2018-11-09T13:06:17-06:00 2017-12-31 911056739 VINE DAHLEN PLLC 3500 188TH STREET SW STE 322 LYNNWOOD WA 98037 990 2017-01-01 911102033 PUGET SOUND KIDNEY CENTERS PUGE 4252595195 1019 PACIFIC AVENUE EVERETT WA 98201 HAROLD KELLY PRESIDENT AND CEO 4252595195 2018-11-08 1 KIMBERLY D FYFE CPA P01422564 4257716055 2018-11-08 68.64.52.10 2018-11-08 15:45:40 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D08C6E78AF9089008AAAFAE3D7CB9F2EBAEECFC7 2017 2019-02-21 02:37:17Z HAROLD KELLY 1019 PACIFIC AVENUE EVERETT WA 98201 30494851 0 X WWW.PSKC.NET X 1980 WA TO PROVIDE KIDNEY DIALYSIS AND RELATED PATIENT CARE SERVICES IN WASHINGTON STATE. 11 11 270 28 0 0 164786 182426 28810253 29782512 96809 -46068 49328 32400 29121176 29951270 0 0 0 0 14882914 15705453 0 0 0 11322959 12036677 26205873 27742130 2915303 2209140 49256696 52516022 2757390 3780687 46499306 48735335 TO ENHANCE THE QUALITY OF LIFE OF THOSE WITH KIDNEY DISEASE THROUGH OUTSTANDING DIALYSIS CARE, EDUCATION AND COMMUNITY SUPPORT. 0 0 16980153 21754606 IN CENTER DIALYSIS TREATMENTS - 70,327 TREATMENTS PROVIDED. 1715663 2198071 MOBILE DIALYSIS GIVEN TO AREA HOSPITALS - 4,103 TREATMENTS PROVIDED. 4550371 5829837 HOME TREATMENT PROGRAM - PROVIDES SUPERVISION, TRAINING AND EQUIPMENT TO PATIENTS WHO SELF DIALYZE AT HOME - 30,818 TREATMENTS PROVIDED. 23246187 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 31 0 1 270 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 4252595195 1019 PACIFIC AVENUE EVERETT WA 98201 PETRUCCELLI ANTHONY DIRECTOR 0.25 X 1600 0 0 COBBS BETTY DIRECTOR 0.25 X 1600 0 0 BOWDEN GEORGE DIRECTOR 0.25 X 1600 0 0 CHASE GENE DIRECTOR 0.25 X 1700 0 0 DE TUERK KATHRYN DIRECTOR 0.25 X 1800 0 0 HAUGEN KIRSTEN JENSEN DIRECTOR 0.25 X 1800 0 0 JONES JAMES DIRECTOR 0.25 X 1800 0 0 JONES FONTELLE TREASURER 0.25 X X 1700 0 0 VUKICH SUSAN CHAIRMAN 0.25 X X 1400 0 0 SENTER DONALD DIRECTOR 0.25 X 1200 0 0 BEYER DAVID DIRECTOR 0.25 X 0 0 0 KELLY HAROLD PRESIDENT & CEO 40.00 X X 432676 0 100824 CRAIN AMANDA COO 40.00 X 154475 0 21010 KOUCHI KENNETH CFO 40.00 X 171136 0 23141 KEECH PAMILA CMO 40.00 X 277099 0 28869 TYNER JENNIFER DNS 40.00 X 119586 0 18035 HEROLD AARON DAS 40.00 X 118665 0 17693 LIGHTFOOT KIM DPA 40.00 X 127908 0 21714 MARCOS CARMELITA RN 40.00 X 129585 0 19429 EDRIS ZOE RN 40.00 X 126730 0 19307 1674060 0 270022 13 0 1 0 NEWLAND CONSTRUCTION CO 3300 CHESTNUT STREET EVERETT WA 98201 BUILDING CONTRACTOR 2852291 SPECTRA LABORATORIES PO BOX 360790 MILPITAS CA 95036 LABORATORY SERVICES 399521 WESTERN WASHINGTON MEDICAL GROUP 1330 ROCKEFELLER AVE SUITE 450 EVERETT WA 98201 MEDICAL DIRECTORS 185000 BOTESCH NASH & HALL 2727 OAKES AVENUE SUITE 100 EVERETT WA 98201 ARCHITECT 156726 VANGUARD 6912 220TH ST SW 306 MOUNTLAKE TERRACE WA 98043 JANITORIAL 122140 6 182426 182426 DIALYSIS 621492 22465333 22465333 PHARMACY 621492 5919304 5919304 LABORATORY 621492 833506 833506 RENAL MEDICATION 621492 444301 444301 MEDICAL SUPPLIES 621492 120068 120068 29782512 62739 62739 434774 415299 128282 19475 -128282 -108807 -108807 HOSPITAL SHARED SERVICES 621492 28082 28082 MISC. REVENUE 621492 2518 2518 MEDICAL RECORDS 621492 1800 1800 32400 29951270 29814912 0 -46068 1225431 1225431 11590767 10092933 1497834 478948 429962 48986 1294880 1124949 169931 1115427 890493 224934 50836 50836 36985 36985 13062 13062 402601 375000 27601 54556 54556 444745 214621 230124 224544 224544 589669 535957 53712 24282 24282 51598 51598 