2016-11-29T15:30:37-06:00 2016-06-30 221478099 COHNREZNICK LLP 350 Church Street 12th floor Hartford CT 06103 990 2015-07-01 223160873 STAYWELL HEALTH CARE INC STAY 2037568021 80 PHOENIX AVENUE No 201 WATERBURY CT 06702 Donald J Thompson Jr Chief Executive Officer 2037568021 2016-11-11 1 PAUL BALLASY P00852868 9592007000 2015 2017-02-10 21:41:12Z Donald J Thompson Jr 80 PHOENIX AVENUE No 201 WATERBURY CT 06702 19840052 0 X WWW.STAYWELLHEALTH.ORG X 1992 CT PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 9 9 207 111 0 0 5068232 5787182 11346859 13793028 1636 1271 255343 90230 16672070 19671711 0 0 0 0 12649330 14658680 0 0 0 3630794 4284926 16280124 18943606 391946 728105 10422579 11864599 2266597 2980512 8155982 8884087 PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 0 0 16114802 13920143 MEDICAL CLINIC, HEALTHY START, AND DENTAL CLINIC WHICH PROVIDE MEDICAL, PRENATAL, AND CHILDCARE FOR INNER CITY RESIDENTS AND UNINSURED RESIDENTS AND REStORATIVE DENTAL CARE FOR INNER CITY CHILDREN. THE TOTAL NUMBER OF VISITS DURING FISCAL YEAR 2016 WAS 93,341. 16114802 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 98 0 1 207 1 0 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 0 0 CT X Lule Tracey 2037568021 80 Phoenix Avenue Suite 201 Waterbury CT 06702 CAROLYn a highsmith TREASurer 2.00 X X 0 0 0 JUDY ACOSTA OUTGOING MEMBER 2.00 X 0 0 0 MAGDALIA ROSARIO OUTGOING MEMBER 2.00 X 0 0 0 MARK BRIGGS CHairperson 2.00 X X 0 0 0 Mr Herbert L Terry III member 2.00 X 0 0 0 MR QUY TRAN MEMber 2.00 X 0 0 0 REV DR MAYNER TYSON MEMber 2.00 X 0 0 0 RICHARD LEE MEMber 2.00 X 0 0 0 SANdra j sorel-leduc VIce chair 2.00 X X 0 0 0 THOMAS JOHNSON SEcretary 2.00 X X 0 0 0 WALTER R MACHNICZ member 2.00 X 0 0 0 DONALD J THOMPSON JR ceo/president 40.00 X 227318 0 74936 LULE TRACEY CFO 40.00 X 183823 0 52759 Amit Patel Dental Director 40.00 X 214219 0 45604 Sunil D'Cunha CMO 40.00 X 263686 0 35159 christine bianchi CDO 40.00 X 150305 0 38301 radhika agrawal pediatrician 40.00 X 161215 0 20897 shalini keswani pediatrician 40.00 X 153500 0 39428 stephen spear internist 40.00 X 174302 0 20663 vaishali bansilal pediatrician 40.00 X 164646 0 17465 1693014 0 345212 14 0 1 0 wellmore inc 141 e main street waterbury CT 06702 bh services 274925 1 5764548 22634 871232 5787182 PATIENT SERVICE 621400 12568865 12568865 pharmacy 304B 446110 1224163 1224163 13793028 1271 1271 131456 168341 -36885 -36885 -36885 MEANINGFUL USE INCENTIVE 900099 102000 102000 OTHER REVENUE 900099 25115 25115 127115 19671711 13920143 0 -35614 1083457 906642 176815 10026612 8390319 1636293 978803 819067 159736 1718000 1437631 280369 851808 712797 139011 26244 26244 37420 37420 1101895 957415 144480 47292 39574 7718 33622 28135 5487 26569 26569 363459 339669 23790 34361 28753 5608 40559 33940 6619 -2544 -2129 -415 243384 243384 35491 35491 Vaccines 871232 871232 Clinic supplies 643759 538701 105058 provision for uncollect 421107 421107 equipment rental and ma 198332 169886 28446 162744 143188 19556 18943606 16114802 2828804 0 1713266 1737210 2177438 1613372 396020 1787097 867153 1005885 223408 243299 8091012 3178400 