2019-02-11T11:42:47-06:00 2018-03-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 191037341 990 2017-04-01 222682708 HENRY J AUSTIN HEALTH CENTER INC HENR 6092785900 321 N WARREN STREET TRENTON NJ 08618 JAMES T FOLEY CFO 6092785912 2019-02-11 1 JULIUS C GREEN CPA P00350393 2159720701 X 216.255.126.197 2019-02-11 10:39:50 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45D50D8E3994CEF8BF8842BFE43A81B55B26F885 2017 2019-02-21 02:37:17Z KEMI ALLI MD 321 N WARREN STREET TRENTON NJ 08618 18577170 0 X WWW.HENRYJAUSTIN.ORG X 1986 NJ TO PROVIDE QUALITY HEALTHCARE TO MERCER COUNTY'S UNINSURED AND UNDERINSURED. 8 8 186 33 0 0 6878381 6974711 8300451 10832145 313 415 8043 751795 15187188 18559066 0 0 0 0 10303400 11087148 0 0 0 4914427 8297863 15217827 19385011 -30639 -825945 6229900 5676892 3572569 3845506 2657331 1831386 X THE HENRY J. AUSTIN HEALTH CENTER, INC. PROVIDES PATIENT-CENTERED, COMPREHENSIVE, ACCESSIBLE, EFFICIENT, QUALITY PRIMARY CARE SERVICES TO THE CULTURALLY DIVERSE GREATER TRENTON COMMUNITY. OUR EXCEPTIONAL, DEDICATED, WELL-TRAINED TEAM DELIVERS BEST PRACTICE HEALTH CARE, WORKING WITH COMMUNITY PARTNERS TO PROVIDE EXTRAORDINARY CUSTOMER SERVICE AND QUALITY OUTCOMES. 0 0 11788492 8199292 HENRY J. AUSTIN HEALTH CENTER PROVIDES MEDICAL, DENTAL, MENTAL AND OTHER HEALTH CARE SERVICES TO THE LARGELY MEDICALLY UNDERSERVED POPULATION OF THE SURROUNDING TRENTON AREA. DURING THE YEAR, THE ORGANIZATION SAW 16,194 PATIENTS AND HAD 68,788 PATIENT VISITS. THE AVERAGE NUMBER OF VISITS PER PATIENT WAS 4.25. 1030157 797442 HENRY J. AUSTIN HEALTH CENTER PROVIDES MEDICAL, DENTAL, MENTAL AND OTHER HEALTH CARE SERVICES TO THE HOMELESS POPULATION IN THE SURROUNDING TRENTON AREA. DURING THE YEAR, THE ORGANIZATION SAW 503 PATIENTS AND HAD 2,898 PATIENT VISITS. THE AVERAGE NUMBER OF VISITS PER PATIENT WAS 5.76. 1807641 1835411 HENRY J. AUSTIN HEALTH CENTER PROVIDES MEDICAL, DENTAL, MENTAL AND OTHER HEALTH CARE AND RELATED SUPPORTING SOCIAL SERVICES TO THE AFFECTED HIV POPULATION OF THE SURROUNDING TRENTON AREA. THESE SERVICES ALSO INCLUDE HIV EDUCATION AND PREVENTION SERVICES. DURING THE YEAR, THE ORGANIZATION SAW 414 PATIENTS AND HAD 7,005 PATIENT VISITS. THE AVERAGE NUMBER OF VISITS PER PATIENT WAS 16.92. 14626290 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 57 0 186 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NJ X JAMES T FOLEY CFO 6092785912 321 N WARREN STREET TRENTON NJ 08618 CHARLES DAVIS II CHAIRPERSON 1.50 0.00 X X 0 0 0 BEVERLY ANN SMITH VICE CHAIRPERSON 1.50 0.00 X X 0 0 0 DANIEL R BENSON BOARD TREASURER 1.50 0.00 X X 0 0 0 TYRONE GASKINS BOARD SECRETARY 1.50 0.00 X X 0 0 0 DR JONATHAN P UY DIRECTOR 1.50 0.00 X 0 0 0 MARGE CALDWELL-WILSON DIRECTOR 1.50 0.00 X 0 0 0 DETRAVIUS BETHEA DIRECTOR 1.50 0.00 X 0 0 0 CHINWEZE AHAGHOTUSHERMAN DIRECTOR 1.50 0.00 X 0 0 0 KEMI ALLI MD CEO 35.00 0.00 X 199811 0 30283 RACHAEL EVANS MD CMO 35.00 0.00 X 145281 0 31182 RENEE HAYNES COO 35.00 0.00 X 138090 0 22527 ELIDORO PRIMERO