2013-01-11T09:48:51-07:00 2012-06-30 660561068 DIAZ AND CANDELARIA PSC SUITE 112 PMB 294 100 GRAN BULEVAR PASEOS SAN JUAN PR 00926 990 2011-07-01 660329532 SALUD INTEGRAL EN LA MONTANA INC SALU 7878695900 PO BOX 515 NARANJITO PUERTO RICO RQ 00719 ADA T TORRES VAZQUEZ 7878695900 2012-12-26 1 JOSE G CANDELARIO CASTRO P01448309 7873994556 2012-12-26 2011 2016-02-25 16:41:14Z ADA T TORRES VAZQUEZ PO BOX 515 NARANJITO PR 00719 38788989 0 X WWW.SIMPR.COM X 1974 PR To provide excellent ambulatory and home health-care services in a safe environment, to procure the physical, mental, and social wellbeing of the residents of our community. SIM provides preventive, primary and home health services that include medical services, clinical laboratory, radiology, emergency room, immunization, pharmacy, dental services, social work among others. 11 0 450 0 0 0 7418601 9420300 25140688 28734616 51959 58046 535567 576027 33146815 38788989 0 0 0 0 10791165 10266045 0 0 0 21938593 23629624 32729758 33895669 417057 4893320 26644108 30992570 16614429 9281409 10029679 21711161 To provide excellent ambulatory and home healthcare services in a safe environment, to procure the physical, mental and social wellbeing of the residents of our communities. 0 0 23831115 0 37005517 Community Health Center- a comprehensive primary health care program which provides services to low income families, agricultural migrants and seasonal farm workers as well as to their dependents in six municipalities located at the central and northern areas of Puerto Rico - Naranjito, Comerio, Corozal, Orocovis, Barranquitas and Toa Alta. 540361 850028 Hospice - to provide support services to patients with terminal diseases. 653635 0 933444 Home Care - to provide nursing, therapautic and other complimentary services to elderly patients at their homes. 0 0 0 25025111 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 0 1 0 0 0 450 1 0 0 0 0 0 0 X 11 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Lillian Cruz Alvarez 7878695900 Carr 152 KM 12 2 Bo Cedro Arriba Naranjito PR 00719 Gerardo M Hernandez 2 X 0 0 0 Arlin E Ramirez Vega 2 X 0 0 0 Maribel Concepcion 2 X 0 0 0 Ignacio Febus 2 X 0 0 0 Maria A Rios 2 X 0 0 0 Florentino Aviles 1 X 0 0 0 Ignacio Padilla 1 X 0 0 0 Omayra Acevedo 1 X 0 0 0 Nereida Rodriguez 1 X 0 0 0 Sylma Maldonado 1 X 0 0 0 Marcos A Melendez 1 X 0 0 0 Marien Vazquez 40 X X 66402 0 500 Anabelle Torres 40 X 38839 0 108 Ada T Torres 40 X 44904 0 0 Sandra V Garcia Rodriguez 40 X X X X 131718 0 6000 Lillian Cruz 40 X 62230 0 1800 Fernando Rivera Torres 40 X 114902 0 0 458995 0 8408 2 1 0 0 Quest Diagnostics 1st Floor Federal Building Road 2 KM 11 Bayamon PR 00956 Laboratory 396385 CJO Construction Corp PO Box 844 Road 164 Fermin Morale Bo Achiote Naranjito PR 00719 Construction 428327 Bersa Group 497 Emilia San Juan PR 00926 Professional Services 200000 HS Contractors Inc 9 Principal Sect Tiburones Ponce PR 00716 Construction 258879 Jose Vilmery Altiery PO BOX 515 NARANJITO PR 00719 Sonograms 175873 8 0 0 0 0 9420300 0 0 9420300 PREMIUM REVENUES (CAPITATION) 621400 17088190 17088190 0 0 NET PATIENTS SERVICES 621400 11646426 11646426 0 0 0 0 0 0 28734616 58046 58046 0 0 0 0 0 0 0 0 0 0 416921 0 0 0 416921 0 416921 416921 0 0 0 0 0 CAFETERIA & VENDING 722210 139831 139831 0 0 19275 19275 0 0 159106 38788989 29368689 0 0 147881 147881 0 7688210 5348642 2339568 75000 75000 1365593 882266 483327 989361 605984 383377 1046784 1046784 3463698 3463698 0 2057847 364730 1693117 51633 2500 49133 288736 288736 495766 17893 477873 121798 121798 Claims Paid and IBNR (note 2) 11130784 11130784 0 0 Drugs and Paid Medicines 2479394 2479394 0 0 Supplies 1089274 584765 504509 0 Other Expenses 908806 0 908806 0 495104 144455 350649 33895669 25025111 8870558 0 8611157 10549905 612253 1407254 603848 1047239 5053032 2845099 0 0 0 320006 341062 128118 170686 13416722 3541534 11144824 9875188 170870 4756137 26644108 30992570 1936514 1911925 5446261 4920084 0 9231654 2449400 16614429 9281409 X 8240383 17701169 1789296 4009992 0 0 10029679 21711161 26644108 30992570 X 4893320 6788162 X 0 1 1 X 1 1 X 27091947 29577739 31232257 32559289 38154916 158616148 0 0 0 0 0 0 0 0 0 0 27091947 29577739 31232257 32559289 38154916 158616148 158616148 95721 58840 54583 51959 58046 319149 0 0 0 0 768287 613959 553476 535567 576027 3047316 161982613 0.97922 0.97669 X Other Income: Rental of health facilities - $ 416,921 Cafeteria and vending machines - 139,831 Other Income - 19,275 Total $ 576,027 0 1959760 1959760 0 7670090 2020025 5650065 0 273008 66139 206869 0 3408040 1361086 2046954 0 105824 