HomeMy WebLinkAboutOriginals 2009/2010 Agency Funding Applications Result 2, Tabs 9-14 only ORIGINALS
2009/2010 Agency Funding Applications
Result 2, Tabs 9- 14 only
Result 1
Rated by Rolf, Alicia, Adria,
Elizabeth, Margie
Result 2
Rated by Rolf, Alicia, Adria,
Elizabeth, Margie
Result 3
Rated by Rolf, Alicia, Adria,
Elizabeth, Margie
Result 4
Rated by Charlie, Cheryl, Tony,
Robin, Sammi
Result 5
Rated by Rolf, Alicia, Adria,
Elizabeth, Margie
Result 8
Rated by Charlie, Cheryl, Tony,
Robin, Sammi
Result 9
Rated by Charlie, Cheryl, Tony,
Robin, Sammi
9
Appliciation Cover Pages (Agency Information and Questions 1 — 7)
I. A ._m_.ti ___.._.: -.a.r
�a ��. .� A ency Inforation i''
agency Name: i,
Applicant Name and Address: Agency Director:
Faith)Wimberley Thomas Trompeter, Chief
Executive Officer
955 Powell Ave SW Ste. A Name and Title
Renton, WA 98057 (425) 277-1311
(Area Code) Telephone
fwi I berley@chckc.org (425) 277-1566
E-mail address (if available) (Area Code) Fax Number
Required signatures: By signing below, you certify that the information in this application is
accurate to the best of your knowledge and that you have read the ap lication, certifications, and
appendixes. (SIGNATURES MUST BE IN BLUE INK) ��
Gf"� ( . t �7 rector?e,4,/ 'te
i ature of A e cyBoa�Preside Date Signature o Agency Di
g ,
Vitoria Goetz Thomas Trompeter____
Printed Name of Agency Board President __ _P nted Name of-Agericy Dire o
tl
•
Progyram Information u.' `�� qq
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, �:V UN..9tl\I
1. Pro ram Name Primary Dental �HCMAN S . = tICE , II—_,
Contact Person (available to answer specific questions on this application)
Faith Wimberley (425) 203-0419
Name (Area Code) Telephone
1
i
I Address (if different than above)
fimberley@chckc.org (425) 277-1566
E-mail address (if available) (Area Code) Fax Number
2. Program is New for our agency ❑ An Ongoing Program IZI
3. Brief Description of Program(One sentence)
Community Health Centers of King County's Primary Dental Program delivers high quality,evidence based,affordable
and culturally conscious preventive,routine,restorative and urgent care dental services to people in South King
County.
4. Where are services provided? (If different from agency location)
- Services are provided to anyone regardless of their residency at health centers in Auburn,Federal Way and Kent.
Page 1
5. Total Program Cost:
Actual 2007: $ 6,045,932 Proposed 2009: $ 6,732,302
Projected 2008: $ 6,358,782
6. Total City Funds Requested for this Program:
City Awarded 2008 Requested 2009*
General Fund CDBG Total Requested**
Auburn - 20,000 25,000
Federal Way 15,900 12,149 32,000
Kent 20,000 - 35,000
_ Renton 19,000 - 20,000
City Awarded 2008 Requested 2009*
General Fund General Fund
Burien - 10,000
Covington 2,400 3,400
Des Moines - 2,400
Enumclaw - -
SeaTac 5,000 34,000
Tukwila 2,500 5,000
*Cities on a two year funding cycle will renew 2009 awards to 2010 based upon performance and
availability of funds. See Part II for city specific information.
**Include your total request for Auburn, Federal Way Kent and Renton. The source of funding will be
,determined by staff.
Page 2
7. Agency Contact Sheet
Provide the following information for the agency and for the program requesting funds.
Agency Contacts
Ge eral Agency Name: Community Health Centers of King County_
Address: 955 Powell Ave SW Ste. A
City/State/Zip: Renton, WA 98057
Phone/Fax: 425-277-1311 425-277-1566
Agency Web Address: www.chckc.org
Ex cutive Director Name: Thomas Trompeter
Title: CEO
Direct Phone: 425-277-1311
E-Mail: ttrompeter@chckc.org
Development Director Name: Faith Wimberley
(or Grant Writer) Title: Resource Manager
Direct Phone: 425-203-0419
E-Mail: fwimberley@chckc.org
Finance/Accountant Name: Jody Putman
(person preparing invoices) Title: CFO
Direct Phone: 425-277-1311
E-Mail: jputman@chckc.org
Program Contact
(Staff contact for contracting, reporting and program implementation.)
Program Name: Primary Dental
Staff Name: Faith Wimberley
Title: Resource Manager
Direct Phone: 425-203-0419
E-Mail: fwimberley@chckc.org
Page 3
Application Narrative Section (Questions 8—12)
8. ORGANIZATIONAL EXPERIENCE(2 page maximum)
` -k. Experience.
Community Health Centers of King County(CHCKC) is a network of seven medical, four dental, and one
school based health centers that serve families and individuals in south, north and east King County.
CHCKC also provides on-site care in homeless shelters throughout south, north and east King County. In
2008 CHCKC will expand its Federal Way Medical Center and Kent Dental Center.
Medical services provided by CHCKC include the full scope of primary medicine: diagnosis and
treatment of acute and chronic illness and minor injuries; screenings for STDs, cancer, diabetes,
hypertension, and other major illnesses; preventive care for adults and children; referral for specialty
diagnostic evaluations and treatment; and prenatal/obstetric care, including delivery. Our medical support
programs are Natural Medicine, Pharmacy, and Behavioral Health. The Natural Medicine Program is
natt.ropathic care, stress management, nutrition counseling and acupuncture at each center. Behavioral
Health is a stepped care approach to mental health and mood disorder interventions. Dental services
provided by CHCKC include: preventive, operative, periodontal and pediatric care, including limited
prosthetic and oral surgery services. We offer emergent care clinics weekly at each location. Homeless
healthcare services provided by CHCKC include: nursing and primary care services provided on-site at
transitional shelters, emergency shelters, and permanent supportive housing throughout King County as
well as at a child care center at a transitional housing complex in east King County. Interpretation
services are provided for all patients requesting them at no additional cost to the patient.
CHCKC has been providing King County with high quality, culturally sensitive, primary health care
services for 30+years, since it's founding as the Valley Pulse Community Clinic in 1971. CHCKC was
formed in response to the unmet health care needs of its target population: low-income uninsured
I.
families and individuals in suburban King County. Those needs continue as does the mission of CHCKC:
"Toll provide complete primary health care services to the people in our communities, with special
attention to the needs of the medically under-served populations of King County. Our services encompass
not only treatment and prevention of illness but also health education, behavioral health service, outreach,
interpretation and a variety of other services that our patients want and need."
As he only federally qualified health center network serving communities in Suburban King County,
CHCKC has come to be recognized and depended upon for delivery of health care. CHCKC has
demonstrated its capabilities in meeting the needs of its target populations. The organization's track
recdrd is evidence of its expertise in managing scarce resources efficiently.
B. Operational Structure.
Listed below are the key staff responsible for the agency and its programs.
Senior leaders of the organization are:
Chief Executive Officer Thomas Trompeter, MPA
Medical Director Judith Featherstone, MD
Dental Director John Caron, DMD
Chief Operating Officer Debbie Wilkinson
Chief Financial Officer Jody Putman
Page 4
Mr. Trompeter has worked at CHCKC for 11 years—the last 7 years as Chief Executive Officer. He has
ove twenty-five years of experience working with community health centers.
- Dr. eatherstone has been with CHCKC for 16 years—the last 6 as Medical Director. Dr. Featherstone
'1as een a practicing family practice/OB,physician for 17 years.
Dr. aron,DMD, CHCKC's Dental Director has over 27 years of experience running a dental program.
Dr. anon served 16 years in the United States Navy as a Dental Specialist in Public Health, 7 years as the
Chi f of Dental Operations for Public Health—Seattle and King County, and 7 years as the Dental
Dir ctor at Community Health Centers of King County.
Ms. Wilkinson has worked at CHCKC for the last 5 years as Chief Operating Officer. Prior to joining
CH KC she was the Director of Community Support Services at Highline Community Hospital/Highline
Me ical Enterprise for 16 years.
Ms. Putman is a Certified Public Accountant with over 18 years in financial leadership of various
organizations. Ms. Putman joined CHCKC three years ago as the Chief Financial Officer.
Program Directors responsible for the operations of their program are:
Director of Medical Operations Jeanne Ziltener
Dental Programs Manager Pamela Gorsuch
Lead Naturopathic Physician Cindy Breed, ND
Director of Health Systems (Community Programs) Terri Calnan, LP
Ms. Gorsuch, CHCKC's Dental Program Director, has over 25 years experience working in dental offices
wit over nine years of experience managing the Kent Community Dental Center and the past three years
is t e Dental Program Director.
The CHCKC Board of Directors strives to maintain a highly trained and effective Board that is
kno ledgeable regarding its role,responsibilities, CHCKC programs, and the broader environment within
whi h CHCKC operates. The CHCKC Board of Directors is comprised of community members, 64% of
who are patients of the health centers. The Board strives to recruit consumer directors who are
repr sentative of the individuals being served by CHCKC in terms demographic factors such as age, sex,
race(ethnicity and geographic location, and there is a Board Development Committee that actively
reviews this information. Members of the Board of Directors serve as volunteers in support of the
org ization's stated mission, goals and work plan. The board is a"working board" and meets on a
monthly basis. The board is responsible for establishing policies, approving budgets and programs, and
mo litoring operations of the organization. The Board of Directors recruits and hires the CEO.
The Board stays connected and informed about the needs in South King County by including consumers
as b and members and by actively attending school, city and community sponsored events, and through
civi organizations such as Rotary and the Chamber of Commerce. The Board also hosts open houses and
spec'al events at each of the health centers so that members of the community can learn more about the
services CHCKC provides.
9. EED FOR YOUR PROGRAM
A. roblem Statement.
cc rding to 2000 Census data there are significant low-income populations in south King County
communities. The proportion of persons living with incomes below 200% of the Federal Poverty Level
FPL (Medicaid's eligibility cutoff) range from 11% in Covington to 28% of Auburn residents. On
Page 5
average, 21.5% of South King County city residents live on less than 200%FPL (that's less than 35,000
annually for a family of 3). The county average is only 19%.
The2005 A Matter of Need publication by The South King Council of Human Services reports findings
;onsistent with the above data stating that "South King County has the highest number of families living
below the poverty level and the largest number of single-parent households. More people are on food
stamps and in the State's Aid to Needy Families program than in any other part of the county."
According to this same report, "South County has more than twice the number of public school students
enrolled in the federal Free and Reduced Price Lunch Program as Seattle, and more than three times as
many as East and North King County combined."
Lack of dental care coverage is a major barrier to care for south King County residents. In Public
Health's—Social and Health Indicators across King County 2005 Communities Count Report, the
percentage of Adults without health insurance continued to rise. The South Region experienced an
increasing trend in the percent of residents uninsured for both the 10 year period 1995-2004 and from
2000-2004. Within King County the South Region has the highest average adult uninsured rate at 18%."
Furthermore says the study, 35% of those adults who do carry health coverage still lack dental coverage.
Adults who lacked health insurance were almost seven times more likely to have not gotten care they felt
they; needed due to cost (41%) than their insured counterpart (6%). There is a direct relationship between
lack of health inusrance and increased risk of death and hospitalization from causes that may be
preventable.
The most significant gap in dental care for this area is coverage for adults. Adults more than any other
group lack resources: access and payment for dental care. They are the most likely to delay dental care
and in 2006, one public health report noted 50.3% of adults have had a tooth removed due to decay.
Beyond the federal Medicaid program that only covers dental care to the aged,blind, disabled,pregnant
)r those with exceptional high risk(less than 100% of FPL, with children in the home), there is little to no
iowf income dental health care coverage. This leaves a gap of more than 150,000 adults who are ineligible
for coverage, 71,791 of whom are still low-income and/or elderly.
Starting in 2008, the Delta Dental Foundation will sponsor children through a King County Kids pilot as
part]of the Children's Health Initiative in King County. This program will extend coverage to some kids
who are not eligible for the state and federal sponsored programs mentioned above. The program will not
cover the parents or family members. Furthermore, Basic Health, which covers the majority of
Washington States moderate-income families, only offers emergency dental coverage to its children and
adult enrollees. As dental carries are passed within families, these parents and other family members
must receive dental care to protect the children from oral health disease. Many private dentists who will
accept Medicaid reimbursements generally limit the number of Medicaid-sponsored clients that they will
see. South King County residents who have Medicaid coverage frequently cannot find a provider willing
to serve them because Medicaid reimbursement is perceived to be much less than what third party
insurance pays. This leaves many children(the majority of those with Medicaid dental coverage) with
little practical access to dental care. A significant portion of south King County has been designated as a
dental Health Professional Shortage Area(HPSA). Presently, in south King County, along with
CHCKC's community dental centers, only one public health dental clinic and one dental assistant training
program in Sea Tac, that sees a very limited number of visits,provide a sliding-fee scale for uninsured
and underinsured patients. Of these, only the CHCKC sites accept adults between eighteen and sixty five
years of age.
k.s explained above, some efforts are underway to enroll low-income children in King County. Coverage
does not exist for moderate-income children, their family members and adults. While coverage is being
extended to some children, capacity has not been extended and so the overtaxed dental centers, such as
Page 6
CHCKC do not have capacity to extend appointments to all of the newly enrolled children and their
uninsured family members. The need for additional dental facilities continues to be critical. According
Public Health's—Health of King County 2006 report: "Dental access to care does not always mean
zccessibility to services. Data from the ABCD program shows less than 1/3 of Medicaid children aged 0
o 5 receive dental service, even though they are eligible. In 2004, about 25.9% of King County adults
had not seen a dentist or a dental clinic in the past year." In addition, the report mentioned that the cities
of Tlukwila/SeaTac,Renton and Seattle tend to have the highest rates of no regular dental care within
King County. Expanding dental services for both low-income children and adults is a priority of
CHCKC, although securing adequate resources may be a major challenge.
As noted in the table below and the Healthy People 2010 Report, race & ethnicity has a direct correlation
with the rate of untreated, historical, and rampant tooth decay.
C IZi 1;.a;ta!r Jic:a:ors by Rae:E`hn:.itj."King County_2300
White <S°k ♦:HP 2010 goal cf:1
• African Am.23%
"rllspanie 2p%
E API 24 b
O*er 15%
›-Wh'ts t3° tea 201C oaa;0542'
rifrioa"t Am. re°h •
„ Hisparic °.5 ,
c, AFI 72%
r
• O:her 40%
IS%
Afribeg Am.4%
• Hispanic •e%.
AFr 21%
:her 10%
C :3 SO SO
San.Scarce::0C3 StAl-ET;arrey
Prsdubed by:Epidfr:icic y,Plannl,g Evaluston,r GIblic Hs.;l:h-34a:t`s&Kirg County
The South King County Population, including the largest group of immigrant, refugee, and racial
minorities in all of King County, is in dire need of additional dental health care. With more area
resi tents affected by oral disease than asthma or diabetes (two of the top five most common causes of
hospitalization and death in our county), we are experiencing the prevalence of oral disease in pandemic
proportions.
B.Target Population.
CHCKC's target population are the families and individuals who have difficulty accessing primary dental
care)services through traditional private provider systems due to financial, cultural, language or other
barriers to care. In 2007, 62% of CHCKC's south King County dental clients were persons of color or
persons of Hispanic origin, 33%were persons with a primary language other than English, 55%had
family incomes below the Federal poverty level, 30%lived in single parent households, and 4%were
,.omeless. In addition, 62% of CHCKC's south King County dental clients in 2007 had Medicaid
coverage and only 3%had 3rd party health care coverage. More than one out of three clients (35%) had
no dental care coverage at all.
Page 7
So h King County Dental clients come from all the cities in South County with the majority residing in
Au urn, Federal Way and Kent.
[0. PROPOSED PROGRAM/SERVICE
A. 1 rogram Description.
CHCKC provides dental care services by licensed dentists and dental assistants on a sliding scale basis for
um sured and underinsured clients and no one is ever denied essential services due to an inability to pay.
For patients with limited English speaking ability or hearing impairment, interpretation services are
pro ided at no additional cost to the patient. Taxi vouchers and bus passes are available for patients with
identified transportation barriers
CHCKC strives to meet the need for dental care in South King County by operating three dental centers
located in Auburn, Federal Way, and Kent. The program has dental teams providing comprehensive
preventive, restorative, diagnostic,periodontal and pediatric dentistry. Limited prosthetic, endodontic,
and oral surgery services such as extractions and root canals are also available. CHCKC contracts with a
dental anesthesiologist to provide general anesthetic services one day per month for children with serious
oralhealth issues such as baby bottle tooth decay. In addition to its quality clinical staff, CHCKC
proides other services for clients including client service representatives (CSR) at its medical centers
who are responsible for helping patients acquire and retain health care coverage such as Medicaid or
Bas.c Health. Dental patients may access CSRs at the medical centers as well. The Kent dental center
has a full-time Spanish interpreter on staff to help with the many Spanish-speaking clients with limited
En lish speaking ability. The Federal Way facility is often able to utilize the services of the medical
cen er's interpreter staff. CHCKC contracts with interpretation agencies for clients speaking languages
for hich staffs are not fluent or for when staff are not available. Case management and care
{ ,00hdination services are offered to our high risk patients as identified by the dental care team. CHCKC
woitks with private dental specialists to refer for those services such as crowns that are not provided. .
Services are provided Monday through Friday from 8:00 a.m. —4:00 p.m. at all dental centers. Four hours
each week are designated at each site for emergency clinic where patients are served on a case by case
bass for emergency needs. Outside of the emergency clinics patients in pain or with other emergency
denial needs are seen on a stand by basis. All other patients are seen by appointment.
Co unity Health Centers of King County strives to provide culturally relevant and language-
app opriate services to its clients and potential clients. CHCKC advertises in local ethnic and English
lan age publications. CHCKC's brochures and marketing materials are translated into Korean, Spanish,
Russian and Vietnamese and can be found at community centers, libraries,public health offices,hospital
urgent care centers and other non-profit social service agencies. CHCKC's Board of Directors has been
hosts open houses and special events at the health centers so that members of the community can learn
mo le about the services provided by CHCKC. Testimony to our success in welcoming persons of racial
mi orities is that these groups return for care more frequently, and give higher satisfaction ratings than
Ca casian patients.
O target population is reached through marketing, community referrals and medical program referrals.
Pat ents can either self-refer into the dental practice or they can be referred by the primary care providers
who include a cursory review of dental health in the course of a medical exam. CHCKC is well
_ established within the social and health safety net of South King County. Collaborative partners like
( Jnited Way, ReWA, CHAP and Public Health refer patients to our services.
Page 8
The primary dental care program does not have any formal collaborations at this time. NO significant
cha ges are planned for the coming years. Our intent is to expand our programs to meet the growing
capacity. These expansions will require: space, and staffing consistent with our current model.
`3. Performance Measures and Outcomes. (1 page maximum)
Performance Measure: 10,000 South King County residents receive dental care in 2009 and
2010 Number of South King County residents who receive dental care at one of three South
King County CHCKC dental centers.
Outcome: Increased access to oral health services for children and adults living in South King
County communities.
Indicator 1: 60% or more of pediatric patients complete their oral health treatment plan as
designed with their dental provider.
Indicator 2: 35% or more of adult pediatric patients complete their oral health treatment plan
as designed with their dental provider.
C. .taffing Plan & Evaluation. (1 page maximum)
Stafing
The primary dental program is currently staffed with 47 FTEs across 3 sites. This includes a dental team
of approximately 13 dentists (DDS -Doctor of Dental Surgery) and 21 Dental Assistants. The dental
assistants are licensed in the State of Washington and support dentists in appointment scheduling, teeth
cleanings and procedure assistance. The Dentists are licensed. CHCKC contracts with a dental
{ pine thesiologist to provide general anesthetic services one day per month.
In addition to its quality clinical staff, CHCKC provides other services for clients including client service
representatives (CSR) at its medical centers who are responsible for helping patients acquire and retain
health care coverage such as Medicaid or Basic Health. Dental patients may access CSRs at the medical
centers as well. The Kent Dental Center has a full-time Spanish interpreter on staff to help with the many
Spanish-speaking clients with limited English speaking ability. The Federal Way facility is often able to
utilize the services of the medical center's interpreter staff.
Evafluation:
CHCKC continuously monitors its primary dental care program and its targeted outcomes including those
listed in section III, part B as well as others that are part of the dental care program's Health Care Plan.
Comprehensive regular reporting on the agency's Health Care Plan is submitted to The Bureau of Primary
Health Care in conjunction with Federal grant support. In addition the Washington State Health Care
Authority monitors and conducts annual reviews of CHCKC's programs and outcomes. Dental measures
are tracked, analyzed and reported on a regular basis. Also a sample of clients is surveyed on a regular
basis about their satisfaction with the services they are receiving. Service or clinical changes or
improvement initiatives are undertaken based on those outcomes results.
Results are monitored at the health center level as well as for the agency as a whole. The leadership of the
organization and program managers regularly review key outcome measures and makes regular reports to
the Board of Directors. The board includes consumers who also receive this information. In addition an
:nnnal report is published that summarizes key accomplishments and measures of success.
Page 9
D. ifferences in Service Delivery by City.
OurID
service delivery model is standardized across cities. As our dental centers are located in Auburn,
Federal Way and Kent,residents of the other cities must travel beyond their city boarders to receive care.
This is the only difference between cities.
Please note that in Table 14 the cost per patient varies slightly due to rounding. In actuality the cost per
patient is the same across South King County.
11. LONG RANGE PLAN (1 page maximum)
CHCKC's Leadership Team and Board of Directors meet annually to update our Strategic Plan and long
range objectives. Our long range planning is focused in three areas:
.) To be the Provider of Choice in the communities we serve,
2.) To be the Employer of Choice within our field,
3.) To be Financially Strong and Positioned for the Future.
To t arry out the three prongs or our long range planning,we are continually implementing new programs,
exp ding our sites and services, and redesigning our staffing plans. Some of the new projects we have
coning up in the next two years include: partnering with a medical school to train medical students in the
art of community health, expanding our dental program, and implementing an endowment fund to help
suport the uncompensated care we deliver.
Duel to the continued growth in need in South King County, CHCKC has plans to expand its Primary
Dental Care program over the next 5 years with plans for opening a dental center in Renton as well as an
expansion of the Federal Way Dental Center to better serve that community and others in South King
Co nty. Expenses and Productivity are projected to increase in 2009 at our Kent Dental Center as we will
exp nd that clinic to six providers FTE from four providers FTE. These FTE will provider services for
__ 1.,5 0 more patients annually. Projections for 2007 do not include any increases in visits or expenses, as
.undo ing is not yet secured for this expansion and implementation dates are still undecided.
South King County municipal support is critical to CHCKC's effort to provide quality primary dental care
on a sliding scale to low income, uninsured families and individuals of South King County who otherwise
would likely have no access to these services. Funding from local municipalities helps show community
sup l ort for our health care programs when seeking federal, state and private funding. This funding allows
CHCKC to provide the dental care it on a sliding fee to its uninsured and underinsured south King County
patients. It is anticipated that funding will continue to come from local, state and federal sources, as well
as pi 'vate and public payors.
12. BUDGET (2 page maximum)
A. Budget Request Narrative.
In order to meet the growing demand for health services in the South King County area, CHCKC is
expanding the capacity to serve patients with the opening of expanded health centers and the addition of
staff. With the uncompensated cost per dental visit at $68, this funding is vital to continue to expand our
ability to see the growing number of low-income and uninsured patients in South King County.
Reqiested funding will help support the uncompensated cost of each visit that includes:
Salaries paid to providers and support staff $ 121.65
Patient interpretation services, lab fees and other services $ 4.04
'atint supplies $ 10.27
Cost of dental facilities $ 36.69
TOTAL $172.65
Page 10
B. Changes to Budget. Explain any significant changes between 2008, 2009 and 2010 expenses or
revenues as noted in Question 17. Are there any known or anticipated changes to the program's 2008
T3udget since adopted?
C. Cost per Service Unit(s). You should provide an estimate of your cost per service unit provided by
the program you propose. Explain how your cost per service unit was determined. These should be based
on the total cost of the program and the total number of clients served,not just the funds requested. You
have the option of providing a cost per service unit for each separate service provided within the program.
Cost Per Service Unit (dental visit): $ 172.65
Explanation of how determined:
The,uncompensated cost for each patient served or service contact for dental care is $ 172.65. This was
determined by the average cost of a dental visit ($200) less the average patient(sliding scale or flat fee)
resPlonsibility portion of the cost of the visit. Expenses are largely attributed to staffing. Our facilities
costs are unusually low because CHCKC either owns, or rents the space at reduced cost from our
collaborative partner,Public Health Seattle and King County. On average, children come to the CHCKC
health centers for dental care about 2.5 times per year and adults come about 3.5 times per year. Based on
these averages, the uncompensated cost per child patient is $431.63 and each adult patient is $604.28.
CHCKC uses a sliding scale fee for all uninsured patients based on the Federal poverty level standards.
This gives greater ability for low-income patients to access dental care.
Page 11
Agency: Community Health Centers
Data Table Requirements (Questions 13— 18) of King County
Program:Dental
13. NUMBER of INDIVIDUALS/HOUSEHOLDS SERVED BY PROGRAM
K Individuals? or ❑ Households? (Check which applies and use for reporting all demographics.)
Unduplicated
*Unduplicated Number of all Clients Served by Clients Served
All Funding Sources with Funds
Requested
2007
of column 2009
2007 2008 2009
(Actual) 1 clients (Anticipated) (Projected) (City Requested
served by Funding Only)
i City
Auburn 2533 19% 2644 2,776 58
Burien 38 0% 40 140 23
Covington 104 1% 140 146 8
Des Moines 245 2% 278 292 6
Enumclaw 0 0% 0 0 0
Federal Way 1705 13% 1,809 1,900 74
gent 3158 24% 4,340 4,840 81
Renton 523 4% 556 585 46
SeaTac 117 1% 139 146 79
Seattle 310 2% 278 292 0
Tukwila 29 0% 0 0 12
Other 4492 34% 4731 4,968 ' .
100%
Total 13254 (This column 14,957 16,085 387
must total
100%)
*Unduplicated means count each client only once per calendar year per program. This number should
match the number of clients by city indicated in the top row of Question 15.
Page 12
Agency: Community Health Centers
of King County
14. Performance Measures (Data Table) Program:Primary Dental Care
.4a. Service with 2009 Requested Funds
Proposed Performance Measures as defined below.
A) Visits B) C)
Auburn 174
Burien 69
Covington 24
Des Moines 18
Enumclaw 0
Federall Way 222
Kent 243
Renton 138
aeaTac 237
Seattle 0
Tukwila 36
14b.i Performance Measures 2009 Proposed with funds requested City Funding Only
Title: Brief explanation:
A) Dental Visits Patients of the Primary Dental Program return for care on average, 3
times per year for routine maintenance and treatment plan
completion.
B)
C)
Page 13
Agency: Community Health Centers
of King County
14 Performance Measures (Data Table), Cont. Program:Primary Dental Care
a
Average Cost of Service
14c.
Unduplicated Clients
Served with Funds Average Cost of Service per
Requested 2009 Requested 2009 Client
(Same as last column of (Same as last column of Column 1 divided.by Column
Question 6) Question 13) 2
Example: $5,000 $111.11
Auburn 25,000 58 431
Burieni 10,000 23 435
Covington 3,400 8 425
Des Moines 2,400 6 400
Enumclaw - 0 0
Federal Way 32,000 74 432
Kent 35,000 81 432
Renton 20,000 46 435
SeaTac 34,000 79 430
Seattle - 0 0
Tukwila 5,000 12 417
Page 14
Agency: Community Health Centers
of King County
15. Demographics (from all funding sources) (Data Table) Program:Dental
Client Residence �oW+ 3
co r4
74
•5.
� �4 EdaEd cd F> =
0 0 0 N Q 0 N 04) N
Q Oa U Q W w u; v) cA E- F+
Unduplicated
(check one)
®Individuals cn
rn ro o v o cq
N o N
0 Households N N -� M '^ `^ 00
!Served in 2007*
Household Income Level
30%of Median or Below 1661 28 64 165 1074 2025 337 88 232 20 5694
50%of Median or Below 491 2 20 48 291 627 96 18 37 5 1635
80%of Median or Below 84 1 5 4 50 95 27 2 2 1 271
Above 80%of Median 264 6 13 25 269 375 59 9 32 2 1054
I Unknown 33 1 2 3 21 36 4 0 7 1 108
I TOTAL 2533 38 104 245 1705 3158 523 117 310 29 8762
Gender
Male 1066 18 43 105 711 1310 216 44 152 11 3676
Female 1467 20 61 140 994 1848 307 73 158 18 5086
TOTAL 2533 38 104 245 1705 3158 523 117 310 29 8762
'age;
0-4 years 368 2 9 35 205 502 57 12 24 2 1216
1 5 - 12 years 652 5 36 58 465 919 84 23 41 4 2287
13 - 17 years 309 6 11 30 179 333 49 8 19 2 946
18-34 years 573 9 25 66 382 663 142 31 104 7 2002
35-54 years 484 10 16 43 337 546 134 32 87 10 1699
55-74 years 134 6 7 11 129 173 53 10 32 4 559
75+years 13 0 0 2 8 22 4 1 3 0 53
Unknown 0 0 0 0 0 0 0 0 0 0 0
TOTAL 2533 38 104 245 1705 3158 523 117 310 29 8762
Ethnicity
Asian 147 2 2 19 175 304 40 9 24 2 724
Black/African American 190 8 12 43 296 478 74 25 65 6 _1197
I Hispanic/Latino(a) 895 9 31 87 515 1050 126 37 40 7 2797
Native 29 0 2 2 18 32 5 1 5 0 94
American/Alaskan
Pacific Islander 66 1 0 6 98 81 10 2 8 0 272
j White/Caucasian 1093 14 49 78 519 943 227 38 150 9 3120
Other/Multi-Ethnic 113 4 8 10 84 270 41 5 18 5 558
j TOTAL 2533 38 104 245 1705 3158 523 117 310 29 8762
Female Headed 641 3 38 67 493 850 141 28 76 8 2345
Household
Disabling Condition 209 10 6 13 117 253 59 17 50 2 736
Limited English--,;peaking 676 7 15 61 425 1033 109 35 32 8 2401
1
Page 15
16.PROGRAM STAFF(DATA TABLE)
2007 2008 2009
(Actual) (Budgeted) (Projected)
Total Number of Staff(FTEs) 44.26 51.80 55
Nuber of Volunteer(FTEs) 0
m 0 0
Actual Number of Volunteers 0 0 0
Page 16
Agency: Community Health Centers
of King County
17.PROGRAM REVENUE BUDGET(DATA TABLE) Program:Primary Dental Care
Revenue Source 2007 2008 2009
(Actual) (Budgeted) (Projected/
Requested)
City Funding (General Fund & CDBG)
• Auburn 20,000 20,000 25,000
• Burien 10,000
• Covington 2,160 2,400 3,400
• Des Moines 2,400
• Enumclaw
• Federal Way 28,049 28,049 32,000
• Kent 20,000 20,000 35,000
• Renton 19,000 19,000 20,000
• SeaTac 5,000 5,000 34,000
• Seattle
• Tukwila 2,500 2,500 5,000
• Other (North King County Cities) 86,647 91,373 96,357
•
Other Government Funds
■ King County 153,880 150,863 150,000
• Washington State 374,258 333,907 350,000
■ Federal Government(Specify) 403,559 460,483 525,437
• Other(Specify)
Private Sources
• United Way(grants & designated donors) 36,067 37,194 38,356
• Foundations and Corporations
• Contributions (e.g., Events, Mailings)
• Program Service Fees (User Fees) 3,492,124 3,909,343 4,376,409
• Other 1,402,688 1,278,670 1,028,942
TOTAL PROGRAM BUDGET 6,045,932 6,358,782 6,732,301
Page 17
I
Agency: Community Health Centers
17.PROGRAM EXPENSE BUDGET,CONT. of King County
(D1LTA TABLE)
Program:Primary Dental
Expenses 2007 2008 2009
(Actual) (Budgeted) (Projected)
Personnel Costs
1
• Salaries 2,758,610 2,940,341 3,122,073
• 1 Benefits 628,471 659,343 690,215
• Other 50,593 52,523 54,453
• Total Personnel 3,437,674 3,652,207 3,866,741
Operating and Supplies
• Office/Program Supplies 376,654 347,608 368,026
• Rent and Utilities 222,814 221,878 234,911
• Repair and Maintenance 77,045 54,508 57,710
■ I Insurance 25,603 27,237 28,837
1
• Postage and Shipping 7,155 7,720 8,174
• Printing and Advertising 24,005 22,100 23,398
• Telephone 29,261 27,168 28,764
• Equipment 176,069 177,855 188,302
• Conference/Travel/Training/Mileage 41,777 74,278 78,641
• Dues and Fees 2,618 4,326 4,580
• 11 Professional Fees/Contracts 93,480 83,040 87,918
• Direct Asst. to Individuals
1
• Administrative Costs 1,210,092 1,361,024 1,440,971
• ' Other(Bad Debt) 240,844 232,436 246,089
• Other (EMR System) 78,921 59,547 63,045
• Other(Staff Recruitment) 2,350 2,488
• Other (Misc. Staff Expense) 1,920 3,500 3,706
• I
TOTAL PROGRAM EXPENSES 6,045,932 6,358,782 6,732,301
Net Profit(Loss) 0 0 0
(reivenue-expenses) =
Page 18
Agency: Community Health Centers
of King County
18. SUBCONTRACTS(DATA TABLE)
Program:Primary Dental Care
�ist all the agencies you will be subcontracting with for this program. Provide the agency name in the first
column, a description of the contract/service in the second column, and the contract amount in the third
column. Do not list agencies you coordinate with on a referral only basis. Indicate not applicable if
you do not subcontract for any part of this program.
Collaborative Agency Specific Subcontracted Activities Contract
in the Operation of Your Program Amount
AT Stills Dental Assistant and Dental Students $0.00
AT Still University perform internship rotations at Auburn and Kent
Community Health Centers
Page 19
19.APPLICATION CHECKLIST
Cont nts (Your application should contain each of these items in this order.)
[ ] Application Cover Pages.The top three pages of your application must be a completed copy of the
( Agency Information and Questions 1-7.
Applicat n Narrative:
Question 8 Organizational Experience(2 page maximum)
Question 9 Need for Your Program(2 page maximum)
Question 10 Proposed Program/Service(6 page maximum)
Question 11 Long Range Plan(1 page maximum)
Question 12 Budget(2 page maximum)
Data Tables
Question 13 Number of Individuals/Households Served
Question 14a-c Performance Measures and Average Cost of Service
Question 15 Demographics(from all funding sources)
Question 16 Program Staff
Question 17 Program Revenue&Expense Budgets
Question 18 Subcontracts
Required documentation. Supply one copy of the following required documents with the signed original
a plication. See Part II: City Specific Supplemental Information to determine whether additional copies of the
applicati n and required documentation need to be submitted.
Question 19 Required Documentation, including:
• Proof of non-profit status
• Organizational Chart
• Agency/Organization Mission Statement
• Board resolution authorizing submittal of the application(may be submitted up to 60 days after
application).
• List of the current governing board and local board, if applicable, (include name, position/title,
city residence, length of time on the Board, and expiration of terms. Note any vacancies.)
• Board Meeting Minutes of last three board meetings of governing board and local board as
applicable
• Annual Budget
• Financial Audit Cover Letter
• Financial Audit Management Letter
• Financial Statement
• Verification of Non-Discrimination Policy
• Program Intake Form
• Sliding Fee Scale
Application Check List. (Signed below.)
t. City Specific Supplemental Information.Required in
art II for applicable City only. Name: Faith Wimberley
Position: Resource Development Manager
Phone#: 425-203-0419
,Ar E-mail: fwimberley@chckc.org
- J ( Ma,„ignature of Person Completing Checklist
DO NOT SUBMIT ANY OTHER MATERIALS WITH THIS APPLICATION
r
Make sure that you carefully check Part II of this application
to see what additional attachments each city requires.
Page 20
, Community Health Centers of King County
(City or Renton Application for 2009—2010 Funding
Supplemental Questions -Dental
April 30th, 2008
City of Renton Result that best correlates to our Dental Program:
Result#2 Individuals have adequate clothing, food housing, and healthcare.
Strategy B: Increase the capacity of programs that provide food, clothing, housing and healthcare
and residents access to them.
Community Health Centers of King County focuses on the healthcare aspect of City or Renton
Result#2. Our mission is to provider more than adequate, high quality and dazzling healthcare
services to every Renton resident in need or want of care. The activities we deliver to achieve
! this result include operation of three South King County full time dental centers in the cities of
Auburn, Federal Way, and Kent. The dental center staffs Dentists and Dental Assistants who
offer a full scope of Dental Services.
CHCKC Outcome as reported on page 9 of the application:
Increased access to oral health services for children and adults living in South King County
communities.
CHCKC's outcome mirrors the City of Renton's Result by aligning the goal of increasing access
to dental services for Renton residents. The outcome is achieved through two venues:
1.) The Kent Community Dental Center will expand by two dental chairs in 2008. This
addition means that 1,500 additional patients will have access to dental services every
year starting in 2009.
2.) CHCKC continually tracks, evaluates and revises our dental delivery system design.
Projects we are developing for implementation over the next two years include mobile
dental access, an electronic dental record, and a new staffing model. Through quality and
program improvements, we are able to deliver better services, more efficiently to more
patients.
Community Health Centers of King County
Required Documentation Page Number
Proof of non-profit status 1
Organizational chart 3
Agency/Organization Mission Statement 4
Board resolution 5
Current governing board list 6
Board Meeting Minutes 8
Annual Budget 18
Financial Audit Cover Letter 19
Financial Audit Management Letter N/A
Financial Statement 20
Verification of non-discriminatory policy 37
Program intake form 39
Sliding fee scale 41
Internal Revenue Service Department of the Treasury
District 915 Second Ave.,Seattle,Wash.98174
Director
Person to Contact:
o' South King County Community EO Desk Officer
Health Centers Telephone Number:
1025 South Third (206) 442-5106
Renton, Washington 98055 Refer Reply to:
• EO-IV:MS 550
Date:
JUN 11 1987
. Dear Sir or Mada
m:
This is in reply to your inquiry of June 11, 1987, regarding
your exempt status.
Our records show that your organization is exempt from
Federal income tax under Section 501(c)(3) of the Internal
Revenue Code.
This exemption was granted in June of 1982, and remains in
effect.
Also, our records indicate that you are not a private foun-
dation, because you are an organization described in Sections
509(a)(1) and 170(b)(1)(A)(iii) of the Cade.
As of January 1, 1984, you are liable for taxes under the Federal
Insurance Contributions Act (social security taxes) on
remuneration of $100 or more you pay to each of your employees
during a calendar year. You are not liable for the tax imposed
under the Federal Unemployment Tax Act (FUTA).
Sincerely,
• 44tAtd &Lj/liiiit
Edna G. Bonnist
Exempt Organizations
Group Manager .
•
• Page 1 of 44
r
•
•
Internal Revenue Service Department of the Treasury
District Director •
•
Paw SEP 13 1BB8 imptoymsnt ldunttdaauon 4411111442NumbM.
•
EOMF COORDINATOR
Contact.YCtephoM Number:
COMMUNITY HEALTH CENTERS OF KING COUNTY Mntessal Heinous Cede S0oo611on: sotlox3 t
699 Strander Blvd., Suite D
Tukwila, WA 98188
•
•
•
Thank you for submitting the information showti below or on the enclosure. Ws have
Made it a part of your file,
The changes indicated do not adversely affect your exempt statue and the exemption
letter issued to you continues in effect.
•
oPlease let us know about any future change in the character, purpose, method of
peration, name or address of your organization. This is a requirement tor retainin `'exempt status. E your
Thank you for your cooperation.
Sincerely yours,
Itam Changed, • From To
NAME & ADDRESS CHANGE . South King County Community SEE ABOVE
Health Centers
1025 South Third
Renton, WA 98055
•
•
P.O.Box 2380,Los Angeles,CA 90083 Lstter 970(00)(Rev. 1-i7)L.
•
Page 2 of 44 J
_
Community Health Centers of King County
r
ReALN i l
Board of Directors t.
ifilfifiraggeliraiffiliiiiiiiiigkiii!..:
r,w • Yvonne Westover Administrative•
Thanes Trompeter,MPA I
YvOAdmin.Services Mgr/ Services Team
Chief Executive Officer g Safety Officer
LI
Judy Featherstone,MO • JOM Cron.DMD Jody Putman,CPA Debbie Wilkinson Meredith Vaughan
Medical Director Dental Director Chief Financial Officer Chief Operations Officer log&Development
Director
___I_ i
Jeanne Miner Pamela Gorsuch
RLead Physicians Dentists Medical Operations Controller _ Dental Operations
Convnunity Relations
Director Director —
Manager
� I
Lead N David Rosa Meseta Horluchl
LeAnne Setter Henan Reaceoea
Doctor Patient Accounts Pharmacy DirectorDirector �yl I GrantManager ,
Manager
Clinical Programs Jo Abraham Terri Cohan
Team IS Director Health Systems
Director
I
Medical Staff I Operations Team
Coordinator —7I
•
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—41
11
MISSION STATEMENT
Our mission is to provide complete primary health care services to the people in our communities
with special attention to the needs of the medically underserved populations of King County. Our
services encompass not only treatment and prevention and illness but the health education,
behavioral health services outreach interpretation and a variety of other services that our patients
want and need.
VISION STATEMENT
We are the provider of choice for quality health care services in the communities we
serve.
GUIDING PRINCIPLES
CHCKC is an environment that encourages creativity and responsibility,
respect and a strong sense of being valued.
We are a work community embracing diversity,respect, creativity and support.
We provide a productive and creative work environment that provides
value for our patients and our organization.
We provide flexible, supportive and inclusive leadership and are responsive to each
other's needs.
CHCKC offers patient-centered and accessible healthcare—all patients are treated with
care, compassion and understanding.
We treat our patients with dignity and offer education on choices of medicine so they can
gain access and make informed choices in their healthcare.
•
Page 4 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
BOARD OF DIRECTORS RESOLUTION#08-001
WHEREAS,Community Health Centers of King County(CHCKC)has applied for
grants to various funding sources to support its mission of providing quality medical and
dental care to the underserved,
THEREFORE BE IT RESOLVED that the Board of Directors approves applying for
grants for funding for the year 2009.
pL RESOLUTION PASSED without modification.
RESOLUTION PASSED with noted modification(s).
RESOLUTION DID NOT PASS.
—I/ 4-- -----
//Z Ce/0 6
Victoria G Date
Board C r
c:Woardkes02-003(ylw)
Page 5 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
955 Powell St.SW,Suite A
• Renton,WA 98057-2908
(425)277-1311 FAX:(425)277-1566
BOARD OF DIRECTORS--2008
Rev.April 15,2008
CONFIDENTIAL
NAME,ADDRESS,PHONE OCCUPATION Consumer? Officer TERM
1 8k/or Committee EXPIRES
Thomas(Tom)Cross President and CEO Member-At-Large 2008
11023 Marine View Dr.S.W. Executive
Seattle,WA 98146
H:(206)243-1420 e-mail:tonrctjlstanb►•ooke.corn
Best Contact#(206)427-5222
Member since 10/1995
Laurence M.DeShields II Patient Navigator CHCKC Chair,Strategic 2009
365212514 Ave.S. Fax:(253)874-6861 Consumer Planning
Federal Way,WA 98003-9104 email: Finance
H:253-838-0560 1ao49 r@r conicast.net
Member since 6/1998
Robert Ellis CHCKC Audit 2008
401 37t Street SE,Sp.121 Retired Consumer Quality
Auburn,WA 98002 Email:rrellis33 a,aol.com
H:253-735-1192
Member since 5/2000
Luis H.Garcia,Sr.. Retired CHCKC 2010
608 Chelan Pl.NE Email:luishrarciarcomcast.net Consumer
Renton,WA 98059
425430.2672
ember since 11/2007
ietoria Goetz Homemaker,Student CHCKC Chair, 2010
417 Wells Ave S.,Apt.#3 Email;jvsgaetz61 comcast.net Consumer Executive •
Renton,WA 98057 Board Development
H:(425)204-8802 Finance
Member since 4/2001
Chad Homer Attorney CHCKC Vice-Chair, 2008
CURRAN Law Firm Email:chorner@curranfirm.com Consumer Executive
P.OJ Box 140 Cell#206-498-6482 Chair,Board
Kent,WA 98035.0140 Development
WIdPH:(253)852-2345 Audit
FAX: (253)859-8037 Strategic Planning
Member since 1112005
John Payne Physical Therapist Board Development 2009
5319 Monta Vista Dr.E. OutPatient Physical Therapy Quality
Edgewood,WA 98372 701 M St.NE,Ste 102
H:(253)863.0654 Auburn,WA 98002
Member since 12/2006 Phone: 253.833.874
Email johnpavneptta'�vahoo.com
I
«lbmtdlbovd IM(ylw)WISNN 1:58 PM Page 6 of 44
2006 CHCKC Board of Directors p.2
Rev.4/15/2008 •
CONFIDENTIAL
NAME,ADDRESS,PHONE OCCUPATION' Consumer? Officer TERM
&/or Committee EXPIRES
Sheryl Pot Homemaker/Bus Driver CHCKC Secretary 2009
3111 SW 313th Street Email-spot98765@nrsn.com Consumer Executive
Federal Way,WA 98023 Chair,Quality
I H:253-815-8239 Comm.
Member since 2/2004 Audit
Julie D.Shoji Senior Financial Manager 2010
17323 SE 185th P1. Russell Investment Group
Renton,WA 98058 Wk:253-439-5732
11:425-793-7970 Cell:206-335-1128
Member since 6/2007 Email:jshoji@russell.com
Kathleen(Kathy)A.Smith Homemaker/Conununity Activist CHCKC Treasurer 2010
8326;59thAve.E. Consumer Executive
Puyallup,WA 98371 cell: 253-223-8434 Finance
H: Quality
Member since 4/1992 email:KSmith235@hohnail.com
ex-ofcio: Chief Executive Officer
Thomas Trompeter Community Health Centers of King Co.
4314-12th Ave South 955 Powell St SW,Suite A
Seattle,WA 98108 Renton,WA 98057-2908
(206)762-6337 w:(425)277-1311-wf(425)277-1566
email:rtrompeter(Ochckc.org
Election of directors is by an affirmative vote of two thirds of the members present of the Board of Directors,providing a quorum is present. Directors
are selected based on the Board of Directors'perceived need for financial,legal,public relations,planning,fundraising,health care,consumer or other
areas of expertise. At least 51%of the board will consist of CHCKC consumers. An effort will be made to recruit consumer directors who are
representative of the individuals being served by CHCKC in terms of demographic factors such as race,ethnicity,sex and age.
e:Woudlboad list 2007400s(ytw)WIsas I5BPM Page 7 of 44
- — Community Health Centers of King County
Board of Directors --- - ---December 12,2007
6:00 p.m.-9:00 p.m.
Administrative Offices
Present: Thomas Cross,Laurence DeShields,II,Robert Ellis,Luis Garcia,Victoria Goetz,Chad Homer,John Payne, Sheryl Pot,Julie
Shoji,Kathleen Smith, Shailesh Tatu,Thomas Trompeter(ex-officio)
Absent:
Guests:
Staff: Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
Topic Discussion A=Actions D=Decisions
Convene Meeting The CHCKC Board meeting was convened at6:35 pm
Newest Board member,Luis Garcia,was officially welcomed to the Board of
Directors.
I. Consent The consent agenda was presented for approval. A-It was moved(Laurence
Agenda -Board Meeting Minutes, 11/14/07 DeShields,II)
and seconded(Shailesh Tatu)
to approve consent agenda.
Motion approved unanimously
II. Board Tom Cross, Chair,welcomed everyone. He acknowledged that this has been
Chair's a very eventful year especially with NextGen.
Report
co There are three(3)Board members retiring from the board. Mark Mitchell,
o Barbara Kanaya and Shailesh Tatu. A plaque was presented to Shailesh Tatu
thanking him for his commitment to the Board of Directors. Plaques will be
mailed to Mark and Barbara.
December 12,2007 CHCKC Board Meeting Minutes - '- CONFIDENTIAL AND PROPRIETARY Page 1 of 4
'anc'
,c Discussion A=Actions D=Decisions = _
There will be no regular Board of Director's business meeting in January,in
lieu of the board retreat January 25,26 and 27,2008. The agenda is under
construction. Any necessary business will be conducted as a separate meeting
at the retreat.
The Friday night session at the retreat will be devoted to Board function and
governance. Chad Homer has been asked to talk about governance based on
his experience with the Carver Model of Governance. Our current Mission
Statement is in need of revision and will be discussed during the retreat.
The annual Oath of Office&Confidentiality Statement,Conflict of Interest
Statement and Conflict of Interest Disclosure document were placed in the
hand-out folders.
Several board members have not completed the board survey. Some surveys
are showing partial completion. This will be investigated.
III. Committee A. Board Development Committee:
Reports
This committee recommends Board Membership re-elections as follows: A—It was moved(Chad Homer)and
Tom Cross—1 year(2008) seconded(Robert Ellis)to accept
Laurence DeShields,II—2 years(2008,2009) the recommended re-elections to
Victoria Goetz—3 years(2008,2009,2010) the Board of Directors for the
Kathleen Smith—3 years(2008,2009,2010) terms stated.
• Motion Approved Unanimously.
co This committee recommends voting on the proposed Slate of Officers for A—Tom Cross distributed the ballots.
cu 2008 as follows: Julie Shoji tabulated the votes.
CO • Victoria Goetz—Chair The Slate of Officers was
• Chad Homer—Vice-Chair accepted by unanimous vote for
• Sheryl Pot—Secretary each position
December 12,2007 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 4
Discussion. A=Actions D=Decisions
There was a discussion regarding the compensation package. The 6%
increase to grades and bringing all staff to 93%of mid-point was thoroughly
explained. The capital budget had a few changes from the 1 s<draft. The
cash flow for 2008 showed ending cash with and with-out the proposed new
clinic.
Kathleen Smith praised Jody Putman and her staff for all of their diligent and
time consuming work in preparation of this balanced budget. .
V. Q&Aon The 2008 Board Calendar topics will be discussed at the retreat. It is
Board important that everyone has input on what are the really important topics that
Calendar need to be on the calendar.
Topics
VI. Board The business meeting adjourned at 8:35 pm,at which time the board entered
Executive executive session.
Session
Respectfully Submitted By:
I I: 14_ .its:/ V j3 D
Sheryl Pot, S: Date
co
co
co
•
December 12,2007 CHCKC Board Meeting Minutes - CONFIDENTIAL AND PROPRIETARY Page 4 of 4
There was no Community Health Centers of King County Board of Director's Business Meeting
held in January,2008.
Page 11 of 44
ti
Community Health Centers of King County
Board of Directors
February 13,2008
6:00 p.m.—9:00 p.m.
Administrative Offices
Present: Laurence DeShields,II,Luis Garcia,Victoria Goetz,Chad Homer,John Payne,Julie Shoji,Kathleen Smith,Thomas Trompeter
(ex-officio)
Absent: Thomas Cross,Robert Ellis,Sheryl Pot
Guests:
Staff: John Caron,Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
Convene Meeting The CHCKC Board meeting was convened at6:41 pm
Prior to convening the board meeting,a presentation of our new name and
logo was given by Thomas Trompeter.
I. Consent The consent agenda was presented for approval. A—It was moved(Chad Homer)
Agenda -Board Meeting Minutes, 12/12/07 and seconded(Julie Shoji)
-Preliminary Financial Statement for the period ending December 31, to approve consent agenda.
2007 Motion Approved With One(1)
Abstention,Kathleen Smith.
IL Board Victoria Goetz,Board Chair,welcomed everyone and thanked Thomas
Chair's Trompeter for the presentation of the new name and logo.
Report
• Retreat Recap -The 2008 retreat was really good. Chad Homer was
thanked for his presentation on a different way of looking at strategic
governance. The retreat was a great place to start looking at how we
manage meetings,mission and where we are going. The 2008
CHCKC Retreat Summary was passed out at tonight's board meeting
February 13,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 1 of 3
•�,r, .'Y'•.t r:�°�'...: ,•.x.? {ill 6 yd,;',)L. r,. l:'.•:',.c�-•?:.�i •'r i:::.. : :ct i;'.I FLU.� •�•i l;� :.. is a!.i 'I
,, I,. _::.J .-;'_. .,;L }, .'i.`•: ,,C i..,._.::u=•, -:;r.tits-_7L;•-r .�.i. , .l._• �f�t.t_;.. .q-1�I
(! ..r�,, ,. .;;7i,.t.?A...i;coi tc ,t.�`ti;;•� ! �., i y Li:+_� .:�trG��!`� _ .a.•�.�.
v,:.tt;..�, p ,. .��°';1. i i . .�tl1. u.t. 1�_.,5�,: 4 il'�' -. _�?:L,- .:L�-
a_.�etF��il�tt1L6tiwRu�t:,.raranmam..:.ovaa.,.,......,r...i..:r: . I .. .d:'L•
There was a brief discussion on location for next year's retreat. A—2009 Retreat location will be
January weather seemed to be the major concern in regards fo driving discussed in Executive-Session-
to Alderbrook Resort. Several board members felt this location did
not have activities for families,while others' felt the retreat was more
productive if family members were not in attendance.
• Board Calendar—The list of brainstorming calendar topics was A—An email will be sent out showing
reviewed,discussed and added to. Some of the suggested topics were all of the topics. Board members
not at the higher strategic level. Goal is to have the calendar complete will have an opportunity to give
by March board meeting. input on what they think are
priority topics. Victoria Goetz
and Thomas Trompeter will then
devise a draft calendar with the
"big ticket"topics.
• 2008 Committee—The proposed 2008 Committee Charters were A—Review proposed new committee
handed out for review and discussion. The Strategic Planning charter along with old committee
Committee has been eliminated. The Board Development Committee charter. Send comments to
has been renamed Governance Committee. Along with the charter Victoria Goetz. Willingness to
handout was the"Willingness to Serve: form. Strategic issues can Serve forms should be completed
solicit Ad Hoc meeting of specific committees and then brought back and turned into Yvonne
to the full board. Westover.
III. Committee . A. Finance Committee
Reports The Finance Committee met on February 4t. The preliminary financial
statements for December,2007 were accepted as preliminary. Write-off
receivables will be seen by April,when the audit takes place. A pie chart
showing CHCKC Revenue Streams was handed out. This chart can serve
as a reference for revenue stream discussions. The Revenue Bond, Series
2008 timeline was reviewed.
-o
cQ There was a discussion at the board retreat on the use of reviewing Key A-A potential format will be brought
m Indicators rather than the entire financial packet to the March board meeting.
G' N. CEO Report • Strategic Plan Reporting Schedule- The proposed Strategic Plan
reporting schedule for Provider of Choice and Employer of Choice
was reviewed. This proposal was the outcome of work done at the
February 13,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 3
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board retreat on the reporting schedule. There were questions •
surrounding the proposed dates for turnover rates.Of concern is"how
can we shoot for a goal without knowing the goal?" Goal is to have a A—The most recent EEOC report will
benchmark in April for turnover rates. There was a brief discussion be brought to the next Executive
on the diversity make-up.of higher level positions at CHCKC. Overall session.
there is a concern over reporting timelines that will be reviewed as we
get more information of the measurement goals.
• National and State Policy Update—The high level State Legislative
Priorities are the expansion of the Health Professions Scholarship and
Loan Repayment Program and a one-time grant to expand physical
capacity in CHC dental clinics. The high level Federal Legislative
Priorities are reauthorization of the Health Center Program;Increase
funding for the Health Center Program and Increase funding for
National Health Service Corps. Handouts showed how much money
and notes.
V. Other For the record,the following Board Resolutions were passed at the Annual
Business Board Retreat on 1/26/08:
#8-001 —approval for applying for grants for funding for the year 2009
#8-002—Removal of Mark Mitchell as an authorized signer on the Charles
Schwab and all Kibble and Prentice investment accounts. The
approval to replace Mark Mitchell with Kathleen Smith
#8-003—approval to remodel 6,000 square feet of the Powell building and
approval to finance or refinance up to$1,100,000 of the cost
through the issuance of tax-exempt bonds.
The March 2008 Board meeting will be held on Wednesday March 19,2008.
VI. Board The business meeting adjourned at 8:01 pm,at which time the board entered
Executive executive session.
Session
Respectfully Submitted By:
cp
.p .
0
42 Sheryl Pot, Secretary Date
•
February 13,2008 CHCKC Board Meeting Minutes . CONFIDENTIAL AND PROPRIETARY Page 3 of 3
Community Health Centers of King County
Board of Directors
March 19,2008
6:00 p.m.—9:00 p.m.
Administrative Offices
Present: Laurence DeShields,II,Robert Ellis,Luis Garcia,Victoria Goetz,Chad Homer,Sheryl Pot,Julie Shoji,Kathleen Smith,Thomas
Trompeter(ex-officio)
Absent: Thomas Cross,John Payne
Guests:
Staff: John Caron,Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
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Convene Meeting The CHCKC Board meeting was convened at.6:32 pm
I. Consent The consent agenda was presented for approval. A—It was moved(Chad Homer)
Agenda -Board Meeting Minutes,2/13/08 and seconded(Julie Shoji)
- Special Session Conference Call Board Meeting Minutes 3/7/08 to approve consent agenda.
-Preliminary Financial Statement for the period ending December 31, Motion Passed Unanimously.
2007
-Financial Statement for the period ending 1/31/08
IL Board Victoria Goetz,Board Chair,welcomed everyone.
Chair's
Report NACHC Policy and Issues Forum—Chad Homer,Victoria Goetz and
Thomas Trompeter attended the NACHA P &I Forum in
Washington D.D.,March 12—18,2008. They were able to talk to
Congress along with other Community Health Center forum
delegates. The main issues at stake were"
• Re-authorization of Health Center Program with a five(5)year
co renewal.
cD • Health Center Grant Program making it through the
Appropriation Committee
• Medicare hasn't been adjusted since `93/'94. Better
reimbursement is needed.
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 1 of 3
•
L�.. '��
Our group was able to consult with Bait to continue the discussion of A—Chad Homer and Thomas
wording for our mission statement. It was agreed that an outside Trompeter will-be meeting with
consultant would best be able to wordsmith our mission statement the outside consultant to see how
once we come up with the key points. The mission statement should he might phrase our mission
be short and concise and tell why we exist. statement.
• Board Calendar—The calendar was briefly reviewed. Some of the A—Several Board members want to
suggested topics were not at the higher strategic level and therefore know which topics were taken off
moved to the Governance Committee. The numbers in parenthesis the calendar and given to the
with some of the topics indicates the number of times the topic has Governance Committee. Victoria
been presented. A correction needs to be made to 2009 Budget. Goetz will email the list to all
September will be the 3"discussion and November will be the 4th board members.
discussion. Most board members were contacted about their
committee membership. A—Review committee membership.
Send comments to Victoria
• 2008 Committee—The proposed 2008 Committee membership and Goetz.
Charters were handed out for review.
• Town Hall Meetings—Laurence DeShields and Debbie Wilkinson
attending a Town Meeting hosted by Ron Sims on the inequities
across society in all areas including healthcare. The discussions were
around how we need to work towards a better society and have
everyone on a level playing field. PBS will be doing a serious on
"Unnatural Causes"which deals with these issues. Another Town
Hall meeting is scheduled for Kent Senior Center on Monday,March
24s'.
III. Committee A. Finance Committee
Reports The Finance Committee met on March 4th. The Financial Statements for A—It was moved(Sheryl Pot)and
period ending January 31,2008 were sent out in the board packet. seconded(Chad Homer)to accept
Kathleen Smith asked the board if they were comfortable with the Key the Key Indicators as the monthly
mIndicators. Any comments need to be directed to Kathleen Smith. Full financial report with expanded
financial reports will be given on a quarterly basis. financial to be presented on a
rn quarterly basis. The Motion
° Passed Unanimously.
Powell Building Financing
An overview of the Powell Building Remodel summary was distributed. A—It was moved(Sheryl Pot) and
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 3
n ib; _ `� -+• • r' .. r.�: ,.4 y 1 t t n::rF1+ =rF r.q;d;try
girl�j ...iil. ;f; ttLL tw >f,i... ^ .•• rr � '} ram'I:.�ttNr � .1 .^1... ..0 f... rc: '.:.�nri ,':r.rt 'll �:..�y.. �.c �r E k< 1 .r. 2....
� 1 � 1n r.....� -.J.�F 1•r...� i I Js.ih: i^i f tip, 'f r__..�..it 1 ..Fi. �{l, � �+, r !r `'rcl, u � 4 � r< �. �3 I U }l-f 1,.:� f l^-r_ �, ! 1 t,4 .I �'i-%fin_. .r:_.s,.i�r .. l.:i.. .,� .,: _ � iIIl..'t.�•
In order to borrow the maximum allowable funds,we needed to use the seconded(Kathleen Smith)to
Kent building as collateral and therefore had to get it appraised. The move ahead with the plans for
appraisal came in at 7.3 million. Remodel uses and overview of costs tenant improvement to the Powell
were reviewed. Building. The Motion Passed
Unanimously.
IV.CEO Report Dental Benchmark Report(2008 Strategic Plan)
The Dental Dashboard showing the percentage of patient who completed
their dental treatment plan within 12 months was reviewed. There are
different goals for kids(60%)and Adults(45%). Adults have a more
difficult time making their follow-up appointments and also have more
complex treatment plans.
EEOC Report
The CHCKC Employees by Race/Ethnicity and Position Class as of
9/30/07 was presented and reviewed. One-third of our employees speak
another language in addition to English. This report is filed every
September.
Provider Recruitment and Retention
The organization recognizes the need to increase provider salaries. There
has been difficulty in bringing in new hires at the 93%medium level. The
ELT would like to bump the initial salary offering to the 95%level and
balance the existing salaries accordingly. Competition for providers is
stiff across the state. CHCKC has 6 provider vacancies.
Insurance Summary
As requested at the retreat,the Insurance Summary was distributed and
reviewed. Bottom line,we are well protected.
VI. Board There being no further business,the business meeting adjourned at 7:45 pm at
Executive which time the board entered executive session.
caw
Session
Respectfully Submitted By:
0
Sheryl Pot,Secretary Date
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 3 of 3
Community Health Centers of King County
4-
2008 Budget Summary 0
a)
rn
cc
TOTAL 2008 a.
Budget
STATISTICS-UnitsNisits 169,711
•
REVENUE
Fee for Service Revenue 13,810,286
Grant Revenue 5,604,018
Managed Care Revenue 13,269,844
Other(Rental, Interest, etc) 1,826,943
•
EXPENSES
Personnel Costs 25,055,911
Services 653,192
Supplies Exp 1,877,015
General Exp 1,965,884
Overhead Exp 4,944,763
C:1Documents and Setd 1reyerlLocal Settings\Temporary Internet Files1OLKE812008 Budd , ummary
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Independent Auditors'Report rw�rN�t�►�r
Pmcigor srrvkes[orpotafton
Board of Directors
Community Health Centers of King County
Kent, Washington
We have audited the accompanying statement of financial position of Community Health Centers of King
' County (the Organization) as of December 31, 2006, and the related statements of activities, functional
• expenses, and cash flows for the year then ended. These financial statements are the responsibility of the
Organization's management. Our responsibility is to express an opinion on these financial statements
based on our audit. The prior year summarized comparative information has been derived from the
Organization's 2005 audited financial statements and in our report dated March 29, 2006, we expressed
an unqualified opinion on those financial statements.
•
We conducted our audit
in accordance
with auditing standards generally accepted in the United States of
America and the standards applicable to financial audits contained in Government Auditing Standards,
issued by the Comptroller General of the United States.Those standards require that we plan and perform
the audit to obtain reasonable assurance about whether the financial statements are free of material
• misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and
• disclosures in the financial statements. An audit also includes assessing the accounting principles used
and significant estimates made by management, as well as evaluating the overall financial statement
presentation. We believe that our audit provides a reasonable basis for our opinion.
In our opinion, the financial statements referred to above present fairly, in all material respects, the
financial position of Community Health Centers of King County as of December 31, 2006, and the
changes in its net assets and its cash flows for the year then ended in conformity with accounting
principles generally accepted in the United States of America.
In accordance with Government Auditing Standards,we have also issued our report dated April 11,2007,
on our consideration of Community.Health Centers of King County's internal control over financial
reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, and
grant agreements.The purpose of that report is to describe the scope of our testing of internal control over
financial reporting and compliance and the results of that testing, and not to provide an opinion on the
internal control over financial reporting or on compliance. That report is an integral part of an audit
performed in accordance with Government Auditing Standards and should be considered in assessing the
results of our audit. .
•
Certified Public Accountants
April 11,2007 Page 19 of 44
171
COMMUNITY HEALTH CENTERS
OF RING COUNTY
Financial Statements And Independent Auditors'Report
December 31,2006
Page 20 of 44
Table Of Contents
Page
Independent Auditors'Report 1
Financial Statements:
Statement Of Financial Position 2-3
Statement Of Activities 4
Statement Of Functional Expenses 5
Statement Of Cash Flows 6
Notes To Financial Statements 7_16
Page 21 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
Statement Of Financial Position
Assets
December 31,2006
(With Comparative Totals For 2005)
2006 2005
Current Assets:
Cash and cash equivalents(Note 2) $ 319,514 $ 2,130,433
Investments(Note 3 and 13) 1,891,005
Patient fees receivable, net of allowance for doubtful accounts
and contractual adjustments of$1,070,835($1,610,075-2005) 1,748,799 1,787,138
CHNW receivable(Note 11) 916,185 949,686
Grants receivable 760,585 613,224
Other receivables 86,360 76,709
Inventory 70,636 122,743
Prepaid expenses 175,089 132,950
Total Current Assets 4,077,168 7,703,888
Land, buildings,furniture, and equipment(Note 4) 25,076,246 20,720,593
Construction in progress(Note 4) 694,554 400,241
Less accumulated depreciation and amortization (5,490,389) (4,632,121)
20,280,411 16,488,713
PTSO costs, net of amortization(Note 6) 625,074 772,924
Investments(Notes 3 and 13) 15,702,170 12,966,338
Land held for future use(Note 5) 256,420 256,420
Deposits 56,166 129,356
Total Assets $ 40,997,409_ $ 38,317,639
The accompanying notes are an integral part of these financial statements. Page 22 of 44
-2-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Statement Of Financial Position
Liabilities And Net Assets
December 31,2006
(With Comparative Totals For 2005)
2006 2005
Current Liabilities:
Accounts payable(Note 2) $ 1,061,661 $ 677,093
Accrued wages and related payables 1,338,073 1,272,853
Other accrued expenses 29,318 24,298
Current portion of loan payable(Note 10) 92,815 91,667
Total Current Liabilities 2,521,867 2,065,911
Loan payable, less current portion(Note 10) 2,156,656 2,249,471
Total Liabilities 4,678,523 4,315,382
Commitments and contingencies(Note 12)
Net Assets:
Unrestricted
Undesignated 20,616,716 21,035,919
Designated by the Board of Directors(Note 13) 15,702,170 12,966,338
Total Unrestricted 36,318,886 34,002,257
Total Net Assets 36,318,886 34,002,257
Total Liabilities and Net Assets $40,997,409 $38,317,639
The accompanying notes are an integral part of these financial statements.
-3- Page 23 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
Statement Of Activities
For The Year Ended December 31,2006
(Wills Comparative Totals For 2005)
2006 2005
OPERATING ACTIVITIES
Revenue and Support
Patient service revenue,net of contractual adjustments $19,193,489 $17,466,146
Grants and contracts from governmental agencies 5,053,351 4,465,484
United Way of King County 127,263 142,734
Donations and contributions from private agencies,
including donated services and supplies 148,845 18,795
Rental income 305,039 299,628
Investment income(Note 3) 608,291 506,068
Other income 139,340 167,768
Total Operating Revenue and Support 25,575,618 23,086,603
Expenses
Program Services:
Primary medical care 17,168,912 15,073,335
Primary dental care 4,359,592 4,151,715
Total Program Services 21,528,504 19,225,050
Supporting Services:
Management and general 5,155,610 4,860,044
Total Operating Expenses 26,684,114 24,085,094
Change in Net Assets from Operating Activities (1,108,496) (998,491)
NON-OPERATING ACTIVITIES
Loss on disposal of assets (799) (101,757)
Loss on Impairment of assets(Note 4) (257,017)
Unrealized Gain or(loss)on investments(Note 3) 165,897 (85,392)
Contributions 70,522 1,960,445
Pool savings(Note 11) 3,446,522 3,429,444
Change In Net Assets from Non-Operating Activities 3,425,125 5,202,740
Change In Net Assets 2,316,629 4,204,249
Net assets,beginning of year 34,002,257 29,798,008
Net Assets,End of Year $36,318,886 $34,002,267
The accompanying notes are an integral part of these financial statements. Page 24 of 44
-4-
i
COMMUIVITYHEALTH CENTERS OF KING COUNTY
Statement Of Functional Expenses
For The Year Ended December 31,2006
(With Comparative Totals for 2006)
Program Services Supporting Services
•
Primary Primary Total Management
Medical Dental Program And 2006 2005
Care Care Services General Total Total
Salaries. $ 9,414,301 $2,447,240 $11,861,541 $ 2,584,477 $14,446,018 $13,169,073
Payroll taxes and fringe benefits 2,100,122 575,102 2,675,224 575,935 3,251,159 $ 2,908,095
Total Salary and Related Expenses 11,514,423 3,022,342 14,536,765 3,160,412 17,697,177 16,077,168
Contract Labor _ 469,532 48,049 517,581 34,632 552,213 584,015
Professional fees 887,148 82,841 969,989 273,181 1,243,170 1,192,641
Occupancy 692,383 174,672 867,055 232,614 1,099,669 1,010,779
Dues,publications,and subscriptions 79,150 10,580 89,730 73,682 163,412 184,364
Travel 43,350 8,566 51,916 134,108 . 186,024 133,003
Medical/dental supplies 1,432,063 313,566 1,745,629 5,797 1,751,426 1,139,712
Office supplies 182,449 33,344 215,793 55,522 271,315 352,462
Printing 46,582 11,823 58,405 13,051 71,456 66,608
Equipment lease and maintenance 504,233 114,183 618,416 179,586 798,002 882,543
Postage 67,692 10,513 78,205 22,585 100,790 75,674
Telephone 216,533 53,628 270,161 91,128 361,289 321,654
Insurance 45,363 15,524 60,887 39,288 100,175 93,345
Interest and banking fees 61,564 35,808 97,372 90,041 187,413 198,051
Property taxes 6,156 3,898 10,054 43,739 53,793 33,284
Bad debts 247,475 159,755 407,230 12,000 419,230 375,378
Mscellaneous 149,642 72,427 222,069 228,191 450,260 397,999
o Total Expenses Before
c
CD Depreciation and Amortization 16,645,738 4,171,519 20,817,257 4,689,557 25,506,814 23,118,680
Depreciation and amortization 523,174 188,073 711,247 466,053 1,177,300 966,414
0
Total Expenses $17,168,912 $4,359,592 $21,528,504 ' $ 5,155,610 $26,684,114 $24,085,094
The accompanying notes are an integral part of these financial statements.
-5-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Statement Of Cash Flows
For The Year Ended December 31,2006
(With Comparative Totals For 2005)
2006 2005
Cash Flows from Operating Activities:
Change in net assets $ 2,316,629 $ 4,204,249
Adjustments to reconcile to net cash provided by operating activities:
Depreciation and amortization 1,177,300 966,414
Unrealized(Gain)or loss on investments (165,897) 85,392
Loss on disposal of assets 799 101,757
Loss on impairment of assets 257,017
Changes in assets and liabilities
Grants receivable (147,361) (159,914)
Accounts and interest receivable 38,339 (765,357)
CHNW receivable 33,501 561,075
Inventory 52,107 (67,465)
Other assets 21,400 5,137
Accounts payable 384,568 (161,993)
Accrued liabilities 70,240 39,284
•
Cash Provided by Operating Activities 4,038,642 4,808,579
Cash Flows from Investing Activities:
Payments for land,building and equipment acquisition (5,036,038) (4,601,525)
Payments for PTSO costs (42,926) (372,917)
Purchase of investments (3,556,074) (19,058,975)
Proceeds from sale of investments 2,877,144 4,116,243
Cash Used by Investing Activities (5,757,894) (19,917,174)
Cash Flows from Financing Activities:
Debt service principal payments (91,667) (86,680)
Cash Used by Financing Activities (91,667) (86,680)
Net decrease in cash and cash equivalents (1,810,919) (15,195,275)
Cash and cash equivalents, beginning of year 2,130,433 17,325,708
Cash and Cash Equivalents,End of Year $ 319,514 $ 2,130,433
Supplemental Disclosure of Cash Flow Information:
Cash paid for interest $ 128,487 $ 133,498
The accompanying notes are an integral part of these financial statements.
