2023-05-08T13:39:02-05:00 2022-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2021-07-01 680437840 PETALUMA HEALTH CENTER INC PETA 7075597500 1179 NORTH MCDOWELL BLVD PETALUMA CA 94954 MOLLY JOUANEH CFO 7075597500 2023-05-08 1 MOLLY JOUANEH 999009999 MICHAEL LUMSDEN P01262236 4159561500 2023-05-08 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KATHRYN POWELL 1455 N MCDOWELL BLVD PETALUMA CA 94954 63544286 0 X WWW.PHEALTHCENTER.ORG X 1999 CA TO ENSURE ACCESS & PROVIDE HIGH QUALITY PREVENTION-FOCUSED HEALTH CARE FOR THE COMMUNITIES WE SERVE. 11 10 767 39 0 0 26697201 12319234 38580965 51090204 150 26992 2008112 107856 67286428 63544286 0 0 0 0 39139803 44727434 0 0 0 14688823 15281353 53828626 60008787 13457802 3535499 54716771 54279302 28836475 25093010 25880296 29186292 X THE PETALUMA HEALTH CENTER'S MISSION IS TO ENSURE ACCESS, AND TO PROVIDE HIGH QUALITY PREVENTION-FOCUSED HEALTH CARE FOR THE COMMUNITIES WE SERVE. 0 0 29060856 0 36463139 FAMILY PRACTICE SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF FAMILY PRACTICE VISITS DURING FISCAL YEAR 2022 WAS 129,289. 7237382 0 7828758 GENERAL DENTISTRY AND FLUORIDE VARNISHING SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF DENTAL VISITS DURING FISCAL YEAR 2022 WAS 24,828. 3565493 0 5179484 OBSTETRIC AND GYNECOLOGY SERVICES PROVIDED TO PATIENTS, INCLUDING BIRTHING AND PREGNANCY SERVICES. THE TOTAL NUMBER OF OB/GYN VISITS DURING FISCAL YEAR 2021 WERE 14,427. 9730771 0 1618823 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. 9730771 0 1618823 49594502 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 0 0 0 0 0 0 0 0 0 1 69 0 1 767 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 KATHRYN POWELL MHA MA CHIEF EXECUTIVE OFFICER 40.00 X 443016 0 48994 KEN WEINSTOCK MD DIR. OF BEHAVIORAL HEALTH SERVICES 40.00 X 294417 0 39387 NURIT LICHT MD CHIEF MEDICAL OFFICER 40.00 X 285756 0 24194 RAMONA ENGLISH DMD CHIEF DENTAL OFFICER 40.00 X 259548 0 29377 DANIELLE ORYN DO MPH CHIEF MEDICAL INFORMATICS OFFICER 40.00 X 252611 0 27867 PHILIPPE EDOUARD MD FACP FAMILY PHYSICIAN 35.00 X 250397 0 22701 PEDRO TOLEDO JD MA MHSA CHIEF ADMINISTRATIVE OFFICER 40.00 X 245008 0 24675 REBECCA KATZ MD PRIMARY CARE SITE DIRECTOR 36.00 X 226680 0 34661 SAFI AHMED MD FAMILY PHYSICIAN 36.00 X 244968 0 12278 ANDREW ASHCROFT MD MPH FAMILY PHYSICIAN 36.00 X 211232 0 38671 CARLIN CHI MD MEDICAL DIRECTOR, PRIMARY CARE 36.00 X 218086 0 31781 CASSIE IUTZI MD MPH FAMILY PHYSICIAN 40.00 X 202368 0 40068 JONATHAN CHOE MD ASSOC MEDICAL DIR, WOMEN'S HEALTH 34.00 X 225791 0 13135 FIONA REDWOOD MD CLINICAL SERV. DIR, WOMEN'S HEALTH 32.00 X 210540 0 28062 MOLLY JOUANEH CMA CHIEF FINANCIAL OFFICER 40.00 X 230420 0 5866 MICHELLE GLANCY MBA CHIEF HUMAN RESOURCES OFFICER 40.00 X 214578 0 20416 JOHN PENDLETON MD ASSOC MEDICAL DIRECTOR, OPERATIONS 34.00 X 205901 0 26334 IUN-LU AILEEN CHEN DO FAMILY PHYSICIAN 36.00 X 211878 0 14915 SCOTT HOLMES