CFO 35.00 0.00 X 131767 0 47835 MALA KAILASAM INTERNIST 35.00 0.00 X 200108 0 24766 SPRING MATTHEWS-BROWN INTERNIST 35.00 0.00 X 153304 0 0 MAGALI SANTOS DENTIST 35.00 0.00 X 145343 0 37607 DEVIN GOODMAN DDS DIRECTOR OF DENTISTRY 35.00 0.00 X 143685 0 731 SHAUNON MOTEN DENTIST 35.00 0.00 X 138056 0 13113 1395445 0 208044 16 0 1 0 PSSMCKESSON 208 PASSAIC AVENUE FAIRFIELD NJ 07004 PHARMACEUTICAL SUPPLIER 1177489 ABW MEDICAL LLC PO BOX 882141 PORT ST LUCIE FL 34988 BILLING AND EMR SPECIALISTS 267432 ATHENAHEALTH INC PO BOX 415615 BOSTON MA 02241 EMR SYSTEMS SUPPORT AND TRAINING 160746 SCRIBE AMERICA LLC PO BOX 417756 BOSTON MA 02241 MEDICAL SCRIBES 145870 WHISTLE BUILDING MAINTENANCE 210 DRYDEN AVE EWING NJ 08638 JANITORIAL SERVICES 113285 8 6193107 781604 545574 6974711 PATIENT SERVICE REVENUE 621400 9922446 9922446 CONTRACT SERVICES 900099 567038 567038 340B PROGRAM 621400 304865 304865 THIRD PARTY INCENTIVES 621400 37796 37796 10832145 415 415 13051 18104 -5053 -5053 -5053 ADMINISTRATION FEES 900099 731589 731589 MEDICAL RECORDS SUBPOENA FEES 900099 20738 20738 QI PARTICIPATION FEES 900099 4022 4022 499 499 756848 18559066 10832145 0 752210 834979 834979 8422118 6299503 2122615 1174529 925047 249482 655522 467855 187667 117527 83881 33646 87692 87692 1775635 1267295 508340 2963 2115 848 373734 266739 106995 63577 45376 18201 182565 182565 10954 7818 3136 87510 62457 25053 86378 61649 24729 353181 252070 101111 82683 59012 23671 MEDICAL SUPPLIES 2300906 2300906 0 BAD DEBT EXPENSE 1268631 1268631 PENALTIES 871875 622269 249606 EQUIPMENT & REPAIRS 269322 192219 77103 362730 258883 103847 19385011 14626290 4758721 0 2680 2680 187340 124288 528852 304212 1615821 1202847 51867 98361 7384782 3827583 3773803 3557199 69537 387305 6229900 5676892 1821047 2601332 64749 176820 1686773 1067354 3572569 3845506 X 2657331 1831386 2657331 1831386 6229900 5676892 -825945 0 X 0 1 X 1 1 1 X 5727224 5908790 6288520 6878381 6974711 31777626 6253184 8296475 7893813 8300451 10832145 41576068 11980408 14205265 14182333 15178832 17806856 73353694 0 0 0 73353694 36079 31185 16952 10874 13466 108556 36079 31185 16952 10874 13466 108556 211340 25458 11296 756848 1004942 12227827 14236450 14224743 15201002 18577170 74467192 0.98500 0.99370 0.00150 0.00190 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2013 AMOUNT: $ 211,340. 2015 AMOUNT: $ 20,918. GAIN ON EXTINGUISHMENT OF DEBT - 2015 AMOUNT: $ 4,540. MEDICAL RECORDS SUBPOENA FEES - 2016 AMOUNT: $ 2,030. 2017 AMOUNT: $ 20,738. QI PARTICIPATION FEES - 2016 AMOUNT: $ 510. 2017 AMOUNT: $ 4,022. REFUNDS AND INCENTIVES - 2016 AMOUNT: $ 8,756. 2017 AMOUNT: $ 499. ADMINISTRATIVE FEES - 2017 AMOUNT: $ 731,589. 36142 36142 3972147 1359317 2612830 1835743 1215952 619791 1540552 1252283 288269 198 31 167 3557199 PHARMACY STOCK 387305 387305 X 17308539 0 17308539 1250527 1250527 18559066 18134484 0 18134484 1250527 1250527 19385011 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 2018 AND 2017. