2016-05-16T07:43:58-05:00 2015-06-30 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2014-07-01 042610447 NORTH SHORE COMMUNITY HEALTH INC NORT 9788251109 27 CONGRESS ST NO 504 SALEM MA 01970 MARGARET BRENNAN CHIEF EXECUTIVE OFFICER 9788251109 2016-05-13 1 PAUL BALLASY P00852868 9592007000 2014 2016-08-17 19:52:53Z MARGARET BRENNAN 27 CONGRESS ST NO 504 SALEM MA 01970 12458854 0 X WWW.NSCHI.ORG X 1977 MA 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. 13 13 135 0 0 0 3824937 3919087 7172324 8359112 -1847 -77448 338482 176319 11333896 12377070 0 0 0 0 8143484 8436016 0 0 0 3833549 4591019 11977033 13027035 -643137 -649965 6250266 5656575 2652805 2709079 3597461 2947496 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 9076339 6611930 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 39190 MEDICAL VISITS DURING THE TAX YEAR. 1838838 1842225 DENTAL SERVICES - DENTAL SERVICES PROVIDED TO THE RESIDENTS OF SALEM, PEABODY, GLOUCESTER AND SURROUNDING COMMUNITIES. THERE WERE 17516 DENTAL VISITS DURING THE TAX YEAR. 75276 SCHOOL BASED HEALTH CENTER - HEALTH SERVICES PROVIDED TO STUDENTS AT SALEM HIGH SCHOOL. THERE WERE 485 SCHOOL BASED HEALTH CENTER VISITS DURING THE TAX YEAR. 10915177 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 4 0 1 135 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 CHARLIE BLUTE BOARD MEMBER 2.00 X 0 0 0 EDWARD BAILEY OUTGOING BOARD MEMBER 2.00 X 0 0 0 GABRIELLE ROSS BOARD MEMBER 2.00 X 0 0 0 GINA FLYNN TREASURER 2.00 X X 0 0 0 JACK VONDRAS VICE PRESIDENT 2.00 X X 0 0 0 LUCY CORCHADO BOARD MEMBER 2.00 X 0 0 0 MARION WINFREY 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 SECRETARY 2.00 X X 0 0 0 RITA BADAMI BOARD MEMBER 2.00 X 0 0 0 STEPHEN MEUNIER BOARD MEMBER 2.00 X 0 0 0 VENTURA LOREDO BOARD MEMBER 2.00 X 0 0 0 MARGARET BRENNAN CEO 40.00 X 186759 0 14336 THOMAS DOWLEY CFO 40.00 X 128928 0 3768 AZRA ALI FAMILY PRACTICE PHYSICIAN 40.00 X 183308 0 0 DAMIAN ARCHER ASSOCIATE MEDICAL DIRECTOR 40.00 X 165042 0 3327 KIAME MAHANIAH CMO 40.00 X 223263 0 11336 RODRIGO TAVARES RODRIGUES INTERNAL MEDICINE/PEDIATRICS 40.00 X 211591 0 670 STEPHEN F KULCSAR FAMILY PRACTICE PHYSICIAN 40.00 X 161316 0 5095 1260207 0 38532 11 0 1 0 PRIORITY MANAGEMENT GROUP INC 700 SCHOOL STREET PAWTUCKET RI 02860 PATIENT BILLING SERVICES 374294 NORTH SHORE PHYSICIANS GROUP TWO CORPORATE WAY SUITE 180 PEABODY MA 01960 OB/GYN PROVIDER SERVICES 165233 ACCOUNTING MANAGEMENT SOLUTIONS INC 800 SOUTH STREET SUITE 195 WALTHAM MA 02453 ACCOUNTING CONSULTING SERVICES 107229 3 2395325 1523762 3919087 MEDICAID 621110 5169619 5169619 PHARMACY REVENUE 621110 1371737 1371737 HEALTH SAFETY NET 621110 641768 641768 MEDICARE 621110 567161 567161 THIRD-PARTY PAYORS 621110 531423 531423 77404 77404 8359112 4336 4336 6000 0 6000 6000 6000 81784 -81784 -81784 -81784 EMR INCENTIVE 621110 93500 93500 OTHER INCOME 621110 69447 69447 MEDICAL RECORDS FEES 621110 7372 7372 170319 12377070 8529431 0 -71448 301364 268011 33353 6632543 5918641 713902 962336 802758 159578 539773 410805 128968 43167 932 42235 45750 45750 659763 7420 652343 72123 22777 49346 260218 215797 44421 314095 284804 29291 498951 444563 54388 32488 18049 14439 2317 407 1910 37572 15258 22314 339669 315817 23852 61502 48786 12716 HOUSEKEEPING SERVICES A 929563 919209 10354 PHARMACY AND RELATED FE 593226 593226 CONTRACTED SERVICES 262077 260577 1500 PROVISION FOR UNCOLLECT 124079 124079 314459 243261 71198 13027035 10915177 2111858 0 530982 138942 574239 135055 979905 810230 1118696 1520523 27225 29816 194106 161627 5839858 2979476 2825113 2860382 6250266 5656575 1711911 1622722 940894 1086357 2652805 2709079 X 1457606 1887882 2139855 1059614 3597461 2947496 6250266 5656575 -649965 0 X X 0 1 X 1 1 1 X 2199539 4048532 3384843 3824937 3919087 17376938 2199539 4048532 3384843 3824937 3919087 17376938 942852 16434086 10234 8862 5223 7414 10336 42069 66540 546091 290840 338482 170319 1412272 18831279 34137442 0.87270 0.91940 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2010 AMOUNT: $ 66,540. 2011 AMOUNT: $ 425,000. 2012 AMOUNT: $ 69,840. 2013 AMOUNT: $ 236,482. 2014 AMOUNT: $ 69,447. EMR INCENTIVE - 2011 AMOUNT: $ 121,091. 2012 AMOUNT: $ 221,000. 2013 AMOUNT: $ 102,000. 2014 AMOUNT: $ 93,500. MEDICAL RECORDS FEES - 2014 AMOUNT: $ 7,372. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1415592 689239 726353 2883859 1205536 1678323 1487922 1084701 403221 52485 52485 2860382 X 12289891 36900 -124079 -87179 12377070 0 12377070 12939856 36900 36900 12902956 124079 124079 13027035 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2015 AND 2014. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL 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 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 -124,079. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 124,079. X X X X 0 0 0 0 0 0 0 0 0 MARGARET BRENNAN CEO 186759 0 0 0 0 0 0 0 14336 0 201095 0 0 0 AZRA ALI FAMILY PRACTICE PHYSICIAN 183308 0 0 0 0 0 0 0 0 0 183308 0 0 0 DAMIAN ARCHER ASSOCIATE MEDICAL DIRECTOR 165042 0 0 0 0 0 0 0 3327 0 168369 0 0 0 KIAME MAHANIAH CMO 223263 0 0 0 0 0 0 0 11336 0 234599 0 0 0 RODRIGO TAVARES RODRIGUES INTERNAL MEDICINE/PEDIATRICS 211591 0 0 0 0 0 0 0 670 0 212261 0 0 0 STEPHEN F KULCSAR FAMILY PRACTICE PHYSICIAN 161316 0 0 0 0 0 0 0 5095 0 166411 0 0 0 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.