2017-05-15T14:25:31-05:00 2016-06-30 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2015-07-01 042610447 NORTH SHORE COMMUNITY HEALTH INC NORT 9788251109 27 CONGRESS ST NO 504 SALEM MA 01970 MARGARET BRENNAN CHIEF EXECUTIVE OFFICER 9788251109 2017-05-15 1 PAUL BALLASY P00852868 9592007000 2015 2021-01-29 14:40:06Z MARGARET BRENNAN 27 CONGRESS ST NO 504 SALEM MA 01970 12831796 0 X WWW.NSCHI.ORG X 1977 MA NORTH SHORE COMMUNITY HEALTH'S MISSION IS TO BUILD HEALTHY COMMUNITIES BY PROVIDING EXCEPTIONAL CARE TO ALL. 13 13 148 0 0 0 3919087 4722271 8359112 7894174 -77448 111 176319 215240 12377070 12831796 0 0 0 0 8436016 8372848 0 0 0 4591019 4055584 13027035 12428432 -649965 403364 5656575 5400367 2709079 2049507 2947496 3350860 THE HEALTH CENTER'S MISSION IS TO PROVIDE HIGH QUALITY, COMPREHENSIVE PRIMARY CARE THAT IS ACCESSIBLE, CULTURALLY AND LINGUISTICALLY COMPETENT, AND COMMUNITY DIRECTED FOR ALL RESIDENTS OF MASSACHUSETTS' NORTH SHORE AND CAPE ANN COMMUNITIES REGARDLESS OF ABILITY TO PAY. 0 0 8181763 6363440 MEDICAL SERVICES - MEDICAL SERVICES PROVIDED TO THE RESIDENTS OF SALEM, PEABODY, GLOUCESTER AND SURROUNDING COMMUNITIES. SERVICES INCLUDE MEDICAL SERVICES TO ADULTS AND CHILDREN, HIV COUNSELING AND OTHER. THERE WERE 41,341 MEDICAL VISITS DURING THE TAX YEAR. 1897472 1663032 DENTAL SERVICES - DENTAL SERVICES PROVIDED TO THE RESIDENTS OF SALEM, PEABODY, GLOUCESTER AND SURROUNDING COMMUNITIES. THERE WERE 16,432 DENTAL VISITS DURING THE TAX YEAR. 273288 76942 SCHOOL BASED HEALTH CENTERS - HEALTH SERVICES WERE PROVIDED TO STUDENTS AT SALEM AND PEABODY VETERAN MEMORIAL HIGH SCHOOLS. THERE WERE 1,716 SCHOOL BASED HEALTH CENTER VISITS DURING THE TAX YEAR. 10352523 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 0 0 0 0 0 0 0 0 0 1 11 0 1 148 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X MARGARET BRENNAN 9788251109 27 CONGRESS ST NO 504 SALEM MA 01970 CHARLOTTE OHANNESSIAN BOARD MEMBER 2.00 X 0 0 0 GABRIELLE ROSS BOARD MEMBER 2.00 X 0 0 0 GINA FLYNN BOARD MEMBER 2.00 X 0 0 0 JACK VONDRAS PRESIDENT 2.00 X X 0 0 0 JOHN BELCHERS BOARD MEMBER 2.00 X 0 0 0 LUCY CORCHADO SECRETARY 2.00 X X 0 0 0 MARION WINFREY IMMEDIATE PAST PRESIDENT 2.00 X X 0 0 0 MATTHEW VENO BOARD MEMBER 2.00 X 0 0 0 MICHAEL BABB BOARD MEMBER 2.00 X 0 0 0 PAMELA PAINE BOARD MEMBER 2.00 X 0 0 0 RITA BADAMI VICE PRESIDENT 2.00 X X 0 0 0 ROBERT TOLU TREASURER 2.00 X X 0 0 0 STEPHEN MEUNIER OUTGOING BOARD MEMBER 2.00 X 0 0 0 VENTURA LOREDO BOARD MEMBER 2.00 X 0 0 0 FAITH BAIGELMAN CFO 40.00 X 14407 0 1742 MARGARET BRENNAN CEO 40.00 X 182471 0 21143 SYLVIA CARTER INTERIM CFO 40.00 X 100782 0 0 THOMAS