DO ASSOC MEDICAL DIRECTOR, PRIMARY CARE 40.00 X 199433 0 19480 CHRISTINA GOMEZ-MIRA MD LEAD PHYS, RURAL PRIM. CARE SERV 36.00 X 189553 0 10241 TIFFANY JIMENEZ RN CHIEF OPERATING OFFICER 40.00 X 160528 0 35545 JANE READ MSA RN FORMER COO (THROUGH 4/2021) 40.00 X 117976 0 14088 ROBERT RAMIREZ PRESIDENT 2.00 X X 0 0 0 ELISA VELASQUEZ-ANDRADE PHD VICE PRESIDENT 2.00 X X 0 0 0 MARC POUNDS CPA TREASURER 2.00 X X 0 0 0 VANESSA LUNA SHANNON SECRETARY 2.00 X X 0 0 0 WILLIAM BARRETT BOARD MEMBER 2.00 X 0 0 0 CECILIA G CASTANEDA BOARD MEMBER 2.00 X 0 0 0 PHOEBE ELLIS BOARD MEMBER 2.00 X 0 0 0 ELIZABETH GOLDBLATT PHD MPAHA BOARD MEMBER 2.00 X 0 0 0 TOM ISAAK BOARD MEMBER 2.00 X 0 0 0 TERESA TAYLOR-KING BOARD MEMBER 2.00 X 0 0 0 CATHERINE WEST MD DRPH BOARD MEMBER 2.00 X 0 0 0 5100685 0 562736 84 1 1 0 ECLINICALWORKS LLC TWO TECHNOLOGY DR WESTBOROUGH MA 01581 IT SUPPORT SERVICES 414641 SCANSTAT TECHNOLOGIES LLC PO BOX 791522 BALTIMORE MD 212791522 DOCUMENT MANAGEMENT 409753 BARBIER SECURITY GROUP 369-B THIRD STREET 440 SAN RAFAEL CA 94901 SECURITY SERVICES 323310 MOSS ADAMS LLP PO BOX 101822 PASADENA CA 911891822 AUDITING & TAX SERVICES 145350 4 10938573 1380661 9000 12319234 NET PATIENT SERVICE REVENUE 621400 42504404 42504404 PERFORMANCE PAYMENTS-HEALTH PLANS 621400 6202091 6202091 PHARMACY REVENUE 621400 2383709 2383709 51090204 26910 26910 82 82 OTHER REVENUE 561000 107856 107856 107856 63544286 51090204 0 134848 4606772 2592467 2014305 29529865 26052359 3477506 1196109 1080308 115801 7009565 5851112 1158453 2385123 2073607 311516 117822 117822 125427 125427 4327873 3406252 921621 40836 26368 14468 1043218 764671 278547 812583 652393 160190 2598224 2032718 565506 152711 129645 23066 172707 101427 71280 216123 216123 1759655 1538963 220692 153285 80215 73070 MEDICAL SUPPLIES/DRUGS 2126520 2126520 MINOR EQUIPMENT 693344 599980 93364 DUES AND SUBSCRIPTIONS 569028 290312 278716 371997 195185 176812 60008787 49594502 10414285 0 8789999 8800879 1421413 821961 798592 843240 4957638 5838489 71920 23973 89135 198202 565978 1079317 33743146 13402352 20209882 20340794 3947952 3733756 13864262 12598691 54716771 54279302 6560933 7239295 777217 1776888 4920353 4726914 1307236 0 15270736 11349913 28836475 25093010 X 25820596 29126592 59700 59700 25880296 29186292 54716771 54279302 3535499 -229503 0 X 0 1 X 1 1 1 X 4451384 4608360 5027133 26697201 12319234 53103312 4451384 4608360 5027133 26697201 12319234 53103312 53103312 4011 9966 6755 45442 26992 93166 432814 785952 1288063 2008112 107856 4622797 57819275 205150368 0.91840 0.90290 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7125 7125 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 17900672 6100480 11800192 4325502 1259383 3066119 5305940 3707574 1598366 4376032 2334915 2041117 20340794 OTHER RECEIVABLES 1638470 DEPOSITS 63163 BOND PRINCIPAL/INTEREST FUNDS 55700 ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS 1627620 