2023-09-28T11:51:16-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2021-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS CEO 3604782366 2023-09-25 1 JENNIFER KREIDLER-MOSS 999009999 KURT BENNION CPA P01469618 4252506100 2023-09-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X JENNIFER KREIDLER-MOSS PO BOX 960 BREMERTON WA 98337 56787648 0 X WWW.PCHSWEB.ORG X 1987 WA PCHS EXEMPLIFIES A CULTURE OF COMMUNITY SERVICE. 10 10 446 312 0 0 12023199 18157872 29197320 38273043 132843 182313 117801 174420 41471163 56787648 3816 0 0 0 24186895 26947903 0 0 0 11032664 14974361 35223375 41922264 6247788 14865384 52071400 65067790 12349235 9949970 39722165 55117820 X PCHS EXEMPLIFIES A CULTURE OF COMMUNITY SERVICE. 0 0 18816818 0 24075451 MEDICAL - DURING 2021, PCHS PROVIDED 92,237 MEDICAL ENCOUNTERS TO 31,400 PATIENTS AT SIXTEEN CLINICAL SITES LOCATED IN BREMERTON (SIX SITES), BELFAIR (TWO SITES), KINGSTON (TWO SITES), PORT ORCHARD (TWO SITES), POULSBO, SHELTON, SILVERDALE (FOUR 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. 7334849 0 1750027 DENTAL - IN 2021, PCHS PROVIDED 29,376 DENTAL VISITS TO 14,675 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT SEVEN CLINICAL SITES IN BREMERTON (TWO 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. 5163562 0 4434909 PHARMACY - IN 2021, PCHS PROVIDED 83,248 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. 2979706 0 2612656 BEHAVIORAL HEALTH - DURING 2021, PCHS PROVIDED 16,089 BEHAVIORAL HEALTH ENCOUNTERS TO 4,030 PATIENTS AT FOURTEEN CLINICAL SITES LOCATED IN BREMERTON (SIX SITES), BELFAIR (TWO SITES), KINGSTON (TWO SITES), PORT ORCHARD (TWO SITES), POULSBO, AND SILVERDALE (FOUR 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. 2979706 0 2612656 34294935 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 41 0 446 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 3604782366 400 WARREN AVENUE SUITE 200 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS PHARMD CEO 40.00 X 355598 0 192001 REGINA BONNEVIE ROGERS MD CHIEF MEDICAL OFFICER 40.00 X 371327 0 0 MANDEEP DHAWAN MD PHYSICIAN 40.00 X 293697 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 40.00 X 286964 0 0 JORGE ZAPATA MD PHYSICIAN 40.00 X 286565 0 0 CHRISTOPHER PROMPUNTAGORN MD PHYSICIAN 40.00 X 277286 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR 40.00 X 257261 0 0 CLEMENT LE THANH MD PHYSICIAN 40.00 X 250091 0 0 JOEL EMERY CFO 40.00 X 150926 0 0 BRYNN FELIX GENERAL COUNSEL 40.00 X 84184 0 0 MONICA BERNHARD PRESIDENT 3.00 X X 0 0 0 EVELYN HETRICK VICE PRESIDENT 1.00 X X 0 0 0 PAUL HATHAWAY SECRETARY (THROUGH JUNE 2021) 2.00 X X 0 0 0 SHANNON TURNER DIRECTOR & SECRETARY 1.00 X X 0 0 0 CHRISTOPHER COOK TREASURER 1.00 X X 0 0 0 SUSAN ASTLE DIRECTOR 2.00 X 0 0 0 ANN BARBILLION DIRECTOR (THROUGH AUG 2021) 1.00 X 0 0 0 BERYL COCHRAN DIRECTOR (THROUGH SEP 2021) 1.00 X 0 0 0 SHARON CROMLEY DIRECTOR 1.00 X 0 0 0 JILL GUERRERO DIRECTOR 1.00 X 0 0 0 JO PEDERSON DIRECTOR (THROUGH APRIL 2021) 1.00 X 0 0 0 AL PINKHAM DIRECTOR 1.00 X 0 0 0 JEANELL RASMUSSEN DIRECTOR 1.00 X 0 0 0 DAVID WINDOM DIRECTOR 1.00 X 0 0 0 2613899 0 192001 57 0 1 0 HUTCHCON CONSTRUCTION PO BOX 482 MANCHESTER WA 98353 CONSTRUCTION 2177863 ATHENA HEALTH 311 ARSENAL STREET WATERTOWN MA 02472 PRACTICE MANAGEMENT SYSTEM SUPPORT 924828 NEXTGEN HEALTHCARE SERVICES PO BOX 511449 LOS ANGELES CA 90051 PRACTICE MANAGEMENT SYSTEM SUPPORT 305993 STRATUS INDEMAND LLC 555 ANDOVER PARK W SEATTLE WA 98188 TRANSLATION SERVICES 289655 JOHNSON OAKLIEF 2124 3RD AVENUE SUITE 200 SEATTLE WA 98121 CONSTRUCTION 258887 