94284 11540 9875188 Construction in Progress (Corozal) 3735522 Restricted Cash Accounts 1020615 4756137 0 Incurred But Not recorded (medical claims) 2449400 2449400 38788989 33895669 4893320 0 0 0 0 6788162 6788162 11681482 38788989 0 0 0 0 0 38788989 0 0 0 38788989 33895669 0 0 0 0 0 33895669 0 0 0 33895669 SchD_P11_S00_L08 Schedule D, Part XI, Line 8 On January 2012 SIM entered into a settlement agreement and mutual release with Humana Health Plans of Puerto Rico, Inc. and Humana Insurance of Puerto Rico. In this agreement all the parties agreed to settle any and all pending surplus or deficit compensation discrepancies, including but not limited to all the extinguishment of outstanding credits and claims related to the parties Health Care Organization (HCO) Participation Agreement. The agreement includes balances as of October 31, 2011. As of October 31, 2011 SIM had a balance payable to Humana of $6,788,162. These balances corresponded entirely to losses accumulated in the Manage Care Contract between SIM and Humana up to June 30, 2011. X X X 0 0 0 0 0 0 0 0 0 Sandra V Garcia Rodriguez 131718 0 0 0 6000 0 0 0 0 0 137718 0 127399 0 Marien Vazquez 66402 0 0 0 500 0 0 0 0 0 66902 0 33328 0 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 Executive Director salary is approved by the Board. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b All questions related to governance, managament & disclosures were asked to the Board members by the CPA Firm partner in charge. Form 990 was presented to the Board of Directors on a regular meetting on December 26, 2012. The content of the form was reviewed and approved for filling by the Board. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The members of Board of Directors are required to complete on an annual basis a certification of not conflict of interest. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The salary of the Executive Director is determined and approved by the Board of Directors. It is determined based on performance and comparability data from other nonprofit organizations in Puerto Rico. The salaries of other key officers such as Medical Director, Finance Director, Director of Human Resources and Director of Operations are determined and approved by the Executive Director, based on performance, comparability data provided by trade associations, benchmarking data, and the experience of the local labor market for positions with health professional shortages. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The Accounting and Finance Policy and Procedures Manual of Salud Integral en la Montana, Inc. established that:.."the corporation will make the following forms available to the general public: a. Three most recent annual Return of Organization Exempt From Income Tax (990) b. The original tax exempt application (Form 1023 or 1024) filed with IRS. It is the policy of the Corporation to follow the following rules to fulfill the requirements of the public statements mentioned above. a. A copy of the forms will be provided to any person that requests in person to inspect those forms during regular business hours. The Finance Director is responsible for keeping a copy and for making it available to the public. b. For requests received by mail, the Corporation will request payment in advance for the costs of copies and shipping charges. If the request does not include payment, the Corporation will notify the person by phone or by mail of its prepayments policy within the seven days after receiving the original request. c. The cost per copy will be $1.00 for the first copy and $.15 for each additional page. All copies will be sent to the person that requests them by priority mail within 30 days of receiving the request. F990_P11_S00_L05 Form 990, Part XI, Line 5 On January 2012 SIM entered into a settlement agreement and mutual release with Humana Health Plans of Puerto Rico, Inc. and Humana Insurance of Puerto Rico. In this agreement all the parties agreed to settle any and all pending surplus or deficit compensation discrepancies, including but not limited to all the extinguishment of outstanding credits and claims related to the parties Health Care Organization (HCO) Participation Agreement. The agreement includes balances as of October 31, 2011. As of October 31, 2011 SIM had a balance payable to Humana of $6,788,162. These balances corresponded entirely to losses accumulated in the Manage Care Contract between SIM and Humana up to June 30, 2011. Audited Financial Statements were not completed on November 15, 2012; an extension was filled and approved.