALAN CHUN........................................................................
MD/PROVIDER
36.00
.......................0.00
        X   162,990 0 11,016
(24) HARVEY WU........................................................................
DDS/PROVIDER
40.00
.......................0.00
        X   151,724 0 10,608
(25) DANIEL COPP........................................................................
MD/PROVIDER
40.00
.......................0.00
        X   155,338 0 10,755
(26) CHRISTOPHER YEE........................................................................
MD/PROVIDER
39.00
.......................0.00
        X   149,092 0 10,651
(27) UYENVY PHAM........................................................................
MD/PROVIDER
40.00
.......................0.00
        X   160,859 0 10,959






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 1,831,391 0 117,078
Form 990 (2013)
Page 9
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 603,452
e Government grants (contributions)1e 3,705,544
f All other contributions, gifts, grants, and similar amounts not included above1f 1,174,449
g Noncash contributions included in lines 1a-1f:$ 648,741
h Total.Add lines 1a-1f.......MediumBullet 5,483,445
 Program Service RevenueAmt Business Code
2a PATIENT SERVICE FEES 624100 16,034,869 16,034,869    
b POOL SAVINGS REVENUE 900099 2,184,132 2,184,132    
c OTHER MEDICAL REVENUE 900099 14,714 14,714    
d
e
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet 18,233,715
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ........MediumBullet 38,046     38,046
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents 48,700  
b Less: rental expenses 24,809  
c Rental income or (loss) 23,891  
d Net rental income or (loss)......MediumBullet 23,891     23,891
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 6,251,096  
b Less: cost or other basis and sales expenses 6,254,111 5,144
c Gain or (loss) -3,015 -5,144
d Net gain or (loss).....MediumBullet -8,159     -8,159
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a MANAGEMENT FEES 900099 266,800     266,800
b MISCELLANEOUS REVENUE 900099 26,716     26,716
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 293,516
12 Total revenue. See Instructions......MediumBullet 24,064,454 18,233,715 0 347,294
Form 990 (2013)
Page 10
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,114,477 525,250 589,227  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 11,428,194 9,182,440 2,032,924 212,830
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 337,049 270,780 60,026 6,243
9 Other employee benefits ....... 1,424,458 1,128,724 260,904 34,830
10 Payroll taxes ........... 992,715 780,254 212,461  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 59,714 2,804 56,910  
c Accounting ........... 40,315   40,315  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 889,145 579,429 309,716  
12 Advertising and promotion .... 8,527 3,750 4,777  
13 Office expenses ....... 182,143 148,678 33,465  
14 Information technology ...... 89,355 73,456 15,899  
15 Royalties ..        
16 Occupancy ........... 1,085,854 922,130 163,724  
17 Travel ............ 54,202 29,695 24,507  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 32,414 13,997 18,417  
20 Interest ........... 159,934 146,693 13,241  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 868,909 603,971 264,938  
23 Insurance ... 101,437 75,798 25,639  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 2,224,487 2,206,697 17,790  
b DUES AND SUBSCRIPTION 260,355 13,060 247,295  
c EQUIPMENT 230,945 107,491 123,454  
d LICENSE AND TAXES 146,335 96,956 49,379  
e All other expenses 228,716 151,453 77,263  
25 Total functional expenses. Add lines 1 through 24e 21,959,680 17,063,506 4,642,271 253,903
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Page 11
Form 990 (2013)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year
(B)
End of year
1 Cash–non-interest-bearing ............. 10,853,916 1 24,844,892
2 Savings and temporary cash investments ......... 6,791,923 2 540,827
3 Pledges and grants receivable, net ........... 721,452 3 800,730
4 Accounts receivable, net ............. 1,990,139 4 1,652,958
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net ....   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 1,059,193 9 706,913
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 24,252,164
b Less: accumulated depreciation 10b 5,849,994 12,225,427 10c 18,402,170
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 525,912 15 921,953
16 Total assets. Add lines 1 through 15 (must equal line 34)... 34,167,962 16 47,870,443
17 Accounts payable and accrued expenses ......... 2,936,827 17 3,162,322
18 Grants payable ...   18  
19 Deferred revenue ................ 571,233 19 623,083
20 Tax-exempt bond liabilities .............   20 10,126,031
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..   22  
23 Secured mortgages and notes payable to unrelated third parties .. 2,915,291 23 2,766,504
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D 0 25 1,343,118
26 Total liabilities. Add lines 17 through 25.. 6,423,351 26 18,021,058
Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 27,043,437 27 28,681,057
28 Temporarily restricted net assets ........... 701,174 28 1,168,328
29 Permanently restricted net assets   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 27,744,611 33 29,849,385
34 Total liabilities and net assets/fund balances ........ 34,167,962 34 47,870,443
Form 990 (2013)
Page 12
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
24,064,454
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
21,959,680
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
2,104,774
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
27,744,611
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
29,849,385
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description

Additional Data


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