-6- Page 26 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY •
Notes To Financial Statements
Note 1-Summary Of Significant Accounting Policies
Description of Operations - Community Health Centers of King County (CHCKC) is a not-for-profit
organization providing comprehensive primary medical and dental care through the operation of health
centers in Kent, Renton,Auburn, Eastside, Bothell, and Federal Way. CHCKC's mission is to provide care to
all, regardless of ability to pay and to specialize in providing care for the medically.underserved, low income,
and other disadvantaged populations In King County. CHCKC provides comprehensive and coordinated
services, including allopathic and naturopathic family medicine, family dentistry, acupuncture, behavioral
health care, nutrition services and massage therapy. CHCKC also provides a variety of supportive services to
increase the effectiveness of the health care services provided. These supportive services include outreach ,
and insurance eligibility assistance, referral coordination and patient care coordination. CHCKC strives to
improve the overall health of the general population through education and treatment of illnesses through a
comprehensive set of service modalities. CHCKC's philosophy is that all people are entitled to affordable,
high quality health care.
Basis of Presentation - The financial statements are presented in accordance with generally accepted
accounting and reporting standards for not-for-profit organizations. p
Under these standards, net assets and revenues, expenses, gains and losses are classified based on the
existence or absence of donor-imposed restrictions. Accordingly, the net assets of CHCKC and changes
therein are classified and reported as follows:
Unrestricted net assets-Net assets that are not subject to externally imposed restrictions. Amounts
designated by the Board of CHCKC are included in this classification.
Temporarily restricted net assets - Net assets subject to donor-imposed stipulations that may or will
be met either by actions of CHCKC and/or the passage of time. CHCKC had no temporarily restricted
net assets as of December 31,2006 and 2005.
Permanently restricted net assets-Net assets subject to donor-imposed restrictions that stipulate the
resources be maintained permanently, but permit CHCKC to use, or expend part or all of the income
derived from the donated assets for either specified or unspecified purposes. CHCKC had no
permanently restricted net assets as of December 31,2006 and 2005.
Revenues are reported as increases In unrestricted net assets unless use of the related assets is limited by
donor-imposed restrictions. Expenses are reported as decreases in unrestricted net assets. Gains and losses
on investments and other assets or liabilities are reported as increases or decreases in unrestricted net
assets unless their use is restricted by explicit donor restriction or by law. Expirations of temporary restrictions
on net assets are reported as transfers between the applicable classes of net assets. Contributions with
externally imposed restrictions that are met In the same year as received are reported as revenues of the
unrestricted net asset class.
Cash and Cash Equivalents - CHCKC considers all highly liquid investments purchased with an original
maturity of three months or less to be cash equivalents, except for funds held in the investment accounts
designated for long-term purposes.
Page 27 of 44
7-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 1-Continued
Investments- Investments in debt, equity, or other securities that do not meet the criteria for cash and cash
equivalents are accounted for as investments. Investments with readily determinable fair values are stated at
fair market values in the accompanying financial statements.
Credit Risk - Financial instruments that potentially subject CHCKC to concentration of credit risk consist
principally of cash, short-term Investments, and receivables. CHCKC places its cash and investments only in
high quality financial institutions. At December 31, 2006, CHCKC has cash deposits and investments in
excess of the federally insured limit of$100,000 in an institution.
inventory - Inventory is stated at the lower of cost or market. Cost is determined by the first-in, first-out
method.
Accounts Receivable -Trade accounts receivable are stated at the amount management expects to collect
from outstanding balances. Management provides for probable uncollectible amounts through a charge to
earnings and a credit to a valuation allowance based on its assessment of the current status of individual
accounts. Balances that are still outstanding after management has used reasonable collection efforts are
written off through a change to the valuation allowance and a credit to trade accounts receivable.
Land,Buildings,Furniture,and Equipment-Land, buildings,furniture,and equipment are recorded at cost
or, if donated, at the fair market value at the date of donation. Repairs and maintenance are charged to
expense as incurred. Leasehold improvements are amortized over the shorter of the useful life or lease term.
Depreciation is provided using the straight-line method over the following estimated lives:
Building and Improvements 10-40
Furniture and Equipment 3-10
Patient Service Revenue - Patient service revenue is recognized at the date of service based on estimated
net realizable amounts from patients and third-party payers for services rendered or is recognized based on a
specified dollar amount per month for patients enrolled in a managed care plan.
Revenues from third party payer agreements are subject to audit and retroactive adjustments. Retroactive
adjustments are recorded at the time that such amounts can first be reasonably determined, which Is
normally upon notification by the paying entity. Currently,the adjustments for Medicaid services are recorded
at the time of billing based upon the Medicaid fee schedule instead of at the time of notification.
A significant percentage of patient service revenue were for services provided to Medicaid participants.
Medicaid revenue represented 74% and 72% of patient service revenue for 2006 and 2005, respectively.
Medicaid receivables represented 39% and 44% of net patient fees receivable at December 31, 2006 and
2005,respectively.
Contributions - Contributions, which include unconditional promises to give (pledges), are recognized as
revenue in the period received. Currently it is the policy of management to recognize certain contributions as
non-operating revenue. These contributions are given to support the overall mission and are not specifically
set aside or earned through operations.
Page 28 of 44
-8-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 1 -Continued
Charity Care - CHCKC has a policy of providing care to patients, who meet certain criteria under its policy,
without charge or at amounts less than its established rates. However, all patients are requested to pay a
minimum fee for each visit and no patient is denied services because of inability to pay. Since management
does not expect payment for this care, the discounted services are excluded from revenue. During the year
ended December 31, 2006 and 2005, CHCKC provided $4,414,605 and $4,334,892, respectively, of charity
care services under this policy.
Grant Revenue - CHCKC receives support from various federal, state and local government agencies.
Grants receipts are subject to restrictions on the use of funds placed by the grantor. CHCKC administers
these funds In accordance with grantor guidelines. Grant revenue under cost reimbursement arrangements is
recognized as expenses are incurred. Amounts incurred but not yet reimbursed are reported as grant
receivables.
in-Kind Contributions - CHCKC receives contributed services and supplies from various sources.
Volunteers, including members of the Board of Directors, have made significant contributions of time to
CHCKC. The value of this contributed time does not meet the criteria for recognition under current accounting
standards, and accordingly is not reflected in the accompanying financial statements. Certain professional
services formally documented and charged to the relevant project are recorded in the accompanying financial
statements.At December 31,2008, in-kind contributions were included in both grant and contribution revenue
in the statement of activities. These services and contributions of materials are recorded at market values.
Summarized below are totals for 2008.
Contributed labor $ 55,945
Contributed supplies 467,558
Contributed use of space 12.800
$__S36.303
Federal Income Tax-CHCKC has received a determination letter from the IRS that states it is exempt from
federal income taxes under Section 501(c)(3)of the Internal Revenue Code.
Use of Estimates-The preparation of financial statements in conformity with accounting principles generally
accepted in United States of America requires management to make estimates and assumptions that affect
the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of
the financial statements and reported amounts of revenues and expenses during the reporting period.Actual
results could differ from those estimates.
•
Comparative Totals - The financial information includes certain prior-year summarized comparative
information in total but not by net asset class. Such information does not include sufficient detail to constitute
a presentation in conformity with accounting principles generally accepted in the United States. Accordingly,
such information should be read in conjunction with CHCKC's financial statements for the year ended
December 31,2005, from which the summarized information was derived.
Page 29 of 44
-9-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 2-Cash And Cash Equivalents
During 2006, CHCKC became the fiscal agent for the Community Health Council of Seattle/King County
(CHCSKC). CHCSKC is a 501(c)(3)organization made up of membership from Community Health Centers in
Seattle and King County including CHCKC. CHCSKC's mission is to maintain and enhance the ability of the
member Health Centers to provide comprehensive, culturally and linguistically appropriate health care to
underserved populations in King County.As the fiscal agent for CHCSKC, CHCKC collects monies and pays
obligations for CHCSKC. Included in the cash and cash equivalents for the year ended December 31, 2006
are CHCSKC funds held of $58,841 which is also Included in accounts payable as an amount due to
CHCSKC.
Note 3-Investments
CHCKC Invests funds with Charles Schwab & Co., Inc. and FTN Financial that are managed by Kibble &
Prentice, a group of private asset managers. These funds are invested based upon the designations by the
Board of Directors. These investments pay interest and dividends at variable rates and some of the
investments are subject to market fluctuation increases and decreases. The investment of these funds is
controlled by the investment policies of CHCKC as approved by the Board of Directors.
Investments are carried at market value and consist of the following at December 31,2006:
Equity securities $ 1,219,268
Certificates of deposit 783,702
Money market funds 3,681,586
Fixed income 10.017.614
05.702.170
Investment Income consisted of the following for the year ended December 31,2006:
Interest and dividends $ 590,691
Realized gains 17,600
Unrealized gains 185.897
$ _ 774.1011
Unrealized gains and losses are considered non-operating in the statement of activities.The balance of
undesignated investments for 2005 and 2006 were$1,891,005 and$0 respectively.
Page 30 of 44
-10-
III
,
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 4-Land,Buildings, Furniture And Equipment
The cost and accumulated depreciation of fixed assets at December 31 were as follows:
2006 2005
Land $ 2,890,013 $ 2,890,013
Building and improvements 16,322,029 13,009,201
Leasehold improvements 1,282,503 985,580
Medical and dental equipment 1,176,576 1,152,906
Billing computer 819,634 784,055
Office equipment and other 2.585.491 1.898.838
25,076,246 20,720,593
Less accumulated depreciation and amortization (5.490.389) (4.632.121)
19,585,857 16,088,472
Construction in progress 694.554 400.241
Total 520.2_ 80.411 118.488,713
Included in land, buildings, furniture, and equipment Is the cost of the Auburn Medical Arts Building
purchased in February 1999 for$3,372,357 of which a portion is leased to other medical organizations under
operating lease arrangements(Note 16).
As of December 31, 2006, the construction in progress balance of$694,554'consisted of three projects. In
2001, CHCKC started planning for the rebuilding of the Bothell Health Center on land purchased in 1999.
Design and other costs related to the project of$263,040 were incurred prior to 2008. it was determined in
2006 that $257,017 of the design costs associated with this planning were no longer able to be used and
were written off in the current year. The balance of the costs of$6,023 along with costs incurred in 2008 for
feasibility studies for rebuilding this clinic of$16,000, make up the balance of$22,023 at December 31, 2008.
Lutheran Community Services NW(LCS)is building a community center at Angle Lake in the City of SeaTac.
CHCKC Is currently building out approximately 8,000 square foot space with tenant improvements as part of
a long-term lease with LCS and has incurred costs to date of$537,492. This health center is proposed to be
completed and opened in the second quarter of 2007. In 2006, CHCKC started the remodel of the third floor
of the Kent Community Health Center after administration moved to Renton and has incurred costs to date of
$135,039. This remodel is planned to be completed in the second quarter of 2007.
In May of 2006, CHCKC opened the new school-based Tyee Campus Health Center on the campus of Tyee
High School in SeaTac WA. Approximately 1,100 square feet was remodeled in the school space.
Additionally, in November of 2006, another health center was opened in Burien WA under a leasing
arrangement with Wesbild BP Inc. The costs of both of these new health centers are included in the
leasehold improvement and are being depreciated over the estimated lease lives.
Note 5-Land Held For Future Use
In August 1999, CHCKC purchased the Bothell Clinic building along with some adjacent land with a value of
$256,420. This land is currently being held for future use and is vacant.
Page 31 of 44
-11 -
COMMUNITY HEALTH CENTERS OF SING COUNTY
Notes To Financial Statements
Note 6-Practice Technology Services Organization(PTSO)
In May 2004, CHCKC became a participant in Practice Technology Services Organization (PTSO) along with
other community health centers in the State of Washington. The PTSO was formed in order to realize such
benefits as group discount purchasing, shared database management and support, grant opportunities and
standardized processes and data. In order to participate in the PTSO, CHCKC invested a level of funding of
costs for equipment, membership fees, software license costs, start-up and operating costs and service fees.
CHCKC will receive a future benefit from the use of the shared database management system. Accordingly,
the amounts have been capitalized and will be amortized over the useful lives of the hardware and software
license.
The PTSO costs as of December 31,2006,were as follows:
2006 2005
PTSO license, software and hardware costs $ 991,084 $ 948,158
Less accumulated amortization (386.010) (175.234)
Total $ 625.074 L 772.924
Note 7-Leased Facilities And Equipment
CHCKC is obligated under leases for the Bothell, Eastslde and the Federal Way clinics.These leases provide
for annual adjustments to the minimum rental payments based on increases in building operation costs or the
consumer price index. In June of 2005, CHCKC entered into a lease agreement with Lutheran Community
Services NW to lease a portion of a building set to begin construction in 2006. Construction was completed in
2006 at which time CHCKC began tenant improvements to their approximate 8,000 square foot shell space
projected to cost approximately $1,000,000, which CHCKC will pay. This lease agreement provides for a
lease period of ten years and has three successive options to extend the lease for five years each. Lease
obligations for this lease over the ten-year period total$1,375,248.
In November 2006, CHCKC entered Into a short-term lease with Wesbild BP Inc for a medical clinic in Burden
WA that opened In the same month. This lease expires on April 30,2007 due to availability of space and calls
for lease payments of$1,600 per month. At the expiration of the lease, CHCKC will determine if other space
is available.
The facility rent expense for the years ended December 31, 2006 and 2005, was $359,221 and $343,172,
respectively. CHCKC also leases various office equipment under operating leases which expire through April
2011.The rent expense related to these leases was$94,230 and$86,691 for the years ended December 31,
2006 and 2005, respectively.
Page 32 of 44
- 12-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 7-Continued
The future minimum lease payments under these leases are as follows:
Years Ending December 31,
2007 $ 266,086
2008 200,293
2009 173,727
2010 149,444
2011 142,304
Thereafter 764.023
Total $ 1,696a1
Note 8-Retirement Plan
CHCKC maintains two tax sheltered annuity retirement plans under Internal Revenue Code Section 403(b),
which covers substantially all employees. One of these plans, Vanguard Group, was authorized in 2005 and
allows employees to self-direct investments.
For the years ended December 31, 2006, and 2005, there were no employer contributions or employer
matching of employee contributions under the plan.
Note 9-Managed Care
CHCKC Is a member of Community Health Network of Washington (the Plan), a managed care plan formed
by twenty-one community and migrant health centers throughout the State of Washington to participate in the
managed care marketplace. The Plan is a not-for-profit corporation. The Plan accepts the full insurance and
financial risk of providing health care services to enrollees in the State Medicaid and Basic Health Plan
programs. As part of this agreement, the individual Centers are contingently liable for their proportionate
share of any claims should the Plan be unable to meet Its financial obligations. The Office of the Insurance
Commissioner (OIC) requires all plans to maintain reserves to meet these financial obligations. The Plan
maintains assets in excess of the OIC's requirements and believes that its assets are sufficient to meet
financial obligations.
As part of this agreement, CHCKC has agreed to serve as a provider of primary care services for a certain
amount per member per month and to provide case management services to these same members related to
specialty and hospital services. In return, CHCKC will participate in any savings realized by the Plan in
providing these services,based upon a formula determined by the Board of Directors of the Plan.
Page 33 of 44
- 13-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 10-Loan Payable
A loan payable to U.S. Bank with a current interest rate of 5.53%. Principal and interest payments are due
monthly through January 2022. The Loan and Security Agreement allows for two optional prepayments
periods known as Reset Dates at January 23,2007 and 2017 respectively without penalty.The interest rate is
also reset at these Reset Dates based on a formula derived from market rates. This loan is collateralized with
the Kent facility and land.At December 31, 2006,CHCKC was in compliance with all covenants related to the
loan.
CHCKC had the following loan payable balance at December 31,
2006 2005
$2,249,471 $2,341,138
Less current portion (92.8151 (91.667)
Total $ 2,155,656 $ 2,249,471
Scheduled principal repayments on the above loan payable are as follows:
Years Ending December 31,
2007 $ 92,815
2008 97,521
2009 104,303
2010
111,137
2011 118,420
Thereafter 1.725.275
Total
2,249,471
Note 11-Hospital And Specialty Pools
Included on the statement of activities are $3,446,522 and $3,429,444 of Hospital and Specialty Pool
Revenues for 2006 and 2005, respectively. This income Is classified as non-operating as it is not directly
related to services provided by CHCKC, but rather the result of savings realized by CHNW (Note 9) on
specialty and hospital care.This income is accrued as it becomes known to CHCKC, generally at or near the
time cash is received. The estimate is based on the preliminary settlement statement prepared by the
Community Health Plan for the most recently completed plan year which is calendar year 2005. CHCKC
'receives distributions of these savings over a 15 to 18 month period following the end of a plan year.
Note 12- Commitments And Contingencies
Grants-CHCKC has received federal grants for specific purposes that are subject to review and audit by the
grantor agencies. Entitlements to these resources are generally conditional upon compliance with the terms
and conditions of grant agreements and applicable federal regulations, including the expenditure of resources
for allowable purposes. Any disallowance resulting from a review or audit by the grantor may become a
liability of CHCKC.
Page 34 of 44
- 14-
COM
MUNITY CENTERS OF KING COUNTY
Notes To Financial Statements
Note 12-Continued
Use of Facility Restriction-In 1991,CHCKC received$29,663 from King County DSHS for the construction
of real property at 403 E. Meeker St. in Kent. Under the terms of this grant, CHCKC is obligated to use the
facility to provide comprehensive health care to the.low-income population of South King County until April 5,
2006. A promissory note was issued in November 1998 for the above amount,which was forgiven on April 5,
2006, because CHCKC met the use of facility restriction specified in the grant.A release of the restriction was
filed with King County in February 2007. It is expected that this release will occur in 2007.
Note 13-Designated By Board Of Directors
The Board of Directors of CHCKC designated cash and cash equivalents and investments for the following
purposes at December 31:
2006 2005
Managed care reserves $1,100,000 $1,100,000
Operating reserves 6,743,030 5,500,000
Reserve for capital and program development 6,722,370 5,366,338
Reserve for endowment 1 136.770 1.000.000
$15,702,17Q $12,986,338
Reserves designated by the Board of Directors include an allocation for unanticipated expenses in CHCKC's
managed health care programs, operating reserves equivalent to approximately three months of normal
operating expenses, reserves for capital and program development, and an initial reserve for start-up of an
endowment that in future years will help finance special strategic initiatives.
Note 14-Malpractice Insurance
Effective January 1, 2003, CHCKC was covered under the provision of the Federal Tort Claims Act (FTCA)
for malpractice. The FTCA is a government funded program which allows community health centers and
other qualified providers to be covered for malpractice. CHCKC has purchased malpractice insurance for
activities not covered under the FiCA.
Note 15-Self Insurance
CHCKC is a member of 501c Services(the Trust), formerly the Northwest Agency Trust The Trust facilitates
the utilization by member agencies of the Reimbursement Financing Method of meeting obligations under
State Unemployment Insurance Statutes. As of December 31, 2006 and 2005, CHCKC had on deposit
$63,923 and$54,378, respectively,with the Trust to fund these obligations.The deposit is included in prepaid
( expenses on the statement of financial position. Any potential claims that may exist cannot be estimated at
- December 31,2006;therefore, no accrual has been made.
Page 35 of 44
-15-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 16-Lease Agreement
In November 2004, CHCKC entered into a lease agreement with another organization to lease a portion of a
building owned by CHCKC. This lease calls for monthly lease payments of$9,722 for the period February
2005 to October 2009 and $10,734 for the period November 2009 to October 2014.This lease Is a triple net
lease and the lessee is obligated to pay a Pro Rata share of the operating costs of the building as additional
rent each month. At the time of the lease signing, the lessee was required to make a security deposit of
$10,734 which Is refundable upon fulfillment of certain lease conditions and.a prepaid rent amount of$9,722
which represents the fourth month's lease of the lease period. Additionally, approximately 3,000 square feet
of this same building Is leased to another tenant under a triple net lease that is currently set to expire on June
30, 2007. The lessee Is also obligated to pay a pro rata share of the operating costs based on their share of
the space leased.
Aggregate future minimum rental payments to be received under the operating leases are as follows:
Year Ended December 31,
2007 $160,134
2008 116,664
2009 118,888
2010 128,808
2011 128,808
Thereafter 364.956
$ 1,018ans$
Page 36 of 44
-16-
I. FAIR EMPLOYMENT PRACTICES
Equal Employment Opportunity
CHCKC affirms its continuing commitment to extend to all qualified individuals an equal
opportunity to compete for employment and advancement within the company. We are committed
to the philosophy and principle of equal employment opportunity for all present and prospective
employees.
To assure equal employment opportunity,there shall be no discrimination and/or preferred treatment
concerning any individual or group because of race,color,creed,religion, sex, age,national origin,
citizenship, marital status,veteran status,sexual orientation,political ideology,medical condition, or
because of sensory,physical,or mental disability,or any other factor protected by law.
Further, it is the policy of CHCKC to comply with the Americans With Disabilities Act and other
federal and state laws prohibiting discrimination against applicants or employees with disabilities.
• Accordingly, we will reasonably accommodate applicants and employees with known physical or
mental disabilities to the extent required by law. This reasonable accommodation policy extends to
all services,programs,and facilities that are provided through employment with us. We reserve the
right to modify,or make exceptions to,any of its existing policies or practices to the extent necessary
to provide a reasonable accommodation to an applicant or employee whom we know has a disability.
If you believe that you need an accommodation because of a disability or medical condition,please
discuss this with the Health Center Manager,Dental Center Manager,Dental Center Supervisor or
a human resources representative.
Management at CHCKC is expected to carry forward the company's policy of nondiscrimination and
equal employment opportunity in every aspect of employment. All decisions made with respect to
recruiting, hiring, and promotion for all job classifications will be based solely on individual
qualifications related to the requirements of the position. Likewise,all other personnel matters such
as compensation,. benefits, transfers, termination's, staff reduction, training, education, .and
social/recreational programs will be administered free from any unlawful discriminatory practices.
Anti-Harassment and Discrimination Policy
CHCKC recognizes and values the integrity of its employees and their right to work in an
environment that fosters mutual respect and is free of harassment or discrimination. CHCKC is,
therefore, committed to a policy that prohibits harassment or discrimination based upon any
individual employee's race, color, religion, creed, ancestry, sex, age, national origin, sexual
orientation,marital status,veteran status,or physical,mental,or sensory disability.
This policy applies to all employees, applicants, vendors, customers, contractors, and any other
person doing business with CHCKC. Harassment and discrimination not only violates CHCKC's
policy but may be a violation of state and federal law.
Harassment is verbal or physical conduct that denigrates, or shows hostility or aversion toward,
an individual because of his or her status as protected by law and that unreasonably interferes
with that individual's work performance or creates an intimidating work environment. Conduct
that the company determines constitutes a violation of this policy will result in strict disciplinary
Employee Handbook Page 4
Fair Employment Practices January 2008
Page 37 of 44
it
action, including immediate termination. Examples of such conduct include (1)demeaning or
hostile written, graphic,or verbal communications,including off-hand comments,epithets,jokes,
emails, slurs or negative stereotyping directed at any individual because of or regarding that
individual's race, color, religion, creed, ancestry, sex, age, national origin, sexual orientation,
marital status,veteran status,or physical,mental,or sensory disability; (2)hostile,intimidating or
threatening conduct directed at an individual because of that individual's status as protected by
law.
Sexual harassment is one form of harassment. It is also a violation of the law and will not be
tolerated by CHCKC. Sexual harassment is defined as:
Unwelcome sexual advances, requests for sexual favors, or other verbal
or physical conduct of a sexual nature constitute sexual harassment
when: (1)submission to such conduct is made either explicitly or
implicitly a term or condition of the individual's employment;
(2)submission to or rejection of such conduct by an individual is used as
a basis for employment decisions affecting such individual; or (3)such
conduct has the purpose or effect of unreasonably interfering with an
individual's work performance or creating an intimidating, hostile or
offensive working environment.
-Equal Employment Opportunity Commission,29 C.F.R.Part 1604,and"Guidelines on Discrimination Because of Sex."
Discrimination and harassment includes many forms of offensive behavior and can include
gender-based harassment of a person of the same sex as the harasser. Behavior that may violate
this Policy includes: ,
• unwanted sexual advances or making or threatening reprisals after a
negative response to sexual advances
• visual conduct: leering, making sexual gestures, displaying of
sexually suggestive or racially motivated objects or pictures,
cartoons,or posters
• verbal conduct: making or using derogatory comments, epithets,
slurs,jokes,or sexual advances/propositions
• physical conduct: touching, assaulting, impeding, or blocking
movements.
Complaint Procedure
If you feel you have been harassed or discriminated against because of your race,color,religion,
creed, ancestry, sex, age, national origin, sexual orientation, marital status, veteran status, or
physical, mental, or sensory disability, you should immediately contact the Health Center
Manager, Dental Center Manager, Dental Center Supervisor or Human Resources. Your
complaint will be treated seriously and investigated. The investigation may include interviewing
witnesses and gathering other relevant data. The investigation will be as confidential as possible
consistent with the need to conduct a full investigation. If substantiated, appropriate corrective
action will be taken if warranted. This can include a verbal or written warning, suspension, or
termination of employment.
Employee Handbook Page S
Fair Employment Practices January 2008
Page 38 of 44
'"^,MMUNrTY HEALTH CENTERS OF KING COUNTY PATIENT REGISTRATION
Lac_.:�md/Apellido patemo First Name/Nombre de pila Middle Name/Segundo nombre
Social Security Number/Ntimero de seguro social Birth Date/Fecha de nacimiento Gender/Sexo
❑ M ❑ F .
Mailing Address/Direccion de correos City/Ciudad State/Estado Zip/Cddigo postal
Home Address(If dlfferent)/Domicilio(si es distinto) City/Ciudad State/Estado Zip/Cddigo postal
Do you live within the city limits of your town?
Which county do you live in?/l,En que condado vive Ud.? /l,Vive Ud.dentro de los limiter de su eiudad?
❑King 0 Pierce ❑Snohomish 0 Other/Otro:
❑Yes/Si ❑No
Check if Primary Phone/ Check if Primary Phone/:
❑ Home Phone/Telefono de la casa: ❑ Alternate Phone Number(s)/Teldfono(s)alterno(s)
❑ Work Phone/Telefono de trabajo: 0 Emergency Contact Phone/Telefono de emergencia:
❑ Cell Phone/Telefono de cellular: Emergency Contact/Contacto de emergencia: •
Relationship:
How will you pay for your visits?(Check all that apply)
Are you interested in applying for Sliding Scale
/,Como pagard sus visitas?(Marque todos los que correspondan) Discount?/LLe interesa solicitar descuento de Escala Movil?
❑ Self-pay/Paga Ud.mismo ❑Yes/Si ❑No
❑ Medical Coupons/Cupones medicos Are you interested in applying for affordable health
❑ Insurance/Aseguranza insurance?/tLe interesa solicitar aseguranza mddica de bajo costo?
❑ Other/Otro: ❑Yes/SI ❑No
If patient is less than 18:ltii ri p.ickI P r,nil ii n de I C
Parent/Guardian's Last Name/Apellido de padre o madre/Tutor Parent/Guardian's Flit Name/Nombre de pila de padre o cadre/Tutor
Relationshlb to Patient Social Security Number Gender/Sexo Birth Date/Fecha de nacimiento
/Parentesco o relacibn al paciente /Minero de seguro social M ❑ F
❑Parent/Padre o Madre
•
❑Guardian/Tutor
❑ r/Otro:
Please complete both sides/Favor de completar los dos lados
•For office use only/Solo pare use oficial de CHCKC
'Witness(CHCKC Staff) Date:
Page 39 of 44
Sliding Scale Category: ❑A ❑B ❑C ❑D ❑E ❑F Insurance:
Answering these questions may help us obtain funding for services.
Ali/Sus respuestas alas siguientes preguntas podrian ayudamos a conseguir financiamiento pare los servicios quo podemos ofrecerle.
WAN your race or biological family background? Are you disabled?/LEsta Ud.Discapacitado?
(Check all that apply)/LCual es la raza suya o lade su familia ❑Yes/Si 0 No
biologics? (Marque todos los que correspondan)
❑White/Blanco Are you an immigrant or refugee?
❑Asian/Asiatico /LEs Ud.inmigrante o rcfugiado?
❑Black/Negro El
0 No
❑Native Hawaiian/Indio Hawaiano Total number of people in your household(people who
❑Other Pacific Islander/Otro lsleilo live in the same house and depend on the same Income)
❑American Indian/Alaskan Native/Indio Americano/Indio Alaskefto MSmero total de personas que viven en su hogar(y dependen del mismo
ingreso)
Are you Hispanic?LEs usted Hispano(a)? Total number of children under 18 in your household
Minnero total de nifios menores de 18 que viven en su hogar
❑Yes/Si ❑No
What language do you usually speak? Which of the following best describes your
/LQue idioma habla Ud.generalmente? household?/LCual de los siguientes describe mejor a los de su hogar?
❑EngllshMgles 0 Married with no dependent children/Casado(a)sin cargas
❑Spanish/Espanolfamiliares(nifios)
0 Russian/Ruso 0 Single Person/Soltero(a)
❑Other/Otro: ❑Single female with dependent children living with you/
Mujer soltera viviendo con cargas familiares(nifos)
Do you use an interpreter?/LNecesita un interprete? 0 Single male with dependent children living with
❑Yes/Sf ❑No you/Hombre soltero viviendo con cargas familiares(nifios)
Wha is. your ethnicity or social/cultural background? 0 Two-parent household/Hogar con dos padres
Ch ll that apply:/LCual es su origen etnico u origen social/ 0 Other/Otro:
cul Marque todos los que correspondan:
❑Alaskan Native/Indio Alaskelio Are you homeless or in a temporary shelter?
❑Cambodian-Khmer/Camboyano-Khmer /LEsta Ud.sin hogar o vive en un refugio temporal?
❑Chinese/Chino ❑Not homeless/Tengo hogar
❑Filipino/Filipino ❑Doubling Up/Compartiendo habitacibn
❑Guam-Chamarro/Guam-Chamarro ❑Street/Calle
❑Hmong/Hmong ❑Transitional/En transicitn
❑7apanese/Japones 0 Public Housing/Vivienda P6blica
❑Korean/Koreano Laotian/Laosiano 0 Shelter/Refugio
❑Mien/Mien 0 Other/Otro:
❑Native American/Indio Americano
SamoaNsamoyano Are you a migrant or seasonal farm workerV Trabaja Ud.en
❑Somalian/De Somalia el campo por temporadas o es un trabajador itinerante?
0 Not a farm worker/No campesino
❑South Asian/Sudasiatico
❑Talwanese/Taiwan8s 0 Migrant farm worker/Campesino itinerante
❑7hal/Taitandas ❑Seasonal farm worker/Campesino por temporadas
0 Tongan/De Tonga What is your Primary Medical Insurance?
❑VietnameseNietnamita /LCual es su principal aseguranza medica?
❑Other/Otro:
Marital status/Estado civil: How did you hear about this Health Center?
❑Single/Soltero(a) /LCbmo supo Ud.de rite Centro de Salud?
❑M rried/Casado(a)
❑ wedNiudo(a) What is your household's monthly income? (The cash
❑Dsvoreed/Divorciado(a) flow that you live on)?//Cuanto es el total del ingreso mensual de
❑Legally Separated/Separado(a)Legaimente las personas quo viven en su hogar? (El dinero que usan al mes pare
Are you a veteran?/LEs Lid.veteran de guerra? vivir.)
❑Yes/SI ❑No $ per month/al mes
Page 40 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY N MEDICAL FRONT OFFICE MANUAL
Sliding Scale Eligibility
1. Check patient's sliding scale eligibility status In NextGen.
2. If patient is not currently eligible for the discount, ask if they would like to fill out an application.
Participation is optional.
3. Ask patient to show proof of income for every individual in the household who has income. The
following are acceptable:
a.l Payroll check that shows year-to-date income or 1 month's worth of pay stubs.
b. Wage statements (written statement from employer).
One month's worth of unemployment check stubs.
d. Bank statement that shows flow of money in/out of account.
e. Statement from Social Security office.
f. Letter from individual who supports patient financially. Must state a dollar amount.
g. Income tax forms (first page only).
h. W-2 form.
For business owners, look at profit/loss statement, line 7, on tax form.
4. Photocopy income verification documents. Return originals to the patient.
• If the patient does not have proof of income and it is not their first visit:
a. Inform patient that they will be charged full fee for today's services.
b. Instruct patient to bring proof of income on their next visit to qualify for sliding scale.
c. File application form In patient's chart. No further action is necessary on this visit.
6. Once patient has satisfactorily shown proof of income for every income earner In the household,
sign, date, and indicate sliding scale category in gray box at bottom of form.
7. Enter Information into NextGen. (Multiply monthly income by 12 to get annual income.)
8. File application in patient's chart under"PT INFO"tab, on top of the registration forms.
sliding scale eligibility Last updated:7/16/2007 Page 1 of 4
Page 41 of 44
,race period for new patients
._:3w patients are eligible to receive a sliding scale discount for their first visit without showing proof
of income, if they fill out an application form. Enter today's date as the expiration date in NextGen.
Inforrn the patient that a sliding scale discount will not apply to any future visits until they bring proof
of income. Any patient who is new to NextGen may be considered a new patient.
Unable to show proof of income
If an applicant presents a reasonable case for why they cannot provide proof of income for
themselves, ask them to compose, sign, and date a statement to that effect. Accept that statement
as proof of income. If the applicant is unable to show proof of income for another person in their
household, however, they may not claim that individual as part of their household. (Please see
definition of income and household size on next page)
Zero income
If the patient claims zero income for themselves or other adult members of the household, remind
them of our definition of income and ask screening questions such as"Who supports you?""How do
you pay for your living?"etc. Zero income may only be accepted with a verification letter—without
that letter, they will be full fee.
Accurate effective and expiration dates
It is critical that the verify/effective date and the expiration date are accurate. Entering today's date
or a future expiration date for someone who is unqualified to receive the sliding scale discount may
-suit in disciplinary action. Also, because the patient accounts department needs accurate historical
Formation about the patient's sliding scale eligibility, be sure to create a new sliding scale profile
every time a new application is completed. Do not save new dates on top of the previous profile.
Verification/effective dates should not change. Expiration dates should only change if household size
or income changes. When expiring an outdated eligibility, you would usually set.the expiration date
earlier than yesterday's date. Setting it too far back would confuse appropriate billing of past
encounters.
Other household members, other CHCKC sites
If the discount will be used at other CHCKC sites, or if the discount will be used by more household
members beyond just the applicant, create the eligibility profile in NextGen for every household
member and add a note in each household member's account listing names and birthdates of all the
individuals on the application. Also, distribute copies of the paper information to every chart for
every household member at every clinic.
Paper charts
If there are people in your clinic who refer to the paper chart for eligibility, be sure to update sliding
scale information in the paper chart in all 3 places (patient registration form, sliding scale application,
and patient labels.)
Nothing in the chart
If you wish to refer to a patient's application or income verification and cannot locate them in the
chart, look at the who/when button by the verification date in NextGen, and/or the notes section in
e account. Either place should give you clues as to where find the documentation. Use the"clinic-
to-clinic records request"form to request the documents from the other site. Never require a patient
to complete a new application simply because you have not found the application form in their chart.
sliding scale eligibility Last updated:7/16/2007 Page 2 of 4
Page 42 of 44
,If-employed
business owners, look at profit/loss statement, line 7, on tax form.
Changes to Income or household size:
If an established patient who is currently receiving sliding scale has a change to their income or
household size, and the new amount does not change their sliding scale category, they do not need
to reverify income. If the new amount does change which sliding scale category they qualify for,
change their expiration date to today's date and explain to the patient:,"Your income (or household
size) has changed significantly enough to put you in a different sliding scale category. For today's
visit,your charges will be based on the income you verified with us previously. Because of the
change in your household income (or household size),your sliding scale eligibility needs to be
reevaluated. You will need to fill out a new application and verify the new income amount."
Definition of income; "the cash flow on which ou and those in our household live"
ncome Not income
Salary Child support
Interest from savings Financial assets (stocks, bonds, account
balances)
Dividends from stocks, bonds, mutual funds, etc. Physical assets (items you would have to sell or
liquidate to convert to income such as a home,
boat, etc.)
Monetary gifts Money drawn from a credit card
ins, scholarships, or grants for living expenses
nony
Welfare
Unemployment
Grants
Assets that have been converted to cash flow
Money that has been drawn from savings account
Definition of household size
People that live in the same home and depend on the same income, not including foster children.
Household Size for Homeless
For homeless patients, household size should include those people that the patient stays with,
transitions with, and shares income with.
Seasonal workers
To determine monthly income for an individual who works during some months of the year, you may
take their yearly income and divide by 12.
WA State Residents
Patients do not need to be WA State residents to be eligible. •
_ lvacy
:he patient feels uncomfortable discussing Income or personal information in the lobby, ask the
patient if they would like to speak in a more private location, like the manager's office, exam room,
sliding scale eligibility Last updated:7/16/2007 Page 3 of 4
Page 43 of 44
le CSR's office. Some clinics regularly have the CSRs spend time with patients who have
with the income verification process.
Sliding scale categories are based on Federal Poverty Levels as listed below.
Do note share the information below with patients:
a. Category A: up to 100% of Federal Poverty Level
b. 'Category B: up to 125%
c. Category C: up to 150%
• d. Category D: up to 175%
e. Category E: up to 200%
f. Category F: over 200% (no discount)
Dollar,amounts for the 2007 category cut offs are listed below.
Do not share this information with patients.
Persons in
Family A B C D E Full
1 10,210 12,763 15,315 17,868 20,420 20,421
2 13,690 17,113 20,535 23,958 27,380 27,381
3 17,170 21,463 25,755 30,048 34,340 34,341
4 20,650 25,813 30,975 36,138 41,300 41,301
5 24,130 30,163 36,195 42,228 48,260 48,261
6 27,610 34,513 41,415 48,318 55,220 55,221
7 31,090 38,863 46,635 54,408 62,180 62,181
8 34,570 43,213 51,855 60,498 69,140 69,141
9 38,050 47,563 57,075 66,588 76,100 76,101
10 41,530 51,913 62,295 72,678 83,060 83,061
11 45,010 56,263 67,515 78,768 90,020 90,021
12 48,490 60,613 72,735 84,858 96,980 96,981
13 51,970 64,963 77,955 90,948 103,940 103,941
14 55,450 69,313 83,175 97,038 110,900 110,901
sliding scale eligibility last updated:7/16/2007 Page 4 of 4
Page 44 of 44
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Application Cover Pages (Agency Information and Questions 1 — 7)
Agency Information:
•Agency Name:
Applicant Name and Address: Agency irector:
Faith Wimberley Thomas Trompeter, Gfiief Executive
Officer U' Vl=�
955 Powell Ave SW Ste.A ame and4itle,
° A io
Renton,WA 98057 ! (42507(Z-13.11 q
(.ara'hCode)iTelephone
cs. 0)v
fmberley@chckc.org (425)277-1566 E'p
E-mail address(if available) (Area Code)Fax Num erg`
Required signatures: By signing below,you certify that the information in this application is accurate to
the best of your knowledge and that you have read the application, certifications, and appendixes.
(SIG TURES MUST BE IN BLUE INy�KJ�) / /////////� /J/�
ijw-Avg
Signature of Agency '• Presi t/Date Signature of Agency irector/D4d
Victoria Goetz Thomas Trompeter
Printed Name of Agency Board President Printed Name of Agency Director
. .. Program Information" `... .::: .. . -
1. Program Name Primary Medical
Contact Person (available to answer specific questions on this application)
Faith Wimberley (425)203-0419
Name (Area Code)Telephone
Address(if different than above)
(425)277-1566
E-mail address (if available) (Area Code)Fax Number
2. Program is New for our agency ❑An Ongoing Program El
3. Brief Description of Program(One sentence)
Community Health Centers of King County's Primary Medical Program delivers high quality, evidence
based, affordable and culturally conscious medical services to patients of South King County.
4. Where are services provided? (If different from agency location)
Services are provided to anyone regardless of their residency at health centers in Auburn,Federal Way,
Kent,Renton and SeaTac.
Page 1
5. Total Program Cost:
Actual 2007: $ 20,533,027 Proposed 2009: $ 27,471,673
Projected 2008: $ 23,075,526
6. Total City Funds Requested for this Program:
City Awarded 2008 Requested 2009*
General CDBG Total Requested**
Fund
Auburn 32,000 53,000
federal Way 31,827 40,000
Kent 83,000 103,000
Renton 30,000 38,000
City Awarded 2008 Requested 2009*
General Fund General Fund
Burien 10,000
Covington 3,420 4,500
Des Moines 3,000 5,400
Enumclaw
SeaTac 38,400 45,000
Tukwila 3,000 10,000
*Cities on a two year funding cycle will renew 2009 awards to 2010 based upon performance and
availability of funds. See Part II for city specific information.
**'Include your total request for Auburn, Federal Way Kent and Renton. The source of funding will be
determined by staff.
2
7. Agency Contact Sheet
Provide the following information for the agency and for the program requesting funds.
agency Contacts
•
General Agency Name: Community Health Centers of King County_
Address: 955 Powell Ave SW Ste. A
City/State/Zip: Renton, WA 98057
Phone/Fax: 425-277-1311 425-277-1566
Agency Web Address: www.chckc.org
Executive Director Name: Thomas Trompeter
Title: CEO
Direct Phone: 425-277-1311
E-Mail: ttrompeter@chckc.org
Development Director Name: Faith Wimberley
(or Grant Writer) Title: Resource Manager
Direct Phone: 425-203-0419
E-Mail: fwimberley@chckc.org
Finance/Accountant Name: Jody Putman
(person preparing invoices) Title: CFO
Direct Phone: 425-277-1311
E-Mail: jputman@chckc.org
Program Contact
(Staff contact for contracting, reporting and program implementation.)
Program Name: Primary Medical
Staff Name: Faith Wimberley
Title: Resource Manager
Direct Phone: 425-203-0419
E-Mail: fwimberley@chckc.org
3
Ap lication Narrative Section (Questions 8—12)
8. ORGANIZATIONAL EXPERIENCE(2 page maximum)
, k. Experience.
Co unity Health Centers of King County(CHCKC) is a network of seven medical, four dental, and one
sch of based health centers that serve families and individuals in south,north and east King County.
CkKC also provides on-site care in homeless shelters throughout south, north and east King County. In
2008 CHCKC will expand its Federal Way Medical Center and Kent Dental Center.
Me ical services provided by CHCKC include the full scope of primary medicine: diagnosis and
treatment of acute and chronic illness and minor injuries; screenings for STDs, cancer, diabetes,
hypertension, and other major illnesses;preventive care for adults and children; referral for specialty
diagnostic evaluations and treatment; and prenatal/obstetric care, including delivery. Our medical support
programs are Natural Medicine,Pharmacy, and Behavioral Health. The Natural Medicine Program is
nat Itropathic care, stress management,nutrition counseling and acupuncture at each center. Behavioral
Health is a stepped care approach to mental health and mood disorder interventions. Dental services
provided by CHCKC include: preventive, operative,periodontal and pediatric care, including limited
prosthetic and oral surgery services. We offer emergent care clinics weekly at each location. Homeless
heathcare services provided by CHCKC include: nursing and primary care services provided on-site at
transitional shelters, emergency shelters, and permanent supportive housing throughout King County as
well as at a child care center at a transitional housing complex in east King County. Interpretation
services are provided for all patients requesting them at no additional cost to the patient.
CHCKC has been providing King County with high quality, culturally sensitive,primary health care
services for 30+years, since it's founding as the Valley Pulse Community Clinic in 1971. CHCKC was
brmed in response to the unmet health care needs of its target population: low-income uninsured
families and individuals in suburban King County. Those needs continue as does the mission of CHCKC:
"To provide complete primary health care services to the people in our communities,with special
attention to the needs of the medically under-served populations of King County. Our services encompass
not only treatment and prevention of illness but also health education,behavioral health service, outreach,
interpretation and a variety of other services that our patients want and need."
As the only federally qualified health center network serving communities in Suburban King County,
CHCKC has come to be recognized and depended upon for delivery of health care. CHCKC has
de onstrated its capabilities in meeting the needs of its target populations. The organization's track
rec rd is evidence of its expertise in managing scarce resources efficiently.
B. Operational Structure.
Listed below are the key staff responsible for the agency and its programs.
Senior leaders of the organization are:
Chief Executive Officer Thomas Trompeter, MPA
Medical Director Judith Featherstone,MD
Dental Director John Caron, DMD
Chief Operating Officer Debbie Wilkinson
Chief Financial Officer Jody Putman
Mr. Trompeter has worked at CHCKC for 11 years—the last 7 years as Chief Executive Officer. He has
over twenty-five years of experience working with community health centers.
--Dr. eatherstone has been with CHCKC for 16 years—the last 6 as Medical Director. Dr. Featherstone
has een a practicing family practice/OB physician for 17 years.
4
' years of experience runninga dental program.
Dr. Caron, DMD, CHCKC's Dental Director has over 27 p p gr
Dr. Caron served 16 years in the United States Navy as a Dental Specialist in Public Health, 7 years as the
`thief of Dental Operations for Public Health—Seattle and King County, and 7 years as the Dental
)irector at Community Health Centers of King County.
Ms!Wilkinson has worked at CHCKC for the last 5 years as Chief Operating Officer. Prior to joining
CHCKC she was the Director of Community Support Services at Highline Community Hospital/Highline
Medical Enterprise for 16 years.
Ms! Putman is a Certified Public Accountant with over 18 years in financial leadership of various
organizations. Ms. Putman joined CHCKC three years ago as the Chief Financial Officer.
Program Directors responsible for the operations of their program are:
Director of Medical Operations Jeanne Ziltener
Dental Programs Manager Pamela Gorsuch
Lead Naturopathic Physician Cindy Breed, ND
Director of Health Systems (Community Programs) Terri Calnan, LP
Ms. Ziltener is the Medical Operations Director, responsible for daily functions of the medical centers.
As 'she herself was a medical center manager for over 10 years, she is well qualified and experienced in
this position.
Ms: Calnan started at CHCKC 12 years ago as the Federal Way Health Center Supervisor, she left for 7
years to teach medical assistant courses at Renton Technical College and returned to us in 2004 to direct
our health systems and implementation team, staff development efforts and community programs. Our
Lomeless care programs full under her community programs efforts.
The CHCKC Board of Directors strives to maintain a highly trained and effective Board that is
knowledgeable regarding its role, responsibilities, CHCKC programs, and the broader environment within
which CHCKC operates. The CHCKC Board of Directors is comprised of community members, 64% of
whom are patients of the health centers. The Board strives to recruit consumer directors who are
representative of the individuals being served by CHCKC in terms demographic factors such as age, sex,
race/ethnicity and geographic location, and there is a Board Development Committee that actively
reviews this information. Members of the Board of Directors serve as volunteers in support of the
organization's stated mission, goals and work plan. The board is a"working board" and meets on a
monthly basis. The board is responsible for establishing policies, approving budgets and programs, and
monitoring operations of the organization. The Board of Directors recruits and hires the CEO.
The Board stays connected and informed about the needs in South King County by including consumers
as board members and by actively attending school, city and community sponsored events, and through
civic organizations such as Rotary and the Chamber of Commerce. The Board also hosts open houses and
special events at each of the health centers so that members of the community can learn more about the
services CHCKC provides.
9. NEED FOR YOUR PROGRAM (2 page maximum)
A. ,Problem Statement.
'he target population served by Community Health Centers of King County is the poor, marginalized,
under- or un-insured residents of Suburban King County. The problem is that the barriers outlined below
impede peoples' ability to receive timely, culturally aware, cost appropriate and high quality healthcare.
5
These populations face disproportionately high barriers to accessing care and are therefore in poorer
health than other residents of King County. According to 2000 Census data there are significant low-
income populations in south King County communities. The proportion of persons living with incomes
'�elow 200% of the Federal Poverty Level FPL range from 11% in Covington to 28% of Auburn residents.
Ehc following shows the percentage of residents with income levels below 200% of FPL:
Auburn 28%
Covington 11%
Des Moines 16%
Federal Way 21%
Kent 23%
Renton 21%
SeaTac23%
Tukwila 27%
Listed Cities 22%
King County 19%
Washington 26%
In addition, according to the State of Washington Office of Superintendent of Public Instruction Free and
Reduced-Price Meal Eligibility by School District for October 31, 2003, a group of south King County
school districts has a higher percentage of students requiring services than King County and the State of
Wa hington. The family income standard for the free lunch program is below 130% of FPL and for
reduced lunch is between 131 and 185% of FPL. The following shows the percentage of children eligible
for free or reduced lunches for certain south King County school districts compared to the county and the
state:
Auburn School District 42%
Federal Way School District 27%
Highline School District 55%
Kent School District 32%
Renton School District 43%
Tukwila School District 62%
Listed School Districts 42%
King County 27%
Washington 37%
The 2005 A Matter of Need publication by The South King Council of Human Services reports findings
consistent with the above data stating that"South King County has the highest number of families living
belibw the poverty level and the largest number of single-parent households. More people are on food
stamps and in the State's Aid to Needy Families program than in any other part of the county."
According to this same report, "South County has more than twice the number of public school students
enrolled in the federal Free and Reduced Price Lunch Program as Seattle, and more than three times as
many as East and North King County combined."
In Public Health's—Social and Health Indicators across King County 2005 Communities Count Report,
the percentage of Adults without health insurance continued to rise. This data was furthered analyzed in
The Health of King County 2006 which stated"access to health care declined notably in the past five
yeas with 15.5%being a record proportion of the population lacking health insurance. The South Region
experienced an increasing trend in the percent of residents uninsured for both the 10 year period 1995-
20014 and from 2000-2004. In 2002 the South Region surpassed Seattle with the highest percent of
Lni h sured.
6
This has led to increasing numbers of residents reporting unmet medical needs due to cost and 16,000
hospitalizations per year for avoidable conditions. Limited access to care translates into poorer health
outcomes as opportunities for prevention and effective management of diseases are lost." "Within King
`7,bunty the South Region has the highest average adult uninsured rate at 18%." Also according to this
eport the region of the county experiencing the poorest health has expanded south. "The South
Seattle/South County area(includes Tukwila, SeaTac, Kent and Auburn) experiences lower health status
anci more limited access to health care than other regions." Poor health causes residents to miss school,
miss days at work, and in general reduced their daily function with in turn contributes to poverty and a
poor quality of life.
B. arget Population. Identify and describe the population to be served by your program—both
demographically and geographically.
C CKC's target population are the uninsured or underinsured families and individuals in Suburban King
County who have difficulty accessing primary medical care services through traditional private provider
sys:ems due to financial, cultural, language or other barriers to care.
In 2008, CHCKC will serve 44,000 patients for approximately 100,000 medical visits. Ninety percent
(90I%) of these patients reside in King County. Additionally, CHCKC will serve over 2,000 homeless
patients. Forty percent(40%) of these patients are pediatric (between age 0 and 19)however our geriatric
patient population is increasing at a faster rate than the pediatric or adult patient population. The largest
ethnic group is Caucasian at 43%, followed by Hispanic at 33%. The remaining group is made up of
almost equal parts, Russian,Asian, Black and other. Many patients have Medicaid coverage, however
over 34% of our patients remain uninsured. Less than 5% of our patients have third-party insurance.
Approximately 24,000 of our patients survive on less than 100% of FPL, and an additional 12,000 survive
on less than 200% of FPL. .
So th King County clients come from all the cities in South County with the majority residing in Auburn,
Federal Way, Kent, and Renton. Over the past few years, there have been significant increases in the
number of individuals accessing care from the cities or Burien, Covington and SeaTac. This is due to the
2006 launch of a School Based Health Center at the Tyee Campus High school in 2006 and the 2007
launch of a health center in SeaTac. Both clinics are ramping up in terms of patient visits with extensive
outreach and community networking.
10. PROPOSED PROGRAM/SERVICE
A. rogram Description.
The services available through the primary medical care program meet the needs of the targeted
population from many perspectives including: accessibility and availability, appropriate scope and
qua ity of care, cost, culture and language needs.
The six health centers in South King County provide a comprehensive array of outpatient primary,
preventive and urgent health services with clinical teams providing preventive care and diagnosis and
treatment for chronic conditions including asthma, hypertension, and diabetes as well as more minor acute
conditions such as colds, flu and hay fever. CHCKC medical facilities also treat minor injuries such as
sprains and minor operations such as stitching wounds, vasectomies, and wart removal. The health
ceners provide a full range of services for all life cycles from a professional group made up
predominantly of family practitioners and augmented by limited internal medicine, pediatrics, and mid-
7l providers. Services include access for lab, x-ray and pharmacy. CHCKC does not deny care for
primary care services based on ability to pay.
In addition to its quality clinical staff, CHCKC provides other supportive services for clients. These
inc}ude client service representatives who are responsible for helping patients acquire and retain health
care coverage such as Medicaid or Basic Health. Nurse clinicians are available at every CHCKC health
- -,enter to provide patient education. Behavioral Health Consultants work with the patients in consultation
with providers to improve patients' mental health, mood disorders, unhealthy behaviors and quality of
life. Many of these patients have a mental health or mood disorder. Some patients receive behavioral
health services for problem specific interventions and behavior changes regardless of mental health
diagnoses such as: tobacco cessation, obesity, and medication compliance. Referral coordinators work to
hell patients needing specialty or diagnostic services. CHCKC provides referrals for specialty services
with a conscious effort to get services provided on a sliding-scale or pro bono basis. Each health center
hasp at least one interpreter on staff to help with the many clients with limited English speaking ability.
CHCKC contracts with interpretation agencies for clients speaking languages for which staffs are not
fluent. These additional services are available at no additional cost to the client.
Medical services are provided during normal business hours (8:00 a.m. —5:00 p.m.)with each health
center providing services at least one evening per week as per the table below:
DAY Auburn Federal Way Kent Renton SeaTac, Tyee
Monday 8:00a—8:OOp 8:OOa-5:OOp 8:00a—8:00p 8:00a-7:00p 8:00a-5:00p 9:00 a-5:00 p
Tuesday 8:00a—8:00p 8:00 a-7:00 p 8:00a—8:00p 8:00a-7:00p 8:00a-5:00 p 8:00 a-4:00 p
Wednesday 9:00a-5:OOp 8:00a-5:OOp 8:00a- 5:OOp 8:00a-5:OOp 8:00a-5:OOp 9:00 a-5:00 p
Thursday 8:00a-5:OOp 8:00a-5:OOp 8:00a-5:OOp 8:00a-5:O0p 8:00a-5:OOp 8:00 a-4:00 p
Friday 8:00a-5:00p 8:00a-5:00p 8:00a-5:00p 8:00a-5:00p 8:OOa-5:00p 9:00a-5:00p
After hours, patients may call in and the answering service will contact a triage nurse with any clinical
needs. The triage nurse speaks to the patient and if needed calls in the physician on-call. Services are
>rovided by appointment. CHCKC strives to see each patient within one week of the request and is
usually able to accommodate clients within two days.
Community Health Centers of King County strives to provide culturally relevant and language-
appropriate services to our clients and potential clients. CHCKC advertises in local ethnic and English
language publications. CHCKC's brochures and marketing materials are translated into Korean, Spanish,
Rusian and Vietnamese and can be found at community centers, libraries, public health offices, hospital
urgent care centers and other non-profit social service agencies. CHCKC's Board of Directors hosts open
houses and special events at each of the six community health centers so that members of the community
can learn more about the services provided by CHCKC.
Ye end 2008 is the close of an extensive capital improvement phase that lasted two years and expanded
capacityl in seven of our health centers. Because of this, 2009 and 2010 are less focused on capital
expansions, and more on program improvements and strength. Our Strategic Plan notes that in the
coming two years we plan to enhance several of our clinical programs particularly, behavioral health. We
are seeking support to couple social work case managers within our Behavioral Health team to support
high risk patient's ability to link and access a full scope of social and health services. We have also
identified a need to extend our hours into the evenings and weekends. The majority of patients who
access the emergency room do so afterhours and our partners at the local emergency departments seek to
refer inappropriate emergency department patients back into the primary care setting at our clinics. This
expansion will require extensive collaboration with the local hospitals as well as resource and staffing
development.
Furlthermore, we anticipate that 2009 will be the first year that our endowment fund will be operational.
Thi fund will help support our uncompensated care to Complimentary and Alternative Medicine and
8
Dental Adults as well as fund staff development in our medical program. Each year, staff will be selected
from a pool of applicants to receive scholarship funding to medical and nursing schools. This staff
development is intended to offset the growing shortage of healthcare providers,particularly in community
,health. Finally, we intend to investigate the opportunity of further expanding our Auburn and Federal
Way locations. As always, CHCKC is committed to staying on the forefront of healthcare innovation and
2009 and 2010 may bring further,unexpected developments not yet identified.
CI- CKC currently collaborates with many other health care providers to ensure clients receive
comprehensive quality medical care services. CHCKC participates in the Community Diabetes Initiative
of the Community Health Council of Seattle/King County, a three-year collaborative effort of local
community health centers to improve the clinical outcomes of diabetic clients. In addition to the
Community Diabetes Initiative of the Community Health Council, the network of CHCs in King County,
brings together Executive Directors and Medical Directors to work together to better serve all CHC
patients in King County in areas such as identifying cost appropriate specialty care and interpretation
assistance. Many of the network members convened a technology partnership called the Patient
Technology Systems Organization in 2006 which manages a shared Electronic Health Record for all
participating health centers including CHCKC. Our co-location with Public Health—Seattle &King
County(PHSKC) offices in Federal Way and Auburn underscore a key, long-term partnership that is
committed to integrating primary care and public health efforts as much as possible, with resource savings
for both agencies. CHCKC also collaborates with Community Health Plan of Washington, a community
health center member health plan, to improve service and clinical outcomes. Finally, CHCKC
collaborates with many local service agencies in conducting annual health fairs targeted at women and
children in the community.
Through these collaborations and other avenues, we reach out to the community, identify and link with
residents needing medical services. We have outreach partnerships with Public Health Seattle and King
:ounty through several programs (children's health, veteran's health, healthcare for the homeless). We
nave internal methods to follow-up and retain our patients in need including tracking systems and
reminder recalls. We work with local pharmacies, hospitals, daycare centers and other locations to
identify the need. Staff partner with new patients to help them navigate the system and identify CHCKC
as their medical home.
B. Performance Measures and Outcomes.
Performance Measure: 28,000 south King County residents receive medical care in 2009
and 2010.
Outcome: Increased access to primary care and preventive health services within the south
King County community.
Indicator: 80% of children age 18-24 months will be fully immunized for preventable
childhood diseases as recommended by the CDC.
Performance Measure: CHCKC primary care providers will deliver 70,000 visits to south
King County residents in 2009 and 2010.
Outcome: Enhanced quality of life for individuals with specific chronic diseases through the
use of coordinated self-management programs dealing with conditions such as asthma,
hypertension and diabetes.
9
Indicator: The percentage of diabetic patients having a documented self management goal
will improve 5% each year with a target of 70%.
-- '. Staffing Plan &Evaluation. (1 page maximum)
i. Staffing Plan.
Th-re are approximately 176 FTES who currently work in this program and that number will increase in
2009 and 2010 with the expansion and addition of health centers. At the health centers, clinical staff
provide a full range of services for all life cycles from a professional group made up predominantly of
Family Practitioners and augmented by limited Internal Medicine, Pediatrics, and mid-level providers.
In addition to its quality clinical staff, CHCKC employees staff for other client services including:
• Client Service Representatives who are responsible for helping patients acquire and retain health
care coverage such as Medicaid or Basic Health.
• Nurse clinicians are available at every CHCKC medical center to provide patient education.
• Behavioral Health Consultants work with the chronically ill patients in consultation with providers
to improve patients' outcomes and quality of life.
• Referral coordinators work to help patients needing specialty or diagnostic services. CHCKC
provides referrals for specialty services with a conscious effort to get services provided on a
sliding-scale or pro bono basis. Each health center has at least one interpreter on staff to help with
the many clients with limited English speaking ability. CHCKC contracts with interpretation
agencies for clients speaking languages for which staffs are not fluent.
• Patient Care Coordinators who monitor clinical outcomes and work on program and process
improvements with care teams.
• Health Center Managers who oversee the staff and are responsible for day to day operations
- • Reception and Medical Assistant staff who work in supportive roles to the primary care team.
ii. Evaluation.
CHCKC continuously monitors its primary medical care program and its targeted outcomes including
those listed in section III, part B as well as others that are part of the medical care program's Health Care
Plafi. Comprehensive regular reporting on the agency's Health Care Plan is submitted to The Bureau of
Primary Health Care in conjunction with Federal grant support. In addition the Washington State Health
Caie Authority monitors and conducts annual reviews of CHCKC's programs and outcomes. Clinical
measures are tracked, analyzed and reported on a regular basis. Also a sample of clients is surveyed on a
regular basis about their satisfaction with the services they are receiving. Service or clinical changes or
improvement initiatives are undertaken based on those outcomes results.
Re ults are monitored at the health center level as well as for the agency as a whole. The leadership of the
organization and program managers monthly and quarterly reviews key outcome measures and make
regnlar reports to the Board of Directors. The board includes consumers who also receive this
information. In addition an annual report is published that summarizes key accomplishments and
measures of success.
D. Differences in Service Delivery by City.
O service delivery model is standardized across cities. As our health centers are located in Auburn,
Federal Way,Kent, Renton and SeaTac, residents of the other cities must travel beyond their city borders
to rceive care. This is the only difference between cities.
'lease note that in Table 14 the cost per patient varies slightly due to rounding of figures. In actuality the
cost per patient is the same across South King County.
10
11. LONG RANGE PLAN
C CKC's Leadership Team and Board of Directors meet annually to update our Strategic Plan and long
range objectives. Our long range planning is focused in three areas:
1.) To be the Provider of Choice in the communities we serve,
2.) To be the Employer of Choice within our field,
3.) To be Financially Strong and Positioned for the Future.
To carry out the three prongs or our long range planning, we are continually implementing new programs,
expanding our sites and services, and redesigning our staffing plans. Some of the new projects we have
coming up in the next two years include: partnering with a medical school to train medical students in the
art of community health, expanding our dental program, and implementing an endowment fund to help
suport the uncompensated care we deliver. Due to the continued growth in need in South King County,
C CKC has plans to expand its primary medical care program over the next 5 years, including
expansions of health centers in Renton and Federal Way to increase capacity to better meet the needs of
the growing underserved in those areas. As mentioned in the 2007 to 2008 application, significant
expansions are underway at the Kent, Federal Way, and SeaTac locations.
South King County municipal support is important to the primary medical care program. Funding from
local municipalities helps show community support for our health care programs when seeking Federal,
State and private funding. This funding allows CHCKC to provide medical care on a sliding fee to its
uninsured and underinsured south King County patients. It is anticipated that funding will continue to
come from local, State and Federal sources, as well as private and public payors. CHCKC is experiencing
a decrease in its insurance reimbursement rates so, now more than ever, grant funding is critical to our
services to all patients.
12. BUDGET (2 page maximum)
The budget section of your application pertains to the information provided in Question 17 of your
,, Lpplication.
A. Budget Request Narrative. In this section of the application narrative,provide a short paragraph
explaining how your requested funds in Question 17 will be used.
In order to meet the growing demand for health services in the South King County area, CHCKC is
expanding the capacity to serve patients with the opening of new health centers and the addition of
medical and dental staff With the uncompensated cost per medical visit at$160.17, this funding is vital
to continue to expand our ability to see the growing number of low-income and uninsured patients in
South King County. Requested funding will help support the uncompensated cost of each visit that
includes:
Salaries paid to providers and support staff $ 120.51
Patent interpretation services, lab fees and other services $ 3.06
Patient supplies $ 4.99
Cost of medical facilities $ 32.16
TOTAL $ 160.17
B. Changes to Budget.
There are no known or anticipated changes to the program's 2008 Budget and no significant changes from
2008 to 2009 or 2010 budgets.
C. Cost per Service Unit(s).
11
Cost Per Service Unit(medical visit): $ 160.17
Explanation of how determined:
- The uncompensated cost for each patient medical visit is $160.17. This was determined by the average
ost of a medical visit($175) less the average patient generated revenue (fee for service and sliding scale)
of the cost of the visit. On average,patients come to the CHCKC health centers for medical care about
2.5 times per year. Based on this average, the uncompensated cost per client or patient is $400.43.
C CKC uses a sliding scale,based on the Federal Poverty Level standards, flat fee for all uninsured
patients. This gives greater ability for low-income patients to access medical care.
12
13. NUMBER of INDIVIDUALS/HOUSEHOLDS SERVED BY PROGRAM
®'Individuals? or❑ Households? (Check which applies and use for reporting all demographics.)
Unduplicated
*Unduplicated Number of all Clients Served by Clients Served
All Funding Sources with Funds
Requested
2007
2007 % of column 2009
2008 2009
(Actual) 1 clients (Anticipated) (Projected) (City Requested
served by Funding Only)
City
Auburn 5,257 13.85 % 6,094 6,399 132
Burien 298 0.79 % 348 365 25
Covington 146 0.38 % 167 175 11
Des Moines 1,041 2.74 % 1,206 1,266 13
Enumclaw 221 .58 % 255 268 0
Federal Way 5,287 13.93 % 6,129 6,435 100
Kent 7,082 18.67 % 8,215 8,626 257
Lefton 3,795 10.00 % 4,400 4,620 95
SeaTac 892 2.35 % 2,034 4,136 112
Seattle 1,804 4.75 % 2,090 2195 0
i
Tukwila 211 0.56 % 546 773 25
Othler 12,137 31.98 % 12,871 13,515 "
100.00 %
Total 37,950 (This column 44,000 48,773 771
must total
100%)
*Unduplicated means count each client only once per calendar year per program. This number should
match the number of clients by city indicated in the top row of Question 15.
13
Agency: Community Health Centers of King County
14./Performance Measures (Data Table) Program:Primary Medical
4a.
Service with 2009 Requested Funds
Proposed Performance Measures as defined below.
A) Medical Visits B) C)
Auburn 331
Burien 62
Covington 28
Des Moines 34
Enumclaw 0
Federal Way 250
Kent 643
Renton 237
eaTac 281
Seattle 0
Tukwila 62
{
14b:i Performance Measures 2009 Proposed with funds requested City Funding Only
Title: Brief explanation:
A) Medical Visit Patients of the Primary Medical Program return for care on average,
2.5 times per year for preventive, chronic and acute healthcare.
B)
C)
14
Agency: Community Health Centers
of King County
- 14 Performance Measures (Data Table), Cont. Program:Primary Medical
14c. Average Cost of Service
Unduplicated Clients
Served with Funds Average Cost of Service per
Requested 2009 Requested 2009 Client*
(Same as last column of (Same as last column of Column 1 divided by Column
Question 6) Question 13) 2*
Example: $5,000 45 $111.11
Auburn 53,000 132 401.52
Buren 10,000 25 400.00
Co ington 4,500 11 409.09
Des Moines 5,400 13 415.38
Enumclaw - - -
I
Federal Way 40,000 100 400.00
rent 103,000 257 400.78
Renton 38,000 95 400.00
SeaTac 45,000 112 401.79
Seattle - - -
Tukwila 10,000 25 400.00
308,900 771 401.16
*cost per patient varies slightly due to rounding. In actuality the cost per patient is the same across South
King County. The reflection here has to do with rounding between column 1 and 2.
15
Agency: Community Health Centers of
Complete Question 15 with 2007 Actual numbers reported in column 1 of Question 13. King County
15. Demographics (from all funding sources) (Data Table) Program: Medical
I '
cd
cd 1-4
Client Residenceo 0 °)
cd
o a� 0 - 0
MI U Q W 4-( '1) rn ci) l-4 E-I
Unduplicated
(check one) N - N ,n 7 _ M
// Individuals N ch o N o °, ono O0
ID Households N — N cn co ,. N N
Served in 2007*
Household Income Level
30%of Median or Below 3277 165 79 594 3391 4002 2075 493 1062 118 15216
50%of Median or Below 976 36 24 124 901 1096 576 107 200 23 4063
80%of Median or Below 191 8 8 27 166 185 98 17 41 4 745
Above 80%of Median 688 87 32 263 681 1576 994 264 439 62 5086
Unknown 125 2 3 33 148 223 52 11 62 4 663
TOTAL 5257 298 146 1041 5287 7082 3795 892 1804 211 25813
Gender
Male 2007 116 53 415 2031 2887 1580 381 775 80 10325
Female 3250 182 93 626 3256 4195 2215 511 1029 131 15488
TOTAL 5257 298 146 1041 5287 7082 3795 892 1804 211 25813
Age
0-4 years 730 16 14 155 906 1028 376 97 150 28 3500
5- 12 years 686 20 21 121 775 1015 375 84 124 20 3241
13- 17 years 419 24 19 121 403 492 303 196 129 21 ) 2127
18-34 years 1339 72 39 313 1326 1818 1032 221 523 57 6740
35-54 years 1415 124 36 253 1267 1856 1152 198 611 58 6970
55-74 years 584 40 13 72 561 805 495 88 248 27 2933
75+years 84 2 4 6 49 68 62 8 19 0 302
Unknown 0 0 0 0 0 0 0 0 0 0 0
TOTAL 5257 298 146 1041 5287 7082 3795 892 1804 211 25813
Ethnicity
Asian 388 27 10 58 543 810 382 93 169 18 2498
Black/African American 344 43 11 181 700 1010 539 167 375 49 3419
Hispanic/Latino(a) 1693 48 48 359 2126 2487 1033 249 308 54 8405
Native 45 2 2 8 27 30 32 6 22 1 175
American/Alaskan
Pacific Islander 135 6 1 48 203 168 76 54 52 4 747
White/Caucasian 2414 158 68 336 1468 2176 1534 270 797 66 9287
Other/Multi-Ethnic 238 14 6 51 220 401 199 53 81 19 1282
TOTAL 5217 298 146 1041 5287 7082 3795 892 1804 211 25813
Female Headed 1091 50 34 226 1290 1511 783 172 337 34 541
Household
Disabling Condition 472 51 9 86 375 581 358 69 220 20 2246
Limited English 1367 39 29 259 1651 2206 821 165 225 57 6594
Speaking
* C eck Individual or Household,which should be the same as checked in Question 13. Unduplicated means count each client
inl I once per calendar year. This should match the number served by City in the Actual 2007 column of Question 13. The
total"column will be different from Question 13 since the"other"column is not included due to space limitations.
16
16.PROGRAM STAFF(DATA TABLE)
2007 2008 2009
(Actual) (Budgeted) (Projected)
Total Number of Staff(FTEs) 161.87 204.86 255.55
Number of Volunteer(FTEs) 0 0 0
Actual Number of Volunteers 0 0 0
17
Agency: Community Health Centers
17.PROGRAM REVENUE BUDGET(DATA TABLE) of King County
Program: Primary Medical
Revenue Source 2007 2008 2009
(Actual) (Budgeted) (Projected/
Requested)
Cliity Funding (General Fund & CDBG)
• Auburn 40,000 32,000 53,000
• Burien 10,000
• Covington 3,421 4,500
• Des Moines 2,500 5,400
• Enumclaw
• Federal Way 31,600 31,827 40,000
• Kent 83,000 83,000 103,000
• Renton 30,000 30,000 38,000
• SeaTac 38,400 5,000 45,000
• Seattle
• Tukwila 3,000 3,000 10,000
• Other(North King County Cities) 138,361 137,336 137,336
Other Government Funds
• King County 841,785 715,484 715,484
• Washington State 399,457 375,713 375,713
• Federal Government(Specify) 1,860,191 2,227,130 2,666,451
• Other (Specify)
Private Sources -=_ .
