2019-09-24T14:46:40-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS CEO 3604782366 2019-08-30 1 KURT BENNION CPA P01469618 4252506100 2019-08-30 67.137.57.251 2019-08-30 15:46:50 PD P AA627A63F630E2EFD1435F04ECCF881DFF3D020E E09C09F2C4E2FA36523102FEE5AD791B68C33EF8 2018 2019-02-21 02:37:17Z JENNIFER KREIDLER-MOSS PO BOX 960 BREMERTON WA 98337 35370736 0 X WWW.PCHSWEB.ORG X 1987 WA PROVIDE ACCESSIBLE, AFFORDABLE, QUALITY HEALTH AND WELLNESS SERVICES FOR OUR COMMUNITIES. 12 12 309 15 0 0 4213085 6072589 25140888 27181832 -10887 94425 121592 6115 29464678 33354961 1594 1032 0 0 16886066 19092954 0 0 0 8123549 9328450 25011209 28422436 4453469 4932525 32970194 34693512 9274967 6324754 23695227 28368758 X PENINSULA COMMUNITY HEALTH SERVICES PROVIDES ACCESSIBLE, AFFORDABLE, QUALITY HEALTH AND WELLNESS SERVICES FOR OUR COMMUNITIES. 0 0 11691214 1032 10441791 MEDICAL - DURING 2018, PCHS PROVIDED 76,976 MEDICAL ENCOUNTERS TO 26,394 PATIENTS AT EIGHT CLINICAL SITES LOCATED IN BREMERTON (THREE SITES), BELFAIR (TWO SITES), KINGSTON, PORT ORCHARD AND POULSBO. SERVICES INCLUDE COMPREHENSIVE, PRIMARY MEDICAL SERVICES FOR CHILDREN AND ADULTS, EMPHASIZING WHOLE-PERSON, PATIENT-CENTERED APPROACH. PCHS OFFERS ALL SERVICES ON A SLIDING FEE SCHEDULE. 5501138 0 10466130 DENTAL - IN 2018, PCHS PROVIDED 30,522 DENTAL VISITS TO 12,829 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT FIVE CLINICAL SITES IN BREMERTON (TWO SITES), POUSLBO, PORT ORCHARD AND BELFAIR. SERVICES INCLUDE PREVENTATIVE CARE, ORAL EXAMS, ORAL HYGIENE, X-RAYS, EMERGENCY CARE AND DENTAL EDUCATION. REFERRAL SERVICES ARE OFFERED FOR MORE SPECIALIZED CARE. A SLIDING FEE SCALE IS AVAILABLE TO PATIENTS WHO QUALIFY. 4118462 0 4233572 PHARMACY - IN 2018, PCHS PROVIDED 85,046 PRESCRIPTIONS TO ITS ELIGIBLE PATIENTS. FULLY LICENSED PHARMACIES ARE LOCATED AT FIVE CLINICAL SITES IN BREMERTON (TWO SITES), BELFAIR, POULSBO AND PORT ORCHARD. 1652029 0 2040339 BEHAVIORAL HEALTH - DURING 2018, PCHS PROVIDED 6,896 BEHAVIORAL HEALTH ENCOUNTERS TO 2,031 PATIENTS AT SEVEN CLINICAL SITES LOCATED IN BREMERTON (TWO SITES), BELFAIR (TWO SITES), KINGSTON, PORT ORCHARD, AND POULSBO. BY FOCUSING ON A PATIENT'S BEHAVIORAL HEALTH AS PART OF AN INTERGRATED CARE MODEL, WE ARE ABLE TO BETTER COORDINATE COMPLETE AND TIMELY ACCESS TO CARE. OUR LICENSED, CERTIFIED COUNSELORS AND CHEMICAL DEPENDENCY PROFESSIONALS ADDRESS THE INDIVIDUALIZED NEEDS OF OUR PATIENTS BY WORKING ALONGSIDE OUR PRIMARY CARE PROVIDERS. 1652029 0 2040339 22962843 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 37 0 309 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOEL EMERY 3604756710 400 WARREN AVENUE SUITE 200 BREMERTON WA 98337 CHRISTOPHER COOK PRESIDENT 3.00 X X 0 0 0 EVELYN HETRICK VICE PRESIDENT 2.00 X X 0 0 0 YOLANDA FONG SECRETARY 2.00 X X 0 0 0 PAUL HATHAWAY TREASURER 2.00 X X 0 0 0 SUSAN ASTLE DIRECTOR 1.00 X 0 0 0 MONICA BERNHARD DIRECTOR 1.00 X 0 0 0 BERYL COCHRAN DIRECTOR 1.00 X 0 0 0 SHARON CROMLEY DIRECTOR 1.00 X 0 0 0 RENEE KIMBALL-ROUSE DIRECTOR (THROUGH MAY 2018) 1.00 X 0 0 0 MARGARET MOORE DIRECTOR 1.00 X 0 0 0 AL PINKHAM DIRECTOR 1.00 X 0 0 0 JEANELL RASMUSSEN DIRECTOR 1.00 X 0 0 0 CLAUDIA REALEGENO DIRECTOR (THROUGH NOVEMBER 2018) 1.00 X 0 0 0 SHANNON TURNER DIRECTOR 1.00 X 0 0 0 JENNIFER KREIDLER-MOSS PHARMD CEO 40.00 X 288332 0 19508 JOEL EMERY CFO 40.00 X 139995 0 7008 AARON FORSTER CIO 