2023-07-25T09:31:25-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-01-01 260493856 INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION INTE 2067883585 720 8TH AVENUE SOUTH 100 SEATTLE WA 98104 KELLI NOMURA ICHS CEO 2067883585 2023-07-24 1 KELLI NOMURA XXX-XX-XXXX 0 KURT BENNION P01469618 4252506100 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHRISTINE CONSOLACION 720 8TH AVENUE SOUTH 100 SEATTLE WA 98104 572380 0 X WWW.ICHS.COM/MAKE-A-GIFT/FOUNDATION/ X 2007 WA TO RAISE FUNDS FOR AND PROVIDE PHILANTHROPIC SUPPORT TO INTERNATIONAL COMMUNITY HEALTH SERVICES. 10 9 0 21 0 0 1096925 564820 0 0 0 0 -10682 -7830 1086243 556990 735135 430163 0 0 0 0 0 0 285065 423894 667679 1159029 1097842 -72786 -540852 293084 396231 2839831 3483830 -2546747 -3087599 X TO RAISE FUNDS FOR AND PROVIDE PHILANTHROPIC SUPPORT TO INTERNATIONAL COMMUNITY HEALTH SERVICES (ICHS). 0 0 430163 430163 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 2022, ICHS FOUNDATION RAISED $572,380 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.ICHS CURRENTLY OPERATES 11 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 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- A PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY AT LEGACY HOUSEICHS 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. 430163 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 1 1 0 0 0 0 0 0 X 10 9 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 TERESITA BATAYOLA DIRECTOR (THROUGH NOVEMBER 2022) 2.00 52.00 X 0 416636 34984 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 2.00 42.00 X 0 239287 18031 HEIDI WONG EXECUTIVE DIRECTOR (THROUGH NOVEMBER 2022) 20.00 20.00 X 0 125960 14687 CHRISTINE CONSOLACION INTERIM EXECTIVE DIRECTOR 20.00 20.00 X 0 80090 11853 KELLI NOMURA DIRECTOR 2.00 40.00 X 0 31290 2226 LEECHING TRAN PRESIDENT 2.00 0.00 X X 0 0 0 JENNY SHIN VICE PRESIDENT 1.00 0.00 X X 0 0 0 TOM VAN BRONKHORST SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 LUMOR CHET DIRECTOR 0.50 0.00 X 0 0 0 TESSA CHU DIRECTOR (THROUGH APRIL 2022) 0.50 1.50 X 0 0 0 JOHN FOZ DIRECTOR 0.50 3.00 X 0 0 0 BRYAN IMANISHI DIRECTOR 0.50 0.00 X 0 0 0 AMANDA KIMURA DIRECTOR 0.50 1.50 X 0 0 0 ARIGIN SAKDA DIRECTOR 0.50 0.00 X 0 0 0 CHARLES WU DIRECTOR 0.50 0.00 X 0 0 0 0 893263 81781 0 0 1 0 INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVENUE S 100 SEATTLE WA 98104 MANAGEMENT SERVICES 382614 1 75254 489566 152843 564820 7560 75254 15390 -7830 -7830 556990 0 0 -7830 430163 430163 382614 382614 4093 4093 2934 2934 70527 70527 7016 7016 16064 16064 996 996 20366 20366 1037 1037 29647 29647 346 346 1718 1718 SUPPLIES 129582 129582 DUES AND TAXES 739 739 1097842 430163 382614 285065 124565 270622 168474 125609 45 2221 2221 0 0 293084 396231 4349 14206 4597 2110 2830885 3467514 2839831 3483830 X -2546747 -3087599 -2546747 -3087599 293084 396231 -540852 0 X 0 1 X 1 1 1 X X X 1 INTERNATIONAL COMMUNITY HEALTH SERVICES 910947084 3 1 430163 0 1 430163 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 PAYABLE TO RELATED ORGANIZATION 3467514 3467514 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 FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE FOUNDATION'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION (ASC). LUNAR 5K RUN 36119 28559 7560 8789 ROOTED 46695 46695 6601 82814 75254 7560 15390 15390 -7830 1 INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVENUE SOUTH SUITE 100 SEATTLE WA 98104 910947084 501(C)(3) 430163 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. 0 0 0 0 0 0 1 0 0 TERESITA BATAYOLA DIRECTOR (THROUGH NOVEMBER 2022) 0 359451 0 31295 0 25890 0 15972 0 19012 0 451620 0 0 HERMES SHAHBAZIAN CHIEF FINANCIAL OFFICER 0 232089 0 2710 0 4488 0 9382 0 8649 0 257318 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. WRITTEN EMPLOYMENT CONTRACT 2. COMPENSATION SURVEY OR STUDY 3. 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 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 60 FAIR MARKET VALUE X 1 23201 MARKET PRICE X 4 87232 FAIR MARKET VALUE X EQUIPMENT 1 32450 FAIR MARKET VALUE X FLOWERS 1 9900 FAIR MARKET VALUE 0 0 1 0 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. 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 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0