• United Way (grants & designated donors) 84,441 94,070 104,797
• Foundations and Corporations
• Contributions (e.g., Events, Mailings)
• Program Service Fees (User Fees) 14,969,748 18,468,554 22,785,119
• Other(Specify) 2,007,124 872,412 1,260,298
TOTAL PROGRAM BUDGET 20,533,028 23,075,526 27,471,673
18
Agency: Community Health Centers
17.PROGRAM EXPENSE BUDGET,CONT. of King County
(DATA TABLE)
Program:Primary Medical
Expenses 2007 2008 2009
(Actual) (Budgeted) (Projected)
Personnel Costs °"" " a
• Salaries 8,955,442 10,905,054 13,784,793
• Benefits 2,001,961 2,414,471 3,031,533
• Other 741,212 662,120 625,214
• Total Personnel 11,698,615 13,981,645 17,441,541
Operating and Supplies
• Office/Program Supplies 1,013,771 671,722 806,066
• Rent and Utilities 994,548 1,178,655 1,414,386
• Repair and Maintenance 234,357 255,928 307,114
• Insurance 76,309 79,468 95,362
• Postage and Shipping 59,647 65,496 78,595
• Printing and Advertising 65,616 65,571 78,685
• Telephone 179,740 165,877 199,052
■ Equipment 577,425 390,468 468,562
• Conference/Travel/Training/Mileage 105,857 152,710 183,253
• Dues and Fees 22,591 25,441 30,529
• Professional Fees/Contracts 629,897 324,066 388,879
• Direct Asst. to Individuals
• Administrative Costs 3,975,940 4,940,021 5,928,025
• Other(Bad Debt) 347,867 267,191 320,629
• Other(EMR Systems) 543,124 439,513 527,416
• Other(Staff Recruitment) 2,056 65,505 78,607
• Other (Staff Misc.) 5,669 6,249 7,500
•
TOTAL PROGRAM EXPENSES 20,533,028 23,075,526 28,354,198
Net Profit(Loss) 0 0 0
(revenue-expenses) =
19
Agency: Community Health Centers
of King County
18.SUBCONTRACTS(DATA TABLE)
Program:Primary Medical
:,is:all the agencies you will be subcontracting with for this program. Provide the agency name in the first
column, a description of the contract/service in the second column, and the contract amount in the third
column. Do not list agencies you coordinate with on a referral only basis. Indicate not applicable if
you do not subcontract for any part of this program.
Collaborative Agency Specific Activities Contract
in the Operation of Your Program Amount
Insurance carrier; program, quality and process _
Co munity Health Plan improvement support
Psychology Support to high risk,mental health
Valey Cities Counseling and patients in need of long term psychological -
Copsultation counseling
Psychology Support to high risk,mental health
Ke t Youth and Family Services patients in need of long term psychological -
counseling
A partnership of community health centers Approx
PTSO of WA sharing an Electronic Health Record $650,000
functionality and management
Valley Regional Hospital Clinical Patient Care Coordination and Referral -
Clinical Patient Care Coordination and Referral
Highline Hospital -
3t. rancis Hospital Clinical Patient Care Coordination and Referral -
A charitable collaboration of medical specialty
Project Access providers offering specialty care pro-bono to -
CHCKC patients in need
Multiple program and funding supports
Pu lic Health Seattle and King including emergency preparedness, diabetes _
County care, healthcare for the homeless, children's
health outreach and linkage and others.
•
20
19.APPLICATION CHECKLIST
Contents (Your application should contain each of these items in this order.)
El Application Cover Pages. The top three pages of your application must be a completed copy of
he Agency Information and Questions 1-7.
Application Narrative:
Ft Question 8 Organizational Experience (2 page maximum)
aQuestion 9 Need for Your Program(2 page maximum)
Question 10 Proposed Program/Service (6 page maximum)
Fri Question 11 Long Range Plan(1 page maximum)
ED Question 12 Budget(2 page maximum)
Data Tables
n Question 13 Number of Individuals/Households Served
❑ Question 14a-c Performance Measures and Average Cost of Service
Question 15 Demographics (from all funding sources)
Question 16 Program Staff
Question 17 Program Revenue &Expense Budgets
Question 18 Subcontracts
Required documentation. Supply one copy of the following required documents with the signed
original application. See Part II: City Specific Supplemental Information to determine whether
additional copies of the application and required documentation need to be submitted.
Question 19 Required Documentation, including:
• Proof of non-profit status
• Organizational Chart
• Agency/Organization Mission Statement
• Board resolution authorizing submittal of the application(may be submitted up to 60
days after application).
• List of the current governing board and local board, if applicable, (include name,
position/title, city residence, length of time on the Board, and expiration of terms.
Note any vacancies.)
• Board Meeting Minutes of last three board meetings of governing board and local
board as applicable
• Annual Budget
• Financial Audit Cover Letter
• Financial Audit Management Letter
• Financial Statement
• Verification of Non-Discrimination Policy
• Program Intake Form
• Sliding Fee Scale
MI Application Check List. (Signed below.)
3111 City Specific Supplemental Information. Required in
= P II for applicable City only. Name: Faith Wimberley
I Wil Position: _Resource Development Manager
G ! j Phone#: 425-203-0491
E-mail: _fwimberley@chckc.org
Signature of Person Completing Checklist
1
-- DOI NOT SUBMIT ANY OTHER MATERIALS WITH THIS APPLICATION
Make sure that you carefully check Part H of this application
to see what additional attachments each city requires.
Community Health Centers of King County
j City or Renton Application for 2009—2010 Funding
Supplemental Questions -Medical
April 30th, 2008
City of Renton Result that best correlates to our Medical Program:
Result#2 Individuals have adequate clothing, food housing, and healthcare.
Strategy B: Increase the capacity of programs that provide food, clothing, housing and healthcare
and residents access to them.
Community Health Centers of King County focuses on the healthcare aspect of City or Renton
Result#2. Our mission is to provider more than adequate, high quality and dazzling healthcare
services to every Renton resident in need or want of care. The activities we deliver to achieve
this result include operation of a full time health center in Renton. The health center staffs
Medical Providers,Natural Medicine Providers, and a supportive care team including Behavioral
Health Consultants, Nurses,Nutritionists, and Client Service Representatives (staff who help
patients navigate the social and human services network in South King County).
CHCKC Outcomes as reported on page 9 of the application:
Outcome#1: Increased access to primary care and preventive health services within the south
King County community.
We commit to providing access to primary and preventive medical treatment for Renton
residents. This includes not only appointments at our Renton Health Center,but also
transportation, language and insurance assistance. By removing barriers to care and coaching
patients to make healthy choices at home we are increasing their ability to attain adequate
healthcare and ultimately a high functioning life.
Outcome#2: Enhanced quality of life for individuals with specific chronic diseases through the
use of coordinated self-management programs dealing with conditions such as asthma,
hypertension and diabetes.
Teaching self-management to patients with chronic diseases allows for home care and behavior
modifications. When a patient is better equipped to care for themselves, and live a healthy life,
they free up the healthcare system for patients in need of preventive and acute care. Secondly,
giving patients the ability to manage their health is the ultimate goal of healthcare; beyond access
to services the ultimate goal of living a health life is ultimately attained.
Community Health Centers of King County
Required Documentation Page Number
Proof of non-profit status 1
Organizational chart 3
Agency/Organization Mission Statement 4
Board resolution 5
Current governing board list 6
Board Meeting Minutes 8
Annual Budget 18
Financial Audit Cover Letter 19
Financial Audit Management Letter N/A
Financial Statement 20
Verification of non-discriminatory policy 37
Program intake form 39
Sliding fee scale 41
r`
Internal Revenue Service Department of the Treasury
District 915 Second Ave.,Seattle,Wash.981T4
Director
•
Person to Contact:
' South King County Community EC Desk Officer
Health Centers Telephone Number:
1025 South Third (206) 442-5106
Renton, Washington 98055 Refer Reply to:
• EO-IV:MS 550
Date:
JUN 11 $987
• Dear Sir or Madam:
This is in reply to your inquiry of June 11, 1987, regarding
your exempt status.
Our records show that your organization is exempt from
Federal income tax under Section 501(c)(3) of the Internal
Revenue Code.
This exemption was granted in June of 1982, and remains in
effect.
•
Also, our records indicate that you are not a private foun-
dation, because you are an organization described in Sections
509(a)(1) and 170(b)(1)(A)(iii) of the Code.
As of January 1, 1984, you are liable for taxes under the Federal
Insurance Contributions Act (social security taxes) on
remuneration of $100 or more you pay to each of your employees
during a calendar year. You are not liable for the tax imposed
under the Federal Unemployment Tax Act (FUTA).
Sincerely,
. it
Edna O. 8onnist
Exempt Organizations
Croup Manager
•
•
Page 1 of 44
•
r
Internal Revenue Service Department of the Treasury
District Director
Date SEP 1 3 1988 Employment Iduntifkauon Number.
Iim88441
i to um toot2
EOMF COORDINATOR
Contact.Telephone Number:
COMMUNITY HEALTH CENTERS OF KING COUNTY InternallRevee a CCe�dil>t0eedene 801(o)(3l
699 Strander Blvd., Suite D
Tukwila, WA 98188
Thank you for submitting; the information shown below or on the enclosure. We have
made it a part of your file.
The changes indicated do not adversely affect your exempt status and the exemption
letter issued to you oontinues in effect.
Please let us know about any future ohange in the character, purpose, method of
operation, name or address of your organization. This is a requirement for retaining your
exempt status.
Thank you for your 000peration.
Sincerely yours,
Ite Changed From To
m
NAME & ADDRESS CHANGE • South King County Community SEE ABOVE
Health Centers
1025 South Third
Renton, WA 98055
•
•
P.O.Box 2380,Los Angeles,CA 90053 Letter 97S(00)(Rev. 14t7)
Page 2 of 44 J
Community Health Centers of King County
r .. . gal.- ,. .i•... '..:_ ,.w'iR'. , :.J ...11.iiliia%ai .._..... . .
n�
HrCwr.TH 1
Board of Directors
;n
y' tiMariOD:MirlaiihTililligilli g
CZNTC .e
1 Thomas Trompeter,MPA ' f I Yvonne Westover Administrative
Chief Executive Officer Tg Admen.Services Mgr/ Services Team
Safety Officer
ri
•
Judy Featherstone,MO .DMD Meredith Vaughan
Jody Putman,CPA Debbie Wilkinson ... &Development
Medical Diracter Dental Director Chief Financial Officer Chief Operations Officer Directorevr
Lead Phyaklarrs Dentists Medical Billings Jeanne Moller Pamela Caaeucir Masi eli g&
Operations _ Dental Operations
ContiollerDins ter Director — ManagerConoramity '
Lead N I David Ross Moselle Hoduchi
l e nne Settler Human Reaouoes
DoctorPatient Accounts Plrarrrmty Director Director 1 Gard Manager
Manager
Clinical Programs Jo Abraham Terri Calnan
Team IS Director — Health
Systems
Director
Medical Stair 7 Operations Team
Coordinator
•
Sp Page 1
m�aras�sent�m......w�.....er:t«rn............,re.....:........ •
CD
Cr)
0
MISSION STATEMENT
Our mission is to provide complete primary health care services to the people in our communities
with special attention to the needs of the medically underserved populations of King County. Our
services encompass not only treatment and prevention and illness but the health education,
behavioral health services outreach interpretation and a variety of other services that our patients
want and need.
VISION STATEMENT
We are the provider of choice for quality health care services in the communities we
serve,
GUIDING PRINCIPLES
CHCKC is an environment that encourages creativity and responsibility,
respect and a strong sense of being valued.
We are a work community embracing diversity,respect, creativity and support.
We provide a productive and creative work environment that provides
value for our patients and our organization.
We provide flexible, supportive and inclusive leadership and are responsive to each
other's needs.
CHCKC offers patient-centered and accessible healthcare—all patients are treated with
care, compassion and understanding.
We treat our patients with dignity and offer education on choices of medicine so they can
gain access and make informed choices in their healthcare.
Page 4 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
BOARD OF DIRECTORS RESOLUTION#08-001
WHEREAS,Community Health Centers of King County(CHCKC)has applied for
grants to various funding sources to support its mission of providing quality medical and
dental care to the underserved,
THEREFORE BE IT RESOLVED that the Board of Directors approves applying for
grants for funding for the year 2009.
pL RESOLUTION PASSED without modification.
RESOLUTION PASSED with noted modification(s).
RESOLUTION DID NOT PASS.
L" victonazfQ4 Date
Board C
•
•
c:lboardlres02-003(y1w)
Page 5 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
955 Powell St.SW,Suite A
Renton,WA 98057-2908
III (425)277-1311 FAX:(425)277-1566
BOARD OF DIRECTORS-2008
Rev.April 15,2008
CONFIDENTIAL
NAME,ADDRESS,PHONE OCCUPATION Consumer? Officer TERM 3
&/or Committee EXPIRES i
Thomas(Tom)Cross President and CEO Member-At-Large 2008
11023 Marine View Dr.S.W. Executive
Seattle,WA 98146
" H:(206)243-1420 e-mail:tomc@stanbrooke.com
stanbrooke.com
Best'Contact#(206)427-5222
Member since 10/1995
Laurence M.DcShields II Patient Navigator CHCKC Chair,Strategic 2009
36521251h Ave.S. Fax:(253)874.6861 Consumer Planning
Federal Way,WA 98003-9104 email: Finance
H:253-838-0560 /ao49@co►►►cast.net
Member since 6/1998
Robert Ellis CHCKC Audit 2008
401 1 37h Street SE,Sp. 121 Retired ' Consumer Quality
Auburn,WA 98002 Email:rrellis33 a.aoLcon
H:253-735-1192
Member since 5/2000
Luis H.Garcia,Sr. Retired CHCKC 2010 1
608 Chelan Pl.NE Email:luishgarciaecomcast.net Consumer
Renton,WA 98059
425-430-2672
Oember since 11/2007
icteria Goetz Homemaker,Student CHCKC Chair, 2010 =
417 Wells Ave S.,Apt.#3 Email;jvsgoetz a.co►►►cast net Consumer Executive
Renton,WA 98057 Board Development
H:(425)204-8802 Finance
Member since 4/2001
Chad Homer Attorney CHCKC Vice-Chair, 2008
CURRAN Law Firm Email:chorner a.curranrrm.co,n Consumer Executive
P.O.Box 140 Cell#206.498-6482 Chair,Board
1 Kent,WA 98035-0140 Development
WK PH:(253)852-2345 Audit
FAX: (253)859-8037 Strategic Planning
Member since 11/2005
John Payne Physical Therapist Board Development 2009
5319;Monte Vista Dr.E. OutPatient Physical Therapy Quality
Edgewood,WA 98372 701 M St.NE,Ste 102
H:(253)863-0654 Auburn,WA 98002
Member since 12/2006 Phone: 253.833.87 t
Email johnpaynept vjahoo.com
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c: aua(yhv)a►1s►ai:ssPM Page 6 of 44
2006 CHCKC Board of Directors p.2
Rev.L4/15/2008
•
CONFIDENTIAL
NAME,ADDRESS,PHONE OCCUPATION Consumer? Officer TERM
&/or Committee EXPIRES
Sheryl Pot Homemaker/Bus Driver CHCKC Secretary 2009
3111 SW 3131h Street Email-spol98765@msn.com Consumer Executive
Federal Way,WA 98023 Chair,Quality
H:253-815-8239 Comm.
Member since 2/2004 Audit
Julie D.Shoji Senior Financial Manager 2010
17323 SE 185th P1. Russell Investment Group
Renton,WA 98058 Wk:253-439-5732
H:425-793-7970 Cell:206-335-1128
Member since 6/2007 Email:jshoji@russell.com
Kathleen(Kathy)A.Smith Homemaker/Community Activist CHCKC Treasurer 2010
8326 59th Ave.E. Consumer Executive
Puyallup,WA 98371 cell: 253-223-8434 Finance
H: Quality
Meriiber since 4/1992 email:KSmith235@hoimai.co,n
ex-o, cio: Chief Executive Officer
Thomas Trompeter Community Health Centers of King Co.
4314-12th Ave South 955 Powell St SW,Suite A
Seattle,WA 98108 Renton,WA 98057-2908
(206)762-6337 w:(425)277-1311-wt:(425)277-1566
email:ttrompeler@chckc,org
r -
•
Election of directors is by an affirmative vote of two thirds of the members present of the Board of Directors,providing a quorum is present. Directors
are selected based on the Board of Directors'perceived need for financial,legal,public relations,planning,fundraising,health care,consumer or other
areas of expertise. At least 51%of the board will consist of CHCKC consumers. An effort will be made to recruit consumer directors who are
represl ntative of the individuals being served by CHCKC in terms of demographic factors such as race,ethnicity,sex and age.
o:\Dondlboetd list 2007-2008(ylw)OYISPoi 118PM Page 7 of 44
Community Health Centers of King County
Board of Directors
December 12,2007
6:00 p.m.—9:00 p.m.
Administrative Offices
Present: Thomas Cross,Laurence DeShields,II,Robert Ellis,Luis Garcia,Victoria Goetz, Chad Homer,John Payne,Sheryl Pot,Julie
Shoji,Kathleen Smith,Shailesh Tatu,Thomas Trompeter(ex-officio)
Absent:
Guests:
Staff: Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
Topic Discussion • A=Actions D=Decisions
Convene Meeting The CHCKC Board meeting was convened at.6:35 pm
Newest Board member,Luis Garcia,was officially welcomed to the Board of
Directors.
I. Consent The consent agenda was presented for approval. A—It was moved(Laurence
Agenda -Board Meeting Minutes, 11/14/07 DeShields,II)
and seconded(Shailesh Tatu)
to approve consent agenda.
Motion approved unanimously
II. Board Tom Cross, Chair,welcomed everyone. He acknowledged that this has been
Chair's a very eventful year especially with NextGen.
Report
There are three(3)Board members retiring from the board. Mark Mitchell,
co
Barbara Kanaya and Shailesh Tatu. A plaque was presented to Shailesh Tatu
426 thanking him for his commitment to the Board of Directors. Plaques will be
mailed to Mark and Barbara.
December 12,2007 CHCKC Board Meeting Minutes ' '- CONFIDENTIAL AND PROPRIETARY Page 1 of 4
'anC'
is Discussion _ ' A=Actions D=Decisions
There will be no regular Board of Director's business meeting in January,in
lieu of the board retreat January 25,26 and 27,2008. The agenda is under
construction. Any necessary business will be conducted as a separate meeting
at the retreat.
The Friday night session at the retreat will be devoted to Board function and
governance. Chad Homer has been asked to talk about governance based on
his experience with the Carver Model of Governance. Our current Mission
Statement is in need of revision and will be discussed during the retreat.
The annual Oath of Office&Confidentiality Statement,Conflict of Interest
Statement and Conflict of Interest Disclosure document were placed in the
hand-out folders.
Several board members have not completed the board survey. Some surveys
are showing partial completion. This will be investigated.
III. Committee A. Board Development Committee:
Reports
This committee recommends Board Membership re-elections as follows: A—It was moved(Chad Homer)and
Tom Cross—1 year(2008) seconded(Robert Ellis)to accept
Laurence DeShields,II—2 years(2008,2009) the recommended re-elections to
Victoria Goetz—3 years(2008,2009,2010) the Board of Directors for the
Kathleen Smith—3 years(2008,2009,2010) terms stated.
• Motion Approved Unanimously.
co This committee recommends voting on the proposed Slate of Officers for A—Tom Cross distributed the ballots.
CD 2008 as follows: Julie Shoji tabulated the votes.
Co • Victoria Goetz—Chair The Slate of Officers was
411. • Chad Homer—Vice-Chair accepted by unanimous vote for
each position
• Sheryl Pot—Secretary
December 12,2007 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 4
c Discussion. A=Actions D=Decisions
There was a discussion regarding the compensation package. The 6%
increase to grades and bringing all staff to 93%of mid-point was thoroughly
explained. The capital budget had a few changes from the la draft. The
cash flow for 2008 showed ending cash with and with-out the proposed new
clinic.
Kathleen Smith praised Jody Putman and her staff for all of their diligent and
time consuming work in preparation of this balanced budget .
V. Q&A on The 2008 Board Calendar topics will be discussed at the retreat. It is
Board important that everyone has input on what are the really important topics that
Calendar need to be on the calendar.
Topics
VI. Board The business meeting adjourned at 8:35 pm,at which time the board entered
Executive executive session.
Session
Respectfully Submitted By:
r f •
is / r 71130
Sheryl Pot, Seer' r.' ' Date
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December 12,2007 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 4 of 4
There was no Community Health Centers of King County Board of Director's Business Meeting
held in January,2008.
•
Page 11 of 44
I � r
Community Health Centers of King County
Board of Directors
February 13,2008
6:00 p.m.—9:00 p.m.
Administrative Offices
Present: Laurence DeShields,II,Luis Garcia,Victoria Goetz, Chad Homer,John Payne,Julie Shoji,Kathleen Smith,Thomas Trompeter
• (ex-officio)
Absent: Thomas Cross,Robert Ellis,Sheryl Pot •
Guests:
Staff: John Caron,Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
�N d MUM 1
Convene Meeting The CHCKC Board meeting was convened at6:41 pm
Prior to convening the board meeting,a presentation of our new name and
logo was given by Thomas Trompeter.
I. Consent The consent agenda was presented for approval. A—It was moved(Chad Homer)
Agenda -Board Meeting Minutes, 12/12/07 and seconded(Julie Shoji)
-Preliminary Financial Statement for the period ending December 31, to approve consent agenda.
2007 Motion Approved With One(1)
Abstention,Kathleen Smith.
II. Board Victoria Goetz,Board Chair,welcomed everyone and thanked Thomas
Chair's Trompeter for the presentation of the new name and logo.
Report
• Retreat Recap -The 2008 retreat was really good. Chad Homer was
thanked for his presentation on a different way of looking at strategic
cp
governance. The retreat was a great place to start looking at how we
manage meetings,mission and where we are going. The 2008
CHCKC Retreat Summary was passed out at tonight's board meeting
February 13,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 1 of 3
,.. r a,- r n. •fir .� J r+
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There was a brief discussion on location for next year's retreat. A—2009 Retreat location will be
January weather seemed to be the major concern in regards to driving discussed in Executive Session.
to Alderbrook Resort. Several board members felt this location did
not have activities for families,while others' felt the retreat was more
productive if family members were not in attendance.
• Board Calendar—The list of brainstorming calendar topics was A—An email will be sent out showing
reviewed,discussed and added to. Some of the suggested topics were all of the topics. Board members
not at the higher strategic level. Goal is to have the calendar complete will have an opportunity to give
by March board meeting. input on what they think are
priority topics. Victoria Goetz
and Thomas Trompeter will then
devise a draft calendar with the
"big ticket"topics.
• 2008 Committee—The proposed 2008 Committee Charters were A—Review proposed new committee
handed out for review and discussion. The Strategic Planning charter along with old committee
Committee has been eliminated. The Board Development Committee charter. Send comments to
has been renamed Governance Committee. Along with the charter Victoria Goetz. Willingness to
handout was the"Willingness to Serve: form. Strategic issues can Serve forms should be completed
solicit Ad Hoc meeting of specific committees and then brought back and turned into Yvonne
to the full board. - Westover.
III. Committee A. Finance Committee
Reports The Finance Committee met on February 4t. The preliminary financial
statements for December,2007 were accepted as preliminary. Write-off
receivables will be seen by April,when the audit takes place. A pie chart
showing CHCKC Revenue Streams was handed out. This chart can serve
as a reference for revenue stream discussions. The Revenue Bond, Series
2008 timeline was reviewed.
co There was a discussion at the board retreat on the use of reviewing Key A-A potential format will be brought
Indicators rather than the entire financial packet. to the March board meeting.
u' N. CEO Report • Strategic Plan Reporting Schedule- The proposed Strategic Plan
° reporting schedule for Provider of Choice and Employer of Choice
was reviewed. This proposal was the outcome of work done at the
February 13,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 3
•
r , -
board retreat on the reporting schedule. There were questions
surrounding the proposed dates for turnover rates. Of concern is"how
can we shoot for a goal without knowing the goal?" Goal is to have a A—The most recent EEOC report will
benchmark in April for turnover rates. There was a brief discussion be brought to the next Executive
on the diversity make-up.of higher level positions at CHCKC. Overall session.
there is a concern over reporting timelines that will be reviewed as we
get more information of the measurement goals.
• National and State Policy Update—The high level State Legislative
Priorities are the expansion of the Health Professions Scholarship and
Loan Repayment Program and a one-time grant to expand physical
capacity in CHC dental clinics._The high level Federal Legislative
Priorities are reauthorization of the Health Center Program;Increase
funding for the Health Center Program and Increase funding for
National Health Service Corps. Handouts showed how much money
and notes.
V. Other For the record,the following Board Resolutions were passed at the Annual
Business Board Retreat on 1/26/08:
#8-001 —approval for applying for grants for funding for the year 2009
#8-002—Removal of Mark Mitchell as an authorized signer on the Charles
Schwab and all Kibble and Prentice investment accounts. The
approval to replace Mark Mitchell with Kathleen Smith
#8-003—approval to remodel 6,000 square feet of the Powell building and
approval to finance or refinance up to $1,100,000 of the cost
through the issuance of tax-exempt bonds.
The March 2008 Board meeting will be held on Wednesday March 19,2008.
VI. Board The business meeting adjourned at 8:01 pm, at which time the board entered
Executive executive session.
Session
Respectfully Submitted By:
41 Sheryl Pot, Secretary Date
February 13,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 3 of 3
t i
Community Health Centers of King County
Board. 'Directors
March 19,2008
6:00 p.m.—9:00 p.m.
Administrative Offices
Present: Laurence DeShields,II,Robert Ellis,Luis Garcia,Victoria Goetz,Chad Homer,Sheryl Pot,Julie Shoji,Kathleen Smith,Thomas
Trompeter(ex-officio)
Absent: Thomas Cross,John Payne
Guests:
Staff John Caron,Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
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Convene Meeting The CHCKC Board meeting was convened at.6:32 pm
I. Consent The consent agenda was presented for approval. A—It was moved(Chad Homer)
Agenda -Board Meeting Minutes,2/13/08 and seconded(Julie Shoji)
-Special Session Conference Call Board Meeting Minutes 3/7/08 to approve consent agenda.
-Preliminary Financial Statement for the period ending December 31, Motion Passed Unanimously.
2007
-Financial Statement for the period ending 1/31/08
H. Board Victoria Goetz,Board Chair,welcomed everyone.
Chair's
Report NACHC Policy and Issues Forum—Chad Homer,Victoria Goetz and
Thomas Trompeter attended the NACHA P &I Forum in
Washington D.D.,March 12— 18,2008. They were able to talk to
Congress along with other Community Health Center forum
delegates. The main issues at stake were"
- • Re-authorization of Health Center Program with a five(5)year
to
co renewal.
m • Health Center Grant Program making it through the
c' Appropriation Committee
o '
• Medicare hasn't been adjusted since `93/'94. Better
reimbursement is needed.
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 1 of 3
PAII
Our group was able to consult with Bent to continue the discussion of 'A Chad Homer and Thomas
wording for our mission statement. It was agreed that an outside Trompeter will be meeting with
consultant would best be able to wordsmith our mission statement the outside consultant to see how
once we come up with the key points. The mission statement should he might phrase our mission
be short and concise and tell why we exist. statement.
• Board Calendar—The calendar was briefly reviewed. Some of the A—Several Board members want to
suggested topics were not at the higher strategic level and therefore know which topics were taken off
moved to the Governance Committee. The numbers in parenthesis the calendar and given to the
with some of the topics indicates the number of times the topic has Governance Committee. Victoria
been presented. A correction needs to be made to 2009 Budget. Goetz will email the list to all
September will be the 3`d discussion and November will be the 4th board members.
discussion. Most board members were contacted about their
committee membership. A—Review committee membership.
Send comments to Victoria
• 2008 Committee—The proposed 2008 Committee membership and Goetz.
Charters were handed out for review.
• Town Hall Meetings—Laurence DeShields and Debbie Wilkinson
attending a Town Meeting hosted by Ron Sims on the inequities
across society in all areas including healthcare. The discussions were
around how we need to work towards a better society and have
everyone on a level playing field. PBS will be doing a serious on
"Unnatural Causes"which deals with these issues. Another Town
Hall meeting is scheduled for Kent Senior Center on Monday,March
24th.
III. Committee A. Finance Committee
Reports The Finance Committee met on March 4s'. The Financial Statements for A—It was moved(Sheryl Pot) and
period ending January 31, 2008 were sent out in the board packet. seconded(Chad Homer)to accept
Kathleen Smith asked the board if they were comfortable with the Key the Key Indicators as the monthly
Indicators. Any comments need to be directed to Kathleen Smith. Full financial report with expanded
cp financial reports will be given on a quarterly basis. financial to be presented on a
rn quarterly basis. The Motion
o Passed Unanimously.
Powell Building Financing
An overview of the Powell Building Remodel summary was distributed. A—It was moved(Sheryl Pot) and
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 3
1 �6r
In order to borrow the maximum allowable funs,we needed to use the seconded(Kathleen Smith)to
—Kent building as colla e�ral and therefore hhad to get-it appraised:-The move ahead with t e�plans for
appraisal came in at 7.3 million. Remodel uses and overview of costs tenant improvement to the Powell
were reviewed. Building. The Motion Passed
Unanimously.
N.CEO Report Dental Benchmark Retort(2008 Strategic Plan)
The Dental Dashboard showing the percentage of patient who completed
their dental treatment plan within 12 months was reviewed. There are
different goals for kids(60%)and Adults(45%). Adults have a more
difficult time making their follow-up appointments and also have more
complex treatment plans.
EEOC Report
The CHCKC Employees by Race/Ethnicity and Position Class as of
9/30/07 was presented and reviewed. One-third of our employees speak
another language in addition to English. This report is filed every
September.
Provider Recruitment and Retention
The organization recognizes the need to increase provider salaries. There
has been difficulty in bringing in new hires at the 93%medium level. The
ELT would like to bump the initial salary offering to the 95%level and
balance the existing salaries accordingly. Competition for providers is
stiff across the state. CHCKC has 6 provider vacancies.
Insurance Summary
As requested at the retreat,the Insurance Summary was distributed and
reviewed. Bottom line,we are well protected.
VI. Board There being no further business,the business meeting adjourned at 7:45 pm at
Executive which time the board entered executive session.
cp Session
i Respectfully Submitted By:
0
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Sheryl Pot, Secretary Date
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 3 of 3
Community Health Centers of King County
2008 Budget Summary
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TOTAL 2008 d
Budget
STATISTICS-Units/Visits 169,711
REVENUE
Fee for Service Revenue 13,810,286
Grant Revenue 5,604,018
Managed Care Revenue 13,269,844
Other(Rental, Interest, etc) 1,826,943
EXPENSES
Personnel Costs 25,055,911
Services 653,192
Supplies Exp 1,877,015
General Exp 1,965,884
Overhead Exp 4,944,763
C:1Documents and Settii,, .;IreyenLocal SettingslTemporary Internet Files1OLKE812008 Budd'. iummary
ralIZ Publk Aceountitntr
ilonwlhiilto
10900NE4"Strcet
CLARK NUBER Suite 1700
8r0eweWA90004
Tr475A54.4919
F147s.454A620
000.504.5747
kelorknub•r.eom
Independent Auditors'Report tm,tk��.�sa
Prot,ulonaJSerV,eseornoacuon
Board of Directors
Community Health Centers of King County
Kent, Washington
We have audited the accompanying statement of financial position of Community Health Centers of King
• County (the Organization) as of December 31, 2006, and the related statements of activities, functional
expenses, and cash flows for the year then ended. These financial statements are the responsibility of the
Organization's management. Our responsibility is to express an opinion on these financial statements
based on our audit. The prior year summarized comparative information has been derived from the
Organization's 2005 audited financial statements and in our report dated March 29, 2006, we expressed
' ; an unqualified opinion on those financial statements.
We conducted our audit in accordance with auditing standards generally accepted in the United States of
America and the standards applicable to financial audits contained in Government Auditing Standards,
issued by the Comptroller General of the United States. Those standards require that we plan and perform
the audit to obtain reasonable assurance about whether the financial statements are free of material
• misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and
disclosures in the financial statements. An audit also includes assessing the accounting principles used
and significant estimates made by management, as well as evaluating the overall financial statement
presentation. We believe that our audit provides a reasonable basis for our opinion.
• In our opinion, the financial statements referred to above present fairly, in all material respects, the
financial position of Community Health Centers of King County as of December 31, 2006, and the
•• changes in its net assets and its cash flows for the year then ended in conformity with accounting
• principles generally accepted in the United States of America.
In accordance with Government Auditing Standards,we have also issued our report dated April 11,2007,
on our consideration of Community Health Centers of King County's internal control over financial
' . reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, and
grant agreements.The purpose of that report is to describe the scope of our testing of internal control over
financial reporting and compliance and the results of that testing, and not to provide an opinion on the
internal control over financial reporting or on compliance. That report is an integral part of an audit
performed in accordance with Government Auditing Standards and should be considered in assessing the
results of our audit.
•
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Certified Public Accountants
April 11,2007 Page 19 of 44
. - I
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COMMUNITY HEALTH CENTERS
OF KING COUNTY
Financial Statements And Independent Auditors'Report
December 31,2006
Page 20 of 44
Table Of Contents
Page
Independent Auditors'Report 1
Financial Statements:
Statement Of Financial Position 2-3
Statement Of Activities 4
Statement Of Functional Expenses 5
Statement Of Cash Flows 6
Notes To Financial Statements 7_16
Page 21 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
Statement Of Financial Position
Assets
December 31, 2006
(With Comparative Totals For 2005)
2006 2005
Current Assets:
Cash and cash equivalents(Note 2) $ 319,514 $ 2,130,433
Investments(Note 3 and 13) 1,891,005
Patient fees receivable, net of allowance for doubtful accounts
and contractual adjustments of$1,070,835($1,610,075-2005) 1,748,799 1,787,138
CHNW receivable (Note 11) 916,185 949,686
Grants receivable 760,585 613,224
Other receivables 86,360 76,709
Inventory 70,636 122,743
Prepaid expenses 175,089 132,950
Total Current Assets 4,077,168 7,703,888
Land, buildings,furniture, and equipment(Note 4) 25,076,246 20,720,593
Construction in progress(Note 4) 694,554 400,241
Less accumulated depreciation and amortization (5,490,389) (4,632,121)
20,280,411 16,488,713
PTSO costs,net of amortization (Note 6) 625,074 772,924
Investments(Notes 3 and 13) 15,702,170 12,966,338
Land held for future use(Note 5) 256,420 256,420
Deposits 56,166 129,356
Total Assets $ 40,997,409 $ 38,317,639
The accompanying notes are an integral part of these financial statements. Page 22 of 44
-2-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Statement Of Financial Position
Liabilities And Net Assets
December 31,2006
(With Comparative Totals For 2005)
2006 2005
Current Liabilities:
Accounts payable(Note 2) $ 1,081,681 $ 677,093
Accrued wages and related payables 1,338,073 1,272,853
Other accrued expenses 29,318 24,298
Current portion of loan payable(Note 10) 92,815 91,667
Total Current Liabilities 2,521,867 2,065,911
Loan payable, less current portion(Note 10) 2,156,656 2,249,471
Total Liabilities 4,678,523 4,315,382
Commitments and contingencies(Note 12)
Net Assets:
Unrestricted
Undesignated 20,616,716 21,035,919
Designated by the Board of Directors(Note 13) 15,702,170 12,966,338
Total Unrestricted 36,318,886 34,002,257
Total Net Assets 36,318,886 34,002,257
Total Liabilities and Net Assets $40,997,409 $38,317,639
The accompanying notes are an integral part of these financial statements.
-3- Page 23 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
Statement Of Acdvities
For The Year Ended December 31,2006
(With Comparative Totals For 2005)
2006 2005
OPERATING ACTIVITIES
Revenue and Support
Patient service revenue,net of contractual adjustments $19,193,489 $17,466,146
Grants and contracts from governmental agencies 5,053,351 4,465,484
United Way of King County 127,283 142,734
Donations and contributions from private agencies,
including donated services and supplies 148,845 18,795
Rental income 305,039 299,628
investment income(Note 3) 608,291 506,088
Other Income 139,340 167,768
Total Operating Revenue and Support 25,575,618 23,086,603
Expenses
Program Services:
Primary medical care 17,168,912 15,073,335
Primary dental care 4,359,592 4,151,715
Total Program Services 21,528,504 19,225,050
Supporting Services:
Management and general 5,155,610 4,860,044
Total Operating Expenses 26,684,114 24,085,094
Change in Net Assets from Operating Activities (1,108,496) (998,491)
NON-OPERATING ACTIVITIES
Loss on disposal of assets (799) (101,757)
Loss on impairment of assets(Note 4) (257,017)
Unrealized Gain or(loss)on investments(Note 3) 165,897 (85,392)
Contributions 70,522 1,960,445
Pool savings(Note 11) 3,446,522 3,429,444
Change In Net Assets from Non-Operating Activities 3,425,125 5,202,740
Change in Net Assets 2,316,029 4,204,249
Net assets,beginning of year 34.002,257 29,798,008
Net Assets,End of Year $36,318,886 $34,002,257
The accompanying notes are an integral part of these financial statements. Page 24 of 44
-4-
COMMUNITY HEALTH CENTERS OF SING COUNTY
Statement Of Functional Expenses
For The Year Ended December31,2006
(With Comparative Totals for 2005
Program Services Supporting Services
Primary Primary Total Management
Medical Dental Program And 2006 2005
Care Care Services General Total Total
Salaries $ 9,414,301 $2,447,240 $11,861,541 $ 2,584,477 $14,446,018 $13,169,073
Payroll taxes and fringe benefits 2,100,122 575,102 2,675,224 575,935 . 3,251,159 $ 2,908,095
Total Salary and Related Expenses 11,514,423 3,022,342 14,536,765 3,160,412 17,697,177 16,077,168
Contract Labor 469,532 48,049 517,581 34,632 552,213 584,015
Professional fees 887,148 82,841 969,989 273,181 1,243,170 1,192,641
Occupancy 692,383 174,672 867,055 232,614 1,099,669 1,010,779
Dues,publications,and subscriptions 79,150 10,580 89,730 73,682 163,412 184,364
Travel 43,350 8,566 51,916 134,108 . 186,024 133,003
Medical/dental supplies 1,432,063 313,566 1,745,629 5,797 1,751,426 1,139,712
Office supplies 182,449 33,344 215,793 55,522 271,315 352,462
Printing 46,582 11,823 58,405 13,051 71,456 66,608
Equipment lease and maintenance 504,233 114,183 618,416 179,586 798,002 882,543
Postage 67,692 10,513 78,205 22,585 100,790 75,674
Telephone 216,533 53,628 270,161 91,128 361,289 321,654
Insurance 45,363 15,524 60,887 39,288 100,175 93,345
Interest and banking fees 61,564 35,808 97,372 90,041 187,413 198,051
Property taxes 6,156 3,898 10,054 43,739 53,793 33,284
Bad debts 247,475 159,755 407,230 12,000 419,230 375,378
Miscellaneous 149,642 72,427 222,069 . 228,191 450,260 397,999
v Total Expenses Before
co Depreciation and Amortization 16,645,738 4,171,519 20,817,257 4,689,557 25,506,814 23,118,680
N
Dapredation and amortization 523,174 188,073 711,247 466,053 1,177,300 966,414
0
Total Expenses $17,168,912 $4,359,592 $21,528,504 $ 5,155,610 $26,684,114 $24,085,094
41.
The accompanying notes are an integral part of these financial statements.
-5-
COMMUNITY HEALTH CENTERS OF SING COUNTY
Statement Of Cash Flows
For The Year Ended December 31,2006
(With Comparative Totals For 2005)
2006 2005
Cash Flows from Operating Activities:
Change in net assets $ 2,316,629 $ 4,204,249
Adjustments to reconcile to net cash provided by operating activities:
Depreciation and amortization 1,177,300 966,414
Unrealized (Gain)or loss on investments (165,897) 85,392
Loss on disposal of assets 799 101,757
Loss on impairment of assets 257,017
Changes in assets and liabilities
Grants receivable (147,361) (159,914)
Accounts and interest receivable 38,339 (765,357)
CHNW receivable 33,501 561,075
Inventory 52,107 (67,465)
Other assets 21,400 5,137
Accounts payable 384,568 (161,993)
Accrued liabilities 70,240 39,284
Cash Provided by Operating Activities 4,038,642 4,808,579
Cash Flows from Investing Activities:
Payments for land, building and equipment acquisition (5,036,038) (4,601,525)
Payments for PTSO costs (42,926) (372,917)
Purchase of investments (3,556,074) (19,058,975)
Proceeds from sale of investments 2,877,144 4,116,243
Cash Used by investing Activities (5,757,894) (19,917,174)
Cash Flows from Financing Activities:
Debt service principal payments (91,667) (86,680)
Cash Used by Financing Activities (91,667) (86,680)
Net decrease in cash and cash equivalents (1,810,919) (15,195,275)
Cash and cash equivalents, beginning of year 2,130,433 17,325,708
Cash and Cash Equivalents,End of Year $ 319,614 $ 2,130,433
Supplemental Disclosure of Cash Flow information:
Cash paid for interest $ 128,487 $ 133,498
f�
The accompanying notes are an integral part of these financial statements.
-6- Page 26 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 1-Summary Of Significant Accounting Policies
Description of Operations - Community Health Centers of King County (CHCKC) is a not-for-profit
organization providing comprehensive primary medical and dental care through the operation of health
centers in Kent, Renton, Auburn, Eastside, Bothell, and Federal Way. CHCKC's mission is to provide care to
all, regardless of ability to pay and to specialize in providing care for the medically.underserved, low income,
and other disadvantaged populations In King County. CHCKC provides comprehensive and coordinated
services, including allopathic and naturopathic family medicine, family dentistry, acupuncture, behavioral
health care, nutrition services and massage therapy. CHCKC also provides a variety of supportive services to
increase the effectiveness of the health care services provided. These supportive services include outreach
and insurance eligibility assistance, referral coordination and patient care coordination. CHCKC strives to
improve the overall health of the general population through education and treatment of illnesses through a
comprehensive set of service modalities. CHCKC's philosophy is that all people are entitled to affordable,
high quality health care.
Basis of Presentation - The financial statements are presented in accordance with generally accepted
accounting and reporting standards for not-for-profit organizations.
Under these standards, net assets and revenues, expenses, gains and losses are classified based on the
existence or absence of donor-imposed restrictions. Accordingly, the net assets of CHCKC and changes
therein are classified and reported as follows:
Unrestricted net assets- Net assets that are not subject to externally imposed restrictions. Amounts
designated by the Board of CHCKC are included in this classification.
Temporarily restricted net assets- Net assets subject to donor-imposed stipulations that may or will
be met either by actions of CHCKC and/or the passage of time. CHCKC had no temporarily restricted
net assets as of December31, 2006 and 2005.
Permanently restricted net assets-Net assets subject to donor-imposed restrictions that stipulate the
resources be maintained permanently, but permit CHCKC to use, or expend part or all of the income
derived from the donated assets for either specified or unspecified purposes. CHCKC had no
permanently restricted net assets as of December 31,2008 and 2005.
Revenues are reported as increases in unrestricted net assets unless use of the related assets is limited by
donor-imposed restrictions. Expenses are reported as decreases in unrestricted net assets. Gains and losses
on investments and other assets or liabilities are reported as increases or decreases in unrestricted net
assets unless their use is restricted by explicit donor restriction or by law. Expirations of temporary restrictions
on net assets are reported as transfers between the applicable classes of net assets. Contributions with
externally imposed restrictions that are met in the same year as received are reported as revenues of the
unrestricted net asset class.
Cash and Cash Equivalents - CHCKC considers all highly liquid investments purchased with an original
maturity of three months or less to be cash equivalents, except for funds held in the investment accounts
designated for long-term purposes.
Page 27 of 44
- 7-
COMMUNITY HEALTH CENTERS OF ICING COUNTY
Notes To Financial Statements
Note 1-Continued
investments -Investments in debt, equity, or other securities that do not meet the criteria for cash and cash
equivalents are accounted for as investments. Investments with readily determinable fair values are stated at
fair market values in the accompanying financial statements.
Credit Risk - Financial instruments that potentially subject CHCKC to concentration of credit risk consist
principally of cash, short-term investments, and receivables. CHCKC places its cash and investments only in
high quality financial institutions. At December 31, 2006, CHCKC has cash deposits and investments in
excess of the federally insured limit of$100,000 in an institution.
Inventory - Inventory Is stated at the lower of cost or market. Cost is determined by the first-in, first-out
method.
Accounts Receivable -Trade accounts receivable are stated at the amount management expects to collect
from outstanding balances. Management provides for probable uncollectible amounts through a charge to
earnings and a credit to a valuation allowance based on its assessment of the current status of individual
accounts. Balances that are still outstanding after management has used reasonable collection efforts are
written off through a change to the valuation allowance and a credit to trade accounts receivable.
Land,Buildings,Furniture,and Equipment-Land, buildings,furniture,and equipment are recorded at cost
or, if donated, at the fair market value at the date of donation. Repairs and maintenance are charged to
expense as incurred. Leasehold improvements are amortized over the shorter of the useful life or lease term.
Depreciation is provided using the straight-line method over the following estimated lives:
Building and Improvements 10-40
Furniture and Equipment 3-10
Patient Service Revenue - Patient service revenue is recognized at the date of service based on estimated
net realizable amounts from patients and third-party payers for services rendered or is recognized based on a
specified dollar amount per month for patients enrolled in a managed care plan.
Revenues from third party payer agreements are subject to audit and retroactive adjustments. Retroactive
adjustments are recorded at the time that such amounts can first be reasonably determined, which is
normally upon notification by the paying entity. Currently, the adjustments for Medicaid services are recorded
at the time of billing based upon the Medicaid fee schedule instead of at the time of notification.
A significant percentage of patient service revenue were for services provided to Medicaid participants.
Medicaid revenue represented 74% and 72% of patient service revenue for 2006 and 2005, respectively.
Medicaid receivables represented 39% and 44% of net patient fees receivable at December 31, 2006 and
2005,respectively.
Contributions - Contributions, which include unconditional promises to give (pledges), are recognized as
revenue in the period received. Currently it is the policy of management to recognize certain contributions as
non-operating revenue. These contributions are given to support the overall mission and are not specifically
set aside or earned through operations.
•
Page 28 of 44
-8-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note I-Continued
Charity Care - CHCKC has a policy of providing care to patients, who meet certain criteria under its policy,
without charge or at amounts less than its established rates. However, all patients are requested to pay a
minimum fee for each visit and no patient is denied services because of inability to pay. Since management
does not expect payment for this care, the discounted services are excluded from revenue. During the year
ended December 31, 2006 and 2005, CHCKC provided $4,414,605 and $4,334,892, respectively, of charity
care services under this policy.
Grant Revenue - CHCKC receives support from various federal, state and local government agencies.
Grants receipts are subject to restrictions on the use of funds placed by the grantor. CHCKC administers
these funds In accordance with grantor guidelines. Grant revenue under cost reimbursement arrangements is
recognized as expenses are incurred. Amounts incurred but not yet reimbursed are reported as grant
receivables.
In-Kind Contributions - CHCKC receives contributed services and supplies from various sources.
Volunteers, including members of the Board of Directors, have made significant contributions of time to
CHCKC. The value of this contributed time does not meet the criteria for recognition under current accounting
standards, and accordingly is not reflected in the accompanying financial statements. Certain professional
services formally documented and charged to the relevant project are recorded in the accompanying financial
statements.At December 31, 2008, in-kind contributions were included in both grant and contribution revenue
in the statement of activities. These services and contributions of materials are recorded at market values.
Summarized below are totals for 2008. •
Contributed labor $ 55,945
Contributed supplies 467,558
Contributed use of space 12.800
$_ _538,303
Federal Income Tax-CHCKC has received a determination letter from the IRS that states it Is exempt from
federal income taxes under Section 501(c)(3)of the Internal Revenue Code.
Use of Estimates-The preparation of financial statements in conformity with accounting principles generally
accepted in United States of America requires management to make estimates and assumptions that affect
the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of
the financial statements and reported amounts of revenues and expenses during the reporting period.Actual
results could differ from those estimates.
•
Comparative Totals - The financial information includes certain prior-year summarized comparative
information in total but not by net asset class. Such information does not Include sufficient detail to constitute
a presentation in conformity with accounting principles generally accepted in the United States. Accordingly,
such information should be read in conjunction with CHCKC's financial statements for the year ended
December 31,2005, from which the summarized information was derived.
Page 29 of 44
-9-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 2-Cash And Cash Equivalents
During 2006, CHCKC became the fiscal agent for the Community Health Council of Seattle/King County
(CHCSKC).CHCSKC is a 501(c)(3)organization made up of membership from Community Health Centers in
Seattle and King County including CHCKC. CHCSKC's mission is to maintain and enhance the ability of the
member Health Centers to provide comprehensive, culturally and linguistically appropriate health care to
underserved populations in King County.As the fiscal agent for CHCSKC, CHCKC collects monies and pays
obligations for CHCSKC. Included in the cash and cash equivalents for the year ended December 31, 2006
are CHCSKC funds held of $58,841 which is also included in accounts payable as an amount due to
CHCSKC.
Note 3-Investments
CHCKC invests funds with Charles Schwab & Co., Inc. and FTN Financial that are managed by Kibble &
Prentice, a group of private asset managers. These funds are invested based upon the designations by the
Board of Directors. These investments pay interest and dividends at variable rates and some of the
investments are subject to market fluctuation increases and decreases. The investment of these funds is
controlled by the investment policies of CHCKC as approved by the Board of Directors.
Investments are carried at market value and consist of the following at December 31, 2006:
Equity securities $ 1,219,268
Certificates of deposit 783,702
Money market funds 3,681,586
Fixed income 10.017.614
$15.702.174
Investment income consisted of the following for the year ended December 31,2006:
Interest and dividends $ 590,691
Realized gains 17,600
Unrealized gains 165.897
$ . 774.18a
Unrealized gains and losses are considered non-operating in the statement of activities.The balance of
undesignated investments for 2005 and 2006 were$1,891,005 and$0 respectively.
Page 30 of 44
-10-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 4-Land, Buildings, Furniture And Equipment
The cost and accumulated depreciation of fixed assets at December 31 were as follows:
2006 2005
Land $ 2,890,013 $ 2,890,013
Building and improvements 16,322,029 13,009,201
Leasehold improvements 1,282,503 985,580
Medical and dental equipment 1,176,576 1,152,906
Billing computer 819,634 784,055
Office equipment and other 2.585.491 1.898.838
25,076,246 20,720,593
Less accumulated depreciation and amortization (5.490.389) (4.632.121)
19,585,857 18,088,472
Construction in progress 694.554 400.241
Total 520.2K all $16.488,713,
Included in land, buildings, furniture, and equipment Is the cost of the Auburn Medical Arts Building
purchased in February 1999.for$3,372,357 of which a portion is leased to other medical organizations under
operating lease arrangements(Note 16).
As of December 31, 2006, the construction in progress balance of$694,554 consisted of three projects. In
2001, CHCKC started planning for the rebuilding of the Bothell Health Center on land purchased in 1999.
Design and other costs related to the project of$263,040 were incurred prior to 2006. It was determined in
2006 that $257,017 of the design costs associated with this planning were no longer able to be used and
were written off in the current year. The balance of the costs of$6,023 along with costs incurred in 2006 for
feasibility studies for rebuilding this clinic of$16,000, make up the balance of$22,023 at December 31,2008.
Lutheran Community Services NW(LCS)is building a community center at Angle Lake in the City of SeaTac.
CHCKC is currently building out approximately 8,000 square foot space with tenant improvements as part of
a long-term lease with LCS and has Incurred costs to date of$537,492. This health center Is proposed to be
completed and opened in the second quarter of 2007. In 2006, CHCKC started the remodel of the third floor
of the Kent Community Health Center after administration moved to Renton and has incurred costs to date of
$135,039. This remodel is planned to be completed in the second quarter of 2007.
In May of 2006, CHCKC opened the new school-based Tyee Campus Health Center on the campus of Tyee
High School in, SeaTac WA. Approximately 1,100 square feet was remodeled in the school space.
Additionally, in November of 2006, another health center was opened in Burien WA under a leasing
arrangement with Wesbild BP Inc. The costs of both of these new health centers are included in the
leasehold improvement and are being depreciated over the estimated lease lives.
Note 5-Land Held For Future Use
In August 1999, CHCKC purchased the Bothell Clinic building along with some adjacent land with a value of
$258,420. This land is currently being held for future use and is vacant.
Page 31 of 44
-11 -
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 6-Practice Technology Services Organization(PTSO)
In May 2004, CHCKC became a participant in Practice Technology Services Organization (PTSO) along with
other community health centers in the State of Washington. The PTSO was formed in order to realize such
benefits as group discount purchasing, shared database management and support, grant opportunities and
standardized processes and data. In order to participate in the PTSO, CHCKC invested a level of funding of
costs for equipment, membership fees, software license costs, start-up and operating costs and service fees.
CHCKC will receive a future benefit from the use of the shared database management system. Accordingly,
the amounts have been capitalized and will be amortized over the useful lives of the hardware and software
license.
The PTSO costs as of December 31,2006,were as follows:
2006 2005
PTSO license, software and hardware costs $ 991,084 $ 948,158
Less accumulated amortization (386.010) (175.234)
Total $ 625.074 L 772.924
Note 7-Leased Facilities And Equipment
CHCKC is obligated under leases for the Bothell, Eastside and the Federal Way clinics. These leases provide
for annual adjustments to the minimum rental payments based on increases in building operation costs or the
consumer price index. In June of 2005, CHCKC entered into a lease agreement with Lutheran Community
Services NW to lease a portion of a building set to begin construction in 2008. Construction was completed in
2006 at which time CHCKC began tenant improvements to their approximate 8,000 square foot shell space
projected to cost approximately $1,000,000, which CHCKC will pay. This lease agreement provides for a
lease period of ten years and has three successive options to extend the lease for five years each. Lease
obligations for this lease over the ten-year period total$1,375,248.
In November 2006, CHCKC entered Into a short-term lease with Wesbild BP Inc for a medical clinic in Burien
WA that opened In the same month. This lease expires on April 30,2007 due to availability of space and calls
for lease payments of$1,800 per month. At the expiration of the lease, CHCKC will determine if other space
is available.
The facility rent expense for the years ended December 31, 2006 and 2005, was $359,221 and $343,172,
respectively. CHCKC also leases various office equipment under operating leases which expire through April
2011.The rent expense related to these leases was$94,230 and$86,691 for the years ended December 31,
2008 and 2005, respectively.
Page 32 of 44
- 12-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 7-Continued
The future minimum lease payments under these leases are as follows:
Years Ending December 31,
2007 $ 266,086
2008 200,293
2009 173,727
2010 149,444
2011 142,304
Thereafter 764.023
Total $ l.sasA
Note 8-Retirement Plan
CHCKC maintains two tax sheltered annuity retirement plans under Internal Revenue Code Section 403(b),
which covers substantially all employees. One of these plans,Vanguard Group, was authorized in 2005 and
allows employees to self-direct investments.
For the years ended December 31, 2006, and 2005, there were no employer contributions or employer
matching of employee contributions under the plan.
Note 9-Managed Care
CHCKC is a member of Community Health Network of Washington (the Plan), a managed care plan formed
by twenty-one community and migrant health centers throughout the State of Washington to participate in the
managed care marketplace. The Plan is a not-for-profit corporation. The Plan accepts the full insurance and
financial risk of providing health care services to enrollees In the State Medicaid and Basic Health Plan
programs. As part of this agreement, the individual Centers are contingently liable for their proportionate
share of any claims should the Plan be unable to meet Its financial obligations. The Office of the Insurance
Commissioner (OIC) requires all plans to maintain reserves to meet these financial obligations. The Plan
maintains assets in excess of the OIC's requirements and believes that its assets are sufficient to meet
financial obligations.
As part of this agreement, CHCKC has agreed to serve as a provider of primary care services for a certain
amount per member per month and to provide case management services to these same members related to
specialty and hospital services. In return, CHCKC will participate in any savings realized by the Plan in
providing these services,based upon a formula determined by the Board of Directors of the Plan.
Page 33 of 44
- 13-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 10-Loan Payable
A loan payable to U.S. Bank with a current interest rate of 5.53%. Principal and interest payments are due
monthly through January 2022. The Loan and Security Agreement allows for two optional prepayments
periods known as Reset Dates at January 23,2007 and 2017 respectively without penalty.The interest rate is
also reset at these Reset Dates based on a formula derived from market rates.This loan is collateralized with
the Kent facility and land.At December 31, 2006, CHCKC was in compliance with all covenants related to the
loan.
CHCKC had the following loan payable balance at December 31,
2006 2005
$2,249,471 $2,341,138
Less current portion (92.815) (91.667)
Total $ 2,159.656 $ 2,249,477
Scheduled principal repayments on the above loan payable are as follows:
Years Ending December 31,
2007 $ 92,815
2008 97,521
2009 104,303
2010 111,137
2011 118,420
Thereafter 1.725.275
Total
$ 2,249,471
Note 11-Hospital And Specialty Pools
Included on the statement of activities are $3,446,522 and $3,429,444 of Hospital and Specialty Pool
Revenues for 2006 and 2005, respectively. This income is classified as non-operating as it is not directly
related to services provided by CHCKC, but rather the result of savings realized by CHNW (Note 9) on
specialty and hospital care.This Income is accrued as it becomes known to CHCKC, generally at or near the
time cash is received. The estimate Is based on the preliminary settlement statement prepared by the
Community Health Plan for the most recently completed plan year which is calendar year 2005. CHCKC
receives distributions of these savings over a 15 to 18 month period following the end of a plan year.
Note 12- Commitments And Contingencies
Grants-CHCKC has received federal grants for specific purposes that are subject to review and audit by the
grantor agencies. Entitlements to these resources are generally conditional upon compliance with the terms
and conditions of grant agreements and applicable federal regulations, Including the expenditure of resources
for allowable purposes. Any disallowance resulting from a review or audit by the grantor may become a
liability of CHCKC.
Page 34 of 44
- 14-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 12- Continued
Use of Facility Restriction-In 1991,CHCKC received$29,663 from King County DSHS for the construction
of real property at 403 E. Meeker St. in Kent. Under the terms of this grant, CHCKC is obligated to use the
facility to provide comprehensive health care to the low-income population of South King County until April 5,
2006. A promissory note was issued in November 1998 for the above amount,which was forgiven on April 5,
2008, because CHCKC met the use of facility restriction specified in the grant.A release of the restriction was
filed with King County in February 2007. It is expected that this release will occur in 2007.
Note 13-Designated By Board Of Directors
The Board of Directors of CHCKC designated cash and cash equivalents and investments for the following
purposes at December 31:
2006 2005
Managed care reserves $1,100,000 $1,100,000
Operating reserves 8,743,030 5,500,000
Reserve for capital and program development 6,722,370 5,366,338
Reserve for endowment 1.136.770 1.000.000
115,702,170 $12.986,33@
Reserves designated by the Board of Directors include an allocation for unanticipated expenses in CHCKC's
managed health care programs, operating reserves equivalent to approximately three months of normal
operating expenses, reserves for capital and program development, and an initial reserve for start-up of an
endowment that in future years will help finance special strategic initiatives.
Note 14-Malpractice Insurance
Effective January 1, 2003, CHCKC was covered under the provision of the Federal Tort Claims Act (FTCA)
for malpractice. The FTCA is a government funded program which allows community health centers and
other qualified providers to be covered for malpractice. CHCKC has purchased malpractice insurance for
activities not covered under the FTCA.
Note 15-Self Insurance
CHCKC is a member of 501c Services(the Trust),formerly the Northwest Agency Trust. The Trust facilitates
the utilization by member agencies of the Reimbursement Financing Method of meeting obligations under
State Unemployment insurance Statutes. As of December 31, 2006 and 2005, CHCKC had on deposit
$63,923 and$54,378, respectively,with the Trust to fund these obligations.The deposit Is Included in prepaid
expenses on the statement of financial position. Any potential claims that may exist cannot be estimated at
December 31,2006;therefore, no accrual has been made.
Page 35 of 44
- 15-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 16-Lease Agreement
In November 2004, CHCKC entered into a lease agreement with another organization to lease a portion of a
building owned by CHCKC. This lease calls for monthly lease payments of $9,722 for the period February
2005 to October 2009 and $10,734 for the period November 2009 to October 2014.This lease is a triple net
lease and the lessee is obligated to pay a Pro Rata share of the operating costs of the building as additional
rent each month. At the time of the lease signing, the lessee was required to make a security deposit of
$10,734 which Is refundable upon fulfillment of certain lease conditions and a prepaid rent amount of$9,722
which represents the fourth month's lease of the lease period. Additionally, approximately 3,000 square feet
of this same building is leased to another tenant under a triple net lease that is currently set to expire on June
30, 2007. The lessee is also obligated to pay a pro rata share of the operating costs based on their share of
the space leased.
Aggregate future minimum rental payments to be received under the operating leases are as follows:
• Year Ended December 31,
2007 $160,134
2008 116,664
2009 118,688
2010 128,808
2011 128,808
Thereafter 364.956
$ 1.018,0sa
Page 36 of 44
-16-
I. FAIR EMPLOYMENT PRACTICES
Equal Employment Opportunity
CHCKC affirms its continuing commitment to extend to all qualified individuals an equal
opportunity to compete for employment and advancement within the company. We are committed
to the philosophy and principle of equal employment opportunity for all present and prospective
employees.
To assure equal employment opportunity,there shall be no discrimination and/or preferred treatment
concerning any individual or group because of race,color,creed,religion, sex, age,national origin,
citizenship,marital status,veteran status,sexual orientation,political ideology,medical condition, or
because of sensory,physical,or mental disability,or any other factor protected by law.
Further, it is the policy of CHCKC to comply with the Americans With Disabilities Act and other
federal and state laws prohibiting discrimination against applicants or employees with disabilities.
Accordingly, we will reasonably accommodate applicants and employees with known physical or
mental disabilities to the extent required by law. This reasonable accommodation policy extends to
all services,programs,and facilities that are provided through employment with us. We reserve the
right to modify,or make exceptions to,any of its existing policies or practices to the extent necessary
to provide a reasonable accommodation to an applicant or employee whom we know has a disability.
If you believe that you need an accommodation because of a disability or medical condition,please
discuss this with the Health Center Manager,Dental Center Manager,Dental Center Supervisor or
a human resources representative.
Management at CHCKC is expected to carry forward the company's policy of nondiscrimination and
equal employment opportunity in every aspect of employment. All decisions made with respect to
recruiting, hiring, and promotion for all job classifications will be based solely on individual
qualifications related to the requirements of the position. Likewise,all other personnel matters such
as compensation,. benefits, transfers, termination's, staff reduction, training, education, .and
social/recreational programs will be administered free from any unlawful discriminatory practices.
Anti-Harassment and Discrimination Policy
CHCKC recognizes and values the integrity of its employees and their right to work in an
environment that fosters mutual respect and is free of harassment or discrimination. CHCKC is,
therefore, committed to a policy that prohibits harassment or discrimination based upon any
individual employee's race, color, ,religion, creed, ancestry, sex, age, national origin, sexual
orientation,marital status,veteran status,or physical,mental,or sensory disability.
This policy applies to all employees, applicants, vendors, customers, contractors, and any other
person doing business with CHCKC. Harassment and discrimination not only violates CHCKC's
policy but may be a violation of state and federal law.
Harassment is verbal or physical conduct that denigrates, or shows hostility or aversion toward,
an individual because of his or her status as protected by law and that unreasonably interferes
with that individual's work performance or creates an intimidating work environment. Conduct
that the company determines constitutes a violation of this policy will result in strict disciplinary
Employee Handbook Page 4
Fair Employment Practices January 2008
Page 37 of 44
action, including immediate termination. Examples of such conduct include (1)demeaning or
hostile written,graphic,or verbal communications,including off-hand comments,epithets,jokes,
emails, slurs or negative stereotyping directed at any individual because of or regarding that
individual's race, color, religion, creed, ancestry, sex, age, national origin, sexual orientation,
marital status,veteran status,or physical,mental,or sensory disability; (2)hostile,intimidating or
threatening conduct directed at an individual because of that individual's status as protected by
law.
Sexual harassment is one form of harassment. It is also a violation of the law and will not be
tolerated by CHCKC. Sexual harassment is defined as:
Unwelcome sexual advances, requests for sexual favors, or other verbal
or physical conduct of a sexual nature constitute sexual harassment
when: (1)submission to such conduct is made either explicitly or
implicitly a term or condition of the individual's employment;
(2)submission to or rejection of such conduct by an individual is used as
a basis for employment decisions affecting such individual; or (3)such
conduct has the purpose or effect of unreasonably interfering with an
individual's work performance or creating an intimidating, hostile or
offensive working environment.
-Equal Employment Opportunity Commission,29 C.F.R.Part 1604,and"Guidelines on Discrimination Because of Sex."
Discrimination and harassment includes many forms of offensive behavior and can include
gender-based harassment of a person of the same sex as the harasser. Behavior that may violate
this Policy includes: ,
• unwanted sexual advances or making or threatening reprisals after a
negative response to sexual advances
• visual conduct: leering, making sexual gestures, displaying of
sexually suggestive or racially motivated objects or pictures,
cartoons,or posters
• verbal conduct: making or using derogatory comments, epithets,
slurs,jokes,or sexual advances/propositions
• physical conduct: touching, assaulting, impeding, or blocking
movements.
Complaint Procedure
If you feel you have been harassed or discriminated against because of your race, color,religion,
creed, ancestry, sex, age, national origin, sexual orientation, marital status, veteran status, or
physical, mental, or sensory disability, you should immediately contact the Health Center
Manager, Dental Center Manager, Dental Center Supervisor or Human Resources. Your
complaint will be treated seriously and investigated. The investigation may include interviewing
witnesses and gathering other relevant data. The investigation will be as confidential as possible
consistent with the need to conduct a full investigation. If substantiated, appropriate corrective
action will be taken if warranted. This can include a verbal or written warning, suspension, or
termination of employment.
Employee Handbook Page S
Fair Employment Practices January 2008
Page 38 of 44
''IMMUNITY HEALTH CENTERS OF KING COUNTY PATIENT REGISTRATION
La' _ ,ime/Apellido patemo First Name/Nombre de pile Middle Name/Segundo nombre
Social Security Number/Nt mero de seguro social Birth Date/Fecha de nacimiento Gender/Sexo
❑ M ❑ F
Mailing A I dress/Direccidn de correos City/Ciudad State/Estado Zip/Cddigo postal
Home Address(If different)/Domicilio(si es distinto) City/Ciudad State/Estado Zip/Cddigo postal
Do you live within the city limits of your town?
Which county do you live in7/LEn que condado vive Ud.? /LVive Ud.dentro de los limiter de su Ciudad?
❑King O Pierce ❑Snohomish 0 Other/Otro:
❑Yes/Si ❑No
Check if Primary Phone/ Check if Primary Phone/:
❑ Home Phone/Telefono de la case: 0 Alternate Phone Number(s)/Teldfono(s)alterno(s)
❑ Work Phone/Telefono de trabajo: 0 Emergency Contact Phone/Telefono de emergencia:
a Cell Phone/Telefono de cellular:: Emergency Contact/Contacto de emergencia:
Relationship:
How will you pay for your visits?(Check all that apply)
Are you interested in applying for Sliding Scale
/LComo pagard sus visitas?(Marque todos los que correspondan) Discount?/LLe interesa solicitar descuento de Escala Mbvil?
❑ Self-paIy/Page Ud.ntismo ❑Yes/SI 0 No
I
❑ Medical Coupons/Cupones medicos Are you interested in applying for affordable health
❑ Insurance/Aseguranza Insurance?/LLe interesa solicitar aseguranza medica de bajo costo?
❑ Other/Otro: ❑Yes/Si 0 No
If patient is less than 18:/tii it Ip,i ' .•illy L ilirirui Lie I\,
Parent/Guardian's Last Name/Apellido de padre o madrelTutor Parent/Guardian's First Name/Nombre de pita de padre o madre/Tutor
Relationship to Patient Social Security Number Gender/Sexo Birth Date/Fecha de nacimiento
/Parentesco d relacidn al paciente /blamero de seguro social ❑ M ❑ F
ElParent/Padre o Madre
❑Guardian/Tutor
❑', Ir/Otro:
Please complete both sides/Favor de completer los dos lados
For office use only/Solo para use oficial de CHCKC
Witness(CHCKC Staff) Date:
Page 39 of 44
Sliding Scale Category: ❑A ❑B ❑C ❑D ❑E 0 F Insurance:
Answering these questions may help us obtain funding for services.
/Sus respuestas alas siguientes preguntas podrfan ayudarnos a conseguir financiamiento pars los servicios que podemos ofrecerle.
WL I your race or biological family background? Are you disabled?4Esta Ud,Discapacitado?
(Check all that apply)/LCuil es la raze suya o lade su familia ❑Yes/Si ❑No
biolegica? (Marque todos los que correspondan)
Are you an immigrant or refugee?
❑White/BlIlanco
❑AsisNAkiitico //,Es Ud.inmigrante o rcfugiado?
❑Black/Negro 0 Yes/Si 0 No
❑Native Hawaiian/Indio Hawaiano Total number of people in your household(people who
live in the same house and depend on the same income)
❑Other Pacific Islander/Otro Isla)
❑American Indian/Alaskan Native/Indio Americano/Indio Alaskeflo Mtimero total de personas que viven en su hogar(y dependen del mismo
ingreso)
Are you Hrpanic?LEs usted Hispano(a)? Total number of children under 18 in your household
Mtimero total de nifios menores de 18 que viven en su hogar
❑Yes/S1 ❑No
What language do you usually speak? Which of the following best describes your
/One idioms habla Ud.generalmente? household?4Cuil de los siguientes describe mejor a los de su hogar?
❑English/Ingles 0 Married with no dependent children/Casado(a)sin cargas
❑Spanish/Espaftol familiares(nifios)
0 Ruselan/Ruso 0 Single Person/Soltero(a)
❑Other/otro: ❑Single female with dependent children living with you/
Mujer soltere viviendo con cargas familiares(nifios)
Do you use an interpreter?/LNecesita un interprete? 0 Single male with dependent children living with
❑Yes/Si ❑No you/Hombre soltero viviendo con cargas familiares(nifios)
What is your ethnicity or social/cultural background? 0 Two-parent househoid/Hogar con dos padres
Ci all that apply:/LCuil es su origen etnico u origen social/ 0 Other/Otro:
cu' Marque todos los que correspondan:
❑Alaskan Native/indio Alaskefio Are you homeless or in a temporary shelter?
❑Cambodian-Khmer/Camboyano-Khmer /LEsta Ud.sin hogar o vive en un refugio temporal?
❑Chinese/Chino 0 Not homeless/Tengo hogar
❑Fiiipine(Filipino 0 Doubling Up/Compartiendo habitacidn
❑Guam-Chamarro/Guam-Chamarro 0 Street/Calle
❑Hmong%Hmong 0 Transitional/En transition
❑Japanese/Japones 0 Public Housing/Vivienda Piblica
❑Koreanl/Koreano Laotian/Laosiano 0 Shelter/Refugio
❑Mien/Mien 0 Other/Otro:
❑Native American/Indio American
❑Samoan/Samoyano Are you a migrant or seasonal farm worker?4Trabaja Ud.en
❑Somalian/De Somalia el campo por temporadas o es un trabajador itinerante?
❑Not a farm worker/No campesino
❑South Asian/Sudasiitico
El Taiwanese/Tafwanes 0 Migrant farm worker/Campesino itinerante
i 0 Seasonal farm worker/Campesino por temporadas
❑Thal/Tailandes
❑Tongan/De Tonga What is your Primary Medical Insurance?
❑VletnameseNietnamita /ZCu�es su principal aseguranza medica?
❑Other/Otro:
Marital status/Estado civil: How did you hear about this Health Center?
❑Single/Soltero(a) /LCamo supo Ud.de este Centro de Salud?
❑Married/Casado(a)
❑ owedNiudo(a) What is your household's monthly income? (The cash
G_._Jrced/Divorciado(a) flow that you live on)?/LCuinto es el total del ingreso mensual de
❑Legally Separated/Separado(a)Legalmente las personas que viven en su hogar? (El dinero que usan al mes para
Are you a veteran?/LEs Ud.veteran de guerra? vivir.)
