2016-07-20T14:39:21-05:00 2015-12-31 221478099 COHNREZNICK LLP 4 Becker Farm Road Roseland NJ 07068 990 2015-01-01 132813103 OPEN DOOR FAMILY MEDICAL CENTER INC OPEN 9145021470 165 MAIN STREET OSSINING NY 10562 LINDSAY C FARRELL PRESIDENT & CEO 9145021470 2016-07-20 1 THOMAS LANNING P00851654 9732283500 2015 2016-09-27 15:27:22Z LINDSAY C FARRELL 165 MAIN STREET OSSINING NY 10562 60692832 0 X WWW.OPENDOORMEDICAL.ORG X 1975 NY OPEN DOOR FAMILY MEDICAL CENTER PROVIDES QUALITY PRIMARY HEALTH CARE AND HUMAN SERVICES AT AFFORDABLE PRICES TO THE COMMUNITY, PARTICULARLY LOW-INCOME, UNDER-SERVED RESIDENTS AND THOSE LACKING ACCESS TO HEALTH CARE. 16 16 515 130 0 0 10087522 10431943 28991462 30261841 3885354 488368 301875 1057922 43266213 42240074 0 0 0 0 23873386 27933398 0 0 235764 12000673 14466171 35874059 42399569 7392154 -159495 89772968 90686585 8840831 8215187 80932137 82471398 THE MISSION OF THE OPEN DOOR FAMILY MEDICAL CENTER, INC. IS TO PROVIDE QUALITY PRIMARY HEALTH CARE AND HUMAN SERVICES AT AFFORDABLE PRICES TO THE COMMUNITY, PARTICULARLY LOW-INCOME, UNDER-SERVED RESIDENTS AND THOSE LACKING ACCESS TO HEALTH CARE. 0 0 28890078 24680777 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 50,212 MEDICAL PATIENTS THAT GENDERATED 170,599 VISITS IN 2015.Additional funding for this program is provided through federal grants, as shown on Form 990, Part VIII, Line 1e. 5088419 5456177 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 17,525 DENTAL PATIENTS THAT GENDERATED 40,508 VISITS IN 2015.Additional funding for this program is provided through federal grants, as shown on Form 990, Part VIII, Line 1e. 1644522 1170809 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 6,614 MENTAL HEALTH PATIENTS THAT GENDERATED 18,631 VISITS IN 2015.Additional funding for this program is provided through federal grants, as shown on Form 990, Part VIII, Line 1e. 35623019 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 1 1 0 0 1 24 0 1 515 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MARIA MAZZOTTA 9145021470 165 MAIN STREET OSSINING NY 10562 ANDRES VALDESPINO CHAIRMAN 1.00 1.10 X X 0 0 0 ANTONIO MEJIAS BOARD MEMBER 1.00 0.10 X 0 0 0 CARMEN TAVERAS-CRUZ BOARD MEMBER 1.00 0.10 X 0 0 0 CHARLES CHEHEBAR BOARD MEMBER 1.00 0.10 X 0 0 0 DAVID K SHERMAN TREASURER 1.00 0.10 X X 0 0 0 DIANA SCHAEFER VICE CHAIRPERSON 1.00 0.10 X X 0 0 0 DONNA WADE BOARD MEMBER 1.00 0.10 X 0 0 0 DORIAN LINDSAY BOARD MEMBER 1.00 0.10 X 0 0 0 ELIZABETH SHARPE thru 515 secreTARY 1.00 0.10 X X 0 0 0 HOWARD S SCHRADER BOARD MEMBER 1.00 1.10 X 0 0 0 JOHN CONYERS BOARD MEMBER 1.00 0.10 X 0 0 0 JULIE PESKOE thru 1115 BOARD MEMBER 1.00 0.10 X 0 0 0 LORETTA MOLINARI BOARD MEMBER 1.00 0.10 X 0 0 0 Luis Vicetti thru 0515 bOARD MEMBER 1.00 0.10 X 0 0 0 MARGOTH PILLA SECRETARY 1.00 0.10 X X 0 0 0 PATRICIA PEREZ thru 1115 BOARD MEMBER 1.00 