2023-02-27T09:02:47-06:00 2022-06-30 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2021-07-01 223160873 STAYWELL HEALTH CARE INC STAY 2037568021 80 PHOENIX AVENUE 201 WATERBURY CT 06702 DONALD J THOMPSON JR CHIEF EXECUTIVE OFFICER 2037568021 2023-02-23 1 DONALD THOMPSON JR 999009999 LORI ROTHE YOKOBOSKY CPA P01273422 9592007000 2023-02-09 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z DONALD J THOMPSON JR 80 PHOENIX AVENUE 201 WATERBURY CT 06702 36278229 0 X WWW.STAYWELLHEALTH.ORG X 1992 CT PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 8 8 295 8 0 0 11741183 13740694 18502942 22088517 7101 9482 128748 231286 30379974 36069979 0 0 0 0 19939795 22179213 0 0 0 9519348 10987512 29459143 33166725 920831 2903254 18010645 17651255 7880094 4620696 10130551 13030559 PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 0 0 27412335 22308676 MEDICAL CLINIC, HEALTHY START, AND DENTAL CLINIC WHICH PROVIDE MEDICAL, PRENATAL, AND CHILDCARE FOR INNER CITY RESIDENTS AND UNINSURED RESIDENTS AND RESTORATIVE DENTAL CARE FOR INNER CITY CHILDREN. THE TOTAL NUMBER OF VISITS DURING FISCAL YEAR 2022 WAS 113,869. 27412335 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 31 0 1 295 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CT X LULE TRACEY 2037568021 80 PHOENIX AVENUE SUITE 201 WATERBURY CT 06702 ALISON CAMPBELL BOARD MEMBER 0.75 X 0 0 0 CAROLYN A HIGHSMITH TREASURER 0.75 X X 0 0 0 DANA M EVORA OUTGOING BOARD MEMBER 0.80 X 0 0 0 ELIZABETH BURGOS BOARD MEMBER 0.75 X 0 0 0 LINDA RICCIARDI OUTGOING BOARD MEMBER 0.75 X 0 0 0 MANER TYSON BOARD MEMBER 0.75 X 0 0 0 MARK BRIGGS CHAIRPERSON 0.75 X X 0 0 0 REV DR MAYNER TYSON OUTGOING BOARD MEMBER 0.75 X 0 0 0 SANDRA J SOREL-LEDUC VICE CHAIR 0.75 X X 0 0 0 THOMAS JOHNSON SECRETARY 0.75 X X 0 0 0 WANDA DUNBAR BOARD MEMBER 0.75 X 0 0 0 DONALD J THOMPSON JR CEO 40.00 X 284364 0 73302 LULE TRACEY CFO 40.00 X 238628 0 48969 AMIT PATEL DENTAL DIRECTOR 40.00 X 245413 0 85217 CHRISTINE BIANCHI CHIEF DEVELOPMENT OFFICER 40.00 X 179710 0 67987 TESS LOMBARD MD CHIEF MEDICAL OFFICER 40.00 X 338108 0 77758 ALISON GROVER PHYSICIAN 40.00 X 203984 0 37641 DEBBIE CAYABYAB PHYSICIAN 40.00 X 199202 0 59022 ELIE HELOU PHYSICIAN 40.00 X 232385 0 39455 JILL BERNSTEIN PHYSICIAN 40.00 X 201952 0 22188 STEPHEN SPEAR PHYSICIAN 40.00 X 220450 0 40966 2344196 0 552505 34 0 1 0 WELLMORE INC 141 E MAIN STREET WATERBURY CT 06702 BEHAVIORIAL HEALTH - OASIS CLINICAL SERV 657123 ALLEHEALTH SERVICES 13127 KINGS LAKE DRIVE 102 GIBSONTON FL 33534 ALLERGY TESTING SERVICES TO OUR PATIENTS 651856 WATERBURY HOSPITAL 64 ROBBINS ST WATERBURY CT 06708 INFECTIOUS DISEASE, CARDIOLOGIST, BH 595747 INTERPRETERS & TRANSLATORS 232 WILLIAM ST GLASTONBURY CT 06033 TRANSLATION SERVICES TO OUR PATIENTS 247821 JANIKING OF HARTFORD INC PO BOX 415346 BOSTON MA 06708 CLEANING SERVICES 133570 8 52366 12736540 951788 1083973 13740694 MEDICAID 621400 13077179 13077179 PHARMACY 340B 446110 5951415 5951415 MEDICARE 621400 1734745 1734745 THIRD-PARTY PAYORS 621400 845844 845844 SELF-PAY PATIENTS 621400 479334 479334 22088517 13396 13396 25125 13998 11127 11127 11127 190338 194252 -3914 -3914 -3914 INCENTIVE PAYMENTS 900099 213131 213131 MEDICAL RECORDS COPYING FEES 900099 7028 7028 220159 36069979 22308676 0 20609 X 1646638 1370852 275786 15100269 13590242 1510027 1409752 776250 633502 2734907 1505920 1228987 1287647 709016 578631 58063 58063 56737 56737 4040504 3388669 651835 59585 53775 5810 26906 24283 2623 1114565 1005895 108670 748910 674527 74383 29513 26635 2878 92512 83492 9020 63002 63002 315104 284382 30722 121674 109811 11863 PROG. ACTIVITIES, SUPPL 2691450 2327136 364314 CONTRIBUTED NONFINANCIA 1083973 1083973 EQUIPMENTAL RENTAL AND 179616 162104 17512 DUES AND SUBSCRIPTIONS 73290 66144 7146 232108 169229 62879 33166725 27412335 5754390 0 4655634 4587884 4137798 4279248 1390385 929407 2170695 2567609 425950 230502 9177459 4954180 4339338 4223279 29577 31217 108333 108333 752935 693776 18010645 17651255 2279495 1828026 578888 798362 5021711 1994308 7880094 4620696 X 10130551 13030559 10130551 13030559 18010645 17651255 2903254 -3246 0 X X 0 1 X 1 1 1 X 7585180 7803540 7319281 11741183 13740694 48189878 7585180 7803540 7319281 11741183 13740694 48189878 48189878 45794 63678 71933 39074 38521 259000 63314 132599 75901 110368 220159 602341 49051219 91648972 0.98240 0.98040 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MEANINGFUL USE INCENTIVE - 2018 AMOUNT: $ 68,596. 