PENINSULA COMMUNITY HEALTH SERVICES: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- PENINSULA COMMUNITY HEALTH SERVICES (EIN 94-3079770)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-06-03
- IRS object ID
- 201641559349300039
- Schema version
- 2015v2.1
- 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 | 2016-06-03T19:38:04-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 3000 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 | 2015-01-01 | 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 | 2016-05-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KYLA DELGADO CPA | PreparerPersonNm |
| PTIN | P01874220 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2016-12-15 16:53:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $19,816,529 | 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 | 1989 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF KITSAP COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 217 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,052,118 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,872,155 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,548,665 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,734,905 | CYProgramServiceRevenueAmt |
| PY Investment Income | $156,675 | PYInvestmentIncomeAmt |
| CY Investment Income | -$2,095 | CYInvestmentIncomeAmt |
| PY Other Revenue | $26,184 | PYOtherRevenueAmt |
| CY Other Revenue | $64,971 | CYOtherRevenueAmt |
| PY Total Revenue | $18,783,642 | PYTotalRevenueAmt |
| CY Total Revenue | $18,669,936 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | 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 | $11,628,412 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,588,304 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,598,205 | PYOtherExpensesAmt |
| CY Other Expenses | $5,233,033 | CYOtherExpensesAmt |
| PY Total Expenses | $16,226,617 | PYTotalExpensesAmt |
| CY Total Expenses | $17,821,337 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,557,025 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $848,599 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,338,757 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,562,590 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,868,703 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,243,937 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,470,054 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,318,653 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PCHS IS A COMMUNITY BASED NONPROFIT ORGANIZATION DEDICATED TO PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF KITSAP COUNTY. PCHS OFFERS QUALITY, LOW-COST CARE FOR CHILDREN AND ADULTS WITH A TARGET POPULATION OF LOW INCOME, UNINSURED AND UNDERSERVED FAMILIES. SERVICES INCLUDE PRIMARY MEDICAL CARE, DENTAL CARE, MENTAL HEALTH COUNSELING, PHARMACY SERVICES, AND HEALTH EDUCATION AND PROMOTION ACTIVITIES. PATIENTS ARE CHARGED FOR SERVICES ACCORDING TO A SLIDING FEE SCALE BASED ON THEIR INCOME. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,279,942 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $11,457,058 | RevenueAmt |
| Desc | MEDICAL: DURING 2015, PCHS PROVIDED 64,401 MEDICAL ENCOUNTERS TO 22,124 PATIENTS AND 5,979 BEHAVIORAL HEALTH ENCOUNTERS TO 1,372 PATIENTS AT FOUR CLINICAL SITES IN BREMERTON (TWO CLINICS), PORT ORCHARD, AND POULSBO. FULLY LICENSED CLASS A PHARMACIES ARE LOCATED AT ALL FOUR HEALTH CENTERS AND WERE FULLY AVAILABLE TO DISBURSE LOW-COST MEDICATIONS TO ALL OF ITS QUALIFIED PATIENTS. SERVICES INCLUDE PREVENTATIVE SERVICES, IMMUNIZATIONS, SCREENINGS, HEALTH EDUCATION, AND COMMUNITY OUTREACH. PCHS OFFERS ALL SERVICES ON A SLIDING FEE SCHEDULE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,671,483 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $4,277,847 | RevenueAmt |
| Desc | DENTAL: IN 2015, PCHS PROVIDED 14,948 DENTAL VISITS TO 7,134 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT THE BREMERTON AND PORT ORCHARD DENTAL CLINIC AND 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $12,951,425 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | 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 | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 217 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| 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 |
| States Where Copy Of Return Is Fld | WA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BENJAMIN POTTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CHRISTOPHER COOK | ||||||||
| PRESIDENT | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SHARON TUCKER | ||||||||
| VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| YOLANDA FONG | ||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PAUL HATHAWAY | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MONICA BERNHARD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY ANN BEST-RABONZA | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BERYL COCHRAN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SHARON CROMLEY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| EVELYN HETRICK | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RENEE KIMBALL-ROUSE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| AL PINKHAM | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JEANELL RASMUSSEN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RUTHANN RAULSOME | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA MALICH | ||||||||
