2023-09-28T08:17:44-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3603773776 PO BOX 960 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS CEO 3603773776 2023-09-25 1 JENNIFER KREIDLER-MOSS 999009999 0 KURT BENNION CPA P01469618 4252506100 2023-09-25 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JENNIFER KREIDLER-MOSS PO BOX 960 BREMERTON WA 98337 58173385 0 X WWW.PCHSWEB.ORG X 1987 WA PCHS EXEMPLIFIES A CULTURE OF COMMUNITY SERVICE. 10 10 467 65 0 0 18157872 11730563 38273043 45647227 182313 63471 174420 438218 56787648 57879479 0 0 0 0 26947903 28520582 0 0 0 14974361 16100613 41922264 44621195 14865384 13258284 65067790 83135265 9949970 15550037 55117820 67585228 X PCHS EXEMPLIFIES A CULTURE OF COMMUNITY SERVICE. 0 0 19493138 0 29342473 MEDICAL - DURING 2022, PCHS PROVIDED 91,482 MEDICAL ENCOUNTERS TO 32,622 PATIENTS AT TWENTY-ONE CLINICAL SITES LOCATED IN BREMERTON (TEN SITES), BELFAIR (TWO SITES), KINGSTON (TWO SITES), PORT ORCHARD (TWO SITES), POULSBO, SHELTON, SILVERDALE (TWO SITES), KEY PENINSULA, AS WELL AS TWO MOBILE SITES. SERVICES INCLUDE COMPREHENSIVE PRIMARY MEDICAL SERVICES FOR CHILDREN AND ADULTS, EMPHASIZING A WHOLE-PERSON, PATIENT-CENTERED APPROACH. PCHS CONTINUED TO TAKE ON ADDITIONAL COVID-RELATED WORK BY OFFERING COVID TESTING AND RELATED CARE TO MUCH OF OUR REGION. 8154167 0 9102343 DENTAL - IN 2022, PCHS PROVIDED 30,203 DENTAL VISITS TO 14,851 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT EIGHT CLINICAL SITES IN BREMERTON (THREE SITES), POULSBO, PORT ORCHARD, SILVERDALE, KEY PENINSULA 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. 5796003 0 5346122 PHARMACY - IN 2022, PCHS PROVIDED 85,166 PRESCRIPTIONS TO ITS ELIGIBLE PATIENTS. FULLY LICENSED PHARMACIES ARE LOCATED AT SIX CLINICAL SITES IN BREMERTON (TWO SITES), BELFAIR, POULSBO, KEY PENINSULA AND PORT ORCHARD. 2904796 0 1856289 BEHAVIORAL HEALTH - DURING 2022, PCHS PROVIDED 13,703 BEHAVIORAL HEALTH ENCOUNTERS TO 4,009 PATIENTS AT TWENTY CLINICAL SITES LOCATED IN BREMERTON (TEN SITES), BELFAIR (TWO SITES), KEY PENINSULA, KINGSTON (TWO SITES), PORT ORCHARD (TWO SITES), 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. 2904796 0 1856289 36348104 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 11 0 467 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOEL EMERY 3603773776 400 WARREN AVENUE SUITE 200 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS PHARMD CEO 40.00 X 369565 0 102514 REGINA BONNEVIE ROGERS MD CHIEF MEDICAL OFFICER 40.00 X 378330 0 0 MANDEEP DHAWAN MD PHYSICIAN 40.00 X 306985 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 40.00 X 304771 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR 40.00 X 268594 0 0 CLEMENT LE THANH MD PHYSICIAN 40.00 X 260541 0 0 ERIC GRUNOW DMD DENTIST 50.00 X 250257 0 0 KRISTOFFER VALENZUELA MD PHYSICIAN 40.00 X 241378 0 0 JOEL EMERY CFO 40.00 X 154685 0 0 BRYNN FELIX GENERAL COUNSEL 40.00 X 128493 0 0 MONICA BERNHARD PRESIDENT 1.00 X X 0 0 0 EVELYN HETRICK VICE PRESIDENT 1.50 X X 0 0 0 SHANNON TURNER SECRETARY (THROUGH JANUARY 2022) 2.00 X X 0 0 0 SUSAN ASTLE DIRECTOR & SECRETARY 1.00 X X 0 0 0 CHRISTOPHER COOK TREASURER 1.50 X X 0 0 0 SHARON CROMLEY DIRECTOR 0.50 X 0 0 0 JILL GUERRERO DIRECTOR 0.80 X 0 0 0 AL PINKHAM DIRECTOR 1.30 X 0 0 0 JEANELL RASMUSSEN DIRECTOR 0.50 X 0 0 0 TAMASIPANI SOUSOU DIRECTOR 0.50 X 0 0 0 DAVID WINDOM DIRECTOR 0.50 X 0 0 0 2663599 0 102514 55 0 1 0 HUTCHCON CONSTRUCTION PO BOX 482 MANCHESTER WA 98353 CONSTRUCTION 5769892 ATHENA HEALTH 311 ARSENAL STREET WATERTOWN MA 02472 PRACTICE MANAGEMENT SYSTEM SUPPORT 771406 STRATUS INDEMAND PO BOX 675248 DETROIT MI 48267 TRANSLATION SERVICES 487842 JOHNSON OAKLIEF 2124 3RD AVENUE SUITE 200 SEATTLE WA 98121 ARCHITECTURAL SERVICES 388022 MCS PO BOX 11044 TACOMA WA 98411 JANITORIAL SERVICES 278794 10 11391126 339437 1076094 11730563 PATIENT SERVICE REVENUE 621400 45647227 45647227 45647227 357377 357377 293906 -293906 -293906 -293906 OTHER