2014-08-13T12:43:59-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2013-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 BARBARA MALICH CEO 3604782366 2014-08-12 1 PAUL MBAILEY CPA P00292653 4252506100 2013 2015-11-30 17:44:51Z BARBARA MALICH PO BOX 960 BREMERTON WA 98337 15817322 0 X WWW.PCHSWEB.ORG X 1989 WA PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF KITSAP COUNTY. 14 14 186 35 0 0 1560330 1746432 12529110 12481131 -142353 67131 6089 116729 13953176 14411423 0 0 0 0 10283345 10667265 0 0 0 3665683 3803147 13949028 14470412 4148 -58989 20258145 20008154 6286122 6095125 13972023 13913029 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 9682025 0 9764319 MEDICAL: DURING 2013, PCHS PROVIDED 64,840 MEDICAL ENCOUNTERS TO 20,299 PATIENTS AND 2,976 BEHAVIORAL HEALTH ENCOUNTERS TO 836 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. 1321799 0 2716812 DENTAL: IN 2013, PCHS PROVIDED 9,370 DENTAL VISITS TO 5,373 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. 11003824 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 22 0 1 186 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 WA X NANCY SCHNOOR 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 PATRICIA COCHRELL CHAIR OF QUALITY MANAGEMENT 2.00 X 0 0 0 SHARON TUCKER CHAIR OF HUMAN RESOURCES 2.00 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 RICHARD LEMIEUX DIRECTOR 1.00 X 0 0 0 BRITTNEY MCGHEE DIRECTOR 1.00 X 0 0 0 KIM MCKOY DIRECTOR 1.00 X 0 0 0 REIKO SO DIRECTOR 1.00 X 0 0 0 CASSIE UNDLIN DIRECTOR 1.00 X 0 0 0 BARBARA MALICH CEO 40.00 X 175024 0 7800 NANCY SCHNOOR CFO 40.00 X 115932 0 7800 JENNIFER KREIDLER-MOSS COO 40.00 X 138941 0 7800 AARON FORSTER CIO 40.00 X 115545 0 7800 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 40.00 X 245106 0 7800 OSCAR COGAN MD PHYSICIAN 40.00 X 174574 0 7800 MANDEEP DHAWAN MD PHYSICIAN 40.00 X 189542 0 7800 CLEMENT LE MD PHYSICIAN 40.00 X 172995 0 7800 ANDREA OPALENIK DO PHYSICIAN 40.00 X 165579 0 7800 DONNA ORTIZ MD PHYSICIAN 40.00 X 170476 0 7800 1663714 0 78000 20 0 1 0 0 1283361 463071 1746432 PATIENT SERVICE REVENUE 621400 12481131 12481131 12481131 73660 73660 1398732 638 1289896 116003 108836 -115365 -6529 -6529 OTHER INCOME 621400 116729 116729 116729 14411423 12481131 0 183860 829548 370299 459249 7913411 6067737 1845674 1146132 883864 262268 778174 578097 200077 25964 17529 8435 35111 23704 11407 209551 141472 68079 850251 816676 33575 858118 717176 140942 34562 4114 30448 88181 67398 20783 119322 99714 19608 526936 437793 89143 60622 50270 10352 EQUIP MAINT & REPAIR 371815 269494 102321 MISCELLANEOUS 319301 192884 126417 COMMUNICATIONS 160514 122704 37810 BAD DEBT 142899 142899 14470412 11003824 3466588 0 8799873 9072845 42717 42823 766726 608341 159979 157164 146880 148775 12090577 4722069 7937542 7368508 2283242 2434229 59186 113469 62000 62000 20258145 20008154 2536047 2565021 3051408 2936237 698667 593867 6286122 6095125 X 13972023 13913029 13972023 13913029 20258145 20008154 -58989 -5 0 X 0 1 X 1 1 1 X 1568908 1898233 1712903 1560330 1746432 8486806 9495932 13519002 11594614 12529110 12481131 59619789 11064840 15417235 13307517 14089440 14227563 68106595 0 0 0 68106595 33373 18662 105747 95696 73660 327138 33373 18662 105747 95696 73660 327138 18519 6089 116729 141337 11098213 15435897 13431783 14191225 14417952 68575070 0.99320 0.99500 0.00480 0.00500 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 578550 578550 6553210 2414868 4138342 2036376 389047 1647329 2922441 1918154 1004287 7368508 X 13715359 115365 115365 13599994 811429 811429 14411423 14470412 0 14470412 0 14470412 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. THE CLINIC IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON ASSET DISPOSAL 115,365. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER OPERATING INCOME 116,729. CONTRIBUTIONS 22,055. INVESTMENT GAIN 176,453. POOL SAVINGS REVENUE 496,192. X X X 0 0 0 0 0 0 0 0 0 BARBARA MALICH CEO 175024 0 0 0 0 0 0 0 7800 0 182824 0 0 0 REGINA BONNEVIE ROGERS MD MEDICAL DIRECTOR 245106 0 0 0 0 0 0 0 7800 0 252906 0 0 0 OSCAR COGAN MD PHYSICIAN 174574 0 0 0 0 0 0 0 7800 0 182374 0 0 0 MANDEEP DHAWAN MD PHYSICIAN 189542 0 0 0 0 0 0 0 7800 0 197342 0 0 0 CLEMENT LE MD PHYSICIAN 172995 0 0 0 0 0 0 0 7800 0 180795 0 0 0 ANDREA OPALENIK DO PHYSICIAN 165579 0 0 0 0 0 0 0 7800 0 173379 0 0 0 DONNA ORTIZ MD PHYSICIAN 170476 0 0 0 0 0 0 0 7800 0 178276 0 0 0 A WA HEALTH CARE FACILITIES AUTHORITY 911108929 93978EUWO 2003-01-23 1110000 REMODEL OF BREMERTON BUILDING 0 0 1 B WA HEALTH CARE FACILITIES AUTHORITY 911108929 2005-12-18 3000000 CONSTRUCTION FINANCING 0 0 1 A 600036 1110000 64793 1045207 2003 0 0 1 1 B 573727 3000000 51942 2948058 2005 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WA HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/23/2013 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.