2025-05-06T15:11:19-05:00 2024-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2023-07-01 680437840 PETALUMA HEALTH CENTER INC PETA 7075597500 1016 CLEGG COURT PETALUMA CA 94954 MOLLY JOUANEH CFO 7075597500 2025-05-05 1 0 MICHAEL LUMSDEN P01262236 4159561500 2025-05-05 2023 2025-03-06 01:10:19Z X PEDRO TOLEDO JD MA MHS 1016 CLEGG COURT PETALUMA CA 94954 77833964 0 X WWW.PHEALTHCENTER.ORG X 1999 CA TO ENSURE ACCESS & PROVIDE HIGH QUALITY PREVENTION-FOCUSED HEALTH CARE FOR THE COMMUNITIES WE SERVE. 11 10 628 33 0 0 18644349 13416910 54761399 62917381 76779 135554 40158 111642 73522685 76581487 0 36760 0 0 50796973 53423572 0 0 0 20453178 22675306 71250151 76135638 2272534 445849 57279151 55258656 25686938 23012552 31592213 32246104 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 35024649 0 37388548 FAMILY PRACTICE SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF FAMILY PRACTICE VISITS DURING FISCAL YEAR-ENDING JUNE 30, 2024 WAS 116,708. 10521662 0 11698204 GENERAL DENTISTRY AND FLUORIDE VARNISHING SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF DENTAL VISITS DURING THE FISCAL YEAR-ENDING JUNE 30, 2024 WAS 33,669. 4478120 0 5134116 OBSTETRIC AND GYNECOLOGY SERVICES PROVIDED TO PATIENTS, INCLUDING BIRTHING AND PREGNANCY SERVICES. THE TOTAL NUMBER OF OB/GYN VISITS DURING FISCAL THE FISCAL YEAR-ENDING JUNE 30, 2024 WAS 15,753. 13246774 36760 8696513 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. 13246774 36760 8696513 63271205 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 1 1 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 72 0 1 628 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 1016 CLEGG COURT PETALUMA CA 94954 ROBERT RAMIREZ PRESIDENT 2.00 X X 0 0 0 TOM ISAAK VICE PRESIDENT 2.00 X X 0 0 0 PHOEBE ELLIS SECRETARY 2.00 X X 0 0 0 ELIZABETH GOLDBLATT INTERIM TREASURER 2.00 X X 0 0 0 WILLIAM BARRETT BOARD MEMBER 2.00 X 0 0 0 FERNANDO CARRILLO BOARD MEMBER 2.00 X 0 0 0 CECILIA G CASTANEDA BOARD MEMBER THROUGH 5/2024 2.00 X 0 0 0 ANNE MIRANTE BOARD MEMBER 2.00 X 0 0 0 SILVIA RODRIGUEZ BOARD MEMBER 2.00 X 0 0 0 TERESA TAYLOR-KING BOARD MEMBER 2.00 X 0 0 0 ELISA VELASQUEZ-ANDRADE BOARD MEMBER 2.00 X 0 0 0 CATHERINE WEST BOARD MEMBER 2.00 X 0 0 0 KATHRYN POWELL MHA MA CEO THROUGH 2/2024 / CEO EMERITA 40.00 X 481799 0 47790 PEDRO TOLEDO MD MA MHSA INTERIM CEO START 2/2024 40.00 X 279896 0 44165 NURIT LICHT MD CHIEF MEDICAL OFFICER 40.00 X 337737 0 45552 RAMONA ENGLISH DMD CHIEF DENTAL OFFICER 40.00 X 307442 0 34609 MOLLY JOUANEH CMA CHIEF FINANCIAL OFFICER 40.00 X 304906 0 35236 TIFFANY JIMENEZ RN CHIEF OPERATING OFFICER THRU 3/2024 40.00 X 207683 0 51584 KIMBERLY KELLER MBA CHIEF OPERATING OFFICER START 5/2024 40.00 X 159353 0 24897 SVEINN SIGURDSSON MA MS-HSM CHIEF ADMINISTRATIVE OFFICER 40.00 X 194730 0 32135 CARLIN CHI MD MEDICAL DIRECTOR, PRIMARY CARE 36.00 X 245604 0 36207 REBECCA KATZ MD MED DIR OF PRIMARY CARE/CLINICAL INTG 40.00 X 261629 0 38589 KEN WEINSTOCK MD DIR OF BEHAVIORAL HEALTH SERVICES 40.00 X 323002 0 34032 PHILIPPE EDOUARD MD FACP INTERNAL MEDICINE PHYS, GERIATRICS 40.00 X 285260 0 19983 SCOTT HOLMES MD DIRECTOR OF CLINICAL