2018-10-09T09:45:32-05:00 2017-12-31 221478099 COHNREZNICK LLP 4 BECKER FARM ROAD ROSELAND NJ 07068 990 2017-01-01 132813103 OPEN DOOR FAMILY MEDICAL CENTER INC OPEN 9145021470 165 MAIN STREET OSSINING NY 10562 LINDSAY C FARRELL PRESIDENT & CEO 9145021470 2018-10-04 1 THOMAS LANNING P00851654 9732283500 2018-08-10 209.3.217.20 2018-10-04 09:22:59 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 238159564A7F207AC3E2D33505B4833284B8AC6F 2017 2018-06-14 16:35:46Z LINDSAY C FARRELL 165 MAIN STREET OSSINING NY 10562 82689624 0 X WWW.OPENDOORMEDICAL.ORG X 1975 NY OPEN DOOR FAMILY MEDICAL CENTER PROVIDES QUALITY PRIMARY HEALTH CARE AND HUMAN SERVICES AT AFFORDABLE PRICES TO THE COMMUNITY, PARTICULARLY LOW-INCOME, UNDER-SERVED RESIDENTS AND THOSE LACKING ACCESS TO HEALTH CARE. 14 14 564 75 0 0 11820630 15451895 32091863 46424263 1477337 1722182 1364335 3856309 46754165 67454649 0 0 0 0 31806139 37428648 0 0 2816 16131774 17628476 47937913 55057124 -1183748 12397525 91907886 114043445 8846504 9117420 83061382 104926025 THE MISSION OF THE OPEN DOOR FAMILY MEDICAL CENTER, INC. IS TO PROVIDE QUALITY PRIMARY HEALTH CARE AND HUMAN SERVICES AT AFFORDABLE PRICES TO THE COMMUNITY, PARTICULARLY LOW-INCOME, UNDER-SERVED RESIDENTS AND THOSE LACKING ACCESS TO HEALTH CARE. 0 0 39501116 40768211 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 56,698 MEDICAL PATIENTS THAT GENDERATED 192,815 VISITS IN 2017.ADDITIONAL FUNDING FOR THIS PROGRAM IS PROVIDED THROUGH FEDERAL GRANTS, AS SHOWN ON FORM 990, PART VIII, LINE 1E. 5785769 6930337 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 19,118 DENTAL PATIENTS THAT GENDERATED 46,891 VISITS IN 2017.ADDITIONAL FUNDING FOR THIS PROGRAM IS PROVIDED THROUGH FEDERAL GRANTS, AS SHOWN ON FORM 990, PART VIII, LINE 1E. 1949881 2582024 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 9,642 MENTAL HEALTH PATIENTS THAT GENDERATED 26,345 VISITS IN 2017.ADDITIONAL FUNDING FOR THIS PROGRAM IS PROVIDED THROUGH FEDERAL GRANTS, AS SHOWN ON FORM 990, PART VIII, LINE 1E. 47236766 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 1 1 0 0 1 21 0 1 564 1 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 1 0 NY X MARIA MAZZOTTA 9145021470 165 MAIN STREET OSSINING NY 10562 ANDRES VALDESPINO VICE-CHAIRMAN 1.00 X X 0 0 0 ANTONIO MEJIAS BOARD MEMBER 1.00 X 0 0 0 CHARLES CHEHEBAR BOARD MEMBER 1.00 X 0 0 0 DANIEL ROSS BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID K SHERMAN THRU 1217 BOARD MEMBER 1.00 X 0 0 0 DAVID WHITLINGER FROM 517 BOARD MEMBER 1.00 X 0 0 0 DIANA SCHAEFER THRU 317 BOARD MEMBER 1.00 X 0 0 0 DONNA WADE CHAIRWOMAN 1.00 X X 0 0 0 DORIAN LINDSAY BOARD MEMBER 1.00 X 0 0 0 HOWARD S SCHRADER BOARD MEMBER 1.00 X 0 0 0 JOHN CONYERS THRU 517 BOARD MEMBER 1.00 X 0 0 0 LORETTA MOLINARI BOARD MEMBER 1.00 X 0 0 0 MARGOTH PILLA TREASURER 1.00 X X 0 0 0 SHIRLEY BUONTEMPO SECRETARY 1.00 X X 0 0 0 STEWART TABIN THRU 517 BOARD MEMBER 1.00 X 0 0 0 TYLER BEEBE BOARD MEMBER 1.00 X 0 0 0 WALTER EDGE BOARD MEMBER 1.00 X 0 0 0 LINDSAY C FARRELL PRESIDENT & CEO 35.50 2.00 X 365855 19255 19035 MARIA MAZZOTTA CHIEF FINANCE OFFICER 35.50 2.00 X 234342 12333 9728 DAREN WU CHIEF MEDICAL OFFICER 37.50 X 349631 0 9450 JANET BOZZONE CHIEF DENTAL OFFICER 37.50 X 232168 0 10734 BRUCE M SHAFFER PODIATRIST 37.50 X 227239 0 29337 JACOB ALBERT SAMANDER PSYCHIATRIST 37.50 X 258038 0 18681 JAY ABRAM ZASLOW FAMILY PRACTICE PHYSICIAN 37.50 X 261930 0 36805 KAREN MURRAY OB/GYN PHYSICIAN 37.50 X 288720 0 32754 THOMAS YUEN FAMILY PRACTICE PHYSICIAN 37.50 X 229111 0 35738 2447034 31588 202262 76 0 1 0 HITCH INC 2 CHURCH STREET SUITE 110 OSSINING NY 10562 CSP SERVICES 630355 MEDCOR REVENUE SERVICES