2020-11-09T07:55:08-06:00 2019-12-31 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2019-01-01 510567466 COMMUNITY HEALTH CENTER OF RICHMOND INC COMM 7189242254 439 PORT RICHMOND AVENUE STATEN ISLAND NY 10302 HENRY THOMPSON CEO 7189242254 2020-11-06 1 KERRI N BOGDA CPA P00760402 7177404863 174.55.78.125 2020-11-06 13:12:55 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AF78FC311707138AE8A35EE5AF434BBB9CACA7EB 2019 2021-01-29 14:40:06Z HENRY THOMPSON 439 PORT RICHMOND AVENUE STATEN ISLAND NY 10302 16932945 0 X CHCRICHMOND.ORG X 2006 NY TO PROVIDE QUALITY HEALTH CARE AND SPECIALTY SERVICES THAT IS AFFORDABLE AND ACCESSIBLE. 9 9 123 9 0 0 6099115 6941794 7608241 8250546 2235 1998 1622675 1738607 15332266 16932945 0 0 0 0 10526664 11223532 0 0 0 5065679 5294520 15592343 16518052 -260077 414893 19303706 19289995 7359339 6930735 11944367 12359260 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 12966129 0 8250546 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 41,973 VISITS FOR 2019. CHCR HAS PROVIDED SERVICES TO 11,534 PATIENTS OF WHICH 2,722 WERE UNINSURED AND 10,616 WERE AT 200% OR BELOW THE FEDERAL POVERTY GUIDELINE. THERE WERE 46.54 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 $1,054,710 FOR THE YEAR ENDED DECEMBER 31, 2019. 12966129 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 54 0 123 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 HENRY THOMPSON CHIEF EXECUTIVE OFFICER 40.00 X 373407 0 56173 BENITO LINDO CHIEF FINANCIAL OFFICER 40.00 X 220660 0 17549 ROSALINDA ROSARIO-LIPKA DO CHIEF MEDICAL OFFICER 30.00 X 188110 0 30318 MONIQUE WELBECK DNP NURSE PRACTITIONER 40.00 X 183962 0 32871 VLADIMIR BARAYEV PHYSICIAN 40.00 X 161542 0 42452 ELAINE CLARK MD PHYSICIAN 40.00 X 161037 0 42858 GONZALO OLIVARES-MALDONADO MD PHYSICIAN 40.00 X 182509 0 14439 THAN SEIN PHYSICIAN 40.00 X 158049 0 7633 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 STANLEY CHARZWESKI MEMBER (RESIGNED MAY '19) 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 1629276 0 244293 8 0 1 0 HENRICH GROUP LLC 125-28 QUEENS BLVD SUITE 617 KEW GARDENS NY 11415 CONSTRUCTION MGMT 112225 1 6688396 253398 401711 6941794 NET PATIENT SVC REV 623000 8250546 8250546 8250546 1998 1998 PATIENT INCENTIVE REVENUE 900099 880857 880857 PHARMACY SALES AT COST 446110 795650 795650 CHIPA PARTNERSHIP 900099 43027 43027 19073 19073 1738607 16932945 8250546 0 1740605 886217 268883 617334 7563133 6290865 1272268 336172 260991 75181 1829938 1525279 304659 608072 466617 141455 81390 81390 36935 36935 844522 375532 468990 57799 57799 1739988 1377204 362784 30457 30457 696113 696113 105342 97615 7727 333010 333010 799770 799770 46771 46771 REPAIRS AND MAINTENANCE 121929 121929 DUES AND SUBSCRIPTIONS 119563 101580 17983 TRAINING EXPENSE 62999 62999 MEALS AND ENTERTAINMENT 46081 46081 171851 111204 60647 16518052 12966129 3551923 0 350 350 259882 310603 550450 708466 1449148 1277106 122443 384876 21741468 5320063 16735134 16421405 186299 187189 19303706 19289995 1282072 1348187 225246 14777 5852021 4617670 0 950101 7359339 6930735 X 11944367 12359260 11944367 12359260 19303706 19289995 414893 0 X 0 1 X 1 1 1 X 6226638 4988432 5664656 6099115 6941794 29920635 5487314 6815170 9559504 7608241 8250546 37720775 11713952 11803602 15224160 13707356 15192340 67641410 0 0 0 67641410 4670 3368 1671 2235 1998 13942 4670 3368 1671 2235 1998 13942 337066 821961 703821 1622575 1738607 5224030 12055688 12628931 15929652 15332166 16932945 72879382 0.92810 0.94000 0.00020 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 - 2015 AMOUNT: $ 150,530. 2016 AMOUNT: $ 124,146. 2017 AMOUNT: $ 132,845. 2018 AMOUNT: $ 352,615. 2019 AMOUNT: $ 795,650. MEDICAL RECORDS - 2015 AMOUNT: $ 9,175. 2016 AMOUNT: $ 3,062. 2017 AMOUNT: $ 3,098. 2018 AMOUNT: $ 3,589. 2019 AMOUNT: $ 15,573. INCENTIVE PROGRAM - 2015 AMOUNT: $ 177,361. 2016 AMOUNT: $ 324,190. 2017 AMOUNT: $ 109,934. 2018 AMOUNT: $ 479,248. 2019 AMOUNT: $ 254,151. DSRIP INCENTIVE - 2016 AMOUNT: $ 370,285. 2017 AMOUNT: $ 449,138. 2018 AMOUNT: $ 729,927. 2019 AMOUNT: $ 626,706. CHIPA PARTNERSHIP - 2019 AMOUNT: $ 43,027. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5290364 5290364 13919598 4181774 9737824 1572549 1138289 434260 958957 958957 16421405 LONG TERM DEBT 950101 950101 X 16906312 -26633 -26633 16932945 0 16932945 16491419 0 16491419 26633 26633 16518052 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 2019 AND 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISON FOR BAD DEBTS NETTED AGAINST REVENUE -26,633. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISON FOR BAD DEBTS NETTED AGAINST REVENUE 26,633. X X 0 0 0 0 0 0 0 0 0 HENRY THOMPSON CHIEF EXECUTIVE OFFICER 373407 0 0 0 0 0 26303 0 29870 0 429580 0 0 0 BENITO LINDO CHIEF FINANCIAL OFFICER 220660 0 0 0 0 0 17549 0 0 0 238209 0 0 0 ROSALINDA ROSARIO-LIPKA DO CHIEF MEDICAL OFFICER 188110 0 0 0 0 0 15075 0 15243 0 218428 0 0 0 MONIQUE WELBECK DNP NURSE PRACTITIONER 183962 0 0 0 0 0 15054 0 17817 0 216833 0 0 0 VLADIMIR BARAYEV PHYSICIAN 161542 0 0 0 0 0 13269 0 29183 0 203994 0 0 0 ELAINE CLARK MD PHYSICIAN 161037 0 0 0 0 0 13675 0 29183 0 203895 0 0 0 GONZALO OLIVARES-MALDONADO MD PHYSICIAN 182509 0 0 0 0 0 14439 0 0 0 196948 0 0 0 THAN SEIN PHYSICIAN 158049 0 0 0 0 0 7633 0 0 0 165682 0 0 0 X 2 401711 VACCINES/MEDICAL SUPPLY 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 OF FILING. 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.