2024-05-03T11:41:28-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-07-01 811037696 COLUMBIA BASIN CIRCLE OF CARE COLU 5094885256 1515 EAST COLUMBIA STREET OTHELLO WA 99344 NIEVES GOMEZ CHAIRMAN OF THE BOARD 5094885256 2024-05-01 1 NIEVES GOMEZ 999009999 0 KURT BENNION CPA P01469618 4252506100 2024-05-01 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z NIEVES GOMEZ 1515 EAST COLUMBIA STREET OTHELLO WA 99344 33203050 0 X N/A X 2016 WA TO FINANCIALLY AND OPERATIONALLY SUPPORT AND BENEFIT COLUMBIA BASIN HEALTH ASSOCIATION. X 3 2 0 2 0 0 0 1793050 0 0 0 0 -809372 29973647 -809372 31766697 0 25736643 0 0 0 0 0 0 0 681122 572428 681122 26309071 -1490494 5457626 29328450 0 34786076 0 -5457626 0 THE PURPOSE OF THE CORPORATION IS TO EXCLUSIVELY SUPPORT AND BENEFIT, FINANCIALLY AND/OR OPERATIONALLY, COLUMBIA BASIN HEALTH ASSOCIATION, A WASHINGTON NONPROFIT PUBLIC BENEFIT CORPORATION. 0 0 26236691 25736643 29973647 THE PURPOSE OF THE CORPORATION IS TO EXCLUSIVELY SUPPORT AND BENEFIT, FINANCIALLY AND/OR OPERATIONALLY, COLUMBIA BASIN HEALTH ASSOCIATION, A WASHINGTON NONPROFIT PUBLIC BENEFIT CORPORATION. DURING THE FISCAL YEAR, COLUMBIA BASIN CIRCLE OF CARE TRANSFERRED ALL ASSETS AND OPERATIONS TO COLUMBIA BASIN HEALTH ASSOCIATION. COLUMBIA BASIN OF CIRCLE OF CARE IS CURRENTLY DORMANT WITH NO ASSETS OR ACTIVITIES. 26236691 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X JOSHUA BUNCH 5094885256 1515 EAST COLUMBIA STREET OTHELLO WA 99344 NIEVES GOMEZ CHAIRMAN 1.00 50.00 X X 0 374326 16668 PRISCILLA RODRIGUEZ TREASURER 1.00 0.00 X X 0 0 0 CYNTHIA GARZA SECRETARY 1.00 0.00 X X 0 0 0 0 374326 16668 0 0 1 0 0 1793050 1793050 900000 1436353 -536353 -536353 -536353 GAIN ON EXTINGUISHMENT OF DEBT 900099 30510000 30510000 30510000 31766697 29973647 0 0 25736643 25736643 58356 58356 14000 14000 11571 11571 24 24 488477 488477 26309071 26236691 72380 0 2138879 0 0 0 27172995 0 16576 0 29328450 0 34786076 0 34786076 0 X -5457626 0 -5457626 0 29328450 0 5457626 0 X X 0 1 X 1 0 X X X 1 COLUMBIA BASIN HEALTH ASSOCIATION 910896701 10 1 2008781 25736643 1 2008781 25736643 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 X 1 1 PART IV, SECTION D, LINE 2: NIEVES GOMEZ IS THE CHIEF EXECUTIVE OFFICER OF THE SUPPORTED ORGANIZATION, COLUMBIA BASIN HEALTH ASSOCIATION, AND IS THE CHAIRMAN OF THE BOARD OF COLUMBIA BASIN CIRCLE OF CARE. THUS, COMMUNICATIONS, BOTH FORMAL AND INFORMAL, BETWEEN THE TWO OCCUR DAILY AND ARE ONGOING. PART IV, SECTION D, LINE 3: COLUMBIA BASIN HEALTH ASSOCIATION HAS A SIGNIFICANT VOICE IN COLUMBIA BASIN CIRCLE OF CARE'S INVESTMENT POLICIES AND IN DIRECTING THE ORGANIZATION'S INCOME AND ASSETS THROUGH THE OVERLAP OF THE BOARD CHAIR BETWEEN ORGANIZATIONS. PART IV, SECTION E, LINE 2A: ACTIVITIES CONDUCTED BY THE ORGANIZATION CONSIST OF THE CONSTRUCTION OF A HEALTH CARE FACILITY AND LEASING THE FACILITY TO THE SUPPORTED ORGANIZATION, COLUMBIA BASIN HEALTH ASSOCIATION, IN ORDER TO ASSIST THEM IN CARRYING OUT THEIR MISISON OF PROVIDING HEALTH CARE TO MEDICALLY UNDERSERVED POPULATIONS. THIS FACILITY IS USED TO PROVIDE PRIMARY AND MULTI-SPECIALTY HEALTHCARE SERVICES TO INDIVIDUALS THAT STRUGGLE WITH ACCESS TO HEALTHCARE, SUCH AS FARMWORKERS AND LOW-INCOME INDIVIDUALS AND FAMILIES. PART IV, SECTION E, LINE 2B: WITHOUT THE CREATION AND UTILIZATION OF COLUMBIA BASIN CIRCLE OF CARE TO CONSTRUCT AND OWN REAL PROPERTY, COLUMBIA BASIN HEALTH ASSOCIATION WOULD HAVE DIRECTLY CONSTRUCTED AND OWNED THE REAL PROPERTY. PART I, LINE 12G, COLUMN (VI): OTHER SUPPORT CONSISTS OF A BUILDING, FURNITURE AND FIXTURES THAT WERE TRANSFERRED TO COLUMBIA BASIN HEALTH ASSOCIATION AT THE END OF THE NEW MARKETS TAX CREDIT (NMTC). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X 7466407 6209710 6209710 1256697 30510000 30510000 31766697 2008781 1436353 1436353 572428 25736643 25736643 26309071 PART X, LINE 2: UNDER PROVISIONS OF SECTION 501(C)(3) OF THE IRC, THE CORPORATION IS EXEMPT FROM FEDERAL INCOME TAXES, EXCEPT FOR NET INCOME FROM UNRELATED BUSINESS ACTIVITIES. AS OF JUNE 30, 2023 AND 2022, THE CORPORATION HAD NO UNRELATED BUSINESS ACTIVITIES SUBJECT TO FEDERAL INCOME TAXES. MANAGEMENT EVALUATED THE CORPORATION'S TAX POSITIONS AND CONCLUDED THAT THE CORPORATION HAD TAKEN NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH PROVISIONS OF TOPIC 740 OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION. THE CORPORATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,436,353. GAIN ON NEW MARKET TAX CREDIT CLOSE OUT 4,773,357. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN ON EXTINGUISHMENT OF DEBT 30,510,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,436,353. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFER OF ASSETS TO CBHA 25,736,643. 1 COLUMBIA BASIN HEALTH ASSOCIATION 1515 E COLUMBIA STREET OTHELLO WA 99344 910896701 501(C)(3) 0 25736643 BOOK BUILDING, FURNITURE AND FIXTURES TO SUPPORT HEALTH CARE SERVICES. 1 0 PART I, LINE 2: THE ONLY GRANT MADE WAS TO COLUMBIA BASIN HEALTH ASSOCIATION, THE SUPPORTED ORGANIZATION. THE CHAIRMAN OF THE BOARD OF COLUMBIA BASIN CIRCLE OF CARE IS ALSO THE CHIEF EXECUTIVE OFFICER OF COLUMBIA BASIN HEALTH ASSOCIATION, SO HE ENSURED THAT THE TRANSFERRED ASSETS WERE USED APPROPRIATELY. X X X X 0 1 0 0 0 0 0 0 0 NIEVES GOMEZ CHAIRMAN 0 269860 0 91750 0 12716 0 9030 0 7638 0 390994 0 0 PART I, LINE 3 THE BOARD OF DIRECTORS OF COLUMBIA BASIN HEALTH ASSOCIATION (CBHA), A RELATED ORGANIZATION, DETERMINES THE CEO'S COMPENSATION FROM CURRENT MARKET DATA AND 990 COMPENSATION FROM A POOL OF OTHER COMMUNITY HEALTH CENTERS THROUGHOUT THE STATE AND NATIONALLY. A CONSULTING FIRM PUTS TOGETHER THE MARKET DATA WHICH IS USED TO SET PAY SCALES AND PAY GRADES FOR THE ORGANIZATION WHICH INCLUDES A PAY GRADE FOR THE CEO. PART I, LINE 4B CBHA HAS A 457(F) PLAN FOR NIEVES GOMEZ. DURING 2022, $65,500 WAS CONTRIBUTED INTO THE PLAN AND NO DISTRIBUTIONS WERE MADE OUT OF THE PLAN. BUILDING, FURNITURE & FIXTURES 2023-04-01 25736643 BOOK VALUE 910896701 COLUMBIA BASIN HEALTH ASSOCIATION 1515 E COLUMBIA STREET OTHELLO WA 99344 501(C)(3) 0 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: NIEVES GOMEZ PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: NIEVES GOMEZ WAS THE BOARD CHAIRMAN OF COLUMBIA BASIN CIRCLE OF CARE AND IS THE CEO OF COLUMBIA BASIN HEALTH ASSOCIATION. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT DUTIES AND RESPONSIBILITIES ARE PERFORMED BY COLUMBIA BASIN HEALTH ASSOCIATION, THE SUPPORTED ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS DISTRIBUTED TO BOARD MEMBERS FOR REVIEW AND WAS REVIEWED BY THE BOARD PRIOR TO FILING THE RETURN. A COPY IS AVAILABLE UPON REQUEST FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND ENFORCED WHEN DISCLOSURES ARISE. ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF A BOARD MEMBER SHALL BE DISCLOSED TO THE BOARD. WHEN ANY SUCH INTEREST BECOMES A MATTER OF BOARD ACTION, SUCH MEMBER SHALL NOT VOTE OR USE PERSONAL INFLUENCE ON THE MATTER, AND SHALL NOT BE COUNTED IN THE QUORUM FOR A MEETING AT WHICH BOARD ACTION IS TO BE TAKEN ON THE INTEREST. THE MEMBER MAY, HOWEVER, BRIEFLY STATE A POSITION ON THE MATTER, AND ANSWER PERTINENT QUESTIONS OF BOARD MEMBERS. THE MINUTES OF ALL ACTIONS TAKEN ON SUCH MATTERS SHALL CLEARLY REFLECT THAT THESE REQUIREMENTS HAVE BEEN MET. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES DURING THE YEAR IN HOW THE ORGANIZATION SELECTS THE FINANCIAL STATEMENT AUDITOR AND MONITORS THE AUDIT PROCESS. COLUMBIA BASIN HEALTH ASSOCIATION 1515 E COLUMBIA STREET OTHELLO WA 99344 910896701 HEALTH CARE WA 501(C)(3) LINE 10 N/A 0 0 1 1 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0