2018-11-08T14:04:05-06:00 2017-12-31 341876254 CBIZ MHM LLC 28614 MARLBORO AVE SUITE 103 EASTON MD 21601 990 2017-01-01 521116591 CHOPTANK COMMUNITY HEALTH SYSTEM INC CHOP 4104794306 PO BOX 660 DENTON MD 21629 SARA RICH CEO 4104794306 2018-11-07 1 CARVILLE B LEAF JR P00040844 4108226950 138.207.175.194 2018-11-07 12:54:52 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B7262524F9D6FC8FD70D077A6FA39F78D7814145 2017 2019-02-21 02:37:17Z SARA RICH PO BOX 660 DENTON MD 21629 18318710 0 X CHOPTANKHEALTH.ORG X 1978 MD PRIMARY HEALTH CARE SERVICES, DELIVERY OF HEALTH CARE TO MEDICALLY UNDERSERVED COMMUNITY 13 13 197 15 0 0 5266085 5291692 10936405 10889048 97108 127334 1576515 2010636 17876113 18318710 0 0 0 0 12956513 13502158 0 0 0 3965919 4130601 16922432 17632759 953681 685951 13591527 14015400 1790193 1574515 11801334 12440885 PRIMARY HEALTH CARE SERVICES: DELIVERY OF HEALTH CARE TO MEDICALLY UNDERSERVED COMMUNITY 0 0 13581658 13027018 PRIMARY HEALTH CARE SERVICES: DELIVERY OF HEALTHCARE TO MEDICALLY UNDERSERVED COMMUNITY 13581658 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 41 0 1 197 1 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 CHAIRMAN 1.00 X X 0 0 0 IVONNE GARRIDO DIRECTOR 1.00 X 0 0 0 REBECCA LOUKIDES DIRECTOR 1.00 X 0 0 0 CRYSTAL DADDS DIRECTOR 1.00 X 0 0 0 WILLIAM CORBA VICE CHAIR 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 DIRECTOR 1.00 X 0 0 0 BILL SHERTENLIEB DIRECTOR 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 TREASURER 1.00 X 0 0 0 SARA RICH CHIEF EXECUTIVE OFFICER 40.00 X 163015 0 34556 RICARDO DAJANI CHIEF FINANCIAL OFFICER 40.00 X 65828 0 11849 MARK FABER MD PHYSICIAN 40.00 X 181838 0 38362 KATELIN HALEY PHYSICIAN 40.00 X 180671 0 38094 SANDRA GARBELY-KERKOVICH DMD PHYSICIAN 40.00 X 180531 0 38119 LISA URBAN MD PHYSICIAN 40.00 X 175460 0 36991 947343 0 197971 28 0 1 0 HEALTH CHOICE NETWORK INC 9064 NW 13TH TERRACE DORAL FL 33172 HEALTH TECHNOLOGY SOLUTIONS 652134 MCALLISTER DETAR SHOWALTER & WALKER LL 100 N WEST STREET EASTON MD 21601 LEGAL SERVICES 312348 HENRY SCHEIN PO BOX 382023 PITTSBURGH PA 15250 MEDICAL SUPPLIES 308789 BENCO DENTAL PO BOX 731372 DELLAS TX 75397 DENTAL SUPPLIES 194789 GEORGE MILES & BUHR LLC 206 WEST MAIN STREET SALISBURY MD 21801 ARCHITECTURAL AND ENGINEERING DESIGN 146129 5 4921482 370210 5291692 MEDICAL SERVICES 621400 10889048 10889048 10889048 127334 127334 1872836 1872836 MISCELLANEOUS 900099 137800 137800 137800 18318710 13027018 0 0 10720159 8194659 2525500 226491 173133 53358 1733574 1325171 408403 821934 628299 193635 85129 42929 42200 59142 59142 444012 333520 110492 76004 58099 17905 553205 442564 110641 47289 27730 19559 PROFESSIONAL FEES 1210475 996434 214041 SUPPLIES 964480 909929 54551 TELEPHONE 117756 58878 58878 BAD DEBTS 113313 113313 459796 217858 241938 17632759 13581658 4051101 0 1 -3 5906332 6189064 906888 857714 350966 347795 24649 87127 14511942 7978339 6238464 6533603 100 100 164127 0 13591527 14015400 1505915 1262561 185922 212900 98356 99054 1790193 1574515 X 11801334 12440885 11801334 12440885 13591527 14015400 685951 -46400 0 X 0 1 X 1 1 1 X 4045666 4144570 4541975 5266085 5291692 23289988 4045666 4144570 4541975 5266085 5291692 23289988 23289988 10713 14638 82065 97108 127334 331858 170074 109762 69848 51463 137800 538947 24160793 50132205 0.96400 0.96980 X 603175 603175 8842715 3814259 5028456 5066052 4164080 901972 6533603 PATIENT OVERPAYMENTS 99054 99054 X 18263998 -46398 105000 58602 18205396 113313 113313 18318709 17624447 105000 105000 17519447 113313 113313 17632760 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 113,313. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 113,313. X X 0 0 0 0 0 0 0 0 0 SARA RICH CHIEF EXECUTIVE OFFICER 163015 0 0 0 0 0 5214 0 29342 0 197571 0 0 0 MARK FABER MD PHYSICIAN 158810 0 23028 0 0 0 5631 0 32731 0 220200 0 0 0 KATELIN HALEY PHYSICIAN 153906 0 26765 0 0 0 5573 0 32521 0 218765 0 0 0 SANDRA GARBELY-KERKOVICH DMD PHYSICIAN 157408 0 23123 0 0 0 5624 0 32495 0 218650 0 0 0 LISA URBAN MD PHYSICIAN 150968 0 24492 0 0 0 5408 0 31583 0 212451 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.