PENINSULA COMMUNITY HEALTH SERVICES: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- PENINSULA COMMUNITY HEALTH SERVICES (EIN 94-3079770)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-07-10
- IRS object ID
- 202011929349300016
- Schema version
- 2019v5.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-07-10T11:50:14-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 943079770 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PENINSULA COMMUNITY HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PENI | BusinessNameControlTxt |
| Phone | 3604782366 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 960 | AddressLine1Txt |
| City | BREMERTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98337 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER KREIDLER-MOSS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3604782366 | PhoneNum |
| Signature | 2020-06-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2020-06-25 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-06-25 | IPDt |
| IP Tm | 20:05:04 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 13D2D6CE62C2C3BC6CBA5B3F38E71F8D2ADB3C18 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JENNIFER KREIDLER-MOSS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 960 | AddressLine1Txt |
| City | BREMERTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98337 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $37,889,598 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PCHSWEB.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1987 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE ACCESSIBLE, AFFORDABLE, QUALITY HEALTH AND WELLNESS SERVICES FOR OUR COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 373 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,072,589 | PYContributionsGrantsAmt |
| CY Contributions Grants | $9,914,132 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $27,181,832 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $27,738,361 | CYProgramServiceRevenueAmt |
| PY Investment Income | $94,425 | PYInvestmentIncomeAmt |
| CY Investment Income | $210,968 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,115 | PYOtherRevenueAmt |
| CY Other Revenue | $26,137 | CYOtherRevenueAmt |
| PY Total Revenue | $33,354,961 | PYTotalRevenueAmt |
| CY Total Revenue | $37,889,598 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,032 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,200 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,092,954 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $22,671,230 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,328,450 | PYOtherExpensesAmt |
| CY Other Expenses | $11,203,418 | CYOtherExpensesAmt |
| PY Total Expenses | $28,422,436 | PYTotalExpensesAmt |
| CY Total Expenses | $33,875,848 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,932,525 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,013,750 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $34,693,512 | TotalAssetsBOYAmt |
| Total Assets EOY | $38,636,440 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,324,754 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,648,068 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $28,368,758 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $32,988,372 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE ACCESS TO AFFORDABLE, QUALITY HEALTH AND WELLNESS SERVICES AND REDUCE HEALTHCARE DISPARITIES FOR OUR COMMUNITIES. PENINSULA COMMUNITY HEALTH SERVICES OFFERS ALL SERVICES ON A SLIDING FEE SCHEDULE FOR THOSE THAT QUALIFY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,997,625 | ExpenseAmt |
| Grant | $1,200 | GrantAmt |
| Revenue | $16,288,440 | RevenueAmt |
| Desc | MEDICAL - DURING 2019, PCHS PROVIDED 85,240 MEDICAL ENCOUNTERS TO 27,012 PATIENTS AT NINE CLINICAL SITES LOCATED IN BREMERTON (THREE SITES), BELFAIR (TWO SITES), KINGSTON, PORT ORCHARD, POULSBO AND SHELTON, AS WELL AS ONE MOBILE SITE. SERVICES INCLUDE COMPREHENSIVE PRIMARY MEDICAL SERVICES FOR CHILDREN AND ADULTS, EMPHASIZING A WHOLE-PERSON, PATIENT-CENTERED APPROACH. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,108,561 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $6,967,894 | RevenueAmt |
| Desc | DENTAL - IN 2019, PCHS PROVIDED 31,967 DENTAL VISITS TO 14,215 CHILDREN AND ADULTS FOR PREVENTATIVE AND RESTORATIVE CARE. DENTAL SERVICES ARE PROVIDED AT FIVE CLINICAL SITES IN BREMERTON (TWO SITES), POULSBO, PORT ORCHARD AND BELFAIR. SERVICES INCLUDE PREVENTATIVE CARE, ORAL EXAMS, ORAL HYGIENE, X-RAYS, EMERGENCY CARE AND DENTAL EDUCATION. REFERRAL SERVICES ARE OFFERED FOR MORE SPECIALIZED CARE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,950,617 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,683,415 | RevenueAmt |
