2023-05-15T08:07:09-05:00 2022-06-30 111986323 MARCUM LLP 555 LONG WHARF DRIVE NEW HAVEN CT 06511 990 2021-07-01 061436620 NORWALK COMMUNITY HEALTH CENTER NORW 2038991770 120 CONNECTICUT AVENUE NORWALK CT 06854 KENNETH WALLER CHIEF EXECUTIVE OFFICER 2038991770 2023-05-11 1 KENNETH WALLER 999009999 MARY ANTONETTI P00431862 2037819600 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KENNETH WALLER 120 CONNECTICUT AVENUE NORWALK CT 06854 13792880 0 X WWW.NORWALKCHC.ORG X 1999 CT TO PROVIDE QUALITY, INNOVATIVE CARE THAT ENRICHES THE LIVES OF OUR PATIENTS. 11 11 129 12 0 0 7127694 7076973 6261342 6637201 1912 2629 74715 76077 13465663 13792880 0 0 0 0 7065567 8572157 0 0 0 4160750 4651147 11226317 13223304 2239346 569576 5602930 6154083 2772709 2754286 2830221 3399797 TO PROVIDE QUALITY, INNOVATIVE CARE THAT ENRICHES THE LIVES OF OUR PATIENTS. 0 0 11138286 6637201 TO ESTABLISH, DEVELOP, MAINTAIN, MANAGE AND OPERATE A NONPROFIT OUTPATIENT CLINIC PROVIDING COMPREHENSIVE PRIMARY CARE TO THE NORWALK, CT COMMUNITY. 11138286 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 16 0 1 129 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 CT X JOHN J GETTINGS III 2038991770 120 CONNECTICUT AVENUE NORWALK CT 06854 ADRIANA FIELDS DIRECTOR 1.00 X 0 0 0 ALICIA BRIGGS DIRECTOR 1.00 X 0 0 0 DARLENE YOUNG VICE CHAIR 3.00 X X 0 0 0 JAMES WHITING TREASURER 2.50 X X 0 0 0 JOSEPH E MANN BOARD CHAIR 2.50 X X 0 0 0 LENORE JORDAN SECRETARY 2.50 X X 0 0 0 LISETTE FORD DIRECTOR 1.00 X 0 0 0 LUNDA ASMANI DIRECTOR 1.00 X 0 0 0 PETER KORZENIK DIRECTOR 1.00 X 0 0 0 THANA VAN ROOYEN DIRECTOR 1.00 X 0 0 0 YVONNE RODRIGUEZ DIRECTOR 1.00 X 0 0 0 JOHN J GETTINGS III CFO 40.00 X 181400 0 20966 KENNETH WALLER CEO 40.00 X 200507 0 0 DJANA HARP CMO 40.00 X 63169 0 570 MERYL HERTZ DIRECTOR OF DENTAL 40.00 X 153505 0 27827 REBECCA KAPLAN DIRECTOR OF CLINICAL OPERATIONS AND HEALTHCARE INN 40.00 X 178467 0 29085 ELIZABETH THOMAS PROVIDER 40.00 X 188109 0 13096 GERALDINE SIMPLICE PROVIDER 40.00 X 138541 0 24565 JILL GOLDBERG PROVIDER 40.00 X 131971 0 17425 KATHLEEN PUNDY PROVIDER (TERM 4/2/22) 40.00 X 166121 0 8132 SIVAN DORON PROVIDER 32.00 X 126839 0 25892 ANDREA VALI PROVIDER 24.00 X 108078 0 0 MARCELYN MOLLOY FORMER CMO (TERM 6/1/21) 40.00 X 109128 0 3819 1745835 0 171377 13 1 1 0 NORWALK HOSPITAL ASSOCIATION 24 STEVENS STREET NORWALK CT 06850 PRIMARY CARE MEDICAL PROVIDERS 651640 SALLY R BERGWERK MD 35 RIDGEFIELD ROAD PO BOX 725 WILTON CT 06897 PROVIDER 159478 2 5693420 1383553 519563 7076973 PATIENT SERVICES 621110 6637201 6637201 6637201 2629 2629 76077 0 76077 76077 76077 13792880 6637201 0 78706 X 606926 199039 407887 6644366 5688698 955668 67302 54646 12656 687063 557866 129197 566500 471707 94793 39467 39467 33000 33000 1098515 1057880 40635 1606 1606 155618 131951 23667 426846 426846 1095189 878768 216421 5535 5535 131764 113768 17996 2190 2190 219639 192066 27573 98411 81139 17272 VACCINES 519563 519563 CLINICAL SUPPLIES 358030 358030 REPAIRS & MAINTENANCE 172927 139475 33452 MISCELLANEOUS 94351 73753 20598 198496 183760 14736 13223304 11138286 2085018 0 3214116 3823145 19387 75420 509674 521952 124030 106241 4879122 3251797 1735723 1627325 5602930 6154083 721918 855344 189926 40137 31373 0 1829492 1858805 2772709 2754286 X 2830221 3399797 2830221 3399797 5602930 6154083 569576 