2018-05-08T13:20:06-05:00 2017-06-30 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2016-07-01 680437840 Petaluma Health Center Inc PETA 7075597500 1179 North McDowell Blvd Petaluma CA 94954 Brian Burns CFO 7075597500 2018-05-07 1 Michael Lumsden P01262236 4159561500 2016 2022-09-23 18:48:47Z Kathryn Powell 1179 North McDowell Blvd Petaluma CA 94954 37888169 0 X www.phealthcenter.org X 1999 CA To ensure access & provide high quality prevention-focused health care for the communities we serve. 10 9 420 12 0 0 4263609 3762595 27439083 33913050 843 -11222 322105 210464 32025640 37874887 0 0 0 0 21295709 27505730 0 0 0 9310168 10757886 30605877 38263616 1419763 -388729 29687738 30520452 12775877 15071083 16911861 15449369 X The Petaluma Health Center's mission is to ensure access, and to provide high quality prevention-focused health care, for the communities we serve. 0 0 14724014 16888429 Family Practice services provided to patients. The total number of Family Practice visits during fiscal year 2017 were 80,729. 5576891 5664422 General Dentistry and Fluoride Varnishing services provided to patients. The total number of Dental visits during fiscal year 2017 were 27,939. 3494840 3392244 Obstetric and Gynecology services provided to patients, including birthing and pregnancy services. The total number of OB/GYN visits during fiscal year 2017 were 18,085. 6607545 7967955 Other program services include integrated behavioral health, vision, wellness, and nutrition services provided to patients. 6607545 7967955 30403290 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 109 0 1 420 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CA X Brian Burns 7075597588 1179 North McDowell Blvd Petaluma CA 94954 X Tony Sarno President 2.00 0.00 X X 0 0 0 Gloria Robinson Vice President 2.00 0.00 X X 0 0 0 Georgina Warmoth Secretary 2.00 0.00 X X 0 0 0 Marc Pounds CPA Treasurer 2.00 0.00 X X 0 0 0 Mary Celestre Member 2.00 0.00 X 0 0 0 Tom Isaak Member 2.00 0.00 X 0 0 0 Elad Levinson LCSW Member 2.00 0.00 X 0 0 0 Patricia Padilla MD Member 2.00 0.00 X 0 0 0 Robert Ramirez Member 2.00 0.00 X 0 0 0 Joe Tambe Member 2.00 0.00 X 0 0 0 Kathryn E Powell Chief Executive Officer 40.00 0.00 X 279586 0 30774 Tim Moran CFO (through 8/1/2016) 40.00 0.00 X 146541 0 13931 Brian Burns CFO (start 7/25/16) 40.00 0.00 X 76016 0 3247 Pedro Toledo JD Chief Administrative Officer 40.00 0.00 X 174944 0 19169 Nurit Licht MD Medical Director 32.00 0.00 X 209810 0 26068 Danielle Oryn DO Chief Medical Informatics Officer 40.00 0.00 X 235443 0 34767 Ramona English DDS Dental Director 40.00 0.00 X 195903 0 25003 Andrew Ashcroft MD Family Physician 34.00 0.00 X 180159 0 34529 Iun-lu Aileen Chen MD Family Physician 36.00 0.00 X 182924 0 8235 Jonathan Choe MD Associate Medical Director 32.00 0.00 X 186360 0 10340 Philippe Edouard MD Family Physician 40.00 0.00 X 243936 0 20340 Fiona Redwood MD OB/GYN 32.00 0.00 X 205231 0 30822 2316853 0 257225 39 0 1 0 Najine Shariat 427 Doyle Park Dr Santa Rosa CA 95405 Nutritional Counseling 386340 Servico Building Maintenance PO Box 25 Glen Ellen CA 954420025 Janitorial Services 282262 Leap Solutions Group Inc 1400 N Dutton Ave 15 Santa Rosa CA 95401 Human Resources Services 259963 Elizabeth Van Tassell DDS 135 Keller St Petaluma CA 94952 Dentist Services 177171 Barbier Security Group 369-B Third St San Rafael CA 94901 Security Services 154758 6 3186076 576519 37387 3762595 Net Patient Service Revenue 621400 28654040 28654040 Performance Pymnts - Health Plans 621400 3430022 3430022 Pharmacy Revenue 446110 1491238 1491238 Meaningful Use Revenue 900099 337750 337750 33913050 1060 1060 1000 13282 -12282 -12282 -12282 Other Revenue 900099 210464 210464 210464 37874887 32421812 0 1690480 1611222 589959 1021263 19780063 16987436 2792627 584381 516962 67419 3916183 3216646 699537 1613881 1342449 271432 41183 41183 70200 70200 2784047 1883541 900506 47983 576 47407 606508 377702 228806 937474 749979 187495 1821595 1593616 227979 129954 60377 69577 126062 83012 43050 263798 263798 1488392 1147254 341138 66060 37659 28401 Medical Supplies/Drugs 1273188 1273188 Minor Equipment 555546 429646 125900 Dues and Subscriptions 195542 98069 97473 350354 15219 335135 38263616 30403290 7860326 0 3333059 3166267 249895 250702 192751 274536 4560270 5492988 3644 143110 73680 547699 730925 25502792 7369791 18221234 18133001 155000 155000 2284720 2239709 29687738 30520452 2934836 3879858 452247 145985 4862136 5624112 1073876 1644476 3452782 3776652 12775877 15071083 X 16911861 15449369 16911861 15449369 29687738 30520452 X -388729 -1073763 X 0 1 X 1 1 1 X 1416514 2057963 3424063 4263609 3762595 14924744 1416514 2057963 3424063 4263609 3762595 14924744 103223 14821521 2015 1310 1382 843 1060 6610 29848 108781 337379 322105 210464 1008577 15939931 117305029 0.92980 0.93770 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1500000 1500000 14386971 2813175 11573796 2101258 260978 1840280 6081827 3489971 2591856 1432736 805667 627069 18133001 Debt Service Fund 174708 Other Receivables 1961873 Deposits 52202 Reserve for Unemployment 13479 Bond Principal/Interest Funds 37447 2239709 Estimated Amounts Due to 3rd Party Payers 3776652 3776652 X 37986058 111171 111171 37874887 0 37874887 39448550 111171 1073763 1184934 38263616 0 38263616 Part X, Line 2: The Organization is a nonprofit