PUGET SOUND KIDNEY CENTERS: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PUGET SOUND KIDNEY CENTERS (EIN 91-1102033)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202223199349322612
- Schema version
- 2021v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T15:42:51-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2707 COLBY AVENUE SUITE 801 | AddressLine1Txt |
| City | EVERETT | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98201 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911102033 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUGET SOUND KIDNEY CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PUGE | BusinessNameControlTxt |
| Phone | 4252595195 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 PACIFIC AVENUE | AddressLine1Txt |
| City | EVERETT | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98201 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HAROLD KELLY | PersonNm |
| Person Title | PRESIDENT AND CEO | PersonTitleTxt |
| Phone | 4252595195 | PhoneNum |
| Signature | 2022-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | HAROLD | PersonFirstNm |
| Person Last | KELLY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | COLLEEN RAMIRES | PreparerPersonNm |
| PTIN | P01251320 | PTIN |
| Phone | 4252597227 | PhoneNum |
| Preparation | 2022-11-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | HAROLD KELLY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 PACIFIC AVENUE | AddressLine1Txt |
| City | EVERETT | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98201 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $75,172,043 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PSKC.NET | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1980 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE KIDNEY DIALYSIS AND RELATED PATIENT CARE SERVICES IN WASHINGTON STATE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 392 | TotalEmployeeCnt |
| Total Volunteers | 29 | TotalVolunteersCnt |
| Total Gross UBI | -$8,453 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,653,136 | PYContributionsGrantsAmt |
| CY Contributions Grants | $34,057,221 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $31,367,219 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,976,022 | CYProgramServiceRevenueAmt |
| PY Investment Income | $112,649 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,084,878 | CYInvestmentIncomeAmt |
| PY Other Revenue | $619,569 | PYOtherRevenueAmt |
| CY Other Revenue | $23,191 | CYOtherRevenueAmt |
| PY Total Revenue | $34,752,573 | PYTotalRevenueAmt |
| CY Total Revenue | $71,141,312 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $153,082 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,183,204 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,589,873 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,038,424 | PYOtherExpensesAmt |
| CY Other Expenses | $18,152,451 | CYOtherExpensesAmt |
| PY Total Expenses | $31,221,628 | PYTotalExpensesAmt |
| CY Total Expenses | $38,895,406 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,530,945 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $32,245,906 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $62,224,818 | TotalAssetsBOYAmt |
| Total Assets EOY | $94,855,583 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,349,651 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,806,737 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $54,875,167 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $87,048,846 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO ENHANCE THE QUALITY OF LIFE OF THOSE WITH KIDNEY DISEASE THROUGH OUTSTANDING DIALYSIS CARE, EDUCATION AND COMMUNITY SUPPORT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $30,705,328 | ExpenseAmt |
| Grant | $153,082 | GrantAmt |
| Revenue | $35,976,022 | RevenueAmt |
| Desc | PATIENT DIALYSIS AND RELATED CARE - PSKC PROVIDES IN-CENTER DIALYSIS TREATMENTS TO PATIENTS. DIALYSIS TREATMENTS ARE ALSO PROVIDED TO HOSPITALIZED PATIENTS AT A NUMBER OF AREA HOSPITALS. TRAINING, SUPPLIES, EQUIPMENT AND CONTINUING SUPERVISION ARE PROVIDED TO PATIENTS WHO SELF-DIALYZE IN THEIR HOMES. PROFESSIONAL MEDICAL SOCIAL WORKERS WORK WITH EACH OF PSKC'S PATIENTS TO ENSURE EACH PATIENT HAS THE SUPPORT THEY NEED TO MANAGE PHYSICAL, FINANCIAL AND PSYCHO-SOCIAL NEEDS. RENAL DIETITIANS PROVIDE KIDNEY PATIENTS WITH NUTRITIONAL COUNSELING, SO PATIENTS CAN LEARN TO MANAGE THEIR DIET AND LIVE WELL WITH KIDNEY DISEASE. TREATMENTS ARE APPLIED AT VARIOUS LOCATIONS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $346,772 | ExpenseAmt |
