2024-05-02T12:40:23-05:00 2023-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2022-07-01 680437840 PETALUMA HEALTH CENTER INC PETA 7075597500 1179 NORTH MCDOWELL BLVD PETALUMA CA 94954 MOLLY JOUANEH CFO 7075597500 2024-05-02 1 MOLLY JOUANEH 999009999 0 MICHAEL LUMSDEN P01262236 4159561500 2024-05-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z PEDRO TOLEDO JD MA MHS 1455 N MCDOWELL BLVD PETALUMA CA 94954 73522685 0 X WWW.PHEALTHCENTER.ORG X 1999 CA TO ENSURE ACCESS & PROVIDE HIGH QUALITY PREVENTION-FOCUSED HEALTH CARE FOR THE COMMUNITIES WE SERVE. 11 10 650 57 0 0 12319234 18644349 51090204 54761399 26992 76779 107856 40158 63544286 73522685 0 0 0 0 44727434 50796973 0 0 0 15281353 20453178 60008787 71250151 3535499 2272534 54279302 57279151 25093010 25686938 29186292 31592213 X PETALUMA HEALTH CENTER'S MISSION IS TO ENSURE ACCESS TO HIGH-QUALITY HEALTH CARE AND ACHIEVE HEALTH EQUITY FOR THE COMMUNITIES WE SERVE. 0 0 32185204 0 33975843 FAMILY PRACTICE SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF FAMILY PRACTICE VISITS DURING FISCAL YEAR 2023 WAS 104,789. 8141623 0 11103247 GENERAL DENTISTRY AND FLUORIDE VARNISHING SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF DENTAL VISITS DURING FISCAL YEAR 2023 WAS 24,951. 4298328 0 5425813 OBSTETRIC AND GYNECOLOGY SERVICES PROVIDED TO PATIENTS, INCLUDING BIRTHING AND PREGNANCY SERVICES. THE TOTAL NUMBER OF OB/GYN VISITS DURING FISCAL YEAR 2023 WERE 13,926. 14800971 0 4256496 OTHER PROGRAM SERVICES INCLUDE INTEGRATED BEHAVIORAL HEALTH, VISION, WELLNESS, AND NUTRITION PROGRAMS FOR PATIENTS; ADDITIONALLY, THE ORGANIZATION OPERATES A NURSE PRACTITIONER AND PHYSICIAN'S ASSISTANT RESIDENCY PROGRAM TO TRAIN NEW NP/PA'S IN THE COMMUNITY MEDICINE MODEL OF CARE. 14800971 0 4256496 59426126 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 62 0 1 650 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X MOLLY JOUANEH 7075597578 1455 N MCDOWELL BLVD PETALUMA CA 94954 ROBERT RAMIREZ PRESIDENT 2.00 X X 0 0 0 ELISA VELASQUEZ-ANDRADE MA PHD VP THROUGH 1/2023 / BOARD MEMBER 2.00 X X 0 0 0 TOM ISAAK BS VICE PRESIDENT START 1/2023 2.00 X X 0 0 0 VANESSA LUNA SHANNON SECRETARY THROUGH 10/2022 2.00 X X 0 0 0 PHOEBE ELLIS JDMSW BS SECRETARY START 10/2022 2.00 X X 0 0 0 MARC POUNDS CPA TREASURER THROUGH 5/2023 2.00 X X 0 0 0 ELIZABETH LIZA GOLDBLATT PHD MPA INTERIM TREASURER START 5/2023 2.00 X X 0 0 0 WILLIAM BARRETT BOARD MEMBER 2.00 X 0 0 0 FERNANDO CARRILLO BA CPFA BOARD MEMBER 2.00 X 0 0 0 CECILIA CASTANEDA BA LCSW BOARD MEMBER 2.00 X 0 0 0 SILVIA RODRIGUEZ BOARD MEMBER 2.00 X 0 0 0 TERESA TAYLOR-KING MPA BOARD MEMBER 2.00 X 0 0 0 CATHERINE WEST MD DRPH BOARD MEMBER 2.00 X 0 0 0 KATHRYN POWELL MHA MA CHIEF EXECUTIVE OFFICER 40.00 X 434511 0 51060 RAMONA ENGLISH DMD CHIEF DENTAL OFFICER 40.00 X 319419 0 23101 NURIT LICHT MD CHIEF MEDICAL OFFICER 40.00 X 318847 0 41934 MOLLY JOUANEH CMA CHIEF FINANCIAL OFFICER 40.00 X 308373 0 11753 PEDRO TOLEDO JD MA MHSA CHIEF ADMINISTRATIVE OFFICER 40.00 X 286447 