2017-11-14T14:13:20-06:00 2016-12-31 222428965 CITRIN COOPERMAN & COMPANY LLP TEN WEYBOSSET STREET - SUITE 700 PROVIDENCE RI 02903 990 2016-01-01 510183476 BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC BLAC 4017290080 39 EAST AVENUE PAWTUCKET RI 02860 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 4017290080 2017-11-14 1 MARTHA HULTZMAN P00107728 4014214800 38.108.113.34 2017-11-14 13:50:44 ES P 5F78F9A719E69DACE160D09AD4BCADA47CE01B37 B33F9AAA1BB37DDA69855E0057B0BCBF8CB5723C 2016 2017-02-10 21:41:12Z RAYMOND J LAVOIE 39 EAST AVENUE PAWTUCKET RI 02860 20597218 0 X WWW.BLACKSTONECHC.ORG X 1984 RI BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. (BCVHC) IS COMMITTED TO PROVIDING HIGH QUALTIY, ACEESSIBLE, 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. 9 9 198 0 -8018 0 5545450 6439119 11741753 12865406 450 1024 488796 693346 17776449 19998895 0 0 0 0 10539771 13083365 0 0 0 5312415 5819299 15852186 18902664 1924263 1096231 20012836 21965670 7404227 8260829 12608609 13704841 X BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.(BVCHC) IS COMMITTED TO PROVIDING HIGH QUALITY, ACCESSIBLE, AFFORDABLE, COMPREHENSIVE HEALTH CARE AVAILABLE FOR THE RESIDENTS OF THE LOWER BLACKSTONE VALLEY. THE CENTER USES A MODEL OF PRIMARY CARE THAT STRESSES PREVENTION, EDUCATION, AND PATIENT EMPOWERMENT. 0 0 13992945 12897080 OPERATED A COMMUNITY HEALTHCARE CENTER WHICH SERVED APPROXIMATELY 81,000 ENCOUNTERS DURING THE YEAR ENDED DECEMBER 31, 2016. 13992945 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 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 0 0 0 0 1 29 0 1 198 1 1 1 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 X X RAYMOND J LAVOIE 4017290080 39 EAST AVENUE PAWTUCKET RI 02860 JOHN T GANNON ESQ CHAIRPERSON 1.00 X X 0 0 0 MICHELLE ENOS BOARD MEMBER 1.00 X X 0 0 0 ROSALINA LIMARDO SECRETARY 1.00 X X 0 0 0 WILLIAM MCCUSKER TREASURER 1.00 X X 0 0 0 JEAN KUGEL BOARD MEMBER 1.00 X 0 0 0 JOHN LEFRONCOIS BOARD MEMBER 1.00 X 0 0 0 ELIZABETH MORAIS BOARD MEMBER 1.00 X 0 0 0 RONALD WINTER BOARD MEMBER 1.00 X 0 0 0 NORM GEGUILIO BOARD MEMBER 1.00 X 0 0 0 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 40.00 X 229397 0 35181 CHRISTINE GREY CHIEF OPERATING OFFICER 40.00 X 152738 0 24131 SANDRA PARDUS CHIEF FINANCIAL OFFICER 40.00 X 130538 0 8582 KIMBERLY ZELLER CHIEF MEDIAL OFFICER 40.00 X 231388 0 35356 ROBERT GIROUX CHIEF INFORMATION OFFICER 40.00 X 111459 0 31238 MICHAEL FINE SR CLINICAL & POPULATION HEALTH OFFICER 40.00 X 116452 0 32153 NAUSHEEN HUSSAIN MEDICAL DIRECTOR 40.00 X 173722 0 33315 BEATA NELKEN MEDICAL DIRECTOR - ADOLESCENT HEALTH 40.00 X 182077 0 30468 KUNJBALA SHARMA PHYSICIAN 40.00 X 171618 0 20641 AMERICA FOSTER PHYSICIAN 40.00 X 166798 0 34276 YANLI DING PHYSICIAN 40.00 X 139111 0 30626 PEDRO OCHOA PHYSICIAN 40.00 X 125018 0 23598 MILTON LIU DENTIST 40.00 X 134830 0 18313 2065146 0 357878 14 0 1 0 CASE CONSTRUCTION 225 WAMPANOAG TRAIL EAST PROVIDENCE RI 02915 CONSTRUCTION 1073218 EDWARD ROWSE 115 CEDAR STREET PROVIDENCE RI 02903 ARCHITECT 812960 QUALITY SYSTEMS INC 18111 VON KARMAN AVENUE IRVINE CA 92612 EMR SOFTWARE SERVICES 682774 WOMEN'S CARE INC 42 PARK PLACE PAWTUCKET RI 02860 OBSTETRICS 394715 BETTY'S CLEANING 111 WINTER STREET CUMBERLAND RI 02864 CLEANING 164646 5 6412600 26519 6439119 MEDICAID 900099 10096181 10096181 OTHER THIRD PARTY 900099 1238526 1238526 MEDICARE 900099 967133 967133 