| Desc | COMMUNITY EDUCATION AND SUPPORT - PSKC PROVIDES AN EDUCATION PROGRAM DESIGNED TO ASSIST THE COMMUNITY REGARDING CHRONIC KIDNEY DISEASE. THIS PROGRAM INCLUDES TEACHING COMMUNITY RESIDENTS ABOUT SHOPPING, PREPARING AND CONSUMING KIDNEY-FRIENDLY FOODS. THE PROGRAM ALSO GIVES THEM AN UNDERSTANDING OF TREATMENT OPTIONS AVAILABLE IF THEIR CONDITION PROGRESSES FROM CHRONIC KIDNEY DISEASE TO KIDNEY FAILURE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $137,013 | ExpenseAmt |
| Desc | DIALYSIS MANAGEMENT SERVICES - PSKC USES ITS EXPERTISE FOR ENHANCING THE QUALITY OF LIFE OF KIDNEY PATIENTS THROUGH PROVIDING ADMINISTRATION AND MANAGEMENT SERVICES TO A NUMBER OF UNAFFILIATED PATIENT DIALYSIS FACILITIES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $31,189,113 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 42 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 392 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VENKATA RAMANAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4252595195 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 PACIFIC AVENUE | AddressLine1Txt |
| City | EVERETT | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98201 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| DONALD SENTER | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $2,000 | $0 | $0 | |
| BETTY COBBS | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $1,600 | $0 | $0 | |
| FONTELLE JONES | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $2,000 | $0 | $0 | |
| KATHRYN DE TUERK | |||||||
| DIRECTOR | 1.00 | Yes (X) | $1,600 | $0 | $0 | ||
| JAMES JONES | |||||||
| DIRECTOR | 1.00 | Yes (X) | $2,000 | $0 | $0 | ||
| GEORGE BOWDEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $1,800 | $0 | $0 | ||
| GENE CHASE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $2,000 | $0 | $0 | ||
| KRISTEN JENSEN HAUGEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $1,200 | $0 | $0 | ||
| SUHAIL AHMAD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $1,600 | $0 | $0 | ||
| PATRICIA COCHELL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALLEN EAMEA | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DEBBIE MIRCHEFF | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KIM PETERSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HAROLD KELLY | |||||||
| PRESIDENT & CEO | 40.00 | Yes (X) | $505,978 | $0 | $75,824 | ||
| AMANDA CRAIN | |||||||
| COO | 40.00 | Yes (X) | $182,814 | $0 | $20,167 | ||
| RAGHU DURVASULA | |||||||
| CMO | 40.00 | Yes (X) | $258,405 | $0 | $0 | ||
| KENNETH KOUCHI | |||||||
| CFO | 40.00 | Yes (X) | $202,326 | $0 | $22,701 | ||
| AARON HEROLD | |||||||
| CAO (THRU 11/21) | 40.00 | Yes (X) | $140,786 | $0 | $18,120 | ||
| JENNIFER TYNER | |||||||
| CNO | 40.00 | Yes (X) | $153,941 | $0 | $19,107 | ||
| KAREN AYALON | |||||||
| RN | 40.00 | $119,904 | $0 | $12,578 | Yes (X) | ||
| KHIEM GIA NGO | |||||||
| DIS | 40.00 | $117,587 | $0 | $15,548 | Yes (X) | ||
| DANIEL BLATNIK | |||||||
| DSS | 40.00 | $115,706 | $0 | $16,728 | Yes (X) | ||
| KATHERINE HARVEY | |||||||
| DRNS | 40.00 | $113,616 | $0 | $16,545 | Yes (X) | ||
| JOHN GROOMER | |||||||
| RN | 40.00 | $112,389 | $0 | $16,783 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,039,252 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $234,101 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FRESENIUS MEDICAL CARE | |||||
| PO BOX 3936 | BOSTON | MA | 022413936 | MEDICAL SERVICES | $2,258,842 |
| RN NETWORK | |||||
| PO BOX 974088 | DALLAS | TX | 753974088 | CONTRACT LABOR | $706,104 |
| CDW | |||||
| 75 REMITTANCE DR SUITE 1515 | CHICAGO | IL | 606751515 | IT SERVICES | $422,645 |
| SPECTRA LABORATORIES | |||||
| PO BOX 324 | BOSTON | MA | 022413248 | LABORATORY SERVICES | $393,462 |
| BOTESCH NASH | |||||
| 2727 OAKS AVE SUITE 100 | EVERETT | WA | 98201 | ARCHITECT | $334,525 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $131,100 | RelatedOrganizationsAmt |
| Government Grants | $3,976,736 | GovernmentGrantsAmt |
