PENINSULA COMMUNITY HEALTH SERVICES: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- PENINSULA COMMUNITY HEALTH SERVICES (EIN 94-3079770)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-10-17
- IRS object ID
- 201112909349301036
- Schema version
- 2010v3.4
- Note
- A later return for the same period supersedes this one.
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-10-17T14:44:54-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3000 NORTHUP WAY SUITE 200 | AddressLine1 |
| City | BELLEVUE | City |
| State | WA | State |
| ZIP Code | 980041446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 943079770 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PENINSULA COMMUNITY HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PENI | NameControl |
| Phone | 3604782366 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 960 | AddressLine1 |
| City | BREMERTON | City |
| State | WA | State |
| ZIP Code | 98337 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BARBARA MALICH | Name |
| Title | CEO | Title |
| Phone | 3604782366 | Phone |
| Date Signed | 2011-10-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PAUL M BAILEY | Name |
| Phone | 4252506100 | Phone |
| Date Prepared | 2011-10-11 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | BARBARA MALICH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 960 | AddressLine1 |
| City | BREMERTON | City |
| State | WA | State |
| ZIP Code | 98337 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 15869819 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PCHSWEB.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1989 | YearFormation |
| State Legal Domicile | WA | StateLegalDomicile |
| Activity Or Mission Description | PCHS IS A COMMUNITY BASED NONPROFIT ORGANIZATION DEDICATED TO PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF KITSAP COUNTY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 159 | TotalNbrEmployees |
| Total Nbr Volunteers | 35 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1568908 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1898233 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 9462881 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 13473549 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 244099 | InvestmentIncomePriorYear |
| Investment Income Current Year | -18844 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 33051 | OtherRevenuePriorYear |
| Other Revenue Current Year | 45453 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11308939 | TotalRevenuePriorYear |
| Total Revenue Current Year | 15398391 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8216361 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8129706 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3254520 | OtherExpensePriorYear |
| Other Expenses Current Year | 3774971 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 11470881 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11904677 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -161942 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3493714 | RevenuesLessExpensesCY |
| Total Assets BOY | 13748144 | TotalAssetsBOY |
| Total Assets EOY | 17155701 | TotalAssetsEOY |
| Total Liabilities BOY | 5104497 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4946395 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8643647 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 12209306 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8269509 | Expense |
| Grants | 1241343 | Grants |
| Revenue | 11964231 | Revenue |
| Description | MEDICAL: DURING 2010, PCHS PROVIDED MEDICAL AND BEHAVIORAL HEALTH SERVICES FOR 20,089 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. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1157231 | Expense |
| Grants | 55645 | Grants |
| Revenue | 1509318 | Revenue |
| Description | DENTAL: IN 2010, PCHS PROVIDED DENTAL VISISTS TO 5,075 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 |
Activity Other ActivityOther (2 entries)
| DescriptionDescription |
|---|
| DURING 2009, PCHS PROVIDED MEDICAL AND BEHAVIORAL HEALTH SERVICES FOR 17,900 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 SERCICES TO BUSINESSES AND COMMUNITY ORGANIZATIONS. PCHS IS PRESENT AT VARIOUS HELATH 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 SCALE BASED ON THEIR INCOME. |
| IN 2009, PCHS PROVIDED DENTAL VISITS TO 4,844 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATAIVE 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. SERVICES ARE BILLED ON A SLIDING FEE SCALE BASED ON INCOME. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 9426740 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 19 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 159 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WA | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NANCY SCHNOOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3604782366 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 960 | AddressLine1 |
| City | BREMERTON | City |
| State | WA | State |
| ZIP Code | 98337 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JOHN MEHRENS | ||||||||
| PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | ||
| TOM FAIRCHILD | ||||||||
| VICE PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | ||
| CHRIS COOK | ||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | ||
| TINA ROBINSON | ||||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | ||
| PATRICIA COCHRELL | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| CRIS CRAIG | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| EVELYN HETRICK | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| SALLY SANTANA | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| CHARLENE GORDON | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| KISHA THOMAS | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| MONICA BERNHARD | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| BARBARA MALICH | ||||||||
| CEO | 40.00 | X | 143801 | 0 | 7800 | |||
| NANCY SCHNOOR | ||||||||
| CFO | 40.00 | X | 93287 | 0 | 7800 | |||
| REGINA ROGERS MD | ||||||||
| MED DIRECTOR | 40.00 | 192671 | 0 | 7800 | X | X | ||
| MANDEEP S DHAWAN | ||||||||
| PHYSICIAN | 40.00 | 159437 | 0 | 7800 | X | |||
| CLEMENT LE | ||||||||
| PHYSICIAN | 40.00 | 144814 | 0 | 7800 | X | |||
| RACHEL ANDERSON | ||||||||
| DENTIST | 40.00 | 137891 | 0 | 7800 | X | |||
| MICHAEL INSANI | ||||||||
| PHYSICIAN | 40.00 | 144946 | 0 | 7800 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1016847 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 54600 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Government Grants | 942423 | GovernmentGrants |
| All Other Contributions | 955810 | AllOtherContributions |
| Total Contributions | 1898233 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 13473549 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13473549 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 13473549 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 35613 | TotalRevenueColumn |
| Exclusion | $35,613 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14030 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14030 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14030 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14030 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 416971 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 426175 | Securities |
| Other | 45253 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -9204 | Securities |
| Other | -45253 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -54457 | TotalRevenueColumn |
| Exclusion | -$54,457 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER INCOME | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 31423 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31423 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 31423 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15398391 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13519002 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$18,844 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1071447 | Total |
| Program Services | 818759 | ProgramServices |
| Management And General | 252688 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5620332 | Total |
| Program Services | 4326738 | ProgramServices |
| Management And General | 1293594 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 799254 | Total |
| Program Services | 618468 | ProgramServices |
| Management And General | 180786 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 638673 | Total |
| Program Services | 486463 | ProgramServices |
