PENINSULA COMMUNITY HEALTH SERVICES: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PENINSULA COMMUNITY HEALTH SERVICES (EIN 94-3079770)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-13
IRS object ID
201323179349304057
Schema version
2012v2.1
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

FieldValueIRS element (for citing)
Timestamp2013-11-13T13:44:04-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13000 NORTHUP WAY SUITE 200AddressLine1
CityBELLEVUECity
StateWAState
ZIP Code98004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN943079770EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PENINSULA COMMUNITY HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPENINameControl
Phone3604782366Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 960AddressLine1
CityBREMERTONCity
StateWAState
ZIP Code98337ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBARBARA MALICHName
TitleCEOTitle
Phone3604782366Phone
Date Signed2013-11-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NamePAUL MBAILEYName
PTINP00292653PTIN
Phone4252506100Phone
Date Prepared2013-11-05DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBARBARA MALICHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 960AddressLine1
CityBREMERTONCity
StateWAState
ZIP Code98337ZIPCode
FieldValueIRS element (for citing)
Gross Receipts14960564GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PCHSWEB.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1989YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionPCHS IS A COMMUNITY BASED NONPROFIT ORGANIZATION DEDICATED TO PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF KITSAP COUNTY.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees173TotalNbrEmployees
Total Nbr Volunteers24TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1712903ContributionsGrantsPriorYear
Contributions Grants Current Year1560330ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11594614ProgramServiceRevenuePriorYear
Program Service Revenue CY12529110ProgramServiceRevenueCY
Investment Income Prior Year105657InvestmentIncomePriorYear
Investment Income Current Year-142353InvestmentIncomeCurrentYear
Other Revenue Prior Year18519OtherRevenuePriorYear
Other Revenue Current Year6089OtherRevenueCurrentYear
Total Revenue Prior Year13431693TotalRevenuePriorYear
Total Revenue Current Year13953176TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8794362SalariesEtcPriorYear
Salaries Etc Current Year10283345SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2894447OtherExpensePriorYear
Other Expenses Current Year3665683OtherExpensesCurrentYear
Total Expenses Prior Year11688809TotalExpensesPriorYear
Total Expenses Current Year13949028TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1742884RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4148RevenuesLessExpensesCY
Total Assets BOY20484633TotalAssetsBOY
Total Assets EOY20258145TotalAssetsEOY
Total Liabilities BOY6547644TotalLiabilitiesBOY
Total Liabilities EOY6286122TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY13936989NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY13972023NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPCHS 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense9562088Expense
Revenue9611360Revenue
DescriptionMEDICAL: DURING 2012, PCHS PROVIDED MEDICAL AND BEHAVIORAL HEALTH SERVICES FOR 19,991 ADULTS AND CHILDREN AT FOUR CLINICS IN BREMERTON(2 CLINICS), PORT ORCHARD, AND POULSBO. FULLY LICENSED CLASS A PHARMACIES LOCATED AT ALL FOUR HEALTH CENTERS WERE AVAILABLE TO DISBURSE LOW-COST MEDICATIONS TO ALL OF ITS QUALIFIED PATIENTS. SERVICES INCLUDE 24 HOUR ON-CALL CARE, ROUTINE PHYSICALS, IMMUNIZATIONS AND FLU SHOTS; MINOR SURGERY; CANCER SCREENING; HEALTH EDUCATION AND COMMUNITY OUTREACH SERVICES TO BUSINESSES AND COMMUNITY ORGANIZATIONS. PCHS IS PRESENT AT VARIOUS HEALTH RELATED EVENTS THROUGHOUT THE YEAR TO PROMOTE ITS SERVICES TO THOSE WHO NEED IT MOST. PATIENTS ARE CHARGED FOR SERVICES BASED ON A SLIDING FEE SCALED BASED ON THEIR INCOME.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1238338Expense
Revenue2917750Revenue
DescriptionDENTAL: IN 2012, PCHS PROVIDED DENTAL VISITS TO 5,489 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATATIVE DENTAL 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.Description
FieldValueIRS element (for citing)
Total Program Service Expense10800426TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109619NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees173NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1NANCY SCHNOORBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3604782366TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 960AddressLine1