❑Yes/Si 0 No $ per month/al mes
Page 40 of 44
i1N70 I act unriatarl•aH cnnnR
COMMUNITY HEALTH CENTERS OF KING COUNTY ' MEDICAL FRONT OFFICE MANUAL
Sliding Scale Eligibility
1. Check patient's sliding scale eligibility status in NextGen.
2. If patient is not currently eligible for the discount, ask if they would like to fill out an application.
Participation is optional.
3. Ask patient to show proof of income for every individual in the household who has income. The
following are acceptable:
a. Payroll check that shows year-to-date income or 1 month's worth of pay stubs.
b. Wage statements (written statement from employer).
c. One month's worth of unemployment check stubs.
d. Bank statement that shows flow of money in/out of account.
e. Statement from Social Security office.
f. Letter from individual who supports patient financially. Must state a dollar amount.
g. Income tax forms (first page only).
h. W-2 form.
i. For business owners, look at profit/loss statement, line 7, on tax form.
4. Photocopy income verification documents. Return originals to the patient.
If the patient does not have proof of income and it is not their first visit:
a. Inform patient that they will be charged full fee for today's services.
b. Instruct patient to bring proof of income on their next visit to qualify for sliding scale.
c. File application form in patient's chart. No further action is necessary on this visit.
b. Once patient has satisfactorily shown proof of income for every income earner in the household,
sign, date, and indicate sliding scale category in gray box at bottom of form.
7. Enter information into NextGen. (Multiply monthly income by 12 to get annual income.)
8. File application in patient's chart under"PT INFO"tab, on top of the registration forms.
•
sliding scale eligibility Last updated:7/16/2007 Page 1 of 4
Page 41 of 44
-race period for new patients
aw patients are eligible to receive a sliding scale discount for their first visit without showing proof
of income, if they fill out an application form. Enter today's date as the expiration date in NextGen.
Inform the patient that a sliding scale discount will not apply to any future visits until they bring proof
of income. Any patient who is new to NextGen may be considered a new patient.
Unable to show proof of Income
If an,applicant presents a reasonable case for why they cannot provide proof of income for
themselves, ask them to compose, sign, and date a statement to that effect. Accept that statement
as proof of Income. If the applicant is unable to show proof of income for another person in their
household, however, they may not claim that individual as part of their household. (Please see
definition of income and household size on next page)
Zero Income
If the patient claims zero income for themselves or other adult members of the household, remind
them of our definition of income and ask screening questions such as"Who supports you?""How do
you pay for your living?"etc. Zero income may only be accepted with a verification letter—without
that letter, they will be full fee.
Accurate effective and expiration dates
It is critical that the verify/effective date and the expiration date are accurate. Entering today's date
or a future expiration date for someone who is unqualified to receive the sliding scale discount may
...stilt in disciplinary action. Also, because the patient accounts department needs accurate historical
formation about the patient's sliding scale eligibility, be sure to create a new sliding scale profile
every time a new application is completed. Do not save new dates on top of the previous profile.
Verification/effective dates should not change. Expiration dates should only change if household size
or income changes. When expiring an outdated eligibility, you would usually set.the expiration date
earlier than yesterday's date. Setting it too far back would confuse appropriate billing of past
encounters.
Other household members, other CHCKC sites
If the discount will be used at other CHCKC sites, or if the discount will be used by more household
members beyond just the applicant, create the eligibility profile in NextGen for every household
member and add a note in each household member's account listing names and birthdates of all the
individuals on the application. Also, distribute copies of the paper information to every chart for
every household member at every clinic.
Paper charts
If there are people in your clinic who refer to the paper chart for eligibility, be sure to update sliding
scale information in the paper chart in all 3 places (patient registration form, sliding scale application,
and patient labels.)
Nothing in the chart
If you wish to refer to a patient's application or income verification and cannot locate them in the
chart, look at the who/when button by the verification date in NextGen, and/or the notes section in
ie account. Either place should give you clues as to where find the documentation. Use the"clinic-
..a-clinic records request"form to request the documents from the other site. Never require a patient
to complete a new application simply because you have not found the application form in their chart.
sliding scale eligibility Last updated:7/16/2007 Page 2 of 4
Page 42 of 44
' -lf-employed
`, ,r brsiness owners, look at profit/loss statement, line 7, on tax form.
Changes to Income or household size: •
If an established patient who is currently receiving sliding scale has a change to their income or
household size, and the new amount does not change their sliding scale category, they do not need
to re' erify income. If the new amount does change which sliding scale category they qualify for,
change their expiration date to today's date and explain to the patient: "Your Income (or household
size) has changed significantly enough to put you in a different sliding scale category. For today's
visit,your charges will be based on the income you verified with us previously. Because of the
change in your household income (or household size),your sliding scale eligibility needs to be
reevaluated. You will need to fill out a new application and verify the new income amount."
Definition of income: "the cash flow on which ou and those in our household live"
ncome Not income
Salary► Child support
Interest from savings Financial assets (stocks, bonds, account
balances)
Dividends from stocks, bonds, mutual funds, etc. Physical assets (Items you would have to sell or
liquidate to convert to income such as a home,
boat, etc.)
Monetary gifts Money drawn from a credit card
Agans, scholarships, or grants for living expenses
mo;ny
Welfare
Unemployment
Grants
Assets that have been converted to cash flow
Money that has been drawn from savings account
Definition of household size
People that live in the same home and depend on the same income, not including foster children.
Household Size for Homeless
For homeless patients, household size should include those people that the patient stays with,
transitions with, and shares income with.
Seasonal workers
To determine monthly income for an individual who works during some months of the year, you may
take their yearly income and divide by 12.
WA State Residents
Patients do not need to be WA State residents to be eligible.
'vcy
he patient feels uncomfortable discussing Income or personal information in the lobby, ask the
patient if they would like to speak in a more private location, like the manager's office, exam room,
sliding scale eligibility Last updated:7/16/2007 Page 3 of 4
Page 43 of 44
he CSR's office. Some clinics regularly have the CSRs spend time with patients who have
culty with the income verification process.
Sliding scale categories are based on Federal Poverty Levels as listed below.
Do n t share the information below with patients:
a. Category A: up to 100% of Federal Poverty Level
b. Category B: up to 125%
c. Category C: up to 150%
• d. Category D: up to 175%
e. Category E: up to 200%
f. Category F: over 200% (no discount)
Dollar amounts for the 2007 category cut offs are listed below.
Do not share this information with patients.
Persons in
Family A B C D E Full
1 10,210 12,763 15,315 17,868 20,420 20,421
2 13,690 17,113 20,535 23,958 27,380 27,381
3 17,170 21,463 25,755 30,048 34,340 34,341
4 20,650 25,813 30,975 36,138 41,300 41,301
5 24,130 30,163 36,195 42,228 48,260 48,261
6 27,610 34,513 41,415 48,318 55,220 55,221
7 31,090 38,863 46,635 54,408 62,180 62,181
8 34,570 43,213. 51,855 60,498 69,140 69,141
9 38,050 47,563 57,075 66,588 76,100 76,101
10 41,530 51,913 62,295 72,678 83,060 83,061
11 45,010 56,263 67,515 78,768 90,020 90,021
12 48,490 60,613 72,735 84,858 96,980 96,981
13 51,970 64,963 77,955 90,948 103,940 103,941
14 55,450 69,313 83,175 97,038 110,900 110,901
sliding scale eligibility last updated:7/16/2007 Page 4 of 4
• Page 44 of 44
11
o ce,
A plication Cover Pages (Agency Information and Questions 1 — 7) I
Agency Information
A ency Name: COI'1 Yh vmil ( ff et To (enters' lb Pin (tva-hi
�P J V
AP licant Name and Address: Agency Director:
Faith Wimberley Thomas Trompeter Chief Executive
Officer
955 Powell Ave SW Ste.A Name and Title
Renton,WA 98057 (425)277-1311 \.
(Area Code)Telephone
fwimberley@chckc.org (425)277-1566
E-mail address(if available) (Area Code)Fax Number
Required signatures: By signing below,you certify that the information in this application is accurate to
the best of your knowledge and that you have read the application, certifications, and appendixes.
(SIG TURES MUST BE IN BLUE INK)
4-15-08 4/802/d/6/1/ 4
Signature of A ency d Presid ate Si natureAgencyDirector/Date
Thomas Trompeter _ ��
Printed Name of Agency Board President Printed Name of .gene_ Dirrectoi t
Program Information
1. Program Name Primary Natural Qdi Gi Vt� l�e'D�► fz�i'` a
Contact Person(available to answer specific questions on this application) -d1dw` �
Faith Wimberley (425)203-0419
Name (Area Code)Telephone
Address(if different than above)
fwimberley@chckc.org (425)277-1566
E-mail address(if available) (Area Code)Fax Number
2. Program is New for our agency ❑An Ongoing Program ® -
3. Brief Description of Program(One sentence)
Community Health Centers of King County's Complementary and Alternative Medical Program delivers high
quality, evidence based, affordable and culturally conscious medical services to patients of South King County.
These services include naturopathic care,natural supplement distribution, and acupuncture care.
4. Where are services provided? (If different from agency location)
Services are provided to anyone regardless of their residency at health centers in Auburn,Federal Way,
Kent,Renton and SeaTac.
Page 1
I 5. Total Program Cost:
Actual 2007: $ 1,126,346 Proposed 2009: $ 1,126,346
Projected 2008: $ 1,015,306
6. Total City Funds Requested for this Program:
City Awarded 2008 Requested 2009*
General Fund CDBG Total Requested**
Auburn 5,200
Federal Way 5,000 6,000
Kent
Renton 5,000 8,500 i
City Awarded 2008 Requested 2009*
General Fund General Fund
Burien
Covington 2,000 4,000
Des Moines 3,000
Enumclaw
SeaTac 2,000
Tukwila 4,000
*Cities on a two year funding cycle will renew 2009 awards to 2010 based upon performance and availability of funds. See
Part II for city specific information.
**Include your total request for Auburn,Federal Way Kent and Renton. The source of funding will be determined by staff.
Page 2
7. Agency Contact Sheet
_'rovide the following information for the agency and for the program requesting funds.
Agency Contacts
General Agency Name: Community Health Centers for King County
Address: 955 Powell Ave SW Ste.A
City/State/Zip: Renton,WA 98057
Phone/Fax: 425-277-1311 425-277-1566
Agency Web Address: www.chckc.org
Ex cutive Director Name: Thomas Trompeter
Title: CEO
Direct Phone: 425-277-1311
E-Mail: ttrompeter@chckc.org
Development Director Name: Faith Wimberley
(or Grant Writer) Title: Resource Manager
Direct Phone: 425-203-0419
E-Mail: fimberley@chckc.org
Finance/Accountant Name: Jody Putman
person preparing invoices) Title: CFO
Direct Phone: 425-277-1311
E-Mail: jputman@chckc.org
Program Contact
(Staff contact for contracting, reporting and program implementation.)
Program Name: Natural Medicine
Staff Name: Faith Wimberley
Title: Resource Manager
Direct Phone: 425-203-0419
E-Mail: fwimberley@chckc.org
Page 3
Application Narrative Section (Questions 8 — 12)
T116 maximum number of pages is listed after each major section. You are not required to submit the
maximum number of pages for each section, but you may not exceed this limit.
8. ORGANIZATIONAL EXPERIENCE (2 page maximum)
A. Experience.
Community Health Centers of King County(CHCKC) is a network of seven medical, four dental, and one
school based health centers that serve families and individuals in south, north and east King County.
CHICKC also provides on-site care in homeless shelters throughout south,north and east King County. In
2008 CHCKC will expand its Federal Way Medical Center and Kent Dental Center.
Medical services provided by CHCKC include the full scope of primary medicine: diagnosis and
treatment of acute and chronic illness and minor injuries; screenings for STDs, cancer, diabetes,
hypertension, and other major illnesses; preventive care for adults and children; referral for specialty
diagnostic evaluations and treatment; and prenatal/obstetric care, including delivery. Our medical support
programs are Natural Medicine,Pharmacy, and Behavioral Health. The Natural Medicine Program is
nat}iropathic care, stress management, nutrition counseling and acupuncture at each center. Behavioral
Health is a stepped care approach to mental health and mood disorder interventions. Dental services
provided by CHCKC include: preventive, operative,periodontal and pediatric care, including limited
prosthetic and oral surgery services. We offer emergent care clinics weekly at each location. Homeless
hea thcare services provided by CHCKC include: nursing and primary care services provided on-site at
rarsitional shelters, emergency shelters, and permanent supportive housing throughout King County as
yell as at a child care center at a transitional housing complex in east King County. Interpretation
se ices are provided for all patients requesting them at no additional cost to the patient.
7
CHCKC has been providing King County with high quality, culturally sensitive,primary health care
services for 30+years, since it's founding as the Valley Pulse Community Clinic in 1971. CHCKC was
formed in response to the unmet health care needs of its target population: low-income uninsured
families and individuals in suburban King County. Those needs continue as does the mission of CHCKC:
"T provide complete primary health care services to the people in our communities, with special
atte tion to the needs of the medically under-served populations of King County. Our services encompass
not only treatment and prevention of illness but also health education,behavioral health service, outreach,
int rpretation and a variety of other services that our patients want and need."
As the only federally qualified health center network serving communities in Suburban King County,
CHCKC has come to be recognized and depended upon for delivery of health care. CHCKC has
demonstrated its capabilities in meeting the needs of its target populations. The organization's track
rec o rd is evidence of its expertise in managing scarce resources efficiently.
B. Operational Structure.
Lis ed below are the key staff responsible for the agency and its programs.
Se 'or leaders of the organization are:
Chief Executive Officer Thomas Trompeter, MPA
Medical Director Judith Featherstone, MD
Dental Director John Caron, DMD
Chief Operating Officer Debbie Wilkinson
Chief Financial Officer Jody Putman
Page 4
Mr. Trompeter has worked at CHCKC for 11 years—the last 7 years as Chief Executive Officer. He has
over twenty-five years of experience working with community health centers.
Dr. Featherstone has been with CHCKC for 16 years—the last 6 as Medical Director. Dr. Featherstone
has been a practicing family practice/OB physician for 17 years.
Dr. Caron, DMD, CHCKC's Dental Director has over 27 years of experience running a dental program.
Dr. Caron served 16 years in the United States Navy as a Dental Specialist in Public Health, 7 years as the
Chief of Dental Operations for Public Health—Seattle and King County, and 7 years as the Dental
Director at Community Health Centers of King County.
Ms1 Wilkinson has worked at CHCKC for the last 5 years as Chief Operating Officer. Prior to joining
CHCKC she was the Director of Community Support Services at Highline Community Hospital/Highline
Me' ical Enterprise for 16 years.
Ms Putman is a Certified Public Accountant with over 18 years in financial leadership of various
organizations. Ms. Putman joined CHCKC three years ago as the Chief Financial Officer.
Program Directors responsible for the operations of their program are:
Director of Medical Operations Jeanne Ziltener
Dental Programs Manager Pamela Gorsuch
Lead Naturopathic Physician Cindy Breed,ND
Director of Health Systems (Community Programs) Terri Calnan, LP
-2iriidy Breed,ND leads our Natural Medicine Program. Natural Medicine is referred to within the
ind stry as Complementary and Alternative Medicine. She was one of the original naturopathic medicine
providers who, 10 years ago,began integrating natural medicine into services at the Kent Community
Health Center. She is ushered the program through to its current state where natural medicine services are
int grated and available at every one of our health center locations.
Th CHCKC Board of Directors strives to maintain a highly trained and effective Board that is
knowledgeable regarding its role,responsibilities, CHCKC programs, and the broader environment within
which CHCKC operates. The CHCKC Board of Directors is comprised of community members, 64% of
whom are patients of the health centers. The Board strives to recruit consumer directors who are
representative of the individuals being served by CHCKC in terms demographic factors such as age, sex,
racg/ethnicity and geographic location, and there is a Board Development Committee that actively
reviews this information. Members of the Board of Directors serve as volunteers in support of the
organization's stated mission, goals and work plan. The board is a"working board" and meets on a
monthly basis. The board is responsible for establishing policies, approving budgets and programs, and
monitoring operations of the organization. The Board of Directors recruits and hires the CEO.
Th Board stays connected and informed about the needs in South King County by including consumers
as board members and by actively attending school, city and community sponsored events, and through
civc organizations such as Rotary and the Chamber of Commerce. The Board also hosts open houses and
special events at each of the health centers so that members of the community can learn more about the
services CHCKC provides.
9. NEED FOR YOUR PROGRAM(2 page maximum)
Page 5
A. Problem Statement.
The target population served by Community Health Centers of King County is the poor, marginalized,
ander- or un-insured residents of Suburban King County. The problem is that the below mentioned
barriers impede their ability to receive timely, culturally aware, cost appropriate and high quality
healthcare. These populations face disproportionately high barriers to accessing care and are therefore in
poorer health than other residents of King County. According to 2000 Census data there are significant
lov4-income populations in south King County communities. The proportion of persons living with
incomes below 200% of the Federal Poverty Level FPL range from 11% in Covington to 28% of Auburn
residents. The following shows the percentage of residents with income levels below 200% of FPL:
Auburn 28%
Covington 11%
Des Moines 16%
Federal Way 21%
Kent 23%
Renton 21%
SeaTac 23%
Tukwila 27%
Listed Cities 22%
King County 19%
Washington 26%
In addition, according to the State of Washington Office of Superintendent of Public Instruction Free and
Reuced-Price Meal Eligibility by School District for October 31, 2003, a group of south King County
school districts has a higher percentage of students requiring services than King County and the State of
Washington. The family income standard for the free lunch program is below 130% of FPL and for
reduced lunch is between 131 and 185% of FPL. The following shows the percentage of children eligible
for free or reduced lunches for certain south King County school districts compared to the county and the
sta e:
Auburn School District 42%
Federal Way School District 27%
Highline School District 55%
Kent School District 32%
Renton School District 43%
Tukwila School District 62%
Listed School Districts 42%
King County 27%
Washington 37%
The 2005 A Matter of Need publication by The South King Council of Human Services reports findings
consistent with the above data stating that "South King County has the highest number of families living
below the poverty level and the largest number of single-parent households. More people are on food
stamps and in the State's Aid to Needy Families program than in any other part of the county."
Acording to this same report, "South County has more than twice the number of public school students
enrolled in the federal Free and Reduced Price Lunch Program as Seattle, and more than three times as
many as East and North King County combined."
Page 6
In ublic Health's—Social and Health Indicators across King County 2005 Communities Count Report,
the percentage of Adults without health insurance continued to rise. This data was furthered analyzed in
'he Health of King County 2006 which stated"access to health care declined notably in the past five
years with 15.5%being a record proportion of the population lacking health insurance. The South Region
exrierienced an increasing trend in the percent of residents uninsured for both the 10 year period 1995-
2004 and from 2000-2004. In 2002 the South Region surpassed Seattle with the highest percent of
uninsured.
This has led to increasing numbers of residents reporting unmet medical needs due to cost and 16,000
hospitalizations per year for avoidable conditions. Limited access to care translates into poorer health
outcomes as opportunities for prevention and effective management of diseases are lost." "Within King
County the South Region has the highest average adult uninsured rate at 18%." Also according to this
report the region of the county experiencing the poorest health has expanded south. "The South
Seattle/South County area experiences lower health status and more limited access to health care than
other regions." Poor health causes residents to miss school,miss days at work, and in general reduced
theI_r daily function with in turn contributes to poverty and a poor quality of life.
Fu hermore, it has been hypothesized that natural medicine has the potential to reduce frequency of many
dis ases and improve quality and duration of life in populations who have access to this comprehensive
system of complementary and alternative natural medicine. As our target population consists of a large
perentage of immigrants,refugees and diverse race and ethnic groups. Many of these patients are people
whbhave recently arrived in this country and who culturally are often more accustomed to receiving
natural medicine health care services. Often, a barrier to care will be a patients distrust or unfamiliarity
will western medicine. 60% of surveyed CHCKC patients have expressed an interest in receiving natural
nedicine services. Medicaid, Medicare, Basic Health Plan and many third-party insurers do not cover
natural medicine services. This lack of coverage makes natural medicine services unaffordable for many
low1- and moderate-income patients. Our Natural Medicine program is often more familiar and aligned
with patients traditional medicine practices.
B. 1 arget Population.
C CKC's Natural Medicine program target population are the uninsured or underinsured families and
ind viduals in Suburban King County who have difficulty accessing primary medical care services
through traditional private provider systems due to financial, cultural, language or other barriers to care.
In 2008, CHCKC will serve over 2,400 patients for approximately 6,000 natural medicine visits. Ninety
percent (90%) of these patients reside in King County. Seventy-six percent(40%) of these patients are
female. The largest ethnic group is Caucasian at 48%, followed by Hispanic at 27%. The remaining
group is made up of almost equal parts, Russian, Asian,Black and other. Many patients have Medicaid
coverage, however over 34% of our patients remain uninsured. Less than 5% of our patients have third-
pary insurance. Approximately 60% of our patients survive on less than 30% of the Median Income.
South King County clients come from all the cities in South County with the majority residing in Auburn,
Federal Way, Kent, and Renton. Over the past few years, there have been significant increases in the
number of individuals accessing care from the cities or Burien, Covington and SeaTac.
Page 7
10. PROPOSED PROGRAM/SERVICE
A. Program Description.
C CKC's mission is based on a health promotion/disease prevention model. Low-income,uninsured and
underinsured south King County residents will have access to quality primary care services at rates
determined by family size and income. Natural medicine services are designed to empower patients to
assume greater control of their health care by becoming more informed about alternative evidence based
treatment models and skills to make healthy lifestyle choices. This kind of primary care addresses the
whole patient in his/her social context. Together, integrated natural and conventional medicine services
will significantly increase patients' abilities to choose appropriate therapies and to lead healthier lives.
C CKC gives patients the choice of allopathic care (MDs), naturopathic care (NDs) or a combination.
C CKC's natural medicine and primary medical care providers work together and consult with each
oth r often to determine best treatment options for patients. CHCKC does not deny care for services
based on ones inability to pay.
N9ural medicine providers (ND's) are trained and licensed. The schooling for a naturopathic doctor
requires four years of schooling and an internship similar to the level of school one would require to
obtain an MD.
The Natural Medicine program has a natural medicine provider team providing naturopathic, acupuncture,
malsage therapy, and whole foods nutrition services on-site at all five South King County health centers
(A burn, Federal Way, Kent, Renton, SeaTac). Chiropractic services are provided by referral off-site.
Services are provided by appointment during the clinics open hours. A complete schedule is noted in the
`able below. After hours,patients may call in and the answering service will contact a triage nurse with
Lily clinical needs. The triage nurse speaks to the patient and if needed calls in the physician on-call.
CHCKC strives to see each patient within one week of the request and is usually able to accommodate
clie is within two days.
Na , ral Medicine Schedule by Site:
Auburn CHC Federal Way Kent CHC Renton CHC SeaTac CHC
Naturopathic 12n—8p Acupuncture Naturopathic
Monday 9a—5p 9a—5p
Nutritionist
9a—5p
Nutritionist Acupuncture Naturopathic 9a—5p Nutrition
Tuesday l0a—6p 9a—5p Acupuncture 9a—5p 9a—5p
Acupuncture Nutrition Naturopathic 9a—5p
Wednesday 9a—5p 9a—5p Nutritionist 9a—5p
Naturopathic Naturopathic 9a—5p Naturopathic
Thursday 9a—5p Acupuncture 9a—2p 9a—5p
Firiday Naturopathic Naturopathic 9a—5p Acupuncture
9a—5p 9a—5p
The Federal Way CHC clinic schedule is a reasonable and likely example. Currently, the FW CHC is under
construction to accommodate space for Natural Medicine service delivery. Construction will be completed by the
end of Q2 2008.
Page 8
Community Health Centers of King County strives to provide culturally relevant and language
1ppropriate services to our clients and potential clients. CHCKC advertises in local ethnic and English
anguage publications. CHCKC's brochures and marketing materials are translated into Korean, Spanish,
Russian and Vietnamese and can be found at community centers, libraries, public health offices, hospital
urgent care centers and other non-profit social service agencies. CHCKC's Board of Directors has been
hosIts open houses and special events at each of the six community health centers so that members of the
community can learn more about the services provided by CHCKC. As a testament to our ability to
welcome and address the needs of the immigrant/refugee community, on average, ethnic/racial minorities
receive care at the health centers an average of 3 times annually when the Caucasian community only
rec?ives care, 2.2 times per year on average. Surely the fact that this community is more responsive and
ready to receive care and follow-up care demonstrates CHCKC's commitment and effectiveness in
affectively reaching this community.
In 2007, CHCKC expanded its natural medicine services to all sites so that all medical clinics have natural
medicine components available to patients. The plan also included making more natural medicine service
available at each of CHCKC's medical clinics, like acupuncture. CHCKC will continue to strive to
continue this integration as providers and patients reportedly find improved outcomes from the
collaboration.
The Natural Medicine program currently collaborates with Bastyr University by serving as a remote
training site for Bastyr's residency program. The residency students receive exposure to community
medicine and support the work of our natural medicine providers during clinic hours
B. Performance Measures and Outcomes.
Performance Measure: Number of South King County residents who receive natural
medical services in 2009 and 2010.
Outcome: Increased access to primary care and preventive health services within south King
County communities
Indicator: 60% of natural medical patients will receive age appropriate Well Child Checks
(or physicals).
Performance Measure: Number of medical patients who receive integrated naturopathic
care.
Outcome: Improved health among the culturally diverse members of south King County
communities including low income, uninsured and homeless families and individuals living in
south King County
Indicator: 30% of medical patients will receive nutrition services.
C. Staffing Plan & Evaluation. (1 page maximum)
i. Staffing Plan.
;erivices are provided by licensed Naturopaths, Acupuncturists, and Nutritionists. CHCKC employs 2.4
TE Naturopaths, 1.5 FTE Acupuncturist and 1.5 FTE Nutritionist. Cindy Breed, the programs lead,
delivers services at a .8 FTE and then oversees the program at a .2 FTE. In addition to its quality clinical
Page 9
sta f, CHCKC provides other services for clients including client service representatives who are
,--es onsible for helping patients acquire and retain health care coverage such as Medicaid or Basic Health.
e erral coordinators work to help patients needing specialty or diagnostic services. CHCKC provides
ref rrals for specialty services with a conscious effort to get services provided on a sliding-scale or pro
bo o basis. Each clinic has at least one interpreter on staff to help with the many clients with limited
En lish speaking ability. CHCKC contracts with interpretation agencies for clients speaking languages
for which staffs are not fluent. These additional services are available at no additional cost to the client
ii. Evaluation.
C CKC continuously monitors its primary medical care program and its targeted outcomes including
those listed in section III,part B as well as others that are part of the medical care program's Health Care
Plai. Comprehensive regular reporting on the agency's Health Care Plan is submitted to The Bureau of
Prifnary Health Care in conjunction with Federal grant support. In addition the Washington State Health
C e Authority monitors and conducts annual reviews of CHCKC's programs and outcomes. Clinical
me sures are tracked, analyzed and reported on a regular basis. Also a sample of clients is surveyed on a
re ; lar basis about their satisfaction with the services they are receiving. Service or clinical changes or
im rovement initiatives are undertaken based on those outcomes results.
Re ults are monitored at the health center level as well as for the agency as a whole. The leadership of the
or anization and program managers monthly and quarterly reviews key outcome measures and make
regular reports to the Board of Directors. The board includes consumers who also receive this
inf rmation. In addition an annual report is published that summarizes key accomplishments and
me sures of success.
). Differences in Service Delivery by City.
J service delivery model is standardized across cities. As our health centers are located in Auburn,
Fe eral Way, Kent, Renton and SeaTac, residents of the other cities must travel beyond their city borders
to eceive care. This is the only difference between cities.
Ple se note that in Table 14 the cost per patient varies slightly due to rounding of figures. In actuality the
cos per patient is the same across South King County.
11. LONG RANGE PLAN
CHCKC's Leadership Team and Board of Directors meet annually to update our Strategic Plan and long
range objectives. Our long range planning is focused in three areas:
r
Page 10
1.) To be the Provider of Choice in the communities we serve,
2.) To be the Employer of Choice within our field,
( 3.) To be Financially Strong and Positioned for the Future.
To any out the three prongs or our long range planning, we are continually improving our service model,
ex anding our sites and services, and redesigning our staffing plans. An example of this innovation is the
Na ral Medicine program; this is the first natural medicine program available through community health
in the state and one of the first in the nation. One of the new projects we will launch in 2009 will be an
endowment fund to help support the uncompensated care we deliver within our Natural Medicine
proram. Due to the continued growth in need in South King County, CHCKC has plans to expand its
nat.xral and medical care clinics over the next 5 years, including expansions of health centers in Renton
and Federal Way to increase capacity to better meet the needs of the growing underserved in those areas.
As Mentioned in the 2007 to 2008 application, significant expansions are underway at the Kent, Federal
Way, and SeaTac locations.
South King County municipal support is important to the primary medical care program. Funding from
1o41 municipalities helps show community support for our health care programs when seeking Federal,
State and private funding. This funding allows CHCKC to provide medical care on a sliding fee to its
uninsured and underinsured south King County patients. It is anticipated that funding will continue to
come from local, State and Federal sources, as well as private and public payors. CHCKC is experiencing
a d crease in its insurance reimbursement rates so, now more than ever, grant funding is critical to our
se ices to all patients.
12. BUDGET(2 page maximum)
Ch budget section of your application pertains to the information provided in Question 17 of your
Li) I lication.
A. Budget Request Narrative.
In p rder to meet the growing demand for health services in the South King County area, CHCKC is
ex anding the capacity to serve patients with the opening of new health centers and the addition of staff.
Wi h the uncompensated cost per Natural Medicine visit at$232.66, this funding is vital to continue to
exirand our ability to see the growing number of low-income and uninsured patients in South King
Co znty. Requested funding will help support the uncompensated cost of each visit that includes:
Salaries paid to providers and support staff $ 180.45
Pa 'ent interpretation services, lab fees and other services $ 2.13
Pa 'ent supplies $ 3.20
Cost of medical facilities $ 46.87
TOTAL $ 232.66
B. Changes to Budget.
Th re are no significant variations from prior funding cycles to the 2009 2010 cycle.
C. Cost per Service Unit(s).
f �o t Per Service Unit(patient visit): $ 232.66
Ex lanation of how determined:
Page 11
The uncompensated cost of each natural medicine visit delivered in our South King County clinics for
Na ural medicine care is $232.66. This was determined by the average cost of a Natural medicine visit
$3p5.18) less the average patient(or third party)responsibility portion of the cost of the visit. On
avejrage,patients come to the CHCKC health centers for Natural medicine care about 2.4 times per year.
Based on this average, the uncompensated cost per client or patient is $558.38. CHCKC uses a sliding
scale fee for all uninsured patients based on the Federal poverty level standards. This gives greater ability
for low-income patients to access Natural medicine care.
Page 12
Agency: Community Health Centers
of King County
D to Table Requirements (Questions 13 — 18)
Program:Natural Medicine Program
13. NUMBER Of INDIVIDUALS/HOUSEHOLDS SERVED BY PROGRAM
171 Individuals? or n Households? (Check which applies and use for reporting all demographics.)
Unduplicated
*Unduplicated Number of all Clients Served by Clients Served
All Funding Sources with Funds
Requested
2007 2009
2007 % of column 1 2008 2009
(Actual) clients served (Anticipated) (Projected) (City Requested
by City Funding Only)
Auburn 198 9% 208 228 9
But1ien 22 1% 23 25
Cos ington 14 1% 15 16 7
Des Moines 56 3% 59 64 5
Enumclaw 0 0% 0 0
. I
_ederal Way 94 4% 199 108 11
Kent 675 32% 709 777
Renton 164 8% 172 189 12
I
SeaTac 36 2% 38 41 4
Sea Ittle 110 5% 115 127
Tulrila 11 1% 12 13 7
Other 749 35% 786 863 .
Total 2129 100% 2335 2452 52
*Unduplicated means count each client only once per calendar year per program. This number should match the number
of clients by city indicated in the top row of Question 15.
Page 13
Agency: Community Health Centers
of King County
14. Performance Measures (Data Table) Program:Natural Medicine Program
14a. Service with 2009 Requested Funds
Proposed Performance Measures as defined below.
A)Natural Medicine B) C)
Visits
Auburn 22
Burien 0
Coiington 17
Des Moines 12
Enumclaw 0
Fedl ral Way 26
Kent 0
Teuton 22
SeaTac 10
Seattle
II _
Tul�wila 17
14b. Performance Measures 2009 Proposed with funds requested City Funding Only
I
Title: Brief explanation:
Patients of the Natural Medicine or(Complementary and Alternative
A)Natural Medicine Visits Medicine) Program return for care on average, 2.4 times per year for
preventive, chronic,urgent and acute alternative medical treatments.
B)
C)
Page 14
Agency: Community Health Centers
of King County
I Performance Measures (Data Table), Cont. Program:Natural Medicine Program
14c. Average Cost of Service
Unduplicated Clients
Served with Funds Average Cost of Service
Requested 2009 Requested 2009 per Client
(Same as last column of (Same as last column of
Question 6) Question 13) Column 1 divided by Column 2
Example: $5,000 45 $111.11
Auburn 5,200 9.3 558.38
Burien - - -
Covington 4,000 7.2 558.38
Des Moines 3,000 5.4 558.38
Enumclaw - - -
I
Federal Way 6,000 10.7 558.38
Kent - - -
Rei1ton 8,500 12.2 558.38
Sea 'ac 2,000 3.6 558.38
Seattle - - -
Tukwila 4,000 7.2 558.38
Page 15
Agency: Community Health Centers
Complete Question 15 with 2007 Actual numbers reported in column 1 of Question 13. of King County
15. Demographics (from all funding sources) (Data Table) Program:Natural Medicine
o d
Client Residence o g o
a) H O
- a) a. 5) �
al U Q W w rn cn H H
Unduplicated
(check one) o
1®Individuals rn N d- o
1-1
!❑Households
Served in 2007*
Household Income Level
30%of Median or Below 125 13 6 33 58 371 96 24 70 8 793
50%of Median or Below 22 2 4 5 14 110 17 4 8 2 188
80%of Median or Below 11 7 1 2 2 21 7 1 5 0 57
Above 80%of Median 28 0 2 13 16 146 40 5 19 1 270
Unknown 12 0 1 3 4 27 4 2 8 0 57
• 1 TOTAL 198 22 14 56 94 675 164 36 110 11 1380
Gender
Male 47 8 6 12 29 183 35 10 42 2 374
Female 151 14 8 44 65 492 129 26 68 9 1006
TOTAL 198 22 14 56 94 675 164 36 110 11 1380
Age
1 0-4 years 6 0 1 5 6 34 7 1 2 0 62
5- 12 years 10 0 1 2 10 58 3 2 3 0 89
13- 17 years 12 0 2 2 3 55 3 2 2 1 82
1 18-34 years 47 5 5 14 15 198 37 12 22 3 358
35-54 years 91 14 4 19 42 227 74 12 48 6 537
55-74 years 31 3 1 11 17 94 37 7 31 1 233
75+years 1 0 0 3 1 9 3 0 2 0 19
Unknown 0 0 0 0 0 0 0 0 0 0 0
TOTAL 198 22 14 56 94 675 164 36 110 11 1380
Ethnicity
Asian 20 1 1 3 8 80 9 r 8 6 0 136
Black/African American 13 3 3 6 10 74 24 5 14 2 154
Hispanic/Latino(a) 35 4 2 14 25 180 34 4 15 3 316
Native 1 1 0 0 1 3 2 1 1 0 10
American/Alaskan
Pacific Islander 2 0 0 2 0 14 1 0 0 0 21
White/Caucasian 118 9 7 26 46 283 86 16 63 5 659
Other/Multi-Ethnic 9 4 1 5 4 41 8 2 11 1 86
1 TOTAL 198 22 14 56 94 675 164 ' 36 110 11 1380
Female Headed 43 3 5 11 20 133 21 7 12 2 257
Household
Disabling Condition 16 7 1 3 9 49 22 2 21 2 132
Liniited English
;3pe� king 27 1 0 9 13 160 22 1 10 2 245
Ia
*Check Individual or Household,which should be the same as checked in Question 13. Unduplicated means count each client only once per calendar year.
This�should match the number served by City in the Actual 2007 column of Question 13. The"total"column will be different from Question 13 since the
"oth r"column is not included due to space limitations.
Page 16
Agency: Community Health Centers
of King County
- l '. PROGRAM STAFF (DATA TABLE)
Program:Natural Medicine Program
2007 2008 2009
(Actual) (Budgeted) (Projected)
Total Number of Staff(FTEs) 6.40 7.20 7.20
Number of Volunteer(FTEs) 0 0 0
Actual Number of Volunteers 0 0 0
I
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Page 17
Agency: Community Health
Centers of King County
Program:Natural Medicine Program
17. PROGRAM REVENUE & EXPENSE BUDGETS (DATA TABLE)
Revenue Source 2007 2008 2009
(Actual) (Budgeted) (Projected/
Requested)
City Funding (General Fund & CDBG)
• Auburn 5,200
• Burien
• Covington 2,000 2,000 4,000
• Des Moines 3,000
• Enumclaw
• Federal Way 5,000 5,000 6,000
• Kent 15,000
• Renton 5,000 5,000 8,500
• SeaTac 2,000
• Seattle
• Tukwila 4,000
• Other(North King County Cities) 5,100 11,350 25,259
• Other(Specify)
Other Government Funds
• King County
• Washington State
• Federal Government(Specify) 124,172 106,427 106,427
• Other(Specify)
Private Sources
• United Way(grants & designated donors)
• Foundations and Corporations
• Contributions (e.g., Events, Mailings)
• Program Service Fees (User Fees) 186,579 189,187 191,832
• Other(Specify) 798,495 696,342 644,088
TOTAL PROGRAM BUDGET 1,127,346 1,016,306 1,015,306
Page 18
Agency: Community Health Centers
17. PROGRAM EXPENSE BUDGET, CONT. of King County
DATA TABLE) Program:Natural Medicine Program
Expenses 2007 2008 2009
(Actual) (Budgeted) (Projected)
Pi rsonnel Costs
• Salaries 530,784 504,703 504,703
• Benefits 132,788 114,034 114,034
• Other 6,946 0 0
• Total Personnel 670,518 618,737 618,737
Operating and Supplies - ,
• Office/Program Supplies 59,943 11,947 11,947
• Rent and Utilities 54,184 61,707 61,707
• Repair and Maintenance 13,796 16,692 16,692
• Insurance 9,925 10,382 10,392
• Postage and Shipping 2,056 396 396
• Printing and Advertising 274 250 250
• Telephone 5,058 4,523 4,523
• Equipment 13,622 11,206 11,206
• Conference/Travel/Training/Mileage 2,167 11,628 11,628
• Dues and Fees 559 0 0
• Professional Fees/Contracts 1,471 2,080 2,080
• Direct Asst. to Individuals
• Administrative Costs 226,904 217,315 217,315
• Other (specify) 18,588 19,337 19,337
■ 47,107 29,096 29,096
■
■ 173 0 0
■
TOTAL PROGRAM EXPENSES 1,126,346 1,015,306 1,015,306
lSIel t Profit(Loss) 0 0 0
1 (revenue-expenses) =
Page 19
Agency: Community Health Centers
of King County
18. SUBCONTRACTS (DATA TABLE) Program:Natural Medicine
List all the agencies you will be subcontracting with for this program. Provide the agency name in the first
column, a description of the contract/service in the second column, and the contract amount in the third
column. Do not list agencies you coordinate with on a referral only basis. Indicate not applicable if
you do not subcontract for any part of this program.
Subcontracting Agency Specific Subcontracted Activities Contract
in the Operation of Your Program Amount
Ba4yr University Bastyr University Interns and Residency Students partner -
with CHCKC Natural Medicine Providers to have on-site
and interactive learning as well as exposure to the field of
community health care
•
Page 20
19. APPLICATION CHECKLIST
applications missing one or more of the following components or not following these directions may not
le 'reviewed. Sign and submit the application checklist with your application.
Contents (Your application should contain each of these items in this order.)
1
r Application Cover Pages.The top three pages of your application must be a completed copy of the
Agency Information and Questions 1-7.
Application Narrative:
Question 8 Organizational Experience(2 page maximum)
Question 9 Need for Your Program(2 page maximum)
Question 10 Proposed Program/Service(6 page maximum)
Question 11 Long Range Plan(1 page maximum)
Question 12 Budget(2 page maximum)
Data T1 les
Question 13 Number of Individuals/Households Served
Question 14a-c Performance Measures and Average Cost of Service
Question 15 Demographics(from all funding sources)
Question 16 Program Staff
Question 17 Program Revenue&Expense Budgets
❑ Question 18 Subcontracts
Required documentation. Supply one copy of the following required documents with the signed original
ap lication. See Part II: City Specific Supplemental Information to determine whether additional copies of the
application and required documentation need to be submitted.
Question 19 Required Documentation, including:
■ Proof of non-profit status
• Organizational Chart
■ Agency/Organization Mission Statement
• Board resolution authorizing submittal of the application(may be submitted up to 60 days after
application).
• List of the current governing board and local board, if applicable, (include name,position/title,
city residence, length of time on the Board, and expiration of terms. Note any vacancies.)
• Board Meeting Minutes of last three board meetings of governing board and local board as
applicable
• Annual Budget
• Financial Audit Cover Letter
• Financial Audit Management Letter
• Financial Statement
• Verification of Non-Discrimination Policy
• Program Intake Form
• Sliding Fee Scale
3 Application Check List. (Signed below.)
City Specific Supplemental Information.Required in Name: Faith Wimberley
Part II for applicable City only. Position: Resource Development Manager
Phone#: _425-203-0419
ii0c
Vvlt �i(/1 E-mail: fwimberley@chckc.org
1 ' —
"'gnature of Person Completing Checklist
- '.i.)O NOT SUBMIT ANY OTHER MATERIALS WITH THIS APPLICATION
Make sure that you carefully check Part II of this application
Page 21
to see what additional attachments each city requires.
( Community Health Centers of King County
City or Renton Application for 2009—2010 Funding
Supplemental Questions -Natural
April 30th, 2008
City of Renton Result that best correlates to our Natural Medicine Program:
Result#6 All residents are healthy and safe.
Strategy A: Improve community fitness and willingness to access healthcare.
Strategy B: Reduce barriers to care by offering natural medicine services in conjunction with our
western medicine (Primary Medical)program as well as interpretation and transportation for
natural medicine appointments at our Renton Health Center.
As noted in our application, and again here as evidence/research to the correlation of our strategy
and the desired result:
It has been hypothesized that natural medicine has the potential to reduce frequency
of many diseases and improve quality and duration of life in populations who have
access to this comprehensive system of complementary and alternative natural
medicine. As our target population consists of a large percentage of immigrants,
refugees and diverse race and ethnic groups. Many of these patients are people who
have recently arrived in this country and who culturally are often more accustomed to
receiving natural medicine health care services. Often, a barrier to care will be a
patients distrust or unfamiliarity with western medicine. 60% of surveyed CHCKC
patients have expressed an interest in receiving natural medicine services.
CHCKC Outcomes as reported on page 9 of the application:
Outcome#1: Increased access to primary care and preventive health services within the Renton
community.
Outcome#2: Improved health among the culturally diverse members of south King County
communities including low income, uninsured and homeless families and individuals living in
south King County
Community Health Centers of King County
Required Documentation Page Number
Proof of non-profit status 1
Organizational chart 3
Agency/Organization Mission Statement 4
Board resolution 5
Current governing board list 6
Board Meeting Minutes 8
Annual Budget 18
Financial Audit Cover Letter 19
Financial Audit Management Letter N/A
Financial Statement 20
Verification of non-discriminatory policy 37
Program intake form 39
Sliding fee scale 41
' "
Internal Revenue Service Department of the Treasury
District 915 Second Ave.,Seattle,Wash.981T4
_.. Director
Person to Contact:
s' South King County Community EO Desk Officer
Health Centers Telephone Number:
1025 South Third (206) 442-5106
Renton, Washington 98055 ReferReply to:
• D3-IV:MS 550
Date:
JUN 11 1987
• Dear Sir or Madam:
This is in reply to your inquiry of June 11, 1987, regarding
•
your exempt status.
Our records show that your organization is exempt from
Federal income tax under Section 501(c)(3) of the Internal
Revenue Code.
This exemption was granted in June of 1982, and remains in
effect.
•
Also, our records in
dicate that you are not a private foun-
dation, because you are an organization described in Sections
509(a)(1) and 170(b)(1)(A)(iii) of the Code.
As of January 1, 1984, you are liable for taxes under the Federal
Insurance Contributions Act (social security taxes) on
remuneration of $100 or more you pay to each of your employees
during a calendar year. You are not liable for the tax imposed
under the Federal Unemployment Tax Act (FUTA).
Sincerely,
gL. •:
Edna G. Bonnist
Exempt Organizations
•
Croup Manager
•
•
•
Page 1 of 44
r
•
Internal Revenue Service Department of the Treasury
District Director
aeta SEP 1 3 1988 Employment tdsnUttcauon Number.
91-088402
Pinson to gonVISt
EOMF COORDINATOR
Contact Telephone Number.
COMMUNITY HEALTH CENTERS OF KING COUNTY InterhitlRe�ue CodelJOsottlotu 5o104(3 J
699 Strander Blvd., Suite D
Tukwila, WA 98188
Thank you for submitting the information Shore below or on the enclosure. We have
made it a part of your file.
The changes indicated do not adversely affect your exempt status and the exemption
letter issued to you continues in effect.
Please lot us know about any future change in the character, purpose, method of
operation, name or address of your organization. This is a requirement for retaining your ';
exempt atatuo.
•
Thank you for your 000peratioa.
Sincerely yours,
Item Changed From To
NAME & ADDRESS CHANGE . South King County Community SEE ABOVE
Health Centers
1025 South Third
Renton, WA 98055
•
P.O.Box 2350,Los Angeles,CA 90053 Letter 970(00)(Rev. 1--57)
t_
Page 2 of 44 '�
•
Community Health Centers of King County
M inn wllIIIIME it .wiw.i barn .. ' .• •
3IMUIUII
HCAL^H
Board of Directors ;1;.
Iii
•
C1NTaaa
r
Thomas Trompeter,MPA ' r strative
Chief Executive Officer Admin.Services Mgr! Servbes Team
Safety Officer
Iik
t ._;xesaam.F'�„a5gc,:a.d
�'"'� Meredith Vaughan
Judy Featherstone,MD • John Caron,DMD Jody Putman,CPA Debbie Wilkinson ding IL Development
Medical Director ` Dental Director ChiefFinane�l Officer Chief Operations Officer Director
�_ 1 6i
Jeanne Diener Pamela Gorsuch
Lead Physicians Dentists RebeccaMedical Operations — Dental Operations mr ControlierCorartrity MarketRelations
Director Director — Menage?
Lead Naturopathte LeAnne Settler David Rose Moselle Horluchl
Human Resouoes
Doctor Patient Accounts Pharmacy Director Director — Grant Manager
Manager
Clinical Programs Jo Abraham Terri Gorman
Team IS Director — Health Systems
Director
Medical Staff Operations Team
Coordinator
CO •
•
13
, .,. ..mwF:/cr;>nnnl nx,,..a..:nre.I,..:........ Page 1
CD
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0
NIISSION STATEMENT
Our mission is to provide complete primary health care services to the people in our communities
with special attention to the needs of the medically underserved populations of King County. Our
services encompass not only treatment and prevention and illness but the health education,
behavioral health services outreach interpretation and a variety of other services that our patients
want and need.
VISION STATEMENT
We are the provider of choice for quality health care services in the communities we
serve.
GUIDING PRINCIPLES
CHCKC is an environment that encourages creativity and responsibility,
respect and a strong sense of being valued.
We are a work community embracing diversity,respect, creativity and support.
We provide a productive and creative work environment that provides
value for our patients and our organization.
We provide flexible,supportive and inclusive leadership and are responsive to each
other's needs.
CHCKC offers patient-centered and accessible healthcare—all patients are treated with
care,compassion and understanding.
We treat our patients with dignity and offer education on choices of medicine so they can
gain access and make informed choices in their healthcare.
Page 4 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
BOARD OF DIRECTORS RESOLUTION#08-001
WHEREAS,Community Health Centers of King County(CHCKC)has applied for
grants to various funding sources to support its mission of providing quality medical and
dental care to the underserved,
THEREFORE BE IT RESOLVED that the Board of Directors approves applying for
grants for funding for the year 2009.
RESOLUTION PASSED without modification.
RESOLUTION PASSED with noted modification(s).
RESOLUTION DID NOT PASS.
(e/06
Victoria Gp_ Date
Board C .1 r
•
«woardkos02-003(yIw) Page 5 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
955 Powell St.SW,Suite A
Renton,WA 98057-2908
(425)277-1311 FAX:(425)277-1566
BOARD OF DIRECTORS—2008
Rev.April 15,2008
CONFIDENTIAL
NAME,ADDRESS,PHONE OCCUPATION Consumer? Officer TERM
&/or Committee EXPIRES
.Tho}nas(Tom)Cross President and CEO Member-At-Large 2008
11023 Marine View Dr.S.W. - Executive
SeaOle,WA 98146
H:(206)243-1420 e-mail:tonw@stanbrooke.com
stanbrooke.com
Best Contact#(206)427-5222
Member since 10/1995
Laurence M.DeShields II Patient Navigator CHCKC Chair,Strategic 2009
36521 25th Ave.S. Fax:(253)874-6861 Consumer Planning
Federal Way,WA 98003-9104 email: Finance
H:253-838.0560 /ao490co„rcast.net ,
Member since 6/1998
Robert Ellis CHCKC Audit 2008
401-37th Street SE,Sp. 121 Retired Consumer Quality
Aublium,WA 98002 Email:rrellis33@.aoLcom
H:253-735-1192
Member since 5/2000
Luis H.Garcia,Sr. Retired CHCKC 2010
608 Chelan Pl.NE Email:luishaarciaeconrcast.net Consumer
Ren on,WA 98059
425430.2672
Member since 11/2007
✓ictoria Goetz Homemaker,Student CHCKC Chair, 2010
417 Wells Ave S.,Apt.#3 Email;jvsgoetz(aicorncast net Consumer Executive •
Renton,WA 98057 Board Development
H:(425)204-8802 Finance
Member since 4/2001
Chad Homer Attorney CHCKC Vice-Chair, 2008
CURRAN Law Firm Email:chorner@curranfinn.com Consumer Executive
P.O Box 140 Cell#206-498-6482 Chair,Board
Kent,WA 98035.0140 Development
WR PH:(253)852-2345 Audit
FAX: (253)859-8037 Strategic Planning
Member since 11/2005
John Payne Physical Therapist Board Development 2009
531 Monta Vista Dr.E. OutPatient Physical Therapy Quality
Edgewood,WA 98372 701 M St.NE,Ste 102
H:(253)863-0654 Auburn,WA 98002
1 Member since 12/2006 Phone: 253-833-876§ 1
I Ernaikjohnoaynept@,yahoo.com
o:lboudlboud list(yiw)04/15/01 I:58 PM Page 6 of 44
2006 CHCKC Board of Directors P 2
Rev:4/15/2008 .
CONFIDENTIAL
NAME,ADDRESS,PHONE OCCUPATION Consumer? Officer TERM
&/or Committee EXPIRES
Sheryl Pot Homemaker/Bus Driver CHCKC Secretary 2009
31 i 1 SW 3131°Street Email-spot98765@msn.com Consumer Executive
Federal Way,WA 98023 Chair,Quality
I H:253-815.8239 Comm.
Member since 2/2004 Audit
r
Julie D.Shoji Senior Financial Manager 2010
17323 SE 1851h P1. Russell Investment Group
, ReSton,WA 98058 Wk:253-439-5732
1 H:425-793-7970 Cell:206.335-1128
I Member since 6/2007 Email:jshoji@russell.com
' Kathleen(Kathy)A.Smith Homemaker/Community Activist CHCKC Treasurer 2010
8326 59th Ave.E. Consumer Executive
Puyallup,WA 98371 cell: 253-223-8434 Finance
H: Quality
Member since 4/1992 email:KSmith235@hoimail.co,l
ex-offlcio: Chief Executive Officer
Thomas Trompeter Community Health Centers of King Co.
4314.12'h Ave South 955 Powell St SW,Suite A
Seattle,WA 98108 Renton,WA 98057-2908
(206)762-6337 w:(425)277-1311-wE(425)277-1566
email:ttrompeter(e)i chhckc.org
Election of directors is by an affirmative vote of two thirds of the members present of the Board of Directors,providing a quorum Is present. Directors
are selected based on the Board of Directors'perceived need for financial,legal,public relations,planning,fundraising,health care,consumer or other
areas of expertise. At least SI%of the board will consist of CHCKC consumers. An effort will be made to recruit consumer directors who arc
representative of the individuals being served by CHCKC in terms of demographic factors such as race,ethnicity,sex and age.
c::boaresond list 2007.2008(Ow)o4/15ro8 1:511 PM Page 7 of 44
Community Health-Centers-of-King County
Board of Directors
December 12,2007
6:00 p.m.—9:00 p.m.
Administrative Offices
Present: Thomas Cross,Laurence DeShields,II,Robert Ellis,Luis Garcia,Victoria Goetz,Chad Homer,John Payne, Sheryl Pot,Julie
Shoji,Kathleen Smith,Shailesh Tatu,Thomas Trompeter(ex-officio)
Absent:
Guests:
Staff: Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
Topic Discussion A=Actions D=Decisions
Convene Meeting The CHCKC Board meeting was convened at.6:35 pm
Newest Board member,Luis Garcia,was officially welcomed to the Board of
Directors.
I. Consent The consent agenda was presented for approval. A—It was moved(Laurence
Agenda -Board Meeting Minutes, 11/14/07 DeShields,II)
and seconded(Shailesh Tatu)
to approve consent agenda.
Motion approved unanimously
II. Board Tom Cross,Chair,welcomed everyone. He acknowledged that this has been
-o Chair's a very eventful year especially with NextGen.
Report
There are three(3)Board members retiring from the board. Mark Mitchell,
o Barbara Kanaya and Shailesh Tatu. A plaque was presented to Shailesh Tatu
42, thanking him for his commitment to the Board of Directors. Plaques will be
mailed to Mark and Barbara.
December 12,2007 CHCKC Board Meeting Minutes ' '- CONFIDENTIAL AND PROPRIETARY Page I of 4
anc'
opic Discussion - A=Actions D=Decisions
There will be no regular Board of Director's business meeting in January,in
lieu of the board retreat January 25,26 and 27,2008. The agenda is under
construction. Any necessary business will be conducted as a separate meeting
at the retreat.
The Friday night session at the retreat will be devoted to Board function and
governance. Chad Homer has been asked to talk about governance based on
his experience with the Carver Model of Governance. Our current Mission
Statement is in need of revision and will be discussed during the retreat.
The annual Oath of Office&Confidentiality Statement,Conflict of Interest
Statement and Conflict of Interest Disclosure document were placed in the
hand-out folders.
Several board members have not completed the board survey. Some surveys
are showing partial completion. This will be investigated.
III. Committee A. Board Development Committee:
Reports
This committee recommends Board Membership re-elections as follows: A—It was moved(Chad Homer)and
Tom Cross—1 year(2008) seconded(Robert Ellis)to accept
Laurence DeShields,II—2 years(2008,2009) the recommended re-elections to
Victoria Goetz—3 years(2008,2009,2010) the Board of Directors for the
Kathleen Smith—3 years(2008, 2009,2010) terms stated.
• Motion Approved Unanimously.
co This committee recommends voting on the proposed Slate of Officers for A—Tom Cross distributed the ballots.
CD 2008 as follows: Julie Shoji tabulated the votes.
Co • Victoria Goetz—Chair The Slate of Officers was
43, • Chad Homer—Vice-Chair accepted by unanimous vote for
• Sheryl Pot—Secretary each position
December 12,2007 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 4
V 1
„lc Discussion. . A=Actions D=Decisions
There was a discussion regarding the compensation package. The 6%
increase to grades and bringing all staff to 93%of mid-point was thoroughly
explained. The capital budget had a few changes from the 1 s<draft. The
cash flow for 2008 showed ending cash with and with-out the proposed new
clinic.
Kathleen Smith praised Jody Putman and her staff for all of their diligent and
time consuming work in preparation of this balanced budget. .
V. Q&A on The 2008 Board Calendar topics will be discussed at the retreat. It is
Board important that everyone has input on what are the really important topics that
Calendar need to be on the calendar.
Topics
VI. Board The business meeting adjourned at 8:35 pm,at which time the board entered
Executive executive session.
Session
Respectfully Submitted By:
rlL -.41 .VI3 Og
Sheryl Pot, Sec Date
•C r'
O
co
CD
O .
O
.
December 12,2007 CHCKC Board Meeting Minutes . - CONFIDENTIAL AND PROPRIETARY Page 4 of 4
There was no Community Health Centers of King County Board of Director's Business Meeting
- held in January,2008.
•
Page 11 of 44
Community Health Centers of King_County
Board of Directors
February 13,2008
6:00 p.m.—9:00 p.m.
Administrative Offices
Present: Laurence DeShields,II,Luis Garcia, Victoria Goetz, Chad Homer,John Payne,Julie Shoji,Kathleen Smith,Thomas Trompeter
(ex-officio)
Absent: Thomas Cross,Robert Ellis,Sheryl Pot
Guests:
Staff: John Caron,Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
• f. 'i:il F ... ..... N37.., ' ff'"N!�li N.
Convene Meeting The CHCKC Board meeting was convened at6:41 pm
Prior to convening the board meeting, a presentation of our new name and
logo was given by Thomas Trompeter.
I. Consent The consent agenda was presented for approval. A—It was moved(Chad Homer)
Agenda -Board Meeting Minutes, 12/12/07 and seconded(Julie Shoji)
-Preliminary Financial Statement for the period ending December 31, to approve consent agenda.
2007 Motion Approved With One(1)
Abstention,Kathleen Smith.
II. Board Victoria Goetz,Board Chair,welcomed everyone and thanked Thomas
Chair's Trompeter for the presentation of the new name and logo.
Report
• Retreat Recap The 2008 retreat was really good. Chad Homer was
11)
co thanked for his presentation on a different way of looking at strategic
governance. The retreat was a great place to start looking at how we
manage meetings,mission and where we are going. The 2008
CHCKC Retreat Summary was passed out at tonight's board meeting
February 13,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 1 of 3
i
There was a brief discussion on location for next year's retreat. A—2009 Retreatlocationwill be
January weather seemed to be the major concern in regards to driving discussed in Executive Session.
to Alderbrook Resort. Several board members felt this location did
not have activities for families,while others' felt the retreat was more
productive if family members were not in attendance.
• Board Calendar—The list of brainstorming calendar topics was A—An email will be sent out showing
reviewed,discussed and added to. Some of the suggested topics were all of the topics. Board members
not at the higher strategic level. Goal is to have the calendar complete will have an opportunity to give
by March board meeting. input on what they think are
priority topics. Victoria Goetz
and Thomas Trompeter will then
devise a draft calendar with the
"big ticket"topics.
• 2008 Committee—The proposed 2008 Committee Charters were A—Review proposed new committee
handed out for review and discussion. The Strategic Planning charter along with old committee
Committee has been eliminated. The Board Development Committee charter. Send comments to
has been renamed Governance Committee. Along with the charter Victoria Goetz. Willingness to
handout was the"Willingness to Serve: form. Strategic issues can Serve forms should be completed
solicit Ad Hoc meeting of specific committees and then brought back and turned into Yvonne
to the fill board. Westover.
III. Committee A. Finance Committee
Reports The Finance Committee met on February 4t'. The preliminary financial
statements for December,2007 were accepted as preliminary. Write-off
receivables will be seen by April,when the audit takes place. A pie chart
showing CHCKC Revenue Streams was handed out. This chart can serve
as a reference for revenue stream discussions. The Revenue Bond, Series
2008 timeline was reviewed.
mThere was a discussion at the board retreat on the use of reviewing Key A-A potential format will be brought
Indicators rather than the entire financial packet. • to the March board meeting.
G' N. CEO Report • Strategic Plan Reporting Schedule- The proposed Strategic Plan
reporting schedule for Provider of Choice and Employer of Choice
was reviewed. This proposal was the outcome of work done at the
February 13,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 3
rrtll ((.d tx� '� 7..L• }J.•i� ,�,*c,,.l71 1 4.;° h r.'r iL 'r' '4h ''" fl:•' n rq ;�yA;r?�• Yr'" aa-R`��"'•"�r4V-1'.r,i:rrnlr,'U.dUt,'r,
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n..{'�.:ri ._ y IL"�n.i.�. f FF_� I_6..r,:i��r I....L:.7,fir_..r�_•f.}'f"iqt'; ilr�i!"5.-���Sr,I1.. I�. � .I;E;.u;...rC.}..Nrl� ``=•._`far?y']r;��{�rr,
board retreat on the reporting schedule. There were questions
surrounding the proposed dates for turnover rates. Of concern is"how
can we shoot for a goal without knowing the goal?" Goal is to have a A—The most recent EEOC report will
benchmark in April for turnover rates. There was a brief discussion be brought to the next Executive
on the diversity make-up of higher level positions at CHCKC. Overall session.
there is a concern over reporting timelines that will be reviewed as we
get more information of the measurement goals.
• National and State Policy Update—The high level State Legislative
Priorities are the expansion of the Health Professions Scholarship and
Loan Repayment Program and a one-time grant to expand physical
capacity in CHC dental clinics. The high level Federal Legislative
Priorities are reauthorization of the Health Center Program;Increase
funding for the Health Center Program and Increase funding for
National Health Service Corps. Handouts showed how much money
and notes.
V. Other For the record,the following Board Resolutions were passed at the Annual
Business Board Retreat on 1/26/08:
#8-001 —approval for applying for grants for funding for the year 2009
#8-002—Removal of Mark Mitchell as an authorized signer on the Charles
Schwab and all Kibble and Prentice investment accounts. The
approval to replace Mark Mitchell with Kathleen Smith
#8-003—approval to remodel 6,000 square feet of the Powell building and
approval to finance or refinance up to$1,100,000 of the cost
through the issuance of tax-exempt bonds.
The March 2008 Board meeting will be held on Wednesday March 19,2008.
VI. Board The business meeting adjourned at 8:01 pm,at which time the board entered
Executive executive session.
Session
c Respectfully Submitted By:
.a. Sheryl Pot,Secretary Date
February 13,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 3 of 3
Community Health Centers of King County
Board of Directors
March 19,2008
6:00 p.m.—9:00 p.m.
Administrative Offices
Present: Laurence DeShields,II,Robert Ellis,Luis Garcia,Victoria Goetz,Chad Homer, Sheryl Pot,Julie Shoji,Kathleen Smith,Thomas
Trompeter(ex-officio)
Absent: Thomas Cross,John Payne
Guests:
Staff John Caron,Judy Featherstone,Jody Putman,Debbie Wilkinson
Minutes recorded by: Yvonne Westover
•!'°:' t rr r""rfa% _.. .... .y..
nii7 -' n'' "t u ._ . . .. I lid
Convene Meeting The CHCKC Board meeting was convened at.6:32 pm
I. Consent The consent agenda was presented for approval. A—It was moved(Chad Homer)
Agenda -Board Meeting Minutes,2/13/08 and seconded(Julie Shoji)
-Special Session.Conference Call Board Meeting Minutes 3/7/08 to approve consent agenda.
-Preliminary Financial Statement for the period ending December 31, Motion Passed Unanimously.
2007
-Financial Statement for the period ending 1/31/08
II. Board Victoria Goetz,Board Chair,welcomed everyone.
Chair's
Report NACHC Policy and Issues Forum—Chad Homer,Victoria Goetz and
Thomas Trompeter attended the NACHA P &I Forum in
Washington D.D.,March 12—18,2008. They were able to talk to
Congress along with other Community Health Center forum
delegates. The main issues at stake were"
• Re-authorization of Health Center Program with a five(5)year
co renewal.
m • Health Center Grant Program making it through the
Appropriation Committee
• Medicare hasn't been adjusted since 193/'94. Better
reimbursement is needed.
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 1 of 3
?.....� f� � 4���I�ftl1f�.[Il�,hlllx� � } 1 .u='�� .r,rfl •� ii ��(`?rLi a�r. i x�L.� r�`.5".�'�•�ll ice' _ �t': ••1:. �—•.. � -•�:
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: .. _ •:1;.. �.1d'1.:."i.`..�r.1:�-� l.�o- t.�Li'���.,.r,..s.,_�e.r�,.�. il�� � 1. [R�.n,
Our_group_was_able to_consult with_Berit to continue_the_discussion_of_-A—Chad Homer-and-Thomas
wording for our mission statement. It was agreed that an outside Trompeter will be meeting with
consultant would best be able to wordsmith our mission statement the outside consultant to see how
once we come up with the key points. The mission statement should. he might phrase our mission
be short and concise and tell why we exist. statement.
• Board Calendar—The calendar was briefly reviewed. Some of the A—Several Board members want to
suggested topics were not at the higher strategic level and therefore know which topics were taken off
moved to the Governance Committee. The numbers in parenthesis the calendar and given to the
with some of the topics indicates the number of times the topic has Governance Committee. Victoria
been presented. A correction needs to be made to 2009 Budget. ' Goetz will email the list to all
September will be the 3Td discussion and November will be the 4th board members.
discussion. Most board members were contacted about their
committee membership. A—Review committee membership.
Send comments to Victoria
• 2008 Committee—The proposed 2008 Committee membership and Goetz.
Charters were handed out for review.
• Town Hall Meetings—Laurence DeShields and Debbie Wilkinson
attending a Town Meeting hosted by Ron Sims on the inequities
across society in all areas including healthcare. The discussions were
around how we need to work towards a better society and have
everyone on a level playing field. PBS will be doing a serious on
"Unnatural Causes"which deals with these issues. Another Town
Hall meeting is scheduled for Kent Senior Center on Monday,March
24th. •
III. Committee A. Finance Committee
Reports The Finance Committee met on March 4t. The Financial Statements for A—It was moved(Sheryl Pot)and
period ending January 31,2008 were sent out in the board packet. , seconded(Chad Homer)to accept
Kathleen Smith asked the board if they were comfortable with the Key the Key Indicators as the monthly
o Indicators. Any comments need to be directed to Kathleen Smith. Full financial report with expanded
financial reports will be given on a quarterly basis. financial to be presented on a
rn quarterly basis. The Motion
° Passed Unanimously.
4 Powell Building Financing
An overview of the Powell Building Remodel summary was distributed. A—It was moved(Sheryl Pot) and
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 2 of 3
,. ..,PI � "...'LL k.'iir' I s y, ' ,,.-m.71 ..;,... ::.:I:S:rJ.ar ,.1{a l-r..l : { 1 i. t i;ati,}..,trlia J J=�- _ II,',- I',`a•". -ftil.��d •,,i.LL.
l': 19..,.1 t:1'.: .�1 1...jjg1' .t J L. !'aL�.r.1!L�a.,7..1 �{71 ;:r {((.Ha+�` 4a,tir j.,t t.�L.I.: .��la ,t t n21'}I ){"^"I ..ur.x,r..4.t4r-..i}e.... -'• - .,�Itfl.—;17..., Wro .ti;f<"P _ 4 I F!{i(, �,!'..I II.. i.r 4Ml,ull'.�Y :.a. r`cr14.. rl�CAI'r r::ttll LI fMrlllrili-`IL{ lr(hr II.`i—:.IJ. Jv:..JL•4 ...ry'�,L 7'. J�t.11., e,i:l.la r.YS...:j:. 'Yrr.....:•� 'La:, _ iC�l l]'.H ' Y7 1�•'ir ..x..a. "i 7`1....f. r L� A ,l
In order to borrow the maximum allowable funds,we needed to use the seconded(Kathleen Smith)to
Kent building as collateral and therefore had to get it appraised. The move ahead with the plans for
appraisal came in at 7.3 million. Remodel uses and overview of costs tenant improvement to the Powell
were reviewed. Building. The Motion Passed
Unanimously.
IV.CEO Report Dental Benchmark Report(2008 Strategic Plan)
The Dental Dashboard showing the percentage of patient who completed
their dental treatment plan within 12 months was reviewed. There are
different goals for kids(60%)and Adults(45%). Adults have a more
difficult time making their follow-up appointments and also have more
complex treatment plans.
EEOC Report
The CHCKC Employees by Race/Ethnicity and Position Class as of
9/30/07 was presented and reviewed. One-third of our employees speak
another language in addition to English. This report is filed every
September.
Provider Recruitment and Retention
The organization recognizes the need to increase provider salaries. There
has been difficulty in bringing in new hires at the 93%medium level. The
ELT would like to bump the initial salary offering to the 95%level and
balance the existing salaries accordingly. Competition for providers is
stiff across the state. CHCKC has 6 provider vacancies.
Insurance Summary
As requested at the retreat,the Insurance Summary was distributed and
reviewed. Bottom line,we are well protected.
VI. Board There being no further business,the business meeting adjourned at 7:45 pm at
Executive which time the board entered executive session.
Session
Respectfully Submitted By:
0
.p
416.
Sheryl Pot,Secretary Date
March 19,2008 CHCKC Board Meeting Minutes CONFIDENTIAL AND PROPRIETARY Page 3 of 3
Community Health Centers of King County
2008 Budget Summary
co
rn
TOTAL 2008 a.
a
Budget
STATISTICS-UnitsNisits 169,711
•
REVENUE
Fee for Service Revenue 13,810,286
Grant Revenue 5,604,018
Managed Care Revenue 13,269,844
Other(Rental, Interest, etc) 1,826,943
EXPENSES
Personnel Costs 25,055,911
Services 653,192
Supplies Exp 1,877,015
General Exp 1,965,884
Overhead Exp 4,944,763
C:1Documents and Settir;. _reyerrLocal Settings1Temporary Internet Files1OLKE812008 Bud<, immary
•
Cartllled Public Accountants
•
&Consultants
10900.NE4oStreet
CLAR]K NUBER Er
Ft42sA54A620
800.504.0747
Mclorknub.r.com
Independent Auditors'Report CferMNubtr tr a
Prohuionol servkes Cc poretbm
Board of Directors
Community Health Centers of King County
Kent, Washington
•
We have audited the accompanying statement of financial position of Community Health Centers of King
County (the Organization) as of December 31, 2006, and the related statements of activities, functional
. expenses,and cash flows for the year then ended. These financial statements are the responsibility of the
Organization's management. Our responsibility is to express an opinion on these financial statements
based on our audit. The prior year summarized comparative information has been derived from the
Organization's 2005 audited financial statements and in our report dated March 29, 2006, we expressed
an unqualified opinion on those financial statements.
We conducted our audit in accordance with auditing standards generally accepted in the United States of
America and the standards applicable to financial audits contained in Government Auditing Standards,
• issued by the Comptroller General of the United States. Those standards require that we plan and perform
• the audit to obtain reasonable assurance about whether the financial statements are free of material
• misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and
disclosures in the financial statements. An audit also includes assessing the accounting principles used
and significant estimates made by management, as well as evaluating the overall financial statement
presentation. We believe that our audit provides a reasonable basis for our opinion.
• : In our opinion, the financial statements referred to above present fairly, in all material respects, the
financial position of Community Health Centers of King County as of December 31, 2006, and the
• changes in its net assets and its cash flows for the year then ended in conformity with accounting
principles generally accepted in the United States of America.