| All Other Contributions | $29,949,385 | AllOtherContributionsAmt |
| Noncash Contributions | $25,492,486 | NoncashContributionsAmt |
| Total Contributions | $34,057,221 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| DIALYSIS | 621400 | $27,821,817 | $27,821,817 |
| PHARMACY | 621400 | $6,752,654 | $6,752,654 |
| LABORATORY | 621500 | $715,977 | $715,977 |
| MEDICATIONS | 621400 | $371,435 | $371,435 |
| MANAGEMENT SERVICES | 900099 | $220,388 | $220,388 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $93,751 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $93,751 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,976,022 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $235,860 | TotalRevenueColumnAmt |
| Exclusion | $235,860 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $50,092 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $58,545 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$8,453 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$8,453 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$8,453 | UnrelatedBusinessRevenueAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,760,661 | SecuritiesAmt |
| Other | $60,543 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,845,081 | SecuritiesAmt |
| Other | $127,105 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $915,580 | SecuritiesAmt |
| Other | -$66,562 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $849,018 | TotalRevenueColumnAmt |
| Exclusion | $849,018 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISC REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $31,644 | TotalRevenueColumnAmt |
| Exclusion | $31,644 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $31,644 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $71,141,312 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,976,022 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$8,453 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,116,522 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,082 | TotalAmt |
| Program Services | $153,082 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,605,769 | TotalAmt |
| Management And General | $1,605,769 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,069,214 | TotalAmt |
| Program Services | $12,149,435 | ProgramServicesAmt |
| Management And General | $2,919,779 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $507,772 | TotalAmt |
| Program Services | $489,134 | ProgramServicesAmt |
| Management And General | $18,638 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,936,483 | TotalAmt |
| Program Services | $1,532,068 | ProgramServicesAmt |
| Management And General | $404,415 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,470,635 | TotalAmt |
| Program Services | $1,143,173 | ProgramServicesAmt |
| Management And General | $327,462 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,763 | TotalAmt |
| Management And General | $281,763 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,792 | TotalAmt |
| Management And General | $240,792 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,111 | TotalAmt |
| Management And General | $60,111 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,222,960 | TotalAmt |
| Program Services | $2,220,045 | ProgramServicesAmt |
| Management And General | $2,915 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,517 | TotalAmt |
| Program Services | $8,553 | ProgramServicesAmt |
| Management And General | $45,964 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $965,713 | TotalAmt |
| Program Services | $486,114 | ProgramServicesAmt |
| Management And General | $479,599 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,872 | TotalAmt |
| Program Services | $1,894 | ProgramServicesAmt |
| Management And General | $585,978 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,173,290 | TotalAmt |
| Program Services | $1,075,550 | ProgramServicesAmt |
| Management And General | $97,740 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,280 | TotalAmt |
| Program Services | $29,448 | ProgramServicesAmt |
| Management And General | $30,832 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,128 | TotalAmt |
| Program Services | $320 | ProgramServicesAmt |
| Management And General | $20,808 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,064,558 | TotalAmt |
