2021-04-13T12:37:10-05:00 2020-06-30 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2019-07-01 223160873 STAYWELL HEALTH CARE INC STAY 2037568021 80 PHOENIX AVENUE NO 201 WATERBURY CT 06702 DONALD J THOMPSON JR CHIEF EXECUTIVE OFFICER 2037568021 2021-04-12 1 LORI ROTHE YOKOBOSKY CPA P01273422 9592007000 2021-04-09 2019 2022-09-23 18:48:47Z DONALD J THOMPSON JR 80 PHOENIX AVENUE NO 201 WATERBURY CT 06702 26082693 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. 11 11 270 0 0 0 7803540 7319281 17291153 18615578 34692 33755 -24186 100087 25105199 26068701 0 0 0 0 18014642 18682336 0 0 0 7030293 7354588 25044935 26036924 60264 31777 11437753 16355059 2284561 7172227 9153192 9182832 PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 0 0 21982395 18691479 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 2020 WAS 103,503. 21982395 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 1 138 0 1 270 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 11 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 OUTGOING BOARD MEMBER 0.50 X 0 0 0 CAROLYN A HIGHSMITH TREASURER 1.00 X X 0 0 0 DANA M EVORA BOARD MEMBER 0.50 X 0 0 0 ELIZABETH BURGOS BOARD MEMBER 0.50 X 0 0 0 HERBERT L TERRY III OUTGOING BOARD MEMBER 0.50 X 0 0 0 LINDA RICCIARDI BOARD MEMBER 0.50 X 0 0 0 MARK BRIGGS CHAIRPERSON 1.00 X X 0 0 0 NILDA REYES BOARD MEMBER 0.50 X 0 0 0 QUY TRAN OUTGOING BOARD MEMBER 0.50 X 0 0 0 REV DR MAYNER TYSON BOARD MEMBER 0.50 X 0 0 0 RICHARD LEE OUTGOING BOARD MEMBER 0.50 X 0 0 0 SANDRA J SOREL-LEDUC VICE CHAIR 1.00 X X 0 0 0 THOMAS JOHNSON SECRETARY 1.00 X X 0 0 0 WALTER R MACHNICZ BOARD MEMBER 0.50 X 0 0 0 WANDA DUNBAR BOARD MEMBER 0.50 X 0 0 0 DONALD J THOMPSON JR CEO 40.00 X 242485 0 89702 LULE TRACEY CFO 40.00 X 391556 0 47959 AMIT PATEL DENTAL DIRECTOR 40.00 X 220248 0 83819 TESS LOMBARD MD CHIEF MEDICAL OFFICER 40.00 X 266366 0 53153 ALISON GROVER INTERNIST MD 40.00 X 203354 0 41157 ELIE HELOU INTERNIST MD 40.00 X 212243 0 24308 MONIKA MISHRA INTERNIST MD 40.00 X 189038 0 864 NICOLE MAKSYMIW INTERNIST MD 40.00 X 184699 0 13662 STEPHEN SPEAR INTERNIST MD 40.00 X 202296 0 29176 2112285 0 383800 15 0 1 0 WELLMORE INC 141 E MAIN STREET WATERBURY CT 06702 BEHAVIORIAL HEALTH SERVICES 611472 GREENWAY HEALTH PO BOX 203658 DALLAS TX 75320 SOFTWARE PURCHASER, SOFTWARE SUPPORT & M 323081 ALLEHEALTH SERVICES LLC 13127 KINGS LAKE DRIVE 102 GIBSONTON FL 33534 ALLERGY HEALTH SERVICES 203078 JANI-KING OF HARTFORD INC PO BOX 415346 BOSTON MA 02241 JANITORIAL SERVICES 108903 TOWER GENERATOR SYSTEMS 20A CANTON SPRINGS RD CANTON CT 06019 CONTRACTORS 107478 5 28692 6834151 456438 1027775 7319281 MEDICAID 621400 12077938 12077938 PHARMACY 340B 446110 4553783 4553783 MEDICARE 621400 1120881 1120881 SELF-PAY PATIENTS 621400 432327 432327 THIRD-PARTY PAYORS 621400 430649 430649 18615578 33755 33755 38178 13992 24186 24186 24186 INCENTIVE PAYMENTS 900099 47196 47196 MEDICAL RECORDS COPYING