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -18,104. PROVISION FOR DOUBTFUL ACCOUNTS 1,268,631. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -18,104. PROVISION FOR DOUBTFUL ACCOUNTS 1,268,631. X X X 0 0 0 0 0 0 0 0 0 KEMI ALLI MD CEO 199811 0 0 0 0 0 13783 0 16500 0 230094 0 0 0 RACHAEL EVANS MD CMO 145281 0 0 0 0 0 31182 0 0 0 176463 0 0 0 RENEE HAYNES COO 138090 0 0 0 0 0 22527 0 0 0 160617 0 0 0 ELIDORO PRIMERO CFO 131767 0 0 0 0 0 29835 0 18000 0 179602 0 0 0 MALA KAILASAM INTERNIST 200108 0 0 0 0 0 766 0 24000 0 224874 0 0 0 SPRING MATTHEWS-BROWN INTERNIST 153304 0 0 0 0 0 0 0 0 0 153304 0 0 0 MAGALI SANTOS DENTIST 145343 0 0 0 0 0 13607 0 24000 0 182950 0 0 0 SHAUNON MOTEN DENTIST 138056 0 0 0 0 0 13113 0 0 0 151169 0 0 0 X 10200 545574 COST 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 1 IN EMERGENCY SITUATIONS WHERE THE FULL BOARD IS UNAVAILABLE, THE EXECUTIVE COMMITTEE, MADE UP OF THE CHAIRPERSON OF EACH COMMITTEE, MAY ACT. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED IN DETAIL BY THE CFO OF THE ORGANIZATION, WHO HAS NEARLY 20 YEARS OF EXPERIENCE WITH NOT FOR PROFIT ORGANIZATIONS. THE FORM 990 IS THEN GIVEN TO THE FINANCE COMMITTEE FOR THEIR REVIEW AND APPROVAL. THE FINANCE COMMITTEE PERFORMS THE ULTIMATE SIGN OFF ON THE FORM 990. AFTER THE RETURN IS APPROVED INTERNALLY AND PRIOR TO FILING, A COPY IS GIVEN TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR THEIR REVIEW AND THE MEMBERS ARE GIVEN AN OPPORTUNITY TO ASK QUESTIONS REGARDING THE FORM 990. ONCE THIS PROCEDURE IS COMPLETED, THE FORM 990 IS SIGNED BY THE CFO AND FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST POLICY STATEMENT TO EXECUTIVE MANAGEMENT AND THE BOARD OF DIRECTORS FOR THEIR REVIEW AND AFFIRMATIVE ACKNOWLEDGEMENT THAT THEY ARE AWARE OF THE POLICY. THE CEO'S EXECUTIVE ASSISTANT REVIEWS AND MONITORS COMPLIANCE WITH THE CONFLICT STATEMENTS. IN ADDITION, THE ORGANIZATION ASKS FOR INFORMATION REGARDING ANY ORGANIZATION(S) THAT SENIOR MANAGEMENT, MEDICAL STAFF OR BOARD OF DIRECTORS HAVE AN INTEREST IN TO ENSURE THAT REFERRALS OR OTHER VENDOR RELATIONSHIPS ARE NOT BEING CONSUMMATED WITH THOSE ENTITIES. ANY POTENTIAL CONFLICTS OF INTEREST ARE BROUGHT TO A SUBSET OF THE BOARD OF DIRECTORS FOR THEIR INITIAL REVIEW. ANY CONFLICTS DEEMED BY THIS SUBSET TO BE POTENTIALLY DETRIMENTAL TO THE ORGANIZATION ARE REFERRED TO LEGAL COUNSEL FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 15 THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) ISSUES AN ANNUAL SALARY SURVEY, AS DOES THE NEW JERSEY PRIMARY CARE ASSOCIATION (NJPCA). SUCH INFORMATION HAS BEEN PROVIDED TO THE BOARD FOR USE IN DETERMINING THE SALARY FOR THE CURRENT CEO WHO WAS HIRED IN MAY 2015 AND OTHER TOP MANAGEMENT POSITIONS (COO AND CFO) HIRED IN 2014. THE CEO, CFO AND COO ALSO USE THE INFORMATION FOR HIRING SENIOR STAFF MEMBERS. DISCUSSIONS BY THE BOARD REGARDING COMPENSATION DETERMINATION ARE DOCUMENTED IN THE BOARD MEETING 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.