2015-06-15T14:11:37-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2014-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 BARBARA MALICH CEO 3604782366 2015-06-15 1 KYLA DELGADO CPA P01874220 4252506100 2014 2016-04-25 22:37:26Z BARBARA MALICH PO BOX 960 BREMERTON WA 98337 19767132 0 X WWW.PCHSWEB.ORG X 1989 WA PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF KITSAP COUNTY. 13 13 197 30 0 0 1746432 2052118 12481131 16548665 67131 156675 116729 26184 14411423 18783642 0 0 0 0 10667265 11628412 0 0 0 3803147 4598205 14470412 16226617 -58989 2557025 20008154 23338757 6095125 6868703 13913029 16470054 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. 0 0 10804763 0 12916470 MEDICAL: DURING 2014, PCHS PROVIDED 68,028 MEDICAL ENCOUNTERS TO 21,838 PATIENTS AND 5,258 BEHAVIORAL HEALTH ENCOUNTERS TO 1,345 PATIENTS AT FOUR CLINICAL SITES IN BREMERTON (TWO CLINICS), PORT ORCHARD, AND POULSBO. FULLY CLASS A LICENSED 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. 1608867 0 3632195 DENTAL: IN 2014, PCHS PROVIDED 11,434 DENTAL VISITS TO 6,070 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT THE BREMERTON 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. 12413630 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 52 0 197 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 AL PINKHAM PRESIDENT 3.00 X X 0 0 0 EVELYN HETRICK VICE PRESIDENT 2.00 X X 0 0 0 MONICA BERNHARD SECRETARY 2.00 X X 0 0 0 CHRISTOPHER COOK TREASURER 2.00 X X 0 0 0 SHARON TUCKER CHAIR OF HUMAN RESOURCES 2.00 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 YOLANDA FONG DIRECTOR 1.00 X 0 0 0 PAUL HATHAWAY DIRECTOR 1.00 X 0 0 0 RENEE KIMBALL DIRECTOR 1.00 X 0 0 0 JEANELL RASMUSSEN DIRECTOR 1.00 X 0 0 0 RUTHANN RAULSOM DIRECTOR 1.00 X 0 0 0 BARBARA MALICH CEO 40.00 X 193052 0 7800 NANCY SCHNOOR CFO 40.00 X 132452 0 7800 BENJAMIN POTTER CFO 40.00 X 43661 0 7800 JENNIFER KREIDLER-MOSS COO 40.00 X 148190 0 7800 AARON FORSTER CIO 40.00 X 128952 0 7800 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 40.00 X 261400 0 7800 MANDEEP DHAWAN MD PHYSICIAN 40.00 X 204685 0 7800 CLEMENT LE MD PHYSICIAN 40.00 X 186829 0 7800 DONNAVILLE ORTIZ MD PHYSICIAN 40.00 X 181991 0 7800 DARREN CHOTINER MD PHYSICIAN 40.00 X 179318 0 7800 MICHAEL INSANI DENTAL DIRECTOR 40.00 X 168633 0 7800 1829163 0 85800 12 0 1 0 0 1575809 476309 2052118 PATIENT SERVICE REVENUE 621400 16548665 16548665 16548665 83236 83236 1056929 983490 73439 73439 73439 OTHER INCOME 621400 26184 26184 26184 18783642 16548665 0 182859 954507 393992 560515 8550818 6610215 1940603 1233496 940761 292735 889591 663426 226165 828 624 204 57822 43570 14252 215414 162317 53097 916306 889940 26366 879144 728101 151043 34897 4758 30139 99231 70113 29118 127846 106754 21092 580610 439600 141010 65558 52486 13072 EQUIP MAINT & REPAIR 562487 411299 151188 COST SETTLEMENTS 446726 446726 MISCELLANEOUS 289213 168774 120439 COMMUNICATIONS 170674 128725 41949 151449 151449 16226617 12413630 3812987 0 9072845 12540289 42823 42823 608341 966971 157164 150279 148775 137931 12134824 5250728 7368508 6884096 2434229 2549450 113469 66918 62000 0 20008154 23338757 2565021 3557558 2936237 2315775 593867 995370 6095125 6868703 X 13913029 16346128 123926 13913029 16470054 20008154 23338757 2557025 0 X 0 1 X 1 1 1 X 1898233 1712903 1560330 1746432 2052118 8970016 13519002 11594614 12529110 12481131 16548665 66672522 15417235 13307517 14089440 14227563 18600783 75642538 0 0 0 75642538 18662 105747 95696 73660 83236 377001 18662 105747 95696 73660 83236 377001 18519 6089 116729 26184 167521 15435897 13431783 14191225 14417952 18710203 76187060 0.99290 0.99320 0.00490 0.00480 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 578550 578550 6553210 2657094 3896116 2036376 484126 1552250 2966688 2109508 857180 6884096 X 17978590 0 17978590 805052 805052 18783642 16226617 0 16226617 0 16226617 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 4B - OTHER ADJUSTMENTS: OTHER OPERATING INCOME 26,184. UNRESTRICTED CONTRIBUTIONS 17,266. TEMPORARILY RESTRICTED CONTRIBUTIONS 123,926. INVESTMENT GAIN 150,004. POOL SAVINGS REVENUE 487,672. X X X 1 0 0 0 0 0 0 0 0 BARBARA MALICH CEO 193052 0 0 0 0 0 0 0 7800 0 200852 0 0 0 JENNIFER KREIDLER-MOSS COO 148190 0 0 0 0 0 0 0 7800 0 155990 0 0 0 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 261400 0 0 0 0 0 0 0 7800 0 269200 0 0 0 MANDEEP DHAWAN MD PHYSICIAN 204685 0 0 0 0 0 0 0 7800 0 212485 0 0 0 CLEMENT LE MD PHYSICIAN 186829 0 0 0 0 0 0 0 7800 0 194629 0 0 0 DONNAVILLE ORTIZ MD PHYSICIAN 181991 0 0 0 0 0 0 0 7800 0 189791 0 0 0 DARREN CHOTINER MD PHYSICIAN 164289 0 0 0 15029 0 0 0 7800 0 187118 0 0 0 MICHAEL INSANI DENTAL DIRECTOR 168633 0 0 0 0 0 0 0 7800 0 176433 0 0 0 PART I, LINE 4A NANCY SCHNOOR - SEVERANCE PAYMENT - $19,814 DARREN CHOTINER - SEVERANCE PAYMENT - $15,029 A WA HEALTH CARE FACILITIES AUTHORITY 911108929 2005-12-18 3000000 CONSTRUCTION FINANCING 0 0 1 A 684225 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 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 POSTION 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. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORMS 990 ARE PROVIDED UPON REQUEST.