2018-11-15T16:08:18-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2017-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS CEO 3604782366 2018-11-13 1 KURT BENNION CPA P01469618 4252506100 2018-11-13 67.137.57.251 2018-11-13 14:37:18 PS P A52F513B8D8172ADA5E5426B2D9DBB033DEB48E6 84BDE7AD4ADB62213C7E1A191A12ED9082B4B320 2017 2019-02-21 02:37:17Z JENNIFER KREIDLER-MOSS PO BOX 960 BREMERTON WA 98337 30678223 0 X WWW.PCHSWEB.ORG X 1987 WA PROVIDE ACCESSIBLE, AFFORDABLE, QUALITY HEALTH AND WELLNESS SERVICES FOR OUR COMMUNITIES. 12 12 283 22 0 0 2923608 4213085 19132216 25140888 201404 -10887 29794 121592 22287022 29464678 0 1594 0 0 14792090 16886066 0 0 0 5945291 8123549 20737381 25011209 1549641 4453469 28966684 32970194 10098390 9274967 18868294 23695227 X PENINSULA COMMUNITY HEALTH SERVICES PROVIDES ACCESSIBLE, AFFORDABLE, QUALITY HEALTH AND WELLNESS SERVICES FOR OUR COMMUNITIES. 1 0 10772308 1041 11932138 MEDICAL: DURING 2017, PCHS PROVIDED 71,242 MEDICAL ENCOUNTERS TO 24,774 PATIENTS AT 7 CLINICAL SITES LOCATED IN BREMERTON (3 SITES), BELFAIR, KINGSTON, PORT ORCHARD AND POULSBO. SERVICES INCLUDE COMPREHENSIVE, PRIMARY MEDICAL SERVICES FOR CHILDREN AND ADULTS, EMPHASIZING WHOLE-PERSON, PATIENT-CENTERED APPROACH. PCHS OFFERS ALL SERVICES ON A SLIDING FEE SCHEDULE. 5060844 0 8276824 DENTAL: IN 2017, PCHS PROVIDED 26,208 DENTAL VISITS TO 10,851 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT FOUR CLINICAL SITES IN BREMERTON (TWO SITES) AND PORT ORCHARD AND BELFAIR. SERVICES INCLUDE PREVENTATIVE CARE, ORAL EXAMS, ORAL HYGIENE, X-RAYS, EMERGENCY CARE AND DENTAL EDUCATION. REFERRAL SERVICES ARE OFFERED FOR MORE SPECIALIZED CARE. A SLIDING FEE SCALE IS AVAILABLE TO PATIENTS WHO QUALIFY. 2803529 553 3339621 PHARMACY: IN 2017, PCHS PROVIDED 78,282 PRESCRIPTIONS TO ITS ELIGIBLE PATIENTS. FULLY LICENSED PHARMACIES ARE LOCATED AT 5 CLINICAL SITES IN BREMERTON (2 SITES), BELFAIR, POULSBO AND PORT ORCHARD. 1172039 0 1592305 BEHAVIORAL HEALTH: DURING 2017, PCHS PROVIDED 6,117 BEHAVIORAL HEALTH ENCOUNTERS TO 1,908 PATIENTS AT 7 CLINICAL SITES LOCATED IN BREMERTON (3 SITES), BELFAIR, KINGSTON, PORT ORCHARD, AND POULSBO. BY FOCUSING ON A PATIENT'S BEHAVIORAL HEALTH AS PART OF AN INTERGRATED CARE MODEL, WE ARE ABLE TO BETTER COORDINATE COMPLETE AND TIMELY ACCESS TO CARE. OUR LICENSED, CERTIFIED COUNSELORS AND CHEMICAL DEPENDENCY PROFESSIONALS ADDRESS THE INDIVIDUALIZED NEEDS OF OUR PATIENTS BY WORKING ALONGSIDE OUR PRIMARY CARE PROVIDERS. 1172039 0 1592305 19808720 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 0 0 0 0 0 0 0 0 0 1 41 0 283 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOEL EMERY 3604756710 400 WARREN AVENUE SUITE 200 BREMERTON WA 98337 CHRISTOPHER COOK PRESIDENT 3.00 X X 0 0 0 EVELYN HETRICK VICE PRESIDENT 2.00 X X 0 0 0 YOLANDA FONG SECRETARY 2.00 X X 0 0 0 PAUL HATHAWAY TREASURER 2.00 X X 0 0 0 SUSAN ASTLE DIRECTOR 1.00 X 0 0 0 MONICA BERNHARD DIRECTOR 1.00 X 0 0 0 MARY BEST-RABONZA DIRECTOR (THROUGH NOVEMBER 2017) 1.00 X 0 0 0 BERYL COCHRAN DIRECTOR 1.00 X 0 0 0 SHARON CROMLEY DIRECTOR 1.00 X 0 0 0 DAVID FARR DIRECTOR (THROUGH NOVEMBER 2017) 1.00 X 0 0 0 RENEE KIMBALL-ROUSE 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 CLAUDIA REALEGENO DIRECTOR 1.00 X 0 0 0 JENNIFER KREIDLER-MOSS PHARMD CEO 40.00 X 246949 0 7044 JOEL EMERY CFO 40.00 X 134964 0 7044 AARON FORSTER CIO 40.00 X 125885 0 7044 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 40.00 X 293533 0 7044 MICHAEL INSANI MD DENTAL DIRECTOR 40.00 X 201780 0 7044 MANDEEP DHAWAN MD PHYSICIAN 40.00 X 242334 0 7044 DONNAVILLE ORTIZ MD PHYSICIAN 40.00 X 235381 0 7044 CLEMENT LE THANH MD PHYSICIAN 40.00 X 212033 0 7044 CLAIR FELPEL MD PHYSICIAN 40.00 X 188672 0 7044 CHI LAP LI MD DENTIST 40.00 X 183492 0 7044 2065023 0 70440 39 0 1 0 ALDRICH & ASSOCIATES 810 240TH ST SE BOTHELL WA 98021 CONSTRUCTION 1718301 1 1317 3928667 283101 4213085 PATIENT