2012-06-27T18:39:53-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 980041446 990 2011-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 BARBARA MALICH 3604782366 2012-06-21 1 PAUL M BAILEY P00292653 4252506100 2012-06-21 2011 2016-02-24 21:20:13Z BARBARA MALICH PO BOX 960 BREMERTON WA 98337 13431783 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. 12 12 157 40 0 0 1898233 1712903 13473549 11594614 -18844 105657 45453 18519 15398391 13431693 0 0 0 0 8129706 8794362 0 0 0 3774971 2894447 11904677 11688809 3493714 1742884 17155701 20484633 4946395 6547644 12209306 13936989 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 7733671 9946703 MEDICAL: DURING 2011, PCHS PROVIDED MEDICAL AND BEHAVIORAL HEALTH SERVICES FOR 20,687 ADULTS AND CHILDREN AT THREE CLINICS IN BREMERTON, PORT ORCHARD, AND POULSBO. FULLY LICENSED CLASS A PHARMACIES LOCATED AT ALL THREE 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; NEWBORN AND WELL CHILD CARE; WOMEN'S BREAST AND CERVICAL HEALTH CARE; FAMILY PLANNING AND PREGNANCY TESTING; CHRONIC DISEASE CARE; 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. 1103752 1666430 DENTAL: IN 2011, PCHS PROVIDED DENTAL VISITS TO 5,074 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. 8837423 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 18 0 1 157 1 0 0 0 0 0 0 0 0 0 0 X 12 12 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 2.00 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 BILL MCKENZIE 2.00 X 0 0 0 CASSIE UNDLIN 2.00 X 0 0 0 KIM MCKOY 2.00 X 0 0 0 PATRICIA COCHRELL 2.00 X 0 0 0 REIKO SO 2.00 X 0 0 0 RICHARD LEMIEUX 2.00 X 0 0 0 SHARON TUCKER 2.00 X 0 0 0 YOLANDA FONG 2.00 X 0 0 0 BARBARA MALICH 40.00 X 150852 0 7800 NANCY SCHNOOR 40.00 X 96845 0 7800 AARON FORSTER 40.00 X 28363 0 7800 REGINA BONNEVIE ROGERS MD 40.00 X 202377 0 7800 CLEMENT LE MD 40.00 X 159195 0 7800 DONNA ORTIZ MD 40.00 X 140970 0 7800 MANDEEP DHAWAN MD 40.00 X 153137 0 7800 RACHEL ANDERSON MD 40.00 X 136689 0 7800 NOBUHIKO KIRA MD 40.00 X 135684 0 7800 1204112 0 70200 16 0 1 0 ALDRICH & ASSOCIATES 810 240TH ST SE BOTHELL WA 98021 GENERAL CONTRACTOR 456068 1 1036636 676267 1712903 PATIENT SERVICE REVENU 621400 11594614 11594614 11594614 105747 105747 90 -90 -90 -90 OTHER INCOME 621400 18519 18519 18519 13431693 11613133 0 105657 509637 210177 299460 6585309 5106957 1478352 1265409 971801 293608 434007 327897 106110 25095 15192 9903 32430 19633 12797 66142 40042 26100 788488 759128 29360 594868 443284 151584 22008 2294 19714 81375 65137 16238 194946 160340 34606 600517 476392 124125 63859 51713 12146 EQUIPMENT MAINTENANCE & 342412 246238 96174 MISCELLANEOUS 301161 192678 108483 COMMUNICATIONS 137650 105024 32626 BAD DEBT -356504 -356504 11688809 8837423 2851386 0 5510540 8013691 42504 42610 3095 0 846566 1060212 149430 155925 90538 105453 13087661 4270122 8310014 8817539 2076813 2165510 126201 123693 17155701 20484633 778018 2586565 4168377 3961079 4946395 6547644 X 12209306 13936989 12209306 13936989 17155701 20484633 X 1742884 -15201 X 0 1 1 X 1 1 X 2356503 1801546 1568908 1898233 1712903 9338093 8591192 8535475 9495932 13519002 11594614 51736215 10947695 10337021 11064840 15417235 13307517 61074308 0 0 0 61074308 166948 43371 33373 18662 105747 368101 166948 43371 33373 18662 105747 368101 11114643 10380392 11098213 15435897 13413264 61442409 0.99400 0.99290 0.00600 0.00710 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 609727 609727 8329272 2305817 6023455 3531583 1964305 1567278 617079 617079 8817539 13431693 11688809 1742884 -15111 -90 -15201 1727683 13416582 -15111 -15111 13431693 0 13431693 11688899 90 90 11688809 0 11688809 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2008. PART XI, LINE 8 - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS -90. PART XIII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON ASSET DISPOSAL 90. X X X 0 0 0 0 0 0 0 0 0 BARBARA MALICH 150852 0 0 0 0 0 0 0 7800 0 158652 0 0 0 REGINA BONNEVIE ROGERS MD 202377 0 0 0 0 0 0 0 7800 0 210177 0 0 0 CLEMENT LE MD 159195 0 0 0 0 0 0 0 7800 0 166995 0 0 0 MANDEEP DHAWAN MD 153137 0 0 0 0 0 0 0 7800 0 160937 0 0 0 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -15,111. LOSS ON DISPOSAL OF ASSETS -90. TOTAL TO FORM 990, PART XI, LINE 5: -15,201.