2025-08-27T14:30:01-05:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2024-01-01 810856014 AGING IN PACE WASHINGTON AGIN 2067883656 PO BOX 3007 SEATTLE WA 981143007 KELLI NOMURA ICHS CEO 2067883656 2025-08-19 1 0 KURT BENNION CPA P01469618 4252506100 2025-08-19 2024 2025-03-06 01:10:19Z AIPACE KELLI NOMURA PO BOX 3007 SEATTLE WA 981143007 411837 0 X N/A X 2015 WA TO BE A SUPPORTING ORGANIZATION, OPERATED FOR THE BENEFIT OF AND TO SUPPORT INTERNATIONAL COMMUNITY HEALTH SERVICES. 3 3 0 2 0 0 687448 349474 0 0 37335 62363 -10645 0 714138 411837 0 0 0 0 0 0 0 0 0 46488 77323 46488 77323 667650 334514 4441290 16142590 3340776 14707562 1100514 1435028 X AIPACE IS A SUPPORTING ORGANIZATION, OPERATED FOR THE BENEFIT OF AND TO SUPPORT INTERNATIONAL COMMUNITY HEALTH SERVICES. 0 0 0 0 0 AGING IN PACE WASHINGTON IS A SUPPORTING ORGANIZATION, OPERATED FOR THE BENEFIT OF AND TO SUPPORT INTERNATIONAL COMMUNITY HEALTH SERVICES'S PACE PROGRAM. THE PACE PROGRAM IS AN INTEGRATED MODEL OF CARE THAT ENABLES MEDICARE AND MEDICAID BENEFICIARIES AGED 55 YEARS OLD OR OLDER WHO ARE CERTIFIED BY THEIR STATE AS NEEDING NURSING HOME CARE TO LIVE AS INDEPENDENTLY AS POSSIBLE IN THEIR OWN HOMES AND COMMUNITY. THE PACE PROGRAM COORDINATES AND PROVIDES ALL NEEDED PREVENTIVE, PRIMARY, ACUTE AND LONG TERM CARE SERVICES. THE PACE PROGRAM IS GOVERNED BY THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) AT THE FEDERAL LEVEL AND BY THE STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES (DSHS) AT THE STATE LEVEL. THIS PROGRAM IS HIGHLY REGULATED, SUBJECT TO COMPLIANCE WITH THE CMS RULES AND REGULATION. (CONTINUED IN SCHEDULE O)THE APPLICATION PROCESS IS EXTENSIVE AND REQUIRES PROFESSIONAL HELP FROM SPECIALIZED CONSULTING FIRMS SUCH AS ALTITUDE EDGE CONSULTANTS CURRENTLY ENGAGED IN THE APPLICATION PROCESS. 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 1 0 0 0 1 0 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 PRESIDENT 2.00 42.00 X X 0 340438 30263 HERMES SHAHBAZIAN CFO 2.00 42.00 X 0 252547 19150 GILDAS CHEUNG SECRETARY 1.00 4.00 X X 0 0 0 HIROSHI NAKANO TREASURER 1.00 1.50 X X 0 0 0 0 592985 49413 0 0 1 0 0 26301 323173 94219 349474 62363 62363 411837 0 0 62363 X 3150 3150 20000 20000 53744 53744 244 244 69 69 LICENSES & TAXES 116 116 77323 0 77323 0 1547663 2311702 326092 65053 3048 13762787 2567535 13762787 4441290 16142590 36700 68790 3304076 14638772 3340776 14707562 X 1100514 1435028 1100514 1435028 4441290 16142590 334514 0 X X 0 1 X 1 0 X X 1 INTERNATIONAL COMMUNITY HEALTH SERVICES 910947084 3 1 0 0 1 0 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 0 0 0 0 0 0 1 20000 0 0 20000 0 PART II-B, LINE 1: THE ORGANIZATION CONTRACTED WITH A LOBBYING CONSULTANT TO ENGAGE WITH THE SEATTLE MAYOR'S OFFICE, KING COUNTY EXECUTIVE STAFF AND OFFICIALS, AND THE GOVERNOR'S OFFICE BUDGET STAFF AND OFFICIALS RELATED TO PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE). 13762787 13762787 13762787 DUE TO RELATED ORGANIZATIONS 9688772 REFUNDABLE GRANT 4950000 14638772 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). 