2016-11-15T20:03:08-06:00 2015-12-31 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2015-01-01 264826604 Peninsula Primary Care PENI 8317189720 PO Box HH Monterey CA 93942 LAURA ZEHM VP/CFO 8317189720 2016-11-07 1 Richard Croghan P00089862 4159561500 2016-11-07 2015 2017-02-10 21:41:12Z STEVEN PACKER PO Box HH Monterey CA 93942 12984952 0 X www.peninsulaprimarycare.org X 2009 CA TO PROVIDE HEALTH CARE FOR THE GENERAL PUBLIC, CARRY ON ANY EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK OR INJURED, AND TO PARTICIPATE IN SCIENTIFIC HEALTHCARE-RELATED RESEARCH TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. 8 4 142 4 0 0 665996 1500000 6905555 10054815 0 0 695174 1430137 8266725 12984952 0 0 0 0 8641453 11259659 0 0 0 2882033 4659130 11523486 15918789 -3256761 -2933837 2154968 2985603 6093034 9857506 -3938066 -6871903 TO PROVIDE HEALTH CARE FOR THE GENERAL PUBLIC, CARRY ON ANY EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK OR INJURED, AND TO PARTICIPATE IN SCIENTIFIC HEALTHCARE-RELATED RESEARCH TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. 0 0 14788180 10054815 DIRECT CLINICAL SERVICES. 14788180 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 0 0 0 1 17 0 1 142 1 0 0 0 0 0 0 0 0 0 0 X 8 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X SHIRLEY NORMAN 8312428605 PO Box HH Monterey CA 93942 MIKE LYON VICE CHAIR 1.00 2.00 X X 0 0 0 STEVEN PACKER MD President 1.00 54.00 X X 0 929346 309395 Jill Sheffield CHAIR 1.00 0.00 X X 0 0 0 Anthony Chavis SECRETARY 0.00 55.00 X X 0 582678 88713 DAVID STRAFACE MD DIRECTOR 40.00 0.00 X 336427 0 24006 Geraldin Taplin md BOARD MEMBER 1.00 0.00 X 11175 0 0 John Mahoney DIRECTOR 40.00 0.00 X 0 0 0 Stan Mckee DIRECTOR 40.00 0.00 X 0 0 0 LAURA ZEHM CFO 1.00 54.00 X 0 606752 102146 ALEXANDER IZMAILOV MD EMPLOYEE 40.00 0.00 X 370607 79652 18000 JIHAD JAFFER MD EMPLOYEE 40.00 0.00 X 355535 61065 7714 Nicholas Chee MD EMPLOYEE 40.00 0.00 X 403623 2912 35177 Pir Shah MD employee 40.00 0.00 X 397772 63400 41601 Michael Galloway MD employee 40.00 0.00 X 356582 0 9594 2231721 2325805 636346 30 0 1 0 Cypress Healthcare Partners PO Box HH Monterey CA 93942 Medical Services 1041876 Quality Systems Inc PO Box 511449 Los Angeles CA 90051 AR Billing Maintenance 360065 MCKESSON MEDICAL SURGICAL 130-10711 Cambie Road Richmond British Columbia CA MEDICAL 212965 Computer Technical Specialties 7441 Matterhorn Pl Salinas CA 93907 Computer Support 155354 4 1500000 1500000 patient fees 900099 10054815 10054815 10054815 Incentive payments 900099 1430137 1430137 1430137 12984952 10054815 0 1430137 371608 371608 10111128 10111128 21790 21790 507698 507698 247435 247435 1115926 10317 1105609 1498864 1498864 133191 108191 25000 203220 203220 1044671 1044671 143434 143434 Vaccines and Medicine 274526 274526 Medical Supplies 235060 235060 10238 10238 15918789 14788180 1130609 0 28131 295732 754077 1322602 95360 81581 1654645 389973 1256384 1264672 21016 21016 2154968 2985603 1115984 1193579 4977050 8663927 6093034 9857506 X -3938066 -6871903 -3938066 -6871903 2154968 2985603 -2933837 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 66554 5609 60945 1588091 384364 1203727 1264672 LOAN FROM CHOMP 8663712 PENSION LOAN EE 57 Suspense 158 8663927 X Part X, Line 2: CHF, CHOMP, CHE, CHP, and PPC have been determined to be exempt organizations by the Internal Revenue Service and the California Franchise Tax Board and generally are not subject to taxes on income pursuant to Section 501(c)(3) and Section 23701(d) of the Internal Revenue Code and California