40.00 X 152186 0 1075 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 40.00 X 310920 0 7008 MICHAEL INSANI MD DENTAL DIRECTOR 40.00 X 211139 0 7008 MANDEEP DHAWAN MD PHYSICIAN 40.00 X 253017 0 7008 DONNAVILLE ORTIZ MD PHYSICIAN 40.00 X 242972 0 7008 CLEMENT LE THANH MD PHYSICIAN 40.00 X 213316 0 1949 CLAIR FELPEL MD PHYSICIAN 40.00 X 197092 0 638 CHI LAP LI MD DENTIST 40.00 X 195541 0 1848 2204510 0 60058 52 0 1 0 NEW DIRECTIONS 3501 COLBY AVENUE 102 EVERETT WA 98201 CONSULTING 156916 JOHNSON OAKLIEF 2124 THIRD AVENUE SUITE 200 SEATTLE WA 98121 ARCHITECTURE 148204 2 5427 4339286 1727876 852404 6072589 PATIENT SERVICE REVENUE 621400 27181832 27181832 27181832 95088 95088 2015112 2015775 -663 -663 -663 OTHER INCOME 621400 6115 6115 6115 33354961 27181832 0 100540 1032 1032 1144179 782347 361832 14271298 11580715 2690583 2293142 1786905 506237 1384335 1077068 307267 23847 17154 6693 88862 63923 24939 33553 24136 9417 1108426 797350 311076 12255 9928 2327 2873895 2830391 43504 636133 425989 210144 1455479 1203194 252285 78352 15220 63132 449693 311908 137785 963185 836470 126715 70505 54544 15961 MISCELLANEOUS 613642 367602 246040 BAD DEBT 415622 415622 COMMUNICATIONS 280311 210880 69431 EQUIP MAINT & REPAIR 224690 150465 74225 28422436 22962843 5459593 0 15003235 16246463 104265 191366 4269086 3712415 190651 218139 128259 259502 19532982 8173719 10226470 11359263 3001839 2706364 46389 0 32970194 34693512 7274690 3632978 838551 1944929 1822020 55348 31205 9274967 6324754 X 23695227 28368758 23695227 28368758 32970194 34693512 4932525 -258994 0 X 0 1 X 1 1 1 X 2052118 2872155 2923608 4213085 6072589 18133555 16548665 15734905 19132216 25140888 27181832 103738506 18600783 18607060 22055824 29353973 33254421 121872061 0 0 0 121872061 83236 74842 64387 106424 95088 423977 83236 74842 64387 106424 95088 423977 26184 64971 29794 121592 6115 248656 18710203 18746873 22150005 29581989 33355624 122544694 0.99450 0.99260 0.00350 0.00390 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME 1929927 1929927 6742461 3666766 3075695 5473376 1544222 3929154 4663653 2962731 1700922 723565 723565 11359263 X 32835226 -258994 240484 -18510 32853736 501225 501225 33354961 28422436 0 28422436 0 28422436 PART X, LINE 2: THE CLINIC HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE CLINIC'S TAX POSITIONS AND CONCLUDED THAT THE CLINIC HAD TAKEN NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION (ASC). PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT LOSS 240,484. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS 60,927. CAPITAL DEVELOPMENT GRANT 440,298. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 JENNIFER KREIDLER-MOSS PHARMD CEO 288332 0 0 0 0 0 12500 0 7008 0 307840 0 0 0 AARON FORSTER CIO 152186 0 0 0 0 0 0 0 1075 0 153261 0 0 0 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 310920 0 0 0 0 0 0 0 7008 0 317928 0 0 0 MICHAEL INSANI MD DENTAL DIRECTOR 211139 0 0 0 0 0 0 0 7008 0 218147 0 0 0 MANDEEP DHAWAN MD PHYSICIAN 245517 0 7500 0 0 0 0 0 7008 0 260025 0 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 242972 0 0 0 0 0 0 0 7008 0 249980 0 0 0 CLEMENT LE THANH MD PHYSICIAN 209816 0 3500 0 0 0 0 0 1949 0 215265 0 0 0 CLAIR FELPEL MD PHYSICIAN 197092 0 0 0 0 0 0 0 638 0 197730 0 0 0 CHI LAP LI MD DENTIST 192041 0 3500 0 0 0 0 0 1848 0 197389 0 0 0 PART I, LINE 1A EMPLOYEES WHO PARTICIPATE IN THE