2018-11-02T10:49:56-05:00 2017-12-31 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th Floor Manchester NH 03101 990 2017-01-01 510183476 Blackstone Valley Community Health Care Inc BLAC 4017290080 39 East Avenue Pawtucket RI 02860 Raymond J Lavoie Executive Director 4017290080 2018-08-28 1 Dimitrios Panacopoulos P01603705 6036697337 2018-08-28 69.49.157.66 2018-08-28 09:28:04 ED P 7C5DBBACF06D0700CA715A908B316ADB9777F3DC 2822CCB165EE8EB222BC1A8C889357795F91400A 2017 2019-02-21 02:37:17Z Raymond J Lavoie 39 East Avenue Pawtucket RI 02860 20383360 0 X www.bvchc.org X 1984 RI Blackstone Valley Community Health Care, Inc. (BCVHC) is committed to providing high quality, accessible, affordable, comprehensive health care to the residents of the lower Blackstone Valley. BCVHC uses a model of primary care that stresses prevention, education and patient empowerment. 10 10 199 10 0 0 6439119 5828362 12865406 14442877 1024 690 693346 13245 19998895 20285174 0 0 0 0 13083365 13146472 0 0 0 5819299 6781301 18902664 19927773 1096231 357401 21965670 21825574 8260829 7696572 13704841 14129002 X Blackstone Valley Community Health Care, Inc. (BCVHC) is committed to providing high quality, accessible, affordable, comprehensive health care to the residents of the lower Blackstone Valley. BCVHC uses a model of primary care that stresses prevention, education and patient empowerment. 0 0 13212239 14456122 Operated a community healthcare center which served approximately 81,000 encounters during the year ended December 32, 2017. 13212239 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 199 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Raymond J Lavoie 4017290080 39 East Avenue Pawtucket RI 02860 John Lefroncois Chairman 1.00 1.00 X X 0 0 0 Norm Deguilio Vice Chairman 1.00 1.00 X X 0 0 0 Michelle Enos Treasurer 1.00 X X 0 0 0 Rosalina Limardo Assistant Secretary 1.00 X X 0 0 0 Sandra Cano Director 1.00 X 0 0 0 Alba Figueroa Director 1.00 X 0 0 0 John T Gannon Esq Past Chairman/Director 1.00 X 0 0 0 Bernadette Means-Tavares Director 1.00 X 0 0 0 William McCusker Past Treasurer 1.00 X X 0 0 0 Jean Kugel Past Director 1.00 X 0 0 0 Elizabeth Morais Director 1.00 X 0 0 0 Ronald Winter Director 1.00 X 0 0 0 Raymond J Lavoie Executive Director 40.00 1.00 X 191658 0 91723 Sandra Pardus Chief Financial Officer 40.00 X 161408 0 10208 Kimberly Zeller Past Chief Medical Officer 40.00 X 78203 0 10476 Robert Giroux Chief Information Officer 40.00 X 102304 0 37585 Michael Fine Sr. Clinical & Population 20.00 X 223072 0 38577 Beata Nelken Medical Director - Adolesc 40.00 X 199874 0 39980 America Foster Physician 40.00 X 204836 0 43092 Katherene Hofstetter Nurse Practitioner 40.00 X 138580 0 18522 Catherine Parris Director of Optometry 40.00 X 155285 0 8548 David Sam Physician 40.00 X 174230 0 21132 Kunjbala Sharma Physician 40.00 X 196209 0 22586 1825659 0 342429 20 0 1 0 Quality Systems Inc PO Box 809390 Chicago IL 60680 EMR Software Services 635178 Affinity Physician's 455 Toll Gate Road Warwick RI 02886 Obstetrics 347450 Betty's Cleaning 11 Winter Street Cumberland RI 02864 Cleaning 215959 Joel Harrison 230 Airport Road Warwick RI 02889 Oral Surgeon/Dentist 130000 Edward Rowse Architects Inc 400 Massasoit Avenue Providence RI 02914 Architect 107719 5 5795833 32529 5828362 Patient Services 621400 13024056 13024056 340B Pharmacy 621400 1401857 1401857 Miscellaneous Income 621400 16964 16964 14442877 690 690 111431 98186 13245 13245 13245 20285174 14456122 0 690 X 1238503 1238503 9162503 7591619 1570884 304845 304845 1740107 78521 1661586 700514 326947 373567 36558 36558 2721230 2524466 196764 38635 38635 959001 879359 79642 280225 272612 7613 219621 111273 108348 247666 247666 1599720 1076741 522979 140228 140228 Miscellaneous 248890 39866 209024 Repairs & Maintenance 175808 168009 7799 Telephone 113719 104191 9528 19927773 13212239 6715534 0 3400 2500 5332477 5411260 267606 264001 689636 2290755 612 175040 198794 23929764 10596869 15359931 13332895 74631 62949 324757 21965670 21825574 1751534 1061475 610534 5689311 6509295 335252 8260829 7696572 X 13704841 14119002 10000 13704841 14129002 21965670 21825574 X 357401 616760 -550000 X X 0 1 X 1 1 1 X 4130782 4491176 5545450 6439119 5828362 26434889 4130782 4491176 5545450 6439119 5828362 26434889 26434889 1664 23654 48094 105622 112121 291155 8692 14083 66188 31674 120637 26846681 61028337 0.98470 0.98770 X Schedule A, Part II, Line 10, Explanation of Other Income: Other Income - 2013 Amount: $ 8,692. 