4497827 4912612 547467 565124 10422579 11864599 2106981 2786238 159616 194274 2266597 2980512 X 6418570 6728997 1737412 2155090 8155982 8884087 10422579 11864599 728105 0 X X 0 1 X 1 1 1 X 3403013 3873910 3843233 5068232 5787182 21975570 3403013 3873910 3843233 5068232 5787182 21975570 21975570 171660 175368 168159 166084 132727 813998 271 271 281818 155316 215924 260398 127115 1040571 23830410 55640638 0.92220 0.91570 X Schedule A, Part II, Line 10, Explanation of Other Income: meaningful use incentive - 2011 Amount: $ 276,250. 2012 Amount: $ 127,500. 2013 Amount: $ 144,500. 2014 Amount: $ 233,750. 2015 Amount: $ 102,000. Miscellaneous - 2011 Amount: $ 5,568. 2012 Amount: $ 21,211. 2013 Amount: $ 10,997. 2014 Amount: $ 26,648. 2015 Amount: $ 25,115. Fundraising - 2012 Amount: $ 6,605. 2013 Amount: $ 4,915. Program Related - 2013 Amount: $ 55,512. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 384297 384297 6567855 2226253 4341602 703792 952147 -248355 435068 435068 4912612 X 19418945 -252766 -252766 19671711 0 19671711 18690840 168341 168341 18522499 421107 421107 18943606 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 CORPORATION 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: rent expenses 168,341. provision for uncollectible accounts -421,107. Part XII, Line 2d - Other Adjustments: rent expenses 168,341. Part XII, Line 4b - Other Adjustments: provision for uncollectible accounts 421,107. X X X 0 1 0 0 0 0 0 1 0 DONALD J THOMPSON JR ceo/president 221318 0 6000 0 0 0 51831 0 23105 0 302254 0 0 0 LULE TRACEY CFO 177823 0 6000 0 0 0 30715 0 22044 0 236582 0 0 0 Amit Patel Dental Director 205469 0 8750 0 0 0 24707 0 20897 0 259823 0 0 0 Sunil D'Cunha CMO 257686 0 6000 0 0 0 30328 0 4831 0 298845 0 0 0 christine bianchi CDO 144305 0 6000 0 0 0 17404 0 20897 0 188606 0 0 0 radhika agrawal pediatrician 153715 0 7500 0 0 0 0 0 20897 0 182112 0 0 0 shalini keswani pediatrician 153500 0 0 0 0 0 18531 0 20897 0 192928 0 0 0 stephen spear internist 166802 0 7500 0 0 0 0 0 20663 0 194965 0 0 0 vaishali bansilal pediatrician 157146 0 7500 0 0 0 0 0 17465 0 182111 0 0 0 Part I, Line 4b DONALD J. THOMPSON, JR, 457 (F), $25,500 LULE TRACEY, 457 (F), $9,250 Part I, Line 7 THE CENTER PROVIDED AN ANNUAL PROFIT SHARING BONUS. X 1 871232 cost 0 0 0 Part I, Column (b): THE AMOUNT IN SCHEDULE B REPRESENTS NUMBER OF CONTRIBUTORS. Form 990, Part VI, Section B, line 11 THE 990 WILL BE REVIEWED AND ACCEPTED BY THE BOARD BEFORE STAYWELL SUBMITS. Form 990, Part VI, Section B, line 12c DONALD THOMPSON, CEO, MONITORS CONFLICT OF INTEREST POLICY BY REVIEWING AND ADDRESSING ANY POTENTIAL CONFLICTS AND FOLLOWING UP EACH YEAR FOR ANY CHANGES. Form 990, Part VI, Section B, line 15a INFORMATION FROM NATIONAL AND STATEWIDE SURVEYS ARE USED AS CRITERIA TO DETERMINE THE SALARY OF THE CEO. THIS INFORMATION IS GIVEN TO THE PERSONNEL COMMITTEE FOR REVIEW. THE PERSONNEL COMMITTEE NEGOTIATES AND APPROVES THE SALARY OF THE CEO. Form 990, Part VI, Section C, line 19 All governing documents are made available to the public upon request. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.