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3128974 1671757 1457217 1750148 1580040 170108 1627325 DEFERRED LEASE LIABILITY 1858805 1858805 X 13792880 0 13792880 0 13792880 13223304 0 13223304 0 13223304 PART X, LINE 2: NCHC HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON BUSINESS RELATED INCOME. NCHC ACCOUNTS FOR UNCERTAIN TAX PROVISIONS UNDER FASB ASC 740, INCOME TAXES, WHICH PROVIDES A FRAMEWORK FOR HOW ENTITIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. NCHC MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. NCHC DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2022 AND 2021. AS OF JUNE 30, 2022 AND 2021, NCHC DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. X X 0 0 0 0 0 0 0 1 0 REBECCA KAPLAN DIRECTOR OF CLINICAL OPERATIONS AND 173526 0 4941 0 0 0 4830 0 24255 0 207552 0 0 0 JOHN J GETTINGS III CFO 180893 0 507 0 0 0 4259 0 16707 0 202366 0 0 0 ELIZABETH THOMAS PROVIDER 183121 0 4988 0 0 0 4964 0 8132 0 201205 0 0 0 KENNETH WALLER CEO 200000 0 507 0 0 0 0 0 0 0 200507 0 0 0 MERYL HERTZ DIRECTOR OF DENTAL 149087 0 4418 0 0 0 5650 0 22177 0 181332 0 0 0 KATHLEEN PUNDY PROVIDER (TERM 4/2/22) 161176 0 4945 0 0 0 0 0 8132 0 174253 0 0 0 MARCELYN MOLLOY FORMER CMO (TERM 6/1/21) 109128 0 0 0 0 0 3819 0 0 0 112947 0 0 0 PART I, LINE 7 THE FOLLOWING EMPLOYEES RECEIVED PROVIDER INCENTIVE BONUS AS FOLLOWS ELIZABETH THOMAS $4,481 MERYL HERTZ $3,911 REBECCA KAPLAN $4,434 KATHLEEN PUNDY $4,438 THE FOLLOWING EMPLOYEES RECEIVED A SMALL CHRISTMAS BONUS OF $507 EACH JOHN GETTINGS ELIZABETH THOMAS MERYL HERTZ REBECCA KAPLAN KENNETH WALLER KATHLEEN PUNDY X 1 519562 FMV 0 0 0 PART I, COLUMN (B): SCHEDULE M PART 1 LINE 20 VACCINES: THE ORGANIZATION RECEIVED DONATEED VACCINES THROUGHOUT THE YEAR. THE NUMBER LISTED IS ONE BECAUSE ALL VACCINES COME THROUGH ONE IMMUNIZATION GRANT. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE OF MANAGEMENT. A FINAL DRAFT OF THE RETURN IS REVIEWED AND FINALIZED BY THE CFO PRIOR TO DISTRIBUTION TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH PROHIBITS CONFLICT OF INTEREST OR THE APPEARANCE OF CONFLICT OF INTEREST BY BOARD MEMBERS, EMPLOYEES, AND THOSE WHO PROVIDE SERVICES OR FURNISH GOODS TO THE ORGANIZATION. ON AN ANNUAL BASIS, THE BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE WHICH IS REVIEW BY NCHC LEADERSHIP. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES BOARD APPROVED SALARY RANGES THAT UTILIZED DATA FROM NACHC, CHCACT, MGMA AND OTHER SOURCES TO DETERMINE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT AND STAFF. THE BOARD APPROVES THE COMPENSATION OF THE CEO, AND THE CEO HAS THE AUTHORITY TO APPROVE COMPENSATION OF ALL OTHER EMPLOYEES. SUCH APPROVAL IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 24E TELEPHONE: PROGRAM SERVICE EXPENSES 57,056. MANAGEMENT AND GENERAL EXPENSES 6,340. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,396. RECRUITMENT: PROGRAM SERVICE EXPENSES 47,575. MANAGEMENT AND GENERAL EXPENSES 8,396. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,971. DEVELOPMENTAL EXPENSE: PROGRAM SERVICE EXPENSES 49,492. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,492. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 29,637. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,637. FORM 990, PART XII, LINE 2C: NO CHANGES FROM PRIOR YEAR