2017-11-15T14:15:56-06:00 2016-12-31 541342298 KOSITZKA WICKS AND COMPANY 5911 WEST BROAD STREET RICHMOND VA 23230 990 2016-01-01 541884190 CAPITAL AREA HEALTH NETWORK CAPI 8047800840 2809 NORTH AVENUE RICHMOND VA 23222 TRACY CAUSEY CHIEF EXECUTIVE OFFICER 8047800840 2017-11-15 1 STEPHEN G TRAVIS CPA P00158766 8048551200 2017-11-15 64.88.174.3 2017-11-15 08:35:16 ES P 157944B436B8D2CFD2C4AFE06DD33900CD4B6C4F 2AE4826C9E64EFE84662DC44839B81CD3C41C384 2016 2017-02-10 21:41:12Z TRACY CAUSEY 2809 NORTH AVENUE RICHMOND VA 23222 11148191 0 X WWW.CAHEALTHNET.ORG X 1998 VA TO PROVIDE MEDICAL AND DENTAL CARE TO INDIGENTS. WE PROVIDED OVER 15,000 MEDICAL VISITS AND OVER 4,000 DENTAL VISITS. 10 10 184 0 0 0 6554550 6783666 3571711 4360673 2407 3102 -1964 -5393 10126704 11142048 0 0 0 0 5579206 6950478 0 0 0 3750976 4461039 9330182 11411517 796522 -269469 8089080 9271400 774152 2225941 7314928 7045459 TO PROVIDE EFFECTIVE, ACCESSIBLE, AND CULTURALLY RESPONSIVE PATIENT CARE, EDUCATION, AND ADVOCACY THAT PROMOTE THE HEALTH AND QUALITY OF LIFE FOR ALL RESIDENTS OF METROPOLITAN RICHMOND. 0 0 6245351 4360673 PROVIDE MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO THE MEDICALLY UNDERSERVED AND UNINSURED COMMUNITY WITHIN THE METROPOLITAN RICHMOND AREA. ALL SERVICES ARE PROVIDED AT THE FOLLOWING LOCATIONS: VERNON J. HARRIS MEDICAL AND DENTAL CENTER, GLENWOOD MEDICAL AND DENTAL CENTER, NORTHSIDE MEDICAL CENTER, AND SOUTHSIDE MEDICAL CENTER. 6245351 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 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 38 0 1 184 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 VA X TRACY CAUSEY 8047800840 2809 NORTH AVENUE RICHMOND VA 23222 JEFF MARSHALL PRESIDENT 2.00 X X 0 0 0 DENIEZ MOSS VICE PRESIDENT 2.00 X X 0 0 0 DARRELL JOHNSON TREASURER 2.00 X X 0 0 0 RUTH STATON SECRETARY 2.00 X X 0 0 0 REV ROSCOE COOPER III BOARD MEMBER 2.00 X 0 0 0 WILMA HARRIS BOARD MEMBER 2.00 X 0 0 0 MICHELLE HALL PHARMD BOARD MEMBER 2.00 X 0 0 0 VANESSA CABRA PHD BOARD MEMBER 2.00 X 0 0 0 LILIANA CASTILLO MBA BOARD MEMBER 2.00 X 0 0 0 CHRIS LAYNE BOARD MEMBER 2.00 X 0 0 0 TRACY CAUSEY CEO 40.00 X 166674 0 42945 VAN WOODS CFO 40.00 X 13846 0 313 ROBERT RYDER FORMER CFO 40.00 X 51857 0 2373 DR TORINO JENNINGS CMO 40.00 X 153256 0 8666 DR BARBARA STEELE DOCTOR 40.00 X 155000 0 8406 DR ANDREA GONZALEZ DOCTOR 40.00 X 156906 0 3756 DR JEROME SMITH DOCTOR 40.00 X 150000 0 3756 847539 0 70215 5 0 1 0 ECLINICAL WORKS PO BOX 847950 BOSTON MA 02284 113604 1 5894600 889066 887640 6783666 PATIENT FEES 621110 4139603 4139603 PHARMACY INCOME 621110 112390 112390 MISCELLANEOUS 900099 98461 98461 MEDICAL RECORDS TRANSCRIPTION FEE 621110 10219 10219 4360673 3102 3102 750 6143 -5393 -5393 11142048 4360673 0 -2291 917752 458876 458876 5287082 2643541 2643541 75590 37795 37795 142172 71086 71086 527882 263941 