2019 AMOUNT: $ 47,196. 2020 AMOUNT: $ 104,185. 2021 AMOUNT: $ 213,131. MISCELLANEOUS - 2017 AMOUNT: $ 59,114. 2018 AMOUNT: $ 56,913. 2019 AMOUNT: $ 28,705. 2020 AMOUNT: $ 6,183. 2021 AMOUNT: $ 7,028. FUNDRAISING - 2017 AMOUNT: $ 4,200. 2018 AMOUNT: $ 7,090. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 384297 384297 7122286 3605179 3517107 1670876 1349001 321875 4223279 ACCRUED PROFIT SHARING 1594954 SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN 399354 1994308 X 36080731 -3246 -3246 36083977 -13998 -13998 36069979 33180723 13998 13998 33166725 0 33166725 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2022 AND 2021. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2019 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CENTER HAS UNRELATED BUSINESS INCOME TAXES, IT WILL RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE STATEMENTS OF FINANCIAL POSITION. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENT EXPENSES -13,998. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSES 13,998. X X X 0 1 0 0 0 0 0 1 0 TESS LOMBARD MD CHIEF MEDICAL OFFICER 307858 0 30250 0 0 0 44200 0 33558 0 415866 0 0 0 DONALD J THOMPSON JR CEO 277037 0 250 0 7077 0 59700 0 13602 0 357666 0 0 0 AMIT PATEL DENTAL DIRECTOR 245163 0 250 0 0 0 49359 0 35858 0 330630 0 0 0 LULE TRACEY CFO 238378 0 250 0 0 0 47410 0 1559 0 287597 0 0 0 ELIE HELOU PHYSICIAN 232135 0 250 0 0 0 27463 0 11992 0 271840 0 0 0 STEPHEN SPEAR PHYSICIAN 220200 0 250 0 0 0 25791 0 15175 0 261416 0 0 0 DEBBIE CAYABYAB PHYSICIAN 198952 0 250 0 0 0 24067 0 34955 0 258224 0 0 0 CHRISTINE BIANCHI CHIEF DEVELOPMENT OFFICER 179460 0 250 0 0 0 32124 0 35863 0 247697 0 0 0 ALISON GROVER PHYSICIAN 203734 0 250 0 0 0 24250 0 13391 0 241625 0 0 0 JILL BERNSTEIN PHYSICIAN 200662 0 1290 0 0 0 0 0 22188 0 224140 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATE IN 457(F) PLAN: - DONALD J. THOMPSON, JR., CEO - LULE TRACEY, CFO - AMIT PATEL, DENTAL DIRECTOR PART I, LINE 7 THE CENTER PROVIDED AN ANNUAL BOARD APPROVED PROFIT SHARING BONUS. X 2 1083973 FMV 0 1 0 PART I, COLUMN (B): COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE REVIEWED AND ACCEPTED BY THE BOARD BEFORE STAYWELL SUBMITS. FORM 990, PART VI, SECTION B, LINE 12C DONALD THOMPSON, CEO, MONITORS CONFLICT OF INTEREST POLICY BY REVIEWING AND ADDRESSING ANY POTENTIAL CONFLICTS AND FOLLOWING UP EACH YEAR FOR ANY CHANGES. BOARD MEMBERS ARE REQUIRED TO SIGN THE POLICY ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15A INFORMATION FROM NATIONAL AND STATEWIDE SURVEYS ARE USED AS CRITERIA TO DETERMINE THE SALARY OF THE CEO. THIS INFORMATION IS GIVEN TO THE PERSONNEL COMMITTEE FOR REVIEW. THE PERSONNEL COMMITTEE NEGOTIATES AND APPROVES THE SALARY OF THE CEO. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL CONSULTANTS: PROGRAM SERVICE EXPENSES 2,435,863. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,435,863. ANSWERING SERVICE: PROGRAM SERVICE EXPENSES 367,933. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 367,933. PHARMACY CONSULTANTS: PROGRAM SERVICE EXPENSES 323,808. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 323,808. LAB CONSULTANTS: PROGRAM SERVICE EXPENSES 150,676. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 150,676. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 110,389. MANAGEMENT AND GENERAL EXPENSES 651,835. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 762,224. FORM 990, PART XII, LINE 2C: THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.