2013-05-14T20:52:18-05:00 2012-06-30 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2011-07-01 363088628 ERIE FAMILY HEALTH CENTER INC ERIE 3126663494 1701 W SUPERIOR STREET CHICAGO IL 60622 LEE FRANCIS 3126663494 2013-05-14 1 KIMBERLY A HAUMANN P00546491 3122071040 2013-05-14 2011 2016-02-24 21:20:13Z LEE FRANCIS 1701 W SUPERIOR STREET CHICAGO IL 60622 33591809 0 X WWW.ERIEFAMILYHEALTH.ORG X 1970 IL OPERATE A HEALTHCARE CENTER TO SERVE A LARGELY MEDICALLY UNDERSERVED POPULATION IN CHICAGO. 23 23 457 84 0 0 13455508 15418861 16779866 18121102 18134 24361 10683 -23415 30264191 33540909 0 0 0 0 19614327 22641956 0 179443 201588 6235513 7105852 25849840 29927251 4414351 3613658 21802587 25644724 5096665 5325144 16705922 20319580 X ERIE FAMILY MEDICAL CENTER'S (ERIE) MISSION IS TO PROVIDE AFFORDABLE, ACCESSIBLE HIGH-QUALITY CARE TO THOSE IN NEED. IT ACCOMPLISHES THIS OBJECTIVE BY SERVING AS A MEDICAL HOME FOR THE MORE THAN 43,000 PATIENTS EACH YEAR AND CONTINUOUSLY EVOLVING TO RESPOND TO THE NEEDS OF EACH COMMUNITY IT SERVES. 0 0 21558574 16267042 ERIE FAMILY HEALTH CENTER PROVIDES COMPREHENSIVE PRIMARY CARE SERVICES AT THIRTEEN SITES IN CHICAGO AND THE NORTHERN SUBURBS, INCLUDING: FIVE LARGE PRIMARY HEALTH CARE CENTERS, ONE ADOLESCENT-ONLY HEALTH CENTER, FIVE SCHOOL-BASED HEALTH CENTERS, AND TWO DENTAL HEALTH CENTERS. ERIE'S PRIMARY CARE MEDICAL SERVICES INCLUDE PEDIATRICS, INTERNAL MEDICINE, FAMILY MEDICINE, AND WOMEN'S HEALTH. IN ADDITION, ERIE PROVIDES ORAL HEALTH SERVICES, PODIATRY, HIV/AIDS CARE, EYE CARE, BEHAVIORAL HEALTH COUNSELING, CASE MANAGEMENT SERVICES AND HEALTH EDUCATION. NINETY-SEVEN PERCENT OF ERIE'S PATIENTS LIVE AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL AND 33% ARE UNINSURED. ERIE'S HIGHLY SKILLED PROVIDERS, INNOVATIVE PARTNERSHIPS AND FORWARD-THINKING APPROACH MAKE IT A NATIONAL LEADER FOR THE PROVISION OF COMMUNITY-BASED HEALTH CARE. 2675534 1854060 ERIE'S AWARD-WINNING ORAL HEALTH PROGRAM SERVES MORE THAN 7,000 LOW-INCOME CHICAGOANS PER YEAR, INCLUDING CHILDREN AND THEIR NUCLEAR FAMILY MEMBERS, DIABETICS, INDIVIDUALS WITH HIV/AIDS AND PREGNANT WOMEN. SERVICES PROVIDED INCLUDE ROUTINE CLEANINGS, X-RAYS, SEALANTS, FILLINGS, CROWNS, ROOT CANALS AND TOOTH EXTRACTIONS. ERIE FOCUSES NOT ONLY ON TREATING, BUT ALSO ON PREVENTING ORAL HEALTH PROBLEMS. ORAL CARE IS INTEGRATED INTO THE PRIMARY MEDICAL CARE OFFERED AT ALL ERIE LOCATIONS. IN ADDITION, ERIE PROVIDES ORAL HEALTH EDUCATION TO MORE THAN 2,500 COMMUNITY MEMBERS ANNUALLY. TO CONTINUE TO MEET THE GROWING COMMUNITY NEED FOR AFFORDABLE HIGH-QUALITY CARE, ERIE PLANS TO DOUBLE ITS DENTAL CARE CAPACITY WITHIN THE NEXT FIVE YEARS. 