2020-01-30T10:58:00-06:00 2019-03-31 593040705 RIVERO GORDIMER & COMPANY PA P O BOX 172359 TAMPA FL 33672 990 2018-04-01 591664577 PROJECT HEALTH INC D/B/A THOMAS E LANGLEY MEDICAL CENTER PROJ 3527935900 1425 US SOUTH HIGHWAY 301 SUMTERVILLE FL 33585 THOMAS CHASE CEO 3527935900 2020-01-29 1 SAM A LAZZARA P01342929 8138757774 209.202.225.84 2020-01-29 16:04:33 ES P 69A26F9334EBCBBAE563FF7F9523795D603EB3D5 425BBEDD4FE3D6157E7D42C8E7BC794A0085AF35 2018 2020-09-23 17:36:50Z THOMAS CHASE 1425 US SOUTH HIGHWAY 301 SUMTERVILLE FL 33585 17837810 0 X WWW.LANGLEYMEDICAL.COM X 1974 FL OPERATE COMMUNITY HEALTH CENTERS. 14 14 243 14 0 0 5360752 6643782 9180516 11141176 227 207 50775 52645 14592270 17837810 0 0 0 0 9634684 11657033 0 0 0 5270573 5832276 14905257 17489309 -312987 348501 13192563 13864817 7222817 7546570 5969746 6318247 PROVIDE QUALITY, COMPREHENSIVE HEALTH CARE WITH COURTESY, DIGNITY AND COMPASSION BY A PROFESSIONAL, WELL TRAINED STAFF TO ANYONE NEEDING THESE SERVICES. 0 0 13898747 11141176 AMBULATORY AND PRIMARY HEALTH CARE SERVICES PROVIDED ON A SLIDING FEE SCHEDULE - SERVICES INCLUDED MEDICAL, DENTAL, PHARMACY, LABORATORY, AND COMMUNITY HEALTH EDUCATION. 13898747 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 31 0 1 243 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 0 0 FL X CAROL PETERSON DIRECTOR OF FINANCE 3527935900 1425 U S SOUTH HWY 301 SUMTERVILLE FL 33585 IVORY GRAY CHAIRMAN 1.00 X X 0 0 0 JUNE TICKLE VICE CHAIR 1.00 X X 0 0 0 SHERRY OLSZANSKI TREASURER 1.00 X X 0 0 0 MARIA BELLO DIRECTOR 1.00 X 0 0 0 JIM BODENNER DIRECTOR 1.00 X 0 0 0 JOE DONLON DIRECTOR 1.00 X 0 0 0 MAGDA EMBDEN DIRECTOR 1.00 X 0 0 0 JIMMIE ENDERLE DIRECTOR 1.00 X 0 0 0 WANDA FRANCIS DIRECTOR 1.00 X 0 0 0 PAULA KNIGHT DIRECTOR 1.00 X 0 0 0 KRISTY LINDKE DIRECTOR 1.00 X 0 0 0 DEANA LINDSAY DIRECTOR 1.00 X 0 0 0 BROOKE MORRIS DIRECTOR 1.00 X 0 0 0 JON SIMPSON DIRECTOR 1.00 X 0 0 0 THOMAS CHASE CEO 40.00 X 249093 0 0 GARY COSTANTINO CFO 40.00 X 123530 0 5375 VICKI WYNNS COO 40.00 X 128361 0 0 NAEEM AHMED DO CMO 40.00 X 231781 0 8653 FRANCIS GOIRAN CMO 40.00 X 133991 0 0 ANTHONY SHADIACK DO DOCTOR 40.00 X 171618 0 9940 JULIA FASHNER MD DOCTOR 40.00 X 168586 0 5555 DONOFFA NELSON DO DOCTOR 40.00 X 168415 0 6214 SANTHARAM NALLAMSHETTY MD DOCTOR 40.00 X 165693 0 10113 KATHERINE WELTY MD DOCTOR 40.00 X 159626 0 7163 1700694 0 53013 27 0 1 0 0 5645469 998313 6643782 NET PATIENT SERVICE REVENUE 621400 11141176 11141176 11141176 207 207 52645 0 52645 52645 52645 17837810 11141176 0 52852 866755 721994 144761 9383473 7816290 1567183 704253 555089 149164 702552 553749 148803 33379 33379 51542 51542 799607 670485 129122 34811 17102 17709 725486 655142 70344 696886 607280 89606 1324030 800978 523052 300777 240544 60233 718297 288616 429681 206780 30797 175983 PROVISION FOR BAD DEBT 682598 682598 0 0 PHARMACEUTICAL SUPPLIES 258083 258083 0 0 17489309 13898747 3590562 0 369015 443794 257590 257603 269618 752348 892384 1635157 34162 21491 73032 61349 18734563 8052738 11286332 10681825 10430 11250 13192563 13864817 1007321 1381452 9809 7817 6052414 5761592 260802 153273 134907 7222817 7546570 X 5969746 6318247 5969746 6318247 13192563 13864817 348501 0 X X 0 1 X 1 1 1 X 1825515 3368138 5566394 5360752 6643782 22764581 7730433 6953678 8305944 9180516 11141176 43311747 9555948 10321816 13872338 14541268 17784958 66076328 0 0 