CityBREMERTONCity
StateWAState
ZIP Code98337ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
AL PINKHAM
PRESIDENT3.00XX000
EVELYN HETRICK
VICE PRESIDENT2.00X000
MONICA BERNHARD
SECRETARY2.00X000
CHRISTOPHER COOK
TREASURER2.00X000
CASSIE UNDLIN
DIRECTOR1.00X000
KIM MCKOY
DIRECTOR1.00X000
PATRICIA COCHRELL
CHAIR OF QUALITY MANAGEMENT2.00X000
REIKO SO
DIRECTOR1.00X000
RICHARD LEMIEUX
DIRECTOR1.00X000
SHARON TUCKER
CHAIR OF HUMAN RESOURCE COMMITTEE2.00X000
YOLANDA FONG
DIRECTOR1.00X000
SHARON CROMLEY
DIRECTOR1.00X007800
PAUL HATHAWAY
DIRECTOR1.00X000
BRITTNEY MCGHEE
DIRECTOR1.00X000
BARBARA MALICH
CEO40.00X16069507800
NANCY SCHNOOR
CFO40.00X10502607800
AARON FORSTER
CIO40.00X10962307800
REGINA BONNEVIE ROGERS MD
MED DIRECTOR40.0021733607800X
CLEMENT LE MD
PHYSICIAN40.0015818007800X
MANDEEP DHAWAN MD
PHYSICIAN40.0016531607800X
RACHEL ANDERSON MD
DENTIST40.0014294807800X
OSCAR COGAN MD
PHYSICIAN40.0015849000X
MICHAEL WALDMAN MD
PHYSICIAN40.0015341800X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1371032TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation62400TotalOtherCompensation
Number Individuals GT100 K23NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants1123154GovernmentGrants
All Other Contributions437176AllOtherContributions
Total Contributions1560330TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUEDescription
Business Code621400BusinessCode
Total Revenue Column12529110TotalRevenueColumn
Related Or Exempt Function Income12529110RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue12529110TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column95696TotalRevenueColumn
Exclusion$95,696ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities687965Securities
Other81374Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities685453Securities
Other321935Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities2512Securities
Other-240561Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-238049TotalRevenueColumn
Exclusion-$238,049ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER INCOMEDescription
Business Code621400BusinessCode
Total Revenue Column6089TotalRevenueColumn
Exclusion$6,089ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue6089TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13953176TotalRevenueColumn
Related Or Exempt Function Income12529110RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$136,264ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total623880Total
Program Services225136ProgramServices
Management And General398744ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7757979Total
Program Services6170826ProgramServices
Management And General1587153ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1407605Total
Program Services1081877ProgramServices
Management And General325728ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total493881Total
Program Services379594ProgramServices
Management And General114287ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total61320Total
Program Services31837ProgramServices
Management And General29483ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total11877Total
Program Services6166ProgramServices
Management And General5711ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total160948Total
Program Services83562ProgramServices
Management And General77386ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total785841Total
Program Services758115ProgramServices
Management And General27726ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total787057Total
Program Services639442ProgramServices
Management And General147615ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total32782Total
Program Services6845ProgramServices
Management And General25937ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total99267Total
Program Services78083ProgramServices
Management And General21184ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total184524Total
Program Services150876ProgramServices
Management And General33648ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total622228Total
Program Services511821ProgramServices
Management And General110407ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total60290Total
Program Services51768ProgramServices
Management And General8522ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MISCELLANEOUS337444226696110748
EQUIPMENT MAINTENANCE &33706725510281965
COMMUNICATIONS15740012507032330
BAD DEBT1761017610

