PENINSULA COMMUNITY HEALTH SERVICES: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PENINSULA COMMUNITY HEALTH SERVICES (EIN 94-3079770)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2023-09-28
- IRS object ID
- 202322719349300737
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-09-28T11:51:16-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 943079770 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PENINSULA COMMUNITY HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PENI | BusinessNameControlTxt |
| Phone | 3604782366 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 960 | AddressLine1Txt |
| City | BREMERTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98337 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER KREIDLER-MOSS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3604782366 | PhoneNum |
| Signature | 2023-09-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JENNIFER | PersonFirstNm |
| Person Last | KREIDLER-MOSS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2023-09-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | Yes (X) | AmendedReturnInd |
| Principal Officer | JENNIFER KREIDLER-MOSS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 960 | AddressLine1Txt |
| City | BREMERTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98337 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $56,787,648 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PCHSWEB.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1987 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | PCHS EXEMPLIFIES A CULTURE OF COMMUNITY SERVICE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 446 | TotalEmployeeCnt |
| Total Volunteers | 312 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $12,023,199 | PYContributionsGrantsAmt |
| CY Contributions Grants | $18,157,872 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,197,320 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $38,273,043 | CYProgramServiceRevenueAmt |
| PY Investment Income | $132,843 | PYInvestmentIncomeAmt |
| CY Investment Income | $182,313 | CYInvestmentIncomeAmt |
| PY Other Revenue | $117,801 | PYOtherRevenueAmt |
| CY Other Revenue | $174,420 | CYOtherRevenueAmt |
| PY Total Revenue | $41,471,163 | PYTotalRevenueAmt |
| CY Total Revenue | $56,787,648 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,816 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,186,895 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,947,903 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,032,664 | PYOtherExpensesAmt |
| CY Other Expenses | $14,974,361 | CYOtherExpensesAmt |
| PY Total Expenses | $35,223,375 | PYTotalExpensesAmt |
| CY Total Expenses | $41,922,264 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,247,788 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $14,865,384 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $52,071,400 | TotalAssetsBOYAmt |
| Total Assets EOY | $65,067,790 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,349,235 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,949,970 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $39,722,165 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $55,117,820 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PCHS EXEMPLIFIES A CULTURE OF COMMUNITY SERVICE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,816,818 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $24,075,451 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,334,849 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,750,027 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,163,562 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $4,434,909 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,979,706 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,612,656 | RevenueAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,979,706 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $2,612,656 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $34,294,935 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 41 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 446 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOEL EMERY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3604782366 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 WARREN AVENUE SUITE 200 | AddressLine1Txt |
| City | BREMERTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98337 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| JENNIFER KREIDLER-MOSS PHARMD | ||||||||
| CEO | 40.00 | Yes (X) | $355,598 | $0 | $192,001 | |||
| REGINA BONNEVIE ROGERS MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | $371,327 | $0 | $0 | Yes (X) | |||
| MANDEEP DHAWAN MD | ||||||||
| PHYSICIAN | 40.00 | $293,697 | $0 | $0 | Yes (X) | |||
| DONNAVILLE ORTIZ MD | ||||||||
| PHYSICIAN | 40.00 | $286,964 | $0 | $0 | Yes (X) | |||
| JORGE ZAPATA MD | ||||||||
| PHYSICIAN | 40.00 | $286,565 | $0 | $0 | Yes (X) | |||
| CHRISTOPHER PROMPUNTAGORN MD | ||||||||
| PHYSICIAN | 40.00 | $277,286 | $0 | $0 | Yes (X) | |||
| MICHAEL INSANI DDS | ||||||||
| DENTAL DIRECTOR | 40.00 | $257,261 | $0 | $0 | Yes (X) | |||
| CLEMENT LE THANH MD | ||||||||
| PHYSICIAN | 40.00 | $250,091 | $0 | $0 | Yes (X) | |||
| JOEL EMERY | ||||||||
| CFO | 40.00 | Yes (X) | $150,926 | $0 | $0 | |||
| BRYNN FELIX | ||||||||
| GENERAL COUNSEL | 40.00 | Yes (X) | $84,184 | $0 | $0 | |||
| MONICA BERNHARD | ||||||||
| PRESIDENT | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| EVELYN HETRICK | ||||||||
| VICE PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PAUL HATHAWAY | ||||||||
| SECRETARY (THROUGH JUNE 2021) | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SHANNON TURNER | ||||||||
| DIRECTOR & SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| CHRISTOPHER COOK | ||||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SUSAN ASTLE | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| ANN BARBILLION | ||||||||
| DIRECTOR (THROUGH AUG 2021) | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| BERYL COCHRAN | ||||||||
| DIRECTOR (THROUGH SEP 2021) | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| SHARON CROMLEY | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| JILL GUERRERO | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| JO PEDERSON | ||||||||
