2019-08-15T08:28:20-05:00 2018-12-31 341876254 CBIZ MHM LLC 28614 MARLBORO AVE SUITE 103 EASTON MD 21601 990 2018-01-01 521116591 CHOPTANK COMMUNITY HEALTH SYSTEM INC CHOP 4104794306 PO BOX 660 DENTON MD 21629 SARA RICH CEO 4104794306 2019-08-12 1 CARVILLE B LEAF JR P00040844 4108226950 138.207.175.194 2019-08-12 15:00:34 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B7262524F9D6FC8FD70D077A6FA39F78D7814145 2018 2019-02-21 02:37:17Z SARA RICH PO BOX 660 DENTON MD 21629 19770685 0 X CHOPTANKHEALTH.ORG X 1978 MD PRIMARY HEALTH CARE SERVICES, DELIVERY OF HEALTH CARE TO MEDICALLY UNDERSERVED COMMUNITY 13 13 226 13 0 0 5291692 5332456 10889048 12306381 127334 147890 2010636 1983958 18318710 19770685 0 0 0 0 13502158 13830632 0 0 0 4130601 4444507 17632759 18275139 685951 1495546 14015400 16367964 1574515 2520886 12440885 13847078 PRIMARY HEALTH CARE SERVICES: DELIVERY OF HEALTH CARE TO MEDICALLY UNDERSERVED COMMUNITY 0 0 14352744 12373045 PRIMARY HEALTH CARE SERVICES: DELIVERY OF HEALTHCARE TO MEDICALLY UNDERSERVED COMMUNITY 14352744 1 0 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 0 0 0 0 0 0 0 0 0 1 35 0 1 226 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X KIMBERLY R LOVE FINANCE DIRECTOR 4104794306 301 RANDOLPH ST DENTON MD 21629 JOHN MASONE DIRECTOR 1.00 X X 0 0 0 IVONNE GARRIDO DIRECTOR 1.00 X 0 0 0 REBECCA LOUKIDES VICE CHAIR 1.00 X 0 0 0 CRYSTAL DADDS DIRECTOR 1.00 X 0 0 0 WILLIAM CORBA DIRECTOR 1.00 X 0 0 0 MICHAEL CAMPBELL DIRECTOR 1.00 X 0 0 0 TANIA ALEXANDER DIRECTOR 1.00 X 0 0 0 PAULINE PINKETT DIRECTOR 1.00 X 0 0 0 MATTHEW PETERS TREASURER 1.00 X 0 0 0 JENNIFER YOST DIRECTOR 1.00 X 0 0 0 AUSTIN WEBSTER SECRETARY 1.00 X 0 0 0 SARA VISINTAINER CHAIRMAN 1.00 X 0 0 0 KISHA PETTICOLAS DIRECTOR 1.00 X 0 0 0 PATRICK THOMAS DIRECTOR 1.00 X 0 0 0 SARA RICH CHIEF EXECUTIVE OFFICER 40.00 X 165657 0 16673 BEN COTTLE CHIEF FINANCIAL OFFICER 40.00 X 56701 0 2530 MARK FABER MD PHYSICIAN 40.00 X 170565 0 11836 CHRISTINA DORSTIN PHYSICIAN 40.00 X 167644 0 12420 KATELIN HALEY PHYSICIAN 40.00 X 205174 0 11592 SANDRA GARBELY-KERKOVICH DMD PHYSICIAN 40.00 X 180069 0 12690 ADRIENNE WEBB PHYSICIAN 40.00 X 160195 0 8333 1106005 0 76074 27 0 1 0 HEALTH CHOICE NETWORK INC 9064 NW 13TH TERRACE DORAL FL 33172 HEALTH TECHNOLOGY SOLUTIONS 638594 GILLIS GILKERSON 150 WEST MARKET STREET SUITE 200 SALISBURY MD 21801 CONSTRUCTION CONTRACTOR 533831 BENCO DENTAL PO BOX 731372 DALLAS TX 75373 DENTAL SUPPLIES 299754 TOWN OF DENTON 4 N SECOND STREET DENTON MD 21629 GOVERNMENT 296532 HENRY SCHEIN PO BOX 382023 PITTSBURGH PA 15250 MEDICAL SUPPLIES 224986 5 4823819 508637 5332456 MEDICAL SERVICES 621400 12306381 12306381 12306381 147890 147890 1917294 1917294 MISCELLANEOUS 900099 66664 66664 66664 19770685 12373045 0 2065184 11227379 8880466 2346913 200004 158003 42001 1592885 1258379 334506 810364 640188 170176 22048 22048 42275 42275 58093 58093 446727 347664 99063 77663 61354 16309 574961 459969 114992 53899 