2014-11-14T12:53:10-06:00 2013-12-31 453994797 LGC&D LLP TEN WEYBOSSET STREET - SUITE 700 PROVIDENCE RI 02903 990 2013-01-01 510183476 BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC BLAC 4017290080 39 EAST AVENUE PAWTUCKET RI 02860 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 4017290080 2014-11-14 1 GERALD IADELUCA P00247569 4014214800 2013 2015-11-30 17:44:51Z RAYMOND J LAVOIE 39 EAST AVENUE PAWTUCKET RI 02860 13115499 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 10 141 0 0 0 3683828 4130782 8259490 8538225 759 519 144932 220372 12089009 12889898 0 0 0 0 7758445 8449385 0 0 0 3722207 4299300 11480652 12748685 608357 141213 16777011 16366358 7561212 7009346 9215799 9357012 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 9085863 8546917 OPERATED A COMMUNITY HEALTHCARE CENTER WHICH SERVED APPROXIMATELY 63,000 ENCOUNTERS DURING THE YEAR ENDED DECEMBER 31, 2013. 9085863 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 30 0 1 141 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 0 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 WARREN BREER BOARD MEMBER 1.00 X 0 0 0 CARLOS DEBRITO BOARD MEMBER 1.00 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 180730 0 19606 JERALD C FINGERUT MEDICAL DIRECTOR 40.00 X 137534 0 14462 JOSE POLANCO MEDICAL DIRECTOR 40.00 X 186083 0 29771 CHRISTINE GREY CHIEF OPERATING OFFICER 40.00 X 139121 0 22316 ANITA KURBIEC FINANCE DIRECTOR 40.00 X 72609 0 23719 LALITA BHATTACHARYA DENTIST 40.00 X 138224 0 15879 YANLI DING DENTIST 40.00 X 131587 0 26470 AMERICA FOSTER PHYSICIAN 40.00 X 153710 0 27559 KARLA KIKER PHYSICIAN 40.00 X 150737 0 9535 KUNJBALA SHARMA PHYSICIAN 40.00 X 157734 0 14288 1448069 0 203605 9 0 1 0 QUALITY SYSTEMS INC 18111 VON KARMAN AVENUE IRVINE CA 92612 EMR SOFTWARE SERVICES 551269 WOMEN'S CARE INC 407 EAST AVENUE SUITE 150 PAWTUCKET RI 02860 OBSTETRICS 382815 2 4130782 4130782 MEDICAID 900099 6435186 6435186 SELF-PAY 900099 754821 754821 MEDICARE 900099 698925 698925 OTHER THIRD PARTY 900099 649293 649293 8538225 519 519 1145 1145 0 436136 224456 211680 211680 MISCELLANEOUS INCOME 900099 8692 8692 8692 12889898 8546917 0 212199 X 825953 367852 458101 5673058 4361596 1311462 267223 267223 1217552 1086655 130897 465599 332667 132932 1707048 1177894 529154 221248 185440 35808 219045 208620 10425 124821 56734 68087 182250 182250 1142613 801601 341012 96533 96533 BAD DEBTS 380000 380000 REPAIRS AND MAINTENANCE 55103 52074 3029 DUES AND SUBSCRIPTIONS 51555 13902 37653 TELEPHONE 44541 29481 15060 74543 31347 43196 12748685 9085863 3662822 0 3000 2900 1635194 1913683 477864 262878 477367 911224 7450 13368 324804 308054 17876740 5118867 13728259 12757873 82700 89620 40373 106758 16777011 16366358 1286879 753252 6274333 6256094 7561212 7009346 X 9215799 9357012 0 0 9215799 9357012 16777011 16366358 141213 0 X X 0 1 X 1 1 1 X 3195598 3976240 3041644 3683828 4130782 18028092 3195598 3976240 3041644 3683828 4130782 18028092 18028092 12167 14999 11110 10959 1664 50899 7235 8468 16770 14909 8692 56074 18135065 0.99410 0.98800 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1021616 1021616 11260573 2119672 9140901 5116462 2981352 2135110 478089 17843 460246 12757873 13115499 225601 225601 12889898 0 12889898 12974286 225601 225601 12748685 0 12748685 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 1,145. COST OF GOODS SOLD INCLUDED IN REVENUE 224,456. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 1,145. COST OF GOODS SOLD INCLUDED IN REVENUE 224,456. X X X 0 0 0 0 0 0 0 0 0 RAYMOND J LAVOIE EXECUTIVE DIRECTOR 180730 0 0 0 0 0 9055 0 10551 0 200336 0 0 0 JERALD C FINGERUT MEDICAL DIRECTOR 137534 0 0 0 0 0 7678 0 6784 0 151996 0 0 0 JOSE POLANCO MEDICAL DIRECTOR 186083 0 0 0 0 0 8758 0 21013 0 215854 0 0 0 CHRISTINE GREY CHIEF OPERATING OFFICER 139121 0 0 0 0 0 1337 0 20979 0 161437 0 0 0 LALITA BHATTACHARYA DENTIST 138224 0 0 0 0 0 6896 0 8983 0 154103 0 0 0 YANLI DING DENTIST 131587 0 0 0 0 0 6564 0 19906 0 158057 0 0 0 AMERICA FOSTER PHYSICIAN 153710 0 0 0 0 0 7599 0 19960 0 181269 0 0 0 KARLA KIKER PHYSICIAN 150737 0 0 0 0 0 7502 0 2033 0 160272 0 0 0 KUNJBALA SHARMA PHYSICIAN 157734 0 0 0 0 0 7869 0 6419 0 172022 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 CONSULTING: PROGRAM SERVICE EXPENSES 1,177,894. MANAGEMENT AND GENERAL EXPENSES 529,154. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,707,048. 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.