2015-10-05T14:09:50-05:00 2014-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2014-01-01 510567466 COMMUNITY HEALTH CENTER OF RICHMOND INC COMM 7189242254 439 PORT RICHMOND AVENUE STATEN ISLAND NY 10302 HENRY THOMPSON CEO 7189242254 2015-10-02 1 JULIUS GREEN CPA P00350393 2159720701 2014 2016-03-07 17:11:31Z HENRY THOMPSON 439 PORT RICHMOND AVENUE STATEN ISLAND NY 10302 8715482 0 X CHCRICHMOND.ORG X 2006 NY TO PROVIDE QUALITY PRIMARY HEALTH CARE AND COORDINATED ACCESS TO SPECIALTY SERVICES THAT IS AFFORDABLE, ACCESSIBLE AND RESPECTFUL TO ALL PERSONS THAT WE SERVE. 15 15 84 15 0 0 5086817 3609470 3956519 4723771 4062 2981 488962 379260 9536360 8715482 0 0 0 0 3430071 4796729 0 0 0 3129263 3445623 6559334 8242352 2977026 473130 9016629 10014257 814272 1158084 8202357 8856173 X THE MISSION OF THE COMMUNITY HEALTH CENTER OF RICHMOND, INC. (THE CENTER) IS TO PROVIDE AFFORDABLE, QUALITY HEALTH CARE AND COORDINATED ACCESS TO SPECIALTY SERVICES WITH RESPECT AND COMPASSION FOR ALL PEOPLE. 1 0 5804329 4723771 PROVIDING PRIMARY CARE SERVICES TO RESIDENTS OF STATEN ISLAND, NEW YORK WITH PARTICULAR EMPHASIS PLACED ON SERVING THE POOR AND UNDER-INSURED WITHIN THE COMMUNITY. THERE WERE 29,088 VISITS FOR 2014. CHCR HAS PROVIDED SERVICES TO 7,518 PATIENTS OF WHICH 2,432 WERE UNINSURED AND 6,873 WERE AT 200% OR BELOW THE FEDERAL POVERTY GUIDELINE. THERE WERE 24.11 HEALTH CARE PROVIDER FTES WHO DELIVERED THE SERVICES DURING THE YEAR. 5804329 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 29 0 1 84 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X BENNY LINDO CFO 7189242254 439 PORT RICHMOND AVE STATEN ISLAND NY 10302 JACK DE SANTIS CHAIRPERSON 1.00 X X 0 0 0 GONZALO MERCADO SECOND VICE CHAIRPERSON 1.00 X X 0 0 0 CHRISTINE HOLLIE SECRETARY 1.00 X X 0 0 0 SHERIF FARAG MD TREASURER 1.00 X X 0 0 0 MARIBEL SANSON MEMBER 1.00 X 0 0 0 PATRICIA KARNATSKI MEMBER 1.00 X 0 0 0 LUIS RODRIGUEZ MEMBER 1.00 X 0 0 0 TERRY TROIA MEMBER 1.00 X 0 0 0 URSZULA CZYSZKIEWICZ MEMBER 1.00 X 0 0 0 ELIZABETH LOPEZ MEMBER 1.00 X 0 0 0 BARBARA GRIFFITHS MEMBER 1.00 X 0 0 0 CAMILIA RANGEL MEMBER 1.00 X 0 0 0 INES BRATCHER MEMBER 1.00 X 0 0 0 ARACELI ARIZMENDI MEMBER 1.00 X 0 0 0 RAQUEL ARIAS MEMBER 1.00 X 0 0 0 HENRY THOMPSON CHIEF EXECUTIVE OFFICER 40.00 X 201884 0 18110 ROSALINDA ROSARIO-LIPKA DO MEDICAL DIRECTOR 40.00 X 165759 0 9950 BENITO LINDO CHIEF FINANCIAL OFFICER 40.00 X 182500 0 10950 MONIQUE WELBECK NURSE PRACTITIONER 40.00 X 118193 0 13090 KUDUVALLI OMPRAKASH MD PHYSICIAN 40.00 X 149436 0 14970 JESSIE PITA MD PHYSICIAN 40.00 X 141924 0 14520 ELAINE CLARKE MD PHYSICIAN 40.00 X 138882 0 14330 SANDRA BLANDON NURSE PRACTITIONER 40.00 X 110232 0 