0 0 0 0 0 0 1 0 0 KELLI NOMURA PRESIDENT 0 272275 0 52500 0 15663 0 13206 0 17057 0 370701 0 0 HERMES SHAHBAZIAN CFO 0 249180 0 3367 0 0 0 10087 0 9063 0 271697 0 0 PART I, LINE 3 THE BOARD PRESIDENT IS THE CEO OF INTERNATIONAL COMMUNITY HEALTH SERVICES ("ICHS"). 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 6 AT THE DISCRETION OF THE ICHS BOARD, THE CEO RECEIVES PERFORMANCE BONUSES NOT TO EXCEED 20% OF THE CEO ANNUAL SALARY FOR THE CALENDAR YEAR. THE PERFORMANCE BONUS CRITERIA ARE AS FOLLOWS: - FINANCIAL: REMAIN WITHIN 5% OF THE APPROVED ICHS ANNUAL BUDGET OR EXPECTED MARGIN. - STRATEGY: PRESENTATION OF YEARLY IMPLEMENTATION PLAN AND PROGRESS ON AT LEAST 3 INITIATIVES. - COMMUNITY: MEET WITH MINIMUM OF 12 EXISTING OR POTENTIAL PARTNERS TO UNDERSTAND COMMUNITY NEEDS AND REPORT BACK TO THE BOARD. - PEOPLE: CONDUCT AND REPORT STAFF SATISFACTION SURVEY (2X A YEAR) AND STAFF TURNOVER OF <25%. - QUALITY: MEET OR EXCEED 3 OF 7 QUALITY MEASURES FROM ICHS SCORECARD. X 3 94219 DAILY TRADING PRICE 0 0 1 1 PART I, COLUMN (B): THE NUMBERS REPORTED IN PART I, COLUMN B REPRESENT THE NUMBER OF DONATIONS RECEIVED DURING THE YEAR. PART I, LINE 32B: DONATED SECURITIES ARE RECEIVED AND PROCESSED BY OUR INVESTMENT MANAGER. 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 DIRECTOR OF AGING IN PACE WASHINGTON. INTERNATIONAL COMMUNITY HEALTH SERVICES' BOARD APPOINTS AT LEAST A MAJORITY OF THE REMAINING INDIVIDUALS WHO SERVE AS DIRECTORS OF AGING IN PACE WASHINGTON; SUCH APPOINTED INDIVIDUALS MUST ALSO BE CURRENT DIRECTORS OF INTERNATIONAL COMMUNITY HEALTH SERVICES. 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 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO MEMBERS, BOARD MEMBERS AND OFFICERS. INDIVIDUALS ARE REQUIRED TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND ARE GIVEN THE OPPORTUNITY TO DISCLOSE MATERIAL FACTS. IF IT'S UNCLEAR WHETHER A CONFLICT EXISTS, THE CONFLICTED INDIVIDUAL LEAVES THE MEETING WHILE THE REMAINING BOARD MEMBERS DECIDE WHETHER A CONFLICT EXISTS. THE BOARD MAY SEEK ALTERNATIVES TO THE PROPOSED TRANSACITON THAT DO NOT INVOLVE A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT IDENTIFIED, THE CONFLICTED INDIVIDUAL LEAVES THE MEETING WHILE THE REMAINING BOARD MEMBERS DECIDE WHETHER TO ENTER THE TRANSACTION. IF THE BOARD HAS REASON TO BELIEVE THAT AN INDIVIDUAL FAILED TO DISCLOSE A RELEVANT CONFLICT, THE INDIVIDUAL IS GIVEN THE OPPORTUNITY TO EXPLAIN, AFTER WHICH THE BOARD MAY TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. 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 SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 53,744. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,744. 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 AVENUE S SUITE 100 SEATTLE WA 98104 910947084 MEDICAL AND DENTAL CLINICS WA 501(C)(3) LINE 3 N/A 0 INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION 720 8TH AVENUE S SUITE 100 SEATTLE WA 98104 260493856 FUNDRAISING WA 501(C)(3) LINE 12A, I INTERNATIONAL COMMUNITY HEALTH SERVICES 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0