2022-09-14T17:12:01-05:00 2021-10-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-11-01 263084386 LA PINE COMMUNITY HEALTH CENTER LAPI 5415363435 PO BOX 3300 LA PINE OR 97739 CHARLA DEHATE CHIEF EXECUTIVE OFFICER 5415363435 2022-09-14 1 CHARLA DEHATE 999009999 KURT BENNION CPA P01469618 4252506100 2022-09-14 0 AAL1 IAL1 2020 2023-04-26 12:10:37Z CHARLA DEHATE PO BOX 3300 LA PINE OR 97739 10732653 0 X WWW.LAPINECC.COM X 2008 OR LA PINE COMMUNITY HEALTH CENTER IMPROVES LIVES IN OUR COMMUNITY THROUGH ACCESSIBLE AND AFFORDABLE HEALTHCARE PROVIDED WITH KINDNESS, INTEGRITY, AND RESPECT. 11 11 93 14 0 0 3621234 2909918 5562134 6740637 -612901 185 488243 504653 9058710 10155393 0 3720 0 0 5766870 5012517 0 0 0 2028165 2341285 7795035 7357522 1263675 2797871 11774405 14022573 6229383 6018444 5545022 8004129 X LA PINE COMMUNITY HEALTH CENTER IMPROVES LIVES IN OUR COMMUNITY THROUGH ACCESSIBLE AND AFFORDABLE HEALTHCARE PROVIDED WITH KINDNESS, INTEGRITY, AND RESPECT. 1 0 5396728 3720 7099519 LA PINE COMMUNITY HEALTH CENTER (LCHC), A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) FORMED IN 2009, SERVES THE GENERAL POPULATION WITH AN EMPHASIS ON DISADVANTAGED AND MEDICALLY UNDER-SERVED RESIDENTS. LCHC PROVIDES PATIENT-CENTERED, COMPREHENSIVE, AFFORDABLE PRIMARY MEDICAL, BEHAVIORAL/MENTAL HEALTH AND ANCILLARY (OUTREACH) CARE TO PATIENTS LIVING IN THE SERVICE AREA WHICH INCLUDES SOUTH DESCHUTES COUNTY, NORTHERN KLAMATH, AND NORTHWESTERN LAKE COUNTIES. OUR SERVICES INCLUDE PREVENTION, DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC ILLNESS, CHRONIC DISEASE MANAGEMENT, REFERRALS, AND FOLLOW-UP FOR SPECIALTY DIAGNOSTIC TREATMENT. 5396728 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 22 0 93 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1 1 1 1 1 0 OR X X CHARLA DEHATE 5415363435 PO BOX 3300 LA PINE OR 97739 MICHAEL ALLEN DO MEDICAL DIRECTOR (THROUGH AUG 2021) 50.00 X 241819 0 14798 MARTIN SMART MD PHYSICIAN 40.00 X 216656 0 8021 BETH BLUMENSTEIN MD PHYSICIAN 40.00 X 176401 0 12570 CHARLA DEHATE CHIEF EXECUTIVE OFFICER 60.00 X 175738 0 13079 JOAN FRIDERICI MD PHYSICIAN 40.00 X 157055 0 8742 RITA GOEHRING NP NURSE PRACTITIONER 40.00 X 143293 0 10814 MEGAN LEWIS NP NURSE PRACTITIONER 40.00 X 132206 0 12121 DAVID GOSSER CHAIR 1.00 X X 0 0 0 MARIAN MENGEL VICE CHAIR & BOARD MEMBER 1.00 X X 0 0 0 RELINDA REYNOLDS BOARD MEMBER & VICE CHAIR 1.00 X X 0 0 0 JOAN WALTER SECRETARY 1.00 X X 0 0 0 HANNAH OLMSTEAD TREASURER 1.00 X X 0 0 0 DONNY BURKLOW BOARD MEMBER 1.00 X 0 0 0 LYMAN FLENNER III BOARD MEMBER 1.00 X 0 0 0 FRANK HERNANDEZ BOARD MEMBER 1.00 X 0 0 0 ANDREA HINE BOARD MEMBER 1.00 X 0 0 0 TAMMY LESEUER BOARD MEMBER (THROUGH JULY 2021) 1.00 X 0 0 0 RYAN MACIEJ BOARD MEMBER 1.00 X 0 0 0 SHELLEY MIESEN BOARD MEMBER 1.00 X 0 0 0 LINDA VASSALLI BOARD MEMBER (THROUGH SEPT 2021) 1.00 X 0 0 0 1243168 0 80145 13 0 1 0 WESTON TECHNOLOGY SOLUTIONS 19795 VILLAGE OFFICE COURT BEND OR 97702 IT SERVICES 142179 1 2688756 221162 64940 2909918 PATIENT SERVICE REVENUE 621300 6282060 6282060 PAYOR INCENTIVE REVENUE 621300 458577 458577 6740637 185 185 131291 0 131291 131291 131291 936142 577260 358882 358882 MISCELLANEOUS INCOME 900099 14480 14480 14480 10155393 7099519 0 145956 3720 3720 445425 187706 257719 3721308 3176515 544793 65216 52567 12649 435123 361449 73674 345445 278443 67002 13252 13252 38850 38850 560310 320724 239586 35969 35969 54242 34654 19588 226534 86578 139956 369416 235134 134282 45580 27961 17619 133314 133314 258992 97955 161037 30237 24794 5443 MEDICAL SUPPLIES 292698 292698 BAD DEBT EXPENSE 135629 135629 DUES & SUBSCRIPTIONS 69269 13765 55504 RECRUITMENT/RETENTION 68974 61832 7142 8019 4604 3415 7357522 5396728 1960794 0 2986157 5234885 1848616 1851261 0 36303 545188 748931 7044 10035 51330 43860 7422024 1333265 6311253 6088759 12799 8539 12018 0 11774405 14022573 517972 456138 5711411 5562306 6229383 6018444 X 5206257 8004129 338765 0 5545022 8004129 11774405 14022573 2797871 -338764 0 X 