2015-11-12T12:30:32-06:00 2014-12-31 453994797 LGC&D LLP TEN WEYBOSSET STREET - SUITE 700 PROVIDENCE RI 02903 990 2014-01-01 510183476 BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC BLAC 4017290080 39 EAST AVENUE PAWTUCKET RI 02860 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 4017290080 2015-11-12 1 LYNN O'MARRA ESQUIRE P00821716 4014214800 2015-11-12 2014 2016-02-25 16:41:14Z RAYMOND J LAVOIE 39 EAST AVENUE PAWTUCKET RI 02860 15472619 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. 10 10 153 10 0 0 4130782 4491176 8538225 10273026 519 554 220372 427156 12889898 15191912 0 0 0 0 8449385 9316565 0 0 0 4299300 4548013 12748685 13864578 141213 1327334 16366358 17762756 7009346 7078410 9357012 10684346 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 9857448 10287109 OPERATED A COMMUNITY HEALTHCARE CENTER WHICH SERVED APPROXIMATELY 74,000 ENCOUNTERS DURING THE YEAR ENDED DECEMBER 31, 2014. 9857448 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 1 153 1 0 0 0 0 0 0 0 0 0 0 X 10 10 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 JAMES SIMCOCK BOARD MEMBER 1.00 X 0 0 0 BARBARA BERNARD BOARD MEMBER 1.00 X 0 0 0 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 40.00 X 180868 0 19642 JOSE POLANCO MEDICAL DIRECTOR 40.00 X 209106 0 27285 CHRISTINE GREY CHIEF OPERATING OFFICER 40.00 X 146440 0 23882 ANITA KURBIEC FINANCE DIRECTOR 40.00 X 74532 0 19934 KUNJBALA SHARMA PHYSICIAN 40.00 X 161042 0 18715 AMERICA FOSTER PHYSICIAN 40.00 X 162500 0 24708 KARLA FUENTES-KIKER PHYSICIAN 40.00 X 153835 0 9877 NEELAM THAPA PHYSICIAN 40.00 X 147260 0 12308 NAUSHEEN HUSSAIN PHYSICIAN 40.00 X 156366 0 12488 1391949 0 168839 8 0 1 0 QUALITY SYSTEMS INC 18111 VON KARMAN AVENUE IRVINE CA 92612 EMR SOFTWARE SERVICES 695446 WOMEN'S CARE INC 42 PARK PLACE PAWTUCKET RI 02860 OBSTETRICS 377200 2 4491176 4491176 MEDICAID 900099 8176532 8176532 OTHER THIRD PARTY 900099 879356 879356 MEDICARE 900099 772644 772644 SELF-PAY 900099 444494 444494 10273026 554 554 23100 23100 0 670680 257607 413073 413073 MISCELLANEOUS INCOME 900099 14083 14083 14083 15191912 10287109 0 413627 X 701688 236391 465297 6498010 5209784 1288226 263617 263617 1350989 1229742 121247 502261 371551 130710 1978958 1201320 777638 266477 239575 26902 234884 227155 7729 83347 40997 42350 245807 245807 1144481 706611 437870 99656 99656 BAD DEBTS 240000 240000 REPAIRS AND MAINTENANCE 81723 78065 3658 TELEPHONE 44496 35017 9479 DUES AND SUBSCRIPTIONS 41709 18287 23422 86475 22953 63522 13864578 9857448 4007130 0 2900 2900 1913683 2374595 262878 928924 911224 608697 13368 2876 308054 364827 19488991 6268773 12757873 13220218 89620 84624 106758 175095 16366358 17762756 753252 939567 6256094 6138843 7009346 7078410 X 9357012 10684346 0 0 9357012 10684346 16366358 17762756 1327334 0 X X 0 1 X 1 1 1 X 3976240 3041644 3683828 4130782 4491176 19323670 3976240 3041644 3683828 4130782 4491176 19323670 19323670 14999 11110 10959 1664 23654 62386 8468 16770 14909 8692 14081 62920 19448976 0.99360 0.99410 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1027742 1027742 11295447 2703107 8592340 5706410 3542025 2164385 1459392 23641 1435751 13220218 15472618 280706 280706 15191912 0 15191912 14145284 280706 280706 13864578 0 13864578 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 23,100. COST OF GOODS SOLD INCLUDED IN REVENUE 257,606. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 23,100. COST OF GOODS SOLD INCLUDED IN REVENUE 257,606. X X X 0 0 0 0 0 0 0 0 0 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 180868 0 0 0 0 0 9043 0 10599 0 200510 0 0 0 JOSE POLANCO MEDICAL DIRECTOR 209106 0 0 0 0 0 10455 0 16830 0 236391 0 0 0 CHRISTINE GREY CHIEF OPERATING OFFICER 146440 0 0 0 0 0 7322 0 16560 0 170322 0 0 0 KUNJBALA SHARMA PHYSICIAN 161042 0 0 0 0 0 8052 0 10663 0 179757 0 0 0 AMERICA FOSTER PHYSICIAN 162500 0 0 0 0 0 8125 0 16583 0 187208 0 0 0 KARLA FUENTES-KIKER PHYSICIAN 153835 0 0 0 0 0 7772 0 2105 0 163712 0 0 0 NEELAM THAPA PHYSICIAN 147260 0 0 0 0 0 7383 0 4925 0 159568 0 0 0 NAUSHEEN HUSSAIN PHYSICIAN 156366 0 0 0 0 0 2715 0 9773 0 168854 0 0 0 A RI HEALTH AND EDUCATIONAL BUILDNG CORPORATION 521300173 2011-08-02 6450000 CONSTRUCTION OF NEW MEDICAL BUILDING 0 0 0 A 6450000 75000 6331177 43823 2012 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 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 1,201,320. MANAGEMENT AND GENERAL EXPENSES 777,638. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,978,958. 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.