263941 244260 122130 122130 80941 80941 142106 71053 71053 699158 349579 349579 363750 181875 181875 5512 2756 2756 513266 256633 256633 90374 45187 45187 12718 6359 6359 20110 10055 10055 357748 178874 178874 72772 36386 36386 CLINICAL SUPPLIES 952662 952662 REPAIRS AND MAINTENANCE 297524 148762 148762 CONTRACT LABOR 203610 101805 101805 MISCELLANEOUS COSTS 197063 98531 98532 207465 207465 11411517 6245351 5166166 0 1718648 2711600 793577 490353 191411 139589 1558651 1840120 28473 50140 5891263 1869597 3780388 4021666 6000 6000 11932 11932 8089080 9271400 395588 779571 1149591 376836 295131 1728 1648 774152 2225941 X 6184157 5914688 1130771 1130771 7314928 7045459 8089080 9271400 -269469 0 X X 0 0 1 0 X 4234452 5067983 7232838 6554550 6783666 29873489 4234452 5067983 7232838 6554550 6783666 29873489 29873489 34240 25927 2994 2407 3102 68670 29942159 0.99770 0.99750 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 92204 92204 2441179 223843 2217336 1591451 520124 1071327 1689598 1125630 563968 76831 76831 4021666 DUE TO OTHER ORGANIZATIONS 1648 1648 X PART X, LINE 2: THE CENTER IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES AS A NOT-FOR-PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND THE TAX STATUTES OF THE COMMONWEALTH OF VIRGINIA AND WILL BE TAXED ONLY TO THE EXTENT IT HAS TAXABLE TRADE OR BUSINESS INCOME UNRELATED TO ITS EXEMPT PURPOSE. ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE CENTER HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2016. X 0 0 0 0 0 0 0 0 0 TRACY CAUSEY CEO 166674 0 0 0 0 0 0 0 42945 0 209619 0 0 0 DR TORINO JENNINGS CMO 153256 0 0 0 0 0 0 0 8666 0 161922 0 0 0 DR BARBARA STEELE DOCTOR 155000 0 0 0 0 0 0 0 8406 0 163406 0 0 0 DR ANDREA GONZALEZ DOCTOR 156906 0 0 0 0 0 0 0 3756 0 160662 0 0 0 DR JEROME SMITH DOCTOR 150000 0 0 0 0 0 0 0 3756 0 153756 0 0 0 X 239200 X 648440 WHOLESALE ACQUISITION 0 0 0 PART I, COLUMN (B): NUMBER OF SHIPMENTS THROUGHOUT THE YEAR TOTALING 2,839 CASES OF MEDICAL SUPPLIES. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION WILL PROVIDE A COPY OF THE FORM 999 TO ALL VOTING BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND DIRECTORS ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST STATEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES COMPENSATION FOR THE CEO BASED ON CREDENTIALS AND ORGANIZATIONAL PERFORMANCE. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES ARE DETERMINED BASED ON CREDENTIALS, EXPERIENCE, AND THE PERFORMANCE EVALUATION PROCESS SET BY THE CEO, HUMAN RESOURCES AND SENIOR MANAGEMENT. HUMAN RESOURCES RECEIVES SALARY INFORMATION ANNUALLY FROM A STATE ASSOCIATION THAT IS USED TO DETERMINE AND SUPPORT SALARIES. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 3B THE ORGANIZATION IS PLANNING TO UNDERGO THE REQUIRED AUDIT, BUT HAD NOT AT THE TIME OF THE 990 FILING.