0 41657 TIFFANY JIMENEZ RN CHIEF OPERATING OFFICER 40.00 X 205322 0 38532 MICHELLE GLANCY MBA CHRO THROUGH 10/2022 40.00 X 131642 0 11893 DANIELLE ORYN DO MPH CHIEF MEDICAL INFORMATICS OFFICER 40.00 X 253744 0 31236 KEN WEINSTOCK MD DIR. OF BEHAVIORAL HEALTH SERVICES 40.00 X 326470 0 39479 REBECCA KATZ MD PRIMARY CARE SITE DIRECTOR 36.00 X 233256 0 40918 CARLIN CHI MD MEDICAL DIRECTOR, PRIMARY CARE 40.00 X 242016 0 33702 JONATHAN CHOE MD ASSOC. MEDICAL DIR., WOMEN'S HEALTH 34.00 X 248562 0 12401 JOHN PENDLETON MD ASSOC. MEDICAL DIRECTOR, OPERATIONS 34.00 X 220768 0 30104 FIONA REDWOOD MD CLINICAL SERV. DIR. - WOMEN'S HEALTH 32.00 X 239108 0 31506 SCOTT HOLMES DO ASSOC. MEDICAL DIR., PRIMARY CARE 40.00 X 234411 0 16507 CHRISTINA GOMEZ-MIRA MD LEAD PHYS, RURAL PRIMARY CARE SERV 36.00 X 201615 0 12159 IUN-LU AILEEN CHEN DO ASSOC. MEDICAL DIR., PRIMARY CARE 38.00 X 217258 0 18584 PHILIPPE EDOUARD MD FACP FAMILY PHYSICIAN 40.00 X 295086 0 23846 KARL GREER MD FAMILY PHYSICIAN 40.00 X 273980 0 23663 SHANNON MENTOCK MD FAMILY PHYSICIAN 40.00 X 270787 0 7717 CASSIE IUTZI MD MPH FAMILY PHYSICIAN 40.00 X 245201 0 34753 ANDREW ASCHROFT MD MPH FAMILY PHYSICIAN 36.00 X 226912 0 40268 5733735 0 616773 106 0 1 0 SCANSTAT TECHNOLOGIES LLC PO BOX 791522 BALTIMORE MD 212791522 DOCUMENT MANAGEMENT 724077 ECLINICALWORKS LLC TWO TECHNOLOGY DRIVE WESTBOROUGH MA 01581 IT SUPPORT SERVICES 530895 BARBIER SECURITY GROUP 369-B THIRD STREET 440 SAN RAFAEL CA 94901 SECURITY SERVICES 316583 MOSS ADAMS LLP PO BOX 101822 PASADENA CA 911891822 AUDITING & TAX SERVICES 121486 4 16128905 2515444 1618939 18644349 NET PATIENT SERVICE REVENUE 621400 43503373 43503373 PHARMACY REVENUE 621400 3960075 3960075 QIP REVENUE 621400 2805865 2805865 PIP REVENUE 621400 2714350 2714350 CAPITATION REVENUE 621400 713960 713960 1063776 1063776 54761399 65924 65924 10855 10855 OTHER REVENUE 561000 40158 40158 40158 73522685 54761399 0 116937 4479664 2737092 1742572 34522811 30574628 3948183 1487481 1349962 137519 7340274 6141274 1199000 2966743 2526121 440622 45091 45091 164067 164067 5537086 4857082 680004 40121 485 39636 1053423 797420 256003 129329 103944 25385 2934392 2406252 528140 180254 145640 34614 363275 281967 81308 142597 142597 1704834 1212430 492404 169542 88493 81049 MEDICAL SUPPLIES/DRUGS 3905142 3905142 MINOR EQUIPMENT 737978 621197 116781 IN-KIND FOOD 657100 657100 DUES AND SUBSCRIPTIONS 122562 95902 26660 2566385 923995 1642390 71250151 59426126 11824025 0 8800879 6533960 821961 4069657 843240 1003646 5838489 6007881 23973 6646 198202 217505 1079317 1060366 36326625 14699332 20340794 21627293 3733756 3980226 12598691 12771971 54279302 57279151 7239295 8763171 1776888 1925984 4726914 4528475 11349913 10469308 25093010 25686938 X 29126592 31532513 59700 59700 29186292 31592213 54279302 57279151 2272534 133387 0 X 0 1 X 1 1 1 X 4608360 5027133 26697201 12319234 18644349 67296277 4608360 5027133 26697201 12319234 18644349 67296277 27965 67268312 9966 6755 45442 26992 76779 165934 785952 1288063 2008112 107856 40158 4230141 71692352 221859074 0.93830 0.91840 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 785,952. 