0 66076328 56581 51272 51091 51002 52852 262798 56581 51272 51091 51002 52852 262798 9612529 10373088 13923429 14592270 17837810 66339126 0.99600 0.99540 0.00400 0.00460 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1280721 1280721 11664935 3613167 8051768 1152075 588727 563348 4636832 3850844 785988 10681825 CAPITAL LEASES PAYABLE 40907 DUE TO AFFILIATE 94000 134907 X PART X, LINE 2: THE ORGANIZATION HAS DOCUMENTED ITS CONSIDERATION OF FASB ASC 740-10 AND DETERMINED THAT NO MATERIAL UNCERTAIN TAX POSITIONS QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. X X X 0 0 0 0 0 0 0 0 0 THOMAS CHASE CEO 249093 0 0 0 0 0 0 0 0 0 249093 0 0 0 NAEEM AHMED DO CMO 231781 0 0 0 0 0 0 0 8653 0 240434 0 0 0 ANTHONY SHADIACK DO DOCTOR 171618 0 0 0 0 0 0 0 9940 0 181558 0 0 0 JULIA FASHNER MD DOCTOR 168586 0 0 0 0 0 0 0 5555 0 174141 0 0 0 DONOFFA NELSON DO DOCTOR 168415 0 0 0 0 0 0 0 6214 0 174629 0 0 0 SANTHARAM NALLAMSHETTY MD DOCTOR 165693 0 0 0 0 0 0 0 10113 0 175806 0 0 0 KATHERINE WELTY MD DOCTOR 159626 0 0 0 0 0 0 0 7163 0 166789 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE DIRECTOR OF FINANCE, CAROL PETERSON PRESENTS THE COPY OF FORM 990 TO THE BOARD OF DIRECTORS AT THEIR MONTHLY MEETING FOR REVIEW. AFTER REVIEW OF THE DOCUMENTS A MOTION IS MADE BY ONE OF THE BOARD MEMBERS TO ACCEPT THE FORM 990, AND AFTER MOTION IS SECONDED IT IS CONSIDERED APPROVED FOR FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS ARE PROVIDED COPIES OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. DIRECTORS ARE REQUIRED TO COMPLETE A WRITTEN QUESTIONNAIRE ABOUT ANY POTENTIAL CONFLICTS THEY MAY HAVE. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD IS AWARE OF THE PROVISIONS OF SECTION 4958. IN SETTING THE COMPENSATION FOR THE CEO, THE BOARD HAS COMPARATIVE DATA FROM THE FLORIDA ASSOCIATION OF COMMUNITY HEALTH CENTERS (FACHC). THE EXECUTIVE COMMITTEE CONSIDERS THIS DATA, REVIEWS THE PERFORMANCE OF THE CEO AND NEGOTIATES CONTRACTS AND CONTRACT EXTENSIONS FROM TIME TO TIME. THE PROCESS IS DOCUMENTED. THE CURRENT CONTRACT OF THE CEO COMMENCED ON APRIL 1, 2019 AND CONTINUES THROUGH MARCH 31, 2021. COMPENSATION FOR THE CEO DID NOT CHANGE FROM THE CONTRACT FOR THE PERIOD APRIL 1, 2017 THROUGH MARCH 31, 2019. NO OTHER EMPLOYEE IS CONSIDERED A "DISQUALIFIED" INDIVIDUAL. HOWEVER, HISTORICALLY, THE DATA FROM FACHC HAS ALSO BEEN ANALYZED AND REPORTED TO THE BOARD AND HAS BEEN USED TO CONSIDER THE SALARIES OF THE COO, CFO, CMO AND DIRECTOR OF DEVELOPMENT. THOSE SALARIES ARE SET BY THE CEO AND ADJUSTED FROM TIME TO TIME. FORM 990, PART VI, SECTION C, LINE 18 PROJECT HEALTH MAKES ITS FORMS 1023 AND 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 PROJECT HEALTH NOTES THAT IT IS NOT REQUIRED TO MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C, FINANCIAL STATEMENTS AND REPORTING: PROJECT HEALTH'S BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF THE ORGANIZATION'S INDEPENDENT AUDITORS. THE BOARD MAINTAINS COMMUNICATION WITH THE INDEPENDENT AUDITORS, AS NECESSARY, DURING THE AUDIT AND IS RESPONSIBLE FOR REVIEWING AND APPROVING THE AUDITED FINANCIAL STATEMENTS. THOMAS E LANGELY MEDICAL CENTER FOUNDATION INC 1425 SOUTH US HWY 301 SUMTERVILLE FL 33585 650713573 RAISE FUNDS TO SUPPORT THE ACTIVITIES OF PROJECT HEALTH FL 501(C)(3) 509(A)(3) TYPE II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0