2013-04-30T13:34:01-05:00 2012-06-30 221478099 COHNREZNICK LLP 180 GLASTONBURY BOULEVARD GLASTONBURY CT 06033 990 2011-07-01 223160873 STAYWELL HEALTH CARE INC STAY 2037568021 80 PHOENIX AVENUE NO 201 WATERBURY CT 06702 DONALD J THOMPSON JR 2037568021 2013-04-22 1 P00852868 8606333000 2011 2016-03-07 17:11:31Z DONALD J THOMPSON JR 80 PHOENIX AVENUE WATERBURY CT 06702 14361776 0 X WWW.STAYWELLHEALTH.ORG X 1992 CT PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 10 10 155 38 139 0 3170165 3403013 9505293 10505285 8749 5589 -1268 282089 12682939 14195976 0 0 0 0 9666634 10780123 0 0 2565 2708412 2836571 12375046 13616694 307893 579282 9136341 10017874 2857273 2609296 6279068 7408578 PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 0 0 7716012 10787103 MEDICAL CLINIC, HEALTHY START, AND DENTAL CLINIC WHICH PROVIDE MEDICAL, PRENATAL, AND CHILDCARE FOR INNER CITY RESIDENTS AND UNINSURED RESIDENTS AND RESTORATIVE DENTAL CARE FOR INNER CITY CHILDREN. THE TOTAL NUMBER OF VISITS DURING FISCAL YEAR 2012 WAS 86,418. 7716012 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 1 1 1 0 0 1 63 0 1 155 1 1 1 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 1 1 1 1 0 CT X LULE TRACEY 2037568021 80 PHOENIX AVENUE SUITE 201 WATERBURY CT 06702 MIGDALIA ROSARIO 2.00 X X 0 0 0 MARK BRIGGS 2.00 X X 0 0 0 ANGIE MEDINA 2.00 X X 0 0 0 ARLENE M ARIAS LCSW 2.00 X X 0 0 0 SANDRA J SOREL-LEDUC 2.00 X 0 0 0 TYRONE B WILLIAMSON 2.00 X 0 0 0 REV CHRISTOPHER KING 2.00 X 0 0 0 WALTER R MACHNICZ 2.00 X 0 0 0 CAROLYN A HIGHSMITH 2.00 X 0 0 0 LAURIE LOUMINGOU 2.00 X 0 0 0 DONALD J THOMPSON JR 40.00 X 188905 0 63649 LULE TRACEY 40.00 X 161376 0 44302 SUNIL D'CUNHA 40.00 X 230093 0 29817 AMIT PATEL 40.00 X 191972 0 37792 ANN ASUNTO 40.00 X 130362 0 15869 VASUDEV KANADE 40.00 X 131021 0 14676 MONIKA KAUL 40.00 X 130154 0 28287 ADNA SADIQ 40.00 X 131896 0 32165 1295779 0 266557 8 0 1 0 AMARC BUILDERS LLC 691 ROXBURY ROAD SOUTHBURY CT 06488 CONSTRUCTION 122679 GEMINI DENTAL LABS 250 PORTER STREET SUITE 73 WATERTOWN CT 06795 DENTAL LAB SERVICES 102077 2 35000 3360515 7498 494255 3403013 PATIENT SERVICE 621400 10484493 10484493 PHARMACY 446110 20792 20792 10505285 5589 5589 166071 165800 271 271 139 132 MEANINGFUL USE INCENTI 900099 276250 276250 OTHER REVENUE 900099 5568 5568 281818 14195976 10787103 139 5721 738515 403336 335179 7183821 3923401 3260420 492398 268920 223478 1731701 945757 785944 633688 346085 287603 7912 7912 29850 29850 859346 469327 390019 16964 9265 7699 124339 84661 39678 24731 24731 131919 97691 34228 30769 16804 13965 15751 8602 7149 58992 48087 10905 262429 174325 88104 VACCINES 494255 494255 CLINIC SUPPLIES 314456 171738 142718 EQUIPMENT RENTAL AND MA 233983 129067 104916 DUES, LICENSES, & MEMBE 62545 34159 28386 168330 90532 75233 2565 13616694 7716012 5898117 2565 1163523 1856206 2502602 2004489 48759 90449 790274 972010 22983 182467 6573205 