| CEO | 40.00 | Yes (X) | $202,412 | $0 | $4,875 | |||
| JENNIFER KREIDLER-MOSS | ||||||||
| COO & CEO | 40.00 | Yes (X) | $192,377 | $0 | $7,800 | |||
| BENJAMIN POTTER | ||||||||
| CFO | 40.00 | Yes (X) | $130,733 | $0 | $7,800 | |||
| AARON FORSTER | ||||||||
| CIO | 40.00 | Yes (X) | $121,978 | $0 | $7,800 | |||
| REGINA BONNEVIE ROGERS MD | ||||||||
| MEDICAL DIRECTOR | 40.00 | $276,411 | $0 | $7,800 | Yes (X) | |||
| MICHAEL INSANI DDS | ||||||||
| DENTAL DIRECTOR | 40.00 | $186,178 | $0 | $7,800 | Yes (X) | |||
| MANDEEP DHAWAN MD | ||||||||
| PHYSICIAN | 40.00 | $222,677 | $0 | $7,800 | Yes (X) | |||
| DONNAVILLE ORTIZ MD | ||||||||
| PHYSICIAN | 40.00 | $221,909 | $0 | $7,800 | Yes (X) | |||
| JEFFREY TAN | ||||||||
| PHYSICIAN | 40.00 | $204,976 | $0 | $7,800 | Yes (X) | |||
| JEAN RIQUELME MD | ||||||||
| PHYSICIAN | 40.00 | $204,764 | $0 | $7,800 | Yes (X) | |||
| CLEMENT LE MD | ||||||||
| PHYSICIAN | 40.00 | $202,578 | $0 | $7,800 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,166,993 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $82,875 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 27 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ALDRICH & ASSOCIATES | |||||
| 810 240TH ST SE | BOTHELL | WA | 98021 | CONSTRUCTION | $491,413 |
| CROSS CULTURAL COMMUNICATIONS | |||||
| PO BOX 2166 | SUMNER | WA | 98390 | TRANSLATION | $134,556 |
| ORIENTAL GLOW CLEANING SERVICE | |||||
| 3950 LOCKER ROAD SE | PORT ORCHARD | WA | 98366 | JANITORIAL | $110,913 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $1,314 | FederatedCampaignsAmt |
| Government Grants | $2,191,158 | GovernmentGrantsAmt |
| All Other Contributions | $679,683 | AllOtherContributionsAmt |
| Total Contributions | $2,872,155 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $15,734,905 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,734,905 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,734,905 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $74,842 | TotalRevenueColumnAmt |
| Exclusion | $74,842 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,069,656 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,146,593 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$76,937 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$76,937 | TotalRevenueColumnAmt |
| Exclusion | -$76,937 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $64,971 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $64,971 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $64,971 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,669,936 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,734,905 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $62,876 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,153,964 | TotalAmt |
| Program Services | $638,331 | ProgramServicesAmt |
| Management And General | $515,633 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,163,512 | TotalAmt |
| Program Services | $6,772,494 | ProgramServicesAmt |
| Management And General | $2,391,018 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,366,634 | TotalAmt |
| Program Services | $966,588 | ProgramServicesAmt |
| Management And General | $400,046 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $904,194 | TotalAmt |
| Program Services | $633,623 | ProgramServicesAmt |
| Management And General | $270,571 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,552 | TotalAmt |
| Program Services | $846 | ProgramServicesAmt |
| Management And General | $706 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,850 | TotalAmt |
| Program Services | $21,166 | ProgramServicesAmt |
| Management And General | $17,684 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $321,294 | TotalAmt |
| Program Services | $175,045 | ProgramServicesAmt |
| Management And General | $146,249 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,166,069 | TotalAmt |
| Program Services | $1,130,535 | ProgramServicesAmt |
| Management And General | $35,534 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $840,225 | TotalAmt |
| Program Services | $696,440 | ProgramServicesAmt |
| Management And General | $143,785 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,635 | TotalAmt |
| Program Services | $6,737 | ProgramServicesAmt |
| Management And General | $48,898 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,406 | TotalAmt |
| Program Services | $85,818 | ProgramServicesAmt |
| Management And General | $55,588 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,317 | TotalAmt |
| Program Services | $99,599 | ProgramServicesAmt |
| Management And General | $18,718 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $635,362 | TotalAmt |
| Program Services | $466,792 | ProgramServicesAmt |
