2022-10-09T21:39:33-05:00 2021-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2021-01-01 351948768 RAPHAEL HEALTH CENTER RAPH 3178603961 401 E 34TH ST INDIANAPOLIS IN 46205 SHERRY GRAY CEO 3178603961 2022-10-09 1 SHERRY GRAY 999009999 NATHAN A RODGERS CPA P01568275 3176334705 2022-09-30 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z SHERRY GRAY 401 E 34TH ST INDIANAPOLIS IN 46205 8340105 0 X WWW.RAPHAELHC.ORG X 1994 IN TO PROVIDE COMMUNITY-BASED, FULL-SERVICE HEALTHCARE OF THE HIGHEST QUALITY WITH RESPECT AND DIGNITY FOR ALL PEOPLE INCLUDING THE UNDERSERVED AND UNINSURED WITHIN A SETTING THAT SHARES THE LOVE AND HEALING OF JESUS CHRIST. 14 14 77 50 0 0 3200338 4318314 3309152 3954841 14427 14071 18466 52879 6542383 8340105 0 0 0 0 3915302 4303016 0 0 132542 1773817 2310415 5689119 6613431 853264 1726674 6759004 7229259 1685021 441863 5073983 6787396 TO PROVIDE COMMUNITY-BASED, FULL-SERVICE HEALTHCARE OF THE HIGHEST QUALITY WITH RESPECT AND DIGNITY FOR ALL PEOPLE INCLUDING THE UNDERSERVED AND UNINSURED WITHIN A SETTING THAT SHARES THE LOVE AND HEALING OF JESUS CHRIST. 0 0 5156100 4007720 PROVIDING MEDICAL, DENTAL, VISION AND MENTAL HEALTH SERVICES TO INDIGENT INDIVIDUALS. 5156100 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 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 1 0 0 0 1 22 0 1 77 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X X PAUL UTTERBACK CFO 3179261507 401 E 34TH ST INDIANAPOLIS IN 46205 SANFORD GARNER PRESIDENT 2.00 2.00 X X 0 0 0 SARAH NOEL VICE PRESIDENT 2.00 2.00 X X 0 0 0 PAT CASANOVA SECRETARY 2.00 2.00 X X 0 0 0 STEPHANIE CARAWAY TREASURER 2.00 2.00 X X 0 0 0 JULIE FIDLER DIRECTOR 1.00 1.00 X 0 0 0 ERIN GREEN DIRECTOR 1.00 0.00 X 0 0 0 JACQUIE GREEN DIRECTOR 1.00 0.00 X 0 0 0 RHONDA GARRISON DIRECTOR 1.00 0.00 X 0 0 0 JANICE HICKS-SLAUGHTER DIRECTOR 1.00 0.00 X 0 0 0 SHELLY LLOYD-HANKINSON DIRECTOR 1.00 0.00 X 0 0 0 DEMETRIA MCGREW DIRECTOR 1.00 0.00 X 0 0 0 AARON ROBERTS DIRECTOR 1.00 0.00 X 0 0 0 DANIELLE STILES-POLK DIRECTOR 1.00 0.00 X 0 0 0 DR BOB WHITMORE DIRECTOR 1.00 0.00 X 0 0 0 SHERRY GRAY CEO 40.00 2.00 X 151799 0 14393 PAUL UTTERBACK CFO 40.00 2.00 X 106508 0 21881 NATHAN V ROTH PHYSICIAN 40.00 0.00 X 244428 0 34462 RACHEL ZIEGLER BEHAVIORAL HEALTH SUPERVISOR 40.00 0.00 X 127337 0 21312 DINO DIEUDONNE DENTIST 40.00 0.00 X 146694 0 15257 JESSICA BROWN NURSE PRACTITIONER 32.00 0.00 X 103069 0 29044 TELYCIA JOHNSON PHYSICIAN 40.00 0.00 X 102760 0 10480 982595 0 146829 7 0 1 0 MAXIM HEALTHCARE STAFFING SERVICES INC 6612 E 75TH STREET SUITE 400 INDIANAPOLIS IN 46250 TEMPORARY STAFF 120933 1 4205958 112356 207036 4318314 PATIENT SERVICES 621300 3804786 3804786 340B REVENUE 621300 150055 150055 3954841 14071 14071 52879 52879 52879 8340105 4007720 0 14071 294583 220937 67754 5892 3130218 2347663 719950 62605 60216 45162 13850 1204 569916 427440 131080 11396 248083 186062 57059 4962 629823 503858 125965 8849 6460 