YMCA PROGRAM AND WHO HAVE TAXABLE LIFE INSURANCE COVERAGE OVER $150,000 RECEIVE TAX GROSS-UP PAYMENTS. ALL EMPLOYEES LISTED IN FORM 990, PART VII, SECTION A RECEIVED AT LEAST ONE OF THESE BENEFITS. THESE AMOUNTS ARE INCLUDED IN THEIR TAXABLE COMPENSATION. A WA HEALTH CARE FACILITIES AUTHORITY 911108929 2005-12-18 3000000 CONSTRUCTION FINANCING 0 0 1 A 1156592 3000000 51942 2948058 2005 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 1 X 100 852404 INVOICE PRICE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION'S EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD. IT MAY ALSO INCLUDE THE PAST PRESIDENT FOR ONE YEAR AFTER THEY FINISH THEIR SERVICE AS BOARD PRESIDENT AND/OR ONE ADDITIONAL AT-LARGE MEMBER. THE EXECUTIVE COMMITTEE ACTS ONLY AS NECESSARY BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS WITH ALL THE POWERS OF THE BOARD AND REPORTS AND PRESENTS FOR RATIFICATION ANY SUCH ACTION TO THE BOARD AT ITS NEXT MEETING. HOWEVER, THE EXECUTIVE COMMITTEE DOES NOT HAVE AUTHORITY TO BIND THE BOARD OR THE ORGANIZATION ON ANY MATTERS INVOLVING THE PURCHASE OR SALE OF ANY REAL PROPERTY, OR THE PURCHASE OR SALE OF EQUIPMENT, FURNITURE OR FIXTURES IN EXCESS OF 1% OF THE ORGANIZATION'S ANNUAL BUDGET. THE EXECUTIVE COMMITTEE INITIATES ANNUALLY THE PERFORMANCE REVIEW OF THE CEO AND MAKES RECOMMENDATIONS TO THE BOARD FOR APPROVAL. THE EXECUTIVE COMMITTEE REVIEWS AND REVISES THE ORGANIZATION'S GOVERNANCE AND EMPLOYEE POLICIES AND PROVIDES BROAD OVERSIGHT OF ALL EMPLOYMENT MATTERS. THE EXECUTIVE COMMITTEE KEEPS RECORDS OF THE TERMS OF OFFICE AND REPLACEMENTS FOR ANY VACANCIES WHICH MAY ARISE, AND SUPERVISES THE NOMINATIONS OF BOARD MEMBERS. THE EXECUTIVE COMMITTEE SOLICITS AND SCREENS POTENTIAL BOARD MEMBERS AND DETERMINES THEIR QUALIFICATIONS AND WILLINGNESS TO SERVE. THE EXECUTIVE COMMITTEE ALSO HAS THE RESPONSIBILITY OF PREPARING A SLATE OF OFFICERS TO BE SELECTED FROM THE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BEFORE SIGNATURE BY BOTH THE CFO AND CEO, AND WAS PRESENTED TO THE FINANCE COMMITTEE. THE BOARD TREASURER MADE A REPORT TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C PENINSULA COMMUNITY HEALTH SERVICES HAS A WRITTEN CONFLICT OF INTEREST POLICY THAT ALL BOARD DIRECTORS ARE REQUIRED TO SIGN ON AN ANNUAL BASIS. UPON SIGNING THE POLICY, EACH BOARD MEMBER AGREES TO DISCLOSE AN ACTUAL OR PERCEIVED CONFLICT OF INTEREST. THE BOARD OF DIRECTORS, AT ANY TIME A POTENTIAL CONFLICT ARISES, MAY REQUIRE AN INDIVIDUAL TO REFRAIN FROM DISCUSSION OF THE MATTER, REFRAIN FROM VOTING ON THE MATTER, OR BE EXCUSED FROM ATTENDING THE PORTION OF THE MEETING ABOUT THE MATTER OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 PENINSULA COMMUNITY HEALTH SERVICES ATTEMPTS TO COMPENSATE ALL EMPLOYEES FAIRLY, EQUITABLY AND COMPETITIVELY. A SALARY SURVEY THAT INCLUDES A SALARY ANALYSIS OF LIKE JOB DESCRIPTIONS IN THE GEOGRAPHICAL AREA IS COMPLETED BY THE HUMAN RESOURCE DEPARTMENT. THE BOARD OF DIRECTORS APPROVES THE WAGE SCALE ANNUALLY. FOR THE POSITION OF THE CEO THE SALARY DATA IS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. BASED ON THE INFORMATION PROVIDED, THE EXECUTIVE COMMITTEE DETERMINES THE COMPENSATION FOR THE CEO FOR THE ENSUING YEAR WHICH THE FULL BOARD APPROVES. THIS PROCESS LAST OCCURRED IN 2018. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORMS 990 ARE PROVIDED UPON REQUEST.