| Desc | BEHAVIORAL HEALTH - DURING 2019, PCHS PROVIDED 13,339 BEHAVIORAL HEALTH ENCOUNTERS TO 2,031 PATIENTS AT SEVEN CLINICAL SITES LOCATED IN BREMERTON (TWO SITES), BELFAIR (TWO SITES), KINGSTON, PORT ORCHARD, AND POULSBO, AS WELL AS TWO MOBILE SITES. BY FOCUSING ON A PATIENT'S BEHAVIORAL HEALTH AS PART OF AN INTEGRATED CARE MODEL, WE ARE ABLE TO BETTER COORDINATE COMPLETE AND TIMELY ACCESS TO CARE. OUR LICENSED, CERTIFIED COUNSELORS AND SUBSTANCE USE DISORDER PROFESSIONALS ADDRESS THE INDIVIDUALIZED NEEDS OF OUR PATIENTS BY WORKING ALONGSIDE OUR PRIMARY CARE PROVIDERS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,168,924 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,798,612 | RevenueAmt |
| Desc | PHARMACY - IN 2019, PCHS PROVIDED 89,023 PRESCRIPTIONS TO ITS ELIGIBLE PATIENTS. FULLY LICENSED PHARMACIES ARE LOCATED AT FIVE CLINICAL SITES IN BREMERTON (TWO SITES), BELFAIR, POULSBO AND PORT ORCHARD. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,168,924 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $2,798,612 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $27,225,727 | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | 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 | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 44 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 373 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | JOEL EMERY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3604756710 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 WARREN AVENUE SUITE 200 | AddressLine1Txt |
| City | BREMERTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98337 | 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CHRISTOPHER COOK | ||||||||
| PRESIDENT | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| EVELYN HETRICK | ||||||||
| VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| YOLANDA FONG | ||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PAUL HATHAWAY | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SUSAN ASTLE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MONICA BERNHARD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BERYL COCHRAN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SHARON CROMLEY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BRYNN FELIX | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARGARET MOORE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| AL PINKHAM | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JEANELL RASMUSSEN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SHANNON TURNER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID WINDOM | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JENNIFER KREIDLER-MOSS PHARMD | ||||||||
| CEO | 40.00 | Yes (X) | $386,604 | $0 | $23,840 | |||
| JOEL EMERY | ||||||||
| CFO | 40.00 | Yes (X) | $143,030 | $0 | $7,270 | |||
| AARON FORSTER | ||||||||
| CIO | 40.00 | Yes (X) | $158,884 | $0 | $180 | |||
| REGINA BONNEVIE ROGERS MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | $327,532 | $0 | $2,124 | Yes (X) | |||
| MICHAEL INSANI DDS | ||||||||
| DENTAL DIRECTOR | 40.00 | $226,373 | $0 | $7,800 | Yes (X) | |||
| MANDEEP DHAWAN MD | ||||||||
| PHYSICIAN | 40.00 | $267,136 | $0 | $7,188 | Yes (X) | |||
| DONNAVILLE ORTIZ MD | ||||||||
| PHYSICIAN | 40.00 | $263,513 | $0 | $7,128 | Yes (X) | |||
| CLEMENT LE THANH MD | ||||||||
| PHYSICIAN | 40.00 | $221,793 | $0 | $2,221 | Yes (X) | |||
| FAIRYAL KASSAM MD | ||||||||
| PHYSICIAN | 40.00 | $212,958 | $0 | $6,868 | Yes (X) | |||
| CHI LAP LI DDS | ||||||||
| DENTIST | 40.00 | $205,054 | $0 | $7,524 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,412,877 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $72,143 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 55 | 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 |
|---|---|---|---|---|---|
| NEW DIRECTIONS | |||||
| 3501 COLBY AVENUE 102 | EVERETT | WA | 98201 | CONSULTING | $259,415 |
| CLIFTONLARSONALLEN LLP | |||||
| PO BOX 31001-2443 | PASADENA | CA | 91110 | AUDITING | $203,899 |
| JOHNSON OAKLIEF | |||||
| 2124 THIRD AVENUE SUITE 200 | SEATTLE | WA | 98121 | ARCHITECTURE | $163,134 |
| COMMUNITY CLINIC CONTRACTING NETWORK | |||||
| 18 S MISSION ST STE 300 | WENATCHEE | WA | 98801 | CONSULTING | $160,668 |
| MCS JANITORAL | |||||
| PO BOX 11044 | TACOMA | WA | 98411 | JANITORIAL | $150,935 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $7,949,585 | GovernmentGrantsAmt |
| All Other Contributions | $1,964,547 | AllOtherContributionsAmt |
| Noncash Contributions | $810,225 | NoncashContributionsAmt |
| Total Contributions | $9,914,132 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $27,738,361 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $27,738,361 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $27,738,361 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $210,968 | TotalRevenueColumnAmt |
