2016-06-03T19:38:04-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2015-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 JENNIFER KREIDLER-MOSS CEO 3604782366 2016-05-25 1 KYLA DELGADO CPA P01874220 4252506100 2015 2016-12-15 16:53:06Z JENNIFER KREIDLER-MOSS PO BOX 960 BREMERTON WA 98337 19816529 0 X WWW.PCHSWEB.ORG X 1989 WA PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF KITSAP COUNTY. 13 13 217 30 0 0 2052118 2872155 16548665 15734905 156675 -2095 26184 64971 18783642 18669936 0 0 0 0 11628412 12588304 0 0 0 4598205 5233033 16226617 17821337 2557025 848599 23338757 24562590 6868703 7243937 16470054 17318653 X 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. 1 0 10279942 0 11457058 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. 2671483 0 4277847 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. 0 12951425 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 29 0 217 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 WA X BENJAMIN POTTER 3604782366 PO BOX 960 BREMERTON WA 98337 CHRISTOPHER COOK PRESIDENT 3.00 X X 0 0 0 SHARON TUCKER 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 MONICA BERNHARD DIRECTOR 1.00 X 0 0 0 MARY ANN BEST-RABONZA DIRECTOR 1.00 X 0 0 0 BERYL COCHRAN DIRECTOR 1.00 X 0 0 0 SHARON CROMLEY DIRECTOR 1.00 X 0 0 0 EVELYN HETRICK DIRECTOR 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 RUTHANN RAULSOME DIRECTOR 1.00 X 0 0 0 BARBARA MALICH CEO 40.00 X 202412 0 4875 JENNIFER KREIDLER-MOSS COO & CEO 40.00 X 192377 0 7800 BENJAMIN POTTER CFO 40.00 X 130733 0 7800 AARON FORSTER CIO 40.00 X 121978 0 7800 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 40.00 X 276411 0 7800 MICHAEL INSANI DDS DENTAL DIRECTOR 40.00 X 186178 0 7800 MANDEEP DHAWAN MD PHYSICIAN 40.00 X 222677 0 7800 DONNAVILLE ORTIZ MD PHYSICIAN 40.00 X 221909 0 7800 JEFFREY TAN PHYSICIAN 40.00 X 204976 0 7800 JEAN RIQUELME MD PHYSICIAN 40.00 X 204764 0 7800 CLEMENT LE MD PHYSICIAN 40.00 X 202578 0 7800 2166993 0 82875 27 0 1 0 ALDRICH & ASSOCIATES 810 240TH ST SE BOTHELL WA 98021 CONSTRUCTION 491413 CROSS CULTURAL COMMUNICATIONS PO BOX 2166 SUMNER WA 98390 TRANSLATION 134556 ORIENTAL GLOW CLEANING SERVICE 3950 LOCKER ROAD SE PORT ORCHARD WA 98366 JANITORIAL 110913 3 1314 2191158 679683 2872155 PATIENT SERVICE REVENUE 621400 15734905 15734905 15734905 74842 74842 1069656 1146593 -76937 -76937 -76937 OTHER INCOME 621400 64971 0 64971 64971 18669936 15734905 0 62876 1153964 638331 515633 9163512 6772494 2391018 1366634 966588 400046 904194 633623 270571 1552 846 706 38850 21166 17684 321294 175045 146249 1166069 1130535 35534 840225 696440 143785 55635 6737 48898 141406 85818 55588 118317 99599 18718 635362 466792 168570 64626 49709 14917 EQUIP MAINT & REPAIR 1168214 729076 439138 MISCELLANEOUS 320325 184269 136056 COMMUNICATIONS 209709 142908 66801 BAD DEBT 151449 151449 0 17821337 12951425 4869912 0 12540289 13302003 42823 42823 966971 1146294 150279 169318 137931 128544 13089912 5858469 6884096 7231443 2549450 2502868 66918 39297 23338757 24562590 3557558 4942434 2717278 2195473 593867 106030 6868703 7243937 X 16346128 17111063 123926 207590 16470054 17318653 23338757 24562590 848599 0 X 0 1 X 1 1 1 X 1712903 1560330 1746432 2052118 2872155 9943938 11594614 12529110 12481131 16548665 15734905 68888425 13307517 14089440 14227563 18600783 18607060 78832363 0 0 0 78832363 105747 95696 73660 83236 74842 433181 105747 95696 73660 83236 74842 433181 18519 6089 116729 26184 64971 232492 13431783 14191225 14417952 18710203 18746873 79498036 0.99160 0.99290 0.00540 0.00490 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 578550 578550 6554913 2899032 3655881 2660099 604130 2055969 3296350 2355307 941043 7231443 X 18230632 92226 92226 18138406 531530 531530 18669936 17821337 0 17821337 0 17821337 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. X X X X X 0 0 0 0 0 0 0 0 0 BARBARA MALICH CEO 196378 0 0 0 6034 0 0 0 4875 0 207287 0 0 0 JENNIFER KREIDLER-MOSS COO & CEO 192377 0 0 0 0 0 0 0 7800 0 200177 0 0 0 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 276411 0 0 0 0 0 0 0 7800 0 284211 0 0 0 MICHAEL INSANI DDS DENTAL DIRECTOR 186178 0 0 0 0 0 0 0 7800 0 193978 0 0 0 MANDEEP DHAWAN MD PHYSICIAN 222677 0 0 0 0 0 0 0 7800 0 230477 0 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 221909 0 0 0 0 0 0 0 7800 0 229709 0 0 0 JEFFREY TAN PHYSICIAN 204976 0 0 0 0 0 0 0 7800 0 212776 0 0 0 JEAN RIQUELME MD PHYSICIAN 204764 0 0 0 0 0 0 0 7800 0 212564 0 0 0 CLEMENT LE MD PHYSICIAN 202578 0 0 0 0 0 0 0 7800 0 210378 0 0 0 A WA HEALTH CARE FACILITIES AUTHORITY 911108929 2005-12-18 3000000 CONSTRUCTION FINANCING 0 0 1 A 801147 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 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.