| Management And General | $168,570 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,626 | TotalAmt |
| Program Services | $49,709 | ProgramServicesAmt |
| Management And General | $14,917 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| EQUIP MAINT & REPAIR | $1,168,214 | $729,076 | $439,138 |
| MISCELLANEOUS | $320,325 | $184,269 | $136,056 |
| COMMUNICATIONS | $209,709 | $142,908 | $66,801 |
| BAD DEBT | $151,449 | $151,449 | $0 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,821,337 | TotalAmt |
| Program Services | $12,951,425 | ProgramServicesAmt |
| Management And General | $4,869,912 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,540,289 | BOYAmt |
| EOY | $13,302,003 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,823 | BOYAmt |
| EOY | $42,823 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $966,971 | BOYAmt |
| EOY | $1,146,294 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,279 | BOYAmt |
| EOY | $169,318 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,931 | BOYAmt |
| EOY | $128,544 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,089,912 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,858,469 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,884,096 | BOYAmt |
| EOY | $7,231,443 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,549,450 | BOYAmt |
| EOY | $2,502,868 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,918 | BOYAmt |
| EOY | $39,297 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,338,757 | BOYAmt |
| EOY | $24,562,590 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,557,558 | BOYAmt |
| EOY | $4,942,434 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,717,278 | BOYAmt |
| EOY | $2,195,473 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,867 | BOYAmt |
| EOY | $106,030 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,868,703 | BOYAmt |
| EOY | $7,243,937 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,346,128 | BOYAmt |
| EOY | $17,111,063 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,926 | BOYAmt |
| EOY | $207,590 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,470,054 | BOYAmt |
| EOY | $17,318,653 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,338,757 | BOYAmt |
| EOY | $24,562,590 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $848,599 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,712,903 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,560,330 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,746,432 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,052,118 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,872,155 | CurrentTaxYearAmt |
| Total | $9,943,938 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,594,614 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,529,110 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,481,131 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,548,665 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,734,905 | CurrentTaxYearAmt |
| Total | $68,888,425 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,307,517 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,089,440 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,227,563 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,600,783 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,607,060 | CurrentTaxYearAmt |
| Total | $78,832,363 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $78,832,363 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $105,747 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $95,696 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $73,660 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $83,236 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $74,842 | CurrentTaxYearAmt |
| Total | $433,181 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $105,747 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $95,696 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $73,660 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $83,236 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $74,842 | CurrentTaxYearAmt |
| Total | $433,181 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $18,519 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,089 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $116,729 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $26,184 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $64,971 | CurrentTaxYearAmt |
| Total | $232,492 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,431,783 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,191,225 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,417,952 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,710,203 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,746,873 | CurrentTaxYearAmt |
| Total | $79,498,036 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99160 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99290 | PublicSupportPY509Pct |
| Investment Income CY | 0.00540 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00490 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, 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 | $578,550 | OtherCostOrOtherBasisAmt |
