2024-09-25T12:45:10-05:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2023-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3603773776 PO BOX 960 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS CEO 3603773776 2024-09-24 1 1 KURT BENNION CPA P01469618 4252506100 2024-09-24 2023 2024-08-08 14:25:15Z JENNIFER KREIDLER-MOSS PO BOX 960 BREMERTON WA 98337 55983123 0 X WWW.PCHSWEB.ORG X 1987 WA PCHS EXEMPLIFIES A CULTURE OF COMMUNITY SERVICE. 13 13 508 23 0 0 11730563 11246311 45647227 42761950 63471 915065 438218 1058750 57879479 55982076 0 0 0 0 28520582 37239125 0 0 0 16100613 17160322 44621195 54399447 13258284 1582629 83135265 88926932 15550037 18827078 67585228 70099854 X PCHS EXEMPLIFIES A CULTURE OF COMMUNITY SERVICE. 0 0 21406360 0 24209016 MEDICAL - DURING 2023, PCHS PROVIDED 88,329 MEDICAL ENCOUNTERS TO 34,769 PATIENTS AT TWENTY-FOUR CLINICAL SITES LOCATED IN BREMERTON (TEN SITES), BELFAIR (TWO SITES), KINGSTON (TWO SITES), PORT ORCHARD (TWO SITES), POULSBO (TWO SITES), SHELTON, SILVERDALE (FOUR SITES) AND 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. 10883690 0 10613704 DENTAL - IN 2023, PCHS PROVIDED 35,409 DENTAL VISITS TO 17,908 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT NINE CLINICAL SITES IN BREMERTON (FOUR 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. 7104561 0 6153289 PHARMACY - IN 2023, PCHS PROVIDED 82,759 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. 4731553 0 1785941 BEHAVIORAL HEALTH - DURING 2023, PCHS PROVIDED 13,735 BEHAVIORAL HEALTH AND SUD ENCOUNTERS TO 3,225 PATIENTS AT TWENTY-THREE CLINICAL SITES LOCATED IN BREMERTON (TEN SITES), BELFAIR (TWO SITES), KEY PENINSULA, KINGSTON (TWO SITES), PORT ORCHARD (TWO SITES), POULSBO (TWO SITES), 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. 4731553 0 1785941 44126164 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 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 1 1 0 0 0 1 37 0 508 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 1 1 1 1 1 1 1 1 1 1 0 X HEATHER JACOBOVITCH 3603773776 PO BOX 960 BREMERTON WA 98337 TANVEER JOHAL MD PHYSICIAN 40.00 0.00 X 640616 0 0 JENNIFER KREIDLER-MOSS PHARMD CEO 39.80 0.20 X 493916 0 109323 ANTHONY VANCE DDS DENTAL DIRECTOR (AS OF JULY 2023) 40.00 0.00 X 590171 0 0 KAITLYN FREY DMD DENTIST 40.00 0.00 X 578242 0 0 MAKINZEE THOMAS DDS DENTIST 40.00 0.00 X 565343 0 0 REGINA BONNEVIE ROGERS MD CHIEF MEDICAL OFFICER 40.00 0.00 X 479668 0 0 SCOTT SMITH DDS DENTIST 40.00 0.00 X 465725 0 0 GEETA TADEPALLI MD PSYCHIATRIST 40.00 0.00 X 463647 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR (THROUGH JULY 2023) 40.00 0.00 X 299207 0 0 BRYNN FELIX GENERAL COUNSEL 40.00 0.00 X 156257 0 0 JOEL EMERY CFO 39.80 0.20 X 156118 0 0 KEITH STAUFFER CIO 40.00 0.00 X 153249 0 0 LYNETTE BIRD COO 40.00 0.00 X 142255 0 0 ANGELA BLAND CCO 40.00 0.00 X 108639 0 0 EVELYN HETRICK PRESIDENT 1.50 0.00 X X 0 0 0 AL PINKHAM VICE PRESIDENT 1.30 0.00 X X 0 0 0 CHRISTOPHER COOK TREASURER 1.50 0.00 X X 0 0 0 SUSAN ASTLE SECRETARY 1.00 0.00 X X 0 0 0 MARY BERGLIND DIRECTOR 0.50 0.20 X 0 0 0 MONICA BERNHARD DIRECTOR 1.00 0.00 X 0 0 0 SCOTT COPASS DIRECTOR 0.50 0.00 X 0 0 0 MICHELLE DICKERSON DIRECTOR (AS OF APRIL 2023) 0.50 0.00 X 0 0 0 JILL GUERRERO DIRECTOR 0.80 0.20 X 0 0 0 JEANELL RASMUSSEN DIRECTOR 0.50 0.00 X 0 0 0 TAMASIPANI SOUSOU DIRECTOR 0.50 0.00 X 0 0 0 ROGELIO RON VALENCIA DIRECTOR 0.50 0.20 X 0 0 0 DAVID WINDOM DIRECTOR 0.50 0.00 X 0 0 0 5293053 0 109323 101 0 1 0 HUTCHCON CONSTRUCTION PO BOX 482 MANCHESTER WA 98353 CONSTRUCTION 4780147 ATHENA HEALTH 311 ARSENAL STREET WATERTOWN MA 02472 PRACTICE MANAGEMENT SYSTEM SUPPORT 768718 JOHNSON OAKLIEF 2124 3RD AVENUE SUITE 200 SEATTLE WA 98121 ARCHITECTURAL SERVICES 617375 MCS PO BOX 11044 TACOMA WA 98411 JANITORIAL SERVICES 375667 COMMUNITY CLINIC NETWORK 18 S MISSION STREET SUITE 300 WENATCHEE WA 98801 NETWORK SUPPORT SERVICES 336668 11 11164326 81985 1174268 11246311 PATIENT SERVICE REVENUE 621400 42761950 42761950 42761950 916112 916112 1047 -1047 -1047 -1047 OTHER INCOME 621400 1058750 1058750 1058750 55982076 42761950 0 1973815 2688803 1851637 837166 28123145 23341740 4781405 3572223 2922988 649235 2854954 2334531 520423 258868 163558 95310 120161 75920 44241 45873 45873 1721398 1087617 633781 23040 15076 7964 723246 556443 166803 2106245 1781684 324561 253783 47363 206420 141712 75644 66068 2641554 2095697 545857 268148 216287 51861 PHARMACEUTICALS 3427494 3340169 87325 REPAIRS & MAINTENANCE 2434209 1869676 564533 MEDICAL SUPPLIES 1791628 1722192 69436 TAXES 419254 274326 144928 783709 353616 430093 54399447 44126164 10273283 0 40695488 22612943 117467 1222240 984242 340222 4272820 15060397 575779 776162 1296522 1479212 55460469 17140390 27782464 38320079 4567498 5879066 2842985 3236611 83135265 88926932 5224070 11482766 1910309 1910309 3363262 302746 1273470 1116382 3778926 4014875 15550037 18827078 X 67338145 70019160 247083 80694 67585228 70099854 83135265 88926932 1582629 931997 0 X X 0 1 X 1 1 1 X 9914132 12023199 18157872 11730563 11246311 63072077 9914132 12023199 18157872 11730563 11246311 63072077 63072077 210968 132843 182313 357377 916112 1799613 26137 117801 174420 438218 1058750 1815326 66687016 183617901 0.94580 0.97080 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: QUALITY INCENTIVE PAYMENTS OTHER MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2134122 2134122 18498480 2956286 15542194 9571967 4488993 5082974 10863229 9695111 1168118 14392671 14392671 38320079 X 55927054 0 55927054 55022 55022 55982076 54399447 0 54399447 0 54399447 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 36,411. CONTRIBUTIONS WITH DONOR RESTRICTIONS 18,611. NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 PROGRAM SERVICES FACILITY IMPROVEMENTS 153455 0 0 0 0 0 0 153455 0 153455 0 0 0 0 0 0 X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 TANVEER JOHAL MD PHYSICIAN 220413 0 420203 0 0 0 0 0 0 0 640616 0 0 0 JENNIFER KREIDLER-MOSS PHARMD CEO 346383 0 147533 0 0 0 99323 0 10000 0 603239 0 0 0 ANTHONY VANCE DDS DENTAL DIRECTOR (AS OF JULY 2023) 155924 0 434247 0 0 0 0 0 0 0 590171 0 0 0 KAITLYN FREY DMD DENTIST 151943 0 426299 0 0 0 0 0 0 0 578242 0 0 0 MAKINZEE THOMAS DDS DENTIST 146742 0 418601 0 0 0 0 0 0 0 565343 0 0 0 REGINA BONNEVIE ROGERS MD CHIEF MEDICAL OFFICER 377180 0 102488 0 0 0 0 0 0 0 479668 0 0 0 SCOTT SMITH DDS DENTIST 49066 0 416659 0 0 0 0 0 0 0 465725 0 0 0 GEETA TADEPALLI MD PSYCHIATRIST 93230 0 370417 0 0 0 0 0 0 0 463647 0 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR (THROUGH JULY 2023) 204666 0 94541 0 0 0 0 0 0 0 299207 0 0 0 BRYNN FELIX GENERAL COUNSEL 150757 0 5500 0 0 0 0 0 0 0 156257 0 0 0 JOEL EMERY CFO 154618 0 1500 0 0 0 0 0 0 0 156118 0 0 0 KEITH STAUFFER CIO 151749 0 1500 0 0 0 0 0 0 0 153249 0 0 0 PART I, LINE 1A IN 2023, PENINSULA COMMUNITY HEALTH SERVICES GROSSED UP LOAN REPAYMENT ASSISTANCE AND ENHANCED RETENTION BONUSES RECEIVED BY PROVIDERS. THE ORGANIZATION ALSO SUBSIDIZES YMCA MEMBERSHIPS OF ALL ELIGIBLE EMPLOYEES. PART I, LINE 4B THE ORGANIZATION HAS A 457(F) SUPPLEMENTAL RETIREMENT PLAN FOR JENNIFER KREIDLER-MOSS, CEO. DURING 2023, $99,323 WAS CONTRIBUTED INTO THE PLAN AND $51,371 ACCRUED WITHIN THE PLAN. X 14768 1174268 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 THE YEAR. PENINSULA COMMUNITY HEALTH SERVICES FOUNDATION PO BOX 867 BREMERTON WA 98337 933729168 FUNDRAISING WA 501(C)(3) LINE 12A, I PENINSULA COMMUNITY HEALTH SERVICES 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0