2018-01-23T10:20:17-06:00 2017-03-31 390859910 Baker Tilly Virchow Krause LLP 1650 Market Street Suite 4500 Philadelphia PA 191037341 990 2016-04-01 222682708 HENRY J AUSTIN HEALTH CENTER INC HENR 6092785900 321 N WARREN STREET TRENTON NJ 08618 Elidoro Primero CFO 6092785912 2018-01-23 1 Julius C Green CPA P00350393 2159720701 X 216.255.126.197 2018-01-23 08:22:17 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B61FA1639B1C05FB95829B38B50E43F553865046 2016 2021-01-29 14:40:06Z Kemi Alli MD 321 N WARREN STREET TRENTON NJ 08618 15201002 0 X WWW.HENRYJAUSTIN.ORG X 1986 NJ TO PROVIDE QUALITY HEALTHCARE TO MERCER COUNTY'S UNINSURED AND UNDERINSURED. 9 9 191 11 0 0 6288520 6878381 7893813 8300451 261 313 13292 8043 14195886 15187188 300 0 0 0 10488979 10303400 0 0 0 3499039 4914427 13988318 15217827 207568 -30639 6071584 6229900 3383614 3572569 2687970 2657331 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 7911006 6081156 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 12,788 PATIENTS AND HAD 46,354 PATIENT VISITS. THE AVERAGE NUMBER OF VISITS PER PATIENT WAS 3.62. 2219038 1522443 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 823 PATIENTS AND HAD 4,684 PATIENT VISITS. THE AVERAGE NUMBER OF VISITS PER PATIENT WAS 5.69. 731123 696852 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 309 PATIENTS AND HAD 1,799 PATIENT VISITS. THE AVERAGE NUMBER OF VISITS PER PATIENT WAS 5.82. 10861167 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 30 0 1 191 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NJ X Elidoro Primero 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 Wayne Frascella 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 Jordan Clark-Sherman Director 1.50 0.00 X 0 0 0 Kemi Alli MD CEO 35.00 0.00 X 197169 0 29803 Renee Haynes COO 35.00 0.00 X 130003 0 28904 Elidoro Primero CFO 35.00 0.00 X 129141 0 48780 Sariya Pacheco-Smith Pediatrician 35.00 0.00 X 147301 0 25058 Magali Santos Dentist 35.00 0.00 X 143723 0 41611 Srilakshmi Angara Dentist 35.00 0.00 X 131589 0 22500 Mala Kailasam Internist 35.00 0.00 X 129200 0 20279 Khadijah Ismael Dentist 35.00 0.00 X 127281 0 7841 1135407 0 224776 15 0 1 0 PSSMcKesson 208 Passaic Avenue Fairfield NJ 07004 Pharmaceutical Supplier 199224 Foot Health Centers PA 52 Berlin Road Suite 5000 Cherry Hill NJ 08034 Podiatrist 108116 EHS 100 Brookwood Place Suite 410 Birmingham AL 35209 EMR systems support and training 107274 3 6103164 775217 427856 6878381 PATIENT SERVICE REVENUE 621400 7346671 7346671 contract services 900099 493771 493771 340B Program 621400 334445 334445 third party incentives 621400 125564 125564 8300451 313 313 10561 13814 -3253 -3253 -3253 QI participation fees 900099 8756 8756 Medical records subpoena fees 900099 2030 2030 Refunds and Incentives 900099 510 510 11296 15187188 8300451 0 8356 590058 590058 7839178 5566213 2272965 1233134 905527 327607 641030 433448 207582 69083 46712 22371 52000 52000 973552 658292 315260 525 355 170 345490 233612 111878 175322 175322 19566 13230 6336 108526 73383 35143 80559 54472 26087 342552 231625 110927 97899 66197 31702 medical supplies 1549284 1549284 equipment & Repairs 370328 250407 119921 bad debt expense 338624 338624 other expenses 111699 75529 36170 279418 188935 90483 15217827 10861167 4356660 0 2680 187340 505279 528852 1433098 1615821 42021 51867 7248205 3474402 4027755 3773803 63431 69537 6071584 6229900 1625879 1821047 3361 64749 1661027 1686773 93347 0 3383614 3572569 X 2687970 2657331 2687970 2657331 6071584 6229900 -30639 0 X 0 1 X 1 1 1 X 5201985 5727224 5908790 6288520 6878381 30004900 5685927 6253184 8296475 7893813 8300451 36429850 10887912 11980408 14205265 14182333 15178832 66434750 0 0 0 66434750 32874 36079 31185 16952 10874 127964 32874 36079 31185 16952 10874 127964 44288 211340 25458 11296 292382 10965074 12227827 14236450 14224743 15201002 66855096 0.99370 0.99200 0.00190 0.00240 X Schedule A, Part III, Line 12, Explanation of Other Income: OTHER INCOME - 2012 Amount: $ 44,288. 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. QI participation fees - 2016 Amount: $ 510. Refunds and Incentives - 2016 Amount: $ 8,756. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 36142 36142 3972147 1261149 2710998 1697416 1129685 567731 1542303 1083538 458765 197 30 167 3773803 X 14862378 0 14862378 324810 324810 15187188 14893017 0 14893017 324810 324810 15217827 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 2017 and 2016. Part XI, Line 4b - Other Adjustments: rental expenses -13,814. Provision for Doubtful Accounts 338,624. Part XII, Line 4b - Other Adjustments: rental expenses -13,814. Provision for Doubtful Accounts 338,624. X X X 0 0 0 0 0 0 0 0 0 Kemi Alli MD CEO 197169 0 0 0 0 0 13937 0 15866 0 226972 0 0 0 Renee Haynes COO 130003 0 0 0 0 0 28904 0 0 0 158907 0 0 0 Elidoro Primero CFO 129141 0 0 0 0 0 31472 0 17308 0 177921 0 0 0 Sariya Pacheco-Smith Pediatrician 147301 0 0 0 0 0 12879 0 12179 0 172359 0 0 0 Magali Santos Dentist 143723 0 0 0 0 0 17611 0 24000 0 185334 0 0 0 Srilakshmi Angara Dentist 131589 0 0 0 0 0 9061 0 13439 0 154089 0 0 0 X 7595 427856 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.