2014 Amount: $ 14,083. 2015 Amount: $ 66,188. 2016 Amount: $ 31,674. 1750783 1750783 15045604 4972583 10073021 101133 25256 75877 7001038 5570043 1430995 31206 28987 2219 13332895 20383360 98186 98186 20285174 0 20285174 20025959 98186 98186 19927773 0 19927773 Part XI, Line 2d - Other Adjustments: Rental Expense Offset Against Rental Income 98,186. Part XII, Line 2d - Other Adjustments: Rental Expense Offset Against Rental Income 98,186. X X X 0 1 0 0 0 0 0 0 0 Raymond J Lavoie Executive Director 189491 0 0 0 2167 0 62247 0 29476 0 283381 0 0 0 Sandra Pardus Chief Financial Officer 160846 0 0 0 562 0 8042 0 2166 0 171616 0 0 0 Michael Fine Sr. Clinical & Population 222018 0 0 0 1054 0 11352 0 27225 0 261649 0 0 0 Beata Nelken Medical Director - Adolesc 197105 0 2500 0 269 0 10253 0 29727 0 239854 0 0 0 America Foster Physician 204606 0 0 0 230 0 10611 0 32481 0 247928 0 0 0 Katherene Hofstetter Nurse Practitioner 130607 0 7900 0 73 0 6943 0 11579 0 157102 0 0 0 Catherine Parris Director of Optometry 154470 0 0 0 815 0 7724 0 824 0 163833 0 0 0 David Sam Physician 174009 0 0 0 221 0 8739 0 12393 0 195362 0 0 0 Kunjbala Sharma Physician 194297 0 0 0 1912 0 9732 0 12854 0 218795 0 0 0 Part I, Line 4b Raymond Lavoie, Executive Director, participated in a 457f plan. A RI Health and Educational Building Corp 521300173 2011-08-02 6450000 Construction of New Medical Building 0 0 0 A 572231 6450000 75000 6256117 118823 2012 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 1 1 0 0 0 0 A 0 Schedule K, Part IV, Arbitrage The Organization by its tax regulatory agreement dated August 2, 2011 is required to calculate any rebate due every five years subsequent to the date of the agreement. Form 990, Part VI, Section B, line 11b Internal management does a detailed line by line review of the Form 990 prior to it being filed. Any questions from this review are discussed and resolved with the preparer prior to being shared with the board. The Form 990 will only be released once all questions raised by internal staff and the board have been resolved. Form 990, Part VI, Section B, line 12c In 2017, Board of Directors signed conflict of interest statements. The Board must disclose external relationships that may present a conflict. Management monitors conversations to insure Board member recuses themselves in the event of a conflict. Form 990, Part VI, Section B, line 15 The Executive Director's compensation is approved by the board Chairman. To assist in determining the Executive Director's compensation level, the board Chair looks at job duties, job performance, accomplishments, new goals and objectives, and salary information of other health centers of similar size and scope. The Executive Director approves the compensation for all other officers. In determining the compensation level of each officer, the Executive Director will review job duties, job performance, accomplishments, new goals and objectives, and salary information of other health centers of similar size and scope. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy and financial statements are made available to the public upon request. Form 990, Part IX, line 11g Other Fees: Program service expenses 2,524,466. Management and general expenses 196,764. Fundraising expenses 0. Total expenses 2,721,230. Form 990, Part XI, line 9: Equity Transfer to Affiliate -550,000. Form 990, Part XII, Line 2c: The Board of Directors assumes responsibility for oversight of the audit of its financial statements and selection of independent accountants. BVCHC Support Corporation 39 East Avenue Pawtucket RI 02860 822269480 Support of Blackstone Valley Community Health Care, Inc. RI 501(c)(3) Line 12b, II Blackstone Valley Community Health Care Inc 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 BVCHC Support Corporation B 550000 FMV