FEES 900099 28705 28705 75901 26068701 18691479 0 57941 1286166 1103111 183055 13397343 12057609 1339734 809917 492334 317583 2110132 1282711 827421 1078778 655769 423009 76123 76123 56177 56177 2467696 2035322 432374 21783 19776 2007 26938 24455 2483 289989 289989 409435 370415 39020 58437 53052 5385 94318 85626 8692 12360 12360 332734 302072 30662 96907 87977 8930 CLINIC SUPPLIES 1846539 1610205 236334 VACCINES 1023110 1023110 EQUIP RENTAL & MAINT 276050 250611 25439 85494 77615 7879 180498 160636 19862 26036924 21982395 4054529 0 1984319 5998288 2178081 3416942 785620 442105 1248312 1455711 353753 134541 8823515 4298181 4616534 4525334 24980 23127 83333 83333 162821 275678 11437753 16355059 1343632 1706241 146689 1150711 3248125 794240 1067150 2284561 7172227 X 9153192 9182832 9153192 9182832 11437753 16355059 31777 -2137 0 X X 0 1 X 1 1 1 X 5787182 7413613 7585180 7803540 7319281 35908796 5787182 7413613 7585180 7803540 7319281 35908796 35908796 132727 125490 45794 63678 71933 439622 127115 106621 63314 132599 75901 505550 36853968 79477342 0.97440 0.96490 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MEANINGFUL USE INCENTIVE - 2015 AMOUNT: $ 102,000. 2016 AMOUNT: $ 63,750. 2018 AMOUNT: $ 68,596. 2019 AMOUNT: $ 47,196. MISCELLANEOUS - 2015 AMOUNT: $ 25,115. 2016 AMOUNT: $ 42,871. 2017 AMOUNT: $ 59,114. 2018 AMOUNT: $ 56,913. 2019 AMOUNT: $ 28,705. FUNDRAISING - 2017 AMOUNT: $ 4,200. 2018 AMOUNT: $ 7,090. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 384297 384297 6985440 3088988 3896452 1453778 1209193 244585 4525334 ACCRUED PROFIT SHARING 858982 SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN 208168 1067150 X 26080556 -2137 -2137 26082693 -13992 -13992 26068701 26050916 13992 13992 26036924 0 26036924 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2020 AND 2019. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2017 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 DONALD J THOMPSON JR CEO 236485 0 6000 0 0 0 39967 0 49735 0 332187 0 0 0 LULE TRACEY CFO 202442 0 6000 0 183114 0 31500 0 16459 0 439515 0 0 0 AMIT PATEL DENTAL DIRECTOR 214248 0 6000 0 0 0 32050 0 51769 0 304067 0 0 0 TESS LOMBARD MD CHIEF MEDICAL OFFICER 250366 0 16000 0 0 0 15288 0 37865 0 319519 0 0 0 ALISON GROVER INTERNIST MD 203354 0 0 0 0 0 9260 0 31897 0 244511 0 0 0 ELIE HELOU INTERNIST MD 210803 0 1440 0 0 0 12125 0 12183 0 236551 0 0 0 MONIKA MISHRA INTERNIST MD 189038 0 0 0 0 0 0 0 864 0 189902 0 0 0 NICOLE MAKSYMIW INTERNIST MD 184699 0 0 0 0 0 10934 0 2728 0 198361 0 0 0 STEPHEN SPEAR INTERNIST MD 202296 0 0 0 0 0 12283 0 16893 0 231472 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. SCHEDULE J, PART II, COLUMN B(III): IN 2019, LULE TRACEY RECEIVED DEFERRED COMPENSATION PAYOUT WHICH IS INCLUDED IN COLUMN B(III). X 1 1027775 COST 0 0 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 XII, LINE 2C: THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.