2013-10-28T09:22:55-05:00 2012-12-31 420714325 MCGLADREY LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2012-01-01 132813103 OPEN DOOR FAMILY MEDICAL CENTER INC OPEN 9145021470 165 MAIN STREET OSSINING NY 10562 LINDSAY C FARRELL 9145021470 2013-10-28 1 MARTIN GREIF P00029738 2123721000 2012 2016-02-25 16:41:14Z LINDSAY C FARRELL 165 MAIN STREET OSSINING NY 10562 48491972 0 X WWW.OPENDOORMEDICAL.ORG X 1975 NY OPEN DOOR FAMILY MEDICAL CENTER PROVIDES QUALITY PRIMARY HEALTH CARE AND HUMAN SERVICES AT AFFORDABLE PRICES TO THE COMMUNITY, PARTICULARLY LOW-INCOME, UNDER-SERVED RESIDENTS AND THOSE LACKING ACCESS TO HEALTH CARE. 19 19 387 352 0 0 10756507 10018576 24500364 25286649 155851 247475 377091 415562 35789813 35968262 0 0 0 0 18591714 20397432 0 0 0 8400165 9466603 26991879 29864035 8797934 6104227 39065935 46340182 8771656 9757625 30294279 36582557 THE MISSION OF THE OPEN DOOR FAMILY MEDICAL CENTER, INC. IS TO PROVIDE QUALITY PRIMARY HEALTH CARE AND HUMAN SERVICES AT AFFORDABLE PRICES TO THE COMMUNITY, PARTICULARLY LOW-INCOME, UNDER-SERVED RESIDENTS AND THOSE LACKING ACCESS TO HEALTH CARE. 0 0 18908716 19800283 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 34,173 MEDICAL PATIENTS THAT GENERATED 123,974 VISITS IN 2012. 3356691 4509935 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 14,108 DENTAL PATIENTS THAT GENERATED 33,104 VISITS IN 2012. 1593881 976431 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 2,132 MENTAL HEALTH PATIENTS THAT GENERATED 7,528 VISITS IN 2012. 23859288 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 1 1 0 0 1 23 0 1 387 1 0 0 0 0 0 0 0 0 0 0 X 19 19 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MARIA MAZZOTTA 9145021470 165 MAIN STREET OSSINING NY 10562 X TYLER BEEBE 1.00 X 0 0 0 CHARLES CHEHEBAR 1.00 X 0 0 0 JOHN CONYERS 1.00 X 0 0 0 WALTER EDGE 1.00 X 0 0 0 JENNIFER GURAHIAN 1.00 X 0 0 0 DORIAN LINDSAY 1.00 X 0 0 0 TONY MEJIAS 1.00 X 0 0 0 KEVIN NELSON 1.00 X 0 0 0 MARIA M PEREZ 1.00 X 0 0 0 MARGOTH PILLA 1.00 X 0 0 0 ROSA ROJAS 1.00 X 0 0 0 DIANA SCHAEFER 1.00 X X 0 0 0 HOWARD S SCHRADER 1.00 X 0 0 0 DAVID K SHERMAN 1.00 X X 0 0 0 STEWART TABIN 1.00 X 0 0 0 ROSA TAYLOR 1.00 X 0 0 0 ANDRES VALDESPINO 1.00 X X 0 0 0 LUIS VICETTI 1.00 X 0 0 0 DONNA WADE 1.00 X X 0 0 0 LINDSAY C FARRELL 34.00 4.00 X 288088 0 16586 MARIA MAZZOTTA 33.00 2.00 X 165938 0 4671 DAREN WU 38.00 X 279236 0 11846 JANET H BOZZONE 38.00 X 195997 0 9698 BRUCE M SHAFFER 38.00 X 228214 0 20083 KAREN MURRAY 38.00 X 212561 0 18624 ANITA WILENKIN 38.00 X 177845 0 26199 REBECCA ANN WILLIAMS 38.00 X 172686 0 24356 DEBRA L GERSON 38.00 X 178051 0 9793 1898616 0 141856 9 0 1 0 COMPREHENSIVE EYE SERVICES PO BOX 187 ARMONK NY 10504 EYE CLINIC 247951 ECLINICAL WORKS TWO TECHNOLOGY DRIVE WESTBOROUGH MA 01581 ECW SUPPORT & E-SUBSCRIBING 178799 WESTCHESTER INSTITUTE OF