12610 1208810 0 108530 9 0 1 0 HENRICH GROUP LLC 125-28 QUEENS BLVD SUITE 617 KEW GARDENS NY 11415 PROJECT MANAGEMENT 208354 RICHMOND UNIVERSITY MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND NY 10310 OB-GYN SERVICES 193680 DESIGN FOR SOCIAL GOOD 19 HUEMMER TERRACE CLIFTON NJ 07013 COMMUNITY OUTREACH CONSULTANT 114981 3 3576567 32903 322212 3609470 NET PATIENT SVC REV 623000 4723771 4723771 4723771 2981 2981 PATIENT INCENTIVE REVE 900099 203830 203830 PHARMACY SALES AT COST 446110 166775 166775 MEDICAL RECORDS REVENU 900099 8655 8655 379260 8715482 4723771 0 382241 589153 192450 396703 3098819 2501064 597755 87683 77812 9871 765450 530796 234654 255624 187994 67630 54770 54770 30000 30000 751657 206897 544760 25602 25602 1083173 682884 400289 7799 7799 304355 304355 60099 56769 3330 981 981 720408 720408 65145 16204 48941 BAD DEBT EXPENSE 78048 78048 REPAIRS AND MAINTENANCE 58723 58723 LEASED EQUIPMENT 44523 44523 TRAINING EXPENSE 44025 44025 116315 92597 23718 8242352 5804329 2438023 0 250 300 1159885 822553 264896 121148 648108 1264101 62168 68304 9540269 1828184 6856056 7712085 25266 25766 9016629 10014257 804009 1158084 10263 814272 1158084 X 8202357 8856173 8202357 8856173 9016629 10014257 473130 180686 0 X X 0 1 X 1 1 1 X 2803070 3808430 2678498 5086817 3609470 17986285 3181478 2769816 3515979 3956519 4723771 18147563 5984548 6578246 6194477 9043336 8333241 36133848 0 0 0 36133848 3881 2830 6211 4062 2981 19965 3881 2830 6211 4062 2981 19965 26 165122 187648 488962 379260 1221018 5988455 6746198 6388336 9536360 8715482 37374831 0.96680 0.97190 0.00050 0.00060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2010 AMOUNT: $ 26. 2011 AMOUNT: $ 286. 2013 AMOUNT: $ 101. 340B PHARMACY PROGRAM - 2011 AMOUNT: $ 164,836. 2012 AMOUNT: $ 187,648. 2013 AMOUNT: $ 230,581. 2014 AMOUNT: $ 166,775. MEDICAL RECORDS - 2013 AMOUNT: $ 1,187. 2014 AMOUNT: $ 8,655. INCENTIVE PROGRAM - 2013 AMOUNT: $ 257,093. 2014 AMOUNT: $ 203,830. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7801843 1307561 6494282 486220 318910 167310 1252206 201713 1050493 7712085 X 8637434 -78048 -78048 8715482 0 8715482 8164304 0 8164304 78048 78048 8242352 PART X, LINE 2: THE CENTER ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2014 AND 2013. THE CENTER'S TAX RETURNS FOR THE FISCAL YEARS AFTER DECEMBER 31, 2010 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISON FOR BAD DEBTS NETTED AGAINST REVENUE -78,048. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISON FOR BAD DEBTS NETTED AGAINST REVENUE 78,048. X X X 0 0 0 0 0 0 0 0 0 HENRY THOMPSON CHIEF EXECUTIVE OFFICER 201884 0 0 0 0 0 12110 0 6000 0 219994 0 0 0 ROSALINDA ROSARIO-LIPKA DO MEDICAL DIRECTOR 165759 0 0 0 0 0 9950 0 0 0 175709 0 0 0 BENITO LINDO CHIEF FINANCIAL OFFICER 182500 0 0 0 0 0 10950 0 0 0 193450 0 0 0 KUDUVALLI OMPRAKASH MD PHYSICIAN 149436 0 0 0 0 0 8970 0 6000 0 164406 0 0 0 JESSIE PITA MD PHYSICIAN 141924 0 0 0 0 0 8520 0 6000 0 156444 0 0 0 ELAINE CLARKE MD PHYSICIAN 138882 0 0 0 0 0 8330 0 6000 0 153212 0 0 0 X 2 322212 COST PAID BY DONOR 0 0 1 0 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS REPORTED ON LINE 20(A) REPRESENTS THE NUMBER OF DONORS. FORM 990, PART III, LINE 2 IN 2014, THE CENTER BEGAN OFFERING DENTAL AND PODIATRY SERVICES FORM 990, PART VI, SECTION B, LINE 11 THE CEO AND CFO REVIEW THE FORM 990 BEFORE IT IS FILED. THE RETURN IS THEN PRESENTED TO THE FINANCE COMMITTEE FOR REVIEW AND THEN TO THE GENERAL BOARD FOR APPROVAL OF FILING. FORM 990, PART VI, SECTION B, LINE 12C CHCR PROVIDES BOARD MEMBERS AND STAFF WITH A CONFLICT OF INTEREST STATEMENT WHICH SUMMARIZES THE KEY ELEMENTS OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. THE STATEMENT IS PROVIDED TO AND SIGNED BY BOARD MEMBERS AND STAFF BOTH AT THE TIME OF THE INDIVIDUAL'S INITIAL AFFILIATION WITH THE ORGANIZATION AND ANNUALLY THEREAFTER. THE CEO IS RESPONSIBLE FOR MONITORING THE CONFLICTS. THE BOARD OF DIRECTORS REVIEWS THE CEO'S ANNUAL CONFLICT OF INTEREST STATEMENT. IN THE CASE OF CONFLICT OF INTEREST, THE BOARD MEMBER WILL REPORT THE CONFLICT TO THE FULL BOARD PRIOR TO ANY DISCUSSION OF THE MATTER AND POTENTIALLY RECUSE THEMSELVES FROM VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 OFFICER COMPENSATION IS DETERMINED AND COMPARED BASED ON THE CURRENT MARKET, INDUSTRY STANDARDS AND SURVEYS TAKEN. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE CHIEF EXECUTIVE OFFICER'S SALARY. THERE IS A WRITTEN CONTRACT BETWEEN THE CHIEF EXECUTIVE OFFICER AND THE CENTER, AND IS NEGOTIABLE AT A CERTAIN TIME PERIOD. THE COMPENSATION SETTING PROCESS IS DOCUMENTED IN THE EXECUTIVE COMMITTEE MINUTES. THIS PROCESS IS THE DONE WITH THE GOAL OF ENSURING A SALARY OF NO MORE THAN THE FAIR MARKET VALUE OF THE SERVICES RENDERED. SALARIES FOR THE OTHER OFFICERS AND STAFF ARE BASED UPON INDUSTRY SURVEY, E.G. NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC), AND THE COMMUNITY HEALTH CENTER ASSOCIATION OF NEW YORK STATE (CHCANYS). THE ORGANIZATION HAS A BOARD PERSONNEL COMMITTEE THAT OVERSEES HIRING AND CREDENTIALING OF EMPLOYEES. THE CEO HAS THE PRIVILEGE AND SOLE AUTHORITY TO HIRE AND FIRE EMPLOYEES; TO ESTABLISH SALARIES BASED UPON THE SURVEY PARAMETERS, AND PROVIDES RECOMMENDATIONS TO THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS USED BY THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.