2021-11-12T15:34:56-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS CEO 3604782366 2021-10-23 1 JENNIFER KREIDLER-MOSS 999009999 KURT BENNION CPA P01469618 4252506100 2021-10-23 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JENNIFER KREIDLER-MOSS PO BOX 960 BREMERTON WA 98337 41471163 0 X WWW.PCHSWEB.ORG X 1987 WA PROVIDE ACCESSIBLE, AFFORDABLE, QUALITY HEALTH AND WELLNESS SERVICES FOR OUR COMMUNITIES. 13 13 408 17 0 0 9914132 12023199 27738361 29197320 210968 132843 26137 117801 37889598 41471163 1200 3816 0 0 22671230 24186895 0 0 0 11203418 11032664 33875848 35223375 4013750 6247788 38636440 52071400 5648068 12349235 32988372 39722165 X TO PROVIDE ACCESS TO AFFORDABLE, QUALITY HEALTH AND WELLNESS SERVICES AND REDUCE HEALTHCARE DISPARITIES FOR OUR COMMUNITIES. PENINSULA COMMUNITY HEALTH SERVICES OFFERS ALL SERVICES ON A SLIDING FEE SCHEDULE FOR THOSE THAT QUALIFY. 0 0 15176980 3816 19252732 MEDICAL - DURING 2020, PCHS PROVIDED 87,149 MEDICAL ENCOUNTERS TO 29,496 PATIENTS AT FIFTEEN CLINICAL SITES LOCATED IN BREMERTON (SEVEN SITES), BELFAIR (TWO SITES), KINGSTON, PORT ORCHARD, POULSBO, SHELTON AND SILVERDALE (TWO SITES), AS WELL AS TWO MOBILE SITES. SERVICES INCLUDE COMPREHENSIVE PRIMARY MEDICAL SERVICES FOR CHILDREN AND ADULTS, EMPHASIZING A WHOLE-PERSON, PATIENT-CENTERED APPROACH. PCHS ALSO TOOK ON MUCH NEW COVID-RELATED WORK BY OFFERING COVID TESTING AND RELATED CARE TO MUCH OF OUR REGION. 6119888 0 1882921 BEHAVIORAL HEALTH - DURING 2020, PCHS PROVIDED 16,089 BEHAVIORAL HEALTH ENCOUNTERS TO 4,030 PATIENTS AT FOURTEEN CLINICAL SITES LOCATED IN BREMERTON (SEVEN SITES), BELFAIR (TWO SITES), KINGSTON, PORT ORCHARD, POULSBO, AND SILVERDALE (TWO SITES) AS WELL AS THREE MOBILE SITES. BY FOCUSING ON A PATIENT'S BEHAVIORAL HEALTH AS PART OF AN INTEGRATED CARE MODEL, WE ARE ABLE TO BETTER COORDINATE COMPLETE AND TIMELY ACCESS TO CARE. OUR LICENSED, CERTIFIED COUNSELORS AND SUBSTANCE USE DISORDER PROFESSIONALS ADDRESS THE INDIVIDUALIZED NEEDS OF OUR PATIENTS BY WORKING ALONGSIDE OUR PRIMARY CARE PROVIDERS. 4154668 0 4792487 DENTAL - IN 2020, PCHS PROVIDED 24,506 DENTAL VISITS TO 14,416 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT SIX CLINICAL SITES IN BREMERTON (TWO SITES), POULSBO, PORT ORCHARD, SILVERDALE AND BELFAIR, AS WELL AS ONE MOBILE SITE. SERVICES INCLUDE PREVENTATIVE CARE, ORAL EXAMS, ORAL HYGIENE, X-RAYS, EMERGENCY CARE AND DENTAL EDUCATION. REFERRAL SERVICES ARE OFFERED FOR MORE SPECIALIZED CARE. 3035620 0 3269180 PHARMACY - IN 2020, PCHS PROVIDED 89,023 PRESCRIPTIONS TO ITS ELIGIBLE PATIENTS. FULLY LICENSED PHARMACIES ARE LOCATED AT FIVE CLINICAL SITES IN BREMERTON (TWO SITES), BELFAIR, POULSBO AND PORT ORCHARD. 3035620 0 3269180 28487156 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 32 0 408 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOEL EMERY 3604782366 400 WARREN AVENUE SUITE 200 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS PHARMD CEO 40.00 X 315751 0 119731 REGINA BONNEVIE ROGERS MD CHIEF MEDICAL OFFICER 40.00 X 356520 0 0 MANDEEP DHAWAN MD PHYSICIAN 40.00 X 278815 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 40.00 X 274860 0 0 JORGE ZAPATA MD PHYSICIAN 40.00 X 247643 0 899 CLEMENT LE THANH MD PHYSICIAN 40.00 X 237036 0 4021 CHRISTOPHER PROMPUNTAGORN MD PHYSICIAN 40.00 X 231510 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR 40.00 X 225563 0 4021 AARON FORSTER CIO 40.00 X 163112 0 0 JOEL EMERY CFO 40.00 X 144654 0 4021 BRYNN FELIX DIRECTOR JAN-JULY 2020), LEGAL COUNSEL (AUG-DEC 2020) 21.00 X X 34248 0 0 CHRISTOPHER COOK PRESIDENT & TREAUSRER 3.00 X X 0 0 0 YOLANDA FONG SECRETARY & PRESIDENT 3.00 X X 0 0 0 EVELYN HETRICK VICE PRESIDENT & DIRECTOR 2.00 X X 0 0 0 MONICA BERNHARD DIRECTOR & VICE PRESIDENT 2.00 X X 0 0 0 PAUL HATHAWAY TREASURER & SECRETARY 2.00 X X 0 0 0 MARGARET MOORE TREASURER & DIRECTOR (THROUGH JULY 2020) 2.00 X X 0 0 0 SUSAN ASTLE 