0.10 X 0 0 0 SHIRLEY BUONTEMPO BOARD MEMBER 1.00 0.10 X 0 0 0 STEWART TABIN BOARD MEMBER 1.00 0.10 X 0 0 0 TYLER BEEBE BOARD MEMBER 1.00 0.10 X 0 0 0 WALTER EDGE BOARD MEMBER 1.00 0.10 X 0 0 0 LINDSAY C FARRELL PRESIDENT & CEO 35.60 2.00 X 363617 19138 21486 MARIA MAZZOTTA CHIEF FINANCE OFFICER 35.60 2.00 X 196517 10343 8336 ANITA WILENKIN CHIEF OPERATING OFFICER 37.50 X 199252 0 28129 DAREN WU CHIEF MEDICAL OFFICER 37.50 X 342792 0 10712 JANET BOZZONE DIRECTOR OF DENTAL SERVICE 37.50 X 229401 0 10638 BRUCE M SHAFFER PODIATRIST 37.50 X 231756 0 28300 Debrea L Gerson FAMILY PRACTICE PHYSICIAN 37.50 X 211297 0 32613 JAY ABRAM ZASLOW FAMILY PRACTICE PHYSICIAN 37.50 X 228733 0 32742 KAREN MURRAY OB/GYN PHYSICIAN 37.50 X 228911 0 30657 THOMAS YUEN FAMILY PRACTICE PHYSICIAN 37.50 X 226793 0 34755 2459069 29481 238368 54 0 1 0 HITCH Inc 2 CHURCH STREET SUITE 110 OSSINING NY 10562 CSP Services 432828 COMPREHENSIVE EYE SERVICES PO BOX 187 ARMONK NY 10504 EYE CLINIC 388771 KARP RESOURCES PO BOX 515 SOUTHOLD NY 11971 HR CONSULTING SERVICES 252385 ECLINICAL WORKS 112 TURNPIKE ROAD SUITE 200 WESTBOROUGH MA 01581 ECW SUPPORT & E-SUBSCRIBING 242351 The Execu Search Group 675 third avenue 5th floor New York NY 10017 Temp Agency 172744 7 342000 8561263 1528680 10431943 Medicaid Managed Care Plans 621400 9495851 9495851 wrap around 621400 7624477 7624477 MEDICAID 621400 4622733 4622733 SELF-PAY 621400 3791200 3791200 UNCOMPENSATED CARE 621400 2550238 2550238 2177342 2177342 30261841 1145164 1145164 12000 0 12000 12000 12000 17355615 440347 18025061 427697 -669446 12650 -656796 -656796 Medicaid Meaningful use incentive 621400 412250 412250 340b Pharmacy 621400 367266 367266 REIMBURSED SALARIES & FRINGE 900099 231564 231564 34842 34842 1045922 42240074 31307763 0 500368 1413839 1255391 158448 21452640 18894290 2369241 189109 1195090 1048649 146441 2160562 1751803 366304 42455 1711267 1608337 102930 76121 76121 77403 77403 433717 433717 3398230 1867913 1530317 2523491 2139155 384336 1360225 1141843 218382 53601 37716 15885 220307 211958 8349 203116 194991 8125 1397753 1173346 224407 274040 221577 52463 Provision for bad debts 1326921 1326921 PHARMACEUTICALS 677848 677848 RepairS & MAINTENANCE 567874 476703 91171 LABORATORY FEES 521179 521179 1354345 1073399 276746 4200 42399569 35623019 6540786 235764 4039375 4531320 7977864 1430549 1232546 1267141 3383281 3587904 373182 603828 34772862 16627175 14892131 18145687 54169490 60287723 3705099 832433 89772968 90686585 5839535 3738814 197075 129608 2804221 2476922 0 1869843 8840831 8215187 X 80892988 82430083 39149 41315 80932137 82471398 89772968 90686585 X -159495 813068 885688 X X 0 1 X 1 1 1 X 10756507 10018576 9589529 10087522 10431943 50884077 10756507 10018576 9589529 10087522 10431943 50884077 50884077 201594 264378 349896 902137 723447 2441452 377091 415562 404724 301875 1045922 2545174 55870703 133827610 0.91070 0.92960 X Schedule A, Part II, Line 10, Explanation of Other Income: MISCELLANEOUS REVENUE - 2011 Amount: $ 11,468. 