In accordance with Government Auditing Standards,we have also issued our report dated April 11,2007,
on our consideration of Community.Health Centers of King County's internal control over financial
. reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, and
grant agreements.The purpose of that report is to describe the scope of our testing of internal control over
financial reporting and compliance and the results of that testing, and not to provide an opinion on the
internal control over financial reporting or on compliance. That report is an integral part of an audit
performed in accordance with Government Auditing Standards and should be considered in assessing the
results of our audit.
ejoAk
Certified Public Accountants
April 11,2007 Page 19 of 44
ew
COMMUNITY HEALTH CENTERS
OF RING COUNTY
Financial Statements And Independent Auditors'Report
December 31,2006
•
Page 20 of 44
Table Of Contents
Page
Independent Auditors'Report 1
Financial Statements:
Statement Of Financial Position 2-3
Statement Of Activities 4
Statement Of Functional Expenses 5
Statement Of Cash Flows 6
Notes To Financial Statements 7-16
Page 21 of 44
i
COMMUNITY HEALTH CENTERS OF KING COUNTY
. Statement Of Financial Position
Assets
December 31,2006
(With Comparative Totals For 2005)
2006 2005
Current Assets:
Cash and cash equivalents(Note 2) $ 319,514 $ 2,130,433
Investments(Note 3 and 13) 1,891,005
Patient fees receivable, net of allowance for doubtful accounts
and contractual adjustments of$1,070,835($1,610,075-2005) 1,748,799 1,787,138
CHNW receivable(Note 11) 916,185 949,686
Grants receivable 760,585 613,224
Other receivables 86,360 76,709
Inventory 70,636 122,743
Prepaid expenses 175,089 132,950
Total Current Assets 4,077,168 7,703,888
Land, buildings,furniture, and equipment(Note 4) 25,076,246 20,720,593
Construction in progress(Note 4) 694,554 400,241
Less accumulated depreciation and amortization (5,490,389) (4,632,121)
20,280,411 16,488,713
PTSO costs, net of amortization (Note 6) 625,074 772,924
Investments(Notes 3 and 13) 15,702,170 12,966,338
Land held for future use(Note 5) 256,420 256,420
Deposits 56,166 129,356
Total Assets $ 40,997,409 $ 38,317,639
The accompanying notes are an integral part of these financial statements. Page 22 of 44
-2-
COMMUNITY HEALTH CENTERS OF ICING COUNTY
Statement Of Financial Position
Liabilities And Net Assets
December 31,2006
(With Comparative Totals For 2005)
2006 2005
Current Liabilities:
Accounts payable(Note 2) $ 1,061,661 $ 677,093
Accrued wages and related payables 1,338,073 1,272,853
Other accrued expenses 29,318 24,298
Current portion of loan payable(Note 10) 92,815 91,667
Total Current Liabilities 2,521,867 2,065,911
Loan payable, less current portion(Note 10) 2,156,656 2,249,471
Total Liabilities 4,678,523 4,315,382
Commitments and contingencies(Note 12)
Net Assets:
Unrestricted
Undesignated 20,616,716 21,035,919
Designated by the Board of Directors(Note 13) 15,702,170 12,966,338
Total Unrestricted 36,318,886 34,002,257
Total Net Assets •36,318,886 34,002,257
Total Liabilities and Net Assets - $40,997,409 $38,317,639
The accompanying notes are an integral part of these financial statements.
-3- Page 23 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY
Statement Of Activities
For The Year Ended December 31,2006
(With Comparative Totals For 2005)
2006 2005
OPERATING ACTIVITIES
Revenue and Support
Patient service revenue,net of contractual adjustments $19,193,489 $17,466,146
Grants and contracts from governmental agencies 5,053,351 4,485,464
United Way of King County 127,283 142,734
Donations and contributions from private agencies,
including donated services and supplies 148,845 18,795
Rental income 305,039 299,628
Investment income(Note 3) 608,291 506,068
Other income 139,340 167,768
Total Operating Revenue and Support 25,576,818 23,086,603
Expenses
Program Services:
Primary medical care 17,168,912 15,073,335
Primary dental care 4,359,592 4,151,715
Total Program Services 21,528,504 19,225,050
Supporting Services:
Management and general 5,155,610 4,860,044
Total Operating Expenses 28,684,114 24,085,094
Change in Net Assets from Operating Activities (1,108,496) (998,491)
NON-OPERATING ACTIVITIES
Loss on disposal of assets (789) (101,757)
Loss on Impairment of assets(Note 4) (257,017)
Unrealized Gain or(loss)on investments(Note 3) 165,897 (85,392)
Contributions 70,522 1,980,445
Pool savings(Note 11) 3,446,522 3,429,444
Change in Net Assets from Non-Operating Activities 3,425,125 5,202,740
Change In Net Assets 2,316,629 4,204,249
Net assets,beginning of year 34,002,257 29,798,008
Net Assets,End of Year $36,318,886 $34,002,257
The accompanying notes are an integral part of these financial statements. Page 24 of 44
-4-
COMMUNITYHEALTH CENTERS OF KING COUNTY
Statement Of Functional Expenses
For The Year Ended December 31,2006
(With Comiparative Totals for 2003)
Program Services Supporting Services
Primary Primary Total Management
Medical Dental Program And 2006 2005
Care Care Services General Total Total
Salaries $ 9,414,301 $2,447,240 $11,861,541 $ 2,584,477 $14,446,018 $13,169,073
Payroll taxes and fringe benefits 2,100,122 575,102 2,675,224 - 575,935 3,251,159 $ 2,908,095
Total Salary and Related Expenses 11,514,423 3,022,342 14,536,765 3,160,412 17,697,177 16,077,168
Contract Labor 469,532 48,049 517,581 34,632 552,213 584,015
Professional fees 887,148 82,841 969,989 273,181 1,243,170 1,192,641
Occupancy 692,383 174,672 867,055 232,614 1,099,669 1,010,779
Dues,publications,and subscriptions 79,150 10,580 89,730 73,682 163,412 184,364
Travel 43,350 8,566 51,916 134,108 . 186,024 133,003
MedicaUdental supplies 1,432,063 313,566 1,745,629 5,797 1,751,426 1,139,712
Office supplies 182,449 33,344 215,793 55,522 271,315 352,462
Printing 46,582 11,823 58,405 13,051 71,456 66,608
Equipment lease and maintenance 504,233 114,183 618,416 179,586 798,002 882,543
Postage 67,692 10,513 78,205 22,585 100,790 75,674
Telephone 216,533 53,628 270,161 91,128 361,289 321,654
Insurance 45,363 15,524 60,887 39,288 100,175 93,345
Interest and banking fees 61,564 35,808 97,372 90,041 187,413 198,051
Property taxes 6,156 3,898 10,054 43,739 53,793 33,284
Bad debts 247,475 159,755 407,230 12,000 419,230 375,378
i jscellaneous 149,642 72,427 222,069 228,191 450,260_ 397,999
c
Total Expenses Before
c
CDDepreciation and Amortization 16,645,738 4,171,519 20,817,257 4,689,557 25,506,814 23,118,680
Kpreciation and amortization 523,174 188,073 711,247 466,053 1,177,300 966,414
0
Total Expenses $17,168,912 $4,359,592 $21,528,504 $ 5,155,610 $26,684,114 $24,085,094
The accompanying notes are an integral part of these financial statements.
-5-
COMMUNITY HEALTH CENTERS OF ICING COUNTY
Statement Of Cash Flows
For The Year Ended December 31,2006
(With Comparative Totals For 2005)
2006 2005
Cash Flows from Operating Activities:
Change in net assets $ 2,316,629 $ 4,204,249
Adjustments to reconcile to net cash provided by operating activities:
Depreciation and amortization 1,177,300 966,414
Unrealized (Gain)or loss on investments (165,897) - 85,392
Loss on disposal of assets 799 101,757
Loss on impairment of assets 257,017
Changes in assets and liabilities
Grants receivable (147,361) (159,914)
Accounts and interest receivable 38,339 (765,357)
CHNW receivable 33,501 561,075
Inventory 52,107 (67,465)
Other assets 21,400 5,137
Accounts payable 384,568 (161,993)
Accrued liabilities 70,240 39,284
Cash Provided by Operating Activities 4,038,642 4,808,579
Cash Flows from Investing Activities:
Payments for land, building and equipment acquisition (6,036,038) (4,601,525)
Payments for PTSO costs (42,926) (372,917)
Purchase of investments (3,556,074) (19,058,975)
Proceeds from sale of investments 2,877,144 4,116,243
Cash Used by Investing Activities (5,757,894) (19,917,174)
Cash Flows from Financing Activities:
Debt service principal payments (91,687) (86,680)
Cash Used by Financing Activities (91,667) (86,680)
Net decrease in cash and cash equivalents (1,810,919) (15,195,275)
Cash and cash equivalents, beginning of year 2,130,433 17,325,708
Cash and Cash Equivalents,End of Year $ 319,514 $ 2,130,433
Supplemental Disclosure of Cash Flow Information:
Cash paid for interest $ 128,487 $ 133,498
The accompanying notes are an integral part of these financial statements.
-6- Page 26 of 44
COMMUNITY HEALTH CENTERS OF KING COUNTY •
Notes To Financial Statements
•
Note 1-Summary Of Significant Accounting Policies
Description of Operations - Community Health Centers of King County (CHCKC) is a not-for-profit
organization providing comprehensive primary medical and dental care through the operation of health
centers in Kent, Renton,Auburn, Eastside, Bothell, and Federal Way. CHCKC's mission is to provide care to
all, regardless of ability to pay and to specialize in providing care for the medically underserved, low income,
and other disadvantaged populations In King County. CHCKC provides comprehensive and coordinated
services, including allopathic and naturopathic family medicine, family dentistry, acupuncture, behavioral
health care, nutrition services and massage therapy. CHCKC also provides a variety of supportive services to
increase the effectiveness of the health care services provided. These supportive services include outreach ,
and insurance eligibility assistance, referral coordination and patient care coordination. CHCKC strives to
improve the overall health of the general population through education and treatment of illnesses through a
comprehensive set of service modalities. CHCKC's philosophy is that all people are entitled to affordable,
high quality health care.
Basis of Presentation - The financial statements are presented in accordance with generally accepted
accounting and reporting standards for not-for-profit organizations.
Under these standards, net assets and revenues, expenses, gains and losses are classified based on the
existence or absence of donor-imposed restrictions. Accordingly, the net assets of CHCKC and changes
therein are classified and reported as follows:
Unrestricted net assets-Net assets that are not subject to externally imposed restrictions. Amounts
designated by the Board of CHCKC are included in this classification.
Temporarily restricted net assets- Net assets subject to donor-imposed stipulations that may or will
be met either by actions of CHCKC and/or the passage of time. CHCKC had no temporarily restricted
net assets as of December 31, 2006 and 2005.
Permanently restricted net assets-Net assets subject to donor-imposed restrictions that stipulate the
resources be maintained permanently, but permit CHCKC to use, or expend part or all of the income
derived from the donated assets for either specified or unspecified purposes. CHCKC had no
permanently restricted net assets as of December 31,2008 and 2005.
Revenues are reported as increases in unrestricted net assets unless use of the related assets is limited by
donor-imposed restrictions. Expenses are reported as decreases in unrestricted net assets. Gains and losses
on investments and other assets or liabilities are reported as increases or decreases in unrestricted net
assets unless their use is restricted by explicit donor restriction or by law. Expirations of temporary restrictions
on net assets are reported as transfers between the applicable classes of net assets. Contributions with
externally imposed restrictions that are met in the same year as received are reported as revenues of the
unrestricted net asset class.
Cash and Cash Equivalents - CHCKC considers all highly liquid investments purchased with an original
maturity of three months or less to be cash equivalents, except for funds held in the investment accounts
designated for long-term purposes.
Page 27 of 44
- 7-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 1-Continued
Investments- Investments in debt, equity, or other securities that do not meet the criteria for cash and cash
equivalents are accounted for as investments. Investments with readily determinable fair values are stated at
fair market values in the accompanying financial statements.
Credit Risk - Financial instruments that potentially subject CHCKC to concentration of credit risk consist
principally of cash, short-term investments, and receivables. CHCKC places its cash and investments only in
high quality financial institutions. At December 31, 2006, CHCKC has cash deposits and Investments in
excess of the federally insured limit of$100,000 in an institution.
Inventory - inventory is stated at the lower of cost or market. Cost is determined by the first-in, first-out
method.
Accounts Receivable -Trade accounts receivable are stated at the amount management expects to collect
from outstanding balances. Management provides for probable uncollectible amounts through a charge to
earnings and a credit to a valuation allowance based on its assessment of the current status of individual
accounts. Balances that are still outstanding after management has used reasonable collection efforts are
written off through a change to the valuation allowance and a credit to trade accounts receivable.
Land,Buildings,Furniture,and Equipment-Land, buildings,furniture,and equipment are recorded at cost
or, if donated, at the fair market value at the date of donation. Repairs and maintenance are charged to
expense as incurred. Leasehold improvements are amortized over the shorter of the useful life or lease term.
Depreciation is provided using the straight-line method over the following estimated lives:
Building and Improvements 10-40
Furniture and Equipment 3-10
Patient Service Revenue - Patient service revenue is recognized at the date of service based on estimated
net realizable amounts from patients and third-party payers for services rendered or is recognized based on a
specified dollar amount per month for patients enrolled in a managed care plan.
Revenues from third party payer agreements are subject to audit and retroactive adjustments. Retroactive
adjustments are recorded at the time that such amounts can first be reasonably determined, which is
normally upon,notification by the paying entity. Currently, the adjustments for Medicaid services are recorded
at the time of billing based upon the Medicaid fee schedule instead of at the time of notification.
A significant percentage of patient service revenue were for services provided to Medicaid participants.
Medicaid revenue represented 74% and 72% of patient service revenue for 2006 and 2005, respectively.
Medicaid receivables represented 39% and 44% of net patient fees receivable at December 31, 2008 and
2005,respectively.
Contributions - Contributions, which include unconditional promises to give (pledges), are recognized as
_ _ revenue in the period received. Currently it is the policy of management to recognize certain contributions as
non-operating revenue. These contributions are given to support the overall mission and are not specifically
set aside or earned through operations.
•
Page 28 of 44
-8-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note I -Continued
Charity Care - CHCKC has a policy of providing care to patients, who meet certain criteria under its policy,.
without charge or at amounts less than its established rates. However, all patients are requested to pay a
minimum fee for each visit and no patient is denied services because of inability to pay. Since management
does not expect payment for this care, the discounted services are excluded from revenue. During the year
ended December 31, 2006 and 2005, CHCKC provided $4,414,605 and $4,334,892, respectively, of charity
care services under this policy.
Grant Revenue - CHCKC receives support from various federal, state and local government agencies.
Grants receipts are subject to restrictions on the use of funds placed by the grantor. CHCKC administers
these funds in accordance with grantor guidelines. Grant revenue under cost reimbursement arrangements is
recognized as expenses are incurred. Amounts incurred but not yet reimbursed are reported as grant
receivables.
In-Kind Contributions - CHCKC receives contributed services and supplies from various sources.
Volunteers, including members of the Board of Directors, have made significant contributions of time to
CHCKC.The value of this contributed time does not meet the criteria for recognition under current accounting
standards, and accordingly is not reflected in the accompanying financial statements. Certain professional
services formally documented and charged to the relevant project are recorded in the accompanying financial
statements.At December 31,2008, in-kind contributions were included in both grant and contribution revenue
in the statement of activities. These services and contributions of materials are recorded at market values.
Summarized below are totals for 2006.
Contributed labor $ 55,945
Contributed supplies 467,558
Contributed use of space 12.800
_ _.636.303
Federal Income Tax-CHCKC has received a determination letter from the IRS that states it is exempt from
federal income taxes under Section 501(c)(3)of the Internal Revenue Code.
Use of Estimates-The preparation of financial statements in conformity with accounting principles generally
accepted in United States of America requires management to make estimates and assumptions that affect
the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of
the financial statements and reported amounts of revenues and expenses during the reporting period.Actual
results could differ from those estimates.
•
Comparative Totals - The financial information includes certain prior-year summarized comparative
information in total but not by net asset class. Such information does not include sufficient detail to constitute
a presentation in conformity with accounting principles generally accepted in the United States. Accordingly,
such information should be read in conjunction with CHCKC's financial statements for the year ended
December 31,2005, from which the summarized information was derived.
Page 29 of 44
9-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 2-Cash And Cash Equivalents
During 2006, CHCKC became the fiscal agent for the Community Health Council of Seattle/King County
(CHCSKC). CHCSKC is a 501(c)(3)organization made up of membership from Community Health Centers in
Seattle and King County including CHCKC. CHCSKC's mission is to maintain and enhance the ability of the
member Health Centers to provide comprehensive, culturally and linguistically appropriate health care to
underserved populations in King County.As the fiscal agent for CHCSKC, CHCKC collects monies and pays
obligations for CHCSKC. Included in the cash and cash equivalents for the year ended December 31, 2006
are CHCSKC funds held of $58,841 which is also included in accounts payable as an amount due to
CHCSKC.
Note 3-Investments
CHCKC invests funds with Charles Schwab & Co., Inc. and FTN Financial that are managed by Kibble &
Prentice, a group of private asset managers. These funds are invested based upon the designations by the
Board of Directors. These investments pay interest and dividends at variable rates and some of the
investments are subject to market fluctuation increases and decreases. The investment of these funds is
controlled by the investment policies of CHCKC as approved by the Board of Directors.
Investments are carried at market value and consist of the following at December 31, 2006:
Equity securities $ 1,219,268
Certificates of deposit 783,702
Money market funds 3,681,588
Fixed income 10.017.614
$15.702.170
Investment Income consisted of the following for the year ended December 31,2006:
Interest and dividends $ 590,691
Realized gains 17,600
Unrealized gains 165.897
$ 774,_
Unrealized gains and losses are considered non-operating in the statement of activities.The balance of
undesignated investments for 2005 and 2006 were$1,891,005 and$0 respectively.
Page 30 of 44
- 1n_
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 4-Land,Buildings, Furniture And Equipment
The cost and accumulated depreciation of fixed assets at December 31 were as follows:
2006 2005
Land $ 2,890,013 $ 2,890,013
Building and Improvements 16,322,029 13,009,201
Leasehold improvements 1,282,503 985,580
Medical and dental equipment 1,176,576 1,152,908
Billing computer 819,634 784,055
Office equipment and other 2.585.491 1.898.838
25,076,246 20,720,593
Less accumulated depreciation and amortization (5.490.389) (4.632.121)
19,585,857 16,088,472
Construction in progress 694.554 400.241
Total 120480,411 $16.488,718
Included in land, buildings, furniture, and equipment is the cost of the Auburn Medical Arts Building
purchased in February 1999 for$3,372,357 of which a portion is leased to other medical organizations under
operating lease arrangements(Note 16).
As of December 31, 2006, the construction in progress balance of$694,554 consisted of three projects. In
2001, CHCKC started planning for the rebuilding of the Bothell Health Center on land purchased in 1999.
Design and other costs related to the project of$263,040 were incurred prior to 2006. It was determined in
2006 that $257,017 of the design costs associated with this planning were no longer able to be used and
were written off in the current year. The balance of the costs of$6,023 along with costs incurred in 2008 for
feasibility studies for rebuilding this clinic of$16,000, make up the balance of$22,023 at December 31,2006.
Lutheran Community Services NW(LCS)is building a community center at Angle Lake in the City of SeaTac.
CHCKC Is currently building out approximately 8,000 square foot space with tenant improvements as part of
a long-term lease with LCS and has Incurred costs to date of$537,492. This health center Is proposed to be
completed and opened in the second quarter of 2007. In 2006, CHCKC started the remodel of the third floor
of the Kent Community Health Center after administration moved to Renton and has incurred costs to date of
$135,039. This remodel is planned to be completed in the second quarter of 2007.
In May of 2006, CHCKC opened the new school-based Tyee Campus Health Center on the campus of Tyee
High School in SeaTac WA. Approximately 1,100 square feet was remodeled in the school space.
Additionally, in November of 2006, another health center was opened in Burien WA under a leasing
arrangement with Wesbild BP Inc. The costs of both of these new health centers are included in the
leasehold improvement and are being depreciated over the estimated lease lives.
Note S-Land Held For Future Use
In August 1999, CHCKC purchased the Bothell Clinic building along with some adjacent land with a value of
$258,420. This land is currently being held for future use and is vacant.
Page 31 of 44
_ 11 _
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 6-Practice Technology Services Organization(PTSO)
In May 2004, CHCKC became a participant in Practice Technology Services Organization (PTSO)along with
other community health centers in the State of Washington. The PTSO was formed in order to realize such
benefits as group discount purchasing, shared database management and support, grant opportunities and
standardized processes and data. In order to participate in the PTSO, CHCKC invested a level of funding of
costs for equipment, membership fees, software license costs, start-up and operating costs and service fees.
CHCKC will receive a future benefit from the use of the shared database management system. Accordingly,
the amounts have been capitalized and will be amortized over the useful lives of the hardware and software
license.
The PTSO costs as of December 31,2006,were as follows:
2006 2005
PTSO license, software and hardware costs $ 991,084 $ 948,158
Less accumulated amortization (388.010) (175.234)
Total $ 625e074 L _772.924
Note 7-Leased Facilities And Equipment
CHCKC is obligated under leases for the Bothell, Eastside and the Federal Way clinics. These leases provide
for annual adjustments to the minimum rental payments based on increases in building operation costs or the
consumer price index. In June of 2005, CHCKC entered into a lease agreement with Lutheran Community
Services NW to lease a portion of a building set to begin construction In 2006. Construction was completed in
2006 at which time CHCKC began tenant improvements to their approximate 8,000 square foot shell space
projected to cost approximately $1,000,000, which CHCKC will pay. This lease agreement provides for a
lease period of ten years and has three successive options to extend the lease for five years each. Lease
obligations for this lease over the ten-year period total$1,375,248.
In November 2008, CHCKC entered into a short-term lease with Wesbild BP Inc for a medical clinic in Burien
WA that opened in the same month. This lease expires on April 30, 2007 due to availability of space and calls
for lease payments of$1,800 per month. At the expiration of the lease, CHCKC will determine if other space
is available.
The facility rent expense for the years ended December 31, 2006 and 2005, was $359,221 and $343,172,
respectively. CHCKC also leases various office equipment under operating leases which expire through April
2011.The rent expense related to these leases was$94,230 and$88,691 for the years ended December 31,
2008 and 2005, respectively.
Page 32 of 44
- 12-
COMMUNITY HEALTH CENTERS OF RING COUNTY
Notes To Financial Statements
Note 7-Continued
The future minimum lease payments under these leases are as follows:
Years Ending December 31,
2007 $ 268,086
2008 200,293
2009 173,727
2010 149,444
2011 142,304
Thereafter 764.023
Total $ %,69s.l=
, Note 8-Retirement Plan
CHCKC maintains two tax sheltered annuity retirement plans under Internal Revenue Code Section 403(b),
which covers substantially all employees. One of these plans,Vanguard Group, was authorized in 2005 and
allows employees to self-direct investments.
For the years ended December 31, 2006, and 2005, there were no employer contributions or employer
matching of employee contributions under the plan.
Note 9-Managed Care
CHCKC is a member of Community Health Network of Washington (the Plan), a managed care plan formed
by twenty-one community and migrant health centers throughout the State of Washington to participate in the
managed care marketplace. The Plan is a not-for-profit corporation. The Plan accepts the full insurance and
financial risk of providing health care services to enrollees In the State Medicaid and Basic Health Plan
programs. As part of this agreement, the individual Centers are contingently liable for their proportionate
share of any claims should the Plan be unable to meet its financial obligations. The Office of the Insurance
Commissioner (OIC) requires all plans to maintain reserves to meet these financial obligations. The Plan
maintains assets in excess of the OIC's requirements and believes that its assets are sufficient to meet
financial obligations.
As part of this agreement, CHCKC has agreed to serve as a provider of primary care services for a certain
amount per member per month and to provide case management services to these same members related to
specialty and hospital services. In return, CHCKC will participate in any savings realized by the Plan in
providing these services,based upon a formula determined by the Board of Directors of the Plan.
Page 33 of 44
- 13-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 10-Loan Payable
A loan payable to U.S. Bank with a current interest rate of 5.53%. Principal and interest payments are due
monthly through January 2022. The Loan and Security Agreement allows for two optional prepayments
periods known as Reset Dates at January 23,2007 and 2017 respectively without penalty.The interest rate is
also reset at these Reset Dates based on a formula derived from market rates.This loan is collateralized with
the Kent facility and land.At December 31, 2006, CHCKC was in compliance with all covenants related to the
loan.
CHCKC had the following loan payable balance at December 31,
2006 2005
$2,249,471 $2,341,138
Less current portion (92.8151 (91.687,)
Total $ 2,158.956 $ 2,249,471
Scheduled principal repayments on the above loan payable are as follows:
Years Ending December 31,
2007 $ 92,815
2008 97,521
2009 104,303
2010 111,137
2011 118,420
Thereafter 1.725.275
Total $ Z249.471
Note 11-Hospital And Specialty Pools
Included on the statement of activities are $3,446,522 and $3,429,444 of Hospital and Specialty Pool
Revenues for 2006 and 2005, respectively. This income is classified as non-operating as it is not directly
related to services provided by CHCKC, but rather the result of savings realized by CHNW (Note 9) on
specialty and hospital care.This Income is accrued as it becomes known to CHCKC, generally at or near the
time cash is received. The estimate is based on the preliminary settlement statement prepared by the
Community Health Plan for the most recently completed plan year which is calendar year 2005. CHCKC
receives distributions of these savings over a 15 to 18 month period following the end of a plan year.
Note 12- Commitments And Contingencies
Grants-CHCKC has received federal grants for specific purposes that are subject to review and audit by the
grantor agencies. Entitlements to these resources are generally conditional upon compliance with the terms
and conditions of grant agreements and applicable federal regulations, Including the expenditure of resources
for allowable purposes. Any disallowance resulting from a review or audit by the grantor may become a
liability of CHCKC.
Page 34 of 44
- 14-
COMMUIVITYHEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 12-Continued
Use of Facility Restriction-In 1991, CHCKC received$29,663 from King County DSHS for the construction
of real property at 403 E. Meeker St. in Kent. Under the terms of this grant, CHCKC is obligated to use the
facility to provide comprehensive health care to the.low-income population of South King County until April 5,
2006. A promissory note was issued in November 1998 for the above amount,which was forgiven on April 5,
2006, because CHCKC met the use of facility restriction specified in the grant.A release of the restriction was
filed with King County in February 2007. It Is expected that this release will occur in 2007.
Note 13-Designated By Board Of Directors
The Board of Directors of CHCKC designated cash and cash equivalents and investments for the following
purposes at December 31:
2006 2005
Managed care reserves $1,100,000 $1,100,000
Operating reserves 6,743,030 5,500,000
Reserve for capital and program development 6,722,370 5,366,338
Reserve for endowment 1.136.770 1.000.000
$15,702.170 512,986,3311
Reserves designated by the Board of Directors include an allocation for unanticipated expenses in CHCKC's
managed health care programs, operating reserves equivalent to approximately three months of normal
operating expenses, reserves for capital and program development, and an initial reserve for start-up of an
endowment that in future years will help finance special strategic initiatives.
Note 14-Malpractice Insurance
Effective January 1, 2003, CHCKC was covered under the provision of the Federal Tort Claims Act (FTCA)
for malpractice. The FTCA is a government funded program which allows community health centers and
other qualified providers to be covered for malpractice. CHCKC has purchased malpractice insurance for
activities not covered under the FTCA.
Note 15-Self Insurance
CHCKC is a member of 501c Services(the Trust),formerly the Northwest Agency Trust. The Trust facilitates
the utilization by member agencies of the Reimbursement Financing Method of meeting obligations under
State Unemployment Insurance Statutes. As of December 31, 2006 and 2005, CHCKC had on deposit
$63,923 and$54,378, respectively,with the Trust to fund these obligations.The deposit is Included in prepaid
expenses on the statement of financial position. Any potential claims that may exist cannot be estimated at
December 31,2006;therefore, no accrual has been made.
Page 35 of 44
-15-
COMMUNITY HEALTH CENTERS OF KING COUNTY
Notes To Financial Statements
Note 16-Lease Agreement
In November 2004, CHCKC entered into a lease agreement with another organization to lease a portion of a
building owned by CHCKC. This lease calls for monthly lease payments of $9,722 for the period February
2005 to October 2009 and$10,734 for the period November 2009 to October 2014.This lease is a triple net
lease and the lessee Is obligated to pay a Pro Rata share of the operating costs of the building as additional
rent each month. At the time of the lease signing, the lessee was required to make a security deposit of
$10,734 which Is refundable upon fulfillment of certain lease conditions and a prepaid rent amount of$9,722
which represents the fourth month's lease of the lease period. Additionally, approximately 3,000 square feet
of this same building Is leased to another tenant under a triple net lease that is currently set to expire on June
30, 2007. The lessee is also obligated to pay a pro rata share of the operating costs based on their share of
the space leased.
Aggregate future minimum rental payments to be received under the operating leases are as follows:
Year Ended December 31,
2007 $160,134
2008 116,664
2009 118,688
2010 128,808
2011 128,808
Thereafter 364.956
$ 7,018,05f
Page 36 of 44
- Ia_
I. FAIR EMPLOYMENT PRACTICES
Equal Employment Opportunity
CHCKC affinns its continuing commitment to extend to all qualified individuals an equal
opportunity to compete for employment and advancement within the company. We are committed
to the philosophy and principle of equal employment opportunity for all present and prospective
employees.
To assure equal employment opportunity,there shall be no discrimination and/or preferred treatment
concerning any individual or group because of race, color,creed,religion, sex,age,national origin,
citizenship,marital status,veteran status,sexual orientation,political ideology,medical condition,or
because of sensory,physical,or mental disability,or any other factor protected by law.
Further, it is the policy of CHCKC to comply with the Americans With Disabilities Act and other
federal and state laws prohibiting discrimination against applicants or employees with disabilities.
• Accordingly, we will reasonably accommodate applicants and employees with known physical or
mental disabilities to the extent required by law. This reasonable accommodation policy extends to
all services,programs,and facilities that are provided through employment with us. We reserve the
right to modify,or make exceptions to,any of its existing policies or practices to the extent necessary
to provide a reasonable accommodation to an applicant or employee whom we know has a disability.
If you believe that you need an accommodation because of a disability or medical condition,please
discuss this with the Health Center Manager,Dental Center Manager,Dental Center Supervisor or
a human resources representative.
Management at CHCKC is expected to carry forward the company's policy of nondiscrimination and
equalemployment
q p yment opportunity in every aspect of employment. All decisions made with respect to
recruiting, hiring, and promotion for all job classifications will be based solely on individual
qualifications related to the requirements of the position. Likewise,all other personnel matters such
as compensation, benefits, transfers, termination's, staff reduction, training, education, and
social/recreational programs will be administered free from any unlawful discriminatory practices.
Anti-Harassment and Discrimination Policy
CHCKC recognizes and values the integrity of its employees and their right to work in an
environment that fosters mutual respect and is free of harassment or discrimination. CHCKC is,
therefore, committed to a policy that prohibits harassment or discrimination based upon any
individual employee's race, color, religion, creed, ancestry, sex, age, national origin, sexual
II orientation,marital status,veteran status,or physical,mental,or sensory disability.
This policy applies to all employees, applicants, vendors, customers, contractors, and any other
person doing business with CHCKC. Harassment and discrimination not only violates CHCKC's
policy but may be a violation of state and federal law.
Harassment is verbal or physical conduct that denigrates, or shows hostility or aversion toward,
an individual because of his or her status as protected by law and that unreasonably interferes
with that individual's work performance or creates an intimidating work environment. Conduct
that the company determines constitutes a violation of this policy will result in strict disciplinary
Employee Handbook Page 4
Fair Employment Practices January 2008
Page 37 of 44
action, including immediate termination. Examples of such conduct include (1)demeaning or
hostile written, graphic,or verbal communications,including off-hand comments,epithets,jokes,
emails, slurs or negative stereotyping directed at any individual because of or regarding that
individual's race, color, religion, creed, ancestry, sex, age, national origin, sexual orientation,
marital status,veteran status,or physical,mental,or sensory disability; (2)hostile,intimidating or
threatening conduct directed at an individual because of that individual's status as protected by
law.
Sexual harassment is one form of harassment. It is also a violation of the law and will not be
tolerated by CHCKC. Sexual harassment is defined as:
Unwelcome sexual advances, requests for sexual favors, or other verbal
or physical conduct of a sexual nature constitute sexual harassment
when: (1)submission to such conduct is made either explicitly or
implicitly a term or condition of the individual's employment;
(2)submission to or rejection of such conduct by an individual is used as
a basis for employment decisions affecting such individual; or (3)such
conduct has the purpose or effect of unreasonably interfering with an
individual's work performance or creating an intimidating, hostile or
offensive working environment.
-Equal Employment Opportunity Commission,29 C.F.R.Part 1604,and"Guidelines on Discrimination Because of Sex."
Discrimination and harassment includes many forms of offensive behavior and can include
gender-based harassment of a person of the same sex as the harasser. Behavior that may violate
this Policy includes: ,
• unwanted sexual advances or making or threatening reprisals after a
negative response to sexual advances
• visual conduct: leering, making sexual gestures, displaying of
sexually suggestive or racially motivated objects or pictures,
cartoons,or posters
• verbal conduct: making or using derogatory comments, epithets,
slurs,jokes,or sexual advances/propositions
• physical conduct: touching, assaulting, impeding, or blocking
movements.
Complaint Procedure
If you feel you have been harassed or discriminated against because of your race,color,religion,
creed, ancestry, sex, age, national origin, sexual orientation, marital status, veteran status, or
physical, mental, or sensory disability, you should immediately contact the Health Center
Manager, Dental Center Manager, Dental Center Supervisor or Human Resources. Your
complaint will be treated seriously and investigated. The investigation may include interviewing
witnesses and gathering other relevant data. The investigation will be as confidential as possible
consistent with the need to conduct a full investigation. If substantiated, appropriate corrective
action will be taken if warranted. This can include a verbal or written warning, suspension, or
termination of employment.
Employee Handbook Page S
Fair Employment Practices January 2008
Page 38 of 44
COMMUNITY HEALTH CENTERS OF KING Couim' PATIENT REGISTRATION
ION
L ame/Apellido paterno First Name/Nombre de pila Middle Name/Segundo nombre
Social Security Number/Nemero de seguro social Birth Date/Fecha de nacimiento Gender/Sexo
❑ M ❑ F
Mailing Address/Direccidn de correos City/Ciudad State/Estado Zip/Cbdigo postal
Home Address(If different)/Domicilio(si es distinto) City/Ciudad State/Estado Zip/Cddigo postal
Do you live within the city limits of your town?
Which colunty do you live in7/LEn que condado vive Ud.? /LVive Ud.dentro de los limites de su eluded?
❑King ❑Pierce 0 Snohomish 0 Other/Otro:
❑Yes/Si ❑No
Check if Primary Phone/ Check if Primary Phone/:
❑ Home Phone/Telefono de la casa: ❑ Alternate Phone Number(s)/Peldfono(s)alterno(s)
❑ Wor Phone/Telefono de trabajo: 0 Emergency Contact Phone/Telefono de emergencia:
d Cell Phone/Telefono de cellular:: Emergency Contact/Contacto de emergencia:
Relationship:
How will you pay for your visits?(Check all that apply) Are you interested in applying for Sliding Scale
/LComo paged sus visitas?(Marque todos los que correspondan) Discount?/LLe interesa solicitar descuento de Escala Mdvil?
❑ Self-pay/Paga Ud.mismo ❑Yes/Si 0 No
❑ Medical Coupons/Cupones medicos Are you interested in applying for affordable health
❑ Insurnce/Aseguranza Insurance?/LLe interesa solicitar aseguranza mddica de bajo costo?
❑ Other/Otro: ❑Yes/SI 0 No
If patient is less than 18:Ni el ii.kienk e,merlin do IX.
Parent/Guardian's Last Name/Apellido de padre o madre/Tutor Parent/Guardian's First Name/Nombre de pita de padre o madre/Tutor
Relationship to Patient Social Security Number Gender/Sexo Birth Date/Fecha de nacimiento
/Parentesco o relacidn al paciente /Ntimero de seguro social ❑ M ❑ F
❑Parent/Padre o Madre
❑Guardlan/Tutor
[ er/lOtro:
Please complete both sides/Favor de completer los dos lados
For office use only/Solo pars use oficial de CHCKC
•
•Witness(CHCKC Staff) Date:
Page 39 of 44
Sliding Scale Category: ❑A ❑B ❑C ❑D ❑E ❑F Insurance:
Answering these questions may help us obtain funding for services.
/Sus respuestas a las siguientes preguntas podrfan ayudarnos a conseguir financiamiento para los servicios que podemos ofrecerle.
W ;your race or biological family background? Are you disabled?/LEsta Ud,Discapacitado?
(Check all that apply)/LCual es la raza suya o la de su familia ❑Yes/Si 0 No
biolegica? (Marque todos los que correspondan)
❑White/Hlanco Are you an Immigrant or refugee?
❑Asian/Asiatico /LEs Ud.inmigrante o refugiado?
❑Black/tegro ❑Yes/Sf 0 No
❑Native Hawaiian/Indio Hawaiano Total number of people in your household(people who
❑Other Pacific Islander/Otro 1slello live in the same house and depend on the same income)
❑American Indian/Alaskan Native/Indio Americano/Indio Alaskeflo Mumero total de personas que viven en su hogar(y dependen del mismo
ingreso)
Are you Hispanic?Os usted Hispano(a)? Total number of children under 18 in your household
/Numer°total de nifos menores de 18 que viven en su hogar
❑Yes/Si ❑No
What language do you usually speak? Which of the following best describes your
/LQud idioms habla Ud.generalmente? household?/LCugl de los siguientes describe mejor a los de su hogar?
❑English/Inglis 0 Married with no dependent children/Casado(a)sin cargas
❑Spanish/Espafiol familiares(nifios)
❑Russfan/Ruso 0 Single Person/Soltero(a)
❑Other/Otro: 0 Single female with dependent children living with you/
Mujer soltera viviendo con cargas familiares(nifios)
Do you use an interpreter?/LNecesita un interprete? 0 Single male with dependent children living with
❑Yes/Si 0 No you/Hombre soltero viviendo con cargas familiares(nifios)
What is your ethnicity or social/cultural background? 0 Two-parent household/Hogar con dos padres
CI all that apply:/LCuaal es su origen etnico u origen social/ 0 Other/Otro:
ce Marque todos los que correspondan:
❑Alaskan Native/Indio Alaskeflo Are you homeless or in a temporary shelter?
❑Cambodian-Khmer/Camboyano-Khmer /LEsta Ud.sin hogar o vive en un refugio temporal?
❑Chinese/Chino 0 Not homeless/Tengo hogar
❑Filipino/Filipino 0 Doubling Up/Compartiendo habitacidn
❑Guam-Chamarro/Guam-Chamarro 0 Street/Calle
El Hmong/Hmong 0 Transitional/En transition
❑Japanose/Japones 0 Public HousIng/Vivienda Publica
❑Korean/Koreano Laotian/Laosiano 0 Shelter/Refugio
❑Mien/Mien 0 Other/Otro:
❑Native American/Indio American°
❑Semoan/Samoyano Are you a migrant or seasonal farm worker?4Trabaja Ud.en
❑Somalian/De Somalia el camp°per temporadas o es un trabajador itinerante?
0 Not a farm worker/No campesino
❑South AS1aNSudasittico ❑Migrant farm worker/Campesino itinerante
❑Talwanese/Taiwanes
❑Thal/Taitandes ❑Seasonal farm worker/Campesino per temporadas
❑Tongan/De Tonga What is your Primary Medical Insurance?
❑Vletnamese/Vietnamita /LCual es su principal aseguranza medics?
❑Other/Otro:
Marital status/Estado civil: How did you hear about this Health Center?
❑Singlel/Soltero(a) /LComo supo Ud.de este Centro de Salud?
o Married/Casado(a)
[ owed/viudo(a) What is your household's monthly income? (The cash
[,_:=Jrced/Divorciado(a) flow that you live on)?/LCuanto es el total del ingreso mensual de
❑Legally Separated/Separado(a)Legalmente las personas que viven en su hogar? (El diner°que usan al mes pam
Are you a veteran?/as Ud.veteran°de guerra? vivir.)
❑Yes/Si ❑No $ per month/al mes
Page 40 of 44
tr�i')n •�� ..�J�l_J I/ r.AMA
COMMUNITY HEALTH CENTERS OF KING COUNTY N MEDICAL FRONT OFFICE MANUAL
Sliding Scale Eligibility
1. Check patient's sliding scale eligibility status In NextGen..
2. I patient is not currently eligible for the discount, ask if they would like to fill out an application.
Participation is optional.
3. Ask patient to show proof of income for every individual in the household who has income. The
following are acceptable:
a. Payroll check that shows year-to-date income or 1 month's worth of pay stubs.
b. Wage statements (written statement from employer).
c. One month's worth of unemployment check stubs.
dl Bank statement that shows flow of money in/out of account.
e. Statement from Social Security office.
f. Letter from individual who supports patient financially. Must state a dollar amount.
g. Income tax forms (first page only).
h. W-2 form.
i. For business owners, look at profit/loss statement, line 7, on tax form.
4. Photocopy income verification documents. Return originals to the patient.
If the patient does not have proof of income and it is not their first visit:
a. Inform patient that they will be charged full fee for today's services.
b. Instruct patient to bring proof of income on their next visit to qualify for sliding scale.
c. File application form in patient's chart. No further action is necessary on this visit.
b. Once patient has satisfactorily shown proof of income for every income earner in the household,
sign, date, and indicate sliding scale category in gray box at bottom of form.
7. Enter information into NextGen. (Multiply monthly income by 12 to get annual income.)
8. File application in patient's chart under"PT INFO"tab, on top of the registration forms.
sliding scale eligibility Last updated:7/16/2007 Page 1 of 4
Page 41 of 44
race period for new patients
__ew patients are eligible to receive a sliding scale discount for their first visit without showing proof
of income, if they fill out an application form. Enter today's date as the expiration date in NextGen.
Inform the patient that a sliding scale discount will not apply to any future visits until they bring proof
of income. Any patient who is new to NextGen may be considered a new patient.
Unable to show proof of income
If an applicant presents a reasonable case for why they cannot provide proof of income for
themselves, ask them to compose, sign, and date a statement to that effect. Accept that statement
as proof of income. If the applicant is unable to show proof of income for another person in their
household, however, they may not claim that individual as part of their household. (Please see
definition of income and household size on next page)
Zero income
If the patient claims zero income for themselves or other adult members of the household, remind
therm of our definition of income and ask screening questions such as"Who supports you?""How do
you pay for your living?"etc. Zero income may only be accepted with a verification letter—without
that letter, they will be full fee.
Accurate effective and expiration dates
It is critical that the verify/effective date and the expiration date are accurate. Entering today's date
or a future expiration date for someone who is unqualified to receive the sliding scale discount may
-"suit in disciplinary action. Also, because the patient accounts department needs accurate historical
formation about the patient's sliding scale eligibility, be sure to create a new sliding scale profile
every time a new application is completed. Do not save new dates on top of the previous profile.
VeriTication/effective dates should not change. Expiration dates should only change if household size
or income changes. When expiring an outdated eligibility, you would usually set.the expiration date
earlier than yesterday's date. Setting it too far back would confuse appropriate billing of past
encounters.
Other household members, other CHCKC sites
If ti1e discount will be used at other CHCKC sites, or if the discount will be used by more household
members beyond just the applicant, create the eligibility profile in NextGen for every household
member and add a note In each household member's account listing names and birthdates of all the
individuals on the application. Also, distribute copies of the paper information to every chart for
every household member at every clinic.
Paper charts
If there are people in your clinic who refer to the paper chart for eligibility, be sure to update sliding
scale information in the paper chart in all 3 places (patient registration form, sliding scale application,
and patient labels.)
Nothing in the chart
If you wish to refer to a patient's application or income verification and cannot locate them in the
chat, look at the who/when button by the verification date in NextGen, and/or the notes section in
le account. Either place should give you clues as to where find the documentation. Use the"clinic-
- to-clinic records request"form to request the documents from the other site. Never require a patient
to Complete a new application simply because you have not found the application form in their chart.
sliding scale eligibility Lat updated:7/16/2007 Page 2 of 4
Page 42 of 44
Iffemployed
_r business owners, look at profit/loss statement, line 7, on tax form.
Changes to Income or household size:
If an established patient who is currently receiving sliding scale has a change to their income or
household size, and the new amount does not change their sliding scale category, they do not need
to reerify income. If the new amount does change which sliding scale category they qualify for,
change their expiration date to today's date and explain to the patient: "Your income (or household
size) has changed significantly enough to put you in a different sliding scale category. For today's
visit,your charges will be based on the income you verified with us previously. Because of the
change in your household income (or household size), your sliding scale eligibility needs to be
reevaluated. You will need to fill out a new application and verify the new income amount."
Definition of Income; "the cash flow on which ou and those in our household live"
ncome Not income
Salary Child support
Interest from savings Financial assets (stocks, bonds, account
balances)
Dividends from stocks, bonds, mutual funds, etc. Physical assets (items you would have to sell or
liquidate to convert to income such as a home,
boat, etc.)
Monetary gifts Money drawn from a credit card
ans, scholarships, or grants for living expenses
mony
Welfare
Unemployment
Grants
Assets that have been converted to cash flow
Money that has been drawn from savings account
Definition of household size
People that live in the same home and depend on the same income, not including foster children.
Household Size for Homeless
For homeless patients, household size should include those people that the patient stays with,
transitions with, and shares income with.
Seasonal workers
To determine monthly Income for an individual who works during some months of the year, you may
take their yearly income and divide by 12.
WA State Residents
Patients do not need to be WA State residents to be eligible.
,ivacy
the patient feels uncomfortable discussing Income or personal information in the lobby, ask the
patient if they would like to speak In a more private location, like the manager's office, exam room,
sliding scale eligibility Last updated:7/16/2007 Page 3 of 4
Page 43 of 44
,:h CSR's office. Some clinics regularly have the CSRs spend time with patients who have
_...icttity with the income verification process.
Sliding scale categories are based on Federal Poverty Levels as listed below.
Do not share the information below with patients:
a. Category A: up to 100% of Federal Poverty Level
b. 'Category B: up to 125%
c. Category C: up to 150%
• d. Category D: up to 175%
e. Category E: up to 200%
f. Category F: over 200% (no discount)
Dollar amounts for the 2007 category cut offs are listed below.
Do not share this information with patients.
Persons in
Family A B C D E Full
1 10,210 12,763 15,315 17,868 20,420 20,421
2 13,690 17,113 20,535 23,958 27,380 27,381
3 17,170 21,463 25,755 30,048 34,340 34,341
4 20,650 25,813 30,975 36,138 41,300 41,301
5 24,130 30,163 36,195 42,228 48,260 48,261
6 27,610 34,513 41,415 48,318 55,220 55,221
7 31,090 38,863 46,635 54,408 62,180 62,181
8 34,570 43,213 51,855 60,498 69,140 69,141
9 38,050 47,563 57,075 66,588 76,100 76,101
10 41,530 51,913 62,295 72,678 83,060 83,061
11 45,010 56,263 67,515 78,768 90,020 90,021
12 48,490 60,613 72,735 84,858 96,980 96,981
13 51,970 64,963 77,955 90,948 103,940 103,941
14 55,450 69,313 83,175 97,038 110,900 110,901
sliding scale eligibility Last updated:7/16/2007 Page 4 of 4
Page 44 of 44
I
_ 1
f - 12
I
I�
(1--
Application Cover Pages (Agency Information and Questions 1 —7)
'Agency Information- ;
Agency Name: Emergency Feeding Program / APR 2 5 2008
Applicant Name and Address:
pp s Agency Director:
CITY OF RENTON
Emergency Feeding Program of Seattle&King County Arthur;RA. ,eeExecutiye\,Director,
P.Q.Box 18877 Name=and=Title
Seattle,WA 98118-0877 (206)329-0300
(Area Code)Telephone
info@emergencyfeeding.org (206) 860-8200
E-mail address(if available) (Area Code)Fax Number
Required signatures: By signing below,you certify that the information ' this application is accurate to
the,I best of your knowledge and that you have read the applicatio , ifica s,and appendixe .
NAT S MUST BE IN BLUE INIC)
9-6
Signature of Agency Board President/Date Signature of Agency77irector/Date
Constance Bown Arthur R.Lee
Printed Name of Agency Board President Printed Name of Agency Director
{, ,;...
Pro .ram rif®rrria on
1. Program Name Emergency Feeding Program of Seattle&King County
Contact Person(available to answer specific questions on this application)
•
Sam Osborne,Development Director (206)329-0300
Name (Area Code)Telephone
(same as above)
address(if different than above)
sam@emergencyfeeding.org (206)860-8200
E-mail address(if available) (Area Code)Fax Number
2. Program is New for our agency ❑An Ongoing Program
3. Bril f Description of Program (One sentence)
EFP assembles and distributes 14 varieties of nonperishable emergency food packs, and distributes them to
people in crisis through nearly 120 partnering agencies throughout King County,feeding around 50,000 annually.
4. Where are services provided? (If different from agency location)
While the Program's main office and warehouse are located in central Seattle,food is distributed at multiple
locations including social service agencies,faith communities and food banks all over King County.
Page 1
5. 11otal Program Cost:
(Actual 2007: $289,580. Proposed 2009: $405,000.
Projected 2008: $379,297.
6. T,ota1 City Funds Requested for this Program:
City Awarded 2008 Requested 2009*
General Fund CDBG Total Requested**
Auburn $0. $0. $4,500.
Federal Way $7,800. $0. $10,000.
Kent $0. $0. $22,650.
Renton $0. $10,000. $10,000.
1
City Awarded 2008 Requested 2009*
General Fund General Fund
Burien $0. $0.
Col vington $0. $0.
Des Moines $0. $3,000.
Enumclaw $0. $0.
SeaTac $0. $2,500.
Tukwila $0. $0.
*Cities on a two year funding cycle will renew 2009 awards to 2010 based upon performance and availability of funds. See
Part II for city specific information.
**Include your total request for Auburn,Federal Way Kent and Renton. The source of funding will be determined by staff.
Page 2
7. Agency Contact Sheet
Provide the following information for the agency and for the program requesting funds.
Agency Contacts
General Agency Name: Emergency Feeding Program of Seattle—King County
Address: P.O.Box 18877
City/State/Zip: Seattle,WA 98118-0877
Phone/Fax: (206)329-0300
Agency Web Address: www.emergencyfeeding.org
Executive Director Name: Arthur R.Lee
Title: Executive Director
Direct Phone: (206)329-0300
E-Mail: arthurrlee@emergencyfeeding.org
Development Director Name: Sam Osborne
(or Gr allt Writer) Title: Development Director
Direct Phone: (206)329-0300
E-Mail: sam@emergencyfeeding.org
Finance/Accountant Name: Deidre Crawford
(person preparing invoices) Title: Bookkeeper
Direct Phone: (206)329-0300
E-Mail: dcrawford@emergencyfeeding.org
Program Contact
(Staff contact for contracting, reporting and program implementation.)
Progr i m Name: Emergency Feeding Program of Seattle&King County
Staff Name: Brian Anderson
Title: Program Director
Direct Phone: (206)329-0300
E-Mail: brianAemergencyfeeding.org
Page 3
A plication Narrative Section (Questions 8 — 12)
8. ORGANIZATIONAL EXPERIENCE (2 page maximum)
A. Experience.
Sin e 1977,the Emergency Feeding Program of Seattle &King County has assembled and distributed
nonperishable grocery packs designed in concert with nutritionists to meet current USDA nutrition
guidelines and serve as an adequate two-day supply of emergency food, regardless of family size or
special dietary needs or preferences. Over 31 years, we have developed 14 varieties of food packs, each
wits specific diets in mind. For example, in addition to three sizes of typical American diet food packs,
we also assemble family-sized bags of groceries to specifically address the needs of Latino,Asian, vegan
or l�ctose intolerant, Diabetic, and low-sodium diets. We also have a high-protein liquid pack for people
who are too ill to eat solid foods, and two sizes of ready-to-eat foods for homeless individuals and
fair ilies. Our convenient and popular Snack Pack was designed especially for(and with the help of)
ho eless teens, and we even provide a week's worth of infant formula for the youngest among us, and a
week's supply of starter foods for older babies. We distribute these food packs via a network of 120
parnering social service agency and faith community locations countywide, distributing enough food to
fee an average of over 50,000 individuals annually.
B. Operational Structure.
Th Emergency Feeding Program is currently composed of a small, dedicated staff of two full-time
(E ecutive Director and Development Director) and two three-quarter-time individuals (Program Director
an Warehouse Manager), a contract bookkeeper, and over 1,000 active volunteers. If funds are secured
late .this year, we intend to hire an additional support staff person. A Board of Directors (currently with
six embers) oversees policy and evaluates senior staff performance. Arthur R. Lee has served as EFP's
Executive Director since 1991. Under his leadership,EFP has introduced several special diet food packs
incuding the Latino and Teen Snack Packs, and the Vegan Pack. In 2008, we are in the process of
de (Ieloping an East African Pack. The annual Mayors' Day of Concern for the Hungry food drive has
grown to encompass 25 cities in King County. Arthur is a well-known, well-respected member of both
the wider community and the social service delivery arena in King County. Sam Osborne has served as
EF 's Development Director since early 2003. Prior to working with EFP directly, he served as
Ex ecutive Director for one of EFP's highest-volume distribution sites from 1999 to 2002. Brian
Anderson, EFP's Operations Director began his relationship with EFP as the program's liaison at Central
Lutheran Church in Capitol Hill, until joining our staff in late 2003. Gregory Peace, EFP's Warehouse
Manager and Driver,joined our staff in 2007 after starting as a paid volunteer through a program of
AARP. EFP staff are active members in various regional coalitions including Seattle Food Committee,
Seattle Human Services Coalition, Eastside Interfaith Social Concerns Committee, Washington Food
Coalition, and South King County Food Coalition.
The Emergency Feeding Program's Board of Directors meets on the third Wednesday of each month for a
two-hour meeting. Once per year,the Board takes an all-day retreat, usually facilitated by a board
development professional. Board meetings include reports from senior staff, updates on current program
needs, financial and resource development reports, board development suggestions, and any policy or
planning actions needed. One of the reports Board members receive shows a breakdown of service levels
and geographic areas. Through these,they are able to stay informed of trends in South King County.
Adotitionally, one of our Board members is also an Emergency Feeding Program distribution site
volteer at one of our Renton locations, where she is a resident. Thus is she also able to provide
anecdotal stories regarding her personal experiences serving South King County residents. The EFP
r Board steers the long-range and strategic planning for the organization,provides financial oversight,
evaluates the Executive Director, and supports staff in ongoing fund raising efforts. Currently,the Board
is composed of four African American women, one African American man, and one Caucasian woman.
Page 4
Twb reside in Northeast King County, one in South King County, and three in Seattle. Four are in the 35
to 4 age bracket, with the other two over 55. We have Board member openings actively listed on four
webIsites as part of a push this year to build up the Board's capacity and diversity in terms of both
race/ethnicity and also in terms of age, experience,professional skills and geography.
9. NEED FOR YOUR PROGRAM(2 page maximum)
A. Problem Statement.
Washington now ranks 12th in food insecurity among the states. Last year in Washington State, 1.2
million people utilized supplemental food bank services. United States Department of Agriculture
statistics show that in 2007, an estimated 251,000 Washington households lived with hunger or the threat
of t
unger. In King County alone,the Emergency Feeding Program delivered enough food last year to
feeover 50,000 people. Over 26% of these people were residents of South King County. And while
Washington no longer ranks in the nation's top 10 worst for food insecurity,this is not because conditions
halie improved in our state; it's because conditions have gotten worse elsewhere. This tells us that as a
state, we're merely doing a passable job of addressing the nutrition needs of vulnerable populations. We
could be doing a lot better,but food distributors, food banks, and other providers like the Emergency
Feckling Program are strained to the breaking point. With the wholesale inflation rate tripling in the
month of March this year, and the rising costs of fuel and retail food, both vulnerable populations and the
programs that serve them are facing extraordinarily tough times ahead. The specific aspect of this
nationwide problem addressed by the Emergency Feeding Program is hunger crisis, which we define as an
immediate and emergency inability to obtain food for oneself and/or one's family. Hunger crisis can arise
from a host of factors, usually in combination of one or more, such as loss of job(s), loss of home,
physical or mental illness, domestic abuse, drug addiction, exorbitant utility bills,natural disasters, etc.
B. Target Population.
Thg Emergency Feeding Program has seen significant growth in demand for services within the last few
years, even as resources have dwindled. Of the many people accessing our food packs each year all over
King County, about 40% are children age 0 to 18. About 50% are in the 19 to 54 age bracket,with the
remaining 10%in the 55 and over range. Close to 100% of EFP food recipients report incomes well
below federal poverty level, with about 20% of our clients being homeless. While we see many
individuals,the majority of our clients are families with one to six children. Based on data from intake
cards,we determined that one of our food packs feeds an average of 3.8 persons. Racially and ethnically,
program service recipients are on average 50% Caucasian, 30%African American, 10%Latino, and 10%
Native American, Asian, or Pacific Islander. Gender balance among.recipients is approximately equal
between males and females, with a handful of transgendered persons using our program each year.
Reasons for needing emergency food span the full gamut of human difficulties, from physical or mental
illness and disability to domestic violence,homelessness to job loss. We tend to see that the vast
majority, including homeless, do report an income source, even if the income reported is exceedingly
small,with the vast majority being at or below 50% of HUD-defined poverty income levels.
Ge91graphically, 61%of our service recipients are residents of Seattle, with 26% served in South King
Co' ty, and the remaining 13%being residents of Northeast King County.
Page 5
10. PROPOSED PROGRAM/S'ERVICE (See page maximums to each part of this Question below.)
A. Program Description. (2 page maximum)
The Emergency Feeding Program will provide emergency food packs (see Question 8a)to partnering
social service agencies, food banks, schools and faith community locations throughout King County.
These food packs will be available in types and quantities requested by each individual agency, at no
charge to the agency. They will be assembled at a central warehouse in Seattle and delivered upon
request. Prepared food packs are loaded into one of our two delivery vehicles (a cargo van purchased for
us by Boeing, or a 14' box truck purchased with assistance from the State of Washington) and deliveries
are made five days a week. In South King County,the following locations are partners with EFP in
distributing food packs, either to walk-in clients or, in some cases, exclusively for their own clients:
AUBURN: Family of Grace Lutheran Church, DSHS Auburn CSO, Grace Community Church, Auburn
WIC, Green River Community College, Valley Cities Counseling, Seattle Mental Health, and Auburn
Youth Resources are active partners with the Emergency Feeding Program.
DES MOINES: Salt and Light Church and Parkside Elementary School are active partners with us,
however, residents of Des Moines access EFP food packs at other locations in the area as well such as
Boulevard Park Presbyterian Church, Ruth Dykeman Youth and Family Services in Burien, and Beautiful
1.
Saiior Lutheran Church in SeaTac. FEDERAL WAY: Christian Faith Center, Valley Cities
(Laurelwood Gardens), St. Luke's Community Church, Calvary Lutheran Church, and the DSHS Federal
WaV CSO are all active participants with EFP. KENT: Public Health offices at Alder Square and at the
Kent Teen Clinic, Appian Way Family Support Center, DSHS Community Service Office, Kent First
Presbyterian Church, Valley Cities Counseling, and the Nike Shelter all provide food packs from EFP.
RENTON: DSHS Renton CSO, SE Program for Assertive Community Treatment, Daystar Baptist
Church,the YWCA, Harambee Church, St. Matthew's Lutheran Church, and Aging and Disability
Services all partner with EFP to ensure their clients (and anyone in need of food)receives what they need.
SEATAC: While residents of SeaTac may'access food packs at Beautiful Savior Lutheran Church,
depending on their exact location, many of them also find EFP food more convenient at other locations
such as Boulevard Park Presbyterian Church, Ruth Dykeman, or other locations in Renton, south Seattle,
and White Center.
People in need of emergency food are either referred to one of our distributing partners via a network of
an additional 85 agencies countywide, or else offered food directly on-site at the agencies listed above and
oth rs throughout the rest of the County. For many residents of King County, "211" or the Community
Information Line administered through Crisis Clinic is a front door to the Emergency Feeding Program as
well. Beyond that, "word on the street"travels fast, and often people hear about EFP food packs from
friends, family or neighbors. Part of our marketing efforts in 2008 will be to implement an advertising
campaign developed for the Emergency Feeding Program pro bono by a leading local creative agency.
Finding funds to help us place ads on busses and/or billboards will also help people in need know exactly
where to turn when obtaining food becomes a crisis situation. For now,we have fliers posted on bulletin
boards in several "front-line" agencies such as Public Health and DSHS offices that do not themselves
stock our bags on-site.
Because the Emergency Feeding Program knows that over a quarter million households in Washington
experience hunger or the threat of hunger, we directly address this problem in King County by making our
food packs available at as many locations as possible—places where people are likely to go first when
crisis strikes. For 31 years we have operated at the forefront of crisis in the lives of millions, helping to at
least meet the basic human need of healthy food at-times when any food at all is scarce or unobtainable.
Additionally, because people are most frequently referred to EFP food by a social service agency(or more
often are receiving the food directly at a social service agency), we know that they are not only receiving
food; they are receiving information on other community resources available to them to help address,the
underlying causes that precipitated their crisis situation in the first place. If hunger brings them in for
Page 6
fo d, we know they leave not only with a heavy bag of groceries, but also armed with knowledge that can
help put them back on their feet and set them on a path toward independence and solvency rather than
keeping them locked into a pattern of dependency on programs like EFP.
The Emergency Feeding Program has always striven to address the needs of the wide array of diverse
cultures that populate King County. Toward this end, we have developed specific food packs for Asian,
Latino, and Vegan populations, and are now in the midst of launching a new East African Pack to meet
the needs of this growing immigrant group in our region. Our intake card is now available in English or
Spanish, and we hope to have it translated into one or more Asian languages soon, and possibly Amharic
as well. When we have need of translation services,we have ample resources on which to call through
our network of partnering agencies. In addition to these culturally-specific needs, EFP also addresses
medical dietary needs with our Diabetic, Low-Sodium, and High-Protein Liquid Diet Packs.
While we do not propose any sweeping programmatic changes in 2009-10, we will be making some
significant logistical changes in late 2010. The City of Seattle is now in negotiations to obtain our current
warehouse/office property from its present owners,the Central Area Motivation Program. Once the City
takes ownership, we are assured safe haven through the end of 2010, at which time we will have to move.
We are presently gearing up for a major capital campaign with the intent of purchasing (possibly building)
our own space in anticipation of this eventuality (also see Question 11).
The Emergency Feeding Program would not exist without the many partnerships as detailed above. Many
of our partnering agencies—including some of the DSHS offices—quite literally rejoice when they see us
arrive, as the service we allow them to provide to their clients is so tremendously valued and appreciated.
We ask very little in return: for every bag that is handed to a person, a simple intake card should be
completed and returned to us at the end of each month for tabulation and reporting purposes. Convincing
120 agencies (some of whom operate on an entirely volunteer basis) of the vast import of doing this
properly and on-time is no easy task and has proven a perennial challenge for us over three decades. We
know exactly how many bags we bring to any given agency in a given month, and when we return with
moire food the next month to find the shelves bare and a scant handful of intake cards in return, it is,
needless to say, disheartening. Our staff keeps diligent track of bags packed and delivered, and it is these
numbers on which the statistics in the data tables below are based, intimately informed by what data we
are able to retrieve from our partnering agencies.
Page 7
B. Performance Measures and Outcomes. (1 page maximum)
—, Performance Measure: Food Packs delivered to partner agencies.
Outcome: Increase the amount of nutritionally-balanced, culturally and medically appropriate
nonperishable emergency food available to residents of South King County.
Indicator: Signed, dated delivery receipts show exactly how much food is delivered and immediately
available where and when.
Pe formance Measure: Meals Provided
Outcome: Immediate reduction in short-term emergency hunger.
Indicator: At least 96% of respondents say that EFP food will meet their needs for at least two days.*
Performance Measure: Referrals Given
Outcome: Increased knowledge of available community resources to address underlying problems.
In icator: At least 87% of EFP food recipients report that they were given information on other
resources (besides food) and that this information will be helpful.*
* Our intake card concludes with three"customer satisfaction" questions, and the data quoted in the
second and third Indicators is based on responses to those questions.
Page 8
C. Staffing Plan & Evaluation. (1 page maximum)
. Staffing Plan.
The Emergency Feeding Program functions at a high level with a bare minimum of paid staff. Two
full-time and two three-quarter time employees administrate and execute the program, along with the
help of countless volunteer individuals and groups. The Executive Director(full-time) oversees all
aspects of the program and supervises and evaluates other staff. EFP's current Executive Director,
Arthur Lee, has held the title for 17 years and has navigated the program through drought and storm,
feast and famine. A seasoned professional with a vast network of community relationships, Mr. Lee is
truly a man who takes the mission and success of this program first and foremost in his life, second
;only to family. He holds a Bachelor's Degree from Southern University. Prior to working with EFP,
he served as a contract manager with the City of Seattle's Human Services Department. The
Development Director(full-time) is responsible for the financial well-being of the Emergency Feeding
Program. Sam Osborne, who has held this post for over five years, does his best to insure that
adequate funds are always available to meet the staggering need for food in our community. Osborne
has worked in nonprofit administration and development for 11 years in both human services and
;academic settings. He holds a Master's Degree from Seattle University. The Program Director
((three-quarter-time) oversees the daily delivery schedule, engenders and maintains relationships with
gall partnering agencies, and coordinates other events and partnerships such as food drives in
(cooperation with schools, businesses, and faith communities. Our Program Director Brian Anderson,
once a full-time father of three daughters, came to work with us in late 2003 as an office manager and
,rapidly proved his worth was well beyond that job description. He holds a Bachelor's Degree from
;the University of Minnesota. The Warehouse Manager/Delivery Driver(three-quarter-time) is
'responsible for maintaining adequate food inventory, rotating stock,training and supervising
warehouse volunteers, and making daily food deliveries. Gregory Peace, a volunteer in 2005-06,
!returned to us in early 2007 as a regular employee in this position after showing his tireless dedication
and love our work, as well as extensive knowledge of the highways and byways of King County.
Additionally, volunteers are present daily in the EFP warehouse and offices,performing a host of
tasks that would leave our miniscule staff exhausted at the end of the day. From packing bags to
sorting donated food, from repackaging bulk rice, beans, oatmeal and cereal to mopping the floors,
'and from data entry to cleaning the parking lot,volunteers are the lifeblood of the Emergency Feeding
Program. Without them, we would simply cease to function. Individual volunteers come either of
;their own accord or by order the Court system,while groups come from schools, faith communities,
I'businesses and civic organizations.
ii. Evaluation.
The Emergency Feeding Program is evaluated on multiple levels at all times. First and foremost,
many of our funders ask for monthly, quarterly, and/or yearly reports. These in and of themselves are
usually enough to tell us whether we are doing what we set out to do. Weekly staff meetings and
monthly Board meetings also serve in this capacity. Feedback from staff at our partner sites helps us
also tremendously in keeping a finger on the pulse of our daily operations. Further, feedback from
clients has caused us to alter the contents of some of our food packs (e.g., replacing taco shells in our
'Latino Pack with tostadas instead), and is always both heard and taken to heart in all earnestness.
Statistics compiled to measure the indicators as outlined above in the Performance Measures and
Outcomes (part B of this question) are also solid tools for evaluating both the effectiveness of our
I ability to meet client demand and,more importantly, client satisfaction. We are always looking for
ways to improve client satisfaction, and all these ways of analyzing our work contribute to serving
those in need with compassion, integrity and deep respect.
Page 9
D. Differences in Service Delivery by City. (2 page maximum)
Differences in service delivery by city are dependent on a number of factors for the Emergency Feeding
Program. One is obviously population size: a larger city will naturally have more people in need of
emergency food. Another is economic health: a city with low unemployment will naturally have fewer
people in need of help. Most importantly, in looking at the last column of Question 14c,the reader may
note that average cost of service per client is slightly different for each city listed. This is mainly due to
the number and types of bags delivered to.our partners in those cities. For example, one may ask why the
average cost for a Federal Way client is at least a dollar higher than most other cities, at$6.75. The
reason is simple: our partners in Federal Way distribute more of our larger (more expensive) food packs
than other cities in South King County. With the average cost of an EFP food pack at$17.01
(recalculated to reflect the recent spikes in wholesale food cost), Federal Way residents are accessing
more family-sized bags than, for example, Seattle, where there are more individuals using our program,
thuip reducing the average cost per client by half In any case, average cost per client countywide is $5.02.
The amount of funds requested in each city is approximately 75% (give or take a point or two) of the total
cost to bring our services to that city (based on 2007 figures).
Page 10
11. LONG RANGE PLAN (1 page maximum)
Our distributing partnerships with agencies, food banks, schools and faith communities have grown from
85 in 2005 to 120 in 2008. There does not appear to be any slack on the horizon for demand on the
serYices the Emergency Feeding Program provides. Thus, our long range plans include securing funding
from King County cities that do not currently support EFP, as well as support from additional major
donors in every other category, from foundations to corporations, federal grants to individuals. In the Fall
of 2008, we will hold our first annual charity dinner/auction,which we anticipate being a success.
Beond that,we know that the time in our present office/warehouse is limited. While we are physically
saf I until late 2010,the City of Seattle then plans to demolish our current site in order to build a new fire
station. Therefore, we are preparing for a major capital campaign and looking not too far down the road
at the very real possibility of obtaining our own property and building. Depending on availability of
capital funds, we will apply to several cities, as well as other sources for major financial support to help
us move into a new space and a new era for the Emergency Feeding Program. This will require that we
succeed in our current efforts to significantly increase our annual revenues. While we now have several
ver al pledges of major support and assistance in helping us with this transition, we will seek the support
an assistance of other cities we serve as well over the next two years. Beyond this move,we look toward
co inuing to increase our ability to meet the needs in the community, no matter how much we may feel
the inch from high fuel costs and wholesale food inflation. Simply put, over the next three to five years,
we will be looking for funding from sources we have never tapped, others who may have supported us in
the past but have lapsed, and of course, as always, new donors—both individual and corporate,municipal
and private. We anticipate meeting these challenges with courage, determination, and ultimate success.
Long range strategic planning will be a major focus of our upcoming Board retreat in May of this year.
Page 11
12. BUDGET(2 page maximum)
A. Budget Request Narrative.
Funds requested from South King County municipalities would be used primarily for operating expenses,
namely staff salaries, food purchase and delivery vehicle fuel. Typically, in the past we have divided
municipal funding into these two areas (operations and direct client services). However, it should be
noed that more cities awarding funding to the Emergency Feeding Program means more money we can
dedicate to direct client services, and thus more people served. This question assuredly remains open to
negotiation with each individual city at the contract phase, should we be granted funds.
B. Changes to Budget.
Between 2007 and 2008, the Emergency Feeding Program has nearly doubled our annual fund raising
goals. It is our sincere intent to bring in enough additional funds this year,through foundation and
individual contributions,to hire at least one additional staff person to handle routine clerical tasks
including data entry and general office support. Additional dollars allocated to staff would also go toward
upgrading at least one of our part-time positions to full-time. Aside from these items, there are no other
significant changes.
C. Cost per Service Unit(s).
Cost Per Service Unit: $ 0.75
Explanation of how determined:
One service unit= one meal.
Method of calculation: Number and type of each bag delivered to each city served by EFP is then
multiplied by 3.8 (average number of persons fed by one bag). This number is then multiplied by 6 to
determine the number of meals provided in each city(each bag averaging as a two-day supply of food at
three meals per day). Total cost of providing services to each city (calculated exactly to include food cost
anti transportation/human resources) is divided by the number of meals provided there. Individual cities
vary slightly in their individual cost units due to the differences in cost of each bag. For example, we may
deliver more of our Large bags (at$24.35 each)to one city, while we might deliver more Small bags (at
$11.62 each)to another city. The number listed in the blank above is a mean calculation, taking total
program numbers into account. We arrived at this mean from individual city unit costs using the method
in the example given below.
Exaimple:
NulFiber of food packs delivered to locations in the City of Kent in 2007: 1,744
Total cost(including food, transportation and human resources) of providing these services to Kent in
2007=$29,806.89
1,744Abags x 3.8 persons= 6,627 people
6,627 people x 6 meals per person= 39,762 meals
Total program cost_number of meals (29,806.89/39,762) = $0.749
Page 12
Data Table Requirements (Questions 13 — 18)
Agency:Emergency Feeding Program
Program:Emergency Feeding Program
13. NUMBER of INDIVIDUALS/HOUSEHOLDS SERVED BY PROGRAM
® Individuals? or El Households? (Check which applies and use for reporting all demographics.)