24234108 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 33 0 1 457 1 0 0 0 0 0 1 1 0 0 0 0 X 23 23 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X ANGELICA SANCHEZ 3124327389 1701 WEST SUPERIOR STREET CHICAGO IL 60622 BRIAN P MARSELLA 2.00 X X 0 0 0 ANA MARIA SOTO 1.50 X X 0 0 0 ERIC MAYEDA 2.00 X X 0 0 0 DEBORAH B WRIGHT-POWELL 1.50 X X 0 0 0 WILLIAM KISTNER 2.00 X 0 0 0 DANIEL J TOUNSEL III 1.00 X 0 0 0 ROSALIE ALICEA 1.50 X 0 0 0 CELESTE CASTILLO 1.50 X 0 0 0 MICHAEL COLE 1.00 X 0 0 0 LINDA CUSHMAN 0.50 X 0 0 0 PILAR GONZALEZ 0.50 X 0 0 0 MARIA HERNANDEZ 0.50 X 0 0 0 REVEREND ED SARDEN 1.00 X 0 0 0 DARYL TOM 1.00 X 0 0 0 HUMBERTO URIBE 1.00 X 0 0 0 KATHERINE WILSON 1.00 X 0 0 0 JULIE ZERWIC 1.00 X 0 0 0 MATT AARONSON 1.00 X 0 0 0 JILL SIMON SVOBODA 1.50 X 0 0 0 JACQUELINE CERVANTES 1.00 X 0 0 0 AMELIA MADRIGAL 1.00 X 0 0 0 JUAN FERNANDO JAUREGI 1.00 X 0 0 0 ANA LILIA VIVAR 1.00 X 0 0 0 LEE FRANCIS 40.00 X 224778 0 5862 DAVID R BUCHANAN 40.00 X 189218 0 12759 KEVIN GREENBERG 40.00 X 81487 0 1743 ZAKEYA ATIA 40.00 X 108095 0 1434 LUZ JIMENEZ 40.00 X 110177 0 6494 ILIANA MORA 40.00 X 151302 0 3493 RAMON BARAJAS 40.00 X 247230 0 8317 DEBORAH L EDBERG 40.00 X 197244 0 10587 MIRIAH D PLAWER-VOLMERDING 40.00 X 214245 0 4040 GHASSAN SOURI 40.00 X 186747 0 8917 DIANE Q ROZYCKI 40.00 X 185899 0 6285 1896422 0 69931 33 0 1 0 LAB CORP PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 607331 BELCORE ELECTRIC 1600 MAIN STREET MELROSE PARK IL 60160 ELECTRICAL SERVICES 277782 COMCAST PHONE LLC 16333 COLLECTION CENTER DRIVE CHICAGO IL 60693 PHONE AND INTERNET SERVICES 241014 TYMPANI INC 2001 BUTTERFIELD ROAD SUITE 250 DOWNERS GROVE IL 60515 CONSULTING AND PHONE SERVICES 235155 ALLIANCE OF CHICAGO 215 W OHIO ST 4TH FLOOR CHICAGO IL 60654 SUPPORT SERVICES 208039 11 163934 13069997 2184930 15418861 MEDICARE/MEDICAID PAYM 624100 16287226 16287226 SELF-PAY 624100 1305555 1305555 KID CARE/HEALTHY MOM 624100 506083 506083 MEDICAL RECORD FEES 624100 13586 13586 RENTAL INCOME 531120 8652 8652 18121102 24361 24361 27485 163934 50900 -23415 -23415 33540909 18121102 0 946 601107 368692 232415 18658313 15632087 3026226 203098 148870 54228 1854414 1292225 562189 1325024 971239 353785 63513 63513 179443 179443 470793 232592 230075 8126 30268 23691 6577 400592 312515 86480 1597 1131665 1017134 114531 39371 26440 12703 228 92522 62134 29329 1059 82608 82608 1344191 961838 377651 4702 156946 133683 23263 CONTRACTED DIAGNOSTIC S 643623 643623 EQUIPMENT RENTAL & MAIN 591293 446808 144485 MEDICAL AND LAB SUPPLIE 556156 556156 BAD DEBT 551110 551110 951201 853271 91497 6433 29927251 24234108 5491555 201588 2368921 4287556 4420917 4444807 1993216 2246543 1708683 3274264 148928 357305 19072460 8651569 10465581 10420891 462216 466365 234125 146993 21802587 25644724 2533485 2661080 10717 220363 1720353 1611591 832110 832110 5096665 5325144 X 16072557 19919892 633365 399688 16705922 20319580 21802587 25644724 3613658 0 X 0 1 1 X 1 1 X 9769035 10716883 11249810 13455508 15418861 60610097 37597 40830 42883 40002 13586 174898 9806632 10757713 11292693 13495510 15432447 60784995 60784995 83204 74238 17624 18134 24361 217561 37597 40830 42883 40002 13586 174898 61177454 77029301 0.99360 0.99320 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 29927251 29927251 1000000 250000 0 0 1000000 1000000 2000000 3000000 7500 7500 250000 250000 500000 750000 77800 77800 5093236 2229382 2863854 7657084 2585694 