1593 796 211489 158615 38069 14805 228970 183176 41215 4579 407473 325981 73344 8148 11548 8430 2079 1039 100907 80726 18163 2018 31916 25533 5745 638 OTHER MEDICAL EXPENSES 472474 472474 DUES & SUB. 101960 74431 18353 9176 STAFF DEVELOPMENT 58717 42863 10570 5284 LAB/X-RAYS 46189 46189 100 100 6613431 5156100 1324789 132542 2262989 3042754 451583 298322 31129 76931 367448 258984 29972 45614 39667 54404 1944691 1718180 309378 226511 3266838 3225739 6759004 7229259 359321 376403 825700 0 500000 65460 1685021 441863 X 5073983 6787396 5073983 6787396 6759004 7229259 1726674 -13261 0 X X 0 1 X 1 1 1 X 2526515 3559974 2875815 3200338 4316004 16478646 2526515 3559974 2875815 3200338 4316004 16478646 16478646 31327 24145 24037 14427 14071 108007 14777 18466 52879 86122 16672775 10248277 0.98840 0.98930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1944691 1718180 226511 226511 INVESTMENT IN RAPHAEL REALTY 3190335 ESTIMATED THIRD PARTY SETTLEMENTS 35404 3225739 ESTIMATED THIRD-PARTY SETTLEMENTS 65460 65460 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CENTER AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. X 0 0 0 0 0 0 0 0 0 NATHAN V ROTH PHYSICIAN 244428 0 0 0 0 0 9777 0 24685 0 278890 0 0 0 SHERRY GRAY CEO 151799 0 0 0 0 0 6072 0 8321 0 166192 0 0 0 DINO DIEUDONNE DENTIST 146694 0 0 0 0 0 5868 0 9389 0 161951 0 0 0 X 15 204726 FMV 0 0 0 PART I, COLUMN (B): THE AMOUNT IN COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART VI, SECTION B, LINE 11B RAPHAEL HEALTH CENTER, INC.'S FORM 990 IS REVIEWED BY THE FINANCE COMITTEE. FORM 990, PART VI, SECTION B, LINE 12C RAPHAEL HEALTH CENTER PASSES OUT A QUESTIONNAIRE ABOUT CONFLICT OF INTEREST TO BE FILLED OUT AND RETURNED BY EACH DIRECTOR, OFFICER AND STAFF MEMBER. THE POLICY INCLUDES STATEMENTS ABOUT OTHER EMPLOYMENT AND BEING RELATED TO ANYONE ON THE BOARD OF DIRECTORS AND OTHER ITEMS THAT MAY BE AN ISSUE. POTENTIAL ISSUES ARE IDENTIFIED, EVALUATED AND DISCUSSED WITH THE APPROPRIATE LEVEL OF MANAGEMENT OR MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 RAPHAEL HEALTH CENTER, INC.'S BOARD OF DIRECTORS' HR COMMITTEE ESTABLISH ALL STAFFING COMPENSATION PLANS AFTER A THOROUGH REVIEW OF ALL RELATED ISSUES, CONSULTATION WITH INDEPENDENT PERSONS, REVIEW OF COMPARABLE DATA AND DELIBERATION. IT ALSO CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE OTHER OFFICERS AND KEY EMPLOYEES IN CONSIDERING THEIR COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 RAPHAEL HEALTH CENTER, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, AS APPLICABLE, AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST MADE TO THE ATTENTION OF OUR CHIEF EXECUTIVE OFFICER (CEO) AND RECEIVED AT OUR CORPORATE OFFICE ADDRESS. RAPHAEL REALTY 401 EAST 34TH STREET INDIANAPOLIS IN 46205 743093941 REAL ESTATE IN 501(C)(2) 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 RAPHAEL REALTY INC K 239400 BOOK RAPHAEL REALTY INC R 385403 CASH