| Exclusion | $210,968 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $26,137 | TotalRevenueColumnAmt |
| Exclusion | $26,137 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $26,137 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,889,598 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $27,738,361 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $237,105 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,200 | TotalAmt |
| Program Services | $1,200 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,283,637 | TotalAmt |
| Program Services | $892,184 | ProgramServicesAmt |
| Management And General | $391,453 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,096,039 | TotalAmt |
| Program Services | $13,927,361 | ProgramServicesAmt |
| Management And General | $3,168,678 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,609,057 | TotalAmt |
| Program Services | $2,065,270 | ProgramServicesAmt |
| Management And General | $543,787 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,682,497 | TotalAmt |
| Program Services | $1,329,523 | ProgramServicesAmt |
| Management And General | $352,974 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,404 | TotalAmt |
| Program Services | $27,678 | ProgramServicesAmt |
| Management And General | $14,726 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $225,986 | TotalAmt |
| Program Services | $147,505 | ProgramServicesAmt |
| Management And General | $78,481 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,787 | TotalAmt |
| Program Services | $19,442 | ProgramServicesAmt |
| Management And General | $10,345 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,496,140 | TotalAmt |
| Program Services | $981,153 | ProgramServicesAmt |
| Management And General | $514,987 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,827 | TotalAmt |
| Program Services | $5,655 | ProgramServicesAmt |
| Management And General | $3,172 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,444 | TotalAmt |
| Program Services | $138,857 | ProgramServicesAmt |
| Management And General | $51,587 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $888,793 | TotalAmt |
| Program Services | $725,027 | ProgramServicesAmt |
| Management And General | $163,766 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,701,717 | TotalAmt |
| Program Services | $1,309,500 | ProgramServicesAmt |
| Management And General | $392,217 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,812 | TotalAmt |
| Program Services | $39,733 | ProgramServicesAmt |
| Management And General | $92,079 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $498,262 | TotalAmt |
| Program Services | $363,728 | ProgramServicesAmt |
| Management And General | $134,534 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,135,896 | TotalAmt |
| Program Services | $1,006,377 | ProgramServicesAmt |
| Management And General | $129,519 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,705 | TotalAmt |
| Program Services | $76,060 | ProgramServicesAmt |
| Management And General | $20,645 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,993,317 | $2,993,317 | |
| MISCELLANEOUS | $855,088 | $461,808 | $393,280 |
| EQUIP MAINT & REPAIR | $557,707 | $454,946 | $102,761 |
| COMMUNICATIONS | $350,315 | $259,185 | $91,130 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218 | TotalAmt |
| Program Services | $218 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,875,848 | TotalAmt |
| Program Services | $27,225,727 | ProgramServicesAmt |
| Management And General | $6,650,121 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,246,463 | BOYAmt |
| EOY | $17,036,106 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $191,366 | BOYAmt |
| EOY | $142,087 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,712,415 | BOYAmt |
| EOY | $3,255,732 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $218,139 | BOYAmt |
| EOY | $222,220 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $259,502 | BOYAmt |
| EOY | $403,783 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,463,844 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,300,765 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,359,263 | BOYAmt |
| EOY | $14,163,079 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,706,364 | BOYAmt |
| EOY | $3,413,433 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,693,512 | BOYAmt |
| EOY | $38,636,440 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,632,978 | BOYAmt |
| EOY | $2,697,101 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $838,551 | BOYAmt |
| EOY | $1,248,525 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,822,020 | BOYAmt |
| EOY | $1,700,106 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,205 | BOYAmt |
| EOY | $2,336 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,324,754 | BOYAmt |