| DIRECTOR (THROUGH APRIL 2021) | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| AL PINKHAM | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| JEANELL RASMUSSEN | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| DAVID WINDOM | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,613,899 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $192,001 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 57 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HUTCHCON CONSTRUCTION | |||||
| PO BOX 482 | MANCHESTER | WA | 98353 | CONSTRUCTION | $2,177,863 |
| ATHENA HEALTH | |||||
| 311 ARSENAL STREET | WATERTOWN | MA | 02472 | PRACTICE MANAGEMENT SYSTEM SUPPORT | $924,828 |
| NEXTGEN HEALTHCARE SERVICES | |||||
| PO BOX 511449 | LOS ANGELES | CA | 90051 | PRACTICE MANAGEMENT SYSTEM SUPPORT | $305,993 |
| STRATUS INDEMAND LLC | |||||
| 555 ANDOVER PARK W | SEATTLE | WA | 98188 | TRANSLATION SERVICES | $289,655 |
| JOHNSON OAKLIEF | |||||
| 2124 3RD AVENUE SUITE 200 | SEATTLE | WA | 98121 | CONSTRUCTION | $258,887 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $18,065,111 | GovernmentGrantsAmt |
| All Other Contributions | $92,761 | AllOtherContributionsAmt |
| Noncash Contributions | $781,438 | NoncashContributionsAmt |
| Total Contributions | $18,157,872 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $38,273,043 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,273,043 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $38,273,043 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $182,313 | TotalRevenueColumnAmt |
| Exclusion | $182,313 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $174,420 | TotalRevenueColumnAmt |
| Exclusion | $174,420 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $174,420 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $56,787,648 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,273,043 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $356,733 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,411,297 | TotalAmt |
| Program Services | $1,066,667 | ProgramServicesAmt |
| Management And General | $344,630 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,756,124 | TotalAmt |
| Program Services | $17,159,884 | ProgramServicesAmt |
| Management And General | $3,596,240 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,776,028 | TotalAmt |
| Program Services | $2,274,707 | ProgramServicesAmt |
| Management And General | $501,321 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,004,454 | TotalAmt |
| Program Services | $1,643,530 | ProgramServicesAmt |
| Management And General | $360,924 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,567 | TotalAmt |
| Management And General | $88,567 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,454 | TotalAmt |
| Management And General | $177,454 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,570 | TotalAmt |
| Management And General | $33,570 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,747,304 | TotalAmt |
| Program Services | $1,569,735 | ProgramServicesAmt |
| Management And General | $177,569 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $318,148 | TotalAmt |
| Program Services | $12,447 | ProgramServicesAmt |
| Management And General | $305,701 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $779,966 | TotalAmt |
| Program Services | $485,991 | ProgramServicesAmt |
| Management And General | $293,975 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,427,767 | TotalAmt |
| Program Services | $1,007,539 | ProgramServicesAmt |
| Management And General | $420,228 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,972,588 | TotalAmt |
| Program Services | $1,706,763 | ProgramServicesAmt |
| Management And General | $265,825 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,544 | TotalAmt |
| Program Services | $15,069 | ProgramServicesAmt |
| Management And General | $80,475 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $446,917 | TotalAmt |
| Program Services | $380,724 | ProgramServicesAmt |
| Management And General | $66,193 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,817 | TotalAmt |
| Program Services | $4,872 | ProgramServicesAmt |
| Management And General | $1,945 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,794,776 | TotalAmt |
| Program Services | $1,647,932 | ProgramServicesAmt |
| Management And General | $146,844 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,572 | TotalAmt |
| Program Services | $122,174 | ProgramServicesAmt |
| Management And General | $34,398 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $3,420,071 | $3,420,071 | |
| REPAIRS & MAINTENANCE | $1,759,240 | $1,241,451 | $517,789 |
| MISCELLANEOUS | $520,306 | $371,881 | $148,425 |
| TAXES | $228,754 | $163,498 | $65,256 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,922,264 | TotalAmt |
| Program Services | $34,294,935 | ProgramServicesAmt |
| Management And General | $7,627,329 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,326,044 | BOYAmt |
| EOY | $32,963,927 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,830 | BOYAmt |
| EOY | $111,552 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,384,393 | BOYAmt |
| EOY | $1,340,420 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,565,807 | BOYAmt |
| EOY | $3,468,601 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,647 | BOYAmt |
| EOY | $636,926 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $636,464 | BOYAmt |
| EOY | $731,849 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $33,523,437 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,454,952 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,788,266 | BOYAmt |
| EOY | $21,068,485 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,973,949 | BOYAmt |
| EOY | $4,746,030 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,071,400 | BOYAmt |
| EOY | $65,067,790 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,685,588 | BOYAmt |
| EOY | $4,601,502 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,910,309 | BOYAmt |
| EOY | $1,910,309 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,285,533 | BOYAmt |
| EOY | $922,764 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,571,040 | BOYAmt |
| EOY | $1,431,653 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,183,348 | BOYAmt |
| EOY | $1,083,742 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,713,417 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,349,235 | BOYAmt |
| EOY | $9,949,970 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,615,269 | BOYAmt |