HUMAN DEVELOPME CEDAR HALL RM322 VALHALLA NY 10595 PROJECT LAUNCH EVALUATOR 140840 MCGLADREY & PULLEN LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 10036 AUDIT/TAX PREPARATION 138526 4 7921822 2096754 10018576 MEDICAID 621400 14798049 14798049 UNCOMPENSATED CARE 621400 4225595 4225595 CHILD HEALTH PLUS 621400 2557980 2557980 SELF-PAY 621400 2399122 2399122 MEDICARE 621400 710560 710560 595343 595343 25286649 264378 264378 12506807 12523544 166 -16737 -166 -16903 -16903 REIMB SALARIES & FRINGE 900099 379378 379378 MISC. REVENUE 900099 36184 36184 415562 35968262 25286649 0 663037 972060 799407 172653 16044069 12996680 3047389 1384853 1138882 245971 819765 674162 145603 1176685 967688 208997 118099 118099 142371 142371 90461 90461 2239048 1842123 396925 5326 5326 1770073 1308698 461375 207123 207123 857129 732797 124332 28285 21292 6993 183137 90198 92939 268075 268075 1222672 1058834 163838 259898 225072 34826 PHARMACEUTICALS 632952 632952 LABORATORY FEES 491923 491923 REPAIRS & MAINTENANCE 268667 194360 74307 DATA PROCESSING 212197 112866 99331 469167 364231 104936 29864035 23859288 6004747 0 5444209 6987689 479555 2700670 956090 1595925 6345663 4014842 282442 677995 26631133 12831192 14143373 13799941 10779176 15981092 635427 582028 39065935 46340182 4967650 6261793 3739492 3450401 64514 45431 8771656 9757625 X 30210368 36549724 83911 32833 30294279 36582557 39065935 46340182 X 6104227 825892 -641841 X X 0 1 X 1 1 1 X 6469111 6890084 8526604 10756507 10018576 42660882 6469111 6890084 8526604 10756507 10018576 42660882 42660882 75938 48675 153335 201594 264381 743923 20985 5676 338569 377091 415562 1157883 44562688 108934883 0.95730 0.96840 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1740016 1740016 2274217 1384158 890059 13318535 6448560 6869975 3316519 2866892 449627 5981846 2131582 3850264 13799941 CAPITAL LEASE PAYABLE 20945 DUE TO HUDSON HEALTH PLAN 74381 DUE FROM AFFILIATE - EIN # 13-3598184 -49895 45431 X 38513485 825892 304609 1884395 3014896 35498589 90461 379212 469673 35968262 31306051 304609 1227868 1532477 29773574 90461 90461 29864035 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MANAGEMENT EVALUATED THE CORPORATION'S TAX POSITIONS AND CONCLUDED THAT THE CORPORATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF THIS GUIDANCE. WITH FEW EXCEPTIONS, THE CORPORATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2009, WHICH IS THE STANDARD STATUTE OF LIMITATIONS LOOK-BACK PERIOD. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE OF RELATED ENTITIES 1,884,395. PART XI, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED SALARIES/FRINGE 379,378. LOSS ON DISPOSAL OF ASSET -166. PART XII, LINE 2D - OTHER ADJUSTMENTS: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 641,841. REIMBURSED SALARIES/FRINGE -379,379. EXPENSES OF RELATED ENTITIES 965,240. LOSS ON DISPOSAL OF FIXED ASSET 166. X 0 0 X X X 0 0 0 0 0 1 0 1 0 LINDSAY C FARRELL 257004 0 30000 0 1084 0 10138 0 6448 0 304674 0 0 0 MARIA MAZZOTTA 158306 0 7500 0 132 0 0 0 4671 0 170609 0 0 0 DAREN WU 243553 0 29498 0 6185 0 9767 0 2079 0 291082 0 0 0 JANET H BOZZONE 182128 0 13183 0 686 0 6877 0 2821 0 205695 0 0 0 BRUCE M SHAFFER 227584 0 0 0 630 0 7902 0 12181 0 248297 0 0 0 KAREN MURRAY 197377 0 15000 0 184 0 5229 0 13395 0 231185 0 0 0 ANITA WILENKIN 170174 0 7000 0 671 0 6546 0 19653 0 204044 0 0 0 REBECCA ANN WILLIAMS 172313 0 0 0 373 0 854 0 23502 0 197042 0 0 0 DEBRA L GERSON 177736 0 0 0 315 0 6244 0 3549 0 187844 0 0 0 PART I, LINE 1A DAREN WU RECEIVED $6,000 IN TAXABLE HOUSING ALLOWANCE. PART I, LINE 6 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED INCENTIVE BONUSES, WHICH ARE BASED ON THE NET EARNINGS OF EACH INDIVIDUAL'S BUSINESS SEGMENT, DURING THE YEAR ENDED 12/31/12: DAREN WU - $23,998 JANET H. BOZZONE - $10,683 KAREN MURRAY - $15,000 PART I, LINE 7 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED NON-FIXED PAYMENTS, DETERMINED BY THE BOARD, DURING THE YEAR ENDED 12/31/12: LINDSAY C. FARRELL - $30,000 MARIA MAZZOTTA - $7,500 DAREN WU - $5,500 JANET H. BOZZONE - $2,500 ANITA WILENKIN - $7,000 FORM 990, PART VI, SECTION A, LINE 6 OPEN DOOR, INC. IS THE SOLE MEMBER OF OPEN DOOR FAMILY MEDICAL CENTER, INC. FORM 990, PART VI, SECTION B, LINE 11 OPEN DOOR FAMILY MEDICAL CENTER ENGAGES THE SERVICES OF AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE ANNUAL FORM 990 IN CONJUNCTION WITH ITS ANNUAL AUDITED FINANCIAL STATEMENTS. THE PRESIDENT/CEO AND CFO REVIEW THE FORM 990 AND SCHEDULES FOR ACCURACY. IN JUNE 2013, THE FORM 990, FOR THE YEAR ENDED DECEMBER 31, 2012, WAS PRESENTED TO THE FINANCE COMMITTEE AND BOARD MEMBERS FOR REVIEW PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THROUGH ITS CORPORATE COMPLIANCE PROGRAM, THE CENTER'S COMPLIANCE COMMITTEE, WHICH IS COMPRISED OF AN INTERDISCIPLINARY TEAM OF STAFF MEMBERS, MEETS ON A MONTHLY BASIS TO MONITOR THE RESULTS OF ITS INTERNAL AND EXTERNAL AUDITS AND INVESTIGATIONS TO ENSURE COMPLIANCE WITH ITS POLICIES WHICH INCLUDE ANY CONFLICT OF INTEREST. 1. THE MANAGEMENT OF THE OPEN DOOR WILL DEDICATE SUCH RESOURCES AS ARE NECESSARY TO DEVELOP AND IMPLEMENT AN EFFECTIVE CORPORATE COMPLIANCE PROGRAM DESIGNED TO PROMOTE ADHERENCE TO ALL APPLICABLE LAWS, INCLUDING THE STATUTES, REGULATIONS AND REQUIREMENTS APPLICABLE TO MEDICAID, MEDICARE AND OTHER FEDERAL AND STATE HEALTH CARE PROGRAMS. 2. THE COMPLIANCE PROGRAM WILL MEET OR EXCEED THE COMPONENTS OF AN EFFECTIVE COMPLIANCE PROGRAM AS IDENTIFIED BY THE OIG IN ITS COMPLIANCE PROGRAM GUIDANCES. THESE COMPONENTS INCLUDE: A) CONDUCTING INTERNAL MONITORING AND AUDITING; B) IMPLEMENTING WRITTEN STANDARDS AND POLICIES AND PROCEDURES; C) DESIGNATING A COMPLIANCE OFFICER AND COMMITTEE; D) CONDUCTING APPROPRIATE TRAINING AND EDUCATION; E) RESPONDING APPROPRIATELY TO DETECTED OFFENSES AND DEVELOPING CORRECTIVE ACTION; F) DEVELOPING OPEN LINES OF COMMUNICATION; G) ENFORCING DISCIPLINARY STANDARDS THROUGH WELL-PUBLICIZED GUIDELINES. 