2019 AMOUNT: $ 1,288,063. 2020 AMOUNT: $ 2,008,112. 2021 AMOUNT: $ 107,856. 2022 AMOUNT: $ 40,158. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7500 7500 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE CALIFORNIA PRIMARY CARE ASSOCIATION; A PORTION OF THOSE MEMBERSHIP DUES WERE DESIGNATED AS UTILIZED FOR LOBBYING ACTIVITIES FOR LEGISLATION PERTINENT TO THE HEALTH CARE FIELD. 1835000 1835000 17909519 6770729 11138790 4334823 1543534 2791289 5787916 3880900 1907016 6459367 2504169 3955198 21627293 OTHER RECEIVABLES 1318199 DEPOSITS 61362 ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS 3610423 OPERATING LEASE RIGHT-OF-USE ASSETS 7781987 12771971 ESTIMATED AMOUNTS DUE TO THIRD-PARTY PAYORS 2725126 OPERATING LEASE LIABILITIES 7744182 10469308 X 73844642 133387 188570 321957 73522685 0 73522685 71438721 188570 188570 71250151 0 71250151 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2023 AND 2022, THE ORGANIZATION HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. X X X X 0 0 0 0 0 0 0 0 0 KATHRYN POWELL MHA MA CHIEF EXECUTIVE OFFICER 391617 0 36500 0 6394 0 37857 0 13203 0 485571 0 0 0 KEN WEINSTOCK MD DIR. OF BEHAVIORAL HEALTH SERVICES 316161 0 8064 0 2245 0 15645 0 23834 0 365949 0 0 0 NURIT LICHT MD CHIEF MEDICAL OFFICER 305053 0 12807 0 987 0 32707 0 9227 0 360781 0 0 0 RAMONA ENGLISH DMD CHIEF DENTAL OFFICER 293842 0 25000 0 577 0 14383 0 8718 0 342520 0 0 0 PEDRO TOLEDO JD MA MHSA CHIEF ADMINISTRATIVE OFFICER 275818 0 10087 0 542 0 29608 0 12049 0 328104 0 0 0 MOLLY JOUANEH CMA CHIEF FINANCIAL OFFICER 283027 0 25000 0 346 0 9177 0 2576 0 320126 0 0 0 PHILIPPE EDOUARD MD FACP FAMILY PHYSICIAN 281541 0 12189 0 1356 0 13361 0 10485 0 318932 0 0 0 KARL GREER MD FAMILY PHYSICIAN 260571 0 13135 0 274 0 11378 0 12285 0 297643 0 0 0 DANIELLE ORYN DO MPH CHIEF MEDICAL INFORMATICS OFFICER 253170 0 0 0 574 0 11598 0 19638 0 284980 0 0 0 CASSIE IUTZI MD MPH FAMILY PHYSICIAN 240132 0 4791 0 278 0 11143 0 23610 0 279954 0 0 0 SHANNON MENTOCK MD FAMILY PHYSICIAN 216374 0 54191 0 222 0 0 0 7717 0 278504 0 0 0 CARLIN CHI MD MEDICAL DIRECTOR, PRIMARY CARE 235507 0 5756 0 753 0 12660 0 21042 0 275718 0 0 0 REBECCA KATZ MD PRIMARY CARE SITE DIRECTOR 225903 0 6860 0 493 0 13012 0 27906 0 274174 0 0 0 FIONA REDWOOD MD CLINICAL SERV. DIR. - WOMEN'S HEALTH 237620 0 0 0 1488 0 11088 0 20418 0 270614 0 0 0 ANDREW ASCHROFT MD MPH FAMILY PHYSICIAN 220334 0 5878 0 700 0 12262 0 28006 0 267180 0 0 0 JONATHAN CHOE MD ASSOC. MEDICAL DIR., WOMEN'S HEALTH 243974 0 4157 0 431 0 11144 0 1257 0 260963 0 0 0 SCOTT HOLMES DO ASSOC. MEDICAL DIR., PRIMARY CARE 229570 0 4572 0 269 0 6077 0 10430 0 250918 0 0 0 JOHN PENDLETON MD ASSOC. MEDICAL DIRECTOR, OPERATIONS 212710 0 7675 0 383 0 11972 0 18132 0 250872 0 0 0 TIFFANY JIMENEZ RN CHIEF OPERATING OFFICER 186069 0 19000 0 253 0 10527 0 28005 0 243854 0 0 0 IUN-LU AILEEN CHEN DO ASSOC. MEDICAL