2012 Amount: $ 36,184. 2013 Amount: $ 46,557. 2014 Amount: $ 27,789. 2015 Amount: $ 34,842. REIMBURSED SALARIES FRINGE - 2011 Amount: $ 365,623. 2012 Amount: $ 379,378. 2013 Amount: $ 358,167. 2014 Amount: $ 274,086. 2015 Amount: $ 231,564. Medicaid Meaningful use incentive - 2015 Amount: $ 412,250. 340b Pharmacy - 2015 Amount: $ 367,266. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1740016 1740016 2274217 1546182 728035 15207019 8492709 6714310 3383145 1389196 1993949 12168465 5199088 6969377 18145687 Due to related party 979711 Pension liability 890132 1869843 X 42722517 813068 310625 1350952 2474645 40247872 433717 1558485 1992202 42240074 41321914 310625 603922 914547 40407367 433717 1558485 1992202 42399569 Part X, Line 2: THE CORPORATION HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2015. THE CORPORATION'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2012 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CORPORATION HAD 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 CONSOLIDATED STATEMENT OF FINANCIAL POSITION. Part XI, Line 2d - Other Adjustments: REVENUE OF RELATED ENTITIES 1,409,565. Pension-related changes other than net periodic pension 885,688. Intercompany eliminations -944,301. Part XI, Line 4b - Other Adjustments: Provision for bad debts 1,326,921. REIMBURSED SALARIES & FRINGE 231,564. Part XII, Line 2d - Other Adjustments: EXPENSES OF RELATED ENTITIES 1,548,223. Intercompany eliminations -944,301. Part XII, Line 4b - Other Adjustments: Provision for bad debts 1,326,921. REIMBURSED SALARIES & FRINGE 231,564. X X X 0 0 0 0 0 1 0 1 0 LINDSAY C FARRELL PRESIDENT & CEO 333483 17552 28500 1500 1634 86 12720 670 8493 447 384830 20255 0 0 MARIA MAZZOTTA CHIEF FINANCE OFFICER 189738 9986 6511 343 268 14 6883 362 1932 92 205332 10797 0 0 ANITA WILENKIN CHIEF OPERATING OFFICER 192066 0 5940 0 1246 0 7255 0 21625 0 228132 0 0 0 DAREN WU CHIEF MEDICAL OFFICER 313985 0 28456 0 351 0 10712 0 1228 0 354732 0 0 0 JANET BOZZONE DIRECTOR OF DENTAL SERVICE 197019 0 30959 0 1423 0 8047 0 3365 0 240813 0 0 0 BRUCE M SHAFFER PODIATRIST 230257 0 0 0 1499 0 8373 0 20648 0 260777 0 0 0 Debrea L Gerson FAMILY PRACTICE PHYSICIAN 185274 0 25153 0 870 0 7654 0 26086 0 245037 0 0 0 JAY ABRAM ZASLOW FAMILY PRACTICE PHYSICIAN 228220 0 0 0 513 0 8260 0 25646 0 262639 0 0 0 KAREN MURRAY OB/GYN PHYSICIAN 228569 0 0 0 342 0 8400 0 23425 0 260736 0 0 0 THOMAS YUEN FAMILY PRACTICE PHYSICIAN 206123 0 20446 0 224 0 8273 0 27635 0 262701 0 0 0 Part I, Line 6 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED INCENTIVE BONUSES, WHICH ARE BASED ON THE NET EARNINGS OF EACH INDIVIDUAL'S BUSINESS SEGMENT, DURING THE YEAR ENDED 