| Management And General | 152210 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 632 | Total |
| Program Services | 525 | ProgramServices |
| Management And General | 107 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32700 | Total |
| Program Services | 27141 | ProgramServices |
| Management And General | 5559 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147170 | Total |
| Program Services | 122637 | ProgramServices |
| Management And General | 24533 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 885667 | Total |
| Program Services | 859428 | ProgramServices |
| Management And General | 26239 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 788658 | Total |
| Program Services | 571062 | ProgramServices |
| Management And General | 217596 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16862 | Total |
| Program Services | 1745 | ProgramServices |
| Management And General | 15117 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56935 | Total |
| Program Services | 47757 | ProgramServices |
| Management And General | 9178 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 584437 | Total |
| Program Services | 456664 | ProgramServices |
| Management And General | 127773 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64779 | Total |
| Program Services | 52404 | ProgramServices |
| Management And General | 12375 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 479576 | 479576 | |
| EQUIPMENT MAINTENANCE & | 266376 | 189909 | 76467 |
| COMMUNICATIONS | 163837 | 171102 | -7265 |
| TAXES | 111691 | 95354 | 16337 |
| MISCELLANEOUS | 96902 | 41016 | 55886 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78749 | Total |
| Program Services | 59992 | ProgramServices |
| Management And General | 18757 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11904677 | Total |
| Program Services | 9426740 | ProgramServices |
| Management And General | 2477937 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2286211 | BOY |
| EOY | 5510540 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41335 | BOY |
| EOY | 42504 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13917 | BOY |
| EOY | 3095 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 397670 | BOY |
| EOY | 846566 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167805 | BOY |
| EOY | 149430 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 114383 | BOY |
| EOY | 90538 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 11982036 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 3672022 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8614440 | BOY |
| EOY | 8310014 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1983091 | BOY |
| EOY | 2076813 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129292 | BOY |
| EOY | 126201 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13748144 | BOY |
| EOY | 17155701 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 732879 | BOY |
| EOY | 778018 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4371618 | BOY |
| EOY | 4168377 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5104497 | BOY |
| EOY | 4946395 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8643647 | BOY |
| EOY | 12209306 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8643647 | BOY |
| EOY | 12209306 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13748144 | BOY |
| EOY | 17155701 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3493714 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 71945 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1467668 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2356503 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1801546 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1568908 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1898233 | CurrentTaxYear |
| Total | 9092858 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 10304891 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8591192 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 8535475 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9495932 | CurrentTaxYearMinus1Year |
| Current Tax Year | 13519002 | CurrentTaxYear |
| Total | 50446492 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 11772559 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 10947695 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 10337021 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 11064840 | CurrentTaxYearMinus1Year |
| Current Tax Year | 15417235 | CurrentTaxYear |
| Total | 59539350 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 59539350 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 165811 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 166948 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 43371 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 33373 | CurrentTaxYearMinus1Year |
| Current Tax Year | 18662 | CurrentTaxYear |
| Total | 428165 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 165811 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 166948 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 43371 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 33373 | CurrentTaxYearMinus1Year |
| Current Tax Year | 18662 | CurrentTaxYear |
| Total | 428165 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 11938370 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 11114643 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 10380392 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 11098213 | CurrentTaxYearMinus1Year |
| Current Tax Year | 15435897 | CurrentTaxYear |
| Total | 59967515 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99290 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99100 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00710 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00900 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 609727 | InvestmentCostOrOtherBasis |
| Book Value | 609727 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 8329272 | InvestmentCostOrOtherBasis |
| Depreciation | 1988601 | Depreciation |
| Book Value | 6340671 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 3043037 | InvestmentCostOrOtherBasis |
| Depreciation | 1683421 | Depreciation |
| Book Value | 1359616 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8310014 | TotalOfBookValueLandBuildings |
| Total Revenue | 15398391 | TotalRevenue |
| Total Expenses | 11904677 | TotalExpenses |
| Excess Or Deficit For Year | 3493714 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 71945 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 71945 | TotalAdjustments |
| Excess Or Deficit Per FS | 3565659 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 15515589 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 71945 | NetUnrealizedGainsInvestments |
| Other Revenues | 45253 | OtherRevenues |
| Revenue Not Rptd F990 | 117198 | RevenueNotRptdF990 |
| Revenue Subtotal | 15398391 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 15398391 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11949930 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 45253 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 45253 | ExpensesNotRptdF990 |
| Expenses Subtotal | 11904677 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 11904677 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | 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 UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740OF 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 2007. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BARBARA MALICH | |||||||||||||
| 143801 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7800 | 0 | 151601 | 0 | 0 | 0 |
| REGINA ROGERS MD | |||||||||||||
| 192671 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7800 | 0 | 200471 | 0 | 0 | 0 |
| MANDEEP S DHAWAN | |||||||||||||
| 159437 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7800 | 0 | 167237 | 0 | 0 | 0 |
| CLEMENT LE | |||||||||||||
| 144814 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7800 | 0 | 152614 | 0 | 0 | 0 |
| MICHAEL INSANI | |||||||||||||
| 144946 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7800 | 0 | 152746 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | LINE 11A EXPLANATION - FORM 990 IS REVIEWED BEFORE SIGNATURE BY BOTH THE CFO AND CEO, WHO ALSO PRESENT REPORT TO THE BOARD. | |
| 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 12C | |
| 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 B, LINE 15 | |
| ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORMS 990 ARE PROVIDED UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 71,945. | FORM 990, PART XI, LINE 5: |
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