INC 725 W TOWN COUNTRY ROAD SUITE 5 ORANGE CA 92868 BILLING SERVICES 540000 COMPREHENSIVE EYE SERVICES PO BOX 187 ARMONK NY 10504 EYE CLINIC 441433 ECLINICAL WORKS 110 TURNPIKE ROAD SUITE 308 WESTBOROUGH MA 01581 ECW SUPPORT 358799 KAREN KARP & PARTNERS PO BOX 515 SOUTHOLD NY 11971 HR CONSULTING SERVICES 245347 12 12770561 2681334 15451895 WRAP AROUND 621400 14904898 14904898 MEDICAID MANAGED CARE PLAN 621400 10237800 10237800 MEDICAID 621400 8968646 8968646 UNCOMPENSATED CARE 621400 5125615 5125615 SELF-PAY 621400 4191800 4191800 2995504 2995504 46424263 1228572 1228572 15728585 15234975 493610 493610 493610 REIMBURSED SALARIES & FRINGE 900099 2780694 2780694 340 PHARMACY REVENUE 900099 862924 862924 MEDICAL MEANINGFUL USE 900099 200004 200004 12687 12687 3856309 67454649 50280572 0 1722182 1229504 1141528 87976 29364464 25186435 4178029 1271390 1236928 34462 3079457 2995984 83473 2483833 2198176 285657 148695 148695 134371 134371 471292 471292 4685705 3447098 1238607 2904676 2647483 257193 1775825 1554284 221541 103207 81433 21774 182382 143903 38479 143250 136384 6866 1694187 1482831 211356 262373 213092 49281 BAD DEBTS 1486148 1486148 PHARMACEUTICALS 1080665 1080665 REPAIRS & MAINTENANCE 626488 548331 78157 LABORATORY FEE 386698 386698 1542514 1269365 270333 2816 55057124 47236766 7817542 2816 2143427 7574603 3300991 5326608 1256990 1612689 6214043 4439956 807703 908458 47103980 19850854 20394568 27253126 56901012 66239768 889152 688237 91907886 114043445 4951507 6731076 116658 77564 2081874 1657518 1696465 651262 8846504 9117420 X 83061382 104899775 26250 83061382 104926025 91907886 114043445 X 12397525 8614063 853055 X X 0 1 X 1 1 1 X 9589529 10087522 10431943 11820630 15451895 57381519 9589529 10087522 10431943 11820630 15451895 57381519 57381519 349896 902137 723447 1062692 1228572 4266744 404724 301875 1045922 1364335 3856309 6973165 68621428 162600431 0.83620 0.88370 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2013 AMOUNT: $ 46,557. 2014 AMOUNT: $ 27,789. 2015 AMOUNT: $ 34,842. 2016 AMOUNT: $ 17,756. 2017 AMOUNT: $ 12,687. REIMBURSED SALARIES FRINGE - 2013 AMOUNT: $ 358,167. 2014 AMOUNT: $ 274,086. 2015 AMOUNT: $ 231,564. 2016 AMOUNT: $ 342,632. 2017 AMOUNT: $ 2,780,694. MEDICAID MEANINGFUL USE INCENTIVE - 2015 AMOUNT: $ 412,250. 2016 AMOUNT: $ 195,600. 2017 AMOUNT: $ 200,004. 340B PHARMACY - 2015 AMOUNT: $ 367,266. 2016 AMOUNT: $ 808,347. 2017 AMOUNT: $ 862,924. 1740016 1740016 13699566 1615440 12084126 5929143 9889794 -3960651 5180461 3409685 1770776 20554794 4935935 15618859 27253126 DUE TO RELATED PARTY 28383 PENSION LIABILITY 622879 651262 X 76184510 8614063 144500 4606002 13364565 62819945 471292 4163412 4634704 67454649 53376548 144500 2809628 2954128 50422420 471292 4163412 4634704 55057124 PART X, LINE 2: THE CORPORATION HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2017. THE CORPORATION'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2014 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CORPORATION HAD UNRELATED BUSINESS INCOME TAXES, IT WILL RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE CONSOLIDATED STATEMENT OF FINANCIAL POSITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY ELIMINATIONS -1,268,182. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION 853,055. REVENUE OF RELATED ENTITIES 5,021,129. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,486,148. REIMBURSED SALARIES & FRINGE 2,677,264. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES OF RELATED ENTITIES 4,077,810. INTERCOMPANY ELIMINATIONS -1,268,182. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,486,148. REIMBURSED SALARIES & FRINGE 2,677,264. X X X 0 0 0 0 0 1 0 1 0 LINDSAY C FARRELL PRESIDENT & CEO 330103 17374 32419 1706 3333 175 8978 473 9105 479 383938 20207 0 0 MARIA MAZZOTTA CHIEF FINANCE OFFICER 216172 11377 17100 900 1070 56 8205 432 1036 55 243583 12820 0 0 DAREN WU CHIEF MEDICAL OFFICER 317260 0 30597 0 1774 0 9450 0 0 0 359081 0 0 0 JANET BOZZONE CHIEF DENTAL OFFICER 209248 0 20680 0 2240 0 8143 0 2591 0 242902 0 0 0 BRUCE M SHAFFER PODIATRIST 224981 0 0 0 2258 0 8259 0 21078 0 256576 0 0 0 JACOB ALBERT SAMANDER PSYCHIATRIST 248191 0 7570 0 2277 0 9097 0 9584 0 276719 0 0 0 JAY ABRAM ZASLOW FAMILY PRACTICE PHYSICIAN 224184 0 35938 0 1808 0 9450 0 27355 0 298735 0 0 0 KAREN MURRAY OB/GYN PHYSICIAN 260805 0 26250 0 1665 0 9450 0 23304 0 321474 0 0 0 THOMAS YUEN FAMILY PRACTICE PHYSICIAN 206412 0 21300 0 1399 0 8383 0 27355 0 264849 0 0 0 PART I, LINE 6 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED INCENTIVE BONUSES, WHICH ARE BASED ON INDIVIDUAL AND SITE PERFORMANCE, DURING THE YEAR ENDED 12/31/17: JANET BOZZONE - $20,680 DAREN WU - $30,597 THOMAS YUEN - $21,300 KAREN MURRAY - $26,250 JAY ABRAM ZASLOW - $35,938 JACOB SAMANDER- $7,570 PART I, LINE 7 INCLUDED IN PART II COLUMN B(II) ARE AMOUNTS REPRESENTING BONUS PAYMENTS. THESE AMOUNTS WERE APPROVED BY THE BOARD AND INCLUDED IN THE INDIVIDUALS' 2017 W-2S. FORM 990, PART VI, SECTION B, LINE 11B OPEN DOOR FAMILY MEDICAL CENTER ENGAGES THE SERVICES OF AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE ANNUAL FORM 990 IN CONJUNCTION WITH ITS ANNUAL AUDITED FINANCIAL STATEMENTS. THE PRESIDENT/CEO AND CFO REVIEW THE FORM 990 AND SCHEDULES FOR ACCURACY. IN 2017, THE FORM 990, FOR THE YEAR ENDED DECEMBER 31, 2017, WAS PRESENTED TO THE FINANCE COMMITTEE AND BOARD MEMBERS FOR REVIEW PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL THE BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. ALL DISCLOSURE STATEMENTS ARE UPDATED AND REVIEWED ANNUALLY FOR EXISTING OR POTENTIAL CONFLICTS BY THE PRESIDENT/CEO. IF A CONFLICT IS FOUND, THE AFFECTED INDIVIDUAL IS REQUIRED TO RECUSE HIMSELF/HERSELF FROM ANY DECISION MAKING AND VOTING RELATING TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD CONDUCTS PARITY STUDIES TO EVALUATE EXECUTIVE COMPENSATION. THE ENTIRE BOARD GOES INTO EXECUTIVE SESSION TO EVALUATE THE CEO AND DETERMINE COMPENSATION. THE CEO CONDUCTS PARITY STUDIES TO EVALUATE OFFICERS AND KEY EMPLOYEES' SALARIES FOR THE EXECUTIVE COMMITTEE. THESE SALARIES, AND THE SALARIES OF THE ENTIRE ORGANIZATION, ARE PRESENTED TO THE BOARD FOR APPROVAL DURING THE BUDGET APPROVAL PROCESS TOWARD YEAR-END. THERE IS CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION DELIBERATION AND DECISION IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 OPEN DOOR DOES MAKE ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY POSTING ON THE ORGANIZATION'S WEBSITE; PROVIDING COPIES UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D); AND INSPECTION AT AN OFFICE OF THE ORGANIZATION. THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST, AT THE ORGANIZATION'S LOCATION. FORM 990, PART XI, LINE 9: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST PENSION-RELATED CHANGES 853,055. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AS WELL AS THE SELECTION OF THE INDEPENDENT ACCOUNTANT. OPEN DOOR FOUNDATION INC 165 MAIN STREET OSSINING NY 10562 133598184 FUNDRAISING/DEVELOPMENT NY 501(C)(3) LINE 7 OPEN DOOR FAMILY MEDICAL CENTER INC 1 OPEN DOOR LEASING CORP 165 MAIN STREET OSSINING NY 10562 201726717 LEASING SPACE NY OPEN DOOR FAMILY MEDICAL CENTER INC C 955029 110377 1.00000 1 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 1 0 0 0 OPEN DOOR LEASING CORP K 955029 COST