| Book Value | $578,550 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,554,913 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,899,032 | DepreciationAmt |
| Book Value | $3,655,881 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,660,099 | OtherCostOrOtherBasisAmt |
| Depreciation | $604,130 | DepreciationAmt |
| Book Value | $2,055,969 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,296,350 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,355,307 | DepreciationAmt |
| Book Value | $941,043 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,231,443 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $18,230,632 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $92,226 | OtherRevenueAmt |
| Revenue Not Reported | $92,226 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,138,406 | RevenueSubtotalAmt |
| Other Revenues Not Included | $531,530 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $531,530 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,669,936 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,821,337 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,821,337 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,821,337 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE CLINIC HAS RECEIVED A DETERMINATION LETTER FROM THE IRS 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 2D - OTHER ADJUSTMENTS: | INVESTMENT LOSS 8,849. NET ASSETS RELEASED FROM RESTRICTION 83,377. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | UNRESTRICTED CONTRIBUTIONS 16,207. POOL SAVINGS REVENUE 73,282. TEMPORARILY RESTRICTED CONTRIBUTIONS 167,041. CAPITAL CONTRIBUTIONS 275,000. |
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 | 0 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BARBARA MALICH | ||||||||||||||
| CEO | $196,378 | $0 | $0 | $0 | $6,034 | $0 | $0 | $0 | $4,875 | $0 | $207,287 | $0 | $0 | $0 |
| JENNIFER KREIDLER-MOSS | ||||||||||||||
| COO & CEO | $192,377 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $200,177 | $0 | $0 | $0 |
| REGINA BONNEVIE ROGERS MD | ||||||||||||||
| MEDICAL DIRECTOR | $276,411 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $284,211 | $0 | $0 | $0 |
| MICHAEL INSANI DDS | ||||||||||||||
| DENTAL DIRECTOR | $186,178 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $193,978 | $0 | $0 | $0 |
| MANDEEP DHAWAN MD | ||||||||||||||
| PHYSICIAN | $222,677 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $230,477 | $0 | $0 | $0 |
| DONNAVILLE ORTIZ MD | ||||||||||||||
| PHYSICIAN | $221,909 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $229,709 | $0 | $0 | $0 |
| JEFFREY TAN | ||||||||||||||
| PHYSICIAN | $204,976 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $212,776 | $0 | $0 | $0 |
| JEAN RIQUELME MD | ||||||||||||||
| PHYSICIAN | $204,764 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $212,564 | $0 | $0 | $0 |
| CLEMENT LE MD | ||||||||||||||
| PHYSICIAN | $202,578 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $210,378 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WA HEALTH CARE FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 911108929 | BondIssuerEIN |
| Bond Issued | 2005-12-18 | BondIssuedDt |
| Issue Price | $3,000,000 | IssuePriceAmt |
| Purpose | CONSTRUCTION FINANCING | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | Yes (1) | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $801,147 | RetiredAmt |
| Total Proceeds | $3,000,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $51,942 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $2,948,058 | CapitalExpendituresAmt |
| Substantial Completion | 2005 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | ISSUER NAME: WA HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/19/2013 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | PCHS OPENED A NEW DENTAL CLINIC IN PORT ORCHARD, WASHINGTON. |
| 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 EXECUTIVE DIRECTOR. 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 11 | 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 WHICH ALL BOARD DIRECTORS ARE REQUIRED TO SIGN ON AN ANNUAL BASIS. EACH BOARD MEMBER UPON SIGNING THE POLICY AGREES TO DISCLOSE A CONFLICT OF INTEREST 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 WHICH INCLUDES A SALARY ANALYSIS OF LIKE JOB DESCRIPTIONS IN THE GEOGRAPHICAL AREA IS COMPLETED BY THE HUMAN RESOURCE DEPARTMENT. ONCE A SALARY SURVEY IS COMPLETED FOR EACH POSITION IT IS PRESENTED TO THE HUMAN RESOURCE COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW. FOR THE POSITION OF THE CEO, THE SALARY DATA, AFTER THE BOARD'S HUMAN RESOURCE COMMITTEE'S REVIEW, IS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. BASED UPON THE INFORMATION PROVIDED, THE EXECUTIVE COMMITTEE DETERMINES THE COMPENSATION FOR THE CEO FOR THE ENSUING YEAR. THIS PROCESS LAST OCCURRED IN 2015. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORMS 990 ARE PROVIDED UPON REQUEST. |
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