2021-12-22T14:00:31-06:00 2020-12-31 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2020-01-01 510567466 COMMUNITY HEALTH CENTER OF RICHMOND INC COMM 7189242254 439 PORT RICHMOND AVENUE STATEN ISLAND NY 10302 HENRY THOMPSON CEO 7189242254 2021-12-22 1 HENRY THOMPSON 999009999 KERRI N BOGDA CPA P00760402 7177404863 X 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z HENRY THOMPSON 439 PORT RICHMOND AVENUE STATEN ISLAND NY 10302 16734726 0 X WWW.CHCRICHMOND.ORG X 2006 NY TO PROVIDE QUALITY HEALTH CARE AND SPECIALTY SERVICES THAT ARE AFFORDABLE AND ACCESSIBLE. 9 9 122 9 0 0 6590674 7596369 8250546 7073093 1998 1509 1738607 2063755 16581825 16734726 0 0 0 0 11223532 11864046 0 0 0 5294520 5136136 16518052 17000182 63773 -265456 18938875 19691599 6930735 7948915 12008140 11742684 X THE MISSION OF THE COMMUNITY HEALTH CENTER OF RICHMOND, INC. (THE CENTER) IS TO PROVIDE AFFORDABLE, QUALITY PRIMARY HEALTH CARE AND COORDINATED ACCESS TO SPECIALTY SERVICES WITH RESPECT AND COMPASSION FOR ALL PEOPLE. 0 0 13534513 0 7073093 PROVIDING PRIMARY CARE SERVICES TO RESIDENTS OF STATEN ISLAND, NEW YORK WITH PARTICULAR EMPHASIS PLACED ON SERVING THE POOR AND UNDER-INSURED WITHIN THE COMMUNITY. THERE WERE 34,944 VISITS FOR 2020. CHCR HAS PROVIDED SERVICES TO 9,721 PATIENTS OF WHICH 1,841 WERE UNINSURED AND 9,161 WERE AT 200% OR BELOW THE FEDERAL POVERTY GUIDELINE. THERE WERE 45 HEALTH CARE PROVIDER FTES WHO DELIVERED THE SERVICES DURING THE YEAR.THE CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUES OR SHOWN AS GRANTS TO INDIVIDUALS.THE CENTER MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE THAT IT PROVIDES. THE COSTS ASSOCIATED WITH THE CHARITABLE CARE SERVICES PROVIDED ARE ESTIMATED BY APPLYING THE COST-TO-CHARGE RATIO FROM THE MOST RECENTLY FILED COST REPORT TO THE AMOUNT OF GROSS UNCOMPENSATED CHARGES FOR THE PATIENTS RECEIVING CHARITY CARE. TOTAL CHARITY CARE COSTS WERE $944,233 FOR THE YEAR ENDED DECEMBER 31, 2020. 13534513 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 27 0 122 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X BENITO LINDO CFO 7189242254 439 PORT RICHMOND AVE STATEN ISLAND NY 10302 JACK DE SANTIS JR CPA PRESIDENT 1.00 X X 0 0 0 SHERIF FARAG MD 1ST VICE PRESIDENT 1.00 X X 0 0 0 ARACELI ARIZMENDI 2ND VICE PRESIDENT 1.00 X X 0 0 0 DEMETRIUS CAROLINA TREASURER 1.00 X X 0 0 0 BARBARA GRIFFITHS SECRETARY 1.00 X X 0 0 0 JOAN CARUSO MEMBER 1.00 X 0 0 0 CAMELIA RANGEL MEMBER 1.00 X 0 0 0 SHAMEEKA JOHNSON MEMBER 1.00 X 0 0 0 MICHAEL PERRY MEMBER 1.00 X 0 0 0 HENRY THOMPSON CHIEF EXECUTIVE OFFICER 40.00 X 366702 0 56974 BENITO LINDO CHIEF FINANCIAL OFFICER 40.00 X 265885 0 19032 ROSALINDA ROSARIO-LIPKA DO CHIEF MEDICAL OFFICER 30.00 X 209970 0 30813 MONIQUE WELBECK DNP NURSE PRACTITIONER 40.00 X 207008 0 25589 VLADIMIR BARAYEV PHYSICIAN 40.00 X 179456 0 45276 GERARD CASALE PHYSICIAN 40.00 