SELF-PAY 900099 563566 563566 12865406 1024 1024 104598 112616 -8018 -8018 -8018 1155397 485707 669690 669690 MISCELLANEOUS INCOME 900099 31674 31674 31674 19998895 12897080 -8018 670714 X 2600324 1877060 723264 7954545 5723695 2230850 253506 177480 76026 1543090 1104215 438875 731900 526340 205560 1896879 1564904 331975 958803 886305 72498 272829 265914 6915 176765 56848 119917 248996 248996 1452188 1399530 52658 146739 146739 MISCELLANEOUS 199591 64101 135490 REPAIRS AND MAINTENANCE 184697 162857 21840 TELEPHONE 103790 91067 12723 PRINTING AND POSTAGE 78184 56819 21365 99838 35810 64028 18902664 13992945 4909719 0 3000 3400 3431764 5332477 694883 267606 443783 689636 419527 175040 24321949 8962018 14788233 15359931 79627 74631 152019 62949 20012836 21965670 1333142 1751534 6071085 6509295 7404227 8260829 X 12608609 13704841 12608609 13704841 20012836 21965670 X 1096231 -1 X X 0 1 X 0 1 1 X 3683828 4130782 4491176 5567594 6439119 24312499 3683828 4130782 4491176 5567594 6439119 24312499 24312499 10959 1664 23654 26050 105622 167949 14909 8692 14081 66188 31674 135544 24615992 0.98770 0.99080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1750783 1750783 15122801 4051247 11071554 6690843 4882227 1808616 757522 28544 728978 15359931 20597219 598324 598324 19998895 0 19998895 19500987 598324 598324 18902663 0 18902663 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 112,617. COST OF GOODS SOLD INCLUDED IN REVENUE 485,707. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 112,617. COST OF GOODS SOLD INCLUDED IN REVENUE 485,707. X X X 0 0 0 0 0 0 0 0 0 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 229397 0 0 0 0 0 11647 0 23534 0 264578 0 0 0 CHRISTINE GREY CHIEF OPERATING OFFICER 152738 0 0 0 0 0 929 0 23202 0 176869 0 0 0 KIMBERLY ZELLER CHIEF MEDIAL OFFICER 231388 0 0 0 0 0 11859 0 23497 0 266744 0 0 0 NAUSHEEN HUSSAIN MEDICAL DIRECTOR 173722 0 0 0 0 0 8983 0 24332 0 207037 0 0 0 BEATA NELKEN MEDICAL DIRECTOR - ADOLESCENT HEALTH 182077 0 0 0 0 0 8959 0 21509 0 212545 0 0 0 KUNJBALA SHARMA PHYSICIAN 171618 0 0 0 0 0 8510 0 12131 0 192259 0 0 0 AMERICA FOSTER PHYSICIAN 166798 0 0 0 0 0 8698 0 25578 0 201074 0 0 0 YANLI DING PHYSICIAN 139111 0 0 0 0 0 7209 0 23417 0 169737 0 0 0 MILTON LIU DENTIST 134830 0 0 0 0 0 6777 0 11536 0 153143 0 0 0 A RI HEALTH AND EDUCATIONAL BUILDNG CORPORATION 521300173 2011-08-02 6450000 CONSTRUCTION OF NEW MEDICAL BUILDING 0 0 0 A 440727 6450000 75000 6256177 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 SUPPLENTAL INFORMATION 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 I, LINE 6: VOLUNTEERS PLAYED AN INTEGRAL PART IN ALLOWING THE CENTER TO PARTICIPATE IN VARIOUS HEALTH FESTIVALS AND FAIRS THAT PROMOTE HEALTH, WELLNESS, AND SAFETY. 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 IF THE BOARD BECOMES AWARE OF A POTENTIAL CONFLICT OF INTEREST THROUGH SELF DISCLOSURE OR SOME OTHER MANNER, THE BOARD WOULD IMMEDIATELY FOLLOW-UP TO DETERMINE IF A CONFLICT TRULY EXISTS. IF A CONFLICT DOES EXIST THE BOARD WOULD TAKE APPROPRIATE ACTION THAT MAY INCLUDE TERMINATION, WHERE WARRANTED. 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 CONTRACT AND PATIENT SERVICES: PROGRAM SERVICE EXPENSES 1,564,904. MANAGEMENT AND GENERAL EXPENSES 331,975. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,896,879. FORM 990, PART XI, LINE 9: ROUNDING -1. 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.