Unduplicated
*Unduplicated Number of all Clients Served by Clients Served
All Funding Sources with Funds
Requested
2007 2009
2007 %of column 1 2008 2009 (City Requested
(Actual) clients served (Anticipated) (Projected) Funding Only)
by City
Auburn 1,045 1.87% 1,050 1,050 815
I
Burien 175 0.31% 175 175 0
Co ington 8 0.01% 10 10 0
Des Moines 965 1.73% 975 975 674
I
Enumclaw 0 0.00% 0 0 0
I
Federal Way 2,466 4.42% 2,500 2,500 1,481
Kent 6,627 11.87% 6,650 6,650 5,053
Renton 2,896 5.19% 2,900 2,900 2,206
I
Seal Tac 483 0.86% 500 500 400
Se i the 33,847 60.60% 34,000 34,000 19,040
Tukwila 0 0.00% 0 0 0
I
Other 7,338 13.14% 7,350
100%
Total 55,850 (This column must 56,110 56,110 29,669
total 100%)
*Unduplicated means count each client only once per calendar year per program. This number should match the number '
of clients by city indicated in the top row of Question 15.
**Other=residents of NE King County.
Page 13
Agency:Emergency Feeding Program
14. Performance Measures (Data Table) Program:Emergency Feeding Program
14a. Service with 2009 Requested Funds
Proposed Performance Measures as defined below.
A)'Food Packs Delivered B)Meals Provided C)Referrals Given
Auburn 215 4,902 215
I
Burien 0 0 0
I
Co ington 0 0 0
Des Moines 177 4,036 177
Enumclaw 0 0 0
I
Federal Way 390 8,886 390
Ke 1 t 1,330 30,324 1,330
Renton 581 13,247 581
I
Sealfac 105 2,394 105
Seal tle 5,011 114,251 5,011
Tukwila 0 0 0
I
1:4b. Performance Measures"20090 Proposed with funds requested City Funding Only a;;
Tile: Brief explanation:
A)Food Packs Delivered Number of nonperishable grocery bags delivered
B) Meals Provided Average bag feeds 3.8 people multiplied by six meals each
Information given with each food pack on other available
C) Referrals Given community resources to help address underlying problems
Page 14
Agency:Emergency Feeding Program
14 Performance Measures (Data Table), Cont. Program:Emergency Feeding Program
14c. Average Cost of Service
Unduplicated Clients
Served with Funds Average Cost of Service
Requested 2009 Requested 2009 per Client
(Same as last column of (Same as last column of
Question 6) Question 13) Column 1 divided by Column 2
Example: $5,000 45 $111.11
Aul i urn $4,500 815 $5.52
Buien $0 0 $0
Coiington $0 0 $0
Des Moines $3,000 674 $4.45
Enumclaw $0 0 $0
I
Fedl ral Way $10,000 1,481 $6.75
Ke It $22,650 5,053 $4.48
Renton $10,000 2,206 $4.53
Seaac $2,500 400 $6.25
Seattle $60,000 19,040 $3.15
Tukwila $0 0 $0
Page 15
Complete Question 15 with 2007 Actual numbers reported in column 1 of Question 13. Agency:Emergency Feeding Program
15. Demographics (from all funding sources) (Data Table) Program:Emergency Feeding Program
_ a
Client Residence o 0 a.)
o a) 0 a�i aa)i aa)i 0 O
MI C.) Q W .1-4Gz; r/D CA H E-I
Unduplicated
(check one) v, vo N N N
®Individuals o oo o vD ono oMo o �?
Households °1 cr o
N �O N M 7r
" jServed in 2007*
Household Income Level . " ,
30%0 of Median or Below 711 119 6 656 0 1,677 4,506 1,969 328 23,016 0 k 32,988
50°'o of Median or Below 178 30 1 164 0 419 1,127 493 82 5,754 0 8,247
80°/0 of Median or Below
Above 80%of Median
Unknown 156 26 1 145 0 370 994 434 73 5,077 0 7,277
1 TOTAL 1,045 175 8 965 0 2,466 6,627 2,896 483 33,847 0 48,512
Gender;
Male 554 93 4 511 0 1307 3,512 1,535 256 17,939 0 25,711
Female 491 82 4 454 0 1159 3,115 1,361 227 15,908 0 22,801
TOTAL 1,045 175 8 965 0 2,466 6,627 2,896 483 33,847 0 48,512
Age •
0-4 years 125 21 1 _ 116 0 296 795 348 58 _ 4,062 0 5,821
5- 12 years 52 9 0 48 0 123 331 145 24 1,692 0 2,426
13- 17 years 105 18 1 97 0 247 663 290 48 3,385 0 4,851
18-34 years 240 40 2 222 0 567 1,524 666 111 7,785 0 11,158
35-54 years 460 77 4 425 0 1,085 2,916 1,274 213 14,893 0 21,345
55-74 years 21 4 0 19 0 49 133 58 10 677 0 970
75+years . 11 2 0 • 10 0 25 66 29 5 339 0 485
Unknown 31 5 0 29 0 74 199 87 15 1015 0 1,455
TOTAL 1,045 175 8 965 0 2,466 6,627 2,896 483 33,847 0 48,512
.Ethnicity , '
Asian 36 6 0 33 0 84 225 99 16 1,151 0 1,649
Black/African American 230 39 0 212 0 543 1,458 637 106 7,446 0 10,673
Hispanic/Latino(a) 100 17 2 93 0 237 636 278 46 3,249 0 4,657
Native 136 23 1 126 0 321 862 377 63 4,400 0 6,307
American/Alaskan
Pacific Islander 10 _ 2 0 10 0 24 66 29 5 335 0 480
White/Caucasian 376 63 5 347 0 888 2,386 1,043 174 12,185 0 17,464
Other/Multi-Ethnic 157 26 0 145 0 370 994 434 73 5,077 0 7,277
TOTAL 1,045 175 8 965 0 2,466 6,627 2,896 483 33,847 0 48,512
Female Headed 307 52 3 284 0 725 1,946 851 142 9,941 0 14,248
Household" -
Disabling Condition ` 219 37 0 203 0 518 1,392 608 101 7,108 0 10,186
Limited English , 272 46 2 251 0 641 1,723 753 126 8,880 0 12,613
Speaking -
I
* Check Individual or Household,which should be the same as.checked in Question 13. Unduplicated means count each client
only once per calendar year. This should match the number served by City in the Actual 2007 column of Question 13. The
"total"column will be different from Question 13 since the"other"column is not included due to space limitations.
Page 16
16. PROGRAM STAFF (DATA TABLE)
2007 2008 2009
(Actual) (Budgeted) (Projected)
Total Number of Staff(FTEs) 3.5 3.75 4
Number of Volunteer(FTEs) 1 1.5 1.5
Actual Number of Volunteers 1,500 1,500 1,500
Page 17
Agency:Emergency Feeding Program
17. PROGRAM REVENUE BUDGET (DATA TABLE) Program:Emergency Feeding Program
Revenue Source 2007 2008 2009
(Actual) (Budgeted) (Projected/
Requested)
City Funding(General Fund & CDBG)
• Auburn 0.00 0.00 4,500.00
• Burien 0.00 0.00 0.00
• Covington 0.00 0.00 0.00
• Des Moines 0.00 0.00 3,000.00
• Enumclaw 0.00 0.00 0.00
• Federal Way 7,800.00 7,800.00 10,000.00
• Kent 0.00 0.00 22,650.00
• Renton 10,000.00 10,000.00 10,000.00
• SeaTac 0.00 0.00 2,500.00
• Seattle 57,527.00 59,655.00 60,000.00
• Tukwila 0.00 0.00 0.00
• Kenmore 2,500.00 2,500.00 2,500.00
•
Other Government Funds
• King County 0.00 0.00 0.00
• Washington State -EFAP 28,621.00 28,621.00 28,000:60
• Federal Government- FEMA 30,396.00 30,592.00 30,700.00
• Other(Specify)
Private Sources t
• United Way(grants & designated donors)
• Foundations and Corporations 30,865.00 140,000.00 120,000.00
• Contributions (e.g., Events, Mailings) 60,132.00 110,000.00 112,000.00
• Program Service Fees(User Fees) 0.00 0.00 0.00
• Other—Faith Communities 50,167.00 60,000.00 ' . 65,000.00
TOTAL PROGRAM BUDGET 278,008.00 449,168.00 471,350.00
Page 18
I
17. PROGRAM EXPENSE BUDGET, CONT. Agency:Emergency Feeding Program
(DATA TABLE) Program: Emergency Feeding Program
Expenses 2007 2008 2009
(Actual) (Budgeted) (Projected)
Personnel Costs : ` o- y; ,:
• Salaries 102,336.00 145,080.00 165,000.00
■ Benefits 10,320.00 20,000.00 20,000.00
• Other 19,593.00 18,900.00 20,500.00
• Total Personnel 132,249.00 183,980.00 205,500.00
Operating and Supplies
• Office/Program Supplies 6,987.00 6,800.00 7,000.00
• Rent and Utilities 32,479.00 36,776.00 36,800.00
• Repair and Maintenance 343.00 500.00 500.00
• Insurance 9,357.00 10,000.00 10,000.00
• Postage and Shipping 2,677.00 5,000.00 5,000.00
• Printing and Advertising 7,778.00 16,000.00 12,500.00
• Telephone 4,851.00 5,000.00 5,000.00
■ Equipment 0.00 1,000.00 1,000.00
• Conference/Travel/Training/Mileage 340.00 3,000.00 3,000.00
• Dues and Fees 773.00 1,420.00 1,500.00
• Professional Fees/Contracts 15,360.00 17,000.00 18,000.00
• Direct Asst. to Individuals 72,364.00 83,621.00 90,000.00
• Administrative Costs N/A N/A N/A
• Program Vehicle Travel/Maintenance 3,549.00 7,000.00 7,500.00
• Recruitment/Hiring 0.00 500.00 500.00
• Volunteer Appreciation 473.00 1,000.00 1,000.00
• Misc. 0.00 700.00 200.00
I
TOTAL PROGRAM EXPENSES 289,580.00 379,297.00 405,000.00
NeI t Profit(Loss) (11,572.00) 69,871.00 66,350.00
(revenue—expenses) =
Page 19
Agency:Emergency Feeding Program
18. SUBCONTRACTS (DATA TABLE) Program:Emergency Feeding Program
List all the agencies you will be subcontracting with for this program. Provide the agency name in the first
column, a description of the contract/service in the second column, and the contract amount in the third
column. Do not list agencies you coordinate with on a referral only basis. Indicate not applicable if
you do not subcontract for any part of this program.
Subcontracting Agency Specific Subcontracted Activities Contract
in the Operation of Your Program Amount
N/A N/A N/A
Page 20
19. APPLICATION CHECKLIST
Applications missing one or more of the following components or not following these directions may not
be reviewed. Sign and submit the application checklist with your application.
Contents (Your application should contain each of these items in this order.)
Application Cover Pages.The top three pages of your application must be a completed copy of the
Agency Information and Questions 1-7.
Application arrative:
[ Question 8 Organizational Experience(2 page maximum)
+- Question 9 Need for Your Program(2 page maximum)
EVQuestion 10 Proposed Program/Service(6 page maximum)
2"-Question 11 Long Range Plan(1 page maximum)
Question 12 Budget(2 page maximum)
Data Tables
IZ Question 13 Number of Individuals/Households Served
[vjrQuestion 14a-c Performance Measures and Average Cost of Service
[v'Question 15 Demographics(from all funding sources)
[v'Question 16 Program Staff
2--Question 17 Program Revenue&Expense Budgets
❑v--Question 18 Subcontracts
Required documentation. Supply one copy of the following required documents with the signed original
application. See Part II: City Specific Supplemental Information to determine whether additional copies of the
application and required documentation need to be submitted.
Question 19 Required Documentation, including:
• Proof of non-profit status
• Organizational Chart
• Agency/Organization Mission Statement
• Board resolution authorizing submittal of the application(may be submitted up to 60 days after
application).
• List of the current governing board and local board, if applicable, (include name, position/title,
city residence, length of time on the Board, and expiration of terms. Note any vacancies.)
• Board Meeting Minutes of last three board meetings of governing board and local board as
applicable
• Annual Budget
• Financial Audit Cover Letter
• Financial Audit Management Letter
• Financial Statement
• Verification of Non-Discrimination Policy
• Program Intake Form
• Sliding Fee Scale
l- A plication Check List. (Signed below.)
[ ity Specific Supplemental Information.Required in Name: Sam Osborne
Part II for applicable City only. Position: Development Director
Phone#: 206/329-0300
E-mail: sam@emergencyfeeding.org
ignature of Person Completing Checklist
DO NOT SUBMIT ANY OTHER MATERIALS WITH THIS APPLICATION
Make sure that you carefully check Part II of this application
to see what additional attachments each city requires.
Page 21
Agency:Emergency Feeding Program
Program:Emergency Feeding Program
Part II — City Specific Supplemental Information
City of Renton
1. Renton Results, Strategies, and Activities
The Emergency Feeding Program directly works toward the City of Renton's Result#2: Individuals
have adequate clothing,food,housing, and healthcare. The City's "Strategy B: Increase the
capacity of programs that provide food, etc., and residents' access to them," is the avenue through
which we strive to achieve this Result. Continued investment in the Emergency Feeding Program is a
way for the City to increase residents' access to emergency food packs at strategically located
!distribution points around town. Specific Activities include delivering as many food packs as our
partner agencies and faith communities order in as timely and efficient a manner as possible, so that
we can insure immediate access to food when people in crisis need it most.
There are few if any basic needs more fundamental than food,and when an individual or family is
.facing a hunger crisis, it is difficult to think about or act upon anything else. In supplying healthy,
,nutritionally balanced food packs to a variety of locations in the City of Renton,the Emergency
Feeding Program insures that people have this basic need met and are therefore able to concentrate
their energies on addressing whatever deeper problems may have brought on the hunger situation in
the first place. Because a referral for an EFP food pack(if not the food itself) is obtained through a
social service agency, not only is a person's hunger satisfied, but we also know that the majority of
food recipients receive valuable information on the resources they need to get further help. Thus,the
second Activity is an improvement in residents' ability to find the other resources in the community
they need to help move them toward independence and solvency rather than continued reliance on
'programs like the Emergency Feeding Program.
2. Program Outcomes
The outcomes identified in Question 10b of the application narrative (increasing the amount of food
available, immediate reduction in short-term hunger, and increased knowledge of resources) all
directly work toward achieving the City's stated Result#2. Increasing the Emergency Feeding
Program's capacity to deliver food to the City of Renton sets us up to succeed in achieving our stated
outcomes, all of which are solidly in line with Renton's "Results, Strategies, and Activities."
Page 22
....FEEDINkfROGRAM.
KING'
sIHCF
Application for.Human (Public) Service Programs
2009-2010 General Funds
, .
Required Documentation
. 0 REVENUE SERVICE
P :O. DEPARTMENT OF 'PRE TREASURY
BOX 2508
CINCINNATI, OH 45201
Employer Identification Number:
Date: ,JUL 0 3 2003 91-19d2023
DIN:
17053fi74713023
EMERGENCY FEEDING PROGRAM OF Contact person:
SEATTLE & ICING COUNTY GERRY •R MOLAUGHLIN ID# 31115
PO BOX 18145 contact, Telephone Number:
SEATTLE, WA 98118-0145 (877) !829-5500 •
Public 'Charity Status:
170(b)' (1) (A) (vi)
Deer Applicant:
Our letter dated May 26, 1998,. stated you would be exempt from Federal
income tax under section 501(c) (3) of the Internal Revenue Code, and you would
be treated as a public charity during t:n advance ruling period,
Eased on our records and on the information you submitted, we are pleased to
confirm that you are exempt under section 501(c) (3) of the code, and you are
classified as a public charity under tie Code section listed in the heading of
this letter:
Publication 557, Tax-Exempt Status for Your Organization, provides detailed
information about your rights and responsibilities as an exempt organization.
You may request a copy by calling the toll-free number for forms,
(800) 829-3676. Information is also available on our Internet Web Site at
www.irt.gov.
It you havegeneral questions about exempt organizations, please call our
toll-free number shown in the heading between 8:00 a.m. - 6:30 p.m, Eastern
tiMe.
•
Please keep this letter in your permanent records.
sincerel y yours,
•
."0:040 e54A-P-c-"---•
Lois G. Lerner
• • Director, Exempt Organizations
Rulings and Agreements
•
•
•
•
•
•
•
Letter 1050 (DO/CG)
•
•
•
•
• j
L
FEEDIN! PROGRAM
SEATTLE . KING COUNTY
SINCE 1977
•
I ,
Organizational Chart
Board of Directors
Executive Director
Development Director
p Program Director
Operations Staff Warehouse Staff Support Staff
&Volunteers • &Volunteers &Volunteers
Referral Agencies Distribution Sites •
•
I �
•
' 4
.
•
t';:tv,.,
Our mission is to provide an emergency response,to the nutritional needs of
people in crisis hunger situations throughout Seattle and King County. We are
dedicated to alleviating hunger while providing individuals with resource referrals to
help move them towards independence. Our goal its to provide a proactive, non-
traditional approach to food assistance that will eventually lead to self-reliance for
individuals in need of services.
•
•
www.emergencyfeeding.org
P.O.Box 18877•Seattle,WA 1981 18-0877
Main Office 206/329-0300•Eastside 425/653-1652•Fax 206/860-8200
• EMERGENCY
FEEDI, ' PROGRAM
SEATTLE . RING COUNTY
$iNrr 1077
- The Emergency Feeding Program of Seattle and King County
Board of Directors
Funding Resolution
To Whom It May Concern: •
The Board of Directors of the Emergency Feeding Program of Seattle &King County
does hereby authorize and support the efforts of the staff to submit applications for
funding to municipalities, County,state and federal sources. This authorization includes
requests for general service funding,human service funding, Capital funding,
Community Development Facilities Loan Programs,Community Development Block
Grant funds throughout King County, State and Federal funding opportunities as they
may occur.
Specific funding requests are authorized for the.following King County cities:
Auburn Bellevue
Bothell Kenmore
Burien Des Moines
Federal Way Kent •
Kirkland Tukwila
Seattle SeaTac
. Renton Redmond
Shoreline King County
Federal Government Entities
This Resolution authorized, at this,the March 19,2008 regular Board meeting.
(3— / q - D ?
Constance Bown,Board Chair Date
•
� - I
www.emergencyfeeding.org
P.O.Box 18877•Seattle,WA 9,81 18-0877
• Main Office 206/329-0300•Eastside 425/653-1652•Fax 206/860-8200
�_ D1N '� RO�.GRAM
$-> ATTLE::: wKIN:G CQUNTY
Board of Directors
Constance Bown, Chair Occupation: President/CEO
PO Box 18886 The Snowden Co.
Seattle,WA 98118
425.656.8300 Term expires: 2009
Don Taylor,Vice-Chair Occupation: Retired Firefighter
8403—55'h Ave S
Seattle,WA 98118
206.722.4973 Term expires: 2009
Martha Schroeder,Treasurer Occupation: Nursing Care Coordinator
10010 NE 120'h B-4 Horizon House
Kirkland,WA 98034
425.823.0130 Term expires: 2008
Tammi Broughton, Secretary Occupation:Senior Regional Business Analyst
12228 NE 136'1'PL Microsoft Corp.
Kirkland,WA 98034
425.766.1099 Term expires: 2009
Willa Blacknall, Chaplain Occupation: Real Estate Agent
324 S. Smithers Blacknall Realty
Renton,WA 98055
425.226.6464 Term expires: 2008
• Pastor Patrinell Wright, Director Occupation: Founder&Leader
P.O. Box 22776 Total Experience Gospel Choir.
Seattle,WA 98122
206.322.7904 Term expires: 2010
* Expiring terms are eligible for renewal.
•
www.emergencyfeeding.org
PHONE 206/329-0300• FAX 206/860-8200 • P.O.Box 18877• Seattle,WA 98118-0877
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BOARD OF DIRECTORS MEETING MINUTES
March 19, 2008
• CALL TO ORDER
o The meeting was called to order by Connie Bown at 10:40AM
• OPENING
o Prayer- the meeting was opened in prayer by Don Taylor
o Attendees - Donald Taylor, Tammi Broughton, Evangelist Willa
Blacknall, Brian Anderson, Sam Osborne, Arthur Lee, and Connie
Bown. Martha Schroeder called and said that she would be about
30 minutes late. Reverend Pat Wrightwill not be in attendance.
Martha arrived at 10:56AM.
o Connie amended the agenda to include her comments
■ Apologized for not attending the Board meetings over the
past couple of months. Her business has been quite
productive and requires a lot of her time.
• Noticed from the prior minutes that there were concerns
about the election of officers. Willing to step down so that we
can have on-going leadership. Not leaving the Board but
willing to step down. Those in attendance did not recall a
concern being brought regarding the Chair position. The
recollection was about a Chair for the auction and not with
regard to the Board Chair. Tammi shared Election notes from
the January 08 minutes. Connie will find the minutes to which
she referred.
• INTRODUCTIONS
o No introductions were necessary.
• MINUTES
o There were not corrections to the minutes.
o Don Taylor moved that that the minutes be accepted with any
necessary corrections, Tammi seconded.
• REPORTS
o Executive Director's Report (Arthur R. Lee)
• "I must work the work of him..." John 9:4
.. .............. ..... ...... _ . ........ ... .. 1 I Page
• Requested that the Board pass a resolution giving the staff
permission to pursue grants of funds from Community
Development Block Grant funding sources, from city general
funds and fro human services funding for Auburn, Burien,
Federal Way, Kirkland, Seattle, Renton, King County, Bellevue,
Des Moines, Kent, Tukwila, SeaTac, Redmond, and Federal
Government Entities. Kenmore, Shoreline, and Bothell will be
added to the resolution. Martha asked what is the difference
between a resolution and a motion. Rev. Osborne shared
that a resolution is a written document and some
organizations request it. It will be signed by the Board Chair.
Martha made a motion that we approve the resolution and
Don seconded it.
o Financial Report (Martha Schroeder)
• Balance Sheet
• Tammi asked why the Cash On Hand and Accounts
Receivable negative. Martha shared that the
bookkeeper said there was an accounts receivable
entry error for which she requested assistance from the
{ software company but it is reflected as a negative.
With regard to Cash On Hand, this question is still
outstanding.
• Profit & Loss Statement
• We currently have a negative balance but that has
something to do with the truck. The funds came in in
January and it was expended in February.
• 2008 Proposed Budget
• There will be some re-vamping to help us better
understand how we are doing.
• Looking to get an updated reporting format that helps
us to see where we are for each category (i.e. Actual,
Budget)..
• Revenue Goals
• Rev. Osborne distributed a spreadsheet reflecting 2006
Actual Revenue, 2007 Actual Revenue, 2008 Revenue
Goals, and January and February 2008 Actual
Revenue.
• 2007 Income
2IPage
• Rev. Osborne distributed pie charts that reflect 2007
r-
Income. With in-kind and without.
• - Churches fall under the Faith Community Giving
category but things affiliated with Churches (such as St.
Margaret's Thrift Shop) falls under. the Religious
Organization Gifts. •
■ Other
• Martha mentioned that she asked the bookkeeper
where we are with our line of credit. We need to have
this listed on our reports. Also, it was noted that our last
payment was only about the equivalent of the interest
payment. Attendees agreed that we had the
discussion to make payments over the minimum each
month.
• We are looking for a company that will assist with our
networking. The company identified would not accept
the job pro bono and their non-profit rate ($95) was still
too expensive.
■ Evangelist Blacknall moved that the financial report be
accepted and Don seconded.
o Development Director's Report (Reverend Sam Osborne)
■ Rev. Osborne and Evangelist Blacknall attended the Human
(Public) Service meeting. Rev. Osborne has made progress in
completing the application.
■ Auburn, Des Moines, Federal Way, Kent, Renton, and SeaTac
are the cities in South King County from which we will request
funding.
■ A Lapsed Church Donor list was distributed to Board
Members.
• Don volunteered to contact Japanese Baptist Church
• Martha volunteered to contact Inglewood Presbyterian
Church
• Connie will ask the Evergreen Baptist Association (Rev.
Marsha Patton) to put EFP in their budget
• Connie will contact Grace United Methodist Church
• Arthur will follow-up with the North Pacific Convention
r� '
• Getting grant from city of Seattle, VPAT (Vulnerable
Populations Action Team) $2,500 for emergency
preparedness planning.
• May 18, Holy Trinity Lutheran Church (Mercer Island) has
asked Arthur and Rev. Osborne to preach (Rev. Osborne will
take the early service and Arthur the later)
• We will be getting an annual report and quarterly newsletter
within the next three or four weeks.
• FEMA allocation is $30,622.
o Lease - Negotiation (Arthur Lee)
• We are still in a lease with CAMP.
• We will be here until a decision is made to destroy the
building. The city will help us find another location.
• They are waiting on an appraisal to begin the negotiations.
• BOARD DEVELOPMENT
o Retreat
• April 19 was the date discussed for the Board Retreat.
• Connie and Don are not available for April 19.
• May 17 was suggested
o There were no other committee reports.
• OTHER ITEMS
o Strategic Planning
• We are trying to recruit the Department of Park and
Recreations Human Services Manager for the Board. He a is
also looking for a facility for the auction.
o Auction
• Connie will speak with Dell Jackson with regard to serving as
the auctioneer.
• Evangelist Blacknall noted that we need to start procuring
items to auction.
• Connie noted that atmosphere along with the items has a lot
to do with the success of an auction. •
• Arthur will recruit a chair. Don volunteered to recruit
someone to serve on the committee. Tammi noted that she
has a lot on her plate but is definitely willing to move forward
with the auction and will look for someone to serve on the •
committee.
■ Connie noted that Board Members Evangelist Blacknall, Don,
and Tammi said let's move.ahead. Don moved that we
move forward with the auction, Tammi seconded.
Unanimous approval.
• ADJOURNMENT
o Evangelist Blacknall moved that the meeting be adjourned and
Don seconded.
o The meeting was adjourned with prayer by Arthur at 12:34PM.
o Next meeting -Wednesday, April 16, 2008 @ 10:30AM - 12:30PM @
EFP
•
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Board of Directors Meeting Minutes—February 20,2008
Present: Director Martha Schroeder, Director Don Taylor, Executive Director Arthur Lee,
Development Director Sam Osborne, Operations Director Brian Anderson
Call to Order
• The meeting was called to order by Don Taylor in the absence of Board Chair Connie
Bown. The decision was made to proceed with the meeting in spite of the absence of a
quorum with the understanding that actions that required board approval would have to
wait until next month's meeting.
Opening
• Prayer—The meeting was opened in prayer by Director Don Taylor.
Minutes
• The minutes of the January 16,2008 meeting were discussed by not approved due to the
absence of a quorum.
Reports
• Executive Director's Report(Arthur Lee)
o "Being enriched in every thing to all bountifulness, which causeth through us
thanksgiving to God. For the administration of this service not only supplieth the
want of the saints, but is abundant also by many thanksgivings unto God." II
Corinthians 9: 11-12
o Arthur thanked the board for their participation in January's successful Share the
Dream Concert.
o He reported that he and Minister Blacknall traveled to Olympia to meet with
Senator Prentice,with Senator Fraizer's office, and with Representative Pettigrew
to secure pledges of State help as EFP works to secure funding for a new
warehouse/office building.
o Arthur further reported that he,Minister Blacknall and Director Taylor met with
Al Poole of the City of Seattle's Human Services Department and with
representatives of the City's Facilities department to discuss their negotiations
with CAMP concerning our current location. It was a most successful session.
o In addition, other visits with Senator Patty Murray and Representative Pettigrew
are planned to discuss their assistance in an upcoming capital campaign.
• Financial Report(Martha Schroeder)
o Martha reported that January was good month financially partially due to the
f success of the Share the Dream Benefit Concert. EFP is currently in the black
with a net monthly income of$15,942.19.
Page 1 of 3
• Development Report(Sam Osborne)
o Sam reported that much of his time in the month of January was spent dealing
with technology challenges. Two additional work stations have been set up and
the program's internet provider, Qwest, required an upgrade that resulted in the
program temporarily losing email access and other problems. Geek Squad was
eventually called in and the problems have been solved. Martha offered to help
identify someone who EFP can call on in the case of future technology problems.
o Sam also reported that redesign of the EFP website in continuing. Our web
designer, Janet Batiste is working with him to make the site more attractive and
more user-friendly and much progress has been made.
o Despite the necessary focus on problem solving, one grant was submitted in
January.
Board Projects
• Potential Capital Project/Campaign(Arthur Lee)
o As he mentioned in his Executive Director's Report, Arthur has contacted Senator
Prentice and Representative Pettigrew for their help in securing seed money.
• Auction
o The board is still looking for an auctioneer and a site for the first annual EFP
auction. Martha suggested that we approach either Nicole Brodeur of the Seattle
- . Times or one of the DJs at KISS-FM with whom the program has worked on
Jl other projects in the past.
• Mayors Day of Concern for the Hungry
o Letters to King County Mayors and to the corporate offices of grocery store
chains will be mailed by April 1,2008.
o A letter is being drafted that will be sent to the activity/athletic directors of King
County High Schools enlisted student help forming Mayors' Day teams.
• Other School-related Projects: Brian will be contacting Seattle schools requesting their
help in two food drives in 2008: a spring food drive centered on collecting foods to help
us feed children and families in the summer and our annual winter Seattle Firefighters
Food Drive.
• Renton Firefighters Food Drive: Don and Arthur will be contacting the Renton Fire Chief
to discuss their participation in a food drive this year.
• Arthur suggests that EFP investigate the possibility of holding a fundraising garage sale
and as well as the possibility in the future of operating a thrift shop. Martha pointed out
that if the thrift shop idea is to be pursued, adequate space in the future EFP warehouse
should be considered.
- I
Page 2 of 3
• Board Development/Recruitment
o Martha, Willa,Arthur and Brian are planning on taking a class through Bellevue
Community College called"Boards That Work." The class process to teach us
"how easy it is to create an environment where board members govern with
vision, serve as compelling ambassadors, and raise money proudly. This class is
most powerful when attended by both board and staff." For more information
about this opportunity visit
http://at-campus.het/bcc2/ems/Course/Course.aspx?c=8990.
• Publicity
o Two items of note were shared, both involving the publication Colors NW. The
February issue of the magazine features a poem by Arthur's daughter Ash Leigh.
It is something that you will all want to check out. And the March issue will
feature a profile of the Emergency Feeding Program.
Board Committee Reports
• No reports were received. Arthur noted that board committees are not currently active
and that work should be done to change this.
Adjournment
• The meeting was adjourned with a closing prayer offered by Rev. Sam Osborne.
Submitted by Brian Anderson, Operations Director& Secretary Pro Tern
Page 3 of 3
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BOARD OF DIRECTORS MEETING MINUTES
January 16, 2008
• CALL TO ORDER
o The meeting was called to order by Donald Taylor at 10:31 AM
• OPENING
o Prayer- the meeting was opened in prayer by Evangelist Willa
Blacknall
o Attendees - Donald Taylor, Evangelist Willa Blacknall, Tammi
Broughton, Brian Anderson, Arthur Lee. Connie Bown and Martha
Schroeder called and said that they would not be in attendance.
This is a really busy week for Reverend Pat Wright with regard to
Martin Luther King Jr. celebrations.
• INTRODUCTIONS
o No introductions were necessary.
• MINUTES
o There was a typo in the notes from the Executive Director's Report:
causeth appeared twice.
o Evangelist Blacknall moved that that the minutes be accepted,
Tammi seconded.
• REPORTS
o Executive Director's Report (Arthur R. Lee)
■ "Neither do men put new wine into old bottles; else the
bottles break, and the wine runneth out, and the bottles
perish; but they put new wine into new bottles, and both are
preserved." Matthew 9:17
• There were no questions.
• Footnote was added: Boeing wrote a check for$28,600 to
the Emergency'Feeding Program and it is in the mail. This will
enable us fo purchase the new van.
o Financial Report (Sam Osborne)
• Balance Sheet
• Tammi asked why the Cash On Hand and Accounts
Receivable were showing as negative. Arthur shared
that they would sit down with the bookkeeper and get
an understanding.
■ There is no Profit & Loss Statement available at this time
■ 2008 Proposed Budget
• As per the request at our meeting in November, 2007
and 2006 Actuals were added into the report. 2007
numbers are not final, the books are still not closed.
• We are setting some high goals for ourselves this year.
• Sam shared that the income numbers that we are
reflecting in the 2008 Budget are a lot like the numbers
that we used to see when we had our full donor list.
• A Grant Submission Sheet (for the first three months of
the year) was distributed.
• Looking to get money back from Kent, SeaTac, and
others in the South end.
• Evangelist Blacknall asked if we really want to record
the line of credit as income. Tammi recommended
that we asterisk the Line of Credit in Income and
Expense (the offset) as well as add verbiage such as
"Advance" to note the nature of the line item. Sam will
also speak with our accountant to confirm how this
should be shown on the report.
• We will accept the advice of the accountant and
Evangelist Blacknall moved that we adopt the 2008
Budget, Tammi seconded.
■ The 2007 In-Kind Contributions detail report was reviewed.
o Development Director's Report (Sam Osborne)
■ Sam passed around the bulletin for. the Share The Dream
program.
■ The holiday appeal brought in about $18,000. This is down
from last year but we are still getting checks in the mail.
o Lease- Negotiation (Arthur Lee)
■ We were able to get the leas signed early December.
■ The city confirmed that the imminent domain process is
moving forward.
■ For the next two years, if the city acquires the space, we are
here fora $1 a year. .
■ We are assuming the cost of utilities now.
2IPage
• BOARD DEVELOPMENT
o Commitment (Tammi Broughton)
■ We need to be more proactive so that we can be effective.
■ We need to make a list of goals for the year.
o Recruitment
■ Vandy Smith sent a letter of resignation prior to the November
Board Meeting.
■ Don shared that we need to move forward with recruitment.
■ Arthur shared that we really need to decide who/what
resources we need on the Board.
■ Don mentioned that we may want to utilize Project Impact. It
is a list of individuals that want to serve on non-profit boards.
He will come to our next meeting with the information.
■ Evangelist Blacknall distributed a report regarding Board
Development. Arthur asked that we make this an integral
part of our next meeting.
• STRATEGIC PLANNING
o Brian reviewed the 2008 EFP Calendar
o We want to make sure that we are prepared for each
event/activity well in advance.
o Sam mentioned that there is a Hunger Action Day as well as the
Hunger Awareness Day noted on the handout. The Hunger Action
Day occurs in Olympia.
o We have been asked to help procure a venue for an event by the
Provo High School Choir (100 voice choir). Prefer a church on the
east side.
o Brian suggested that we partner with some of the community
festivals.
o Evangelist mentioned that Peoples Institutional has a street fair each
year.
o It would be good if we can get KISS-FM to better understand the
program's needs. We would like to meet with them early.
o If there are any other items that need to be added to the calendar,
send them to Brian.
o We need to get individuals back into the churches to make
announcements about the program.
• OTHER ITEMS
o Auction
31Page
• Arthur and Evangelist Blacknall met with Rita Zawaideh on
December 14, 2007.
• We have tentatively set October 25, 2008 as the date.
• A request was sent to Darywn Anderson of the Human Service
Division of Parks and Recreation requesting a community
center type of facility with no rental fee. He is the individual
that organizes a benefit each year with his fraternity of which
EFP is the beneficiary.
• Evangelist Blacknall shared that she is not stepping up as the
Chair as she would not like to half-do anything.
o Share The Dream Program
• Arthur suggested that we have a Wish List displayed at the
program. The List will include items such as Board Members,
Program Managers (such as the Auction).
o Elections
• Evangelist Blacknall asked when do we hold our elections.
Arthur shared that it was September and we moved it to
November. Although we did not have them this past
November.
• We do want to follow our By-Laws. Don asked Arthur to send
them to us electronically.
• ADJOURNMENT
o Martha moved that the meeting be adjourned and it was
seconded.
o The meeting was adjourned with prayer by Don Taylor at 12:11 PM.
o Next meeting - February 20, 2008 @ 10:30AM - 12:30PM @ EFP
•
4IPage
i ne mmergency reeumg rrogram or aearue-ring t.ounry
2008 Budget
2008 Budget
INCOME
Contributions
Individuals $ 50,000.00
Organizations $ 35,000.00
Businesses $ 5,000.00
Foundations $ 100,000.00
Faith Communities $ 60,000.00
Total Contributions $ 250,000.00
Special Events
Special Events $ 60,000.00
Total Special Events $ 60,000.00
Government Grants
FEMA $• 30,592.00
EFAP (In-Kind Direct Assist for Food) $ 28,621.00
Municipal Contracts $ 79,955.00
Total Government Grants $ 139,168.00
Other Income
Interest& Dividend Income
Refunds
Total Other Income $In Kind
In-Kind Food Contributions $ 325,000.00
In-kind Services $ 55,000.00
Total in-Kind Contributions $ 380,000.00
Total Income (not including in-Kind) $ 449,168.00
EXPENSES 2008 Budget
Personnel
Salary
Salary&wages $ 145,080.00
Total Salary&Wages $ 145,080.00
Employment Taxes&Payroll Expenses
Social Security $ 11,000.00
L&I Compensation $ 2,300.00
Employment Security $ 2,400.00
FUTA $ 800.00
Payroll Expenses $ 2,400.00
Total Employment Taxes $ 18,900.00
Personnel Benefits
Medical Insurance $ 15,000.00
Dental Insurance $ 600.00
Annuity Pension Contributions $ 4,400.00
Total Personnel Benefits $ 20,000.00
Total Personnel $ 183,980.00
Direct Assistance Support
Program Vehicle Travel &Maintenance $ 7,000.00
Assistance (Program Supplies) $ 1,800.00
Assistance (EFP Food Purchases) $ 83,621.00
Assistance (Other)
Total Direct Assistance Support $ 92,421.00
4/16/2008
I ne emergency reeuing rrggram vi Oed«wC-runny ...,ui..y
' 2008 Budget
2008 Budget
I .
Operations
Professional Services
Professional Services-Technology $ 2,000.00
Professional Services-Legal $ -
Professional Services-Accounting $ 15,000.00
Total Professional Services $ 17,000.00
Office Support
Supplies (Office) $ 5,000.00
Supplies(Small Equipment)
Food & Beverages $ 500.00
Telecommunications $ . 5,000.00
Postage&Delivery $ 5,000.00
Copying & Printing $ 6,000.00
Equipment Rental $ 1,000.00
Equipment Rental (Repairs/Maint) $ 500.00
Rent+ Utilities $ 36,776.00
Insurance $ 10,000.00
Total Office Support $ 69,776.00
Travel& Conference
Local Travel (Gas,Mileage& Parking) $ 2,000.00
Out of town Travel
Conferences,Workshops&Training $ 1,000.00
Staff Expenses-Other
Total Travel &Conference $ 3,000.00
Other
Subscriptions& Publications $ 220.00
Advertising & Promotions $ 10,000.00
Media Productions
Recruitment& Hiring $ 500.00
Memberships, Dues& Donations $ 500.00
Taxes& Licenses $ 500.00
Misc(Bank Charges) $ 200.00
Interest Expense Offset
Misc(Volunteer Appreciation) $ 1,000.00
Misc(Other) $ 200.00
Total Other $ 13,120.00
In Kind
In-Kind Food $ 349,000.00
In-Kind Services $ 55,000.00
Total In-Kind $ 404,000.00
Total Income $ 449,168.00
Total Expenses $ 379,297.00
s ���R' �� � �" 'Y, st&h'. �s 'f"� ir' �h�, , c; .,a`� iF
.1- t. �Zr k t I. ' AF;i n Ig fie NN 't_:
Excess/(Deficit) $ 69,871.00
4/16/2008
No audit Management Cover letter received
1
10:49 AM EmFeeding
04/16/08 Profit & Loss
Cash Basis March 2008
Mar08
Ordinary Income/Expense
income
Loan Income 4,000.00
Public Support&Revenu
Contributions
Businesses 3,125.00
Congregations 4,111.00
Individuals 2,750.76
Organizations 165.80
. Total Contributions 10,152.56
Total Public Support&Revenu 10,152.56
Revenue
Government Grants
City Grants&Contracts
City of Seattle 4,971.25
Total City Grants&Contracts 4,971.25
Total Government Grants 4,971.25
Total Revenue 4,971.25
Total Income 19,123.81
Expense
Reconciliation Discrepancies -3,310.00
Loan Payment 198.38
License for Business 9.00
Personnel
Salary&Wages
Wages 1,459.00
Salary&Wages-Other 3,285.20
Total Salary&Wages 4,744.20
Employment Taxes
•
FUTA 11.52
Soc Sec
Match Soc Sec 345.61
Soc Sec-Other 345.61
Total Soc Sec 691.22
Medicare
Match Medicare 80.82
Medicare-Other 80.82
Total Medicare 161.64
Federal 552.74
Employment Security
WA-SW 19.51
WA-SUR 1.67
Total Employment Security 21.18
Department of Labor&Industrie 100.99
Payroll Expenses
PrimePay Expenses • 127.90
Total Payroll Expenses 127.90
Total Employment Taxes 1,667.19
Total Personnel 6,411.39
•
Direct Assistance Support
Assistance-Food Purchases 2,776.99
Page 1
10:49 AM EmFeeding
04/16/08 • Profit & Loss
gash Basis March 2008
Mar 08
Program Vehicle Travel&Maint 200.18
Total Direct Assistance Support 2,977.17
Operations
Dues,Donations&Memberships 84.39
Professional Services
Professional Fee(Bookkeeping) 1,500.00
Total Professional Services 1,500.00
Supplies
Supplies(Program) 42.44
Supplies(Office) 243.40
Total Supplies 285.84
Telecommunications
Telephone 665.53
Total Telecommunications 665.53
Postage 123.34
Total Operations 2,659.10
Total Expense 8,945.04
Net Ordinary Income 10,178.77
Net Income 10,178.77
Page 2
u `
F Eery; - OG
SEATT °' `-XINC COVITIf
Verification of Non-Discrimination Policy
The Emergency Feeding Program of Seattle and King County, its Board of Directors,
staff,volunteers, and partnering agencies provide services to all persons without
regard to race, color, religion, sex, gender, sexual,orientation, marital status, national
origin, creed, age, or disability.
Verified by me, Emergency Feeding Program Executive Director Arthur R. Lee, this
14th Day of April, 2008:
Arthur R. Lee, e Director
To get your food, •
EMERGENCY
take this card to:
FEEDINPROG_RAM_
SEATTLE 'r KING COUNTY
Issued from site#
Hours: Phone:
Type: Small Medium Large Latino Asian BAP F-BAP Snack
Baby A Baby B Low Salt Diabetic TheraPak Vegan
This information Is ronfidentlal.The Emergency Feeding Program is required to maintain this information as a condition of a
Community Development Block Grant(CDBG)award to monitor benefits of the project.
Name:
Address:
City: Zip:
Is this your first emergency food pack this year? ❑Yes ❑ No
Gender: ❑Male .Female ❑Transgendered/Other
Family Status: ❑ Single ❑ Couple ❑ Head of Household
Ethnicity(please select one): ❑ Hispanic/Latino ❑ Not Hispanic/Latino
Race(select all that apply): ❑American Indian/Alaska Native ❑Asian ❑ Other'
❑ Black/African American ❑ Native Hawaiian/Other Pacific Islander ❑White
Your Age: Ages of others in household:
Total Household Monthly Income:$ Source:
Number of persons supported by this income:
Reason for Food Pack
Are you: ❑ Unemployed? ❑ Homeless? ❑ Disabled?
Is your ability to speak English: ❑ Fluent? ❑ Limited?
Do you receive food stamp benefits? ❑Yes ❑ No
If"No," have you applied for food stamps? ❑Yes ❑ No
Were you referred to other community resources in your area? ❑Yes ❑ No
Will the information on.community resources be helpful? ❑Yes ❑ No
Will this food meet your needs for the next two days? ❑Yes ❑ No
I certify that I am 18 years old or older,and that the information given above is accurate and complete to the best of my knowledge
and belief understand this information is tanflrlewlits and will be used only to monitor benefits provided by a,HUD CDBG grant to the
Emergency Feeding Program of Seattle&King County.
Signature: Date:
.}, -,..t`_Tk; .
• tt^:•!!�!!��•_=v::`�Dr;l,;:;tr•,�.. ,�'�,;•�t:s":;-.'�..s,.a;or,".. �_,...,'.°..
., ly t� ..•.}�, .,;i•�.^`-pj'A tel:;":,:�"t; �
SEAT `i E r: I N' � lj'14TY
t:"f�i�{ ''�, ra,§;v.,`����`:�. •---',�:45'7NC;E^�t�D77� `.�s`,'i�t.
Sliding Fee Scale,
The Emergency Feeding Program charges no fee for any of its services.
•
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13
APR 3 0 2008 ,
1 CITY OF RENT®N
�1f�KAN SERVICES !
Application for
Human (Public) Service Programs
Renton
Agency Information .,
Agency Name:Renton Clothes Bank
Applicant Name and Address: Agency Director: Delores Mead
Renton Clothes Bank Delores Mead,President
1025 South 3rd Street Name and Title
Renton,WA 98055 425-255-8018
(Area Code)Telephone
scbressler@comcast.net(Susan Bressler,secretary)
E-mail address(if available) (Area Code) Fax Number
Required signatures: By signing below,you certify that the information in this application is accurate to
the best of your knowledge and that you have read the application,certifications,and appendixes.
(SIGNATURES MUST BE IN BLUE INK)
birsi 14,Afikg
Signature of Agency Bo�dent Date S e of A enc Director/Date
� g cY President/Date
DC A . frig d_ �' toy , (Xl41‘
Printed Name of Agency Board President Printed Name of:Agency Director
-P:rogram Information _
1. Program Name Renton Clothes Bank,Inc.
Contact Person(available to answer specific questions on this application)
Delores A.Mead 425-255-8018
Name (Area Code)Telephone
604 South 17th Street
% Renton,WA 98055
Address(if different than above)
•
1.
scbressler@,comcast.net(Susan Bressler, Secretary) 425-917-2155 (Susan Bressler,secretary)
E-mail address(if available) (Area Code)Fax Number
2. Program is New for our agency ❑An Ongoing Program
3. Brief Description of Program(One sentence)
Provide clean wearable clothing to needy families at no charge.
4. Where are services provided? (If different from agency location)
•
2.
5. Total Program Cost:
Actual 2007: $11,637.92 Proposed 2009: $14, 150.00
Projected 2008: $13,035.00
6. Total City Funds Requested for this Program:
City Awarded 2008 Requested 2009*
General Fund CDBG Total Requested**
Auburn
Federal Way
Kent
Renton $11,385.00 $12,500.00
City Awarded 2008 Requested 2009*
General Fund General Fund
Burien
Covington
Des Moines
Enumclaw
SeaTac
Tukwila
*Cities on a two year funding cycle will renew 2009 awards to 2010 based upon performance and availability of funds. See
Part II for city specific information.
**Include your total request for Auburn,Federal Way Kent and Renton. The source of funding will be determined by staff.
3.
7. Agency Contact Sheet
Provide the following information for the agency and for the program requesting funds.
Agency Contacts
General Agency Name: Renton Clothes Bank
Address: 10225 South 3rd St.
City/State/Zip: Renton,WA 98055
Phone/Fax: 425-271-5091
Agency Web Address: rentonclothesbank.org
Executive Director Name: Delores Mead
Title: President
Direct Phone: 425-255-8018
E-Mail: delmeadq.com OR
scbressler@comcast.net
Development Director Name:
(or Grant Writer) Title:
Direct Phone:
E-Mail:
Finance/Accountant Name: Judy Craig
(person preparing invoices) Title: Treasurer
Direct Phone: 425-255-3210
E-Mail: judvandgenel@comcast.net
Program Contact
(Staff contact for contracting, reporting and program implementation.)
Program Name: Renton Clothes Bank
Staff Name: Same as above
Title:
Direct Phone:
E-Mail:
4.
8. ORGANIZATIONAL EXPERIENCE (2 page maximum)
A. Organizational Experience
In 1965, a handful of service club volunteers came together to dispense free clothing to
Renton's low-income people who were in dire need of assistance. The program began
with a clothing exchange among families of Head Start Mothers following job layoffs
and a severe decline in the economy. The problem was recognized to be prevalent
throughout the school district at which time the Renton Clothes Bank was formulated.
In 1984, after several re-locations,the Clothes Bank leased space in the Renton Area
Youth Services (RAYS) building annex, where it has been serving the community for the
past 24 years. Clients receive free clothing upon referral from DSHS,the Salvation
Army, RAYS, Young Women's Christian Association, churches,teachers, school nurses,
and others acting as sponsor for a family or individual. The Clothes Bank serves as many
as 650 persons monthly, nearly 70% of whom are children.
In 2000, The RCB applied for and received designation as a(501) c(3)Non-Profit
Corporation allowing applications for additional grant funds which have resulted in a
number of new revenues.
RCB experience extends to the youth of the community. We contract with the Renton
School District's (RSD)High School Special Education program. Three days per week
mentally and physically challenged students, age 16-21, come to the clothes bank storage
center for four hours each day, and work on straightening and hanging clothing,which
helps them to emulate a work/employer situation. They gain valuable experience and get
school community service credits and the clothes bank is greatly helped by their
assistance.
The Hazen HS Key Club periodically holds work parties at the Clothes Bank with 38-40
students participating, (sponsored by the Renton Kiwanis Club). Also, student volunteers
from Lindberg and Hazen HS special education programs, KEY and DECA clubs
volunteer at the RCB. Other clubs, such as Girl and Cub Scouts and Brownie troops help
with clothes drives, and sorting and moving donations from one storage center to another.
A team of community-service minded volunteers meet weekly to sort donations and keep
the shelves neatly stacked and assist with picking up and transporting donations to
storage or to the shop and assisting with student work parties.
B.Operational Structure
The Renton Clothes Bank is governed by an eleven-member Board of Directors which
oversees its general operation including: hiring of staff, establishing salaries, adopting a
budget, developing a Mission Statement and Goals, non-discrimination policy,
approving Grant applications, monitoring progress of the Clothes Bank's Programs of
Service, and an annual Audit. The Board also establishes policy for hours of operation,
holiday closures, acceptance of donations,vacations and recruiting volunteers. Board
Meetings are held at noon on the second Thursday of the month. Board members serve
three-year terms and the Election of Officers and Appointments to the Board are made at
•
5.
the Annual Meeting held in September at which time, progress of programs, funding
strategies and goals and objectives are reviewed.
Being affiliated with the Chamber of Commerce, as well as other service clubs and
organizations, Board Members keep connected and informed regarding the needy within
the community. The Board has a diverse membership with representatives from the
Renton Technical College, Renton School District, Renton Housing Authority,business
owners, various service clubs,retired city and school officers and interested citizens of
the community-at-large. All members are residents of Renton.
As it became impractical to maintain staffing on a volunteer basis, a manager and one
staff member were hired. The Manager is a certified educator and has had extensive
experience and training to serve a diverse multi-cultural clientele. The staff member
serves on a part-time on-call basis. Contributions of time, clothing and moneys are
donated by various service clubs and organizations, businesses, schools, churches,
foundations and the City of Renton, each playing a critical role in the existence and
success of the Clothes Bank.
6.
9. NEED FOR YOUR PROGRAM(2 page maximum)
A. Problem Statement
Many families today struggling to overcome financial instability are unable to provide
adequate clothing for employment, school or basic need. The Renton Clothes Bank is the
only available access to FREE clothing for eligible low-income residents of the Clothes
Bank's service area,the boundaries of the Renton School District.
B. Target Population
Geographic: The Renton Clothes Bank is located in downtown Renton, on a bus line and
on ground level,making it more readily accessible to those with disabilities. Low-income
residents are referred to the Clothes Bank by numerous referral agents, listed heretofore,
who screen the applicants and certify eligibility. We also serve a dozen or more
homeless each month, some pregnant, who come.in for clothing, blankets, soap and other
toiletries. (St. Matthews Lutheran Church in the Renton Highlands,provides us with
layettes for new mothers). Although a small operation,the Clothes Bank has for decades
demonstrated a history of major success in serving its low-income,needy residents with
adequate clothing.
Clients of the RCB, all screened by referral agencies are 100%at or below the 30%
median income guidelines.
HUD INCOME GUIDELINES 2/13/2008
Family Size 30% Median/Very 50% Median/Low 80%
Low Income Median/Moderate
Invome
1 $17,100 $28,500 $43,050
2 $18,700 $31,150 $49,200
3 $21,950 $36,650 $55,350
4 $24,400 $40,700 $61,600
5 $26,350 $43,950 $66,400
6 $28,300 $28,300 $71,350
7 $30,250 $50,450 $76,250
8 $32,250 $53,700 $81,200
•
7.
Demographics: Individuals
The RCB serves low-income residents of South King County who reside in the Renton
School District 403 and any other needy persons who are victims of floods,hurricanes,
fires, and other natural disasters and in need of shoes, clothing,household items and
personal hygiene supplies. Referral forms are distributed to various agencies,clubs,
organizations, and others who wish to sponsor someone in need.
Ethnic Groups Served: January—December 2007
Ethnicity Numbers Served Percentage
White/Caucasian 1447 51%
African American 438 15%
Asian/Pacific 117 4%
Hispanic 786 28%
Native American/Ala 47 2%
Total 2834
3868 individuals were served by the Clothes Bank in 2007 and 1586 of those were
children. We do not have the age spread nor household income data as the screening
agencies maintain that information sending only eligible clients to the Clothes Bank,
referral sheets containing the above statistics.
10. PROPOSED PROGRAM/SERVICE (See page maximums to each part of this Question below.)
A. Program Description.
Renton Clothes Bank's basic program of service is to give a sense of dignity, purpose and
pride to low-income,needy persons in the community,by providing adequate and
appropriate clothing at no cost. This service allows a greater concentration on work,
school, and play, and helps to overcome the financial pressure of poverty and makes life
easier for those less fortunate. The shop is located in the Renton Area Youth Services
(RAYS) building at 1025 South 3rd Street, in downtown Renton. We have leased 750
square feet in the RAYS building annex since 1984.
In order to better serve our target population, we have an outreach program wherein
various clubs and organizations collect clothing donations and deliver them to RCB. The
Kennydale Lions Club has collection boxes at the King Country Housing Authority
projects in the Renton Highlands; St. Matthew's Lutheran Church, also in the Highlands .
as collection boxes at the church; The Eagles and Auxiliary, and Renton Lions Club have
collection programs; the remaining donations come from schools and private citizens. In
addition, we collect the lost and found items upon closure of the schools in June.
Communities in Schools of Renton(CISR), and their family liaisons assist with cultural
and language needs in communicating our program to the families in need. They refer
8.
$,
eligible families, and take children shopping for new shoes, socks, underwear, oversized
clothing and athletic shoes not available at RCB. They submit bills to RCB for payment.
RCB works with other agencies that provide referrals, including,The Salvation Army,
RAYS, DSHS, school liaisons,nurses, churches, and others. Board Members addresses
various club and organizations as program speakers to acquaint them with the existence
of the RCB and its free clothing service, which has resulted in additional funding sources
as well as clothing donations. Thanks to the support of the community it has been
possible to maintain a well-established, clean,neat, facility which provides a pleasant
atmosphere for those who visit.
The RCB developed several outreach efforts in 2007. We developed a website at
rentonclothesbank.org and joined the Chamber of Commerce. This has elicited new
volunteers and an increase in donations and public exposure.
B. Performance Measures and Outcomes.
Low income residents,who have received free clothing, are able to better achieve their
goals of financial stability.
i. Performance measures
2834 residents of the City of Renton were referred to RCB in 2007. This figure does
not include referrals from unincorporated King County and other areas. We are
steadily seeing more referrals, and have served 1,728 individuals during the first
quarter of 2008,many of which are new residents arriving on a daily basis.
Clothing donations received in 2007,by number of boxes received into the RCB
January 128
February 164
March 178
April 146
May 190
June 194
July 174
August 146
September 128
October 207
November 195
December 218
ii. Outcomes of the program/service.
Needy individuals and families secure appropriate, clean,wearable clothing. This
service provides them with great sense of dignity, lessens their fmancial burdens and
helps them to maintain their basic needs.
iii. Indicators
9.
C. Staffmg Plan & Evaluation. (1 page maximum)
i. Staffmg Plan.
There are two staff members at the Clothes Bank, a Manager who is a part-time
school teacher and part-time clothes bank employee and a part-time worker who fills
in during vacations or other times when the Manager is unavailable. The Manager, a
certified educator has vast training and experience to serve the vast multi-cultural and
ethnic of our clients and the assistant has learned from her. They assist clients in
securing appropriate clothing and oversee the general,operation of the shop, also
sorting donations and maintaining a neat and clean facility Total hours of work by
both employees is four hours daily,Monday through Thursday, 50 weeks per year.
•
ii. Evaluation. The Program is monitored by the Board of Directors at its monthly meeting and
by individual members weekly. Also quarterly reports to the City indicate program/service
outcome,clients more than doubling during the first quarter of 2008.. Occasionally forms
are distributed to clients to ascertain whether services are adequate and the shop has proven to
be well received and commended.
D. Differences in Service Delivery by City. N/A
(J 3
11. LONG RANGE PLAN (1 page maximum)
Long range plans for the Clothes Bank's free clothing program is to secure adequate
funds and clothing donations so as to continue the successful program and to otherwise
keep pace with ever increasing number of referrals. It would be an ultimate long-range
goal to acquire a larger facility,i.e.,the History Museum'at such time as they acquire a
new building,which could possibly be within the next few years. We have reached a
prior goal of securing storage space to house special clothes drive donations. We now
have a room at Sartori School,which has been a wonderful asset. Our mentally and
physically challenged Special Ed students, emulating a work situation, are based there.
The Clothes Bank Board is committed to serving the low-income, less fortunate members
of the Renton Community well into the future and anticipates ongoing support from the
City,the Renton Community Foundation's Circle of Giving,various service clubs and
organizations,businesses, schools, and individual philanthropic donors Our long-range
goal being to adequately fund and stock the Clothes Bank so as to continue our unique,
FREE-clothing program of service. We are constantly on alert for new areas to explore
for additional resources, it also being desirable to maintain the caring concern of present
supporters while promoting awareness of the availability of the services to secure
additional donations. The Clothes Bank Board is grateful for the support of the City, and
the grant,without which the Clothes Bank would not exist.
11.
12. BUDGET (2 page maximum)
Expenditures: Operating Fund
A. Budget Request Narrative
City Grant funds are used to provide clothing to the needy and cover much of RCB's
operating costs. Wages are $9800, $2000 in rent, office supplies are $200, phone at
$450, cleaning services at$600,postage at$250 and part of our$90 website fee. Other
operation costs include the secretary of state report($10),,chamber of commerce
membership($200)volunteer appreciation(lunches and food at work parties, gift
certificates)for$450,and miscellaneous clothing items for the shop at$100. The City
Administration at one time advised that if we continued the Clothes Bank service,they
would cover all operating expenses. However, in recent years, we are pleased that
Clothes Bank directors have done personal fundraising and speaking engagements,
mailings,public relations and word of mouth have received$1650 from citizens, clubs,
and organizations from those efforts.
B. Changes to Budget
The RCB received a rent increase of$200 in 2008, developed a website, (the $800 cost of
development of the website was donated), and we joined the Chamber of Commerce. The
major budget increase is due to an increase in wages because the staff now work four
hours or more each day rather than the three hours in 2007. We have a greater need for
staffing hours because of an increase in referrals,resulting from the influx of new
residents, and increased amounts of clothing donations that need to be sorted. Much of
this is a result of increased publicity in newspapers and the website increasing our
visibility in the community. We have included a 3%salary increase for 2009.
B. Cost per service unit
RCB anticipates 4,500 individuals being served with clothing in 2009 and dividing that in
the total budget of$14,150 results in $3.1.4 per service unit.
•
12.
Agency:Renton Clothes Bank,
Program: Clothing for the Needy
13. NUMBER of INDIVIDUALS/HOUSEHOLDS SERVED BY
PROGRAM
Individuals? or 111 Households? (Check which applies and use for reporting all
demographics)
Unduplicated
*Unduplicated Number of all Clients Served by Clients Served
All Funding Sources with Funds
Requested
2007
2007 % of column 2008 2009 2009
(Actual) 1 clients (Anticipated) (Projected) (City Requested
served by Funding Only)
City
Auburn
•
Burien
Covington
Des Moines
Enumclaw
Federal Way
Kent
Renton 2834 89% 4000 4500 $12,500
SeaTac
Seattle
Tukwila •
Other 317
11/o
isy.,,.. ,. . . -.-.t.. .......... ......
100%
Total 3151 (This column must 5500 $12,500
total 100%)
i
13.
Agency:Renton Clothes Bank,
Program:Clothing for the nee.
14. Performance Measures & Average Cost of Service (Data
Tables)
14. Performance Measures (Data Table) P o�am:
14a. Service with 2009 Requested Funds
Proposed Performance Measures as defined below.
A) B) C)
Auburn
Burien
Covington
Des Moines
Enumclaw
Federal Way
Kent
Renton 4500
SeaTac
Seattle
Tukwila
•
14.
14b. Performance Measures 2009 Proposed'with funds requested City Funding Only
Title: Brief explanation:
A) Clothes dispensed to 4500
unduplicated and 317 Unlimited amount of clothing,linens,household goods and personal
unincorporated areas. hygiene items provided at no charge.
B)
C)
15.
Agency:Renton Clothes Bank,I
14 Performance Measures (Data Table), Cont. Program:Clothing for the need3
14c. Average Cost of Service
Unduplicated Clients
Served with Funds Average Cost of Servic
Requested 2009 Requested 2009 per Client
(Same as last column of (Same as last column of
Question 6) Question 13) Column 1 divided by Columi
Example: $5,000 45 $11'
Auburn
Burien
Covington
Des Moines
Enumclaw
Federal Way
Bent
Renton $12,500
4500 2.17
SeaTac
Seattle
Tukwila
16.
Complete Question 15 with 2007 Actual numbers reported in column 1 of Questionncy:Renton Clothes Rai
\ 15. Demographics (from all funding sources) (Data Table)
Program:Clothing for t,.-n
y
Client Residence Oho o
r 0U U
0 • �, O cd
g a./ 0 • (1) a.) a) cu 0
W U W w rz4 c cn H
Unduplicated
(check one)
®Individuals en
M
00
0 Households N
Served in 2007*
•
17.
Household Income Level
30%of Median or Below 2834
50%of Median or Below
80%of Median or Below
Above 80%of Median
Unknown
TOTAL
Gender
Male
Female
TOTAL
Ag'e.
0-4years
5-12years
13:17 years
18-34 years
35-54 years
55-74 years
75+years
Unknown
TOTAL
Ethnicity
Asian 97
Black/African American 438
Hispanic/Latino(a) 786
Native American/Alaskan 47
Pacific Islander 20
White/Caucasian 1446
Other/Multi-Ethnic
TOTAL 2834
.Female Headed
'Household
Disabling
-Condition
-Limited English"
'Speaking
16. PROGRAM STAFF (DATA TABLE)
In this data table, record the number of full-time equivalent(FTE)paid staff and
• volunteers for this program. FTE means a 40-hour week throughout the entire year. For
example, if you enter"5" in the box for Number of Volunteer FTEs,this would mean that
you have, on average, five volunteers assisting your program at all times (assuming a 40-
hour week).
If you know only the total number of hours contributed by all volunteers for this program,
simply divide that number by 2,080 to find the total FTE number. For example: 5,000
volunteer hours over the course of a year, divided by 2,080 equals 2.4 FTEs.
18.
2007 2008 2009
(Actual) (Budgeted) (Projected)
Total Number of Staff(FTEs) .38 .38
.28
Number of Volunteer(FTEs)
Actual Number of Volunteers
Agency:Renton Clothes Bank,Inc.
17. PROGRAM REVENUE BUDGET (DATA TABLE)
Program:Clothing for the needy
Revenue Source 2007 2008 2009
(Actual) (Budgeted) (Projected /
Requested)
City Funding(General Fund& CDBG)
• Auburn
• Burien
• Covington
• Des Moines
• Enumclaw
• Federal Way
• Kent
• Renton $11,385.00 $11,385.00 $12,500
• SeaTac
• Seattle
• Tukwila
• Other (Specify) •
• Other (Specify)
Other Government Funds
• King County
• Washington State
• • Federal Government(Specify)
19.
• Other (Specify)
-
.
Private Sources
• United Way (grants&designated donors) 50.00 50.00
• Foundations and Corporations 500.00 500.00 500.00
• Contributions (e.g.,Events,Mailings)
• Program Service Fees (User Fees)
• Other (Specify) * 1,100 1,100 1,150
TOTAL PROGRAM BUDGET $13,035.00 $13,035.00 $14,150.
BOTHER:FAIRWOOD LIONS CLUB,GREATER RENTON KIWANIS(AM),RENTON
HIGHLANDS LIONS,RENTON LIONS CLUB,AND PRIVATE CITIZENS.
1
i
20.
, 17. PROGRAM EXPENSE BUDGET, CONT. Agency:Renton Clothes Ba
(DATA TABLE)
Program: Clothing for the needy
Expenses 2007 2008 2009
(Actual) (Budgeted) (Projected;
A
Personnel Costs
• Salaries $6,252.58 $7,000.00 $8,000.00
• Benefits 1,417.41 1,830.00 1,800.00
• Other '
• Total Personnel $7,669.99 $8,830.00 $9,800.00
:
Operating and Supplies
• Office /Program Supplies 78.37 150.00 200.00
• Rent and Utilities 1,900.00 2,000.00 2,000
• Repair and Maintenance 420.00 600.00 600.00
• Insurance
1
• Postage and Shipping 15.41 150.00 250.00
• Printing and Advertising
• Telephone 375.35 450.00 450.00
• Equipment
• Conference/Travel/Training/Mileage
• Dues and Fees (Chamber of Commerce) 200.00 200.00
• Professional Fees / Contracts
• Direct Asst. to Individuals
• Administrative Costs
• Other(specify)Website 90.00 90.00 90.00
• Sec. Of State 10.00 10.00 10.00
• Volunteer Appreciation 450.00 450.00
• Miscellaneous 395.18 145.00 100.00
•
TOTAL PROGRAM EXPENSES $11,014.30 $13,035.00 $14,150.00
21.
Net Profit (Loss)
(revenue—expenses) = $2,01.00 -0- -0-
22.
Agency:Renton Clothes Bank
18. SUBCONTRACTS (DATA TABLE) Program: Clothing for needy
List all the agencies you will be subcontracting with for this program. Provide the agency
name in the first column,a description of the contract/service in the second column,and
the contract amount in the third column.Do not list agencies you coordinate with on a
referral only basis. Indicate not applicable if you do not subcontract for any part of this
program.
Subcontracting Agency Specific Subcontracted Activities Contract
in the Operation of Your Program Amount
N/A
•
23.
19. APPLICATION CHECKLIST
Applications missing one or more of the following components or not following these
directions may not be reviewed. Sign and submit the application checklist with your
application.
Contents (Your application should contain each of these items in this order.)
0 Application Cover Pages.The top three pages of your application must be a completed
copy of the Agency Information and Questions 1-7.
Application Narrative:
Question•8 Organizational Experience(2 page maximum)
2. Question 9 Need for Your Program (2 page maximum)
® Question 10 Proposed Program/Service(6 page maximum)
[Z Question 11 Long Range Plan (1 page,maximum)
• Question 12 Budget(2 page maximum)
Data Tables
[r Question 13 Number of Individuals/Households Served
O Question 14a-c Performance Measures and Average Cost of Service
[' Question 15 Demographics (from all funding sources)
O Question 16 Program Staff
[i ' Question 17 Program Revenue&Expense Budgets
Question 18 Subcontracts
[Required documentation.Supply one copy of the following required documents with the
signed original application. See Part II: City Specific Supplemental Information to determine whether
additional copies of the application and required documentation need to be submitted.
ffQuestion 19 Required Documentation,including
• Proof of non-profit status
• Organizational Chart
• Agency/Organization Mission Statement
•V Board resolution authorizing submittal of the application (may be submitted up
to 60 days after application).
• List of the current governing board and local board,if applicable, (include
name,position/title,city residence,length of time on the Board,and expiration
of terms. Note any vacancies.)
• Board Meeting Minutes of last three board meetings of governing board and
local board as applicable
• Annual Budget
• Financial Audit Cover Letter
• Financial Audit Management Letter
• Financial Statement
• Verification of Non-Discrimination Polity
• Program Intake Form ;1
• Sliding Fee Scale
]�Application Check List (Signed below.)
gli[]City Specific Supplemental Information.Required in Name:
Part II fora applicable Cityonly. Position:/*?.../4/
%✓..,/
PP Y
Phone#: SAS.h /1
E-mail: AP
6--C6reSSier( edmCu�;''nc°
24.
19. APPLICATION CHECKLIST
Applications missing one or more of the following components or not following these
directions may not be reviewed. Sign and submit the application checklist with your
application.
Contents (Your application should contain each of these items in this order.)
Q Application Cover Pages.The top three pages of your application must be a completed
copy of the Agency Information and Questions 1-7. •
Application Narrative:
111 Question 8 Organizational Experience(2 page maximum)
❑r Question 9 Need for Your Program (2 page maximum)
0 Question 10 Proposed Program/Service(6 page maximum)
[✓� Question 11 Long Range Plan(1 page maximum)
Q Question 12 Budget(2 page maximum)
Data Tables
Er Question 13 Number of Individuals/Households Served
2 Question 14a-c Performance Measures and Average Cost of Service
[v� Question 15 Demographics (from all funding sources)
Et Question 16 Program Staff
2. Question 17 Program Revenue&Expense Budgets
Er Question 18 Subcontracts
[]'Required documentation.Supply one copy of the following required documents with the
signed original application. See Part II: City Specific Supplemental Information to determine whether
additional copies of the application and required documentation need to be submitted.
[r Question 19 Required Documentation,including.
• Proof of non-profit status
■ Organizational Chart
• Agency/Organization Mission Statement
■ Board resolution authorizing submittal of the application(may be submitted up
to 60 days after application).
■ List of the current governing board and local board,if applicable, (include
name,position/title,city residence,length of time on the Board,and expiration
of terms. Note any vacancies.)
• Board Meeting Minutes of last three board meetings of governing board and
local board as applicable
■ Annual Budget
• Financial Audit Cover Letter
• Financial Audit Management Letter
• Financial Statement
■ Verification of Non-Discrimination Policy
• Program Intake Form f
•
• Sliding Fee Scale
Q Application Check List (Signed below.)
gtifn City Specific Supplemental Information.Required in Name:
Part II for applicable City only.
Position: './ /y%
Phone#:
E-mail:
SC6YPS5 le. reedmca),
24.
Application for
Human (Public) Service Programs
Renton supplemental information
Agency: Renton Clothes Bank
Please select ONE Result that is the best fit for the program. Identify what strategies and
activities will achieve the Result. You can choose from strategies and activities that
Renton has already identified or you can identify your own.
#1—Of the Renton Results, Strategies, and Activities, Result#2, Strategy B: "Increase
the capacity of programs that provide food, clothing, housing, and healthcare and
residents access to them"best captures the mission of the Renton Clothes Bank (RCB)
program and activities. Our strategy at the RCB is to link with local service agencies,
Communities in Schools of Renton, and the Renton School District so that individuals
and families with clothing needs get referrals and gain access to free clothing. By
continuing to be the only program in the community that provides free clothing, we are
unique in our mission and services. The RCB, is also uniquely designed that we provide a
"store-like" experience where patrons can select and try on clothing suitable to their
needs.
Additional activities include increasing our public,exposure in the community in the area
of public relations and publishing our website and marketing materials to a wider
audience.
#2-- For all programs: Describe how the program outcomes as identified on page 9 of
the application narrative will help achieve the selected Result.
The outcome of our program is to assist families and individuals in need in two ways. By
providing clothing at no cost we allow families to concentrate their financial need on
their most basic of human needs: food and shelter. Children are able to attend school with
clean, wearable clothing, which gives them a stronger sense of self-esteem and desire to
participate in the education experience. We find that giving children clean clothing,
shoes, socks, and underwear at the beginning of the school year truly gives them a
stronger sense of dignity. In addition, the homeless can gain access to warm clothing
when they have no shelter to keep them warm.
•
•
..-"- W-9 j•
a- (October mentof) Payer's Request for Taxpayer
•
Department of the Treasury Identification Number
Internal Revenue Service
Name as shown on account(if joint account,also give joint owner's name)
•
_ Renton Clothes Bank
Address
6
c/o Renton School District No. 403
0
m City,State,and ZIP code
a 435 Main Avenue So. , Renton, WA. 98055
List account number(s)here(See Instructions))..
