2017-10-27T13:43:51-05:00 2016-12-31 390859910 Baker Tilly Virchow Krause LLP 1650 Market Street Suite 4500 Philadelphia PA 191037341 990 2016-01-01 510567466 Community Health Center of Richmond Inc COMM 7189242254 439 Port Richmond Avenue Staten Island NY 10302 Benito Lindo CFO 7189242254 2017-10-27 1 Julius C Green CPA P00350393 2159720701 X 24.229.124.227 2017-10-27 13:20:36 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1C07D3DB1C94FB752016147E5D6573FD6A6810DC 2016 2021-01-29 14:40:06Z Henry Thompson 439 Port Richmond Avenue Staten Island NY 10302 12628931 0 X chcrichmond.org X 2006 NY To provide quality primary health care and coordinated access to specialty services that is affordable, accessible and respectful to all persons that we serve. 12 12 111 0 0 0 6226638 4988432 5487314 6815170 4670 3368 701718 821961 12420340 12628931 0 0 0 0 6808180 8512853 0 0 0 3849537 3763780 10657717 12276633 1762623 352298 13679059 18995710 3060263 8024616 10618796 10971094 X THE MISSION OF THE COMMUNITY HEALTH CENTER OF RICHMOND, Inc. (THE CENTER) IS TO PROVIDE AFFORDABLE, QUALITY HEALTH CARE AND COORDINATED ACCESS TO SPECIALTY SERVICES WITH RESPECT AND COMPASSION FOR ALL PEOPLE. 0 0 9459183 6815170 Providing primary care services to residents of Staten Island, New York with particular emphasis placed on serving the poor and under-insured within the community. There were 38,913 visits for 2016. CHCR has provided services to 9,557 patients of which 2,367 were uninsured and 8,807 were at 200% or below the federal poverty guideline. There were 39.96 HEALTH CARE provider FTEs who delivered the services during the year.The Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenues or shown as grants to individuals.The Center maintains records to identify and monitor the level of charity care that it provides. The costs associated with the charitable care services provided are estimated by applying the cost-to-charge ratio from the most recently filed cost report, to the amount of gross uncompensated charges for the patients receiving charity care. Total charity care costs were $1,325,613 for the year ended December 31, 2016. 9459183 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 37 0 1 111 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X BENNY LINDO CFO 7189242254 439 PORT RICHMOND AVE Staten Island NY 10302 JACK De Santis Jr CPa PRESIDENT 1.00 X X 0 0 0 SHERIF FARAG MD 1ST VICE PRESIDENT 1.00 X X 0 0 0 ARACELI ARIZMENDI 2ND VICE PRESIDENT 1.00 X X 0 0 0 URSzula CzySZkiewicz TREASURER 1.00 X X 0 0 0 BARBARA GRIFFITHS SECRETARY 1.00 X X 0 0 0 RAQUEL ARIAS member 1.00 X 0 0 0 DEMETRIUS CAROLINA MEmber 1.00 X 0 0 0 JOAN CARUSO MEmber 1.00 X 0 0 0 STANLEY CHARZWESKI MEmber 1.00 X 0 0 0 CECILIA DORTA MEmber 1.00 X 0 0 0 MONICA GARCIA MEmber 1.00 X 0 0 0 CARMELIA RANGEL MEmber 1.00 X 0 0 0 HENRY THOMPSON CHIEF EXECUTIVE OFFICER 40.00 X 265586 0 15129 ROSalinda Rosario-Lipka DO CHIEF MEDICAL OFFICER 30.00 X 148995 0 23274 BENITO LINDO CHIEF FINANCIAL Officer 40.00 X 199695 0 12311 KUDAVALLI OMPRAKASH MD PHYSICIAN 40.00 X 163497 0 18072 JESSIE PITA MD PHYSICIAN 40.00 X 152726 0 24240 Abhilash Durgam MD pHYSICIAN 40.00 X 169788 0 14230 MONIQUE WELBECK DNP NURSE PRACTITIONER 40.00 X 155112 0 15922 ELAINE CLARK MD PHYSICIAN 40.00 X 152524 0 12270 1407923 0 135448 19 0 1 0 intrepid development corp po box 560 Edison NJ 08818 leasehold improvements 207550 Henrich Group LLC 125-28 Queens Blvd Suite 617 Kew Gardens NY 11415 CONSTRUCTION Management 162638 DESIGN FOR SOCIAL GOOD 19 HUEMMER TERRACE clifton NJ 07013 COMMUNITY OUTREACH CONSULTANT 151917 3 4867092 121340 301572 4988432 Net Patient Svc Rev 623000 6815170 6815170 6815170 3368 3368 PATIENT INCENTIVE REVENUE 900099 694475 694475 PHARMACY SALES AT COST 446110 124146 124146 MEDICAL RECORDS REVENUE 900099 3062 3062 278 278 821961 12628931 6815170 0 825329 664990 239408 425582 6029406 5002760 1026646 173336 135734 37602 1198698 1056382 142316 446423 305324 141099 24090 24090 32515 32515 775559 341846 433713 23501 23501 1295586 844164 451422 19763 19763 416507 416507 115505 114597 908 10140 10140 132791 132791 433936 433936 69292 