5071390 3231901 1995862 1236039 3012439 1840631 1171808 10420891 THIRD-PARTY PAYOR LIABILITY 832110 832110 33540909 29927251 3613658 3613658 33619369 78460 78460 33540909 0 33540909 30005711 78460 78460 29927251 0 29927251 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CENTER'S APPLICATION OF GAAPUSA REGARDING UNCERTAIN TAX POSITIONS HAD NO EFFECT ON ITS FINANCIAL POSITION AS MANAGEMENT BELIEVES THE CENTER HAS NO MATERIAL UNRECOGNIZED INCOME TAX BENEFITS, INCLUDING ANY POTENTIAL RISK OF LOSS OF ITS NOT-FOR-PROFIT TAX STATUS. THE CENTER WOULD ACCOUNT FOR ANY POTENTIAL INTEREST OR PENALTIES RELATED TO POSSIBLE FUTURE LIABILITIES FOR UNRECOGNIZED INCOME TAX BENEFITS AS INCOME TAX EXPENSE. THE CENTER IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR PERIODS BEFORE 2009. X X X X X X X 1 THE LOEVY CONSULTING GROUP SARA SE 1321 EAST 50TH STREET CHICAGO IL 60615 INTERIM DIRECTOR OF DEVELOPMENT 0 626633 150410 476223 RACHEL KRAUSE 1439 NORTH OAKLEY CHICAGO IL 60622 GRANT WRITING 0 358090 29033 329057 984723 179443 805280 IL GOLDEN TOOTHBRUSH 132305 129425 2880 21757 11289 ERIEDESCENCE 59114 34509 24605 15027 2827 191419 163934 27485 36784 14116 50900 -23415 X X X X X 0 0 0 0 0 0 0 0 0 LEE FRANCIS 182069 0 42709 0 0 0 4031 0 1831 0 230640 0 0 0 DAVID R BUCHANAN 169903 0 19315 0 0 0 4412 0 8347 0 201977 0 0 0 ILIANA MORA 134421 0 16881 0 0 0 3353 0 140 0 154795 0 0 0 RAMON BARAJAS 236108 0 11122 0 0 0 5925 0 2392 0 255547 0 0 0 DEBORAH L EDBERG 188253 0 8991 0 0 0 4850 0 5737 0 207831 0 0 0 MIRIAH D PLAWER-VOLMERDING 199611 0 14634 0 0 0 3900 0 140 0 218285 0 0 0 GHASSAN SOURI 166266 0 20481 0 0 0 3510 0 5407 0 195664 0 0 0 DIANE Q ROZYCKI 170173 0 15726 0 0 0 4080 0 2205 0 192184 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 ERIE FAMILY HEALTH CENTER (EFHC) USES A THIRD PARTY (INDEPENDENT CPA FIRM) TO PREPARE ITS 990 TAX FORM. UPON THE FORM'S COMPLETION, A COPY IS PROVIDED TO EFHC'S MANAGEMENT FOR REVIEW AND THEN SUBSEQUENTLY REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. ANY NECESSARY CHANGES ARE COMMUNICATED TO THE CPA FIRM AND INCORPORATED AS APPROPRIATE. ONCE THE 990 DRAFT IS FINALIZED A COPY IS MADE AVAILABLE TO THE BOARD OF DIRECTORS. THE THIRD PARTY WILL THEN FILE THE 990 ON EFHC'S BEHALF. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, KEY EMPLOYEES, AND MEMBERS OF THE BOARD ARE ANNUALLY REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM AS A PRECURSOR TO THEIR SERVICE TO THE ORGANIZATION. POTENTIAL CONFLICTS ARE LOGGED WITH AND MONITORED BY EFHC MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 EFHC PERIODICALLY USES AN INDEPENDENT THIRD PARTY TO REVIEW THE CURRENT COMPENSATION FOR MEMBERS OF THE LEADERSHIP TEAM. BASED ON THIS REVIEW, COMPENSATION LEVELS ARE SET FOR EACH LEVEL OF EMPLOYMENT. COMPENSATION REVIEWS BY THIRD PARTIES ARE CONDUCTED EVERY 3 YEARS. THE LAST REVIEW WAS IN 2011. FORM 990, PART VI, SECTION C, LINE 19 EFHC GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE FOR PUBLIC REVIEW UPON REQUEST. REQUESTS ARE REQUIRED TO BE IN WRITING.