X 227157 0 35580 PREETI SHETKAR PHYSICIAN 40.00 X 211316 0 47276 PATRICE FERGUSON PHYSICIAN 40.00 X 196730 0 12677 1864224 0 273217 20 0 1 0 HENRICH GROUP LLC 125-28 QUEENS BLVD SUITE 617 KEW GARDENS NY 11415 CONSTRUCTION MGMT 135500 SHORELINE HEALTH SOLUTIONS LLC 2 PARKMAN PLACE OLD SAYBROOK CT 06475 CONSULTING 103019 2 7459800 136569 313394 7596369 NET PATIENT SVC REV 623000 7073093 7073093 7073093 1509 1509 PATIENT INCENTIVE REVENUE 900099 1086909 1086909 PHARMACY SALES AT COST 446110 970633 970633 MEDICAL RECORDS REVENUE 900099 6213 6213 2063755 16734726 7073093 0 2065264 949376 294357 655019 8009086 6782828 1226258 352537 278504 74033 1955625 1704180 251445 597422 483061 114361 152265 152265 66057 66057 777924 539491 238433 14198 14198 1795191 1469882 325309 96096 96096 639516 639516 54397 54397 327452 258687 68765 801047 632827 168220 50981 24938 26043 REPAIRS AND MAINTENANCE 90203 90203 DUES AND SUBSCRIPTIONS 77648 57452 20196 BDCC SURCHARGE 50712 50712 LEASED EQUIPMENT 49394 49394 93055 78700 14355 17000182 13534513 3465669 0 350 350 310603 1596815 357346 361539 1277106 1292314 384876 132846 22241655 6121109 16421405 16120546 68027 68027 119162 119162 18938875 19691599 1348187 766571 14777 14777 5567771 5167567 2000000 6930735 7948915 X 12008140 11742684 12008140 11742684 18938875 19691599 -265456 0 X 0 1 X 1 1 1 X 4988432 5664656 6099115 6941794 7596369 31290366 6815170 9559504 7608241 8250546 7073093 39306554 11803602 15224160 13707356 15192340 14669462 70596920 0 0 0 70596920 3368 1671 2235 1998 1509 10781 3368 1671 2235 1998 1509 10781 821961 703821 1622575 1738607 2063755 6950719 12628931 15929652 15332166 16932945 16734726 77558420 0.91020 0.92810 0.00010 0.00020 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2016 AMOUNT: $ 278. 2017 AMOUNT: $ 8,806. 2018 AMOUNT: $ 57,196. 2019 AMOUNT: $ 3,500. 340B PHARMACY PROGRAM - 2016 AMOUNT: $ 124,146. 2017 AMOUNT: $ 132,845. 2018 AMOUNT: $ 352,615. 2019 AMOUNT: $ 795,650. 2020 AMOUNT: $ 970,633. MEDICAL RECORDS - 2016 AMOUNT: $ 3,062. 2017 AMOUNT: $ 3,098. 2018 AMOUNT: $ 3,589. 2019 AMOUNT: $ 15,573. 2020 AMOUNT: $ 6,213. INCENTIVE PROGRAM - 2016 AMOUNT: $ 324,190. 2017 AMOUNT: $ 109,934. 2018 AMOUNT: $ 479,248. 2019 AMOUNT: $ 254,151. 2020 AMOUNT: $ 510,144. DSRIP INCENTIVE - 2016 AMOUNT: $ 370,285. 2017 AMOUNT: $ 449,138. 2018 AMOUNT: $ 729,927. 2019 AMOUNT: $ 626,706. 2020 AMOUNT: $ 576,765. CHIPA PARTNERSHIP - 2019 AMOUNT: $ 43,027. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5290364 5290364 13935377 4832165 9103212 1572549 1288944 283605 1443365 1443365 16120546 X 16709232 -25494 -25494 16734726 0 16734726 16974688 0 16974688 25494 25494 17000182 PART X, LINE 2: THE CENTER 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 DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2020 AND 2019. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISON FOR BAD DEBTS NETTED AGAINST REVENUE -25,494. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISON FOR BAD DEBTS NETTED AGAINST REVENUE 25,494. X X 0 0 0 0 0 0 0 0 0 HENRY THOMPSON CHIEF EXECUTIVE OFFICER 366702 0 0 0 0 0 25698 0 31276 0 423676 0 0 0 BENITO LINDO CHIEF FINANCIAL OFFICER 265885 0 0 0 0 0 19032 0 0 0 284917 0 0 0 GERARD CASALE PHYSICIAN 227157 0 0 0 0 0 16800 0 18780 0 262737 0 0 0 PREETI SHETKAR PHYSICIAN 211316 0 0 0 0 0 16000 0 31276 0 258592 0 0 0 ROSALINDA ROSARIO-LIPKA DO CHIEF MEDICAL OFFICER 209970 0 0 0 0 0 14850 0 15963 0 240783 0 0 0 MONIQUE WELBECK DNP NURSE PRACTITIONER 207008 0 0 0 0 0 14615 0 10974 0 232597 0 0 0 VLADIMIR BARAYEV PHYSICIAN 179456 0 0 0 0 0 14000 0 31276 0 224732 0 0 0 PATRICE FERGUSON PHYSICIAN 196730 0 0 0 0 0 12677 0 0 0 209407 0 0 0 X 2 313394 COST 0 0 1 0 PART I, COLUMN (B): THE AMOUNT REPORTED IN COLUMN B OF SCHEDULE M REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE FORM 990 BEFORE IT IS FILED. THE RETURN IS THEN PRESENTED TO THE FINANCE COMMITTEE FOR REVIEW AND THEN TO THE GENERAL BOARD FOR APPROVAL BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C CHCR PROVIDES BOARD MEMBERS AND STAFF WITH A CONFLICT OF INTEREST STATEMENT WHICH SUMMARIZES THE KEY ELEMENTS OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. THE STATEMENT IS PROVIDED TO AND SIGNED BY BOARD MEMBERS AND STAFF BOTH AT THE TIME OF THE INDIVIDUAL'S INITIAL AFFILIATION WITH THE ORGANIZATION AND ANNUALLY THEREAFTER. FAMILY AND BUSINESS RELATIONSHIPS ARE EXPRESSLY MENTIONED IN THE POLICY. THE CEO IS RESPONSIBLE FOR MONITORING THE CONFLICTS. THE BOARD OF DIRECTORS REVIEWS THE CEO'S ANNUAL CONFLICT OF INTEREST STATEMENT. IN THE CASE OF A CONFLICT OF INTEREST, THE BOARD MEMBER WILL REPORT THE CONFLICT TO THE FULL BOARD PRIOR TO ANY DISCUSSION OF THE MATTER AND RECUSE THEMSELVES FROM VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 OFFICER COMPENSATION IS DETERMINED AND COMPARED BASED ON THE CURRENT MARKET, INDUSTRY STANDARDS AND SURVEYS TAKEN. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE CHIEF EXECUTIVE OFFICER'S SALARY. THE COMPENSATION SETTING PROCESS IS DOCUMENTED IN THE EXECUTIVE COMMITTEE MINUTES. THIS PROCESS IS THEN DONE WITH THE GOAL OF ENSURING A SALARY OF NO MORE THAN THE FAIR MARKET VALUE OF THE SERVICES RENDERED. SALARIES FOR THE OTHER OFFICERS AND STAFF ARE BASED UPON AN INDUSTRY SURVEY, E.G. NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC), AND THE COMMUNITY HEALTH CENTER ASSOCIATION OF NEW YORK STATE (CHCANYS). THE ORGANIZATION HAS A BOARD PERSONNEL COMMITTEE THAT OVERSEES HIRING AND CREDENTIALING OF EMPLOYEES. THE CEO HAS THE PRIVILEGE AND SOLE AUTHORITY TO HIRE AND FIRE EMPLOYEES; TO ESTABLISH SALARIES BASED UPON THE SURVEY PARAMETERS, AND TO PROVIDE RECOMMENDATIONS TO THE BOARD FOR APPROVAL. 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.