DOWLEY CFO THRU 6/15 40.00 X 75649 0 5673 AZRA ALI FAMILY PRACTICE PHYSICIAN 40.00 X 180907 0 0 CHITRA VIJAYARAGHAVAN PHYSICIAN 40.00 X 162332 0 21084 DAMIAN ARCHER CMO 40.00 X 167673 0 7527 KIAME MAHANIAH CMO 40.00 X 147469 0 19330 RODRIGO TAVARES RODRIGUES INTERNAL MEDICINE/PEDIATRICIAN 40.00 X 192890 0 475 STEPHEN F KULCSAR FAMILY PRACTICE PHYSICIAN 40.00 X 163137 0 7966 1387717 0 84940 14 0 1 0 PRIORITY MANAGEMENT GROUP INC 700 SCHOOL STREET PAWTUCKET RI 02806 PATIENT BILLING SERVICES 469093 NORTH SHORE PHYSICIANS GROUP TWO CORPORATE WAY SUITE 180 PEABODY MA 01960 OB/GYN PROVIDER SERVICES 148941 INSOURCE SERVICES INC PO BOX 427 NEWTON MA 02464 IT SERVICES 121366 3 3776003 946268 4722271 MEDICAID 621110 4224528 4224528 PHARMACY REVENUE 621110 1483869 1483869 HEALTH SAFETY NET 621110 1086302 1086302 MEDICARE 621110 589498 589498 THIRD-PARTY PAYORS 621110 439620 439620 70357 70357 7894174 111 111 6000 0 6000 6000 6000 OTHER INCOME 621110 99052 99052 MBHP 621110 76484 76484 INCENTIVE PAYMENTS 621110 30158 30158 3546 3546 209240 12831796 8103414 0 6111 415192 360822 54370 6447836 5611380 836456 1030805 879059 151746 479015 404288 74727 23691 2545 21146 58047 58047 566290 65632 500658 64181 45000 19181 254171 229516 24655 381666 347316 34350 413530 365616 47914 26825 10707 16118 34166 14008 20158 330202 308608 21594 67353 53209 14144 HOUSEKEEPING SERVICES A 714602 707456 7146 PHARMACY AND RELATED FE 682344 682344 MISCELLANEOUS 157219 59280 97939 DUES AND SUBSCRIPTIONS 122300 48920 73380 158997 156817 2180 12428432 10352523 2075909 0 138942 689930 135055 205447 810230 593204 1520523 1293141 29816 37919 161627 28347 5862057 3309678 2860382 2552379 5656575 5400367 1622722 1278159 1086357 771348 2709079 2049507 X 1887882 2457502 1059614 893358 2947496 3350860 5656575 5400367 403364 0 X X 0 1 X 1 1 1 X 4048532 3384843 3824937 3919087 4722271 19899670 4048532 3384843 3824937 3919087 4722271 19899670 19899670 8862 5223 7414 10336 6111 37946 546091 290840 338482 170319 209240 1554972 21492588 36197486 0.92590 0.87270 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2011 AMOUNT: $ 425,000. 2012 AMOUNT: $ 69,840. 2013 AMOUNT: $ 236,482. 2014 AMOUNT: $ 69,447. 2015 AMOUNT: $ 99,052. EMR INCENTIVE - 2011 AMOUNT: $ 121,091. 2012 AMOUNT: $ 221,000. 2013 AMOUNT: $ 102,000. 2014 AMOUNT: $ 93,500. 2015 AMOUNT: $ 30,158. MEDICAL RECORDS FEES - 2014 AMOUNT: $ 7,372. 2015 AMOUNT: $ 3,546. MBHP - 2015 AMOUNT: $ 76,484. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1415592 818511 597081 2883859 1281350 1602509 1562606 1209817 352789 2552379 X 12824044 36900 -44652 -7752 12831796 0 12831796 12420680 36900 36900 12383780 44652 44652 12428432 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2016 AND 2015. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2013 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CENTER HAS UNRELATED BUSINESS INCOME TAXES, IT WILL RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE STATEMENTS OF FINANCIAL POSITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS -44,652. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 44,652. X X X X 1 0 0 0 0 0 0 0 0 MARGARET BRENNAN CEO 182371 0 100 0 0 0 0 0 22013 0 204484 0 0 0 AZRA ALI FAMILY PRACTICE PHYSICIAN 180807 0 100 0 0 0 0 0 0 0 180907 0 0 0 CHITRA VIJAYARAGHAVAN PHYSICIAN 162332 0 0 0 0 0 0 0 21084 0 183416 0 0 0 DAMIAN ARCHER CMO 167572 0 101 0 0 0 0 0 7527 0 175200 0 0 0 KIAME MAHANIAH CMO 147469 0 0 0 0 0 0 0 19330 0 166799 0 0 0 RODRIGO TAVARES RODRIGUES INTERNAL MEDICINE/PEDIATRICIAN 192789 0 101 0 0 0 0 0 475 0 193365 0 0 0 STEPHEN F KULCSAR FAMILY PRACTICE PHYSICIAN 163036 0 101 0 0 0 0 0 7966 0 171103 0 0 0 PART I, LINE 4A THOMAS DOWLEY RECEIVED SEVERANCE PAY DURING CALENDAR YEAR 2015 OF $4808 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 INITIAL COMPLETION IS DONE BY OUR AUDITORS. THE FORM 990 IS THEN SENT TO THE NORTH SHORE COMMUNITY HEALTH MANAGEMENT TEAM AND THEN FORWARDED TO THE MEMBERS OF THE BOARD OF DIRECTORS, WHO ARE GIVEN A WEEK TO SUBMIT ANY QUESTIONS, COMMENTS, OR OBSERVATIONS THAT THEY HAVE. THEN MANAGEMENT DISCUSSES ANY CHANGES THEY ARE GOING TO MAKE TO THE 990 FORM. IF CHANGES ARE DEEMED NECESSARY, THEY ARE MADE IMMEDIATELY. THE FORM 990 IS THEN APPROVED FOR SUBMISSION BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C EACH EMPLOYEE, VOLUNTEER, AND BOARD MEMBER WILL ACKNOWLEDGE THAT THEY HAVE READ AND UNDERSTAND NORTH SHORE COMMUNITY HEALTH'S CONFLICT OF INTEREST POLICY UPON BEGINNING THEIR EMPLOYMENT OR TENURE WITH NORTH SHORE COMMUNITY HEALTH BY SIGNING AN ACKNOWLEDGEMENT FORM. THIS IS UPDATED ON A YEARLY BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE HEALTH CENTER'S OFFICERS AND KEY EMPLOYEES IS APPROVED BY THE BOARD OF DIRECTORS UTILIZING A SALARY SURVEY. THE EXECUTIVE DIRECTOR SETS THE OTHER EMPLOYEES' SALARIES BASED ON A SALARY SURVEY IN ACCORDANCE WITH THE HEALTH CENTER'S BUDGET PARAMETERS. FORM 990, PART VI, SECTION C, LINE 19 NORTH SHORE COMMUNITY HEALTH, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS AVAILABLE TO THE GENERAL PUBLIC THROUGH WWW.GUIDESTAR.ORG. FORM 990 XII LINE 2C EXPLANATION THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AS WELL AS THE SELECTION OF THE INDEPENDENT ACCOUNTANT.