INFORMATICS 40.00 X 270080 0 34177 JONATHAN CHOE MD FAMILY PHYSICIAN 30.00 X 255922 0 15200 KARL GREER MD LEAD PHYSICIAN, ADDICTION MEDICINE 40.00 X 253574 0 26271 DANIELLE ORYN DO MPH FORMER OFFICER / CURRENT PHYSICIAN 40.00 X 186704 0 19188 CHRISTINA GOMEZ-MIRA MD FORMER KEY EE / CURRENT PHYSICIAN 36.00 X 214896 0 11411 IUN-LU AILEEN CHEN DO FORMER KEY EE / CURRENT PHYSICIAN 36.00 X 233792 0 15682 JOHN PENDLETON MD FORMER KEY EE / CURRENT PHYSICIAN 32.00 X 222829 0 27626 FIONA REDWOOD MD FORMER KEY EE / CURRENT PHYSICIAN 32.00 X 233640 0 30117 5260478 0 624451 113 1 1 0 ECLINICALWORKS LLC TWO TECHNOLOGY DRIVE WESTBOROUGH MA 01581 SOFTWARE MAINTENANCE AND SUPPORT 1261537 SCANSTAT TECHNOLOGIES LLC PO BOX 791522 BALTIMORE MD 212791522 DOCUMENT MANAGEMENT SERVICES 566115 FELDESMAN TUCKER LEIFER FIDELL LLP PO BOX 791536 BALTIMORE MD 212791536 LEGAL SERVICES 127498 MOSS ADAMS LLP PO BOX 101822 PASADENA CA 911891822 AUDIT & TAX SERVICES 126550 GREG FACKTOR & ASSOCIATES 316 N ROSSMORE AVE 505 LOS ANGELES CA 900042415 LEGAL SERVICES 100885 5 11930528 1486382 1445615 13416910 NET PATIENT SERVICE REVENUE 621400 51750081 51750081 PHARMACY REVENUE 621400 5075612 5075612 PIP REVENUE 621400 2618972 2618972 QIP REVENUE 621400 2246597 2246597 CAPITATION REVENUE 621400 647506 647506 578613 578613 62917381 110666 110666 17579 17579 1259786 1252477 7309 7309 7309 OTHER REVENUE 900099 111642 111642 111642 76581487 62917381 0 247196 2236 2236 34524 34524 3111615 1142594 1969021 41751533 36957742 4793791 1529598 1430047 99551 3648623 3167361 481262 3382203 2885861 496342 114759 114759 198648 198648 5487029 4777279 709750 68816 37051 31765 603367 427142 176225 3276889 2327164 949725 3683497 3064042 619455 198154 106688 91466 121400 65363 56037 283174 283174 2509448 1258381 1251067 468839 82864 385975 MEDICAL SUPPLIES/DRUGS 3621282 3621282 IN-KIND VACCINES 1445615 1445615 DUES AND SUBSCRIPTIONS 147912 111679 36233 LICENSES 127453 68622 58831 319024 257668 61356 76135638 63271205 12864433 0 6533960 3881059 4069657 1581857 1003646 2293437 6007881 6613847 6646 1200 217505 131134 1060366 888486 39010203 16305800 21627293 22704403 3980226 3702997 12771971 13460236 57279151 55258656 8763171 9371180 1925984 1403739 4528475 4320035 1003616 10469308 6913982 25686938 23012552 X 31532513 32196104 59700 50000 31592213 32246104 57279151 55258656 445849 208042 0 X 0 1 X 1 1 1 X 5027133 26697201 12319234 18644349 13416910 76104827 5027133 26697201 12319234 18644349 13416910 76104827 76104827 6755 45442 26992 76779 128245 284213 1288063 2008112 107856 40158 111642 3555831 79944871 244877831 0.95200 0.93830 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2019 AMOUNT: $ 1,288,063. 2020 AMOUNT: $ 2,008,112. 2021 AMOUNT: $ 107,856. 2022 AMOUNT: $ 40,158. 2023 AMOUNT: $ 111,642. 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. 2820000 2820000 19947732 7546045 12401687 4519025 1832890 2686135 5357919 3588382 1769537 6365527 3338483 3027044 22704403 OTHER RECEIVABLES 2303257 DEPOSITS 58995 ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS 4718457 OPERATING LEASE RIGHT-OF-USE ASSETS 6379527 13460236 ESTIMATED AMOUNTS DUE TO THIRD-PARTY PAYORS 525995 OPERATING LEASE LIABILITIES 6387987 6913982 X 76980588 208042 191059 399101 76581487 0 76581487 76326697 191059 191059 76135638 0 76135638 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, 2024 AND 2023, 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. 