2021-12-17T09:54:37-06:00 2021-06-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2020-07-01 208979596 SUSQUEHANNA COMMUNITY HEALTH AND DENTAL CLINIC INC SUSQ 5705675400 471 HEPBURN ST WILLIAMSPORT PA 17701 MAX HOUSEKNECHT JR CFO 5705675400 2021-12-16 1 MAX HOUSEKNECHT JR 999009999 KERRI N BOGDA CPA P00760402 7177404863 X 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z RIVER VALLEY HEALTH & DENTAL CLINIC JAMES YOXTHEIMER 471 HEPBURN ST WILLIAMSPORT PA 17701 14981635 0 X WWW.RIVERVALLEYHEALTHANDDENTAL.ORG X 2007 PA TO EXTEND GOD'S HEALING BY PROVIDING INCLUSIVE, QUALITY PRIMARY MEDICAL AND DENTAL CARE. 14 14 121 14 0 0 3267477 3851348 6328562 8473883 -3608 -2141 872652 2651376 10465083 14974466 0 0 0 0 7375721 7380885 0 0 0 3966571 5405238 11342292 12786123 -877209 2188343 7225205 8033017 6518006 5137475 707199 2895542 X THE ORGANIZATION'S MISSION IS TO EXTEND GOD'S HEALING BY PROVIDING INCLUSIVE, QUALITY PRIMARY MEDICAL AND DENTAL CARE TO ALL THOSE WHO NEED IT. CONTINUED ON SCHEDULE O.LOCATED IN THE CENTER OF WILLIAMSPORT, PENNSYLVANIA, WE SERVE THE RESIDENTS OF THE GREATER RIVER VALLEY COMMUNITY WITH COMPREHENSIVE PRIMARY CARE (MEDICAL AND DENTAL) INCLUDING SPECIALIZED SERVICES FOR BEHAVIORAL AND REPRODUCTIVE HEALTH. 0 0 6153545 0 5091711 PRIMARY HEALTH CARE: WE PROVIDE COMPREHENSIVE PRIMARY CARE SERVICES REGARDLESS OF ABILITY TO PAY. OUR SERVICES INCLUDE SOCIAL WORK, DIRECTLY; AND BEHAVIORAL HEALTH, SUBSTANCE ABUSE, EMERGENCY, CHIROPRACTIC SERVICES, AND SPECIALTY CARE THROUGH REFERRAL RELATIONSHIPS. WE ACCEPT MEDICAID, MEDICARE, PRIVATE INSURANCE, AND HAVE A SLIDING FEE SCALE BASED ON FAMILY INCOME FOR THOSE WITHOUT INSURANCE. WE ARE THE ONLY PRIMARY CARE PROVIDER AND LYCOMING COUNTY THAT IS ACCEPTING PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. WE ARE A COMMUNITY-BASED ORGANIZATION WORKING WITH OTHERS TO INCREASE ACCESS FOR THE UNDER-INSURED AND UN-INSURED. 4087496 0 3382172 DENTAL CARE:WE PROVIDE PREVENTIVE AND RESTORATIVE DENTISTRY INCLUDING CLEANINGS SEALANTS, AND EXTRACTIONS. WE GO THE EXTRA MILE TO HELP OUR PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. WE HAVE A CHILDREN'S READINESS PROGRAM AND ARE BUILDING A COMMUNITY DENTAL EDUCATION PROGRAM. WE ALSO HAVE A DENTAL OUTREACH PROGRAM THAT GOES TO SCHOOLS AND OTHER COMMUNITY EVENTS TO PROVIDE ONSITE DENTAL CARE FOR CHILDREN. WE DO OUR BEST TO GET THOSE SUFFERING FROM PAIN IN TO BE SEEN THE SAME DAY. WE ARE THE ONLY DENTAL CLINIC IN LYCOMING COUNTY AND ARE ACCEPTING NEW PATIENTS. WE ARE A COMMUNITY-BASED ORGANIZATION WORKING WITH OTHERS TO INCREASE ACCESS FOR THE UNDER-INSURED AND UN-INSURED. 10241041 1 1 0 1 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 1 0 0 0 0 0 0 0 0 0 0 1 42 0 121 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 PA X MAX HOUSEKNECHT JR CFO 5705675418 471 HEPBURN ST WILLIAMSPORT PA 17701 DR JOHN BOLL CHAIRPERSON 1.00 X X 0 0 0 ABIGAIL ESCHBACH VICE CHAIRPERSON 1.00 X X 0 0 0 DOROTHY HILLIARD TREASURER 1.00 X X 0 0 0 BARBARA BARBUS SECRETARY 1.00 X X 0 0 0 THOMAS ZIMMERMAN DIRECTOR 1.00 X 0 0 0 SHANTAY HALL DIRECTOR 1.00 X 0 0 0 DWIGHT WYATT DIRECTOR 1.00 X 0 0 0 KIMBERLY WETHERHOLD DIRECTOR 1.00 X 0 0 0 ADANMA AKUJIEZE DIRECTOR 1.00 X 0 0 0 JEAN MYERS DIRECTOR 1.00 X 0 0 0 CHRISTOPHER EBNER DIRECTOR 1.00 X 0 0 0 DR