| Program Services | $2,848,717 | ProgramServicesAmt |
| Management And General | $215,841 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,922 | TotalAmt |
| Management And General | $207,922 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $7,184,601 | $7,184,601 | |
| OTHER MEDICAL EXPENSES | $958,815 | $958,815 | |
| EQUIPMENT MAINTENANCE & | $541,142 | $477,803 | $63,339 |
| HOUSEKEEPING & LAUNDRY | $456,229 | $429,200 | $27,029 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,758 | TotalAmt |
| Program Services | $1,161 | ProgramServicesAmt |
| Management And General | $69,597 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,895,406 | TotalAmt |
| Program Services | $31,189,113 | ProgramServicesAmt |
| Management And General | $7,706,293 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $871,563 | BOYAmt |
| EOY | $1,322,902 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,046,003 | BOYAmt |
| EOY | $9,066,206 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,476,280 | BOYAmt |
| EOY | $5,472,743 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $825,037 | BOYAmt |
| EOY | $1,440,716 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,576 | BOYAmt |
| EOY | $292,888 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $76,555,403 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $18,659,887 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,812,663 | BOYAmt |
| EOY | $57,895,516 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,841,839 | BOYAmt |
| EOY | $17,632,638 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $635,687 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,253,857 | BOYAmt |
| EOY | $1,096,287 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,224,818 | BOYAmt |
| EOY | $94,855,583 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,754,440 | BOYAmt |
| EOY | $4,067,245 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,207,741 | BOYAmt |
| EOY | $68,119 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,153,676 | BOYAmt |
| EOY | $2,890,666 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,794 | BOYAmt |
| EOY | $780,707 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,349,651 | BOYAmt |
| EOY | $7,806,737 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,875,167 | BOYAmt |
| EOY | $86,961,881 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $86,965 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,875,167 | BOYAmt |
| EOY | $87,048,846 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,224,818 | BOYAmt |
| EOY | $94,855,583 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $32,245,906 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$268,333 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $921 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $195,185 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,881,407 | OtherCostOrOtherBasisAmt |
| Book Value | $13,881,407 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $47,155,891 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,557,591 | DepreciationAmt |
| Book Value | $34,598,300 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,757,172 | OtherCostOrOtherBasisAmt |
| Depreciation | $563,903 | DepreciationAmt |
| Book Value | $3,193,269 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,670,444 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,538,393 | DepreciationAmt |
| Book Value | $3,132,051 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,090,489 | OtherCostOrOtherBasisAmt |
| Book Value | $3,090,489 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $57,895,516 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| LEASE LIABILITY | $491,903 |
| OTHER LONG TERM LIABILITY | $288,804 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $780,707 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS BEEN DESIGNATED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. THE INFORMATION RETURN IS FILED ANNUALLY AND IS SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE, GENERALLY FOR THREE YEARS AFTER THE RETURNS ARE FILED. THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND WAS REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2021, THE ORGANIZATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | UNCOMPENSATED CARE | GrantTypeTxt |