29513 39779 Bad Debt Expense 114916 114916 Repairs and Maintenance 66288 66288 Dues and Subscriptions 49529 40014 9515 LEASED EQUIPMENT 43676 43676 140186 111424 28762 12276633 9459183 2817450 0 300 350 1046738 464914 78186 100 1119674 1961068 76246 155630 19466712 3093338 11320693 16373374 37222 40274 13679059 18995710 785759 1042726 22202 763782 2252302 6218108 3060263 8024616 X 10618796 10971094 10618796 10971094 13679059 18995710 352298 0 X 0 1 X 1 1 1 X 2678498 5086817 3609470 6226638 4988432 22589855 3515979 3956519 4723771 5487314 6815170 24498753 6194477 9043336 8333241 11713952 11803602 47088608 0 0 0 47088608 6211 4062 2981 4670 3368 21292 6211 4062 2981 4670 3368 21292 187648 488962 379260 337066 821961 2214897 6388336 9536360 8715482 12055688 12628931 49324797 0.95470 0.96370 0.00040 0.00050 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5321791 5321791 10766528 2382623 8383905 579929 435893 144036 2798464 274822 2523642 16373374 X 12514015 -114916 -114916 12628931 0 12628931 12161717 0 12161717 114916 114916 12276633 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 2016 and 2015. Part XI, Line 2d - Other Adjustments: PROVISON FOR BAD DEBTS NETTED AGAINST REVENUE -114,916. Part XII, Line 4b - Other Adjustments: PROVISON FOR BAD DEBTS NETTED AGAINST REVENUE 114,916. X X 0 0 0 0 0 0 0 0 0 HENRY THOMPSON CHIEF EXECUTIVE OFFICER 265586 0 0 0 0 0 0 0 15129 0 280715 0 0 0 ROSalinda Rosario-Lipka DO CHIEF MEDICAL OFFICER 148995 0 0 0 0 0 9273 0 14001 0 172269 0 0 0 BENITO LINDO CHIEF FINANCIAL Officer 199695 0 0 0 0 0 12025 0 286 0 212006 0 0 0 KUDAVALLI OMPRAKASH MD PHYSICIAN 163497 0 0 0 0 0 9983 0 8089 0 181569 0 0 0 JESSIE PITA MD PHYSICIAN 152726 0 0 0 0 0 9344 0 14896 0 176966 0 0 0 Abhilash Durgam MD pHYSICIAN 169788 0 0 0 0 0 10644 0 3586 0 184018 0 0 0 MONIQUE WELBECK DNP NURSE PRACTITIONER 155112 0 0 0 0 0 9600 0 6322 0 171034 0 0 0 ELAINE CLARK MD PHYSICIAN 152524 0 0 0 0 0 7886 0 4384 0 164794 0 0 0 X 2 301572 VACCINES/MEDICAL SUPPLY 0 1 0 Part I, Column (b): the amount reported in column B of schedule M represents the number of contributions. Form 990, Part VI, Section B, line 11b The CEO and CFO review the Form 990 before it is filed. The return is then presented to the Finance Committee for review and then to the general board for approval of filing. Form 990, Part VI, Section B, line 12c CHCR provides Board members and staff with a conflict of interest statement which summarizes the key elements of the organization's conflict of interest policy. The statement is provided to and signed by Board members and staff both at the time of the individual's initial affiliation with the organization and annually thereafter. The CEO is responsible for monitoring the conflicts. The board of directors reviews the CEO's annual conflict of interest statement. In the case of conflict of interest, the board member will report the conflict to the full Board prior to any discussion of the matter and potentially recuse themselves from voting on the matter. Form 990, Part VI, Section B, line 15 Officer compensation is determined and compared based on the current market, industry standards and surveys taken. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE CHIEF EXECUTIVE OFFICER'S SALARY. THEre IS A WRITTEN CONTRACT BETWEEN THE CHIEF EXECUTIVE OFFICER AND THE CENTER, AND IS NEGOTIABLE AT A CERTAIN TIME PERIOD. The compensation setting process is documented in the executive committee minutes. This process is then done with the goal of ensuring a salary of no more than the fair market value of the services rendered. Salaries for the other officers and staff are based upon industry survey, e.g. National Association of Community Health Centers (NACHC), and the Community Health Center Association of New YOrk State (CHCANYS). The organization has a board personnel committee that oversees hiring and credentialing of employees. The CEO has the privilege and sole authority to hire and fire employees; to establish salaries BASED UPON THE SURVEY PARAMETERS, and PROVIDE RECOMMENDATIONS to the board for approval. 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.