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTMAKING 34524 0 0 0 0 0 0 34524 0 34524 CENTRAL AMERICA AND THE CARIBBEAN TO SUPPORT VISION HEALTH 0 34524 EYEGLASS INVENTORY FAIR MARKET VALUE 1 0 0 0 0 0 0 0 PART I, LINE 2: DURING THE 6/30/2024, THE ORGANIZATION PROVIDED A GRANT IN THE FORM OF EYEGLASS INVENTORY TO A FOREIGN PUBLIC CHARITY EQUIVALENT WITH A SIMILAR EXEMPT PURPOSE OF PETALUMA HEALTH CENTER. THE GRANT WAS UNRESTRICTED AND NOT MONITORED. X X X X 0 0 0 0 0 0 0 0 0 KATHRYN POWELL MHA MA CEO THROUGH 2/2024 / CEO EMERITA 431987 0 45700 0 4112 0 35638 0 12152 0 529589 0 0 0 NURIT LICHT MD CHIEF MEDICAL OFFICER 334121 0 2579 0 1037 0 34950 0 10602 0 383289 0 0 0 KEN WEINSTOCK MD DIR OF BEHAVIORAL HEALTH SERVICES 316637 0 4120 0 2245 0 16707 0 17325 0 357034 0 0 0 RAMONA ENGLISH DMD CHIEF DENTAL OFFICER 270763 0 36096 0 583 0 34609 0 0 0 342051 0 0 0 MOLLY JOUANEH CMA CHIEF FINANCIAL OFFICER 279307 0 25222 0 377 0 34103 0 1133 0 340142 0 0 0 PEDRO TOLEDO MD MA MHSA INTERIM CEO START 2/2024 270797 0 8500 0 599 0 33311 0 10854 0 324061 0 0 0 PHILIPPE EDOUARD MD FACP INTERNAL MEDICINE PHYS, GERIATRICS 274198 0 8522 0 2540 0 15187 0 4796 0 305243 0 0 0 SCOTT HOLMES MD DIRECTOR OF CLINICAL INFORMATICS 264779 0 5006 0 295 0 7095 0 27082 0 304257 0 0 0 REBECCA KATZ MD MED DIR OF PRIMARY CARE/CLINICAL INT 256516 0 4560 0 553 0 12660 0 25929 0 300218 0 0 0 CARLIN CHI MD MEDICAL DIRECTOR, PRIMARY CARE 239897 0 4891 0 816 0 13479 0 22728 0 281811 0 0 0 KARL GREER MD LEAD PHYSICIAN, ADDICTION MEDICINE 244886 0 8161 0 527 0 14016 0 12255 0 279845 0 0 0 JONATHAN CHOE MD FAMILY PHYSICIAN 251163 0 4272 0 487 0 12150 0 3050 0 271122 0 0 0 FIONA REDWOOD MD FORMER KEY EE / CURRENT PHYSICIAN 227586 0 4527 0 1527 0 12483 0 17634 0 263757 0 0 0 TIFFANY JIMENEZ RN CHIEF OPERATING OFFICER THRU 3/2024 188418 0 19000 0 265 0 24958 0 26626 0 259267 0 0 0 JOHN PENDLETON MD FORMER KEY EE / CURRENT PHYSICIAN 213948 0 8143 0 738 0 12522 0 15104 0 250455 0 0 0 IUN-LU AILEEN CHEN DO FORMER KEY EE / CURRENT PHYSICIAN 229126 0 4450 0 216 0 6580 0 9102 0 249474 0 0 0 SVEINN SIGURDSSON MA MS-HSM CHIEF ADMINISTRATIVE OFFICER 174490 0 20000 0 240 0 10113 0 22022 0 226865 0 0 0 CHRISTINA GOMEZ-MIRA MD FORMER KEY EE / CURRENT PHYSICIAN 211285 0 3202 0 409 0 11411 0 0 0 226307 0 0 0 DANIELLE ORYN DO MPH FORMER OFFICER / CURRENT PHYSICIAN 186387 0 0 0 317 0 10599 0 8589 0 205892 0 0 0 KIMBERLY KELLER MBA CHIEF OPERATING OFFICER START 5/2024 144642 0 14500 0 211 0 8809 0 16088 0 184250 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 1350000 5955305 175414 115500 153716 5510674 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 11749 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 1445615 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 ORGANIZATION'S HR LEADERSHIP, 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.