Revenue and Taxation Code, respectively. Aspire, CCCMIC, CMN, and Coastal are taxable entities and income taxes are accounted for using an asset and liability approach that requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined based on the differences between the consolidated financial statement and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Aspire, CCCMIC, CMN, and Coastal have net cumulative losses and the deferred tax assets associated with these losses have been fully reserved. There were no tax provisions recorded for the years ended December 31, 2015 and 2014. The Organization assesses uncertain tax positions in accordance with the provisions of the Financial Accounting Standards Board ("FASB") Accounting Standards Codification ("ASC") Topic 740-10, Income Taxes. The Organization recognizes the tax benefit from uncertain tax positions only if it is more likely than not that the tax positions will be sustained on examination by the tax authorities, based on the technical merits of the position. The tax benefit is measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. The Organization recognizes interest and penalties related to income tax matters in operating expenses. There were no uncertain tax positions as of December 31, 2015 and 2014. 0 0 0 0 0 0 0 0 0 STEVEN PACKER MD President 0 660471 0 231250 0 37625 0 279163 0 30232 0 1238741 0 0 Anthony Chavis SECRETARY 0 440375 0 117404 0 24899 0 65442 0 23271 0 671391 0 0 DAVID STRAFACE MD DIRECTOR 216249 0 56930 0 63248 0 23000 0 1006 0 360433 0 0 0 LAURA ZEHM CFO 0 460836 0 125043 0 20873 0 78875 0 23271 0 708898 0 0 ALEXANDER IZMAILOV MD EMPLOYEE 247521 79652 89857 0 33229 0 18000 0 0 0 388607 79652 0 0 JIHAD JAFFER MD EMPLOYEE 275669 61065 64534 0 15332 0 0 0 7714 0 363249 61065 0 0 Nicholas Chee MD EMPLOYEE 349924 2912 53699 0 0 0 24000 0 11177 0 438800 2912 0 0 Pir Shah MD employee 397772 63400 0 0 0 0 24000 0 17601 0 439373 63400 0 0 Michael Galloway MD employee 333793 0 22789 0 0 0 0 0 9594 0 366176 0 0 0 Part I, Line 3 PPC RELIES ON A RELATED ORGANIZATION, COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA, TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS USING ALL OF THE METHODS DESCRIBED ON LINE 3 EXCEPT "FORM 990 OF OTHER ORGANIZATIONS." Form 990, Part VI, Section A, line 3 Cypress Healthcare is a professional physician management company. When the former Executive director left in March, 2012, Cypress Healthcare assumed some of the responsibilities of the ED. Form 990, Part VI, Section B, line 11 the cfo is responsible for reviewing the form 990 before filing. Electronic copies are sent to all board members for review prior to filing. Form 990, Part VI, Section B, line 12c THE ORGANIZATION USES SELF DISCLOSURE BY INTERESTED PERSONS AND MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC BY REQUEST. COMMUNITY HOSPITAL FOUNDATION po box hh MONTEREY CA 93942 942789696 SUPPORT SERVICES CA 501(C)(3) Line 9 N/A 0 COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA Po box hh MONTEREY CA 93942 940760193 HEALTHCARE SERVICES CA 501(C)(3) Line 3 COMMUNITY HOSPITAL FOUNDATION 0 COMMUNITY HOSPITAL PROPERTIES PO box hh MONTEREY CA 93942 942795922 suppORT SERVICES CA 501(C)(3) Line 11a, I COMMUNITY HOSPITAL FOUNDATION 0 COMMUNITY HOSPITAL ENDOWMENTS po box hh mONTEREY CA 93942 942795423 support SERVICES CA 501(C)(3) Line 11a, I COMMUNITY HOSPITAL FOUNDATION 0 Aspire Health Plan 23625 Holman Highway Monterey CA 93940 461567681 Insurance Company CA N/A C 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1