corporation under Internal Revenue Code Section 501(c)(3) and has been granted tax-exempt status by the Internal Revenue Service and the California Revenue and Taxation Code. As of June 30, 2017, the Organization had no unrecognized tax positions or uncertain tax positions requiring accrual. Therefore, no provision for income taxes has been provided in the financial statements. Part XII, Line 2d - Other Adjustments: Loss on Refinance of Long-Term Debt 1,073,763. X X 0 0 0 0 0 0 0 0 0 Kathryn E Powell Chief Executive Officer 260585 0 17500 0 1501 0 13480 0 17294 0 310360 0 0 0 Tim Moran CFO (through 8/1/2016) 145472 0 0 0 1069 0 8246 0 5685 0 160472 0 0 0 Pedro Toledo JD Chief Administrative Officer 144733 0 30000 0 211 0 9177 0 9992 0 194113 0 0 0 Nurit Licht MD Medical Director 176536 0 20000 0 13274 0 11154 0 14914 0 235878 0 0 0 Danielle Oryn DO Chief Medical Informatics Officer 210491 0 22797 0 2155 0 10928 0 23839 0 270210 0 0 0 Ramona English DDS Dental Director 175301 0 20000 0 602 0 10918 0 14085 0 220906 0 0 0 Andrew Ashcroft MD Family Physician 141641 0 16438 0 22080 0 9722 0 24807 0 214688 0 0 0 Iun-lu Aileen Chen MD Family Physician 146089 0 21063 0 15772 0 0 0 8235 0 191159 0 0 0 Jonathan Choe MD Associate Medical Director 149408 0 18569 0 18383 0 9736 0 604 0 196700 0 0 0 Philippe Edouard MD Family Physician 220881 0 22031 0 1024 0 11728 0 8612 0 264276 0 0 0 Fiona Redwood MD OB/GYN 187652 0 13500 0 4079 0 11126 0 19696 0 236053 0 0 0 A Ca Health Facilities Financing Authority 521643828 13032UET1 2016-09-13 5955305 Refund of Bonds Originally Issued 6/2/2010 0 0 0 A 5955309 174708 115500 153716 5511385 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 Schedule K, Part II, Line 3 The difference between the "Total Proceeds of Issue" in Schedule K, Part II, Line 3 and the issue price listed in Schedule K, Part I, Column (e) represents investments earnings on gross proceeds in reserve funds. North Bay Office Furniture Entity is Solely Owned by Board Member Robert Ramirez 140976 The organization purchased office furniture at fair market value from North Bay Office Furniture, which is solely owned by Board Member Robert Ramirez. 0 X Software 49 37387 FMV 0 0 0 0 Part I, Column (b): The organization is reporting the number of items contributed in Schedule M, Part I, Column (b). Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an outside tax preparer in conjunction with the organization's finance and accounting team. The CEO and CFO of the Organization then review the Form 990 and, upon approval, submits the Form 990 to the Board Finance Committee for review and approval for filing with the Internal Revenue Service; the Form 990 is also made available to all Board Members for review prior to submission. Form 990, Part VI, Section B, line 12c It is the policy of Petaluma Health Center that all full-time and part-time employees, contractors, and members of the Board of Directors avoid conflicts of interest, or appearance of conflict, between their personal interests and the interests of the organization when dealing with any individual or outside organization having, or seeking to have, a business relationship with Petaluma Health Center. All members of the Petaluma Health Center Board of Directors are required to complete the Conflict of Interest Disclosure Statement; all staff members, volunteers, and contractors are required to disclose any potential or actual conflict of interest that arises to the Human Resources Department within 10 business days of learning of it. After disclosure of a possible conflict of interest, the CEO affords the interested person who makes the disclosure an opportunity to explain to the Senior Management Team (for employees), or the Executive Committee of the Board (for Board Members) the facts and circumstances of the transaction or arrangement that led to such disclosure. The interested person leaves the Senior Management Team or Board Executive Committee meeting while the interest is discussed and voted upon. Form 990, Part VI, Section B, line 15a The process for determining the Chief Executive Officer's salary increase involves a discussion amongst the Executive Committee of the Board, salary research by the Director of Human Resources, and recommendation of a new salary from the Executive Committee to the Board of Directors for approval. The CEO reviews and approves the compensation of other officers and managers. Form 990, Part VI, Section C, line 19 The governing DOCUMENTS, conflict of interest policy, and financial statements ARE AVAILABLE UPON REQUEST. Form 990, Part VI, Section A, Line 3 and Form 990 Part VII, Section B: During the 6/30/2017 fiscal year (and the 2016 calendar year, as reported on Form 990, Part VII, Section B), the organization consulted with Leap Solutions Group, Inc. for Human Resource services. These services do not mandate the disclosure on Form 990, Part VI, Section A, Line 3 regarding the delegation of management duties to a management company or other persons as the ultimate responsibility and decision-making for hiring, firing, and supervising personnel rested in exisiting management employees of the organization (rather than Leap Solutions Group, Inc.); the services provided were strictly on a consultative basis. Form 990, Part XI, line 9: Loss on Refinance of Long-Term Debt -1,073,763.