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 JO PEDERSON 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 SHANNON TURNER DIRECTOR 1.00 X 0 0 0 DAVID WINDOM DIRECTOR 1.00 X 0 0 0 2509712 0 132693 55 0 1 0 HUTCHCON CONSTRUCTION PO BOX 482 MANCHESTER WA 98353 CONSTRUCTION 2318659 ATHENA HEALTH 311 ARSENAL STREET WATERTOWN MA 02472 PRACTICE MANAGEMENT SYSTEM SUPPORT 527130 NEXTGEN HEALTHCARE SERVICES PO BOX 511449 LOS ANGELES CA 90051 PRACTICE MANAGEMENT SYSTEM SUPPORT 327719 NEWTON BUILDING & DEVELOPMENT PO BOX 2127 BREMERTON WA 98310 CONSTRUCTION 282509 STUDIO Y CREATIONS 6204 29TH STREET SE UNIT 1 CALGARY ALBERTA CA T2C1W3 DESIGN/ARCHITECTURAL SERVICES 270956 14 11857766 165433 631569 12023199 PATIENT SERVICE REVENUE 621400 29197320 29197320 29197320 132843 132843 OTHER INCOME 621400 117801 117801 117801 41471163 29197320 0 250644 3816 3816 1333373 934490 398883 18403825 14837799 3566026 2635392 2051186 584206 1814305 1412349 401956 30604 23184 7420 104698 79315 25383 29526 22368 7158 1189138 887768 301370 12315 9548 2767 247866 179208 68658 1079778 914497 165281 1772532 1344963 427569 61997 16180 45817 303659 250144 53515 1363363 1238772 124591 133233 98820 34413 MEDICAL SUPPLIES 2848469 2848469 MISCELLANEOUS 863737 539794 323943 EQUIP MAINT & REPAIR 558653 473141 85512 COMMUNICATIONS 433096 321345 111751 35223375 28487156 6736219 0 17036106 24326044 142087 105830 645595 2384393 2610137 3565807 222220 290647 403783 636464 27448315 10660049 14163079 16788266 3413433 3973949 38636440 52071400 2697101 2685588 1910309 1248525 1285533 1700106 1571040 2336 1183348 3713417 5648068 12349235 X 32988372 39615269 0 106896 32988372 39722165 38636440 52071400 6247788 486005 0 X X 0 1 X 1 1 1 X 2923608 4213085 6072589 9914132 12023199 35146613 2923608 4213085 6072589 9914132 12023199 35146613 35146613 64387 106424 95088 210968 132843 609710 29794 121592 6115 26137 117801 301439 36057762 128390617 0.97470 0.97010 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1929927 1929927 11769213 4257770 7511443 6748014 2579088 4168926 6991073 3823191 3167882 10088 10088 16788266 X 41409403 69586 69586 41339817 131346 131346 41471163 35292961 69586 69586 35223375 0 35223375 PART X, LINE 2: THE ORGANIZATION 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 ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION 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 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITHOUT DONOR RESTRICTIONS 24,450. CONTRIBUTIONS WITH DONOR RESTRICTIONS 106,896. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 JENNIFER KREIDLER-MOSS PHARMD CEO 300751 0 15000 0 0 0 119731 0 0 0 435482 0 0 0 REGINA BONNEVIE ROGERS MD CHIEF MEDICAL OFFICER 341520 0 15000 0 0 0 0 0 0 0 356520 0 0 0 MANDEEP DHAWAN MD PHYSICIAN 271315 0 7500 0 0 0 0 0 0 0 278815 0 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 264860 0 10000 0 0 0 0 0 0 0 274860 0 0 0 JORGE ZAPATA MD PHYSICIAN 247643 0 0 0 0 0 0 0 899 0 248542 0 0 0 CLEMENT LE THANH MD PHYSICIAN 233536 0 3500 0 0 0 0 0 4021 0 241057 0 0 0 CHRISTOPHER PROMPUNTAGORN MD PHYSICIAN 231510 0 0 0 0 0 0 0 0 0 231510 0 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR 217563 0 8000 0 0 0 0 0 4021 0 229584 0 0 0 AARON FORSTER CIO 163112 0 0 0 0 0 0 0 0 0 163112 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. PART I, LINE 4B THE ORGANIZATION HAS A 457(F) SUPPLEMENTAL RETIREMENT PLAN FOR JENNIFER KRIEDLER-MOSS, CEO. DURING 2020, $100,731 ACCRUED WITHIN THE PLAN. A WA HEALTH CARE FACILITIES AUTHORITY 911108929 2005-12-18 3000000 CONSTRUCTION FINANCING 0 0 1 A 1424252 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 108 631569 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 2020. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORMS 990 ARE PROVIDED UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS FOR SELECTION OF THE AUDIT FIRM HAS NOT CHANGED FROM THE PRIOR YEAR.