18840 18840 1552598 1372589 180009 114693 101395 13298 MEDICAL SUPPLIES 6963635 6963635 UNCOMPENSATED CARE 488506 488506 HOUSEKEEPING AND LAUNDR 290476 273680 16796 EQUIPMENT REPAIRS AND M 256023 242696 13327 459028 139771 319257 27742130 23246187 4495943 0 8384 10657 7829080 9147483 4860518 4296185 590034 640103 56338 46411 46933281 11221409 30277690 35711872 2012638 1854241 3622014 809070 49256696 52516022 2743637 2461924 1250000 13753 68763 2757390 3780687 X 46499306 48735335 46499306 48735335 49256696 52516022 X 2209140 151484 -124595 X 1 X 0 1 0 X 1312638 191603 1504241 1219748 92890 1312638 1227260 -7512 1219748 1161608 65652 1227260 1032525 129083 1161608 1.00000 0 0 6420999 6420999 32972507 6220893 26751614 177726 75975 101751 4273997 2855471 1418526 3088052 2069070 1018982 35711872 LONG TERM LIABILITY 68763 68763 X PART X, LINE 2: PSKC IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND HAS BEEN DESIGNATED AS AN ORGANIZATION WHICH IS NOT A PRIVATE FOUNDATION. THE INFORMATION RETURN IS FILED ANNUALLY AND IS SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE, GENERALLY FOR THREE YEARS AFTER THE RETURNS ARE FILED. PSKC WOULD RECOGNIZE ACCRUED INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX PROVISIONS, IF ANY, AS PART OF OTHER EXPENSE. X X 0 1 0 0 0 0 0 1 0 KELLY HAROLD PRESIDENT & CEO 286898 0 145778 0 0 0 73910 0 26914 0 533500 0 0 0 CRAIN AMANDA COO 123725 0 30750 0 0 0 10517 0 10493 0 175485 0 0 0 KOUCHI KENNETH CFO 113466 0 57670 0 0 0 11655 0 11486 0 194277 0 0 0 KEECH PAMILA CMO 267099 0 10000 0 0 0 18548 0 10321 0 305968 0 0 0 PART I, LINE 4B THE PRESIDENT/CEO PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. TOTAL ACCRUAL OF $55,010 FOR 2017 IS REPORTED ON PART II, COLUMN C AS DEFERRED COMPENSATION. NO PAYMENTS WERE RECEIVED FROM THE PLAN DURING 2017. PART I, LINE 7 THE CEO, COO, AND CFO PARTICIPATE IN AN INCENTIVE PLAN TO RECOGNIZE THE CONTRIBUTIONS MADE TO PUGET SOUND KIDNEY CENTER'S FINANCIAL AND OPERATIONAL SUCCESS. EACH YEAR, THE BOARD REVIEWS THE PERFORMANCE OF THE ORGANIZATION AS COMPAPARED TO ITS PREDETERMINED GOALS AND SETS APPROPRIATE AND REASONABLE INCENTIVE COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS IS NOTIFIED OF THEIR RIGHT TO OBTAIN, REVIEW AND KEEP A COPY OF THE 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE INTERVIEWED ANNUALLY IN THE DECEMBER BOARD MEETING REGARDING POTENTIAL CONFLICTS OF INTEREST. A NUMBER OF ADMINISTRATIVE POLICIES ARE IN PLACE ADDRESSING THIS ISSUE. POLICIES NO. 108, 90, AND 355 COVERS AREAS OF CONFLICT OF INTEREST, BUSINESS ETHICS AND CONDUCT, AND FRAUD DETECTION AND PREVENTION RESPECTIVELY. ADDITIONALLY, AN ANNUAL IN-SERVICE IS GIVEN TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REVIEWS THE PRESIDENT AND CEO'S COMPENSATION PACKAGES. THE PRESIDENT AND CEO REVIEWS AND ADJUSTS AS NECESSARY ALL OTHERS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND THE FORM 990 ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION 88,860. EXPENES INCURRED FOR THE BENEFIT OF PSKC FOUNDATION -83,556. EDUCATION PROGRAM EXPENSES -129,899. PUGET SOUND KIDNEY CENTERS FOUNDATION 1019 PACIFIC AVE EVERETT WA 98201 454354877 SUPPORT ACTIVITIES OF THE PUGET SOUND KIDNEY CENTERS WA 501(C)(3) LINE 12A, I PUGET SOUND KIDNEY CENTERS 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 PUGET SOUND KIDNEY CENTERS FOUNDATION O 74416 FMV PUGET SOUND KIDNEY CENTERS FOUNDATION C 182426 FMV