2021958 4183285 4551247 424915 361006 9136341 10017874 1583985 1337213 8317 8318 118539 171343 1146432 1092422 2857273 2609296 X 4640468 5962355 1638600 1446223 6279068 7408578 9136341 10017874 X 579282 550228 X X 0 1 1 X 1 1 X 3070656 3066787 3639556 3170165 3403013 16350177 3070656 3066787 3639556 3170165 3403013 16350177 16350177 32826 6332 3860 8749 5589 57356 3045 3613 271 6929 5568 5568 16420030 43683033 0.99570 0.99220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 384297 384297 5239261 1279627 3959634 913153 712687 200466 36494 29644 6850 4551247 14195976 13616694 579282 550228 550228 1129510 14361776 165800 165800 14195976 0 14195976 13782494 165800 165800 13616694 0 13616694 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2012. THE CORPORATION'S U.S. FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2009 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CORPORATION HAS UNRELATED BUSINESS INCOME TAXES, IT RECOGNIZES INTEREST AND PENALTIES ASSOCIATED WITH ANY TAX MATTERS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE STATEMENTS OF FINANCIAL POSITION. PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFER OF TRALEE NET ASSETS UPON DISSOLUTION 550,228. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSES 165,800. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSES 165,800. X X X 0 1 0 0 0 0 0 0 0 DONALD J THOMPSON JR 188905 0 0 0 0 0 25500 0 38149 0 252554 0 0 0 LULE TRACEY 161376 0 0 0 0 0 9250 0 35052 0 205678 0 0 0 SUNIL D'CUNHA 230093 0 0 0 0 0 0 0 29817 0 259910 0 0 0 AMIT PATEL 191972 0 0 0 0 0 0 0 37792 0 229764 0 0 0 MONIKA KAUL 130154 0 0 0 0 0 0 0 28287 0 158441 0 0 0 ADNA SADIQ 131896 0 0 0 0 0 0 0 32165 0 164061 0 0 0 PART I, LINE 4B DONALD J. THOMPSON, JR, 457 (F), $25,500 LULE TRACEY, 457 (F), $9,250 X 1 494255 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 EACH MEMBER OF THE BOARD RECEIVES A COPY OF THE 990 FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C DONALD THOMPSON, CEO, MONITORS CONFLICT OF INTEREST POLICY BY REVIEWING AND ADDRESSING ANY POTENTIAL CONFLICTS AND FOLLOWING UP EACH YEAR FOR ANY CHANGES. FORM 990, PART VI, SECTION B, LINE 15 INFORMATION FROM NATIONAL AND STATEWIDE SURVEYS ARE USED AS CRITERIA TO DETERMINE THE SALARY OF THE CEO. THIS INFORMATION IS GIVEN TO THE PERSONNEL COMMITTEE FOR REVIEW. THE PERSONNEL COMMITTEE NEGOTIATES AND APPROVES THE SALARY OF THE CEO. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: TRANSFER OF TRALEE NET ASSETS UPON DISSOLUTION 550,228. TOTAL TO FORM 990, PART XI, LINE 5: 550,228. FORM 990, PART XII, LINE 2C: THERE HAVE BEEN NO CHANGES IN THE OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR. TRALEE INC 80 PHOENIX AVE STE 201 WATERBURY CT 06702 061594623 PROPERTY CT 501(C)(2) STAYWELL HEALTH CARE INC 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 TRALEE INC J 30990 ACTUAL COST TRALEE INC Q 550228 NET BOOK VALUE