13 18065111 92761 781438 18157872 PATIENT SERVICE REVENUE 621400 38273043 38273043 38273043 182313 182313 OTHER INCOME 621400 174420 174420 174420 56787648 38273043 0 356733 1411297 1066667 344630 20756124 17159884 3596240 2776028 2274707 501321 2004454 1643530 360924 88567 88567 177454 177454 33570 33570 1747304 1569735 177569 318148 12447 305701 779966 485991 293975 1427767 1007539 420228 1972588 1706763 265825 95544 15069 80475 446917 380724 66193 6817 4872 1945 1794776 1647932 146844 156572 122174 34398 MEDICAL SUPPLIES 3420071 3420071 REPAIRS & MAINTENANCE 1759240 1241451 517789 MISCELLANEOUS 520306 371881 148425 TAXES 228754 163498 65256 41922264 34294935 7627329 0 24326044 32963927 105830 111552 2384393 1340420 3565807 3468601 290647 636926 636464 731849 33523437 12454952 16788266 21068485 3973949 4746030 52071400 65067790 2685588 4601502 1910309 1910309 1285533 922764 1571040 1431653 1183348 1083742 3713417 12349235 9949970 X 39615269 55064311 106896 53509 39722165 55117820 52071400 65067790 14865384 530271 0 X X 0 1 X 1 1 1 X 4213085 6072589 9914132 12023199 18157872 50380877 4213085 6072589 9914132 12023199 18157872 50380877 50380877 106424 95088 210968 132843 182313 727636 121592 6115 26137 117801 174420 446065 51554578 147531444 0.97720 0.97470 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1929927 1929927 12787153 4713687 8073466 9183627 3189044 5994583 9089551 4552221 4537330 533179 533179 21068485 X 56775297 29410 29410 56745887 41761 41761 56787648 41951674 29410 29410 41922264 0 41922264 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 35,148. CONTRIBUTIONS WITH DONOR RESTRICTIONS 6,613. NORTH AMERICA 0 0 PROGRAM SERVICES FACILITY IMPROVEMENTS 70762 0 0 0 0 0 0 70762 0 70762 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 338098 0 17500 0 0 0 182001 0 10000 0 547599 0 0 0 REGINA BONNEVIE ROGERS MD CHIEF MEDICAL OFFICER 356327 0 15000 0 0 0 0 0 0 0 371327 0 0 0 MANDEEP DHAWAN MD PHYSICIAN 286197 0 7500 0 0 0 0 0 0 0 293697 0 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 276964 0 10000 0 0 0 0 0 0 0 286964 0 0 0 JORGE ZAPATA MD PHYSICIAN 276565 0 10000 0 0 0 0 0 0 0 286565 0 0 0 CHRISTOPHER PROMPUNTAGORN MD PHYSICIAN 267286 0 10000 0 0 0 0 0 0 0 277286 0 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR 249261 0 8000 0 0 0 0 0 0 0 257261 0 0 0 CLEMENT LE THANH MD PHYSICIAN 246591 0 3500 0 0 0 0 0 0 0 250091 0 0 0 JOEL EMERY CFO 150926 0 0 0 0 0 0 0 0 0 150926 0 0 0 PART I, LINE 4B THE ORGANIZATION HAS A 457(F) SUPPLEMENTAL RETIREMENT PLAN FOR JENNIFER KREIDLER-MOSS, CEO. DURING 2021, $156,814 WAS CONTRIBUTED INTO THE PLAN AND $21,879 ACCRUED WITHIN THE PLAN. X 12246 781438 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. 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 AND OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT DID NOT CHANGE DURING 2021. AMENDED FORM 990: THE FORM 990 WAS ORIGINALLY FILED BASED ON DRAFT FINANCIAL STATEMENTS AND IS NOW BEING AMENDED TO MATCH THE ISSUED AUDITED FINANCIAL STATEMENTS. THE FOLLOWING PARTS, SCHEDULES, LINES, ETC., ARE IMPACTED BY THE AMENDMENT: - THE GROSS RECEIPTS IN FORM 990, PAGE 1, BOX G - THE "CURRENT YEAR" COLUMN IN FORM 990, PART I, LINES 9, 12, 17 - 22 - THE EXPENSE AND REVENUE AMOUNTS IN FORM 990, PART III, LINES 4A-4D - FORM 990, PART VIII, LINES 2A, 2G, 12 - FORM 990, PART IX, LINES 13, 24A, 24C, 25 - FORM 990, PART X, LINES 4, 8, 16, 17, 23, 26, 27, 32, 33 - FORM 990, PART XI, LINES 1 - 3, 10 - SCHEDULE A, PART II, LINE 12 - SCHEDULE D, PART XI, LINES 1, 3, 5 - SCHEDULE D, PART XII, LINES 1, 3, 5