2011-10-17T14:44:54-05:00 2010-12-31 LARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 980041446 990 2010-01-01 943079770 PENINSULA COMMUNITY HEALTH SERVICES PENI 3604782366 PO BOX 960 BREMERTON WA 98337 BARBARA MALICH 3604782366 2011-10-11 1 PAUL M BAILEY 4252506100 2011-10-11 2010 2016-03-07 17:11:31Z BARBARA MALICH PO BOX 960 BREMERTON WA 98337 15869819 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 12 159 35 0 0 1568908 1898233 9462881 13473549 244099 -18844 33051 45453 11308939 15398391 0 0 0 0 8216361 8129706 0 0 0 3254520 3774971 11470881 11904677 -161942 3493714 13748144 17155701 5104497 4946395 8643647 12209306 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 8269509 1241343 11964231 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. 1157231 55645 1509318 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. 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. 9426740 1 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 19 0 159 1 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 JOHN MEHRENS 2.00 X X 0 0 0 TOM FAIRCHILD 2.00 X X 0 0 0 CHRIS COOK 2.00 X X 0 0 0 TINA ROBINSON 2.00 X X 0 0 0 PATRICIA COCHRELL 2.00 X 0 0 0 CRIS CRAIG 2.00 X 0 0 0 EVELYN HETRICK 2.00 X 0 0 0 SALLY SANTANA 2.00 X 0 0 0 CHARLENE GORDON 2.00 X 0 0 0 KISHA THOMAS 2.00 X 0 0 0 MONICA BERNHARD 2.00 X 0 0 0 BARBARA MALICH 40.00 X 143801 0 7800 NANCY SCHNOOR 40.00 X 93287 0 7800 REGINA ROGERS MD 40.00 X X 192671 0 7800 MANDEEP S DHAWAN 40.00 X 159437 0 7800 CLEMENT LE 40.00 X 144814 0 7800 RACHEL ANDERSON 40.00 X 137891 0 7800 MICHAEL INSANI 40.00 X 144946 0 7800 1016847 0 54600 6 0 1 0 0 942423 955810 1898233 PATIENT SERVICE REVENU 621400 13473549 13473549 13473549 35613 35613 14030 14030 14030 14030 416971 426175 45253 -9204 -45253 -54457 -54457 OTHER INCOME 621400 31423 31423 31423 15398391 13519002 0 -18844 1071447 818759 252688 5620332 4326738 1293594 799254 618468 180786 638673 486463 152210 632 525 107 32700 27141 5559 147170 122637 24533 885667 859428 26239 788658 571062 217596 16862 1745 15117 56935 47757 9178 584437 456664 127773 64779 52404 12375 BAD DEBT 479576 479576 EQUIPMENT MAINTENANCE & 266376 189909 76467 COMMUNICATIONS 163837 171102 -7265 TAXES 111691 95354 16337 MISCELLANEOUS 96902 41016 55886 78749 59992 18757 11904677 9426740 2477937 0 2286211 5510540 41335 42504 13917 3095 397670 846566 167805 149430 114383 90538 11982036 3672022 8614440 8310014 1983091 2076813 129292 126201 13748144 17155701 732879 778018 4371618 4168377 5104497 4946395 X 8643647 12209306 8643647 12209306 13748144 17155701 X 3493714 71945 X 0 1 1 X 1 1 X 1467668 2356503 1801546 1568908 1898233 9092858 10304891 8591192 8535475 9495932 13519002 50446492 11772559 10947695 10337021 11064840 15417235 59539350 0 0 0 59539350 165811 166948 43371 33373 18662 428165 165811 166948 43371 33373 18662 428165 11938370 11114643 10380392 11098213 15435897 59967515 0.99290 0.99100 0.00710 0.00900 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 609727 609727 8329272 1988601 6340671 3043037 1683421 1359616 8310014 15398391 11904677 3493714 71945 71945 3565659 15515589 71945 45253 117198 15398391 0 15398391 11949930 45253 45253 11904677 0 11904677 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. X X X 0 0 0 0 0 0 0 0 0 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 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. 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 GAINS ON INVESTMENTS: 71,945.