3. THE BOARD RECOGNIZES THAT THE DEVELOPMENT AND IMPLEMENTATION OF A COMPREHENSIVE AND EFFECTIVE CORPORATE COMPLIANCE PROGRAM WILL BE BOTH TIME CONSUMING AND COSTLY. ACCORDINGLY, OPEN DOOR MANAGEMENT IS DIRECTED TO PROCEED WITH THE DEVELOPMENT AND IMPLEMENTATION OF A PROGRAM BY FOCUSING ON COMPLIANCE FUNCTIONS HAVING PRIORITY AND ON PRACTICE AREAS IDENTIFIED AS POTENTIAL "RISK AREAS" BY THE OPEN DOOR OR, MORE GENERALLY, BY THE OIG AND OTHER FEDERAL OR STATE GOVERNMENT ENFORCEMENT AGENCIES. CONSISTENT WITH THE OIG'S COMPLIANCE PROGRAM GUIDANCE'S, MANAGEMENT WILL PROCEED WITH THE DEVELOPMENT AND IMPLEMENTATION OF THE CORPORATE COMPLIANCE PROGRAM AND SHALL PROVIDE PERIODIC PROGRESS REPORTS TO THE BOARD. 4. BASED ON THE FOREGOING, THE BOARD DIRECTS OPEN DOOR MANAGEMENT TO SEND A LETTER TO ALL OPEN DOOR EMPLOYEES, CONSULTANTS, VENDORS AND VOLUNTEERS ADVISING THEM OF THE INTENDED COMPLIANCE PROGRAM. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD CONDUCTS PARITY STUDIES TO EVALUATE EXECUTIVE COMPENSATION. THE BOARD APPROVES THE CHIEF EXECUTIVE OFFICER'S GOALS ANNUALLY AND ANNUAL PERFORMANCE. FORM 990, PART VI, SECTION C, LINE 19 OPEN DOOR DOES MAKE ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY POSTING ON THE ORGANIZATION'S WEBSITE; PROVIDING COPIES UPON REQUEST; AND INSPECTION AT AN OFFICE OF THE ORGANIZATION. THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST, AT THE ORGANIZATION'S LOCATION. FORM 990, PART VII THE ORGANIZATION, IN A FULL TRANSPARENCY POSTURE TO REPORTING, IS REPORTING ALL BENEFITS IN FULL IN PART VII, COLUMN F AND NOT APPLYING THE $10,000 PER ITEM EXCEPTION FOR CERTAIN BENEFITS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -641,841. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSEEING THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT THAT AUDITED THE FINANCIAL STATEMENTS HAS BEEN CONSISTENT WITH PRIOR YEARS. # OF HOURS WORKED FOR RELATED ENTITIES FORM 990, PART VII LINDSAY FARRELL WORKED 4 HOURS/WEEK FOR OPEN DOOR FOUNDATION, INC. MARIA MAZZOTTA WORKED 2 HOURS/WEEK FOR OPEN DOOR FOUNDATION, INC. OPEN DOOR FOUNDATION INC 165 MAIN STREET OSSINING NY 10562 133598184 FUNDRAISING/DEVELOPMENT NY 501(C)(3) LINE 7 OPEN DOOR INC 0 OPEN DOOR INC 165 MAIN STREET OSSINING NY 10562 133585009 SUPPORTING ORGANIZATION NY 501(C)(3) LINE 11B, II 0 OPEN DOOR LEASING CORP 165 MAIN STREET OSSINING NY 10562 201726717 LEASING SPACE NY OPEN DOOR FAMILY MEDICAL CENTER INC C 290799 13100 1.00000 0 0 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 1 0 0 OPEN DOOR LEASING CORP K 287726 COST