SERVICE REVENUE 621400 25140888 25140888 25140888 106424 106424 1096234 1213545 -117311 -117311 -117311 OTHER INCOME 621400 121592 121592 121592 29464678 25140888 0 110705 1594 1594 1038331 712595 325736 12667372 10044229 2623143 1966422 1528011 438411 1213941 938658 275283 17862 14541 3321 69560 56625 12935 33220 27043 6177 802564 653327 149237 6961 5863 1098 1641166 1595975 45191 710920 420485 290435 1320673 1112948 207725 72513 8888 63625 335000 245448 89552 757543 654869 102674 63474 49847 13627 BAD DEBT 1050041 1050041 MISCELLANEOUS 536173 219635 316538 EQUIP MAINT & REPAIR 418339 247433 170906 COMMUNICATIONS 287540 220665 66875 25011209 19808720 5202489 0 14074421 15003235 93729 104265 2833351 4269086 162711 190651 143360 128259 17456325 7229855 9089979 10226470 2569133 3001839 0 46389 28966684 32970194 7967173 7274690 2051090 1944929 80127 55348 10098390 9274967 X 18636561 23695227 231733 0 18868294 23695227 28966684 32970194 4453469 373464 0 X 0 1 X 1 1 1 X 1746432 2052118 2872155 2923608 4213085 13807398 12481131 16548665 15734905 19132216 25140888 89037805 14227563 18600783 18607060 22055824 29353973 102845203 0 0 0 102845203 73660 83236 74842 64387 106424 402549 73660 83236 74842 64387 106424 402549 116729 26184 64971 29794 121592 359270 14417952 18710203 18746873 22150005 29581989 103607022 0.99260 0.99280 0.00390 0.00440 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME 1929927 1929927 6746311 3408540 3337771 4736892 1109538 3627354 3961932 2711777 1250155 81263 81263 10226470 X 29314799 373464 231733 605197 28709602 755076 755076 29464678 25011209 0 25011209 0 25011209 PART X, LINE 2: THE CLINIC 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 CLINIC'S TAX POSITIONS AND CONCLUDED THAT THE CLINIC 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 2D - OTHER ADJUSTMENTS: FUNDS RETURNED TO GRANTOR 231,733. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT GAIN 476,461. CAPITAL DEVELOPMENT GRANT 65,717. CONTRIBUTIONS 32,898. CAPITAL CONTRIBUTION 180,000. X X X X X 0 0 0 0 0 0 0 0 0 JENNIFER KREIDLER-MOSS PHARMD CEO 217111 0 0 0 29838 0 0 0 7044 0 253993 0 0 0 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 284362 0 0 0 9171 0 0 0 7044 0 300577 0 0 0 MICHAEL INSANI MD DENTAL DIRECTOR 197330 0 0 0 4450 0 0 0 7044 0 208824 0 0 0 MANDEEP DHAWAN MD PHYSICIAN 224892 0 7500 0 9942 0 0 0 7044 0 249378 0 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 218187 0 10000 0 7194 0 0 0 7044 0 242425 0 0 0 CLEMENT LE THANH MD PHYSICIAN 199479 0 3500 0 9054 0 0 0 7044 0 219077 0 0 0 CLAIR FELPEL MD PHYSICIAN 179100 0 0 0 9572 0 0 0 7044 0 195716 0 0 0 CHI LAP LI MD DENTIST 178771 0 0 0 4721 0 0 0 7044 0 190536 0 0 0 A WA HEALTH CARE FACILITIES AUTHORITY 911108929 2005-12-18 3000000 CONSTRUCTION FINANCING 0 0 1 A 1033683 3000000 51942 2948058 2005 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WA HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/19/2013 FORM 990, PART III, LINE 2 DURING 2017, PCHS ADDED NEW SITES IN BELFAIR AND KINGSTON. THE BELFAIR SITE PROVIDES MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES. THE KINGSTON SITE PROVIDES MEDICAL SERVICES. FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION'S EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD AND THE CHAIRS OF STANDING COMMITTEES. THE EXECUTIVE COMMITTEE (A) 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, (B) COORDINATES THE ACTIVITIES OF THE COMMITTEES OF THE BOARD, AND (C) EVALUATES ANNUALLY THE PERFORMANCE OF THE CEO. 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 SALE OR PURCHASE OF EQUIPMENT, FURNITURE OR FIXTURES IN EXCESS OF 1% OF THE ORGANIZATION'S ANNUAL BUDGET. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO AUTHORIZE SUBMITTAL OF GRANT APPLICATIONS. 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 2017. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORMS 990 ARE PROVIDED UPON REQUEST.