PART 1.—Taxpayer Identification Number PART II.—Backup'Withholding On
Accounts Opened After
12/31/83
I.
Enter the taxpayer identification number in the Social security number j
appropriate box. For most individual taxpayers, Ii Check the box if you
this is the social security number. are NOT subject to •
backup
Note:If the account is in more than one name, ;I'AX ID/EXEMP?RNUMBER under the provisions of see the chart on page 2 for guidelines on which t
number to give the payer. I Employer identification number section 3406(a)(1XC)
91-1215384
I of Code the Internal Revenue 1. 1I El(See
Certification.—Under the penalties of perjury, I certify that the information provided on this formHighlight
below.)
hstrue, correct, and complete.
Signature P. r * 4 `�, i
-4, . / Date ► _ /a i 1
Instructions(Section references are to the Internal Revenue Code.) Payments of Interest, Divid nds, and Patronage
Highlight for Interest or Dividend Accounts Opened After Dividends
12/31/83—Backup Withholding Accounts Opened Before January 1,1984
K s cy be notified that you are subject to backup withholding under 3406faifi)(C)because you have underreported interest or To certify that the taxpayer identification number is correct for accounts
{''°",• +*f; .-..V. opened before January 1.'1984,fill out you r nape and address,enter your
DQparrQomow4 04 4OD0 5P
i Internal Revenue Service
•
•
• Date of This Notice
29242556 If you Inquire about
074.27083
your account,please•
refer to this Employer Identification Number
91 i 215884,
number or attach a
RENTON CLOTMES:•BANK. copy of this notice i
• %'• RENTQk: :SCH• .DjS1`
E 8Qi] EDMOND$ N .
` r35• MAIN, Aye, S-, . ;
E I
ti i RENTON. WA. 98056•
6
1 •
NOTICE OF NEW EMPLOYER IDENTIFICATION NUMBER ASSIGNED ts
/4, Thank you .for your application for an employer identification number. The number above
N ' -has. been assigned to you. W, will use it to identify
;,, fated documents, even if you have no employees. your business tax returns and any other re-
o Please keep this number in your permanent records. Use the number and your name, ex-
LT.
6- actly as shown above, on all Federal tax forms that require this information, and refer to +i•..,
ber in all tax payments anrf in tnv_r,,I.,+..a _ .
r
1,mgml�.,(!mpstlgiln V!�JJmV mor !V mirA I mock!', !I�.C!11..Z!mmre�V mtgri1V!�iCwly,Mlmgh
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41
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p...4 4 STATE ►1 `
1 S.N� !p?rc% Fl
} SECRET
E
5
} I, RALPH MUNRO, Secretary of State of the State of Washington and custodian of its seal, ►
E, hereby issue this .11
El
.} CERTIFICATE OF INCORPORATION
to i
l RENTON CLOTHES BANK
al
62 El
El a Washington Non Profit corporation. Articles of Incorporation were filed for record in r
this office on the date indicated below. ►
►i
ai
62
al
UBI Number: 602 063 921 Date: September 07, 2000 EA
I: r
r
' .
g'
ER
tiii Given under my hand and the Seal of the State al
Ei of Washington at Olympia, the State Capital ►
�� r
,.. 4 ci4q.k 1‘) *"°4
13
113 Ralph Munro,Secretary oAs684-9
7,
1,,>„
(iiYyYf)'`fl?'`otyi`(IiY�YfY'�lvri`fiiYsYiYsYlYsl'1iYiYfwY,ori7'�Yi�'`(1fY'cIfY�YR'kl?'`fifYYf? A�Yyl1iYv�y fYYIY�`►1Y`f
RENTON CLOTHES BANK ORGANIZATIONAL CHART
BOARD OF DIRECTORS
EMPLOYEE I EMPLOYEE II
MANAGER
111 RENTON CLOTHES BANK,INC.
MISSION STATEMENT
TO GIVE A SENSE OF DIGNITY, PURPOSE AND PRIDE TO
THOSE IN NEED IN THE RENTON COMMUNITY
PRIMARY GOALS
Provide clean, wearable clothing to the needy of the Greater
Renton community.at no charge.
Maintain the caring concern of present supporters.
Generate additional funding and clothing donations
I
Adopted 4/13/06
Resolution #1, 2006
RENTON CLOTHES BANK, INC.
RESOLUTION NO. 1-2008
WHEREAS, The Renton Clothes Bank Board of Directors has in hand
a City of Renton Human(Public) Services Program Grant
Application for 2009/10, AND,
WHEREAS, Said Grant Funds are a critical source of funding for the
Operating Expenses of the Renton Clothes Bank Budget
and vital to the continuation of the program of dispensing
FREE clothing to the low-income residents of the Renton
School District, AND,
WHEREAS, The Application is due to be filed with the City of Renton on
or by April 30, 2008,NOW THEREFORE, ,
BE IT RESOLVED, That the President of the Renton Clothes Bank Board is
hereby authorized and directed to submit the required
Application to the City of Renton on or before the noted
deadline as required.
A-Nfen
RENTON CLOTHES BANS
BOARD OF DIRECTORS
2007-08
DIRECTOR PHONES MEMBER POSITION TERM
OFFICERS:
DELORES MEAD H-425.255.8018 Renton President 9/07-9/09
604 South 17th St. C-206.371.3875 Soroptimists Director 9/06-9/09
Renton, Wa 98055
ROBERTA LOGUE H-425.226.2834 Lions Vice Presiden 9/07-9/09
17803-110th Ave SE Director 9/07-9/10
Renton WA 98055
JUDY CRAIG H-425.255.3210 Renton Co-Treasurer 9/07-9/09
3204 Park Ave N. C-425.246.5159 Soroptimists Director 9/07-9/10
Renton WA 98056
SUE McCORKLE W-425.228.6133 General Co-Treasurer 9/07-9/09
319 S. 3rd St. H-425.228.5266 Support Director 9/07-9/10
Renton WA 98055
SUSAN BRESSLER H-425.917.2062 Renton Secretary /9/07-9/09
15448 SE 167th PI Technical Director 9/05-9/08.
Renton WA 98058 College
DIRECTORS:
PAT AUTEN H-425.255.1406 Renton Director 9/07-9/10
14401 SE Petrovisky School
Renton WA 98058 District-Ret.
BARBAF1A DOWNS W-253.872.8147 Renton Director 9/05-9/08
13819 156th Ave SE H-425.226.7323 Soroptimists
Renton WA 98059 C-206.295.9831
LILA HOUSER H-425.255.7445 General Director 9/05-9/08
4450 Davis Ave S, Apt #345 Support
Renton WA 98055
JOY JOHNSON* H-425.228.1342 General Director 1/07-9/08
1824 Jones Ave. NE Support
Renton WA 98056
ROSEMARY,McSHANI W-425.226.1850 Renton Director 9/06-9/09
2900 NE 10th St Ext. 233 Housing
Renton WA 98058 H-425.255.029 Authority
*Completing Rose Raihala's term. 10/1/2007jc
.A./ 1 t.1, ',:'.."1...'..',%•r., sl; ..', ..—',..-'.1'-:‘.v.,''',.iii
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.----- -,,
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. .
RENTON CLOTHES BANK
JANUARY 10,2008
MINUTES
Present: Lila Houser, Roberta Logue, Joy Johnson, Pat Auten, Jon Pozega, Susan
Bressler,Judy Craig, Sue McCorkle,Barbara Downs
Roberta called the meeting to order at 12:05 p.m.
Minutes were approved as presented.
Judy presented the fmancial report. Received $500 from Lions Club(budgeted for$250).
Gail Burton returned the $100 bonus back to the Clothes Bank.
Correspondence: Renton Community Foundation is awarding the Clothes Bank, $1000
January 11 @RTC.
REPORTS OF BOARD MEMBERS:
Purchased two new tirered racks for the Clothes Bank from a business that had gone out
of business.
Client count for December: 358
3 month period: 1,188
New volunteer,Kathleen Nass, installed new dressing room rack.
Gifted with new coats from owner of the Apogee, who held a new coat drive.
Children from a local church, donated their favorite clothing item to the Clothes Bank.
Maplewood Heights is having a clothing drive, Sue has dropped off lots of items.
St.Matthew Lutheran Church is collecting a lot of items after we placed an article in the
church newsletter. Judy has dropped off a car load of clothing!
NEW BUSINESS:
Recruitment of new staff members. Del is looking to hiring someone new. Background
checks need to be filled out.
UNFINISHED BUSINESS:
Jon's working on getting some signage donated for the front door of the Clothes Bank
with our website listed. _
IAAP presentation at RTC, January 10,Jon is checking out....
Emergency preparedness. Community organization affiliated with emergency
preparedness. City planning should be aware we have stockpile of clothing at Sartori in
case of disaster. January 31 st is their next meeting--@RTC @ 7:00 p.m. Jon will be our
representative.
Respectfully submitted,
r _ Susan Bressler
Renton Clothes Bank, Inc.
1 41 February 14, 2007
Minutes
Present: Del Mead, Judy Craig, Pat Auten, Lila Houser, Joy Johnson, Roberta Logue
, Del called the meeting to order at 12:07 PM.
Minutes were approved as presented.
Judy presented the financial report and it was filed for audit.
REPORTS OF BOARD MEMBERS:
Lila reported the client count for January was 653.
The Eagles have donated two truck loads of clothing and Roberta stated there is more
clothing to be taken to the Clothes Bank.
NEW BUSINESS:
Del has been working on recruitment of new staff and volunteers. We have volunteers
coming several times a week to help straighten shelves, etc.
A motion was made by Judy and seconded by Roberta to approve the lease with RAYS
for our building for 2008. Del noted that there was a$100.00 increase over last year.
The motion was approved unanimously.
UNFINISHED BUSINESS:
The new signage is in place on the front window at the Clothes Bank courtesy of Rob
Guthrie of R&R Graphics. Rob is a member of the morning Kiwanis group.
The brochures are still in progress.
2008 Budget was discussed. A line item for website maintenance will be added. Del
needs to check on the monthly amount. It was decided that when a new grant is applied
for we will request$12,000.
Respectfully submitted,
•
Pat Auten, Secretary Pro-tern
Renton Clothes Bank, Inc.
•
April 10, 2008
Minutes
Present: Del Mead, Judy Craig, Susan Bressler, Pat Auten, Lila Houser, Joy Johnson,
Barbara Downs
Del called the meeting to order at 12:05 PM.
Minutes were not approved. Appear to be missing, Susan and Pat will check their files.
Judy presented the financial report and it was filed for audit.
REPORTS OF BOARD MEMBERS:
' Lila reported the client count for March was 658. We stand at 1727 for the quarter.
Del reported that the website is being updated with new pictures.
$1,000 donation was received from Soroptimist
New Brochure is in progress, Jon is working on
Room in Kholwes Center has been booked for 2008/2009
Hazen work part on 4/19
NEW BUSINESS:.
Resolution No. 1-2008 authorizing submittal of 2009/10 Grant application to the City of
Renton was passed. Pat motioned, and Barb seconded.
Proposed budget for the grant application was accepted. Pat motioned, and Barb
seconded.
Respectfully submitted,
Susan Bressler, Secretary
(
Pg. 1 of 2
RENTON CLOTHES BANK, INC.
PROPOSED 2009 BUDGET
REVENUE:
OPERATING FUND:
City of Renton Grant $ 12,500.00
DONATIONS:
Fairwood Lions Club $ 250.00
Greater Renton Kiwanis (AM) 500.00
Renton Highlands Lions 250.00
Renton Lions Club 250.00
Renton Prof. Tech. 250.00
United Way 50.00
Miscellaneous 100.00
TOTAL OPERATING FUND $14,150.00
CHILDRENS'NEEDS ACCOUNT:
Greater Renton Kiwanis(AM) $ 500.00
O. J.. Harper Memorial Fund (Pat Auten) 1,000.00
Piazza Renton 200.00
Renton Corn. Foundation- Circle of Giving 1,000.00
Soroptimist Int'l. Of Renton. 1,000..00
Miscellaneous Donaations 300.00
TOTAL CHILDREN'S NEEDS FUND $ 4,000.00
TOTAL REVENUE $ 18,150.00
Jr
RENTON CLOTHES BANK,INC
2009 Budget
Page 2 of 2
EXPENDITURES:
Employee Wages $8,000.00
Employee Accrued Taxes 600.00
Dept. of Labor& Industries 650.00
WA State Employment 50.00
Security
IRS 700.00
Rent 2,000.00
Telephone 450.00
Cleaning Service 600.00
Supplies 250.00
Postage/Office Expense 350.00
Website 50.00
Sec of State Annual Report 10.00
Volunteer Appreciation 240.00
Miscellaneous (Clothing 200.00
Items)
Total Operating Expenditures $14,150.00
CHILDREN'S NEEDS $4,000.00
ACCOUNT
Total Expenditures $18,150.00
RENTON CLOTHES BANK,INC.
The Renton Clothes Bank books of account were duly audited and approved on
9ctit a q for the period of January 1,2007, through December 31, 2007.
The books were found to be in proper balance and maintained in accordance with
standard accounting practices and procedures.
AUDIT COMMITTEE:
ry A-
RENTON CLOTHES BANK AUDIT
DATE: Io
g
CHECKS
Is each check written recorded in the check register(spreadsheet)? v! '
Are check numbers written and stored in sequential order?
Are there any missing checks? Op
Is there sufficient back-up information, receipts, invoices, to justify the check
amounts? 10
Were reimbursements received and made in a timely fashion? ifeo
Were employees paid promptly?
0
2. DEPOSITS
Were deposits received and made in a timely manner?
3. BANK STATEMENTS U
Were bank statements received and balanced to the check register on a regular
basis?
Was a signature card on file at the bank for the officers of the recording period? 0 -'
N)rt
Were Secretary of State and IRS filings done by the required due dates?
Were the City of Renton Grant reports done by required due dates? y
Does.the current treasurer have a record of the Certificate of Incorporation? Is
it on file with any other officer? q'e,,1
4. BUDGET REPORTS
Was a budget created and adopted at a board meeting? (� 1
Was there.any expense that went beyond budget amounts or for items not
,previously approved? i R.5 a,f- Pert.C-e
V1rlA c, QQ4-C�..,b --
How many reports were made during the reporting peri217 -16
Was there a cash-on-hand beginning and ending balance that was tied to the check
register?
Did the check register(spreadsheet) contain notes on where an expense would be
charged in the budget? t..ilth
5. Other questions, concerns or recommendations?
�hC?�xl houu W
Signed and dated by Audit committee members: -
)16v).„,a/viz,. 6Lezde47.
Rev. 12/05 jc
RENTON;CLOTHES BANK,INC.
2007 Treasurer's Report
END OF THE YEAR
BUDGET 2007 JAN.2007 FEB.2007 MAR.2007 APR.2007
REVENUE:
OPERATING FUND:
City of Renton-Grant $ 11,385 2,000.00
DONATIONS:
Fairwood Lions Club $ 250 250.00
Greater Renton Kiwanis(AM) $ 500
Renton Highlands Lions $ 250
Renton Lions Club $ 250
Renton Prof Tech $ 250
United Way $ 50
Miscellaneous Donations • $ 100 56.99
Total Operating Fund $ 13,035 2,056.99 0.00 250.00 0.00
CHILDREN'S NEEDS ACCOUNT:
Greater Renton Kiwanis(AM) $ 500
O.J.Harper Memorial Fund(Pat A.) $ 3,000
Piazza Renton $ 500
Ren.CommFund-Circle of Giving $ 500 500.00
Soroptimist Intl.of Renton $ 1,000 1,000.00
Miscellaneous Donations $ 280
Total Children's Needs Account $ 5,780 500.00 1,000.00 0.00 0.00
TOTAL REVENUE $ 18,815 2,556.99 1,000.00 250.00 0.00
EXPENDITURES:
OPERATING FUND:
Employee Wages(gross-qtrly) $ 7,000 1,618.92
Employee Wages(net) 491.83 1,010.86 420.46
Dept.of Labor&Industries $ 600 107.49 126.01
Wash.State Employment Security $ 50 7.86 6.16
IRS $ 600 957.93 -
Rent $ 1,900 475.00
Telephone $ 450 30.57 31.22 31.40
Cleaning Service $ 480
Supplies $ 150 25.00
Postage/Office Expenses $ 100 59.40 19.53
Sec.Of State Annual Report $ 10
Miscellaneous $ 45 100.00
CHILDREN'S NEEDS ACCOUNT $ 7,430 860.66 88.66 568.82 223.63
TOTAL EXPENDITURES $ 18,815 1,964.51 639.89 1,610.90 1,427.19
NET INCOME(LOSS) 592.48 360.11 (1,360.90) (1,427.19)
Checking
Account
BEGINNING BALANCE $ 8,574.35
ENDING BALANCE $ 11,028.96
Printed 4/8/08
J.Craig PAGE 1 OF 2
•
RENTON CLOTHES BANK,INC.
2007 Treasurer's Report
END OF THE YEAR
MAY 2007 JUN.2007 JULY 2007 AUG.2007 SEP.2007 OCT.2007 NOV.2007 DEC.2007 YEAR TO
DATE
2,846.25 2,846.25 2,846.25 10,538.75
250.00
500.00 500.00
0.00
0.00
0.00
43.36 48.82 92.18
100.00 100.00 256.99
2,846.25 43.36 0.00 2,846.25 0.00 0.00 3,446.25 148.82. 11,637.92
500.00 500.00
3,000.00 3,000.00
200.00 200.00
500.00
1,000.00
420.00 420.00
0.00 . 0.00 0.00 0.00 3,000.00 420.00 500.00 200.00 5,620.00
2,846.25 43.36 0.00 2,846.25 3,000.00 420.00 3,946.25 348.82 17,257.92
1,538.80 1,745.35 1,745.00 1,859.19 6,762.26
1,000.62 539.22 1,072.61 677.46 1,039.52 6,252.58
120.31 79.17 432.98
5.85 6.63 26.50
957.93
475.00 475.00 1,425.00
31.45 62.80 32.33 62.74 30.64 31.24 30.96 375.35
420.00 420.00
10.11 5.00 8.12 30.14 78.37
8.60 20.00 7.88 115.41
10.00 10.00
52.61 26.99 4.33 211.25 111.76 506.94
378.25 134.24 931.38 327.29 182.44 506.88 4,202.25
419.81 1,263.87 692.37 927.33 2,089.18 1,149.98 921.28 1,697.00 14,803.31
2,426.44 (1,220.51) (692.37) 1,918.92 910.82 (729.98) 3,024.97 (1,348.18) 2,454.61
Children's
Needs Fund
$ 2,337.07
$ 3,754.82
Printed 4/8/08
J.Craig PAGE 2 OF 2
/I/
".1)60,7 /rip./ -ArjaAgijAg"./664
zre
RtNTON
!LOTHE$
BANK
a non-profit corporation
FREE CLOTHING
*REFERRALS REQUIRED
lam'
Sys . ' ' • •
' .
Renton Area Multi-Service Center
1025 S. 3rd St.
Renton, WA 98055
• (425) 271-5091
• OPEN
MONDAY THROUGH THURSDAY
(except holidays)
2:00 p.m. - 5:00 p.m.
The RENTON CLOTHES BANK is supported by CLOTHES BANK ADVISORY BOARD
the community and City of Renton,
Delores Mead
Donations of time, clothing, and money are President
given by service clubs, local churches,
Renton School District, School Parent Pat Auten-Renton School District
Teacher Student Associations, Renton area Vice President
businesses and individual citizens. Diane Dobson-Lions Club
Secretary
CLEAN, WEARABLE CLOTHING DONATIONS
WILL BE ACCEPTED AT THE CLOTHES BANK Linda McNeill
DURING NORMAL BUSINESS HOURS OR CALL _Treasurer
(425) 271-5091 FOR FURTHER INFORMATION.
Lila Houser
General Support
*Referrals are available at:
Local Schools Bob Kramer
Salvation Army Kiwanis Club of Greater
Renton
UGN Center
RAYS Rose Raihala
Public Health Office General Support
YWCA
Head Start Shirley Scappini
Local churches Lady Lions
: -' 1�
DSHS
V8i- tcai fm oW-1)1scIr11'vki�-��6Yf 6�'C Barbara Downs
It is the policy of the Renton Clothes Bank that no person Soroptimists
shall be discriminated against on the basis of race, religion, Frank Remengesau
color, national origin, sex, age, marital status or disability,
US Bank
For information regarding board member and volunteer
opportunities, contact Del Mead (425) 255-8018, .
•
40, .va WI �1 I C Gfi k e.
REFERRAL FORM
RENTON CLOTHES BANK •
1025 SOUTH THIRD STREET, RENTON WA. 98055.
OPEN: Monday through Thursday 2:00 p.m. -5:00 p.m.
NAME: DATE:
(please print clearly)
ADDRESS: ZIP:
TELEPHONE: REFERRED BY:
Is this your first visit to the Clothes Bank this year? YES NO
Number of adults receiving clothing Number of children receiving clothing
Ages of children receiving clothing
Check One: White African American Native American or Hispanic Asian or Pacific •
Native Alaskan Islander
It is the policy of the Renton Clothes Bank that no person shall be descriminated against on the
basis of race, religion, color, national origin, sex, age, marital status or disability. We are .
required to collect information on ethnicity by our funding sources. Revised 9/01
NO SLIDING FEE SCALE
Not Applicable-to Clothes Bank Operation
�o lNoT C HAS- Fees,
25.
14.
Application Cover Pages
pp g S (Agency Information and Questions 1 — 7)
AgencyInformation
Agency Name: Senior Services 11"Li L 1 mV E'D
Applicant Name and Address: Agency Director PR 2
.210a8
Kate Turpin Denise klein,Executive Director
Senior Services
Name And TitleT�/OF
� �®�
2208 Second Avenue, Suite 100 206-727-6201
Seattle,WA 98121 (Area Code)Telephone
katet@seniorservices.org 206-448-5756
E-mail address(if available) - (Area Code)Fax Number
Required si atures: By signing below,you certify that the information in this application is accurate to
the best o ou)knowledge and that you have read the application, certifications,and appendixes.
(SIGN MUST BE IN��B f� � ka2444,J4-./4-or
aAcbtei
Si atur of Ag y B and President/Date Signature of Agency Director/Date
• race Wang} Denise Klein
Printed Name of gency Board President Printed Name of Agency Director
Program Information=;
1. Program Name Community Dining(formerly known as Congregate Meals)
Contact Person(available to answer specific questions on this application)
Kate Turpin 206-727-6263
Name (Area Code)Telephone
Address(if different than above)
katet@seniorservices.org 206-448-5756
E-mail address (if available) (Area Code)Fax Number
2. Program is New for our agency ❑An Ongoing Program
3. Brief Description of Program(One sentence)
The Community Dining program provides a nutritionally balanced meal to older adults age 60 or older
in a social setting in partnership with local community and senior centers.
4. Where are services provided? (If different from agency location)
Senior centers and community centers at 24 sites throughout King County.
Page 5
5. Total Program Cost:
Actua12007: $1,802,909.68 Proposed 2009: $2,002,134.61
Projected 2008: $1,937,923.18
6. Total City Funds Requested for this Program:
City Awarded 2008 Requested 2009*
General Fund CDBG Total Requested**
Auburn $4,500.00 $9,778.20
Federal Way $5,000.00 $5,912.40
Kent
Renton $5,457.60
City Awarded 2008 Requested 2009*
General Fund General Fund
Burien
Covington
Des Moines $1,000.00 $4,320.60
Enumclaw
SeaTac $2,000.00 $4,320.60
Tukwila
*Cities on a two year funding cycle will renew 2009 awards to 2010 based upon performance and availability of funds. See
Part II for city specific information.
**Include your total request for Auburn,Federal Way Kent and Renton. The source of funding will be determined by staff.
Page 2
7. Agency Contact Sheet
Provide the following information for the agency and for the program requesting funds.
Agency Contacts
General Agency Name: Senior Services
Address: 2208 Second Avenue, Suite 100
City/State/Zip: Seattle,WA 98121
Phone/Fax: 206-448-5757,206-448-5756 (fax)
Agency Web Address: www.seniorservices.org
Executive Director Name: Denise Klein
Title: Executive Director
Direct Phone: 206-727-6201
E-Mail: denisek@seniorservices.org
Development Director Name: Patricia Hart
(or Grant Writer) Title: Chief Development Officer
Direct Phone: 206-727-6205
E-Mail: patriciah@seniorservices.org
Finance/Accountant Name: Tara Voss
(person preparing invoices) Title: Controller
Direct Phone: 206-727-6298
E-Mail: taravAseniorservices.org
Program Contact
(Staff contact for contracting, reporting and program implementation.)
Program Name: Community Dining
Staff Name: Kate Turpin
Title: Vice President
Direct Phone: 206-727-6263
E-Mail: katet@seniorservices.org
Page 3
8. ORGANIZATIONAL EXPERIENCE (2 page maximum)
A. Experience
Since 1967, Senior Services has been making a difference in the lives of seniors, their families and the
community,by providing essential services that enhance the health, safety, and quality of life of older
adults. Our mission—to promote the emotional, social, and physical well being of older adults—is
achieved through our comprehensive network of centers and services that includes eleven core
programs, eight senior centers, and three adult day health centers. Our core programs include:
Caregiver Outreach and Support: practical resources, caregiver support and counseling, caregiver
training, and help navigating the maze of potential services
Community Dining: nutritious meals, nutrition education and social interaction at 24 sites
EnhanceFitness: aerobic exercise and strength training specifically designed for older adults with
evidence-based results
Enhance Wellness: structure, motivation and encouragement for older adults to take on health
challenges and maintain or regain control of their lives
Homesharing: expert matching of homeowners and renters providing both more affordable housing
and the companionship of living with another person
Meals on Wheels: nutritious frozen meals and groceries delivered to homebound seniors
Minor Home Repair: basic plumbing, carpentry, electrical and other repairs and modifications
Senior Information &Assistance: help and advice from trained advocates who have access to more'
than 7,000 resources in our databank
Senior Outreach: assistance sorting out complex issues and reducing barriers to accessing health
and social services, referrals to critical services, encouragement and connection
Senior Rights Assistance: help and advice from trained volunteers with assistance from our legal
advisor on consumer, estate, retirement and other issues
Transportation: to medical appointments, lunch sites, senior centers, grocery shopping, and errands
Our services touch the lives of all generations—the very young child being raised by a grandparent, the ,
working middle age son or daughter struggling to care for an aging parent, and the frail senior living
alone, striving to remain independent. Last year, with the support of our community partners, we
served more than 55,000 older adults, their families, and caregivers throughout King County.
CLIENT DEMOGRAPHICS
Gender Race/Ethnicity
Female: 71%; Male: 29% Asian/Pacific Islander 8%
Geography: . African American 11%
Lives in East County 12% Caucasian 75%
North County 17% Hispanic/Latino • 2%'
Seattle 36% Native American 1%
South County 17% Other/multi-racial 3%
Other 18%
Age Income
Page 4
Less than 59 Years 8% Very low income (<30%median) 41%
60-74 Years Old 38% Low Income(30%-49% median) 25%
75-84 Years Old 35% Moderate (50%-80%median) 18%
85 and Older 18% Above moderate(80% and above) 16%
B. Operational Structure
Senior Services has a staff of 242 (107 full-time, 135 part-time employees) led by a management team
of five Vice Presidents and an Executive Director. Denise Klein, our Executive Director, has 33 years
experience and is a nationally recognized leader in the field of aging. In addition, the success of each
and every program at Senior Services is dependent upon many.dedicated volunteers who assist in
carrying out the agency's core programs. Last year, 3,579 volunteers of all ages participated in all
areas of organizational operations, from direct service to administrative program support. Please see
attached organizational chart with executive management and program detail.
A 17-member Board of Directors actively governs Senior Services, helping to shape policy, ensure
quality service delivery, maintain fiscal integrity, and advance the agency mission. Board members
serve a three-year term, are required to attend at least 75% of scheduled board meetings, and are asked
to serve on at least one committee and/or hold one leadership position. The Board meets monthly as a
whole,but members also attend committee meetings which are also held monthly.
Board members represent the agency, its programs and services in a positive and professional manner
at all times and contribute to achieving the agency's mission and strategic plan. They also willingly
support the organization financially, support fundraising activities, and cultivate new/existing donors.
The Board is updated on all of the services the agency provides, including those that cover South King
County, through their monthly meetings and with year-end statistics. Top priorities for recruitment
include individuals from South King County, youth, diverse ethnic backgrounds, and experience in
areas such as IT, Strategic Planning, and faith communities. The Board is comprised of members from
diverse backgrounds, ages and expertise to complement the needs of the agency. The elements
recorded are as follows:
BOARD DEMOGRAPHICS (17 members)
Gender - Race/Ethnicity
Female: 5; Male: 12 Asian/Pacific Islander 2
Geography African American 0
Lives in East County 8 Caucasian 14
North County 2 Hispanic/Latino 0
Seattle 7 Native American 0
South County 0 Other/multi-racial 1
Other 0 Sector
Age Public Sector.-
g 2
21-35 0 Law/Labor 3
36-50 4 Marketing/Media 2
51-64 10 Corporate/Business 12
65 and Older 3 Health/Medical 1
Our Presidents Council, representing board presidents of eight affiliated senior centers, fosters clear
communication between volunteer leadership and senior management.
Page 5
9. NEED FOR YOUR PROGRAM(2 page maximum)
This section should describe the specific problem faced by the population you are serving or intend to
serve.
A. Problem Statement. Describe the problem faced by your target population that will be addressed by
your proposed program including any research or data that supports the need and/or gap in services. Do
not describe how your program.will address this problem.
In the latest look at social and health indicators across King County as published in Communities Count
2005, the fastest growing age groups are 45-64 and 75 and up.' Currently, over 15% of King County's
population is over 60. By the year 2025, 23% of the population will be over 60 years old. As people are
living longer, social programs need to grow to meet the need and adapt to the changing face of the
population. Nutrition and social contact are two areas that are key to healthy aging.
Good nutrition can improve quality of life, facilitate aging in place, promote health, and improve
outcomes when people are ill or injured. On the other hand,hunger and food insecurity are associated
with more doctor visits, higher rates of hospitalization and other preventable medical care.2 The vast
majority of older Americans have chronic conditions in which nutrition interventions have been
demonstrated to be effective in improving health and quality-of-life outcomes.3
Purchasing nutritious food is especially challenging for individuals with low or fixed incomes. Since
1990, poverty rates have increased among the elderly. In 1990, 6.9% of County residents 65 and older
were living below the federal poverty level;by 2000, this figure had risen slightly to 7.1%. The latest
data available, from Census Bureau estimates for 2005, show it has risen almost 2 percentage points, to
8.9%.4
Additionally, and not to be underestimated, social contact has been linked to better health among older
adults. According to a study published in"Quality of Life Review," elders without a close friend
experienced similar reduced physical functioning and vitality seen with heavy smokers or seniors with
obesity. Another study showed that"older people with better social networks are also less likely to die
over a 10 year follow-up period than those with fewer friends."5
B.Target Population. Identify and describe the population to be served by your program—both
demographically and geographically.
Based on client data provided to us by our lunch participants,many of our clients in the Auburn, Des
Moines, Federal Way, Renton, and SeaTac communities are nutritionally at risk based on income, age,
and disability. Of participants who responded to the questions pertaining to age, income, and disability:
• 58% are 75 years or older, 85% are low income, and 28% are disabled in Auburn
• 67% are 75 years or older, 89% are low income, and 17% are disabled in Des Moines
Communities Count:Social and Health Indicators Across King County 2005
2 The Economic Cost of Domestic Hunger:Estimated Annual Burden to the United States. June 5,2007. Dr. J.Larry Brown,
Dr.Donald Shepard,Dr.Timothy Martin,Dr.John Orwat.
3 The Role of Nutrition in Maintaining Health in the Nation's Elderly:Evaluating Coverage of Nutrition Services for the
Medicare Population(2000). Institute of Medicine, 1.
4 Aging and Disability Services Area Plan on Aging 2008—2011, Seattle—King County Washington,23.
5 Ibid,71.
Page 6
• 53% are 75 years or older, 100% are low income, and 29% are disabled in Federal Way
• 57% are 75 years or older, 87% are low income, and 17% are disabled in Renton
• 58% are 75 years or older, 73% are low income, and 20% are disabled in SeaTac
Our general target population consists of individuals who are age 60 years or older residing in King
County. We have additional sub-targets within the overall target population which include persons who
are 75 years or older, low income, and minority.
Page 7
10. PROPOSED PROGRAM/SERVICE (See page maximums to each part of this Question below.)
This section should describe the program/service proposed for funding, with specific information on what
you expect to accomplish and the major activities for achieving the proposed outcomes. Best practices
may be cited.
(1) The type of services to be provided:
The Community Dining program (formerly known as Congregate Meals)provides nutritionally balanced
meals in a social setting to eligible individuals who are typically age 60 and older who reside in King
County. The program directly meets the described need in the communities we operate. Service is
provided throughout King County at twenty-four locations,housed at senior and community centers. See
the bottom of this page for specific addresses of the meal sites relevant to this grant. Service is provided
through a combination of paid and volunteer staff The program hours of operation are Monday through
Friday 8:30am to 5:00pm with actual delivery of service generally performed between 9am and 2pm. One
registered dietitian and a nutritionist plan tasty and nutritious meals which meet federal guidelines of 1/3
Recommended Dietary Allowances for seniors while including theme day, holiday, and birthday menus.
We subcontract with the non-profit, Pioneer Human Services (PHS), to provide the meals. Staff and
volunteers at the meal sites cook/reheat and serve meals to eligible seniors. In addition to providing meals
to seniors, the program also offers nutrition'education in the form of classes and written materials with an
emphasis on senior nutrition issues. The program also sponsors annual events including Old Timer's
Picnic and Senior Day at The Aquarium.
(2) Methods (including locations) you will use to serve your target population and (3) What outreach you
will use to reach your target population
A variety of methods are used to reach our target population. Outreach occurs monthly via the
senior/community center brochures and newsletters that are distributed on site and mailed to each center's
members. These include the nutrition program lunch menus and frequently a small section describing the
program. In addition, the staff and meal Site Coordinators attend local senior oriented health fairs hosted
by senior centers, occasionally place ads for the lunch program in local community papers, and hand out
flyers or coupons in various community locations. In April 2008, the program hired a full-time Site
Support Specialist to focus on providing support to center directors, program staff and volunteers, and
increasing participation in the program by conducting traditional outreach (incentives such as raffles, 2-
for-1 lunches, mailings to community churches and businesses, etc.).
Locations of relevant south-end meal sites
Auburn Senior Activity Center: 808 Ninth SE Auburn, WA 98002
Des Moines Activity Center: 2045 S 216th St Des Moines, WA 98576
Klahanee Lake Comm. Center: 33901 9th Ave S Federal Way, WA 98063
North SeaTac Comm. Center: 13735 24th Ave,S SeaTac, WA 98168
Renton Senior Activity Center: 211 Burnett Ave N Renton, WA 98055
(4) How your program addresses the Problem Statement in 9.A.
Community Dining addresses the problems of malnutrition and social isolation that plague the senior
population by giving seniors access to nutritious food in a social environment. While there is a suggested
$3.00 donation for the lunch, no one is turned away based on inability to pay. Our outcome data shows
that 45% of participants eat more fruits and vegetables due to coming to the lunch program. Also, 77% of
participants report that they had more social contact due to utilizing the program.
(5) How the program addresses the language and/or cultural needs of clients
Page 8
, The senior population is becoming more diverse and we are working with partner organizations to better
serve the ethnic populations in Seattle. We have an Ethnic Dietitian on staff who advises us on our meal
selection and nutrient content. We provide meals at the Kawabe House, a home for Japanese and Korean
elders, and Kline Galland, a home for Jewish elders. A number of our sites also have ethnic meal days,
e.g. East Indian Lunch day at the Redmond Senior Center and Latino lunches at SeaTac and Bellevue.
(6) If you are making significant changes to your program or agency in 2009-10, explain these changes
We are carefully looking at the structure of the program into the future. We have been seeing a steady
decline in participation over the last five years—however we know that the senior population is growing
and a greater percentage of them are living in poverty. We know that the current model of providing
Community Dining, a model from the 1970's, may not be the best model for the future. We have been
meeting regularly with center directors throughout King County, particularly Auburn and Des Moines, as
well as others, to problem-solve and plan together how best to partner to meet the needs of our seniors.
Our major funder, Seattle-King County Aging and Disability Services is conducting a Request for
Investment this summer and is also gathering information about best practices. Some of their research
includes models from other parts of the country which we may be able to adapt. At this time, we do not
know if there will be significant changes. It may be that the addition of the Site Support Specialist
mentioned above and a few revisions and tweaks will suffice but it is possible there could be significant
changes as a result of ADS' RFI process.
(7) Detail how this program will work with other programs and/or agencies.
The Community Dining program has a collaborative relationship with the many community and senior
centers which host our program including the Auburn Senior Center, the Des Moines Activity Center, the
Klahanee Lake Community Center, the SeaTac Community Center, and the Renton Senior Center. In
addition we collaborate with Sea Mar Community Health Center and King County Public Health. Sea
Mar brings groups of Latino clients to several of our lunch sites including Des Moines. A dietitian with
the county health department has made herself available to present nutrition classes at a few of our lunch
sites that have requested a series of classes that cover a 4-8 week time period. The Nutrition Program also
has a partnership with EnhanceFitness, a program by Senior Services that offers fitness classes at some of,
the senior centers.
Finally, it is important to note that we are pulling data differently now to more accurately reflect the
actual number of known residents served by this program. Because there are 24 meal sites, participants
do not always eat at the site in their city. In the past we have reported on the unduplicated participants
and demographics at each site. For example, the Auburn site served 617 individuals in 2007. Many of
these people did not live in Auburn. Our data,however, shows 433 Auburn residents ate somewhere
(including the Auburn site) in 2007. We are now using the actual resident number vs. the#of site
participants in our reporting. By using the number of actual residents, it is important to note that the sites
are serving more people and that, on average, 23% of participants do not fill out a Personal Information
Form.
2007 Site vs.Residents Data
City Unduplicated Known Residents from City(at
Participants at Site any site)
Auburn 617 433
Des Moines 402 196
Federal Way 125 89
Renton 759 537
SeaTac 442 196
Page 9
B. Performance Measures and Outcomes. (1 page maximum) List the performance measures which are
the outputs from your program (e.g. the number of home delivered meals) followed by the related
outcome(s) of your program (e.g. increased ability of clients to obtain nutritious food) and the indicator
used to measure the outcome (e.g. percent of survey respondents reporting that receiving home delivered
meals makes it easier to get enough to eat).
The program goal is to promote the nutritional health, independence, and socialization of older persons
residing in King County.
Performance Measure: Number of meals served
Outcome 1: Increase the amount of fruits and vegetables seniors eat
Indicator 1: At least 25% of participants will report an increase in their consumption of fruits and
vegetables.
Outcome 2: Increase seniors' nutrition knowledge
Indicator 2: At least 50% of participants will report that they have seen and read the MealTime Memo
Outcome 3: Seniors will engage in meaningful relationships
Indicator 3: At least 25% of participants will report an increase or maintenance in friendship due to
participation in the Community Dining program
Page 10
C. Staffing Plan & Evaluation. (1 page maximum)
A total of 11.15 FTE's work in the Community Dining Program.
Position FTE Role Experience
Kate Turpin, Vice- .33 Oversees program budget, MSW, over 27 years social
President management and staff service experience in the aging
field.
Hiring currently in 1.00 Manages program, contracts,
process, budget, and supervises office staff
Program Manager
Carolina Apostol, 1.00 Main point of contact with all Certified nutritionist and
Site Supervisor sites,manages staff sanitationist with more than 30
years at Senior Services
Kim Storms, .13 Manages the Ethnic Dietician BA in Nutrition, MPH,
Ethnic Dietitian program. Provides nutritional Registered Dietitian with 12
oversight and education to 17 years on staff
ethnic sites as well as nutritional
consultation to the Community
Dining program.
Charlie Thomas, 1.00 Provides site support to center BA, M.Ed, over 20 years
Site Support directors, volunteers, and staff; experience including 5 years as
Specialist develops and implements a Senior Outreach specialist
outreach plan to increase
participation and frequency of
attendance by participants;
develops targeted outreach plans
to increase participation of
communities of color.
Veronica 1.00 Manages all the data and most of BA, over 20 years relevant
Lewandowski, Data the ADS reporting. experience
Specialist
Shannon Newsum, 1.00 Supports Administrative
Temporary functions
Administrative
Assistant
Site Coordinator 4.43 Coordinates meals at sites
Food Prep Specialist 1.26 Prepares food for serving and
cleanup
Total 11.15
Aside from paid staff, the Community Dining program operates with the assistance of over 500
volunteers. Volunteers help at the meal sites in the following areas: registration for lunch, table setting,
kitchen assistance, serving, and clean up. Many of the volunteers have been working with the program
since it's beginning in 1974.
Evaluation
The Community Dining program monitors progress and success through analysis of data collected from
meal site sign-in sheets. Meal counts and unduplicated participant counts are both tracked then reviewed
on a monthly, quarterly, and annual basis. In addition, an annual survey is completed by meal
participants, which provides us the data to evaluate our anticipated outcomes and client satisfaction.
Page 11
D. Differences in Service Delivery by City. (2 page maximum) Explain any differences in service delivery
for this program among the cities that you are submitting this application to for funding. Explain any
differences in the average cost of service per client relative to funds requested by city as shown in the last
column of Question 14c.
There are no major differences by city.
•
•
Page 12
11. LONG RANGE PLAN (I page maximum)
In this section you should describe your long range plans for this program. Discuss your plans for future
, service delivery, collaboration, and other sources of continued funding for the program. What funding
sources do you anticipate this program will have in the next three to five years?
Senior Services will fulfill its current contract with Aging and Disability Services to provide congregate
meals in King County. When the current contract expires in 2008, it is expected that Senior Services will
bid on the contract to retain operation of most of these services. We anticipate that in the next 3-5 years
we will continue to receive funding from those who currently fund the program; suburban cities, Older
Americans Act,USDA, client contributions, & fundraising. Additionally, we will be diligently seeking
additional new funding sources.
Page 13
12. BUDGET(2 page maximum)
The budget section of your application pertains to the information provided in Question 17 of your
application.
A. Budget Request Narrative. In this section of the application narrative, provide a short paragraph
explaining how your requested funds in Question 17 will be used.
The funds requested will be used towards the total cost of providing meals, which includes food,
transportation, and administration.
We request that each city fund a set number of units, depending upon their funding history. We are
asking Federal Way to fund the meals for 30% of the projected number of city residents who will use the
program. .This city has a history of funding the program at a higher level and we applaud that. We would
ask all the other cities to fund at this level but realize it would be too big of a jump. We are requesting
that Auburn, Des Moines and SeaTac fund 10% of the meals, and that the new city, Renton, fund 5% to
start.
Although the program has a suggested donation of$3.00 per meal to help cover the cost of the meal, the
average donation last year was $1.95 per meal. This has increased slightly in the last few years but it still
doesn't come close to covering the true cost to serve a meal.
B. Changes to Budget. Explain any significant changes between 2008, 2009 and 2010 expenses or
revenues as noted in Question 17. Are there any known or anticipated changes to the program's 2008
Budget since adopted?
None anticipated at this point.
C. Cost per Service Unit(s).You should provide an estimate of your cost per service unit provided by
the program you propose. Explain how your cost per service unit was determined. These should be based
on the total cost of the program and the total number of clients served, not just the funds requested. You
have the option of providing a cost per service unit for each separate service provided within the program.
Cost Per Service Unit: $7.58
Explanation of how determined:
Our service is the provision of meals therefore the estimates provided here are costs per meal. The cost
per meal estimate for 2009 is $7.58. This was calculated by taking the total cost of providing meals or
total projected 2009 program expenses divided by the total number of meals we estimate we will produce.
($2,002,134.61 /264,277=$7.58)
Page 14
Agency: Senior Services -
lProgram: Community Dining
13. NUMBER of INDIVIDUALS/HOUSEHOLDS SERVED BY PROGRAM
171 Individuals? or n HOuseh0lds? (Check which applies and use for reporting all demographics.)
Unduplicated
*Unduplicated Number of all Clients Served by Clients Served
All Funding Sources with Funds
Requested
2007 2009
2007 %of column 1 2008 2009
(Actual) clients served (Anticipated) (Projected) (City Requested
by City Funding Only)
Auburn 433 6.8 433 433 43
Burien 166 2.6 166 166
Covington 0 0 0 0
Des Moines 196 3.0 196 196 19
- Enumclaw 197 3.0 197 197
Federal Way 89 1.4 89 89 26
Kent 99 1.6 99 99
Renton 537 8.4 537 537 24
SeaTac 196 3.1 196 196 19
Seattle 1,124 17.7 1,124 1,124
Tukwila 175 2.6 175 175
Other 3,186** 49.8 3,186 ' 3,186
100%
Total 6,398 (This column must 6,398 6,398 131
total 100%)
•
*Unduplicated means count each client only once per calendar year per program. This number should match the number
of clients by city indicated in the top row of Question 15.
**Other includes all other cities,as well as the 1,453 clients who have not provided demographic information
Page 15
Agency: Senior Services
14. Performance Measures (Data Table) Program: Community Dining
14a. Service with 2009 Requested Funds
Proposed Performance Measures as defined below.
A) Meals served B) C)
Auburn 1,290
Burien
Covington
Des Moines 570
Enumclaw
Federal Way 780
Kent
Renton 720
SeaTac 570
Seattle
Tukwila
14b.`:Performance Measures 2009.Proposed'with funds requested City Funding Only.,
Title: Brief explanation:
A) Meals served One meal served at the center counts as 1 service unit
B) •
C)
Page 16
Agency: Senior Services
-- 14 Performance Measures (Data Table), Cont. Program: Community Dining
14c. Average Cost of Service
Unduplicated Clients
Served with Funds Average Cost of Service
Requested 2009 Requested 2009 per Client
(Same as last column of (Same as last column of
Question 6) Question 13) Column 1 divided by Column 2
Example: $5,000 45 $111.11
Auburn $9,778.20 43 $227.40
Burien
Covington
Des Moines $4,320.60 19 $227.40
Enumclaw
Federal Way $5,912.40 26 $227.40
Kent
Renton $5,457.60 24 $227.40
SeaTac $4,320.60 19 $227.40
Seattle
Tukwila
Page 17
Complete Question 15 with 2007 Actual numbers reported in column 1 of Question 13. Agency: Senior Services
15. Demographics (from all funding sources) (Data Table) Program: Community Dining
cip
0
Client Residence` o - 0 ,
W U Q W w r! cn crp E—+ Fl
- ' Unduplicated
• (check one)"
®Individuals cMn vo
o rn N
ccnn o N N °M`
' - El Households. VI
Served in 2007* • i
Household Income Level `', _ '
30%of Median or Below 26 13 18 22 5 3 63 19 153 14 • 600
50%of Median or Below 13 6 14 6 2 2 32 10 51 8 243
80%of Median or Below 6 2 3 3 0 1 10 7 26 2 106
Above 80%of Median 1 4 1 4 0 0 4 4 10 2 50
Unknown 387 141 160 162 82 93 428 156 884 149 5399
TOTAL 433 166 196 197 89 99 537 ' 196 1124 175 6398
Gender - - " -
Male 150 47 68 59 33 34 190 72 381 51 1870
Female 283 117 128 138 56 65 347 124 739 122 3613
TOTAL 433 1,245 196 197 89 , 99 537 196 1,120 173 5,483
Age • . ., . ..
0-4 years
5- 12 years 1 1
13- 17 years
18-34 years 5 1 2 1 1 1 4 4 23
35-54 years 7 2 7 3 1 3 3 14 4 69
55-74 years 168 60 57 55 36 38 124 65 298 44 1754
75+years 245 101 " 122 131 45 55 304 128 714 109 3332
Unknown 8 2 14 3 4 5 5 94 4 1218
TOTAL 433 166 196 197 89 99 537 196 1124 175 6398
Ethnicity
Asian 2 6 1 1 4 1 37 6 133 5 312
Black/African American 4 : 0 4 0 2 1 11 1 166 4 225
Hispanic/Latino(a) 2 9 8 1 7 4 18 16 40 13 193
Native 5 0 2 2 0 0 2 2 9 3 39
American/Alaskan
Pacific Islander 1 0 1 1 0 0 3 0 2 0 13
White/Caucasian 165 123 153 134 48 61 " 385 142 502 114 3040
Other/Multi-Ethnic 7 0 4 5 2 1 21 2 29 2 127
TOTAL 186 138 173 144 63 68 477 169 881 141 3,949
Female Headed
Household' .-
Disabling Condition 53 36 28 35 18 19 76 34 157 31 780
Limited English - 7 17 12 0 8 6 30 21 118 20 375
Speaking
' *Check Individual or Household,which should be the same as checked in Question 13. Unduplicated means count each client
only once per calendar year. This should match the number served by City in the Actual 2007 column of Question 13. The
"total"column will be different from Question 13 since the"other"column is not included due to space limitations.
Page 18
16. PROGRAM STAFF (DATA TABLE)
In this data table, record the number of full-time equivalent (FTE)paid staff and volunteers for this
program. FTE means a 40-hour week throughout the entire year. For example, if you enter"5" in the box
for Number of Volunteer FTEs, this'would mean that you have, on average, five volunteers assisting your
program at all times (assuming a 40-hour week).
If you know only the total number of hours contributed by all.volunteers for this program, simply divide
that number by 2,080 to find the total FTE number. For example: 5,000 volunteer hours over the course of
a year, divided by 2,080 equals 2.4 FTEs.
2007 2008 2009
(Actual) (Budgeted) (Projected)
Total Number of Staff(FTEs) 9'32 11.15 11.15
Number of Volunteer(FTEs) 40 40 40
Actual Number of Volunteers 787 787 787
Page 19
Agency: Senior Services
17. PROGRAM REVENUE BUDGET (DATA TABLE) Program: Community Dining
Revenue Source 2007 2008 2009
(Actual) (Budgeted) (Projected/
Requested)
City Funding (General Fund & CDBG)
• Auburn 4,500.00 4,500.00 9,778.20
•
• Burien
• Covington
• Des Moines 1,000.00 1,000.00 4,320.60
• Enumclaw
• Federal Way 5,000.00 5,000.00 5,912.40
• Kent
• Renton 5,457.60
• SeaTac 2,000.00 2,000.00 4,320.60
• Seattle
• Tukwila
• Other(Specify)N&E King County 4,975.00 4,975.00 4,975.00
• Other(Specify)
Other Government Funds
• King County
• Washington State
• Federal Government (Specify) 1,070,152.33 1,060,873.00 , 1,060,873.00
• Other(Specify)
• Private Sources
■ United Way(grants &designated donors)
• Foundations and Corporations
• Contributions (e.g., Events, Mailings)
■ Program Service Fees (User Fees/Client 685,732.54 697,325.18 709,113.80
Donations)
• Other(Specify) Agency Fundraising 29,549.81 162,250.00 197,383.41
TOTAL PROGRAM BUDGET 1,802,909.68 1,937,923.18 2,002,134.61
Page 20
17. PROGRAM EXPENSE BUDGET, CONT. Agency: Senior Services
(DATA TABLE) Program: Community Dining '
I
Expenses 2007 2008 2009
(Actual) (Budgeted) (Projected)
Personnel Costs
• Salaries 408,342.23 514,907.90 530,355.13
• Benefits 159,101.16 201,472.90 207,517.09
• Other
• Total Personnel 567,443.39 716,380.80 737,872.22
Operating and Supplies
• Office/Program Supplies 92,258.05 105,496.46 108,661.35
• Rent and Utilities 10,350.84 11,110.90 11,444.22
• Repair and Maintenance 102.59 75.00 77.25 •
• Insurance 21,553.92 11,504.87 11,850.02
• Postage and Shipping 860.75
• Printing and Advertising 5,914.20 4,854.80 5,000.44
• Telephone 1,759.78 1,327.50 1,367.33
• Equipment
• Conference/Travel/Training/Mileage 5,970.71 1,400.00 1,442.00
• Dues and Fees 200.00
• Professional Fees/Contracts (1,224.04)
• Direct Asst. to Individuals
• Administrative Costs 200,406.96 220,919.38 233,620.69
• Other(specify) Food &Beverage 875,599.80 843,245.53 868,542.90
• Miscellaneous 8,394.81 11,500.00 11,845.00
• Transportation 13,317.92 10,107.95 10,411.19
•
TOTAL PROGRAM EXPENSES 1,802,909.68 1,937,923.18 2,002,134.61
Net Profit (Loss)
(revenue—expenses)=
Page 21
•
Agency: Senior Services
• 18. SUBCONTRACTS (DATA TABLE) Program: Community Dining
List all the agencies you will be subcontracting with for this program. Provide the agency name in the first
column, a description of the contract/service in the second column, and the contract amount in the third
column. Do not list agencies you coordinate with on a referral only basis. Indicate not applicable if
you do not subcontract for any part of this program. .
Subcontracting Agency Specific Subcontracted Activities Contract
in the Operation of Your Program Amount
Pioneer Human Services Meal provider 843,245.53
•
Page 22
19. APPLICATION CHECKLIST
Applications missing one or more of the following components or not following these directions may not
be reviewed. Sign and submit the application checklist with your application.
Contents (Your application should contain each of these items in this order.)
Application Cover Pages.The top three pages of your application must be a completed copy of the
Agency Information and Questions 1-7.
Application Narrative:
IA Question 8 Organizational Experience(2 page maximum)
17 Question 9 Need for Your Program(2 page maximum)
11 Question 10 Proposed Program/Service(6 page maximum)
l/ Question 11 Long Range Plan(1 page maximum)
2'Question 12 Budget(2 page maximum)
Data Tables
rq Question 13 Number of Individuals/Households Served
11 Question 14a-c Performance Measures and Average Cost of Service
Question 15 Demographics(from all funding sources)
Question 16 Program Staff
Question 17 Program Revenue&Expense Budgets '
MQuestion 18 Subcontracts
r✓ Required documentation. Supply one copy of the following required documents with the signed original
application. See Part II: City Specific Supplemental Information to deteimine whether additional copies of the
application and required documentation need to be submitted.
VQuestion 19 Required Documentation, including: •
• Proof of non-profit status
■ Organizational Chart
■ Agency/Organization Mission Statement
• Board resolution authorizing submittal of the application(may be submitted up to 60 days after
application).
• List of the current governing board and local board, if applicable, (include name,position/title,
city residence, length of time on the Board, and expiration of terms. Note any vacancies.)
• Board Meeting Minutes of last three board meetings of governing board and local board as
applicable
• Annual Budget
■ Financial Audit Cover Letter
■ Financial Audit Management Letter
• Financial Statement
• Verification of Non-Discrimination Policy
• Program Intake Form
■ Sliding Fee Scale •
pplication Check List. (Signed below.)
O
ity Specific Supplemental Information.Required in Name: Valerie Costa
Part II for applicable City only. Position: Evaluation&Accountability Manager
Phone#: 206-268-6735
E-mail: valeriecna,seniorservices.org
Signature of Person Completing Checklist
DO NOT SUBMIT ANY OTHER MATERIALS WITH THIS APPLICATION
Make sure that you carefully check Part II of this application
to see what additional attachments each city requires.
Page 23
City of Renton Supplemental Questions
1. (For programs that did not complete a pre-application): Select one result that is
the best fit for the program. Identify what strategies and activities will achieve the
Result. You can choose from strategies and activities that Renton has already
identified or you can identify your own. If you use your own, you must cite best
practices or research as to why you think they will work.
Completed pre-application. We most closely identify with Renton Result#2,
"Individuals have adequate clothing, food, housing, and healthcare."
2. Describe how the program outcomes as identified on page 9 of the application
narrative will help achieve the selected Result.
We have identified three outcomes:
• Outcome 1: Increase the amount of fruits and vegetables seniors eat
• Outcome 2: Increase seniors' nutrition knowledge
• Outcome 3: Seniors will engage in meaningful relationships
All three outcomes are the result of meal provision. The first two address the need for
adequate food. Increasing the amount of fruits and vegetables seniors eat leads to greater
nutrition. Increasing seniors' nutrition knowledge gives participants the tools they need
to identify healthy food options outside of the Community Dining program. The third
outcome addresses the need to greater social contact—studies have shown that seniors
with meaningful relationships live longer, happier lives.
Internal Revenue Service Department of the Treasury
P.O. Box 2508
Cincinnati, OH 45201
FEB 0 8 2007
Date: Person to Contact:
Roger Meyer
ID#31-07707
SENIOR SERVICES Toll Free.Telephone Number:
2208 2ND AVE 877-829-5500
SEATTLE, WA 98121-2035. Employer Identification Number:
91-0823767
Dear Sir or Madam:
•
This is in response to the amendment to your organization's Articles of Incorporation filed with the state on
April 10, 2006. We have updated our records to reflect the name change from Senior Services of Seattle-King
County to Senior Services.
Our records indicate that a determination letter was issued in March 1982 that recognized you as exempt from
Federal income tax, and reflect that you are currently exempt under section 501(c)(3) of the Internal Revenue
Code.
i
Our records also indicate you are not a private foundation within the meaning of section 509(a)of the Code
because you are described in section 509(a)(1) and 170(b)(1)(A)(vi).
Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises,
transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the
applicable provisions of sections 2055, 2106, and 2522 of the Code.
If you have any questions, please call us at the telephone number shown in the heading of this letter.
. Sincerely,
4,/,alt3jp(76
Cindy estcott
Manager, Exempt Organizations
Determinations
•
•
•
•
- Internal Revenue Service Department of the Treasury
District Director
. Date: September 8, 1986 • Date of Exemption: 8203
•
• Internal Revenue Code Section: 501(c 3 )
•
• Refer Reply to: E 0 Division
•
Senior Services of Seattle •
King County
1601 Second Ave Suite 800
Seattle, Wash 981011544 •
•
•
•
•
•
Gentlemen:
Thank you for submitting the information shown below. We have made
it a part of your file.
•
The changes indicated do not adversely affect your exempt status
and the exemption letter issued to you continues in effect.
Please let us know about any future change in the character,
purpose, method of operation, name or address of your organization.
This is a requirement for retaining your exempt status.
• Thank you for your cooperation.
Sincerely yours,
•
. Asi / Oft.ti
District Director
•
Item Changed From To
•
Name • Senior Services
• and Centers Above
•
•
•
` Ep 1,0 1986
AND i';ENTF 3
•
P.O. Box 21224,Seattl ,WA 98111 Letter 976(DO) (7-77)
•
U u L.iSlt`JL:lU
•
L • FL Curry (206) 442-5110
oa rragt Da ®@ ®i
Internal Revenue Service.
•
Qau: In reply refer to:
DEC j$ Inq I L-225, Code )6 428
•
•
jt p Senior Services and Centers
800 Jefferson"Street •
Seattle, WA. 98104
•
• Date of Exemption: September,7, 1967
Internal Revenue Code Section: 501(c)(3)
Gentlemen: •
•
Thank you for submitting the information shown below. We have made
• it a part of your file.
The changes ,indicated do not adversely affeot your exempt statue •
and the exemption letter issued to you• continues in effect.
' Please let us know about any future change in the character,.
purpose, method of operation, name or address of your organization.
This is a requirement for retaining your exempt status.
Thank you for your cooperation.
•
Sincerely yours,•
•
•
• Michael Sassi
District Director
Item Changed From To •
•
Name • Senior Centers Incorporated Senior Services
and Centers
•
•
•
•
•
•
•
Form L-,225(Rev.4-70)
-
•
•
•
•
•
• � !L S. Tr ASURY DEPARTMENT
• £
_.-.‘4•i�_• INTERNAL REVENUE SERVICE
• r! DISTRICT DIRECTOR
SIXTH AND LENORA BUILDING
•
SEATTLE, WASHINGTON 46IZ1
iN IMPLY R=TIIN TO
S���ces)ber 7 ir367 Form L-17t3
Code 414 :l
SEA:L•-O:ui-33
PURPOSE
• •
ClI rita,Le •
Cen/or Centers, ,i•i.se;rrper: tee ADDRESS INQUIRIES a FILE RETURNS WITS!
• DISTRICT DIRECTOR OF INTERNAL REVERE'
C/O irrri:�i
1%17
trect
• Seattle. f;_?;:I:3.i�''.t :�:) �.jl0�F � Seattle, ! ::chf4.nf'ton
FORM DSO-A RE- ACCOUNTING PERIOD
•Attn: l;. i E'rlSsta'.?Z? QUIRE) ENDING
••�@• Gentlemen: I._ YES tao December 31
•
On the basis of your stated purposes and the understanding that your operations will continue as
evidenced to date or will conform to those proposed in your ruling application, we have concluded
that you are exempt from Federal income tax as'an organization described in section 501(c)(3) of
the Internal Revenue Code. Any changes in operation from those described, or in your character
or purposes, must be reported immediately to your District Director for consideration of their'effect
upon your exempt status. You must also report any change in your name or address.
You are not required to file Federal income tax returns so long as you retain an exempt status, un-
• less you are subject to the tax on unrelated business income imposed by section 511 of the Code,
in which event you are required to file Form S50-T. Our determination as to your liability for
filing the annual information return, Form 993-A, is set forth above. That return,.if required, must
• be filed on or before the 15th day of the fifth month after the close of your annual accounting period
indicated above.• -
Contributions made to you are deductible by donors as provided in section 170 of the Code. Be-
quests, legacies, devises, transfers or gifts to or for your-use are deductible for Federal estate
and gift tax purposes under the provisions of section 2055, 2106 and 2522 of the Code.
•
You are not liable for the taxes imposed under the Federal Insurance Contributions Act (social
security taxes).unless you file a waiver of exemption certificate as provided in such act. You are •
not liable for the tax imposed under the Federal Unemployment Tax Act. Inquiries about the waiver
of exemption certificate for social security taxes should be addressed to this office, as should any
questions concerning excise, employment or other Federal taxes.
•
• This is a determination letter.
• Very truly yours, •
•
•
•
Neal S. Warren
• District Director
•
•
•
FORM L-178 (6-63)
•
•
•
f'- Denise Klein 'C Wn J
Negro Almassj - i Executive Director -1 Arkia Northere _,.( s. 1
Cultural Competence Executive Assistant ` J
Manager
Tim Bridges Joanne Donohue Patricia Hart Susan Snyder }(ate Turnin
Vice President/CFO Vice President Vice President/CDO Vice President Vice President
{ Karen Beisner CommunityEngagement/ John Deagen Cindy Zwart, ,
;--- Director, — Development Sarah Baler Manager, _ Manager, Director,
i Human Resources Donor Communications Information 8 Assistance Transportation
I
1 Mike Rots a Staff
Ruch.Agary al _ 7_1HR Coordinator "" i fany McCullough CeoHomrsharng
jSenior Centers „_,,,,. Development Associate Coordinator
i sedor somas
Learn Manager
IDavid Chew Cadge Teel,Director ale A.smareta— t&svawote _ - _
I Facilities Manager Ballard Northwest2San peters
Senor Canter
i - J Id AAa�mmu 16A Aawole
I Cynthia Andrews.DirectorEduardo Caballero
Valerie Costa Central Area Giessen Seed
Senior Canter — e -- Ie AAmorate --- Manager,
� Evaluation 8 Minor Home Repair
Accountabtltry Manager _
'TOT(
Direaor n�ncmmm I6AAdrootAlss �a Christian D�lachuk— Bernadette Diachuk t
NDMshore senior Center— Administrative Administrativet DiacT Repair Specialists
John Gleichman Assistant II Assistant I
1— . Manager,Information — Karen Sisson,Director
Senior Center of — Smwmer Truro
Technology west Seattle AdmirrSbaWe assistant To be filled
Manager,--__ —
Bob Lehmeyer,Seeder Health 6 Wellness
• To be filled Shoretma/LFP - Program Manager
Network Administrator
Center Gregory
nsend, t
..............._.Caregiver and Outreach v To be hoed Charlene memos {
Amara Oden.Oueclor Adnonistralire Site Supervisor 50
Chns Maids. Sno Valley Senor Len!er'' i ^• Assistant Specialist —/ cwsuass
Intemn Data Manager Mania Teplm I \ �w•v�vst
I Program Supervisor _ Igm Stems Carelea Apomel I K e /
Senior Outreach RegisteredDietioan Site Supervisor _./r Nagai
Shoshone Elm
TO Be Filled,Director '..I.`".\ \\ )
Resource Data Southeast Senior Center
— Cue 9e Som.')a �'(aclwwtream J l tnmlm
Specialist �' s•eveust —\ )
Abbie Nielson.Dneaor (""'---'-'---""---" Adam Porter,
anager
Vasho
Veremm Lewaotlowsw Serlwr"Center — salt'Fnedman I Meals on Wheels
Data Speciafisl - Dane Sawaveaa
Lead Caregiver Caregiver Advocate
•
Advocate - xmun
Peale Younkin(temp) Paul Leone i.. Cieaesuw
Lee Op,Community Tom LNtatgeld l Helen sawyer OUVeadl Spevatist "' C°mmu�nt151Pmgrem-! 0°P^' ymtivaxumn
1 Engagement Manager ..........
Caregiver Advocate Kinship Navigator nt ' !^^°°I•Lv.:"t"
Tara Voss I. aausa�
Controller - e'°
Sarah Demos
_ Barbara Wd,a Admesitrelne .Project Warehouse Manager ` J
t ' Judith Shoshone Julia Derived, KC Kinship Gollob.
-
Vacant Debra Jenson Barbara Lipton
SRA Legal Director SHIBA Coordinator
Accountant Accountant Acconnanl ( - / nets; b� 23 SIte Coordnaters
L Vacant
MIINell I
Volunteer Coordinator Program Assistant
Communry Enagamem
' i Project Enhance
National
To be filled
•
--.....----.------- Project Enhance
Brenda BerkeyMeera Ndekanl Local Manager
—
Coodinalor Administrative ---
Assistant
Kathy Hultquist Chris Grekog
Terrell Poeton Magian Thompson Clinical Supervisor Master Trainer
— Speuel ProjectsInformation Systems— EnhanceFitness
Specialist
Helen S elalt Senior Services o tonal Ch
Local Enhance rgenrsa ad Admen.Asst. January r.2008
Senior Services
Promoting the well-being of older adults
Y '
AGENCY/ ORGANIZATION MISSION STATEMENT
Senior Services' mission statement is "promoting the emotional, social, and physical well-being
of older adults."
A non-profit agency supported by United Way of King County investments
2208 Second Ave, Seattle,WA 98121
(p) 206 448-31 1 0• (TTY) 206 448-5025 • (f) 206 448-5766 •www.seniorservices.org
s Senior Services
Promoting the well-being of older adults
BOARD RESOLUTION
We will be sending the Board resolution authorizing submittal of the application within
60 days.
A non-profit agency supported by United Way of King County investments
2208 Second Ave, Seattle,WA 98121
(p) 206 448-31 1 0• (TTY) 206 448-5025 • (f) 206 448-5766.www.seniorservices.org
• SENIOR SERVICES
Senior Services 2208 Second Avenue,Suite 100
411) Promoting the well-being of older adults Seattle WA 98121-2055
(206)448-5757
Fax: (206)448-5766
Board of Directors
Revised March 18,2008
Name/ Position City Residence Length of Time on End of Term
Board (in years)
1. John Aslin, Woodinville, WA 3 2008
Secretary
2. Paul Beck, MD, Seattle, WA 6 2008
Immediate Past
President
3. Neal A. Broidy Woodinville, WA 9 2008
4. William (Bill) J. Seattle, WA 15 2008
Cruzen
5. Bill Fenner Bellevue, WA 1 2010
6. Rolf Gruen Bellevue, WA 1 2010
7. Matt Hayes Seattle, WA 9 2008
8. Professor Nancy Seattle, WA 9 2008
Hooyman, Vice
President
9. Earle Leonard Seattle, WA n/a n/a
10. Steve Melton Bothell, WA 1 2010
11. John Norden Seattle, WA 1 2010
12. Bonnie Pladson, Issaquah, WA 1 2010
Treasurer
13. Charles Riley Seattle, WA 10 2010
14. Uma Vanmane Bellevue, WA 1 2010
15. Ron Vivion Mill Creek ,WA 3 2008
16. Grace Wang, PhD, Redmond,WA 6 2008
President
17. Shiao-Yen Wu Seattle, WA 6 2008
AC_, ,Th:?:).- Senior Services Board of Directors
Promoting the well-being of older adults
Meeting Minutes
Thursday,January 3,2008
Senior Services Lillian Rice Center
2208 Second Avenue, Suite 100, Seattle,WA 98121
12:00 noon— 1:30 pm
Facilitator: Grace Wang,President
In Attendance: Bill Fenner,John Aslin, Chuck Riley,Bonnie Pladson, Grace Wang,Matt Hayes, Earle
Leonard,Uma Vanmane, Steve Melton,Ron Vivion
Excused: Alice Sandstrom,Nancy Hooyman,Paul Beck,Rolf Gruen,Bill Cruzen,John Norden, Shiao-Yen
Wu,Neal Broidy
Staff: Denise Klein,Patricia Hart,Arkia Northern
I. Welcome and President's Report: Grace Wang,President
• The meeting was called to order by Grace Wang,Board President at 12:09 pm. Grace
greeted board members and apologized for the delay in meeting materials being distributed.
• Grace provided the board with information on the trainings she has recently attended in
preparation for her leadership in 2008. Explaining that she has completed 35 hours of
training through the United Way of King County and the Non Profit Center.
• Feedback from the board survey showed a consensus within the group that the board
functions and works well together.
II. Approval of December 6,2007 Meeting Minutes
• John Aslin explained revisions made to the meeting minutes after they were distributed.
• Motion: to approve the revised December 6,2007 board meeting minutes by John Aslin.
Second by Matt Hayes. Approved.
III. 2008 Board Priorities and Structure
• The board discussed the 2008 priorities, clarifying questions regarding the language of some
of the bullet points. Many of the members felt that the first bullet point was the most
significant and the other bullet points were supportive.
• Members were very interested in board education and identified the following areas to focus
education efforts: .
o Foundation 101
o Intimate knowledge of key projects of the organization
b What are the needs of the community?
o What other resources are available?Are there other organizations serving the same
population, addressing the same needs in the community?
Discussion continued about the Cultural Competence Initiative and various board education
ideas.
• Grace explained that the board survey results show members were almost equally divided on
the issue of meeting frequency and duration. She expressed concerns with monthly, 90
minute meetings, explaining the business of those meetings leaves little time for substantive
discussion.
Members expressed their concerns with meeting continuity and quorum challenges, if the
board moves to a bi monthly meeting schedule. The idea of maintaining a monthly meeting
schedule, with quarterly extended meetings was discussed. The extended quarterly meeting
would last two hours to accommodate staff presentations for the board's education. The
group agreed on this option and decided to maintain the meeting schedule and extend the
quarterly meetings.
*Board meetings will be held on the first Thursday of every month from 12 pm—1:30 pm,
quarterly the meeting will be extended to 2:00 pm to allow for staff presentations.*
IV. Fund Development Report: Patricia Hart,Vice President
• After a brief overview of her department and her past work experiences,Patricia Hart
presented the board with her two year strategic plan. The major areas of focus:
o Systems Refinement:
✓ The RD team will be restructured to achieve a more integrated team
dynamic. A new in house Special Events position has been added to the
department.
✓ The RD database will be refined and will include names of the agency's
volunteers and new donors identified during the Meals on Wheels direct
mail campaign. The database will also be upgraded with an address
accelerator function and will be linked to our auction software,to streamline
Soiree entry and reporting.
✓ The department will also establish procedures and centralize information by
creating detailed event notebooks and capturing records of database queries
to institutionalize knowledge.
o Marketing Focus:
✓ Will begin with the board refining their own"elevator pitch."
✓ The department will utilize all marketing real estate and marketing leverage
to raise awareness of Senior Services as an agency.
✓ RD will continue to expand the ways it interacts with external partners and
explore new partnerships and alliance to increase sponsorships.
o Individual Giving:
✓ Considered to be the biggest area of opportunity.
✓ The department plans to upgrade gift levels, create donor points of entry and
institutionalize donors.
• Patricia presented the board with a Development Calendar and a document highlighting the
board's area of influence. She answered questions about her plan to achieve the new fund
raising goal that has increased by$1 million, the new structure of her team as well as her
plans for planned giving and endowment. The group decided to continue the endowment
and planned giving discussion during the next Endowment Committee meeting.
