2016-11-08T14:55:12-06:00 2015-12-31 222428965 CITRIN COOPERMAN & COMPANY LLP TEN WEYBOSSET STREET - SUITE 700 PROVIDENCE RI 02903 990 2015-01-01 510183476 BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC BLAC 4017290080 39 EAST AVENUE PAWTUCKET RI 02860 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 4017290080 2016-10-27 1 MARTHA HULTZMAN P00107728 4014214800 2015 2017-02-10 21:41:12Z RAYMOND J LAVOIE 39 EAST AVENUE PAWTUCKET RI 02860 18306322 0 X WWW.BLACKSTONECHC.ORG X 1984 RI BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. (THE CENTER) OPERATES HEALTHCARE CENTERS IN CENTRAL FALLS AND PAWTUCKET, RHODE ISLAND. THE CENTER PROVIDES A BROAD RANGE OF HEALTH, DENTAL, AND SOCIAL SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION. 8 8 168 9 -6750 -6740 4491176 5545450 10273026 11741753 554 450 427156 488796 15191912 17776449 0 0 0 0 9316565 10539771 0 0 0 4548013 5312415 13864578 15852186 1327334 1924263 17762756 20012836 7078410 7404227 10684346 12608609 X BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. 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 11160832 11807941 OPERATED A COMMUNITY HEALTHCARE CENTER WHICH SERVED APPROXIMATELY 77,000 ENCOUNTERS DURING THE YEAR ENDED DECEMBER 31, 2015. 11160832 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 27 0 1 168 1 1 1 0 0 0 0 0 0 0 0 0 X 8 8 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 VICE CHAIRPERSON 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 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 40.00 X 179880 0 23781 JOSE POLANCO MEDICAL DIRECTOR 40.00 X 107654 0 17882 CHRISTINE GREY CHIEF OPERATING OFFICER 40.00 X 149222 0 30723 ANITA KURBIEC FINANCE DIRECTOR 40.00 X 54915 0 19350 KUNJBALA SHARMA PHYSICIAN 40.00 X 165761 0 19869 AMERICA FOSTER PHYSICIAN 40.00 X 165923 0 31622 YANLI DING PHYSICIAN 40.00 X 134291 0 29493 PEDRO OCHOA PHYSICIAN 40.00 X 121159 0 16591 ADRIANA REYNA PHYSICIAN 40.00 X 110450 0 27959 1189255 0 217270 8 0 1 0 CASE CONSTRUCTION 225 WAMPANOAG TRAIL EAST PROVIDENCE RI 02915 CONSTRUCTION 883077 QUALITY SYSTEMS INC 18111 VON KARMAN AVENUE IRVINE CA 92612 EMR SOFTWARE SERVICES 785475 WOMEN'S CARE INC 42 PARK PLACE PAWTUCKET RI 02860 OBSTETRICS 368230 EDWARD ROWSE 115 CEDAR STREET PROVIDENCE RI 02903 ARCHITECT 190591 BETTY'S CLEANING 111 WINTER STREET CUMBERLAND RI 02864 CLEANING 142946 5 5544950 500 500 5545450 MEDICAID 900099 9195961 9195961 OTHER THIRD PARTY 900099 1198102 1198102 MEDICARE 900099 878030 878030 SELF-PAY 900099 469660 469660 11741753 450 450 47644 54394 -6750 -6750 -6750 904837 475479 429358 429358 MISCELLANEOUS INCOME 900099 66188 66188 66188 17776449 11807941 -6750 429808 X 583407 125536 457871 7545728 5684430 1861298 296278 228077 68201 1530858 1178468 352390 583500 449183 134317 2118361 1391204 727157 209041 168060 40981 231186 222653 8533 53091 23597 29494 130116 74415 55701 243078 243078 1192507 662797 529710 112561 112561 BAD DEBTS 737374 737374 REPAIRS AND MAINTENANCE 109081 107463 1618 TELEPHONE 69733 56390 13343 DUES AND SUBSCRIPTIONS 39340 18920 20420 66946 32265 34681 15852186 11160832 4691354 0 2900 3000 2374595 3431764 928924 694883 608697 443783 2876 0 364827 419527 22254710 7466477 13220218 14788233 84624 79627 175095 152019 17762756 20012836 939567 1333142 6138843 6071085 7078410 7404227 X 10684346 12608609 10684346 12608609 17762756 20012836 1924263 0 X X 0 1 X 0 1 1 X 3041644 3683828 4130782 4491176 5567594 20915024 3041644 3683828 4130782 4491176 5567594 20915024 20915024 11110 10959 1664 23654 26050 73437 16770 14909 8692 14081 66188 120640 21109101 0.99080 0.99360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1027742 1027742 11515709 3291544 8224165 6236892 4146833 2090059 3474367 28100 3446267 14788233 18306322 529873 529873 17776449 0 17776449 16382059 529873 529873 15852186 0 15852186 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 54,394. COST OF GOODS SOLD INCLUDED IN REVENUE 475,479. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 54,394. COST OF GOODS SOLD INCLUDED IN REVENUE 475,479. X X X 0 0 0 0 0 0 0 0 0 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 179880 0 0 0 0 0 9036 0 14745 0 203661 0 0 0 CHRISTINE GREY CHIEF OPERATING OFFICER 149222 0 0 0 0 0 7722 0 23001 0 179945 0 0 0 KUNJBALA SHARMA PHYSICIAN 165761 0 0 0 0 0 8260 0 11609 0 185630 0 0 0 AMERICA FOSTER PHYSICIAN 165923 0 0 0 0 0 8626 0 22996 0 197545 0 0 0 YANLI DING PHYSICIAN 134291 0 0 0 0 0 6962 0 22531 0 163784 0 0 0 A RI HEALTH AND EDUCATIONAL BUILDNG CORPORATION 521300173 2011-08-02 6450000 CONSTRUCTION OF NEW MEDICAL BUILDING 0 0 0 A 303915 6450000 75000 6375000 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 11 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 1,391,204. MANAGEMENT AND GENERAL EXPENSES 727,157. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,118,361. 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.