OPERATING LEASE RIGHT-OF-USE ASSETS 9213738 12598691 ESTIMATED AMOUNTS DUE TO THIRD-PARTY PAYORS 2250058 OPERATING LEASE LIABILITIES 9099855 11349913 X 63424829 -229503 110046 -119457 63544286 0 63544286 60118833 110046 110046 60008787 0 60008787 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, 2022 AND 2021, 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 X 0 0 0 0 0 0 0 0 0 KATHRYN POWELL MHA MA CHIEF EXECUTIVE OFFICER 394959 0 41700 0 6357 0 34384 0 14610 0 492010 0 0 0 KEN WEINSTOCK MD DIR. OF BEHAVIORAL HEALTH SERVICES 285545 0 6875 0 1997 0 15982 0 23405 0 333804 0 0 0 NURIT LICHT MD CHIEF MEDICAL OFFICER 264837 0 20000 0 919 0 14722 0 9472 0 309950 0 0 0 RAMONA ENGLISH DMD CHIEF DENTAL OFFICER 209071 0 50000 0 477 0 13621 0 15756 0 288925 0 0 0 DANIELLE ORYN DO MPH CHIEF MEDICAL INFORMATICS OFFICER 239917 0 12138 0 556 0 11182 0 16685 0 280478 0 0 0 PHILIPPE EDOUARD MD FACP FAMILY PHYSICIAN 245446 0 3480 0 1471 0 12915 0 9786 0 273098 0 0 0 PEDRO TOLEDO JD MA MHSA CHIEF ADMINISTRATIVE OFFICER 214690 0 30000 0 318 0 12515 0 12160 0 269683 0 0 0 REBECCA KATZ MD PRIMARY CARE SITE DIRECTOR 221050 0 5173 0 457 0 13022 0 21639 0 261341 0 0 0 SAFI AHMED MD FAMILY PHYSICIAN 239657 0 4931 0 380 0 2464 0 9814 0 257246 0 0 0 ANDREW ASHCROFT MD MPH FAMILY PHYSICIAN 197709 0 12891 0 632 0 12293 0 26378 0 249903 0 0 0 CARLIN CHI MD MEDICAL DIRECTOR, PRIMARY CARE 213317 0 4085 0 684 0 11234 0 20547 0 249867 0 0 0 CASSIE IUTZI MD MPH FAMILY PHYSICIAN 196870 0 5261 0 237 0 11960 0 28108 0 242436 0 0 0 JONATHAN CHOE MD ASSOC MEDICAL DIR, WOMEN'S HEALTH 219431 0 5975 0 385 0 12373 0 762 0 238926 0 0 0 FIONA REDWOOD MD CLINICAL SERV. DIR, WOMEN'S HEALTH 194359 0 14906 0 1275 0 11567 0 16495 0 238602 0 0 0 MOLLY JOUANEH CMA CHIEF FINANCIAL OFFICER 200150 0 30000 0 270 0 5002 0 864 0 236286 0 0 0 MICHELLE GLANCY MBA CHIEF HUMAN RESOURCES OFFICER 193371 0 20000 0 1207 0 8418 0 11998 0 234994 0 0 0 JOHN PENDLETON MD ASSOC MEDICAL DIRECTOR, OPERATIONS 197743 0 7773 0 385 0 11526 0 14808 0 232235 0 0 0 IUN-LU AILEEN CHEN DO FAMILY PHYSICIAN 206955 0 4698 0 225 0 5243 0 9672 0 226793 0 0 0 SCOTT HOLMES DO ASSOC MEDICAL DIRECTOR, PRIMARY CARE 195413 0 3779 0 241 0 0 0 19480 0 218913 0 0 0 CHRISTINA GOMEZ-MIRA MD LEAD PHYS, RURAL PRIM. CARE SERV 186790 0 2521 0 242 0 9483 0 758 0 199794 0 0 0 TIFFANY JIMENEZ RN CHIEF OPERATING OFFICER 150331 0 10000 0 197 0 8049 0 27496 0 196073 0 0 0 JANE READ MSA RN FORMER COO (THROUGH 4/2021) 86566 0 30000 0 1410 0 9143 0 4945 0 132064 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 930000 5955305 174727 115500 153716 5511362 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 8108 THE ORGANIZATION PURCHASED OFFICE FURNITURE AT FAIR MARKET VALUE FROM NORTH BAY OFFICE FURNITURE, WHICH IS SOLELY OWNED BY BOARD MEMBER ROBERT RAMIREZ. 0 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. 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.