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total10028Total
Management And General10028ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13949028Total
Program Services10800426ProgramServices
Management And General3148602ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY8013691BOY
EOY8799873EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY42610BOY
EOY42717EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1060212BOY
EOY766726EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY155925BOY
EOY159979EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY105453BOY
EOY146880EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12556773LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4619231LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8817539BOY
EOY7937542EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2165510BOY
EOY2283242EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY123693BOY
EOY121186EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY20484633BOY
EOY20258145EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2586565BOY
EOY2536047EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3961079BOY
EOY3750075EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6547644BOY
EOY6286122EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY13936989BOY
EOY13972023EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY13936989BOY
EOY13972023EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20484633BOY
EOY20258145EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses4148ReconcilationRevenueExpenses
Reconciliation Unrealized Invest30886ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1801546CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1568908CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1898233CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1712903CurrentTaxYearMinus1Year
Current Tax Year1566419CurrentTaxYear
Total8548009Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8535475CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9495932CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13519002CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11594614CurrentTaxYearMinus1Year
Current Tax Year11997908CurrentTaxYear
Total55142931Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10337021CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11064840CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15417235CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13307517CurrentTaxYearMinus1Year
Current Tax Year13564327CurrentTaxYear
Total63690940Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50963690940PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years43371CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years33373CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18662CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year105747CurrentTaxYearMinus1Year
Current Tax Year119066CurrentTaxYear
Total320219Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years43371CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years33373CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18662CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year105747CurrentTaxYearMinus1Year
Current Tax Year119066CurrentTaxYear
Total320219Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10380392CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11098213CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15435897CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13413264CurrentTaxYearMinus1Year
Current Tax Year13683393CurrentTaxYear
Total64011159Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99500PublicSupportPercentage509
Prior Year Support Percentage0.99400PriorYearSupportPercentage
Investment Income Percentage0.00500InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00600PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis578550OtherCostOrOtherBasis
Book Value578550BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8546037OtherCostOrOtherBasis
Depreciation2476784Depreciation
Book Value6069253BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3432186OtherCostOrOtherBasis
Depreciation2142447Depreciation
Book Value1289739BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7937542TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt14214595TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments30886NetUnrealizedGainsInvestments
Other Revenues240561OtherRevenues
Revenue Not Rptd F990271447RevenueNotRptdF990
Revenue Subtotal13943148RevenueSubtotal
Other Revenues Not Included10028OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt10028RevenueNotRptdOnFinStmt
Total Revenue Per Form99013953176TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt14179561TotExpensesEtcAuditedFinclStmt
Other Expenses Included240561OtherExpensesIncluded
Expenses Not Rptd F990240561ExpensesNotRptdF990
Expenses Subtotal13939000ExpensesSubtotal
Other Expenses Not Included10028OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt10028ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013949028TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: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 PENINSULA COMMUNITY HEALTH SERVICES' TAX POSITIONS AND CONCLUDED THAT PENINSULA COMMUNITY HEALTH SERVICES 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. PENINSULA COMMUNITY HEALTH SERVICES IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2009.
PART XI, LINE 2D - OTHER ADJUSTMENTS:LOSS ON ASSET DISPOSAL 240,561.
PART XI, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT EXPENSES 10,028.
PART XII, LINE 2D - OTHER ADJUSTMENTS:LOSS ON ASSET DISPOSAL 240,561.
PART XII, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT EXPENSES 10,028.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BARBARA MALICH
CEO160695000000078000168495000
REGINA BONNEVIE ROGERS MD
MED DIRECTOR217336000000078000225136000
CLEMENT LE MD
PHYSICIAN158180000000078000165980000
MANDEEP DHAWAN MD
PHYSICIAN165316000000078000173116000
RACHEL ANDERSON MD
DENTIST142948000000078000150748000
OSCAR COGAN MD
PHYSICIAN158490000000000158490000
MICHAEL WALDMAN MD
PHYSICIAN153418000000000153418000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
WA HEALTH CARE FACILITIES AUTHORITY
A91110892993978EUWO2003-01-231110000REMODEL OF BREMERTON BUILDING001
WA HEALTH CARE FACILITIES AUTHORITY
B9111089292005-12-183000000CONSTRUCTION FINANCING001

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
A111000064793104520720030011
B300000051942294805820050011

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
A1
B1

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS REVIEWED BEFORE SIGNATURE BY BOTH THE CFO AND CEO, AND IS PRESENTED TO THE FINANCE COMMITTEE. THE BOARD TREASURER WILL MAKE A REPORT TO THE FULL BOARD.
FORM 990, PART VI, SECTION B, LINE 12CPENINSULA 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 15PENINSULA 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 19ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORMS 990 ARE PROVIDED UPON REQUEST.

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