2022-11-15T15:42:51-06:00 2021-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2021-01-01 911102033 PUGET SOUND KIDNEY CENTERS PUGE 4252595195 1019 PACIFIC AVENUE EVERETT WA 98201 HAROLD KELLY PRESIDENT AND CEO 4252595195 2022-11-15 1 HAROLD KELLY 999009999 COLLEEN RAMIRES P01251320 4252597227 2022-11-15 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z HAROLD KELLY 1019 PACIFIC AVENUE EVERETT WA 98201 75172043 0 X WWW.PSKC.NET X 1980 WA TO PROVIDE KIDNEY DIALYSIS AND RELATED PATIENT CARE SERVICES IN WASHINGTON STATE. 13 13 392 29 -8453 0 2653136 34057221 31367219 35976022 112649 1084878 619569 23191 34752573 71141312 0 153082 0 0 17183204 20589873 0 0 0 14038424 18152451 31221628 38895406 3530945 32245906 62224818 94855583 7349651 7806737 54875167 87048846 TO ENHANCE THE QUALITY OF LIFE OF THOSE WITH KIDNEY DISEASE THROUGH OUTSTANDING DIALYSIS CARE, EDUCATION AND COMMUNITY SUPPORT. 0 0 30705328 153082 35976022 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. 346772 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. 137013 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. 31189113 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 42 0 1 392 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X VENKATA RAMANAN 4252595195 1019 PACIFIC AVENUE EVERETT WA 98201 DONALD SENTER CHAIR 1.00 X X 2000 0 0 BETTY COBBS VICE CHAIR 1.00 X X 1600 0 0 FONTELLE JONES TREASURER 1.00 X X 2000 0 0 KATHRYN DE TUERK DIRECTOR 1.00 X 1600 0 0 JAMES JONES DIRECTOR 1.00 X 2000 0 0 GEORGE BOWDEN DIRECTOR 1.00 X 1800 0 0 GENE CHASE DIRECTOR 1.00 X 2000 0 0 KRISTEN JENSEN HAUGEN DIRECTOR 1.00 X 1200 0 0 SUHAIL AHMAD DIRECTOR 1.00 X 1600 0 0 PATRICIA COCHELL DIRECTOR 1.00 X 0 0 0 ALLEN EAMEA DIRECTOR 1.00 X 0 0 0 DEBBIE MIRCHEFF DIRECTOR 1.00 X 0 0 0 KIM PETERSON DIRECTOR 1.00 X 0 0 0 HAROLD KELLY PRESIDENT & CEO 40.00 X 505978 0 75824 AMANDA CRAIN COO 40.00 X 182814 0 20167 RAGHU DURVASULA CMO 40.00 X 258405 0 0 KENNETH KOUCHI CFO 40.00 X 202326 0 22701 AARON HEROLD CAO (THRU 11/21) 40.00 X 140786 0 18120 JENNIFER TYNER CNO 40.00 X 153941 0 19107 KAREN AYALON RN 40.00 X 119904 0 12578 KHIEM GIA NGO DIS 40.00 X 117587 0 15548 DANIEL BLATNIK DSS 40.00 X 115706 0 16728 KATHERINE HARVEY DRNS 40.00 X 113616 0 16545 JOHN GROOMER RN 40.00 X 112389 0 16783 2039252 0 234101 22 0 1 0 FRESENIUS MEDICAL CARE PO BOX 3936 BOSTON MA 022413936 MEDICAL SERVICES 2258842 RN NETWORK PO BOX 974088 DALLAS TX 753974088 CONTRACT LABOR 706104 CDW 75 REMITTANCE DR SUITE 1515 CHICAGO IL 606751515 IT SERVICES 422645 SPECTRA LABORATORIES PO BOX 324 BOSTON MA 022413248 LABORATORY SERVICES 393462 BOTESCH NASH 2727 OAKS AVE SUITE 100 EVERETT WA 98201 ARCHITECT 334525 8 131100 3976736 29949385 25492486 34057221 DIALYSIS 621400 27821817 27821817 PHARMACY 621400 6752654 6752654 LABORATORY 621500 715977 715977 MEDICATIONS 621400 371435 371435 MANAGEMENT SERVICES 900099 220388 220388 93751 93751 35976022 235860 235860 50092 58545 -8453 -8453 -8453 4760661 60543 3845081 127105 915580 -66562 849018 849018 MISC REVENUE 900099 31644 31644 31644 71141312 35976022 -8453 1116522 153082 153082 1605769 1605769 15069214 12149435 2919779 507772 489134 18638 1936483 1532068 404415 1470635 1143173 327462 281763 281763 240792 240792 60111 60111 2222960 2220045 2915 54517 8553 45964 965713 486114 479599 587872 1894 585978 1173290 1075550 97740 60280 29448 30832 21128 320 20808 3064558 2848717 215841 207922 207922 MEDICAL SUPPLIES 7184601 7184601 OTHER MEDICAL EXPENSES 958815 958815 EQUIPMENT MAINTENANCE & 541142 477803 63339 HOUSEKEEPING & LAUNDRY 456229 429200 27029 70758 1161 69597 38895406 31189113 7706293 0 871563 1322902 4046003 9066206 4476280 5472743 825037 1440716 97576 292888 76555403 18659887 48812663 57895516 1841839 17632638 0 635687 1253857 1096287 62224818 94855583 2754440 4067245 1207741 68119 3153676 2890666 233794 780707 7349651 7806737 X 54875167 86961881 0 86965 54875167 87048846 62224818 94855583 X 32245906 -268333 921 195185 X 1 X 0 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13881407 13881407 47155891 12557591 34598300 3757172 563903 3193269 8670444 5538393 3132051 3090489 3090489 57895516 LEASE LIABILITY 491903 OTHER LONG TERM LIABILITY 288804 780707 X PART X, LINE 2: 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. 1 UNCOMPENSATED CARE 2 153082 PART I, LINE 2: 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. X X 0 1 0 0 0 0 0 1 0 HAROLD KELLY PRESIDENT & CEO 408178 0 97800 0 0 0 75310 0 514 0 581802 0 0 0 RAGHU DURVASULA CMO 247505 0 10900 0 0 0 0 0 0 0 258405 0 0 0 KENNETH KOUCHI CFO 163026 0 39300 0 0 0 13699 0 9002 0 225027 0 0 0 AMANDA CRAIN COO 146514 0 36300 0 0 0 12491 0 7676 0 202981 0 0 0 JENNIFER TYNER CNO 142891 0 11050 0 0 0 10105 0 9002 0 173048 0 0 0 AARON HEROLD CAO (THRU 11/21) 134736 0 6050 0 0 0 9869 0 8251 0 158906 0 0 0 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. X 1 15209529 FMV X 1 8895199 FMV X 1 633207 FMV X OTHER OPKC ASSETS 1 754551 FMV 0 0 0 0 PART I, COLUMN (B): NUMBER OF CONTRIBUTORS. 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. PUGET SOUND KIDNEY CENTERS FOUNDATION 1019 PACIFIC AVE EVERETT WA 98201 454354877 SUPPORT ACTIVITIES OF PUGET SOUND KIDNEY CENTERS WA 501(C)(3) LINE 12A, I PUGET SOUND KIDNEY CENTERS 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 PUGET SOUND KIDNEY CENTERS FOUNDATION O 100640 FMV PUGET SOUND KIDNEY CENTERS FOUNDATION C 131100 FMV