| EOY | $5,648,068 | 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 | $28,368,758 | BOYAmt |
| EOY | $32,988,372 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,368,758 | BOYAmt |
| EOY | $32,988,372 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,693,512 | BOYAmt |
| EOY | $38,636,440 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,013,750 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $605,864 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,872,155 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,923,608 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,213,085 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,072,589 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,914,132 | CurrentTaxYearAmt |
| Total | $25,995,569 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,872,155 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,923,608 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,213,085 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,072,589 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,914,132 | CurrentTaxYearAmt |
| Total | $25,995,569 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $25,995,569 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $74,842 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $64,387 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $106,424 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $95,088 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $210,968 | CurrentTaxYearAmt |
| Total | $551,709 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $64,971 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $29,794 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $121,592 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,115 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $26,137 | CurrentTaxYearAmt |
| Total | $248,609 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $26,795,887 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $114,928,202 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.97010 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99450 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
| Public Support PY509 | 0.99450 | PublicSupportPY509Pct |
| Investment Income PY | 0.00350 | InvestmentIncomePYPct |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME | ExplanationTxt |
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 | $1,929,927 | OtherCostOrOtherBasisAmt |
| Book Value | $1,929,927 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,742,461 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,920,216 | DepreciationAmt |
| Book Value | $2,822,245 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,499,496 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,033,106 | DepreciationAmt |
| Book Value | $3,466,390 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,629,902 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,347,443 | DepreciationAmt |
| Book Value | $2,282,459 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,662,058 | OtherCostOrOtherBasisAmt |
| Book Value | $3,662,058 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,163,079 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $37,296,050 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $37,296,050 | RevenueSubtotalAmt |
| Other Revenues Not Included | $593,548 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $593,548 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $37,889,598 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $33,875,848 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $33,875,848 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $33,875,848 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION (ASC). |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTIONS 33,847. CAPITAL DEVELOPMENT GRANT 559,701. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JENNIFER KREIDLER-MOSS PHARMD | ||||||||||||||
| CEO | $369,179 | $0 | $17,425 | $0 | $0 | $0 | $18,500 | $0 | $5,340 | $0 | $410,444 | $0 | $0 | $0 |
| JOEL EMERY | ||||||||||||||
| CFO | $143,030 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,270 | $0 | $150,300 | $0 | $0 | $0 |
| AARON FORSTER | ||||||||||||||
| CIO | $158,884 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $180 | $0 | $159,064 | $0 | $0 | $0 |
| REGINA BONNEVIE ROGERS MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $327,532 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,124 | $0 | $329,656 | $0 | $0 | $0 |
| MICHAEL INSANI DDS | ||||||||||||||
| DENTAL DIRECTOR | $226,373 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $234,173 | $0 | $0 | $0 |
| MANDEEP DHAWAN MD | ||||||||||||||
| PHYSICIAN | $259,636 | $0 | $7,500 | $0 | $0 | $0 | $0 | $0 | $7,188 | $0 | $274,324 | $0 | $0 | $0 |
| DONNAVILLE ORTIZ MD | ||||||||||||||