| EOY | $55,064,311 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $106,896 | BOYAmt |
| EOY | $53,509 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,722,165 | BOYAmt |
| EOY | $55,117,820 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,071,400 | BOYAmt |
| EOY | $65,067,790 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $14,865,384 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $530,271 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,213,085 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,072,589 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,914,132 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,023,199 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,157,872 | CurrentTaxYearAmt |
| Total | $50,380,877 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,213,085 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,072,589 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,914,132 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,023,199 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,157,872 | CurrentTaxYearAmt |
| Total | $50,380,877 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $50,380,877 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $106,424 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $95,088 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $210,968 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $132,843 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $182,313 | CurrentTaxYearAmt |
| Total | $727,636 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $121,592 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,115 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $26,137 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $117,801 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $174,420 | CurrentTaxYearAmt |
| Total | $446,065 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $51,554,578 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $147,531,444 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.97720 | PublicSupportCY170Pct |
| Public Support PY170 | 0.97470 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,929,927 | OtherCostOrOtherBasisAmt |
| Book Value | $1,929,927 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,787,153 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,713,687 | DepreciationAmt |
| Book Value | $8,073,466 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,183,627 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,189,044 | DepreciationAmt |
| Book Value | $5,994,583 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,089,551 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,552,221 | DepreciationAmt |
| Book Value | $4,537,330 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $533,179 | OtherCostOrOtherBasisAmt |
| Book Value | $533,179 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,068,485 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $56,775,297 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $29,410 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $29,410 | RevenueNotReportedAmt |
| Revenue Subtotal | $56,745,887 | RevenueSubtotalAmt |
| Other Revenues Not Included | $41,761 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $41,761 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $56,787,648 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $41,951,674 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $29,410 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $29,410 | ExpensesNotReportedAmt |
| Expenses Subtotal | $41,922,264 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $41,922,264 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | NORTH AMERICA | RegionTxt |
| Offices | 0 | OfficesCnt |
| Employee | 0 | EmployeeCnt |
| Type Of Activities Conducted | PROGRAM SERVICES | TypeOfActivitiesConductedTxt |
| Specific Services Provided | FACILITY IMPROVEMENTS | SpecificServicesProvidedTxt |
| Region Total Expenditures | $70,762 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 0 | SubtotalEmployeesCnt |
| Continuation Total Office | 0 | ContinuationTotalOfficeCnt |
| Continuation Total Employee | 0 | ContinuationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Subtotal Spent | $70,762 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $70,762 | TotalSpentAmt |
| Transfer To Foreign Corp | 0 | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | 0 | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | 0 | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART III ACCOUNTING METHOD: | FormAndLineReferenceDesc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JENNIFER KREIDLER-MOSS PHARMD | ||||||||||||||
| CEO | $338,098 | $0 | $17,500 | $0 | $0 | $0 | $182,001 | $0 | $10,000 | $0 | $547,599 | $0 | $0 | $0 |
| REGINA BONNEVIE ROGERS MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $356,327 | $0 | $15,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $371,327 | $0 | $0 | $0 |
| MANDEEP DHAWAN MD | ||||||||||||||
| PHYSICIAN | $286,197 | $0 | $7,500 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $293,697 | $0 | $0 | $0 |
| DONNAVILLE ORTIZ MD | ||||||||||||||
| PHYSICIAN | $276,964 | $0 | $10,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $286,964 | $0 | $0 | $0 |
| JORGE ZAPATA MD | ||||||||||||||
| PHYSICIAN | $276,565 | $0 | $10,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $286,565 | $0 | $0 | $0 |
| CHRISTOPHER PROMPUNTAGORN MD | ||||||||||||||
| PHYSICIAN | $267,286 | $0 | $10,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $277,286 | $0 | $0 | $0 |
| MICHAEL INSANI DDS | ||||||||||||||
| DENTAL DIRECTOR | $249,261 | $0 | $8,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $257,261 | $0 | $0 | $0 |
| CLEMENT LE THANH MD | ||||||||||||||
| PHYSICIAN | $246,591 | $0 | $3,500 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $250,091 | $0 | $0 | $0 |
| JOEL EMERY | ||||||||||||||
| CFO | $150,926 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $150,926 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 12246 | ContributionCnt |
| Noncash Contributions Rpt F990 | $781,438 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | INVOICE PRICE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | PART I, COLUMN B REPORTS THE NUMBER OF DONATED ITEMS RECEIVED DURING THE YEAR. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 |
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