DIR., PRIMARY CARE 212744 0 4270 0 244 0 6411 0 12173 0 235842 0 0 0 CHRISTINA GOMEZ-MIRA MD LEAD PHYS, RURAL PRIMARY CARE SERV 198724 0 2617 0 274 0 10720 0 1439 0 213774 0 0 0 A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13032UET1 2016-09-13 5955305 REFUND OF BONDS ORIGINALLY ISSUED 6/2/2010 0 0 0 A 1135000 5955305 175378 115500 153716 5510710 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 NORTH BAY OFFICE FURNITURE ENTITY IS SOLELY OWNED BY BOARD MEMBER ROBERT RAMIREZ 30137 THE ORGANIZATION PURCHASED OFFICE FURNITURE AT FAIR MARKET VALUE FROM NORTH BAY OFFICE FURNITURE, WHICH IS SOLELY OWNED BY BOARD MEMBER ROBERT RAMIREZ. 0 X 1 657100 FAIR MARKET VALUE X 1 961839 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE NUMBER REPORTED IN PART I, COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE TAX PREPARER IN CONJUNCTION WITH THE ORGANIZATION'S FINANCE AND ACCOUNTING TEAM. THE CEO AND MEMBERS OF THE FINANCE AND ACCOUNTING STAFF OF THE ORGANIZATION THEN REVIEW THE FORM 990 AND, UPON APPROVAL, SUBMITS THE FORM 990 TO THE BOARD FINANCE COMMITTEE FOR REVIEW BEFORE FILING WITH THE IRS; THE FORM 990 IS ALSO MADE AVAILABLE TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF PETALUMA HEALTH CENTER THAT ALL FULL-TIME AND PART-TIME EMPLOYEES, CONTRACTORS, AND MEMBERS OF THE BOARD OF DIRECTORS AVOID CONFLICTS OF INTEREST, OR APPEARANCE OF CONFLICT, BETWEEN THEIR PERSONAL INTERESTS AND THE INTERESTS OF THE ORGANIZATION WHEN DEALING WITH ANY INDIVIDUAL OR OUTSIDE ORGANIZATION HAVING, OR SEEKING TO HAVE, A BUSINESS RELATIONSHIP WITH PETALUMA HEALTH CENTER. ALL MEMBERS OF THE PETALUMA HEALTH CENTER BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE THE CONFLICT OF INTEREST DISCLOSURE STATEMENT; ALL STAFF MEMBERS, VOLUNTEERS, AND CONTRACTORS ARE REQUIRED TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICT OF INTEREST THAT ARISES TO THE HUMAN RESOURCES DEPARTMENT WITHIN 10 BUSINESS DAYS OF LEARNING OF IT. AFTER DISCLOSURE OF A POSSIBLE CONFLICT OF INTEREST, THE CEO AFFORDS THE INTERESTED PERSON WHO MAKES THE DISCLOSURE AN OPPORTUNITY TO EXPLAIN TO THE SENIOR MANAGEMENT TEAM (FOR EMPLOYEES), OR THE EXECUTIVE COMMITTEE OF THE BOARD (FOR BOARD MEMBERS) THE FACTS AND CIRCUMSTANCES OF THE TRANSACTION OR ARRANGEMENT THAT LED TO SUCH DISCLOSURE. THE INTERESTED PERSON LEAVES THE SENIOR MANAGEMENT TEAM OR BOARD EXECUTIVE COMMITTEE MEETING WHILE THE INTEREST IS DISCUSSED AND VOTED UPON IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS AND CANNOT BE MITIGATED BY FURTHER ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE CHIEF EXECUTIVE OFFICER'S SALARY INCREASE INVOLVES A DISCUSSION AMONGST THE EXECUTIVE COMMITTEE OF THE BOARD, SALARY RESEARCH BY THE CHIEF HR OFFICER, AND RECOMMENDATION OF A NEW SALARY FROM THE EXECUTIVE COMMITTEE TO THE BOARD OF DIRECTORS FOR APPROVAL. THE CEO REVIEWS AND APPROVES THE COMPENSATION OF OTHER OFFICERS AND MANAGERS UTILIZING COMPARABILITY DATA. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.