INCOME 621400 438218 438218 438218 57879479 45647227 0 501689 1394681 1018587 376094 22067580 18209134 3858446 2836522 2330448 506074 2221799 1823727 398072 248489 248489 112140 112140 32946 32946 1787276 1556439 230837 17291 11773 5518 748344 513443 234901 1119961 885827 234134 2299817 1985168 314649 210394 27930 182464 393990 286914 107076 1022 696 326 2378511 1929448 449063 269488 223668 45820 MEDICAL SUPPLIES 4142371 4142371 MISCELLANEOUS 1089516 448295 641221 REPAIRS & MAINTENANCE 942886 745771 197115 TAXES 306171 208465 97706 44621195 36348104 8273091 0 32963927 40695488 111552 117467 1340420 984242 3468601 4272820 636926 575779 731849 1296522 42290723 14508259 21068485 27782464 4746030 4567498 0 2842985 65067790 83135265 4601502 5224070 1910309 1910309 922764 3363262 1431653 1273470 1083742 3778926 9949970 15550037 X 55064311 67338145 53509 247083 55117820 67585228 65067790 83135265 13258284 -790876 0 X X 0 1 X 1 1 1 X 6072589 9914132 12023199 18157872 11730563 57898355 6072589 9914132 12023199 18157872 11730563 57898355 57898355 95088 210968 132843 182313 357377 978589 6115 26137 117801 174420 438218 762691 59639635 168037783 0.97080 0.97720 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: QUALITY INCENTIVE PAYMENTS STAFF ACTIVITIES INCOME SPEAKER FEES OTHER MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2134122 2134122 17182715 2518493 14664222 8640798 3684453 4956345 10036407 8305313 1731094 4296681 4296681 27782464 X 57637936 0 57637936 241543 241543 57879479 44621195 0 44621195 0 44621195 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 46,543. CONTRIBUTIONS WITH DONOR RESTRICTIONS 195,000. NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 PROGRAM SERVICES FACILITY IMPROVEMENTS 56853 0 0 0 0 0 0 56853 0 56853 0 0 0 0 0 0 PART III ACCOUNTING METHOD: X X X X X 0 1 0 0 0 0 0 0 0 JENNIFER KREIDLER-MOSS PHARMD CEO 352065 0 17500 0 0 0 92514 0 10000 0 472079 0 0 0 REGINA BONNEVIE ROGERS MD CHIEF MEDICAL OFFICER 360830 0 17500 0 0 0 0 0 0 0 378330 0 0 0 MANDEEP DHAWAN MD PHYSICIAN 299485 0 7500 0 0 0 0 0 0 0 306985 0 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 292271 0 12500 0 0 0 0 0 0 0 304771 0 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR 260594 0 8000 0 0 0 0 0 0 0 268594 0 0 0 CLEMENT LE THANH MD PHYSICIAN 255541 0 5000 0 0 0 0 0 0 0 260541 0 0 0 ERIC GRUNOW DMD DENTIST 235177 0 15080 0 0 0 0 0 0 0 250257 0 0 0 KRISTOFFER VALENZUELA MD PHYSICIAN 228878 0 12500 0 0 0 0 0 0 0 241378 0 0 0 JOEL EMERY CFO 154685 0 0 0 0 0 0 0 0 0 154685 0 0 0 PART I, LINE 4B THE ORGANIZATION HAS A 457(F) SUPPLEMENTAL RETIREMENT PLAN FOR JENNIFER KREIDLER-MOSS, CEO. DURING 2022, $92,514 WAS CONTRIBUTED INTO THE PLAN AND ($44,543) ACCRUED WITHIN THE PLAN. X 2910 1076094 INVOICE PRICE 0 0 0 0 PART I, COLUMN (B): PART I, COLUMN B REPORTS THE NUMBER OF DONATED ITEMS RECEIVED DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 1A 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. THE EXECUTIVE COMMITTEE SERVES AS THE STEERING COMMITTEE FOR THE BOARD OF DIRECTORS. AS SUCH, THE EXECUTIVE COMMITTEE MAY PERFORM THE DUTIES OF THE BOARD IN THE EVENT OF AN EMERGENCY. THE COMMITTEE HAS NO POWER OTHER THAN EMERGENCY ACTION OR OTHER POWERS DELEGATED BY THE FULL BOARD AND WILL PRESENT SUCH ACTIONS TO THE BOARD FOR RATIFICATION AT THE NEXT MEETING. THE EXECUTIVE COMMITTEE IS CHARGED TO DO THE WILL OF THE BOARD, NOT SET DIRECTION FOR OR MAKE NEW POLICY FOR THE BOARD. 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 CFO 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 AT LEAST ANNUALLY. FOR THE POSITION OF THE CEO, THE SALARY DATA IS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS EVERY FOUR YEARS. BASED ON THE INFORMATION PROVIDED, THE EXECUTIVE COMMITTEE RECOMMENDS FOUR YEARS OF COMPENSATION FOR THE CEO 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 AND OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT DID NOT CHANGE DURING 2022.