0 1 X 1 1 1 X 1648357 1564536 1712353 3621234 2909918 11456398 5953630 5921832 6186139 6677459 7676779 32415839 7601987 7486368 7898492 10298693 10586697 43872237 0 0 0 43872237 24235 25789 27942 27875 131476 237317 24235 25789 27942 27875 131476 237317 14480 14480 7626222 7512157 7926434 10326568 10732653 44124034 0.99430 0.99680 0.00540 0.00320 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 403375 403375 5578981 155518 5423463 1011725 799453 212272 427943 378294 49649 6088759 X 10048794 29030 29030 10019764 135629 135629 10155393 7250923 29030 29030 7221893 135629 135629 7357522 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT ORGANIZATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A)(III) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 135,629. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 135,629. X X X 0 0 0 0 0 0 0 1 0 MICHAEL ALLEN DO MEDICAL DIRECTOR (THROUGH AUG 2021) 241819 0 0 0 0 0 0 0 14798 0 256617 0 0 0 MARTIN SMART MD PHYSICIAN 216656 0 0 0 0 0 0 0 8021 0 224677 0 0 0 BETH BLUMENSTEIN MD PHYSICIAN 176401 0 0 0 0 0 0 0 12570 0 188971 0 0 0 CHARLA DEHATE CHIEF EXECUTIVE OFFICER 175738 0 0 0 0 0 0 0 13079 0 188817 0 0 0 JOAN FRIDERICI MD PHYSICIAN 157055 0 0 0 0 0 0 0 8742 0 165797 0 0 0 RITA GOEHRING NP NURSE PRACTITIONER 143293 0 0 0 0 0 0 0 10814 0 154107 0 0 0 PART I, LINE 7 DURING 2020, THE BOARD OF DIRECTORS CHOSE TO GIVE ALL EMPLOYEES A ONE-TIME BONUS OF $500. X 3247 64940 INVOICE PRICE 0 0 1 0 PART I, COLUMN (B): THE NUMBER REPORTED IN COLUMN B IS THE NUMBER OF DONATED ITEMS RECEIVED DURING THE FISCAL YEAR. FORM 990, PART III, LINE 2 DURING THE FISCAL YEAR, WE ADDED PSYCHIATRIC SERVICES AND A REGISTERED DIETICIAN TO BETTER SERVE OUR COMMUNITY. FORM 990, PART VI, SECTION A, LINE 8B NO COMMITTEE HAS AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD RECEIVED THE FORM 990 ELECTRONICALLY PRIOR TO THE BOARD MEETING FOR THEM TO REVIEW. THE DOCUMENT WAS REVIEWED BY THE CEO DURING THE BOARD MEETING. ANY QUESTIONS WERE ANSWERED AT THE BOARD MEETING AND IF NECESSARY THE APPROPRIATE CHANGES WERE MADE. THE BOARD VOTED ON THE APPROVAL OF THE FORM 990 AT THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS REVIEWED ANNUALLY WITH THE BOARD MEMBERS, DIRECTORS, MANAGERS AND KEY EMPLOYEES. THE DISCLOSURE STATEMENT AND CONFLICT OF INTEREST ARE SIGNED BY EACH PERSON. A TRANSACTION IN WHICH A BOARD MEMBER HAS A CONFLICT OF INTEREST MAY BE APPROVED BY MAJORITY VOTE OF A QUORUM OF THE BOARD OF DIRECTORS IF THE MATERIAL FACTS OR THE TRANSACTION AND THE DIRECTOR'S INTEREST ARE DISCLOSED OR KNOWN TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE SALARIES ARE ASSESSED BASED ON A SURVEY OF COMMUNITY HEALTH CENTERS IN OUR REGION FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. THE LAST COMPENSATION REVIEW OCCURRED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990 PART XI, LINE 8: DURING THE YEAR ENDED OCTOBER 31, 2021, THE ORGANIZATION MADE A CHANGE IN THE APPLICATION OF FASB ASC TOPIC 958 RELATED TO THE RECEIPT OF GOVERNMENT GRANTS. THIS CHANGE WAS APPLIED TO THE RECEIPT FROM THE GENERAL DISTRIBUTION OF THE PROVIDER RELIEF FUND (PRF), ESTABLISHED BY THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT, DURING THE YEAR ENDED OCTOBER 31, 2020. WHEN INITIALLY RECEIVED, THESE FUNDS WERE RECORDED AS WITH DONOR RESTRICTIONS AND ACCORDINGLY REFLECTED IN NET ASSET WITH DONOR RESTRICTIONS AS OF OCTOBER 31, 2020. DURING THE YEAR ENDED OCTOBER 31, 2021, THE ORGANIZATION CHANGED THE APPLICATION OF ASC 958 TO ACCOUNT FOR THE PRF DISTRIBUTION AS A CONDITIONAL CONTRIBUTION AND ACCORDINGLY RECOGNIZED THE FUNDS AS REVENUE UPON SATISFYING THE ASSOCIATED TERMS AND CONDITIONS DURING THE YEAR ENDED OCTOBER 31, 2021. THE RESULT OF THIS CHANGE WAS TO DECREASE NET ASSETS WITH DONOR RESTRICTIONS AS OF NOVEMBER 1, 2020 BY $338,764 AND TO PRESENT THE FULL AMOUNT AS FEDERAL GRANT REVENUE FOR THE YEAR ENDED OCTOBER 31, 2021 VERSUS A RELEASE FROM NET ASSETS WITH DONOR RESTRICTIONS.