2022-04-12T11:40:18-05:00 2021-06-30 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2020-07-01 223160873 STAYWELL HEALTH CARE INC STAY 2037568021 80 PHOENIX AVENUE NO 201 WATERBURY CT 06702 DONALD J THOMPSON JR CHIEF EXECUTIVE OFFICER 2037568021 2022-04-11 1 DONALD THOMPSON JR 999009999 LORI ROTHE YOKOBOSKY CPA P01273422 9592007000 2022-04-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DONALD J THOMPSON JR 80 PHOENIX AVENUE NO 201 WATERBURY CT 06702 30928581 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. 10 10 283 20 0 0 7319281 11741183 18615578 18502942 33755 7101 100087 128748 26068701 30379974 0 0 0 0 18682336 19939795 0 0 0 7354588 9519348 26036924 29459143 31777 920831 16355059 18010645 7172227 7880094 9182832 10130551 PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 0 0 24140020 18613392 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 2021 WAS 105,741. 24140020 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 53 0 1 283 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 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 ANGELICA CRUZ BOARD MEMBER 0.80 X 0 0 0 CAROLYN A HIGHSMITH TREASURER 0.80 X X 0 0 0 DANA M EVORA BOARD MEMBER 0.80 X 0 0 0 ELIZABETH BURGOS BOARD MEMBER 0.80 X 0 0 0 LINDA RICCIARDI BOARD MEMBER 0.80 X 0 0 0 MARK BRIGGS CHAIRPERSON 0.80 X X 0 0 0 NILDA REYES OUTGOING BOARD MEMBER 0.80 X 0 0 0 REV DR MAYNER TYSON BOARD MEMBER 0.80 X 0 0 0 SANDRA J SOREL-LEDUC VICE CHAIR 0.80 X X 0 0 0 THOMAS JOHNSON SECRETARY 0.80 X X 0 0 0 WANDA DUNBAR BOARD MEMBER 0.80 X 0 0 0 DONALD J THOMPSON JR CEO 40.00 X 259440 0 72411 LULE TRACEY CFO 40.00 X 219551 0 48973 AMIT PATEL DENTAL DIRECTOR 40.00 X 227850 0 81878 TESS LOMBARD MD CHIEF MEDICAL OFFICER 40.00 X 281668 0 75619 ALISON GROVER INTERNIST MD 40.00 X 192434 0 43922 DEB CAYABYAB INTERNIST MD 40.00 X 196580 0 54789 JODY NAVITSKY INTERNIST MD 40.00 X 213082 0 22130 NICOLE MAKSYMIW INTERNIST MD 40.00 X 208486 0 3014 STEPHEN SPEAR INTERNIST MD 40.00 X 215186 0 36052 2014277 0 438788 30 0 1 0 ALLEHEALTH SERVICES LLC 13127 KINGS LAKE DRIVE 102 GIBSONTON FL 33534 ALLERGY HEALTH SERVICES 746425 WELLMORE INC 141 E MAIN STREET WATERBURY CT 06702 BEHAVIORIAL HEALTH SERVICES 703447 2 65011 10865920 810252 902259 11741183 MEDICAID 621400 11464987 11464987 PHARMACY 340B 446110 4543662 4543662 MEDICARE 621400 1537785 1537785 THIRD-PARTY PAYORS 621400 550213 550213 SELF-PAY PATIENTS 621400 406295 406295 18502942 6702 6702 32372 13992 18380 18380 18380 535014 534615 399 399 399 INCENTIVE PAYMENTS 900099 104185 104185 MEDICAL RECORDS COPYING FEES 900099 6183 6183 110368 30379974 18613310 0 25481 X 1321960 1117835 204125 13830264 12447238 1383026 1415933 773380 642553 2233278 1219814 1013464 1138360 621770 516590 63736 63736 63333 63333 3378593 2561354 817239 29089 26333 2756 23342 21131 2211 751312 680137 71175 577689 521636 56053 21430 19400 2030 45039 40772 4267 2746 2746 340892 308598 32294 99874 90412 9462 PROG. ACTIVITIES, SUPPL 2288386 1945286 343100 VACCINES 894814 894814 EQUIPMENTAL RENTAL AND 308254 279052 29202 DUES AND SUBSCRIPTIONS 137402 124385 13017 493417 446673 46744 29459143 24140020 5319123 0 5998288 4655634 3416942 4137798 442105 1390385 1455711 2170695 134541 425950 8978412 4639074 4525334 4339338 23127 29577 83333 108333 275678 752935 16355059 18010645 1706241 2279495 1150711 578888 4315275 5021711 7172227 7880094 X 9182832 10130551 9182832 10130551 16355059 18010645 920831 26888 0 X X 0 1 X 1 1 1 X 7413613 7585180 7803540 7319281 11741183 41862797 7413613 7585180 7803540 7319281 11741183 41862797 41862797 125490 45794 63678 71933 39074 345969 106621 63314 132599 75901 110368 488803 42697569 84187256 0.98040 0.97440 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MEANINGFUL USE INCENTIVE - 2016 AMOUNT: $ 63,750. 2018 AMOUNT: $ 68,596. 2019 AMOUNT: $ 47,196. 2020 AMOUNT: $ 104,185. MISCELLANEOUS - 2016 AMOUNT: $ 42,871. 2017 AMOUNT: $ 59,114. 2018 AMOUNT: $ 56,913. 2019 AMOUNT: $ 28,705. 2020 AMOUNT: $ 6,183. FUNDRAISING - 2017 AMOUNT: $ 4,200. 2018 AMOUNT: $ 7,090. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 384297 384297 7045356 3358695 3686661 1548759 1280379 268380 4339338 ACCRUED PROFIT SHARING 1421823 SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN 351763 PAYCHECK PROTECTION PROGRAM 3248125 5021711 X 30420854 26888 26888 30393966 -13992 -13992 30379974 29473135 13992 13992 29459143 0 29459143 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2021 AND 2020. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2018 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 -13,992. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSES 13,992. X X X 0 1 0 0 0 0 0 1 0 TESS LOMBARD MD CHIEF MEDICAL OFFICER 280228 0 1440 0 0 0 44200 0 31419 0 357287 0 0 0 DONALD J THOMPSON JR CEO 259440 0 0 0 0 0 59700 0 12711 0 331851 0 0 0 AMIT PATEL DENTAL DIRECTOR 227850 0 0 0 0 0 49359 0 32519 0 309728 0 0 0 LULE TRACEY CFO 219551 0 0 0 0 0 47410 0 1563 0 268524 0 0 0 DEB CAYABYAB INTERNIST MD 196380 0 200 0 0 0 24067 0 30722 0 251369 0 0 0 STEPHEN SPEAR INTERNIST MD 214986 0 200 0 0 0 25791 0 10261 0 251238 0 0 0 ALISON GROVER INTERNIST MD 192234 0 200 0 0 0 24250 0 19672 0 236356 0 0 0 JODY NAVITSKY INTERNIST MD 212882 0 200 0 0 0 22130 0 0 0 235212 0 0 0 NICOLE MAKSYMIW INTERNIST MD 208286 0 200 0 0 0 0 0 3014 0 211500 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 902259 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 LAB CONSULTANTS: PROGRAM SERVICE EXPENSES 101,265. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 101,265. MEDICAL CONSULTANTS: PROGRAM SERVICE EXPENSES 2,128,167. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,128,167. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 331,922. MANAGEMENT AND GENERAL EXPENSES 817,239. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,149,161. FORM 990, PART XII, LINE 2C: THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.