V. Executive Director's Report: Denise Klein,Executive Director
• Denise's report will be circulated to the full board via email.
The Board Meeting was adjourned at 1:37 P.M.
•
. Senior Services Board of Directors
" ;" Promoting the well-being of older adults Meeting Minutes
Thursday,February 7,2008
Senior Services Lillian Rice Center
2208 Second Avenue, Suite 100, Seattle,WA 98121
12:00 noon— 1:30 pm
•
Facilitator: Grace Wang,President
In Attendance: Chuck Riley, John Norden,Bonnie Pladson, Shaio Yen Wu, Steve Melton,Bill Fenner,
Grace Wang,John Aslin,Bill Cruzen,Earle Leonard,Nancy Hooyman,Paul Beck,Rolf Gruen,Matt Hayes
Excused: Alice Sandstrom,Nancy Hooyman,Paul Beck,Rolf Gruen, Bill Cruzen,John Norden, Shiao-Yen
Wu,Neal Broidy
Staff: Denise Klein,Arkia Northern
Welcome and President's Report: Grace Wang,President
• The meeting was called to order by Grace Wang,Board President at 12:05 pm. Grace
encouraged members to provide thoughts and ideas to her using a suggestion box.
II. Consent Agenda: John Aslin,Secretary
• On motion by Nancy H. and seconded by Steve M, the following items contained in the
consent agenda were approved:
1. Minutes of the January 3, 2008 Board of Directors meeting.
2. 2008 Board Priorities
III. Operating Plan: Denise Klein,Executive Director
• Denise presented the operating plan to the board, explaining that she has included the
outcomes in the job descriptions of the staff members delineated next to each goal. She will
provide a quarterly status report of the plan to the board.
• Members discussed elements of the plan, focusing mainly on the Memorandum of
Agreement with Senior Centers. The group decided to distribute a copy of the MOA to all
board members and to include the plan in board orientation materials,to ensure all members
are familiar with the agreement prior to a discussion about revising the document in the fall.
IV. Executive Directors Report: Denise Klein,Executive Director
• Announced"I Hear America Singing"-a joint fundraising event that Senior Services and
Ballard Senior Center will host 8:00 pm, March 8, 2008 at the Fifth Avenue Theatre in
Seattle. V.I.P. tickets to the concert and reception are$200 per person, $350 per couple.
The event will be televised and used during the annual PBS fundraiser. The anticipated
revenue from the event is$30,000.
• Business Policy Task Force of staff to be convened. The purpose will be criteria
development and identifying potential partners. The criteria will be presented to the board
for approval. Steve Melton volunteered to join the task force.
• A request for$50,000 from the Schmidt Trust was denied by George Edensworth Beck and
the endowment committee in the interest of protecting the growth of the trust.
• The Community Dining program has been in intense negotiations with the city and has
decided to close three sites,Maple Valley, Burien/Highline and Vashon. Discussion
continued. John Norden suggested a public relations strategy be put in place and will
provide the names of contacts he has.
• There are a number of positions that are vacant and needing to be filled. Susan Compton,
Community Relations Director has resigned.
V. Finance and Audit Committee Report: Matt Hayes,Chair
• The committee is proactively focusing on cash flows and the building financing.
• Highlighted the success of the Meals on Wheels direct mail campaign.
• The Net Operating Assets report was explained,members were informed that the agency is _
below the band but should end the year back in the band.
VI. 2008 Board Meeting Calendar and Dashboard
• Grace explained the revisions to the board meeting calendar, and the extended meetings for
board education.
• The concept of the Board Effectiveness Dashboard was explained. Rolf suggested the
dashboard be used for six months; the board would discuss its effectiveness at this •
benchmark. Discussion continued. •
The Board Meeting was adjourned at 1:36 P.M.
•
7----) Senior Services Board of Directors
of f. ;;:' Promoting the well-being of older adults
Meeting Minutes
Thursday,March 6, 2008
Senior Services Lillian Rice Center
2208 Second Avenue, Suite 100, Seattle,WA 98121
12:00 noon— 1:30 pm
Facilitator: Grace Wang,President
In Attendance: Grace Wang, John Norden, Chuck Riley, Steve Melton,Neal Broidy,Rolf Gruen,Bill
Fenner,Bonnie Pladson, John Aslin,Matt Hayes,Uma Vanname,Paul Beck.
Excused:Nancy Hooyman,Bill Cruzen, Shiao-Yen Wu,Bill Fenner
Staff: Denise Klein,Negin Almassi,Kate Turpin, Charlene Thomas,Kim Storms, Carolina Apostal,Arkia
Northern
Guests: Walter Liang,Bob Friedlander
I. Welcome and President's Report: Grace Wang,President
• The meeting was called to order by Grace Wang, Board President at 12:15 pm. Board
members were provided an opportunity to share memories of Alice Sandstrom.
• Guests Walter Liang,Bob Friedlander, and staff were introduced. Walter Liang
congratulated the agency on the 2008 CFC campaign that raised$8128.00.
II. Consent Agenda: John Aslin, Secretary
• On motion by Chuck Riley, seconded by John Aslin,the minutes of the February 7, 2008
board meeting were approved.
HI. Operating Plan: Denise Klein,Executive Director.
• Discussion tabled for April board meeting.
IV. Finance and Audit Committee Report: Matt Hayes, Chair
• The 2007 year end financial report was consistent with projections. Matt acknowledged
accounting and program staff for the well managed budget.
• The restricted surplus of$126,000 and unrestricted deficit of$32,000 were discussed.
• Some of the Senior Centers are currently reporting a deficit; those centers will utilize reserve
funds to cover the deficits.
• The Endowment fund gains and losses were briefly discussed.
• The Net Operating Assets report shows the agency remaining inside the satisfactory `band.'
• The agency audit is underway; the Finance and Audit committee will meet with the auditors
during the month of March. The board will meet with the auditors later this summer.
V. Community Dining Panel Presentation
• Panelist:Kate Turpin, Vice President;Kim Storms,Ethnic Dietician; Charlene Thomas,
Interim Community Dining Program Manager;Negin Almassi, Cultural Competence
Manager; Carolina Apostal, Site Supervisor; Bob Friedlander,Executive Director of Pacific
Asian Empowerment Program.
• Charlene Thomas presented the challenges for seniors and people of color participating in
the Community Dining Program. Some of the challenges she shared:
✓ Locations are unwelcoming,language barriers; some locations have a past history
of separatism, elitist behaviors.
✓ Loss of•independence, feeling powerless, sense of invasion
✓ Transportation
✓ Inadequate dental care
• Kim Storms informed the board of her role with the Community Dining Program. Kim
provides dietician consultations to 16 community dining sites and 6 ethnic sites in King
County through a partnership with ethnic agencies. The programs serve 11 different ethnic
groups that speak 12 different languages.-Kim shared photos from 7 sites.
• Bob Friedlander spoke to the board about a partnership with the Pacific Asian Empowerment
Program that could match the needs of Filipino Seniors with services provided by Senior
Services. Bob provided information on two Filipino community newspapers and a radio
station, requesting the agency include them in press releases, etc. Bob presented a wish list
for the partnership;
✓ Start a Meals on Wheels Program at PAEP
✓ Two vans for field trips
✓ Opportunity to have monthly health related workshop
✓ Training for relatives to become caregivers
✓ Industrial size refrigerator,freezer and dishwasher
✓ Field trips to visit ill seniors
✓ Board games—Bingo, Chess, Checkers
✓ Expand transportation north and east.
✓ Quarterly update from Senior Services
Discussion continued, sparking interest in many board members. Denise and Grace will
determine another board meeting to continue the discussion.
VI. Board Composition and Recruitment
• The Human Capital Committee is in the process of redefining their role, moving towards a
board education focus. The committee is currently gauging member's interest in
participating in programs. Board members were asked to sign up for program experiences
they would be interested in and rank their top three choices.
• Questions, affirmations and potential board members should be forwarded to the HCC.
The Board Meeting was adjourned at 2:00 P.M.
Senior Services
Agency Budget 2008
2008 Budget
SUPPORT/REVENUE
37000 Carryover Funds 101,340
99100 Fund Transfers 16,308
40000 Contributions 2,927,582
42000 Special Events 519,015
43000 Legacies&Bequests 42,716
4700 United Way Funds 805,318
50100 Government Grants 8,350,468
60000 Membership Dues 173,798
6210 Program Service Fees 1,109,848 •
6220-59 Incidental Revenue 367,250
6400 Sales to the Public 785,663
6600 Investments 25,000
6900 Miscellaneous Income 285,827
Sub-Total 15,510,133
ALLOCATIONS
4800 United Way Allocations -
Admin Allocations -
Total Allocations -
TOTAL REVENUE/SUPPORT 15,510,133
EXPENSES
Sub-Total Cost of Revenues —493,401
Sub-Total Personnel 9,413,892
Total Professional Services 616,439
Total Program/Other Supplies 2,209,335
Total Telephone 89,934
Postage&Shipping 170,082
Total Facilities 900,659
Equip Rental&Maintenance 57,213
Total Printing 267,619
Total Transportation 561,440
Total Conferences&Meetings 105,728
89190 Assistance to Individuals 286,883
90010 Membership Dues 25,185
9151 Awards&Grants -
Total Liability Insurance 68,575
Total Miscellaneous Expense 242,150
Sub-Total Other Expenses 5,602,834
Total Expenses 15,510,133
Excess(Deficit)
budget08.xls 4/15/2008 11:50 AM Page 1 of 1
v-tt
•
pa = Senior Services
Promoting the well-being of older adults
2006 Agency Audit
The attached 2006 Audit includes the necessary attachments 8, 9, 10:
Financial Audit Cover Letter
Financial Audit Management Letter
Financial Statement
A non-profit agency supported by United Way of King County investments
2208 Second Ave, Seattle,WA 98121
(p) 206 448-31 1 0• (TTY) 206 448-5025 • (f) 206 448-5766•www.seniorservices.org
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED FINANCIAL STATEMENTS
With Independent Auditor's Report
YEARS ENDED DECEMBER 31, 2006 AND 2005
OMB A-133 SUPPLEMENTARY FINANCIAL REPORTS
YEAR ENDED DECEMBER 31, 2006
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
TABLE OF CONTENTS
•
INDEPENDENT AUDITOR'S REPORT 2
CONSOLIDATED STATEMENTS OF FINANCIAL POSITION
December 31, 2006 and 2005 4
CONSOLIDATED STATEMENTS OF UNRESTRICTED ACTIVITY
Years ended December 31, 2006 and 2005 5
CONSOLIDATED STATEMENTS OF CHANGES IN NET ASSETS
AND MEMBERS' EQUITY
Years ended December 31, 2006 and 2005 6
CONSOLIDATED STATEMENTS OF FUNCTIONAL EXPENSES
Year ended December 31, 2006 7
Year ended December 31, 2005 8
CONSOLIDATED STATEMENTS OF CASH FLOWS
Years ended December 31, 2006 and 2005 9 - 10
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS 11 - 20
SUPPLEMENTARY INFORMATION
Schedule of Expenditures of Federal Awards
Year ended December 31, 2006 22 -23
Report on Compliance and on Internal Control Over Financial
Reporting Based on an Audit of Financial Statements Performed
in Accordance with Government Auditing Standards 24
Report on Compliance with Requirements Applicable to each
Major Program and on Internal Control Over Compliance
in Accordance with OMB Circular A-133 26
Schedule of Findings and Questioned Costs 28 - 29
Summary of Pior Audit Findings 30
1
JACOBSON JARVIS &. CO, PLLC
C.. is R 't t €= € E o i` U t> I: 1 .; ACCOUNTAKTS
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INDEPENDENT AUDITOR'S REPORT
April 30, 2007 •
Boards of Directors •
Senior Services and Affiliates
Seattle, Washington
We have audited the accompanying consolidated statements of financial position of Senior Services
and Affiliates as of December 31, 2006 and 2005, and the related consolidated statements of
unrestricted activity, changes in net assets and members' equity, functional expenses, and cash flows
for the years then ended. These financial statements are the responsibility of the organization's
management. Our responsibility is to express an opinion on these financial statements based on our
audits.
We conducted our audits in accordance with auditing standards generally accepted in the United States
of America; Government Auditing Standards, issued by the Comptroller General of the United States;
and Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments,
and Non-Profit Organizations. Those standards and OMB Circular A-133 require that we plan and
perform the audits to obtain reasonable assurance about whether the financial statements are free of
material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts
and disclosures in the financial statements. An audit also includes assessing the accounting principles
used and significant estimates made by management, as well as evaluating the overall financial
statement presentation. We believe that our audits provide a reasonable basis for our opinion.
In our opinion, the financial statements referred to above present fairly, in all material respects, the
financial position of Senior_ Services and Affiliates as of December 31, 2006 and 2005, and the
changes in its net assets and members' equity and its cash flows for the years then ended in
conformity with accounting principles generally accepted in the United States of America.
•
In accordance with Government Auditing Standards, we have also issued our report dated.April 30,
2007 on our consideration of Senior Services and Affiliates' internal control over financial reporting
and on our tests of its compliance with certain provisions of laws, regulations, contracts and grants.
This report is an integral part of an audit performed in accordance with Government Auditing
Standards and should be read in conjunction with this report in considering the results of our audit.
2
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Our audits were performed for the purpose of forming an opinion on the basic consolidated financial
statements of Senior Services and Affiliates taken as a whole. The accompanying schedule of
expenditures of federal awards is presented for purposes of additional analysis as required by U.S.
Office of Management and Budget Circular A-133, Audits of States, Local Governments, and Non-
Profit Organizations, and is not a required part of the basic financial statements. Such information
has been subjected to the auditing procedures applied in the audit of the basic-consolidated financial
statements and, in our opinion, is fairly stated, in all material respects, in relation to the basic
consolidated financial statements taken as a whole.
1C1449,10*-VGIA.Zad1 62/ / JCL-d,
Jacobson Jarvis &Co, PLLC
•
•
•
•
JACOBSON.JARVIS &CO. ['LLC
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED STATEMENTS OF FINANCIAL POSITION
•
DECEMBER 31,2006 AND 2005
2006 2005
Belltown Belltown
ASSETS - Agency Centers LLC Eliminations Total Agency Centers LLC Eliminations Total
Current Assets
Cash and cash equivalents $ 181,433 $ 1,217,907 $ 106,013 $ 1,505,353 $ 273,121 $ 1,313,698 $ 83,203 $ 1,670,022
Cash and cash equivalents-restricted 36,953 - 78,886 115,839 30;378 - 71,350 101,728
Investments 1,056,772 28,192 - 1,084,964 905,719 95,347 - 1,001,066
Accounts and grants receivable 1,301,883 - 1,472 $ (14,372) 1,288,983 1,337,188 - 3,258 $ (25,120) 1,315,326
United Way promise to give 523,183 - - 523,183 523,183 - - 523,183
Other promises to give 90,210 110,969 - 201,179 - - - -
Inventory 39,306 - - 39,306 58,193 - - 58,193
Due from(to)other funds 789,329 (789,329) - - 210,205 (210,205) - -
Prepaid expenses 40,770 3,258 14,157 58,185 46,973 3,237 14,760 64,970
Unemployment compensation trust deposits 292,552 - - 292,552 214,441 - - 214,441
Total Current Assets 4,352,391 570,997 200,528 (14,372) 5,109,544 3,599,401 1,202,077 172,571 (25,120) 4,948,929
Cash and Cash Equivalents-restricted to long-term purposes - - - - 310,070 17,723 - 327,793
Promises to Give-long-term or restricted to long-term purposes 100,414 21,877 - 122,291 298,155 86,585 - 384,740
Investment in Partnership (329) - - 329 - (236) - ' - 236 -
Property and Equipment,net 4,688,429 •13,119,812 2,996,018 - 20,804,259 5,028,812 12,403,570 3,113,179 20,545,561
$ 9,140,905 $13,712,686 $ 3,196,546 $ (14,043) $26,036,094 $ 9,236,202 $13,709,955 $ 3,285,750 $ (24,884) $26,207,023
LIABILITIES,NET ASSETS,AND MEMBERS'EQUITY
Current Liabilities
Accounts payable $ 228,753 $ 59,958 $ 57,850 $ (14,372) $ 332,189 $ 172,446 $ 17,064 $ 40,311 $ (25,120) $ 204,701
Accrued payroll 478,651 - - 478,651 811,331 - - 811,331
Refundable advance 43,981 - - 43,981 40,470 234 - 40,704
Line of credit 652,923 - - 652,923 195,923 - - 195,923
Notes payable-current portion 84,081 3,973 10,582 98,636 13,132 3,675 10,230 27,037
Total Current Liabilities 1,488,389 63,931 68,432 (14,372) 1,606,380 1,233,302 20,973 50,541 (25,120) 1,279,696
Notes Payable,less current portion above 1,210,430 1,170,985 1,326,335 3,707,750 1,294,529 1,098,885 1,339,925 3,733,339
Total Liabilities 2,698,819 1,234,916 1,394,767 (14,372) 5,314,130 2,527,831 1,119,858 1,390,466 (25,120) 5,013,035
Net Assets and Members'Equity •
Unrestricted 4,264,305 5,330,266 - 9,594,571 4,317,220 4,962,101 - 9,279,321 .
Temporarily restricted 783,870 7,147,504 - 7,931,374 1,056,449 7,627,996 - 8,684,445
Permanently restricted 1,393,911 - - 1,393,911 1,334,702 - - 1,334,702
Managing member equity - - (329) 329 - - - (236) 236 -
Investor member equity - - 1,802,108 1,802,108 - - 1,895,520 1,895,520
Total Net Assets and Members'Equity 6,442,086 12,477,770 1,801,779 329 20,721,964 6,708,371 12,590,097 1,895,284 236 21,193,988
$ 9,140,905 $13,712,686 $ 3,196,546 $ (14,043) $26,036,094 $ 9,236,202 $13,709,955 $ 3,285,750 $ (24,884) $26,207,023
See notes to financial statements. 4
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED STATEMENTS OF UNRESTRICTED ACTIVITY
YEARS ENDED DECEMBER 31,2006 AND 2005
2006 2005
Belltown Belltown
Agency Centers LLC Eliminations Total Agency Centers LLC Eliminations Total
Unrestricted Public Support
United Way contributions $ 469,436 $ 18,090 $ - $ 487,526 $ 454,226 $ 23,265 $ - $ 477,491
Net assets released from time restrictions-United Way 392,388 - - 392,388 427,885 - - 427,885
Total United Way 861,824 18,090 - 879,914 882,111 23,265 - 905,376
Individuals 899,851- 711,247 - 1,611,098 906,206 428,396 - 1,334,602
Corporations- 351,781 129,763 - 481,544 660,630 76,832 - 737,462
Foundations 222,100 57,153 - 279,253 ,98,240 - 47,576 - 145,816 •
Special events 435,151 419,795 - 854,946 369,036 348,897 - 717,933
In-kind rent 359,714 _ 69,080 - 428,794 360,309 224,708 - 585,017
Government grants and contracts 5,957,934 2,167,023 - 8,124,957 5,673,349 1,913,431 - 7,586,780
Allocations among funds (277,298) 277,298 - - (458,252) 458,252 - -
Net assets released from purpose restrictions 423,282 480,492 - 903,774 391,830 1,710,023 - 2,101,853
Total Unrestricted Public Support 9,234,339 4,329,941 - 13,564,280 8,883,459 5,231,380 - 14,114,839
Revenue
Program service fees 94,860 630,451 - 725,311 89,193 619,578 - 708,771
Program sales 532,174 142,077 674,251 508,725 158,020 - 666,745
Incidental revenue 3,211 252,847 - 256,058 2,740 212,838 - 215,578
Rental and other income 53,371 26,564 141,101 $ (4,131) 216,905 222,576 67,573 146,872 $ (2,895) 434,126
Interest and investment income 98,586 44,362 458 93 143,499 53,454 47,615 943 87 102,099
Total Revenue 782,202 1,096,301 141,559 (4,038) 2,016,024 876,688 1,105,624 147,815 (2,808) 2,127,319
Total Unrestricted Public Support and Revenue 10,016,541 5,426,242 141,559 (4,038) 15,580,304 9,760,147 6,337,004 147,815 (2,808) 16,242,158
Expenses .
Program services • 8,571,901 4,305,827 235,064 (4,131) 13,108,661 8,274,022 4,081,722 235,113 (2,895) 12,587,962
Management and general 1,141,475 573,385 - 1,714,860 1,042,483 514,275 - 1,556,758
Fundraising 356,080 178,865, - 534,945 292,135 144,115 - 436,250
Total Expenses 10,069,456 5,058,077 235,064 (4,131) 15,358,466 9,608,640 4,740,112 235,113 (2,895) 14,580,970
Change in Unrestricted Net Assets and Members'Equity $ (52,915) $ 368,165 $ (93,505) $ 93 $ 221,838 $ 151,507 $ 1,596,892 $ (87,298) $ 87 $ 1,661,188
See notes to financial statements. 5
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED STATEMENTS OF CHANGES IN NET ASSETS AND MEMBERS'EQUITY
YEARS ENDED DECEMBER 31,2006 AND 2005
•
2006 2005
Belltown Belltown
Agency Centers L.LC Eliminations Total Agency Centers LLC Eliminations Total
Unrestricted Net Assets
Unrestricted public support $ 8,418,669 $ 3,849,449 $ 12,268,118 $ 7,863,744 $ 3,521,357 $ 11,385,101
Revenue 782,202 1,096,301 $ 141,559 $ (4,038) 2,016,024 876,688 1,105,624 $ 147,815 $ (2,808) 2,127,319
Net assets released from restriction 815,670 480,492 1,296,162 1,019,715 1,710,023 2,729,738
Total Unrestricted Public Support and Revenue 10,016,541 5,426,242 141,559 (4,038) 15,580,304 9,760,147 6,337,004 147,815 (2,808) 16,242,158
Total expenses (10,069,456) (5,058,077) (235,064) _ 4,131 (15,358,466) (9,608,640) (4,740,112) (235,113) 2,895 (14,580,970)
Change in Unrestricted Net Assets and Members'Equity (52,915) 368,165 (93,505) 93 221,838 151,507 1,596,892 (87,298) 87 1,661,188
Temporarily Restricted Net Assets
Public Support
United Way 392,388 - 392,388 392,388 - 392,388
Contributed use of property - - - - 7,774,477 7,774,477
Other contributions 150,703 - 150,703 46,341 103,134 149,475
Total Temporarily Restricted Public Support 543,091 - 543,091 438,729 7,877,611 - 8,316,340
Net Assets Released from Restriction
• United Way (392,388) - - (392,388) (427,885) - (427,885)
Amortization of contributed use of property - (376,184) (376,184) - (250,789) (250,789)
Net assets transfer(Note D) - - - (200,000) (200,000)
Other contributions (423,282) (104,308) (527,590) (391,830) (1,459,234) (1,851,064)
Total Net Assets Released from Restriction (815,670) (480,492) (1,296,162) (1,019,715) (1,710,023) (2,729,738)
Change in Temporarily Restricted Net Assets (272,579) (480,492) (753,071) (580,986) 6,167,588 5,586,602
Permanently Restricted Net Assets
Contributions 59,209 - 59,209 297,235 - 297,235
Net assets transfer(Note D) - - 200,000 -. 200,000
Change in Permanently Restricted Net Assets 59,209 - 59,209 497,235 - 497,235
Change in Net Assets and Members'Equity (266,285) (112,327) (93,505) 93 (472,024) 67,756 7,764,480 (87,298) 87 7,745,025
Net Assets and Members'Equity
Beginning of year 6,708,371 12,590,097 1,895,284 236 21,193,988 ' 6,640,615 4,825,617 1,982,582 149 13,448,963
End of year $ 6,442,086 $12,477,770 $ 1,801,779 $ 329 $ 20,721,964 $ 6,708,371 $12,590,097 $ 1,895,284 $ 236 $ 21,193,988
See notes to financial statements. 6
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED STATEMENT OF FUNCTIONAL EXPENSES
YEAR ENDED DECEMBER 31,2006
Information
and • Total Management Total
Assistance Nutrition Senior Senior Adult Belltown Program and Fund All
Projects Projects Wellness Centers Day Health L1_,C Services General Raising Services
Salaries and wages $ 2,031,851 $ 917,153 $ 408,583 $ 1,608,163 $ 394,641 $ - $ 5,360,391 $ 750,178 $ 188,639 $ 6,299,208
Employee benefits 389,802 216,157 74,102 303,896 81,465 - 1,065,422 120,253 26,482 1,212,157
Payroll taxes 221,076 90,795 37,538 153,650 39,358 - 542,417 64,434 16,702 623,553
Total Payroll Expenses 2,642,729 1,224,105 520,223 2,065,709 515,464 - 6,968,230 934,865 231,823 8,134,918 •
Program supplies 149,674 1,222,227 27,691 150,674 64,038 2,298 1,616,602 38,883 23,912 1,679,397
Depreciation and amortization 7,384 12,864 - 483,928 265,028 117,163 886,367 315,008 - 1,201,375
Professional fees 42,967 • 509,884 12,768 256,079 16,916 26,660 865,274 119,904 61,914 1,047,092
Occupancy 80,849 74,056 - 426,630 53,994 47,509 683,038 85,119 - 768,157 ,
Client and other transportation 250,587 83,470 6,489 214,953 573 - 556,072 9,978 1,396 567,446
In-kind rent - 359,714 - 69,080 - - 428,794 - • -- 428,794
Other 208,388 (4,936) 1,008 36,574 _ 3,809 6,045 250,888 44,420 77,867 373,175
Printing and publications 70,181 11,593 13,570 101,908 8,250 317 205,819 9,282 41,432 256,533
Cost of special events 30 - - 113,473 - - 113,503 - 79,190 192,693
Interest - - - 14,272 - 32,972 47,244 115,182 - 162,426
Insurance 27,030 39,546 2,502 37,011 5,564 - 111,653 24,302 3,550 139,505
Telephone 35,137 12,212 2,285 55,363 9,623 2,100 116,720 6,932 1,107 124,759
Cost of sales - 87,921 - 30,699 504 - 119,124 - - 119,124
Postage and shipping 30,056 6,407 5,959 27,487 1,663 - 71,572 7,489 7,325 86,386
Meetings 24,438 1,868 12,319 8,320 102 - 47,047 3,010 5,296 55,353
Rental and equipment maintenance 1,771 2,216 183 20,675 . - - 24,845 486 133 25,464
Total Expenses 3,571,221 3,643,147 604,997 4,112,835 945,528 235,064 13,112,792 1,714,860 534,945 15,362,597
Eliminations (4,131) (4,131) (4,131)
$ 3,571,221 $ 3,643,147 $ 604,997 $ 4,112,835 $ 945,528 $ 230,933 $13,108,661 $ 1,714,860 $ 534,945 $15,358,466
See notes to financial statements. 7
i
•
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED STATEMENT OF FUNCTIONAL EXPENSES
YEAR ENDED DECEMBER 31,2005
Information
and Total Management Total
Assistance Nutrition Senior Social Senior Adult Belltown Program and Fund All
Projects Projects Wellness Work Centers Day Health 1.1_,C Services Gener Raising Services
Salaries and wages $ 1,894,141 $ 957,667 $ 317,255 $ 80,999 $ 1,551,696 $ 486,573 $ - $ 5,288,331 $ 748,800 $ 160,723 $ 6,197,854
Employee benefits 324,494 190,012 48,863 12,968 281,279 80,128 - 937,744 96,356 20,418 1,054,518
Payroll taxes 221,948 102,056 30,667 8,373 159,562 51,457 - 574,063 54,915 14,707 643,685
Total Payroll Expenses 2,440,583 1,249,735 396,785 102,340 1,992,537 618,158 - 6,800,138 900,071 195,848 7,896,057
Program supplies 164,398 1,584,982 7,060 20 125,889 65,157 5,154 1,952,660 . 22,318 9,874 1,984,852
Depreciation and amortization 14,509 18,253 663 - 313,195 131,198 117,164 594,982 333,055 - 928,037
Professional fees 22,362 170,082 40,954 350 215,224 19,629 24,907 493,508 98,280 66,116 657,904
Occupancy 68,211 123,395 4,542 - 333,369 30,734 49,597 609,848 33,133 - 642,981
Client and other transportation 213,137 97,800 4,109 729 228,328 1,537 - 545,640 10,527 1,477 557,644
In-kind rent - 360,309 - - 224,708 - - 585,017 - - 585,017
Other 151,391 6,600 1,041 36 38,503 3,417 2,274 203,262 (6,718) 56,403 252,947
Printing and publications 59,241 12,621 11,256 170 83,756 3,274 449 170,767 9,777 27,643 208,187 •
Cost of special events - - - - 86,644 - - 86,644 - 66,580 153,224
Interest - - - - 10,089 - 33,256 43,345 103,376 - 146,721
Insurance 22,576 32,661 2,676 588 63,281 4,651 - 126,433 36,215 2,604 165,252
Telephone 38,580 12,616 2,863 - 43,180 7,665 2,312 107,216 6,301 1,198 114,715
Cost of sales - 99,776 - - 33,308 994 - 134,078 - - 134,078
Postage and shipping 29,604 • 5,688 2,728 - 25,249 1,422 - 64,691 6,496 4,121 75,308
Meetings 24,536 1,998 13,144 562 9,847 253 - 50,340 3,830 4,347 58,517
Rental and equipment maintenance 401 489 41 - 20,856 501 - 22,288 97 39 22,424
Total Expenses 3,249,529 3,777,005 487,862 104,795 3,847,963 888,590 235,113 12,590,857 1,556,758 436,250 14,583,865
Eliminations - (2,895) (2,895) (2,895)
$ 3,249,529 $ 3,777,005 $ 487,862 $ 104,795 $ 3,847,963 $ 888,590 $ 232,218 $12,587,962 $ 1,556,758 $ 436,250 $14,580,970
•
See notes to financial statements. 8
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED STATEMENTS OF CASH FLOWS
YEARS ENDED DECEMBER 31, 2006 AND 2005
2006 2005
Cash Flows from Operating Activities
Cash received from:
Government agencies $ 8,174,287 $ 7,439,164
Donors 3,165,915 2,745,685
United Way 879,914 845,895
Sales to the public 674,251 666,745
Program participants 725,311 708,771
Investments 103,221 96,927
Rental and other income 474,749 438,434
Cash paid for:
Personnel (8,545,709) (8,011,173)
Services and supplies (5,229,384) (5,028,429)
Interest (155,953) (140,249)
Net Cash Provided (Used) by Operating Activities 266,602 (238,230)
Cash Flows from Investing Activities
Purchase,and construction of property and equipment (1,460,071) (3,287,143)
Purchase of investments (848,562) (403,159)
Proceeds from sales of investments 821,664 455,154
Proceeds from sale of building - 284,488
Change in restricted reserves (14,111) (13,689)
Net Cash Used by Investing Activities (1,501,080) (2,964,349)
Cash Flows from Financing Activities
Net proceeds from(repayment of) line of credit 457,000 (259,000)
Proceeds from notes payable 76,075 803,276
Principal payments on notes payable (36,538) (35,224)
Proceeds from contributions restricted to endowment 59,209 129,848
Proceeds from contributions restricted to investment in property 186,270 521,806
Net Cash Provided by Financing Activities 742,016 1,160,706
Change in Cash and Cash Equivalents (492,462) (2,041,873)
Cash and Cash Equivalents - beginning of year 1,997,815 4,039,688.
Cash and Cash Equivalents - end of year $ 1,505,353 $ 1,997,815
See notes to financial statements. 9
SENIOR SERVICES AND AFFILIATES
CONSOLIDATED STATEMENTS OF CASH FLOWS
YEARS ENDED DECEMBER 31, 2006 AND 2005
2006 2005
Reconciliation of Change in Net Assets and Members' Equity
to Net Cash Flows from Operating Activities
Change in net assets and members' equity $ (472,024) $ 7,745,025
Adjustments to reconcile change in net assets and members'
equity to net cash provided (used) by operating activities
Depreciation and amortization 1,201,375 928,037
Donated investments (16,629) (28,287)
Deferred interest 6,473 6,472
Amortization of loan costs 603 603
Gain on investments (40,371) (5,259)
Gain on sale of building - (210,960)
Contributions restricted to investment in property (195,000) (105,634)
Contributions restricted to endowment (59,209) (297,235)
Contributed use of property - (7,980,159)
Bad debt expense 70,000 . 48,275
Decrease (increase) in
United Way promise to give - (23,984)
Accounts and grants receivable 47,839 (186,055)
Inventory 18,887 (2,641)
Prepaid expenses 6,182 28,813
Unemployment compensation trust deposits (78,111) (72,875)
Increase (decrease) in
Accounts payable 105,771 (30,099)
Accrued payroll (332,680) (42,241)
Refundable advance 3,496 (10,026)
Net Cash Provided (Used) by Operating Activities $ 266,602 $ (238,230)
r
See notes to financial statements. 10
•
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE A - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES
Senior Services is a multi-service, not-for-profit agency, which was established in 1967 to provide a
spectrum of services to support seniors in their efforts to live healthy, independent lives. This
mission is carried out through numerous programs, senior centers, and adult day health programs
providing services throughout the County.
The following Senior Centers were in operation during 2006 and 2005. Their financial position and
changes in their net assets and their cash flows have been included in the accompanying consolidated
financial statements. All inter-agency transactions and accounts have been eliminated in
consolidation.
Central Area Southeast Seattle
Northshore (Bothell) Sno-Valley
Northwest (Ballard) Vashon-Maury Island
Shoreline/Lake Forest Park West Seattle
Programs provided by Senior Services include:
Senior Information and Assistance
Information and Assistance is the single access point for the wide range of community services for
older adults. Staff provides information to callers, initiates services for those unable to act on
their own behalf, and follows up to ensure that services are in place and are appropriate.
Minor Home Repair
This program performs critically needed plumbing, electrical, or carpentry repairs or
modifications for low-income Seattle homeowners and disabled renters. The need for repair is
related to preventing harm to the security, safety, or health of the resident.
Homesharing
The goal of this program, which serves City of Seattle residents, is to help seniors stay in their
homes longer and provide affordable housing for people of all ages. The program matches people
who want to share their homes with people who are looking for a place to live.
Senior Outreach
This program is designed to identify individuals sixty years of age and older who face cultural and
racial barriers. The goal of the program is to inform these persons about available services and to
encourage participation.
Project Enhance
This project includes three evidenced-based components: EnhancedFitness, an exercise program;
EnhancedWellness, a health behavior change program; and Living a Healthy Life Workshop, a
chronic disease management program. All three programs are offered to older adults in
community settings in King County and various locations around the country.
11
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE A - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (Continued)
Transportation
This program organizes volunteer drivers to transport the frail elderly to medical and other
essential appointments. The primary objective of the program is to assist elderly individuals who
are unable to utilize other available forms of transportation.
Senior Rights Assistance
This program provides peer counseling by trained volunteers. Information and advocacy is
provided on insurance, Social Security, Medicare, wills, powers of attorney, end-of-life choices,
landlord/tenant issues, and other health, consumer, and legal issues.
Community Dining
This program provides a variety of nutritional services to senior citizens in Seattle/King County.
The objective of the program is to assist older persons to improve their health through good
nutrition. The program is designed to supplement the individual's dietary needs by serving
nutritious meals and to provide knowledge about nutrition by giving nutrition education
presentations.
Meals on Wheels
This program delivers nutritious meals to homebound older or disabled persons who reside in
Seattle/King County. The goal is to enable homebound elderly persons to remain in their homes
as long as possible by providing nutritious meals which they would otherwise be unable to obtain.
Adult Day Health
The adult day health programs provide supportive and therapeutic services that maintain or
improve the health and functioning of frail and disabled elders and provide support to caregivers.
Senior Centers
These centers, located throughout King County, are community focal points where older adults
have comprehensive access to programs and services that maximize their health and independence.
Caregiver Outreach and Support
This program provides outreach, education, and services coordination throughout King County
through community and workplace presentations. Caregiver Advocates offer information about
community resources, encourage caregivers to utilize the full range of services available to them
and the older persons for whom they care, and assist them in securing needed resources.
The Belltown Senior Apartments, LLC (Belltown LLC) was formed in 2001 in order to facilitate the
use of low-income housing tax credits in the development of Belltown Senior Apartments. Senior
Services is the managing member with a 0.1% interest. The Investor Members, holding the
remaining 99.9% interest, purchased the low-income housing tax credits upon project completion.
12
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE A - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (Continued)
The building is divided into two separate condominium units, a residential unit and a commercial
unit. The commercial unit consists of three floors occupied by Senior Services for countywide
operations, a senior health and wellness center, and community room. The residential unit consists of
25 affordable senior housing units on five floors managed by Senior Services.
Principles of consolidation
The financial statements consolidate the assets, liabilities, and activities of Senior Services, its
affiliated Senior Centers, and the Belltown Senior Apartments, LLC. Senior Services is the sole
managing member in the Belltown Senior Apartments, LLC. Senior Services, its affiliated Senior
Centers, and the Belltown Senior Apartments, LLC are collectively referred to as Senior Services
and Affiliates. All significant intercompany transactions have been eliminated in the consolidation.
Financial statement presentation
Financial statement presentation follows the recommendations of the Financial Accounting
Standards Board in its Statement of Financial Accounting Standards (SFAS) No. 117, Financial
Statements of Not-for-Profit Organizations. Under SFAS No. 117, the organization is required to
report information regarding its financial position and activities according to three classes of net
assets: unrestricted net assets, temporarily restricted net assets, and permanently restricted net
assets.
Unrestricted net assets are available without restriction for support of Senior Services' operations.
Temporarily restricted net assets are restricted by the donor to be used for certain purposes or
future periods. Temporarily restricted net assets are available for the following purposes as of
December 31:
2006 2005
Contributed use of property $ 7,147,504 $ 7,523,688
Capital Campaign 254,225 608,225
Subsequent year's operations - United Way 392,388 392,388
West Seattle Senior Center Capital Campaign - 104,308.
Senior Outreach 80,556 -
Meals on Wheels 25,000 25,000
Congregate Meals 11,701 15,836
Minor Home Repair 20,000 15,000
$ 7,931,374 $ 8,684,445
Permanently restricted net assets represent endowment gifts given with the intent that the principal
will be maintained intact in perpetuity, and the income may be used for specific purposes or
current operations.
13
' SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE A - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (Continued)
Permanently restricted net assets as of December 31 are:
2006 2005
Senior Rights Assistance Endowment $ 644,135 $ 644,135
General Endowment 749,776 690,567
$ 1,393,911 $ 1,334,702
Cash and cash equivalents
Cash and cash equivalents consist of general checking and savings accounts, certificates of
deposit, and money market accounts. Senior Services maintains its cash and cash equivalents in
bank accounts that may exceed federally insured limits at times during the year. Senior Services
has not experienced any losses in these accounts, and management does not believe it is exposed
to any significant credit risk. Cash reserves have been established per terms of the contracts with
Washington Community Reinvestment Association. Cash reserves consisted of the following at
December 31:
Senior Services Belltown LLC
2006 2005 2006 2005
Replacement reserves $ 36,953 $ 30,378 $ 26,512 $ 19,308
Operating reserves - - 52,374 52,042
$ 36,953 $ 30,378 $ 78,886 $ 71,350
Investments
Investment securities are recorded at market values and consist of the following at December 31:
2006 2005
Equities $ - 667,963 $ 874,973
Fixed income securities 417,001 126,093
$ 1,084,964 $ 1,001,066
Accounts and grants receivable
Accounts and grants receivable are stated at net realizable value.
Promises to give
In accordance with financial accounting standards, unconditional promises to give are recognized
as support in the period received and as assets, decreases of liabilities, or expenses depending on
the form of the benefits received. Conditional promises to give are recognized when the
conditions on which they depend are substantially met. Senior Services had no conditional
promises to give at December 31, 2006.
14
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE A - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (Continued)
Unconditional promises to give at December 31, 2006 are as follows:
Receivable in less than one year $ 318,982
Receivable in one to five years 131,116
450,098
Less allowance for uncollectible accounts (117,803)
Less discounts to net present value at 5% (8,825)
Unconditional promises to give, net $ 323,470
Deferred financing fees
Loan fees on permanent financing are capitalized and amortized over the term of the loan. At
December 31, 2006 and 2005, deferred financing fees, net of accumulated amortization, were
$27,113 and $27,716, respectively, and are included in prepaid expenses.
Inventory
Inventory, consisting of food and supplies, is stated at the lower of cost (determined on the first-
in, first-out method) or market.
Property and Equipment
Property and equipment are stated at cost or, if donated, at estimated fair value at date of receipt.
Senior Services capitalizes all expenditures for property and equipment in excess of $1,000.
Interest expense capitalized was $57,509 and $6,812 for the years ended December 31, 2006 and
2005, respectively. Depreciation is provided using the.straight-line method over the estimated
useful lives of the assets. Property and equipment consist of the following:
Estimated
'Useful Lives 2006 2005
Land $ 1,440,995 $ 1,440,995
Construction in progress - 1,681,369
Buildings 20-30 years 19,735,897 18,200,782
Equipment 5-10 years 2,669,093 2,662,524
Furniture 5 years 489,528 500,573
Vehicles 5 years 777,767 813,529
Leasehold improvements 5-10 years 1,254,278 358,397
26,367,558 25,658,169
Less: Accumulated depreciation (5,563,299) (5,112,608)
$20,804,259 $20,545,561
15
•
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE A - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (Continued)
Included in total buildings above are the Northshore Senior Center and Northshore Health and
Wellness Center. These buildings and the land on which they are located are owned by the
Northshore Park and Recreation Service Area (PRSA). During 2005, Senior Services and the
PRSA signed a 20-year lease allowing for Senior Services' rent-free use of the building and land
until December 31, 2025. The fair value of the promise to give the use of property evidenced by
this lease has been recognized as an asset (building) and as temporarily restricted support in the
financial statements.
In addition to the contributed portion of the buildings, certain construction costs related to the
Health and Wellness Center and a Skybridge were paid by Senior Services and have been
capitalized subject to the lease agreement noted above. If Senior Services violates the terms of the
lease, the PRSA may terminate the lease. Senior Services would then incur a loss for the net book
value of the buildings of $8,375,000 and the related leasehold improvements of $788,151 as of
December 31, 2006.
Restricted and unrestricted public support
Support that is restricted by the donor is reported as an increase in unrestricted net assets if the
restriction expires in the year in which the support is recognized. All other donor-restricted
support is reported as an increase in temporarily or permanently restricted net assets, depending
on the nature of the restriction. When restrictions expire (that is, when a stipulated time
restriction ends or purpose restriction is accomplished), temporarily restricted net assets are
reclassified to unrestricted net assets and reported in the consolidated statements of unrestricted
activity as net assets released from restrictions.
Gifts of equipment are reported as unrestricted support unless explicit donor stipulations specify
how the donated assets must be used. Gifts of long-lived assets with explicit restrictions that
specify how the assets are to be used and gifts of cash or other assets that must be used to acquire
long-lived assets are reported as restricted support. Absent explicit donor stipulations about how
long those assets must be maintained, expirations of donor restrictions are reported' when the
donated or acquired assets are placed in service.
Revenue from government agencies
Revenue from government agencies is subject to audit, which could result in adjustments to
revenue. The adjustments are recorded at the time that such amounts can first be reasonably
determined, normally upon notification by the government agency. During the years ended
December 31, 2006 and 2005, no such adjustments were made.
16
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE A - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (Continued)
In-kind contributions
Senior Services occupies certain premises at either reduced rates or no charge. The fair value of
the space occupied at below market rates is reflected as in-kind support and expense in the
consolidated statements of unrestricted activity and of functional expenses.
In accordance with financial accounting standards, the financial statements reflect only donated
services requiring specific expertise that Senior Services would otherwise need to purchase.
However, Senior Services receives a significant amount of volunteer services from individuals and
businesses, which are not reflected in the accompanying consolidated financial statements.
Functional allocation of expenses
The costs of providing the various programs and other activities have been summarized on a
functional basis in the consolidated statements of unrestricted activity and of functional expenses.
Accordingly, certain costs have been allocated among the program and supporting services
benefited.
Federal income taxes
The Internal Revenue Service has recognized Senior Services and its Affiliated Senior Centers as
exempt from federal income tax under the provisions of Section 501(a) of the Internal Revenue
Code as nonprofit organizations as described in Section 501(c)(3), and not as private foundations.
Senior Services obtained a group exemption in 1981, which allows Senior Services to fulfill the
Internal Revenue Service's filing requirements for its affiliated Senior Centers. Federal income
tax is not payable by, or provided for, the Belltown Senior Apartments, LLC. Members are taxed
individually on their share of LLC earnings.
Use of estimates
The preparation of financial statements in conformity with generally accepted accounting
principles requires management to make estimates and assumptions that affect the reported
amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of
the financial statements and the reported amounts of revenues and expenses during the reporting
period. Actual results could differ from those estimates.
NOTE B - LINE OF CREDIT
Senior Services has a $750,000 line of credit bearing interest at prime rate plus .25% (8.5% as of
December 31, 2006) maturing August 2007. The line is secured by substantially all assets of the
organization.
17
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE C - NOTES PAYABLE -
• Long-term debt consists of the following: 2006 2005
•
Agency
Note payable to the Washington State Community Reinvestment
Association (WCRA), bearing interest at 7% per annum,
collateralized by the commercial unit of the Belltown Project.
Monthly payments of $7,318 began September 2003. The note
matures August 2018, at which time the remaining principal is
due. $ 1,059,511 $ 1,072,661
Non-interest bearing note payable to the City of Seattle secured by
deed of trust on the Belltown Project. The note expires and the
debt shall be forgiven on December 31, 2017, provided that no
default has occurred. Senior Services fully intends to comply with
the terms of the note. 165,000 165,000
Non-interest bearing note payable to the City of Bellevue secured
by deed of trust on the Belltown Project. The note expires and the
debt shall be forgiven on December 31, 2007, provided that no
default has occurred. Senior Services fully intends to comply with
the terms of the note. 70,000 70,000
Subtotal Agency 1,294,511 1,307,661
Centers
Note payable to Impact Capital, bearing interest at 6% per annum.
Interest only payments are due monthly. The note matures January
2008 and is secured by a deed of trust on the West Seattle.Senior
Center building. $ 879,351 $ 803,276
Non-interest bearing note payable to King County secured by deed
of trust on property owned by Northshore Park and Recreation
Service Area. The note expires and the debt shall be forgiven in
2016, provided that no default has occurred. Senior Services fully
intends to comply with the terms of the note. 185,000 185,000
Note payable to Washington Federal Savings and Loan, due in
monthly installments of$805 including interest at 9% per annum.
The note matures in November 2029 and is secured by a deed of
trust on a Southeast Senior Center building. 93,537 94,716
18
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE C - NOTES PAYABLE (Continued) 2006 2005
Note payable to Washington Mutual, due in monthly installments
of $320 including interest at 7.25% per annum. The note matures
in May 2012 and is secured by a deed of trust on a Southeast
Senior Center building. 17,070 19,568
Subtotal Centers 1,174,958 1,102,560
Belltown LLC
Note payable to the City of Seattle bearing interest at 1% per
annum collateralized by the Belltown Project. The note matures in
October 2051 with the option to extend by one 25 year period. '
Annual payments began June 2004 and are based on net cash flow
of the preceding year. Deferred interest totaled $2,027 and $5,034
as of December 31, 2006 and 2005, respectively. 647,254 647,254
Note payable to the State of Washington, bearing interest at 1%
per annum, collateralized by the Belltown Project. Annual
payments of $9,937 began December 2003. The note matures
December 2052. 364,967 371,193
Note payable to the Washington State Community Reinvestment
Association (WCRA), bearing interest at 7% per annum,
collateralized by the residential unit of the Belltown Project.
Monthly payments of $2,229 began September 2003. The note
matures August 2033. 322,669 326,674
Deferred interest on above notes 2,027 5,034
Subtotal Belltown LLC 1,336,917 1,350,155
Total Notes Payable 3,806,386 3,760,376
Less Current Portion (98,636) (27,037)
$ 3,707,750 $ 3,733,339
Principal reductions of notes payable for the years ending December 31 are:
2007 $ 98,636
2008 909,700
2009 32,185
2010 34,155
2011 221,265
Thereafter 2,510,445
$ 3,806,386
19
SENIOR SERVICES AND AFFILIATES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
YEARS ENDED DECEMBER 31, 2006 AND 2005
NOTE D - NET ASSET TRANSFER
During 2005, management became aware that a certain contribution originally understood to be for
the capital campaign was actually permanently restricted by the donor's trust document. Accordingly,
the amount was transferred from the temporarily restricted net asset class to the permanently
restricted net asset class.
• NOTE E - CAFETERIA PLAN
Senior Services pays the full cost of Medical (Core Plan) and Dental for all benefited employees.
Employees with more than one year of service are awarded a monthly `allowance' to use toward
elected pre-tax Medical premiums, dependent Dental Coverage, Retirement Plan Contributions,
Flexible Spending Accounts (FSA), and/or (taxable) cash.
NOTE F - RETIREMENT PLAN
Effective January 1, 2000, Senior Services adopted a 401(k) defined contribution plan which replaced
an existing plan. All employees over 21 years of age are eligible to make elective deferrals using
their monthly cafeteria plan allowance and/or additional pre-tax payroll deductions.
NOTE G - LEASE COMMITMENTS
Senior Services leases warehouse space under a five-year, non-cancelable operating lease. Rent
expenses under this operating lease were $75,520 and $71,680 respectively, for the years ended
December 31, 2006 and 2005 and are included in occupancy expense. Future minimum lease
payments under this lease for the years ending December 31 are as follows:
2007 $ 79,360
2008 26,880
$ 106,240
20
r ,
SENIOR SERVICES AND AFFILIATES
SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS
YEAR ENDED DECEMBER 31, 2006
Federal Grantor
Pass-through Grantor CFDA Federal
"Program Title" Number Expenditures
Department of Health and Human Services
"Special Program for the Aging: Title IV and Title II -
Discretionary Projects" 93.048 $ 70,000
City of Seattle Human Services Department
"Special Program for the Aging: Title III Part B - Grants for
Supportive Services and Senior Centers" 93.044 * 677,724
"Special Program for the Aging: Title III Part C - Nutrition Services" 93.045 * 1,376,928
"Nutrition.Services Incentive Program" 93.053 * 406,306
Snohomish County Human Services
"Special Program for the Aging: Title III Part B - Grants for
Supportive Services and Senior Centers" 93.044 * 21,474
Total Cluster 2,482,432
City of Seattle Human Services Department
"National Family Caregiver Support" 93.052 323,533
Snohomish County Human Services
"National Family Caregiver Support" 93.052 35,203
Total National Family Caregiver Support 358,736
City of Seattle Human Services Department
"Special Program for the Aging: Title III Part D - Disease
•
Prevention and Health Promotion Services " 93.043 106,821
"Medical Assistance Program (Medicaid: Title XIX)" 93.778 65,000
University of Washington
"Centers for Research and Demonstration for Health Promotion
and Disease Prevention" 93.135 36,213
Department of Housing and Urban Development
City of Seattle Office of Housing
"Community Development Block Grant" 14.218 449,917
City of Bellevue
"Community Development Block Grant" 14.218 61,756
King County
"Community Development Block Grant" 14.218 21,127
City of Shoreline
"Community Development Block Grant" 14.218 88,225
Total Community Development Block Grant 621,025
22
SENIOR SERVICES OF SEATTLE/KING COUNTY AND AFFILIATES
SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (Continued)
YEAR ENDED DECEMBER 31, 2006
Department of Agriculture
City of Seattle Human Services Department
"Child and Adult Care Food Program" 10.558 28,814
"State Administrative Matching Grants for Food Stamp Program" 10.561 4,146
Department of Justice
Washington State Department of Social and Health Services
"Crime Victim Assistance" 16.575 28,581
Total Federal Awards $ 3,801,768
* Denotes the major program.
NOTE A - BASIS OF PRESENTATION
The accompanying schedule of expenditures of federal awards includes the federal grant activity of
Senior Services and Affiliates and is presented on the accrual basis of accounting. The information in
this schedule is presented in accordance with the requirements of OMB Circular A-133, Audits of
States, Local Governments, and Non-Profit Organizations. Therefore, some amounts presented in this
schedule may differ from amounts presented in, or used in the preparation of, the basic financial
statements.
23
JACOBSON J.A..aRVIS & CO, PLLC
.£. ;} Y,.., *#:,;i.1 , ':iti? 12. ' :F—t. •,0
REPORT ON COMPLIANCE AND ON INTERNAL CONTROL OVER FINANCIAL REPORTING
BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE
WITH GOVERNMENT AUDITING STANDARDS
April 30, 2007
Boards of Directors
Senior Services and Affiliates
Seattle, Washington
We have audited the consolidated financial statements of Senior Services and Affiliates as of and for
the year ended December 31, 2006 and have issued our report thereon dated April 30, 2007. We
conducted our audit in accordance with auditing standards generally accepted in the United States of
America and the standards applicable to financial audits contained in Government Auditing Standards,
issued by the Comptroller General of the United States.
Compliance
As part of obtaining reasonable assurance about whether Senior Services and Affiliates' consolidated
financial statements are free of material misstatement, we performed tests of its compliance with
certain provisions of laws, regulations, contracts and grants, noncompliance with which could have a
direct and material effect on the determination of financial statement amounts. However, providing an
opinion on compliance with those provisions was not an objective of our audit and, accordingly, we
do not express such an opinion. The results of our tests disclosed no instances of noncompliance that
are required to be reported under Government Auditing Standards.
Internal Control Over Financial Reporting
In planning and performing our audit, we considered Senior Services and Affiliates' internal control
over financial reporting in order to determine our auditing procedures for the purpose of expressing
our opinion on the consolidated financial statements and not to provide assurance on the internal
control over financial reporting. We noted certain matters, however, involving the internal control
over financial reporting and its operation that we consider to be significant deficiencies.
A significant deficiency is a deficiency in internal control, or combination of deficiencies, that
adversely affects the entity's ability to initiate, authorize, record, process, or report financial data
reliably in accordance with generally accepted accounting principles such that there is more than a
remote likelihood that a misstatement of the entity's financial statements that is more than
inconsequential will not be prevented Or detected. The significant deficiencies are described in the
accompanying schedule of findings and questioned costs as items 06-1 and 06-2.
24
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Our consideration of the internal control over financial reporting would not necessarily disclose all
matters in the internal control over financial reporting that might be a material weakness. A material
weakness is a significant deficiency, or combination of significant deficiencies, that results in more
than a remote likelihood that a material misstatement of the financial statements will not be prevented
or detected; However, we believe the significant deficiency described in item 06-1 to be a material
weakness.
This report is intended for the information of the Board of Directors, management and federal
awarding agencies and pass-through entities and is not intended to be and should not be used by
anyone other than these specified parties.
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Jacobson Jarvis &Co, PLLC
•
25
ACCOI3SON JARVIS &CO, PLLC
JACOBSON €JAARV I S &NCO, P L LC
=f: .zv+AT 3' .'f ST'.x3 . :.. .:.lii!< .JA 4,3101 127'� ..:f.2z. ,•,)3) Z.1)R.•625;
REPORT ON COMPLIANCE WITH REQUIREMENTS APPLICABLE TO EACH MAJOR
PROGRAM AND ON INTERNAL CONTROL OVER COMPLIANCE IN ACCORDANCE WITH
OMB CIRCULAR A-133
April 30, 2007
Boards of Directors
Senior Services and Affiliates
Seattle, Washington
Compliance
We have audited the compliance of Senior Services and Affiliates with the types of compliance
requirements described in the U. S. Office of Management and Budget (OMB) Circular A-133
Compliance Supplement that are applicable to each of its major federal programs for the year ended
December 31, 2006. Senior Services and Affiliates' major federal programs are identified in the
summary of auditor's results section of the accompanying schedule of findings and questioned costs.
Compliance with the requirements of laws, regulations, contracts and grants applicable to each of its
major federal programs is the responsibility of Senior Services and Affiliates' management. Our
responsibility is to express an opinion on Senior Services and Affiliates' compliance based on our
audit.
We conducted our audit of compliance in accordance with auditing standards generally accepted in the
United States of America; the standards applicable to financial audits contained in Government
Auditing Standards, issued by the Comptroller General of the United States; and OMB Circular A-
133, Audits of States, Local Governments, and Non-Profit Organizations. Those standards and OMB
Circular A-133 require that we plan and perform the audit to obtain reasonable assurance about
whether noncompliance with the types of compliance requirements referred to above that could have a
direct and material effect on a major federal program occurred.
An audit includes examining, on a test basis, evidence about Senior Services and Affiliates'
compliance with those requirements and performing such other procedures as we considered necessary
in the circumstances. We believe that our audit provides a reasonable basis for our opinion. Our audit
does not provide a legal determination on Senior Services and Affiliates' compliance with those
requirements.
In our opinion, Senior Services and Affiliates complied, in all material respects, with the requirements
referred to above that are applicable to each of its major federal programs for the year ended
December 31, 2006.
26
.H: §LI RI i<1111:l- 1‘;+;:11: ':; t:1>01,41:,V • RN1 C 1(`t 117i t'si MCC: t'Urit.1..1;:,COUNfAN ,
•
Internal Control Over Compliance
The management of Senior Services and Affiliates is responsible for establishing and maintaining
effective internal control over compliance with requirements of laws, regulations, contracts and grants
applicable to federal programs. In planning and performing our audit, we considered Senior Services
and Affiliates' internal control over compliance with requirements that could have a direct and
material effect on a major federal program in order to determine our auditing procedures for the
purpose of expressing our opinion on compliance and to test and report on internal control over
compliance in accordance with OMB Circular A-133.
Our consideration of the internal control over compliance would not necessarily disclose all matters in
the,internal control that might be material weaknesses. A material weakness is a significant deficiency,
or combination of significant deficiencies, that results in more• than a remote likelihood that
noncompliance with applicable requirements of laws, regulations, contracts and grants that would be
material in relation to a major federal program being audited may occur and not be detected within a
timely period by employees in the normal course of performing their assigned functions. We noted no
matters involving the internal control over compliance and its operation that we consider to be
material weaknesses.
This report is intended solely for the information and use of the Board of Directors, management and
federal awarding agencies and pass-through entities and is not intended to be and should not be used
by anyone other than these specified parties.
alae..0119frv,66.4i,sdog '44e,
Jacobson Jarvis & Co, PLLC
•
•
27
SENIOR SERVICES AND AFFILIATES
SCHEDULE OF FINDINGS AND QUESTIONED COSTS
YEAR ENDED DECEMBER 31, 2006
A. SUMMARY OF AUDIT RESULTS
1. The auditor's report expresses an unqualified opinion on the consolidated financial
statements of Senior Services of Seattle/King County and Affiliates.
2. Significant deficiencies relating to the financial statements is reported in the "Report on
Compliance and on Internal Control Over Financial Reporting Based on an Audit of
Financial Statements Performed in Accordance with Government Auditing Standards." One
of the significant deficiencies is considered to be a material weakness.
3. No instances of noncompliance material to the consolidated financial statements of Senior
Services of Seattle/King County and Affiliates were disclosed during the audit.
4. No material weaknesses relating to the audit of the major federal award programs is
reported in the "Report on Compliance with Requirements Applicable to the Major
Programs and on Internal Control Over Compliance in Accordance with OMB Circular A-
5. The auditor's report on compliance for the major federal award programs for Senior
Services of Seattle/King County and Affiliates expresses an unqualified opinion.
6. Audit findings relative to the major federal award programs for Senior Services of
Seattle/King County and Affiliates are reported in Part C of this Schedule.
7. The program tested as major was the cluster "Special Program for the Aging: Title III Part
B - Grants for Supportive Services and Senior Centers", "Special Program for the Aging:
Title III Part C - Nutrition Services" and "Nutrition Services Incentive Program," CFDA
Nos. 93.044, 93.045 and 93.053, respectively.
8. The threshold for distinguishing Type A and B programs was $300,000.
9. Senior Services and Affiliates was determined to be a low-risk auditee.
•
28
SENIOR SERVICES AND AFFILIATES
SCHEDULE OF FINDINGS AND'QUESTIONED COSTS
YEAR ENDED DECEMBER 31, 2006
B. FINDINGS — FINANCIAL STATEMENT AUDIT
06-1 - Internal Control over External Financial Reporting
The internal control structure of Senior Services has focused primarily on the objective of
effectiveness and efficiency of operations (i.e. performance and mission goals and
safeguarding of resources) and the objective of compliance. However, the system of internal
control over the objective of reliability of financial reporting contains certain significant
deficiencies as evidenced by adjusting journal entries resulting from the audit process. The
internal control structure lacks a'thorough monitoring system to ensure that all accounts are
reconciled on a timely basis and not all reconciliations are independently reviewed for
accuracy.
We recommend that management implement sufficient internal controls to ensure the
accuracy of financial reporting in accordance with required standards.
Views of a Responsible Official: Management concurs with the finding and recommendation
as reflected in the corrective action plan.
06-2 - Segregation of Duties at Senior Center Locations
While the majority of the accounting activities of Senior Services occur within the
centralized finance department of the agency, certain cash receipt and cash disbursement
activities are initiated at the affiliated senior center locations. At certain of these locations,
the segregation of duties over accounting transactions is insufficient to ensure that there is
only a remote likelihood that a misstatement that is more than inconsequential will not be
prevented or detected.
Examples of this lack of segregation of duties include bookkeeping staff with access to both
cash receipts and accounting records, signed disbursement checks returned to bookkeeping
staff and a bookkeeper as an authorized check signers. We also noted the lack of certain
mitigating controls such as the independent review of unopened bank statements and the
immediate endorsement of cash receipt checks upon receipt.
We recommend that management provide education and .support to the Senior Center staff
such that they may design their bookkeeping activities to maximize internal controls.
Views of a Responsible Official: Management concurs with the finding and recommendation
as reflected in the corrective action plan.
C. FINDINGS AND QUESTIONED COSTS — MAJOR FEDERAL AWARD PROGRAM AUDIT
None
29
Senior Services Summary of Prior Audit Findings
Year Ended December 31, 2006
05-1—Internal Control over External Financial Reporting
Finding: Numerous adjustments were made to the accounting records subsequent to the
start of the 2005 audit process. These adjustments affected nearly all financial statement
line items.
Recommendation: Management should implement sufficient internal controls to ensure
the accuracy of financial reporting.
Action Taken: Accounting Department is implementing the following in order to
generate GAAP compliant financial statements.:
1. Formulate all entries necessary to generate GAAP compliant financial statements
and issue these statements; but to ensure the correctness of these entries before
regularly entering them into the general ledger this process will culminate in 2007
with the direct posting, on a monthly basis, of all these entries. These entries
include, but are not limited to depreciation and in-kind rental contributions.
2. Reconciling monthly internal management reports with GAAP statements
3. Reviewing statements on a monthly basis with Denise Klein, Executive Director.
4. Providing both sets of reports to the Finance Committee and Board of Directors.
5. Research and record unique transactions in the month occurred.
05-2—Reportable Condition
Finding: Certain federal awards (both direct and pass-through) were not initially
identified on the schedule of expenditures of federal awards.
Recommendation: Senior Services should implement procedures to review all contracts
in order to identify fund sources. All government grants, including those with federal
funding sources, should be monitored to ensure they are in compliance.
Action Taken: Tara Voss, Controller, inserted an additional column on the internal
contracts tracking schedule,noting the CFDA#, if applicable,beginning April 2006.
Any questions regarding a specific contract's funding source(s) are discussed with Tim
Bridges, CFO. This schedule is reviewed by both Tim and Tara on a monthly basis.
30
•
Senior Services submits the following corrective action plan for the year ended December 31,
2006
Name and address of independent accounting firm: Jacobson Jarvis & Co, PLLC, 600
Stewart Street, Suite 1900, Seattle WA 98101-1219
Audit period: January 1, 2006 — December 31, 2006
Contact person responsible for corrective action: Tim Bridges, Chief Financial Officer
Anticipated completion date for corrective action: These will all be ongoing processes;
although we anticipate the completion of one cycle by the end of 2007.
The findings from the December 31, Schedule of Findings and Questioned Costs are discussed
below. The findings are numbered the same as in the schedule.
06-1 - Internal Control over External Financial Reporting
Staff will put into place the following procedures which will result in a system that
ensures a thorough monitoring system to ensure that all accounts are reconciled on a timely basis
and all reconciliations are independently reviewed for accuracy.
1 All bank and investment accounts will be reconciled on a monthly basis by staff.
2 These reconciliations will be reviewed and signed off on by the Controller and/or
• the Chief Financial Officer.
3 Regular reconciliation of asset and liability accounts will be completed by all •
members of the accounting staff and reviewed by the Controller and/or the Chief
Financial Officer. •
4 The Controller and the Chief Financial Officer will make no less than semi-
annual visits to each Senior Center to provide education and training,and assess
the internal controls.This will begin in May,2007.
5 The Controller and the Chief Financial Officer will make regular visits to each
outlying site(i.e.Community Dining sites,the.transportation program,the
Spokane Street warehouse)to provide education and training, and assess the
internal controls.This will begin in May,2007.
If you have any questions regarding this Corrective Action Plan,please contact Tim
Bridges at 206 727-6211.
Sincerely,
fi
Denise Klein, Executive Director
Senior Services submits the following corrective action plan for the year ended December 31,
2006
Name and address of independent accounting firm: Jacobson Jarvis & Co, PLLC, 600
Stewart Street, Suite 1900, Seattle WA 98101-1219
Audit period: January 1, 2006— December 31, 2006
Contact person responsible for corrective action: Tim Bridges, Chief Financial Officer
Anticipated completion date for corrective action: The first round of visits should be
completed by the end of 2007 and will ongoing thereafter.
The findings from the December 31, Schedule of Findings and Questioned Costs are discussed
below. The findings are numbered the same as in the schedule
06-2-Segregation of Duties at Senior Center Locations
The Controller and the Chief Financial'Officer will make no less than semi-annual visits to each
Senior Center to provide education and training, and assess the internal controls.This will begin
in May, 2007.
If you have any questions regarding this Corrective Action Plan,please contact Tim
Bridges at 206 727-6211.
Sincerely,
2160,1fxz
Denise Klein, Executive Director
SENIOR SERVICES
POLICY TITLE Non-Discrimination in Service Delivery, Contracting and Business
Practices
POLICY NUMBER 17
PURPOSE To insure that Senior Services has a non-discrimination policy in effect at
all times related to service delivery, contracting and business matters (see
the Employee Handbook for specifics related to employment).
Senior Services shall not discriminate on the basis of age, gender,marital status, familial status,
religion,race, color, creed, sex,religion, age, national origin,marital status, sexual orientation,
gender identity,political ideology, the presence of any sensory, mental or physical disability or
any other basis prohibited by law. Senior Services shall comply and cooperate with all federal,
state and local laws and agencies in ensuring full compliance with the laws against
discrimination. Specifically, Senior Services will not:
1. Deny any person facilities, services, financial aid or other benefits provided under the
program or activity.
2. Provide any person with facilities, services, financial aid or other benefits which are
different, or are provided in a different form from that provided to others under the program
or activity.
3. Subject any person to segregated or separate treatment in any facility or in any matter or
process related to receipt of any service or benefit under the program or activity.
4. Restrict in any way access to, or the enjoyment of any advantage or privilege enjoyed by
others in connection with facilities, services, financial aid or other benefits under the program
or activity.
5. Treat any person differently from others in determining whether the person satisfies any
admission, enrollment, eligibility, membership, or other requirement or condition which
individuals must meet in order to be provided any facilities, services or other benefit
provided under the program or activity.
6. Deny any person any opportunity to participate in a program or activity as an employee
7. Utilize criteria or methods of administration, which have the effect of subjecting individuals
to discrimination.
Senior Services shall work with City or County officials in assuring compliance with all
pertinent laws, and specifically laws related to discrimination, when selecting and working with
architects, engineers, subcontractors, vendors, etc. for construction projects paid for, in whole or
in part, by public funds.
Senior Services must balance the value of providing equal access to our programs with the value
of safety for those same persons and others who also participate in the program.
EFFECTIVE,DATE 1/28/97
DATE OF REVISIONS 9/27/01
PREPARED BY Joanne Donohue, Director of Planning & Operations
REVIEWED BY Senior Management Team; Senior Center Directors;
Board of Trustees 1/28/1997
APPROVED BY
Jan Knutson, Chief Executive Officer
1 Do not copy or staple this form -
Nutrition Program
Participant Information Form Sen._..L.:1)41.
ior Services
homotingthew JI.befogolotdtroduttt
Instructions
•Use a BLACK PEN to answer ALL of the questions:on BOTH SIDES of this form. .
•Print CAPITAL letters and avoid contact with the box edges as in this example:
BCDEFGHT J K L M N o P Q R S T 4 v w, X Y Z
*Try to fill all YES/NO circles completely as shown here: •Yes 0 No
•All of your answers will be kept STRICTLY. CONFIDENTIAL.
•
I* A) Please fill in your name, birthdate, and gender:
•
First MI Last •
Name: I I
Optional Nickname:'
Month Da Year _
Birthdate: / M / Gender: 0 Female 0 Male
J •
•
I� /,B).Please fill in your address and phone number:
Street: •
City: State:
Zip Code: - Phone: ( ) -
Do you live in Unincorporated King County? ()Yes 0 No 0 Unknown
C) Please enter an emergency contact not living with you:
Name:
Phone: ( ) •
-
•
Relationship:
D) Please answer the following questions to help us serve you better:
1) Do you live alone? 0 Yes 0 No
2) Do you speak English well? .O Yes 0 No
lk Please turn the page over and continue
•
Version 2005 •
L BE LLEVU E • 11633 IlIllUlDIllIllIll III 1111111 1
•
rDo not copy or staple this form
3) Are you disabled? -O Yes 0 No
4) Do you regularly engage in physical activities? O Yes 0 No
5) Are you an immigrant, refugee, or new arrival to the US? ()Yes 0 No
6) Does your household have children under age 18? -O Yes 0 No
7) Are you a member of Group Health Cooperative? _ -0 Yes 0 No
;` E) Select your ethnicity: *F) Estimate your annual income:
(Check all that apply.) (This information is kept strictly confidential.)
0 American Indian/Alaska Native One Person Household Two Person Household
0Asian/Asian-American 0$16,350 or less 0 $18,700 or less
0 $16,351 to $27,250 0 $18,701 to $31,150
O Black/African-American 0$27,251 to $39,550 0 $31,151 to $45,200
O Hawaiian Native/Pacific Islander 0 $39,551 or more 0 $45,201 or more
O Hispanic/Latino Three Person Household Four Person Household
0 White/Caucasian 0$21,050 or less 0-$23,350 or less
0$21,051 to $35,050 0 $23,351 to $38,950
0 Other 0 $35,051 to $50,850 0 $38,951 to $56,500 )
O Unknown O$50,851 or more 0 $56,501 or more
•
G) Please answer ALL of the following questions:
1) Do you have an illness or condition that has made you change the 0 Yes 0 No
kind or amount of food you eat?
2) Do you eat fewer than 2 meals a day? -0 Yes 0 No
3) Do you eat few fruits or vegetables and/or milk products per day? -O Yes 0 No
This means less than 2 servings of fruit(including juice), less than 3 servings of
vegetables, and/or less than 2 servings of milk products per day.
4) Do you have 3 or more drinks of beer, liquor, or wine almost every day?---0 Yes 0 No
5) Do you have tooth or mouth problems that make it hard for you to eat? 0 Yes 0 No
6) Do you sometimes run out of money to buy.food? -0 Yes 0 No
7) Do you eat alone most of the time? ()Yes 0 No
8) Do you take 3 or more different prescribed and/or over the counter ()Yes 0 No
drugs per day?
9) Have you lost or gained 10 pounds in the last 6 months without trying? 0 Yes 0 No
10) Is it difficult for you to shop, cook, or feed yourself at times? -0 Yes 0 No
Thank you 11633 IIIIIDhIIIIIIDlIIIIIIIIIIII
41(7. Senior Services
Promoting the well-being of older adults
Sliding Fee Scale
We do not have a sliding fee scale for the Community Dining program. Meals are
provided for free (donation suggested)for those who are 60+. Anyone under the age of
60 must pay a fee of$5.75.
A non-profit agency supported by United Way of King County investments
2208 Second Ave, Seattle,WA 98121
(p) 206 448-31 1 0• (TTY) 206 448-5025 • (f) 206 448-5766•www.seniorservices.org