2026-07-21T07:42:26-05:00 2025-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2025-01-01 810856014 AGING IN PACE WASHINGTON AGIN 2067883656 PO BOX 3007 SEATTLE WA 981143007 KELLI NOMURA PRESIDENT 2067883656 2026-07-11 1 KURT BENNION CPA P01469618 4252506100 2026-06-26 2025 2025-03-06 01:10:19Z AIPACE KELLI NOMURA PO BOX 3007 SEATTLE WA 981143007 12055260 0 X N/A X 2015 WA TO BE A SUPPORTING ORGANIZATION, OPERATED FOR THE BENEFIT OF AND TO SUPPORT INTERNATIONAL COMMUNITY HEALTH SERVICES. X 3 2 0 2 0 0 349474 12009092 0 0 62363 46168 0 0 411837 12055260 0 19530967 0 0 0 0 0 0 0 77323 351864 77323 19882831 334514 -7827571 16142590 121457 14707562 6514000 1435028 -6392543 X AIPACE IS A SUPPORTING ORGANIZATION, OPERATED FOR THE BENEFIT OF AND TO SUPPORT INTERNATIONAL COMMUNITY HEALTH SERVICES. 0 0 19530967 19530967 0 AGING IN PACE WASHINGTON IS A SUPPORTING ORGANIZATION, OPERATED FOR THE BENEFIT OF AND TO SUPPORT INTERNATIONAL COMMUNITY HEALTH SERVICES'S (ICHS) PACE PROGRAM. THE PACE PROGRAM OPERATED BY ICHS 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 REGULATIONS. THE DEED OF THE PACE PROGRAM PROPERTY WAS TRANSFERRED FROM AIPACE TO ICHS (APPLICATION FILED IN 2025 AND APPROVED BY KING COUNTY IN 2026). 19530967 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 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 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 353409 30894 GILDAS CHEUNG SECRETARY 1.00 4.00 X X 0 0 0 HIROSHI NAKANO TREASURER 1.00 1.50 X X 0 0 0 HERMES SHAHBAZIAN CFO 2.00 42.00 X 0 264307 19738 0 617716 50632 0 0 1 0 0 9715805 1591000 702287 12009092 46168 46168 12055260 0 0 46168 19530967 19530967 1401 1401 3667 3667 65550 65550 38546 38546 242397 242397 LICENSES & TAXES 303 303 19882831 19530967 351864 0 2311702 65053 121457 3048 0 13762787 16142590 121457 68790 14638772 6514000 14707562 6514000 X 1435028 -6392543 1435028 -6392543 16142590 121457 -7827571 0 X X 0 1 X 1 1 1 X X 1 INTERNATIONAL COMMUNITY HEALTH SERVICES 910947084 3 1 8752 19522215 1 8752 19522215 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 48000 0 0 48000 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 THE CAPITAL CAMPAIGN/PUBLIC FUNDING SUPPORT FOR THE FACILITY WHICH WILL HOUSE THE ICHS PACE PROGRAM. 0 DUE TO RELATED ORGANIZATIONS 64000 REFUNDABLE GRANT 6450000 6514000 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). 1 INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVENUE S SUITE 100 SEATTLE WA 98104 910947084 501(C)(3) 8752 19522215 NET BOOK VALUE PROPERTY, PLANT & EQUIPMENT GENERAL OPERATING SUPPORT 1 0 PART I, LINE 2: AGING IN PACE WASHINGTON ONLY GRANTS MONEY TO INTERNATIONAL COMMUNITY HEALTH SERVICES, ITS SUPPORTED ORGANIZATION, AND INTERNATIONAL COMMUNITY HEALTH SERVICES FOUNDATION, A SUBSIDIARY ORGANIZATION CONTROLLED BY INTERNATIONAL COMMUNITY HEALTH SERVICES.. THESE ORGANIZATIONS ARE UNDER COMMON CONTROL. 0 0 0 0 0 0 1 0 0 KELLI NOMURA PRESIDENT 0 283802 0 55700 0 13907 0 13796 0 17098 0 384303 0 0 HERMES SHAHBAZIAN CFO 0 264307 0 0 0 0 0 10590 0 9148 0 284045 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 MAY RECEIVE A PERFORMANCE BONUS NOT TO EXCEED 20% OF THE CEO'S ANNUAL SALARY FOR THE CALENDAR YEAR. THE PERFORMANCE BONUS CRITERIA INCLUDE THE FIVE FOLLOWING EQUALLY WEIGHTED AREAS: FINANCIAL, STRATEGIC, COMMUNITY, EMPLOYEE/PATIENT SATISFACTION, AND QUALITY. CASH 2025-12-31 8752 CASH 910947084 INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVENUE S SUITE 100 SEATTLE WA 98104 501(C)(3) PROPERTY, PLANT & EQUIPMENT 2025-12-31 19522215 NET BOOK VALUE 910947084 INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVENUE S SUITE 100 SEATTLE WA 98104 501(C)(3) 1 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: KELLI NOMURA, HERMES SHAHBAZIAN, GILDAS CHEUNG AND HIROSHI NAKANO PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: KELLI NOMURA AND HERMES SHAHBAZIAN WERE EMPLOYEES OF INTERNATIONAL COMMUNITY HEALTH SERVICES PRIOR TO THESE TRANSFERS AND WERE OFFICERS OF ALL THREE ORGANIZATIONS PRIOR TO THESE TRANSFERS. THEY CONTINUED TO SERVE AS OFFICERS OF ALL THREE ORGANIZATIONS AFTER THESE TRANSFERS.GILDAS CHEUNG AND HIROSHI NAKANO WERE BOARD MEMBERS OF INTERNATIONAL COMMUNITY HEALTH SERVICES PRIOR TO THESE TRANSFERS AND THEY CONTINUED TO SERVE AS BOARD MEMBERS OF INTERNATIONAL COMMUNITY HEALTH SERVICES AFTER THESE TRANSFERS. 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 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 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0