| PHYSICIAN | $253,513 | $0 | $10,000 | $0 | $0 | $0 | $0 | $0 | $7,128 | $0 | $270,641 | $0 | $0 | $0 |
| CLEMENT LE THANH MD | ||||||||||||||
| PHYSICIAN | $218,293 | $0 | $3,500 | $0 | $0 | $0 | $0 | $0 | $2,221 | $0 | $224,014 | $0 | $0 | $0 |
| FAIRYAL KASSAM MD | ||||||||||||||
| PHYSICIAN | $212,958 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,868 | $0 | $219,826 | $0 | $0 | $0 |
| CHI LAP LI DDS | ||||||||||||||
| DENTIST | $201,554 | $0 | $3,500 | $0 | $0 | $0 | $0 | $0 | $7,524 | $0 | $212,578 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | EMPLOYEES WHO PARTICIPATE IN THE YMCA PROGRAM AND WHO HAVE TAXABLE LIFE INSURANCE COVERAGE OVER $150,000 RECEIVE TAX GROSS-UP PAYMENTS. ALL EMPLOYEES LISTED IN FORM 990, PART VII, SECTION A RECEIVED AT LEAST ONE OF THESE BENEFITS. THESE AMOUNTS ARE INCLUDED IN THEIR TAXABLE COMPENSATION. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WA HEALTH CARE FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 911108929 | BondIssuerEIN |
| Bond Issued | 2005-12-18 | BondIssuedDt |
| Issue Price | $3,000,000 | IssuePriceAmt |
| Purpose | CONSTRUCTION FINANCING | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | Yes (1) | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,296,187 | RetiredAmt |
| Total Proceeds | $3,000,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $51,942 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $2,948,058 | CapitalExpendituresAmt |
| Substantial Completion | 2005 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 121 | ContributionCnt |
| Noncash Contributions Rpt F990 | $810,225 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | INVOICE PRICE | 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 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE ORGANIZATION'S EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD. IT MAY ALSO INCLUDE THE PAST PRESIDENT FOR ONE YEAR AFTER THEY FINISH THEIR SERVICE AS BOARD PRESIDENT AND/OR ONE ADDITIONAL AT-LARGE MEMBER. THE EXECUTIVE COMMITTEE ACTS ONLY AS NECESSARY BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS WITH ALL THE POWERS OF THE BOARD AND REPORTS AND PRESENTS FOR RATIFICATION ANY SUCH ACTION TO THE BOARD AT ITS NEXT MEETING. HOWEVER, THE EXECUTIVE COMMITTEE DOES NOT HAVE AUTHORITY TO BIND THE BOARD OR THE ORGANIZATION ON ANY MATTERS INVOLVING THE PURCHASE OR SALE OF ANY REAL PROPERTY, OR THE PURCHASE OR SALE OF EQUIPMENT, FURNITURE OR FIXTURES IN EXCESS OF 1% OF THE ORGANIZATION'S ANNUAL BUDGET. THE EXECUTIVE COMMITTEE INITIATES ANNUALLY THE PERFORMANCE REVIEW OF THE CEO AND MAKES RECOMMENDATIONS TO THE BOARD FOR APPROVAL. THE EXECUTIVE COMMITTEE REVIEWS AND REVISES THE ORGANIZATION'S GOVERNANCE AND EMPLOYEE POLICIES AND PROVIDES BROAD OVERSIGHT OF ALL EMPLOYMENT MATTERS. THE EXECUTIVE COMMITTEE KEEPS RECORDS OF THE TERMS OF OFFICE AND REPLACEMENTS FOR ANY VACANCIES WHICH MAY ARISE, AND SUPERVISES THE NOMINATIONS OF BOARD MEMBERS. THE EXECUTIVE COMMITTEE SOLICITS AND SCREENS POTENTIAL BOARD MEMBERS AND DETERMINES THEIR QUALIFICATIONS AND WILLINGNESS TO SERVE. THE EXECUTIVE COMMITTEE ALSO HAS THE RESPONSIBILITY OF PREPARING A SLATE OF OFFICERS TO BE SELECTED FROM THE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS WERE AMENDED IN DECEMBER 2019 TO UPDATE THE ORGANIZATION'S MISSION STATEMENT (WITHOUT MATERIALLY CHANGING THE ORGANIZATION'S MISSION) AND UPDATE THE DUTIES OF BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS REVIEWED BEFORE SIGNATURE BY BOTH THE CFO AND CEO, AND WAS PRESENTED TO THE FINANCE COMMITTEE. THE BOARD TREASURER MADE A REPORT TO THE FULL BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | PENINSULA COMMUNITY HEALTH SERVICES HAS A WRITTEN CONFLICT OF INTEREST POLICY THAT ALL BOARD DIRECTORS ARE REQUIRED TO SIGN ON AN ANNUAL BASIS. UPON SIGNING THE POLICY, EACH BOARD MEMBER AGREES TO DISCLOSE AN ACTUAL OR PERCEIVED CONFLICT OF INTEREST. THE BOARD OF DIRECTORS, AT ANY TIME A POTENTIAL CONFLICT ARISES, MAY REQUIRE AN INDIVIDUAL TO REFRAIN FROM DISCUSSION OF THE MATTER, REFRAIN FROM VOTING ON THE MATTER, OR BE EXCUSED FROM ATTENDING THE PORTION OF THE MEETING ABOUT THE MATTER OF CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | PENINSULA COMMUNITY HEALTH SERVICES ATTEMPTS TO COMPENSATE ALL EMPLOYEES FAIRLY, EQUITABLY AND COMPETITIVELY. A SALARY SURVEY THAT INCLUDES A SALARY ANALYSIS OF LIKE JOB DESCRIPTIONS IN THE GEOGRAPHICAL AREA IS COMPLETED BY THE HUMAN RESOURCE DEPARTMENT. THE BOARD OF DIRECTORS APPROVES THE WAGE SCALE ANNUALLY. FOR THE POSITION OF THE CEO THE SALARY DATA IS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. BASED ON THE INFORMATION PROVIDED, THE EXECUTIVE COMMITTEE DETERMINES THE COMPENSATION FOR THE CEO FOR THE ENSUING YEAR WHICH THE FULL BOARD APPROVES. THIS PROCESS LAST OCCURRED IN 2019. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORMS 990 ARE PROVIDED UPON REQUEST. |