| Recipient | 2 | RecipientCnt |
| Cash Grant | $153,082 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION HAS A POLICY OF PROVIDING CARE TO PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. THOSE PATIENTS WHO ARE UNABLE TO PAY ARE IDENTIFIED ONLY AFTER FINANCIAL INFORMATION IS OBTAINED FROM THE PATIENT AND ALL MEANS OF HELPING THEM OBTAIN FINANCIAL ASSISTANCE HAVE BEEN EXHAUSTED. CURRENTLY, THE CHARGES ARE WAIVED AND THEREBY EXCLUDED FROM NET PATIENT SERVICE REVENUES. THE ORGANIZATION DOES NOT HAVE A SIGNIFICANT AMOUNT OF UNINSURED PATIENTS AND HAS NOT DETERMINED THE AMOUNT OF CHARITY CARE PROVIDED AS THE AMOUNTS CANNOT BE REASONABLY ESTIMATED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HAROLD KELLY | ||||||||||||||
| PRESIDENT & CEO | $408,178 | $0 | $97,800 | $0 | $0 | $0 | $75,310 | $0 | $514 | $0 | $581,802 | $0 | $0 | $0 |
| RAGHU DURVASULA | ||||||||||||||
| CMO | $247,505 | $0 | $10,900 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $258,405 | $0 | $0 | $0 |
| KENNETH KOUCHI | ||||||||||||||
| CFO | $163,026 | $0 | $39,300 | $0 | $0 | $0 | $13,699 | $0 | $9,002 | $0 | $225,027 | $0 | $0 | $0 |
| AMANDA CRAIN | ||||||||||||||
| COO | $146,514 | $0 | $36,300 | $0 | $0 | $0 | $12,491 | $0 | $7,676 | $0 | $202,981 | $0 | $0 | $0 |
| JENNIFER TYNER | ||||||||||||||
| CNO | $142,891 | $0 | $11,050 | $0 | $0 | $0 | $10,105 | $0 | $9,002 | $0 | $173,048 | $0 | $0 | $0 |
| AARON HEROLD | ||||||||||||||
| CAO (THRU 11/21) | $134,736 | $0 | $6,050 | $0 | $0 | $0 | $9,869 | $0 | $8,251 | $0 | $158,906 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | THE PRESIDENT/CEO PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. TOTAL ACCRUAL OF $55,010 FOR 2021 IS REPORTED ON PART II, COLUMN C AS DEFERRED COMPENSATION. NO PAYMENTS WERE RECEIVED FROM THE PLAN DURING 2021. |
| PART I, LINE 7 | THE CEO, COO, AND CFO PARTICIPATE IN AN INCENTIVE PLAN TO RECOGNIZE THE CONTRIBUTIONS MADE TO PUGET SOUND KIDNEY CENTER'S FINANCIAL AND OPERATIONAL SUCCESS. EACH YEAR, THE BOARD REVIEWS THE PERFORMANCE OF THE ORGANIZATION AS COMPARED TO ITS PREDETERMINED GOALS AND SETS APPROPRIATE AND REASONABLE INCENTIVE COMPENSATION. |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $15,209,529 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $8,895,199 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $633,207 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | OTHER OPKC ASSETS | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $754,551 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | NUMBER OF CONTRIBUTORS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO SUBMISSION TO THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS ARE INTERVIEWED ANNUALLY AT THE DECEMBER BOARD MEETING REGARDING POTENTIAL CONFLICTS OF INTEREST. A NUMBER OF ADMINISTRATIVE POLICIES ARE IN PLACE ADDRESSING THIS ISSUE. POLICIES NO. 108, 90, AND 355 COVERS AREAS OF CONFLICT OF INTEREST, BUSINESS ETHICS AND CONDUCT, AND FRAUD DETECTION AND PREVENTION RESPECTIVELY. ADDITIONALLY, AN ANNUAL IN-SERVICE IS GIVEN TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD REVIEWS THE PRESIDENT AND CEO'S COMPENSATION PACKAGES AND IT IS APPROVED BY THE SECRETARY/TREASURER. CURRENT MARKET CONDITIONS AT THE TIME IN HEALTH CARE AND REGION WERE USED TO ORIGINALLY DETERMINE COMPENSATION IN 2016. INCREASES IN COMPENSATION SINCE THEN HAVE BEEN MINIMAL AND UNDER INDUSTRY STANDARD. THE PRESIDENT AND CEO REVIEWS AND ADJUSTS AS NECESSARY ALL OTHERS. THE REVIEW USES A STRUCTURED WAGE AND SALARY SCALE, BASED ON CURRENT MARKET CONDITIONS IN HEALTH CARE AND REGION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN FOUNDATION 195,185. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUGET SOUND KIDNEY CENTERS FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 PACIFIC AVE | AddressLine1Txt |
| City | EVERETT | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98201 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454354877 | EIN |
| Primary Activities | SUPPORT ACTIVITIES OF PUGET SOUND KIDNEY CENTERS | PrimaryActivitiesTxt |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUGET SOUND KIDNEY CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| PUGET SOUND KIDNEY CENTERS FOUNDATION | ||
| O | $100,640 | FMV |
| PUGET SOUND KIDNEY CENTERS FOUNDATION | ||
| C | $131,100 | FMV |