12/31/15: Daren Wu - $14,134 Janet Bozzone $20,877 Tom Yuen - $16,366 Debra Gersen - $16,993 Part I, Line 7 INCLUDED IN PART II COLUMN B(ii) ARE AMOUNTS REPRESENTING BONUS PAYMENTS. THESE AMOUNTS WERE APPROVED BY THE BOARD AND INCLUDED IN THE INDIVIDUALS' 2015 W-2S. Form 990, Part VI, Section A, line 6 OPEN DOOR, INC. IS THE SOLE MEMBER OF OPEN DOOR FAMILY MEDICAL CENTER, INC. Form 990, Part VI, Section B, line 11 OPEN DOOR FAMILY MEDICAL CENTER ENGAGES THE SERVICES OF AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE ANNUAL FORM 990 IN CONJUNCTION WITH ITS ANNUAL AUDITED FINANCIAL STATEMENTS. THE PRESIDENT/CEO AND CFO REVIEW THE FORM 990 AND SCHEDULES FOR ACCURACY. IN 2016, THE FORM 990, FOR THE YEAR ENDED DECEMBER 31, 2015, WAS PRESENTED TO THE FINANCE COMMITTEE AND BOARD MEMBERS FOR REVIEW PRIOR TO ITS SUBMISSION. Form 990, Part VI, Section B, line 12c On an annual basis, all the board members, officers and key employees sign a conflict of interest disclosure statement. All disclosure statements are updated and reviewed annually for existing or potential conflicts by the President/CEO. If a conflict is found, the affected individual is required to recuse himself/herself from any decision making and voting relating to the conflict. Form 990, Part VI, Section B, line 15 THE EXECUTIVE COMMITTEE OF THE BOARD CONDUCTS PARITY STUDIES TO EVALUATE EXECUTIVE COMPENSATION. THE ENTIRE BOARD GOES INTO EXECUTIVE SESSION TO EVALUATE THE CEO AND DETERMINE COMPENSATION. THE CEO CONDUCTS PARITY STUDIES TO EVALUATE OFFICERS AND KEY EMPLOYEES' SALARIES FOR THE EXECUTIVE COMMITTEE. THESE SALARIES, AND THE SALARIES OF THE ENTIRE ORGANIZATION, ARE PRESENTED TO THE BOARD FOR APPROVAL DURING THE BUDGET APPROVAL PROCESS TOWARD YEAR-END. THERE IS CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION DELIBERATION AND DECISION IN THE BOARD MINUTES. Form 990, Part VI, Section C, line 19 OPEN DOOR DOES MAKE ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY POSTING ON THE ORGANIZATION'S WEBSITE; PROVIDING COPIES UPON request for the same period of disclosure as set forth in section 6104(d); AND INSPECTION AT AN OFFICE OF THE ORGANIZATION. THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST, AT THE ORGANIZATION'S LOCATION. Form 990, Part XI, line 9: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 885,688. 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 OPEN DOOR FOUNDATION INC 165 MAIN STREET OSSINING NY 10562 133598184 FUNDRAISING/DEVELOPMENT NY 501(c)(3) Line 7 OPEN DOOR INC 0 OPEN DOOR INC 165 MAIN STREET OSSINING NY 10562 133585009 SUPPORTING ORGANIZATION NY 501(c)(3) Line 11a, I 0 OPEN DOOR LEASING CORP 165 MAIN STREET OSSINING NY 10562 201726717 LEASING SPACE NY OPEN DOOR FAMILY MEDICAL CENTER INC C 638930 87161 1.00000 1 0 0 1 1 0 0 0 0 0 0 1 1 0 1 1 0 1 0 0 OPEN DOOR LEASING CORP K 599668 COST