RALPH KAISER DIRECTOR 1.00 X 0 0 0 PASTOR VELINDA WEBB SMITH DIRECTOR 1.00 X 0 0 0 MATTHEW MCLAUGHLIN DIRECTOR 1.00 X 0 0 0 JAMES YOXTHEIMER PRESIDENT/CHIEF EXECUTIVE OFFICER 40.00 X 151280 0 11371 MAX HOUSEKNECHT JR CHIEF FINANCIAL OFFICER 40.00 X 97342 0 9991 DR KAYLA RICHARDSON CHIEF MEDICAL OFFICER 40.00 X 284684 0 22491 CHRISTOPHER COYNER DENTIST 40.00 X 243848 0 25474 STEVEN LEUNG PHYSICIAN 40.00 X 241876 0 1810 WILLIAM BARTLOW PHYSICIAN 40.00 X 217183 0 24098 GWEN MARTIN PHYSICIAN 40.00 X 256063 0 11870 DANIEL BOZZA DENTIST 40.00 X 178322 0 25193 1670598 0 132298 9 0 1 0 CARDINAL HEALTH PHARMACY SOLUTIONA 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY MANAGEMENT 343680 INSIGHT PO BOX 392798 PITTSBURGH PA 15251 BEHAVIORAL HEALTH SERVICES 214875 CHIROPRACTIC SERVICES 14460 FALLS OF NEUSE RD STE 14-3 RALEIGH NC 27614 CHIROPRACTIC SERVICES 214000 3 10000 3835973 5375 3851348 NET PATIENT SERVICES 621400 8473883 8473883 8473883 691 691 4825 4337 488 488 488 2832 -2832 -2832 -2832 340B PROGRAM REVENUE 900099 1299876 1299876 PPP LOAN FORGIVENESS 900099 1205560 1205560 INCENTIVE PAYMENTS 900099 121896 121896 23556 23556 2650888 14974466 8473883 0 2649235 X 273987 273987 5684568 5068284 616284 59269 52986 6283 974864 852948 121916 388197 333177 55020 14561 14561 31764 31764 1250 1250 1482470 1213799 268671 105235 105235 257323 215988 41335 495713 313789 181924 214162 214162 2389 2389 220047 188860 31187 714615 613331 101284 72822 26360 46462 PHARMACEUTICALS 589906 589906 BAD DEBT 213421 213421 MEDICAL SUPPLIES 193109 193109 MINOR EQUIPMENT 179093 179093 617358 183601 433757 12786123 10241041 2545082 0 1450991 1426985 171448 277831 256875 449383 386569 642933 73106 102651 8345954 3270797 4886216 5075157 0 58077 7225205 8033017 1205137 1296835 135500 169976 1198800 0 4114069 3535164 6518006 5137475 X 707199 2895542 707199 2895542 7225205 8033017 2188343 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1250 1250 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO THE PENNSYLVANIA ASSOCIATION OF COMMUNITY HEALTH CENTERS. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING PURPOSES. 4725424 1828250 2897174 843787 330110 513677 1996764 946439 1050325 779979 165998 613981 5075157 CAPITAL LEASE OBLIGATIONS 3535164 3535164 X 14768214 -213421 -213421 14981635 -7169 -7169 14974466 12579871 7169 7169 12572702 213421 213421 12786123 PART X, LINE 2: THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT HAS DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2021 AND 2020. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST REVENUE ON FINANCIALS -213,421. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF PP&E NETTED AGAINST EXPENSES ON FINANCIALS -2,832. RENTAL EXPENSES -4,337. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF PP&E NETTED AGAINST EXPENSES ON FINANCIALS 2,832. RENTAL EXPENSES 4,337. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST REVENUE ON FINANCIALS 213,421. X X X 0 0 0 0 0 0 0 0 0 DR KAYLA RICHARDSON CHIEF MEDICAL OFFICER 284684 0 0 0 0 0 0 0 22491 0 307175 0 0 0 CHRISTOPHER COYNER DENTIST 243848 0 0 0 0 0 1500 0 23974 0 269322 0 0 0 GWEN MARTIN PHYSICIAN 256063 0 0 0 0 0 1500 0 10370 0 267933 0 0 0 STEVEN LEUNG PHYSICIAN 241876 0 0 0 0 0 0 0 1810 0 243686 0 0 0 WILLIAM BARTLOW PHYSICIAN 217183 0 0 0 0 0 1500 0 22598 0 241281 0 0 0 DANIEL BOZZA DENTIST 178322 0 0 0 0 0 1500 0 23693 0 203515 0 0 0 JAMES YOXTHEIMER PRESIDENT/CHIEF EXECUTIVE OFFICER 151280 0 0 0 0 0 1500 0 9871 0 162651 0 0 0 ANGELA HOUSEKNECHT MOTHER OF CFO 51169 SALARY 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CFO. ONCE APPROVED, THE FORM 990 IS SENT TO THE PRESIDENT/CEO FOR REVIEW AND APPROVAL. THE PRESIDENT/CEO WILL THEN FORWARD A COPY OF THE FORM 990 TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE POTENTIONAL CONFLICTS OF INTEREST. ALL CONFLICTS ARE REVIEWED AT THE BOARD LEVEL. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, AND THE FULL BOARD DETERMINES THAT A CONFLICT OR THE APPEARANCE OF A CONFLICT IS PRESENT, THE INDIVIDUAL IS EXCUSED FROM DELIBERATION AND DECISION MAKING. FORM 990, PART VI, SECTION B, LINE 15 REVIEW OF THE PRESIDENT/CEOS COMPENSATION IS PERFORMED ON AN ANNUAL BASIS. THE ORGANIZATION HAS A THIRD PARTY (R ELLEN K RAJEWSKI) CONDUCT A THOROUGH STUDY OF EXECUTIVE COMPENSATION UTILIZING NATIONAL, STATE, AND REGIONAL COMPENSATION DATA TO DEVELOP A RECOMMENDATION OF A COMPETITIVE, FAIR, AND EQUITABLE SALARY RANGE FOR THE CEO. THE BOARD THEN REVIEWS THE RECOMMENDATION AND COMPENSATES ACCORDINGLY. THE REVIEW IS DOCUMENTED IN THE MINUTES. REVIEW OF OTHER EXECUTIVE SALARIES IS COMPLETED BY BENCHMARKING DATA FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE DEPARTMENT OF LABOR BY THE BOARD OF DIRECTORS. THIS REVIEW IS DOCUMENTED IN THE 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 11G BEHAVIORAL HEALTH PROVIDER: PROGRAM SERVICE EXPENSES 101,790. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 101,790. CONSULTING: PROGRAM SERVICE EXPENSES 167,880. MANAGEMENT AND GENERAL EXPENSES 15,767. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 183,647. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 35,169. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,169. RHC: PROGRAM SERVICE EXPENSES 3,205. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,205. TEMP STAFFING FEES: PROGRAM SERVICE EXPENSES 207,410. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 207,410. PHARMACIST: PROGRAM SERVICE EXPENSES 174,233. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 174,233. SHREDDING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,440. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,440. OTHER: PROGRAM SERVICE EXPENSES 559,281. MANAGEMENT AND GENERAL EXPENSES 926. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 560,207. STORAGE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,758. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,758. SECURITY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 39,877. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,877. ADMINISTRATIVE FEES 340B: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 134,376. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 134,376. COVID SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 22,392. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,392. EMPLOYEE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 9,083. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,083. TRANSLATORS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,883. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,883.