2013-11-13T13:44:04-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2012-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 BARBARA MALICH 3604782366 2013-11-07 1 PAUL MBAILEY P00292653 4252506100 2013-11-05 2012 2016-02-24 21:20:13Z BARBARA MALICH PO BOX 960 BREMERTON WA 98337 14960564 0 X WWW.PCHSWEB.ORG X 1989 WA PCHS IS A COMMUNITY BASED NONPROFIT ORGANIZATION DEDICATED TO PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF KITSAP COUNTY. 14 14 173 24 0 0 1712903 1560330 11594614 12529110 105657 -142353 18519 6089 13431693 13953176 0 0 0 0 8794362 10283345 0 0 0 2894447 3665683 11688809 13949028 1742884 4148 20484633 20258145 6547644 6286122 13936989 13972023 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 9562088 9611360 MEDICAL: 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. 1238338 2917750 DENTAL: 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. 10800426 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 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 19 0 1 173 1 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X X NANCY SCHNOOR 3604782366 PO BOX 960 BREMERTON WA 98337 AL PINKHAM 3.00 X X 0 0 0 EVELYN HETRICK 2.00 X 0 0 0 MONICA BERNHARD 2.00 X 0 0 0 CHRISTOPHER COOK 2.00 X 0 0 0 CASSIE UNDLIN 1.00 X 0 0 0 KIM MCKOY 1.00 X 0 0 0 PATRICIA COCHRELL 2.00 X 0 0 0 REIKO SO 1.00 X 0 0 0 RICHARD LEMIEUX 1.00 X 0 0 0 SHARON TUCKER 2.00 X 0 0 0 YOLANDA FONG 1.00 X 0 0 0 SHARON CROMLEY 1.00 X 0 0 7800 PAUL HATHAWAY 1.00 X 0 0 0 BRITTNEY MCGHEE 1.00 X 0 0 0 BARBARA MALICH 40.00 X 160695 0 7800 NANCY SCHNOOR 40.00 X 105026 0 7800 AARON FORSTER 40.00 X 109623 0 7800 REGINA BONNEVIE ROGERS MD 40.00 X 217336 0 7800 CLEMENT LE MD 40.00 X 158180 0 7800 MANDEEP DHAWAN MD 40.00 X 165316 0 7800 RACHEL ANDERSON MD 40.00 X 142948 0 7800 OSCAR COGAN MD 40.00 X 158490 0 0 MICHAEL WALDMAN MD 40.00 X 153418 0 0 1371032 0 62400 23 0 1 0 0 1123154 437176 1560330 PATIENT SERVICE REVENUE 621400 12529110 12529110 12529110 95696 95696 687965 81374 685453 321935 2512 -240561 -238049 -238049 OTHER INCOME 621400 6089 6089 6089 13953176 12529110 0 -136264 623880 225136 398744 7757979 6170826 1587153 1407605 1081877 325728 493881 379594 114287 61320 31837 29483 11877 6166 5711 160948 83562 77386 785841 758115 27726 787057 639442 147615 32782 6845 25937 99267 78083 21184 184524 150876 33648 622228 511821 110407 60290 51768 8522 MISCELLANEOUS 337444 226696 110748 EQUIPMENT MAINTENANCE & 337067 255102 81965 COMMUNICATIONS 157400 125070 32330 BAD DEBT 17610 17610 10028 10028 13949028 10800426 3148602 0 8013691 8799873 42610 42717 1060212 766726 155925 159979 105453 146880 12556773 4619231 8817539 7937542 2165510 2283242 123693 121186 20484633 20258145 2586565 2536047 3961079 3750075 6547644 6286122 X 13936989 13972023 13936989 13972023 20484633 20258145 4148 30886 0 X 0 1 X 1 1 1 X 1801546 1568908 1898233 1712903 1566419 8548009 8535475 9495932 13519002 11594614 11997908 55142931 10337021 11064840 15417235 13307517 13564327 63690940 0 0 0 63690940 43371 33373 18662 105747 119066 320219 43371 33373 18662 105747 119066 320219 10380392 11098213 15435897 13413264 13683393 64011159 0.99500 0.99400 0.00500 0.00600 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 578550 578550 8546037 2476784 6069253 3432186 2142447 1289739 7937542 X 14214595 30886 240561 271447 13943148 10028 10028 13953176 14179561 240561 240561 13939000 10028 10028 13949028 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. X X X 0 0 0 0 0 0 0 0 0 BARBARA MALICH 160695 0 0 0 0 0 0 0 7800 0 168495 0 0 0 REGINA BONNEVIE ROGERS MD 217336 0 0 0 0 0 0 0 7800 0 225136 0 0 0 CLEMENT LE MD 158180 0 0 0 0 0 0 0 7800 0 165980 0 0 0 MANDEEP DHAWAN MD 165316 0 0 0 0 0 0 0 7800 0 173116 0 0 0 RACHEL ANDERSON MD 142948 0 0 0 0 0 0 0 7800 0 150748 0 0 0 OSCAR COGAN MD 158490 0 0 0 0 0 0 0 0 0 158490 0 0 0 MICHAEL WALDMAN MD 153418 0 0 0 0 0 0 0 0 0 153418 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 1110000 64793 1045207 2003 0 0 1 1 B 3000000 51942 2948058 2005 0 0 1 1 A 1 B 1 FORM 990, PART VI, SECTION B, LINE 11 THE 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 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.