26149 27750 PROFESSIONAL FEES 1306721 986767 319954 SUPPLIES 1039721 977402 62319 BAD DEBTS 180905 180905 TELEPHONE 115296 57648 57648 526198 237709 288489 18275139 14352744 3922395 0 -3 6189064 6744333 857714 1461803 347795 364226 87127 96612 16214191 8553301 6533603 7660890 100 100 0 40000 14015400 16367964 1262561 1653920 212900 237900 99054 629066 1574515 2520886 X 12440885 13847078 12440885 13847078 14015400 16367964 1495546 -89353 0 X 0 1 X 1 1 1 X 4144570 4541975 5266085 5291692 5332456 24576778 4144570 4541975 5266085 5291692 5332456 24576778 24576778 14638 82065 97108 127334 147885 469030 109762 69848 51463 137800 66664 435537 25481345 53534305 0.96450 0.96400 X 603175 603175 10173312 4147682 6025630 5437704 4405619 1032085 7660890 PATIENT OVERPAYMENTS 95235 CONSTRUCTION ADVANCES 533831 629066 X 19605427 -89353 105000 15647 19589780 180905 180905 19770685 18199234 105000 105000 18094234 180905 180905 18275139 PART X, LINE 2: THE ORGANIZATION BELIEVES IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 180,905. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 180,905. X X 0 0 0 0 0 0 0 0 0 SARA RICH CHIEF EXECUTIVE OFFICER 165657 0 0 0 0 0 5311 0 11362 0 182330 0 0 0 MARK FABER MD PHYSICIAN 154117 0 16448 0 0 0 5313 0 6523 0 182401 0 0 0 CHRISTINA DORSTIN PHYSICIAN 141863 0 25781 0 0 0 5245 0 7175 0 180064 0 0 0 KATELIN HALEY PHYSICIAN 187238 0 17936 0 0 0 6314 0 5278 0 216766 0 0 0 SANDRA GARBELY-KERKOVICH DMD PHYSICIAN 159865 0 20204 0 0 0 5614 0 7076 0 192759 0 0 0 ADRIENNE WEBB PHYSICIAN 132254 0 27941 0 0 0 4909 0 3424 0 168528 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 PREPARED BY AN OUTSIDE INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY THE ORGANIZATION'S FINANCIAL MANAGER AND CHIEF FINANCIAL OFFICER. THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION REVIEWS THE RETURN BEFORE SIGNING. FORM 990, PART VI, SECTION B, LINE 12C 1. EACH EMPLOYEE IS REQUIRED TO READ THE CONFLICT OF INTEREST POLICY IN THE EMPLOYEE HANDBOOK AND TO SIGN A STATMENT AS TO HAVING HAD REVIEWED AND UNDERSTOOD THE CONFLICT OF INTEREST POLICY. 2. CONFLICTS OF INTEREST OR THE APPEARANCE THEREOF ARE REVIEWED ON AN INDIVIDUAL BASIS AS POSSIBLE OR POTENTIAL CONFLICTS BECOME KNOWN. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AS A PART OF THE DEVELOPMENT OF THE CEO'S EMPLOYMENT CONTRACT. IN ESTABLISHING THE CEO'S COMPENSATION, THE EXECUTIVE COMMITTEE CONSIDERS THE INDIVIDUAL'S PERFORMANCE, ORGANIZATION'S PERFORMANCE, GENERAL MARKET CONDITIONS AND COMPENSATION PAID FOR COMPARABLE POSITIONS IN SIMILAR ORGANIZATIONS. THE DECISIONS OF THE EXECUTIVE COMMITTEE ARE DOCUMENTED IN THE MINUTES OF THE EXECUTIVE COMMITTEE WHICH ARE REVIEWED BY THE BOARD OF DIRECTORS. THE DECISIONS ARE REFLECTED IN THE CEO'S EMPLOYMENT CONTRACT WHICH IS APPROVED BY THE BOARD OF DIRECTORS. ALL OTHER COMPENSATION DECISIONS HAVE BEEN DELEGATED TO THE CEO BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC.