2012-06-25T09:36:12-05:00 2011-12-31 420714325 MCGLADREY LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2011-01-01 132813103 OPEN DOOR FAMILY MEDICAL CENTER INC OPEN 9145021470 165 MAIN STREET OSSINING NY 10562 LINDSAY C FARRELL 9145021470 2012-06-25 1 MARTIN GREIF P00029738 2123721000 2011 2016-02-24 21:20:13Z LINDSAY C FARRELL 165 MAIN STREET OSSINING NY 10562 46530107 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. 20 20 375 358 0 0 8526604 10756507 21602843 24500364 211346 155851 338569 377091 30679362 35789813 0 0 0 0 17571541 18591714 0 0 0 8960254 8400165 26531795 26991879 4147567 8797934 32801136 39065935 10786990 8771656 22014146 30294279 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 16536570 19289943 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 33,687 MEDICAL PATIENTS THAT GENERATED 127,345 VISITS IN 2011. 2935586 4419505 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 13,558 DENTAL PATIENTS THAT GENERATED 32,023 VISITS IN 2011. 1393925 790916 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 1,871 MENTAL HEALTH PATIENTS THAT GENERATED 7,549 VISITS IN 2011. 20866081 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 36 0 1 375 1 0 0 0 0 0 0 0 0 0 0 X 20 20 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 AMY MCNAMARA 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 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 0 0 0 LINDSAY C FARRELL 33.80 X 271509 0 15187 MARIA MAZZOTTA 33.20 X 166027 0 3464 DAREN WU 37.50 X 248121 0 10634 JANET H BOZZONE 37.50 X 201423 0 10117 ANITA WILENKIN 37.50 X 178385 0 25840 BRUCE M SHAFFER 37.50 X 171587 0 10367 ASAF COHEN 37.50 X 161779 0 13119 THOMAS YUEN 37.50 X 155998 0 26183 PATRICIA J MEYER 37.50 X 157081 0 9150 1711910 0 124061 30 0 1 0 COMPREHENSIVE EYE SERVICES PO BOX 187 ARMONK NY 10504 EYE CLINIC 225526 ECLINICAL WORKS 110 TURNPIKE ROAD SUITE 308 WESTBORO MA 01581 ECW SUPPORT & E-SUBSCRIBING 164457 WESTCHESTER INSTITUTE OF HUMAN DEVELOPME CEDAR HALL RM322 VALHALLA NY 10595 PROJECT LAUNCH EVALUATOR 117301 MCGLADREY & PULLEN LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 10036 AUDIT/TAX PREPARATION 107905 FELDSMAN TUCKER LEIFER FIDELL LLC 2001 L STREET NW 2ND FLOOR WASHINGTON DC 20036 LEGAL SERVICES 102471 5 10000 20000 9838961 887546 10756507 MEDICAID 621400 13749200 13749200 UNCOMPENSATED CARE 621400 3887986 3887986 CHILD HEALTH PLUS 621400 3078254 3078254 SELF-PAY 621400 2669822 2669822 MEDICARE 621400 600005 600005 515097 515097 24500364 201594 201594 10694551 10740294 -45743 -45743 -45743 REIMB SALARIES & FRING 900099 365623 365623 MISC. REVENUE 900099 11468 11468 377091 35789813 24500364 0 532942 921894 733942 187952 14470577 11607593 2862984 678134 539879 138255 1439736 1146209 293527 1081373 860907 220466 116969 116969 120335 120335 73127 73127 1116215 517076 599139 12312 12312 1485848 1120103 365745 141107 141107 1000932 842782 158150 31288 22404 8884 164875 82339 82536 332281 282439 49842 1358857 1155028 203829 186431 158466 27965 PHARMACEUTICALS 668519 668519 LABORATORY FEES 435841 435841 MISCELLANEOUS 339989 292136 47853 DATA PROCESSING 249792 57534 192258 565447 342884 222563 26991879 20866081 6125798 0 4861550 5444209 714211 479555 780672 956090 4458925 6345663 218854 282442 25808957 11665584 14726794 14143373 6430393 10779176 609737 635427 32801136 39065935 4084994 4967650 6508180 3739492 193816 64514 10786990 8771656 X 21945479 30210368 68667 83911 22014146 30294279 32801136 39065935 X 8797934 -517801 X 0 1 1 X 1 1 X 6350528 6469111 6890084 8526604 10756507 38992834 6350528 6469111 6890084 8526604 10756507 38992834 38992834 45075 75938 48675 153335 201594 524617 5106 20985 5676 338569 377091 747427 40264878 100046855 0.96840 0.98000 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE MANAGEMENT FEE INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1740016 1740016 2274217 1340733 933484 13312328 5747954 7564374 3290696 2620564 670132 5191700 1956333 3235367 14143373 CAPITAL LEASE PAYABLE 64514 64514 35789813 26991879 8797934 -21952 -495849 -517801 8280133 37002993 -21952 257691 1416191 1651930 35351063 73127 365623 438750 35789813 27937908 257691 761465 1019156 26918752 73127 73127 26991879 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2008, WHICH IS THE STANDARD STATUTE OF LIMITATIONS LOOK-BACK PERIOD. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -495,849. PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE OF RELATED ENTITIES 1,416,191. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED SALARIES/FRINGE 365,623. PART XIII, LINE 2D - OTHER ADJUSTMENTS: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 495,849. REIMBURSED SALARIES/FRINGE -365,623. EXPENSES OF RELATED ENTITIES 631,239. X X X 0 0 0 0 0 1 0 1 0 LINDSAY C FARRELL 245962 0 25000 0 547 0 8575 0 6612 0 286696 0 0 0 MARIA MAZZOTTA 158398 0 7500 0 129 0 0 0 3464 0 169491 0 0 0 DAREN WU 217460 0 30497 0 164 0 8575 0 2059 0 258755 0 0 0 JANET H BOZZONE 182128 0 18604 0 691 0 7091 0 3026 0 211540 0 0 0 ANITA WILENKIN 170714 0 7000 0 671 0 6568 0 19272 0 204225 0 0 0 BRUCE M SHAFFER 170957 0 0 0 630 0 6057 0 4310 0 181954 0 0 0 ASAF COHEN 134678 0 27008 0 93 0 5837 0 7282 0 174898 0 0 0 THOMAS YUEN 151877 0 4005 0 116 0 5800 0 20383 0 182181 0 0 0 PATRICIA J MEYER 138641 0 18001 0 439 0 2389 0 6761 0 166231 0 0 0 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 12/31/11: DAREN WU - $24,997 JANET H. BOZZONE - $16,104 ASAF COHEN - $27,008 THOMAS YUEN - $4,005 PATRICIA J. MEYER - $18,001 PART I, LINE 7 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED NON-FIXED PAYMENTS, DETERMINED BY THE BOARD, DURING THE YEAR ENDED 12/31/11: LINDSAY C. FARRELL - $25,000 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 MAY 2012, THE FORM 990, FOR THE YEAR ENDED DECEMBER 31, 2011, 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 5: NET UNREALIZED LOSSES ON INVESTMENTS: -21,952. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -495,849. TOTAL TO FORM 990, PART XI, LINE 5: -517,801. # OF HOURS WORKED FOR RELATED ENTITIES FORM 990, PART VII LINDSAY FARRELL WORKED 3.8 HOURS/WEEK FOR OPEN DOOR FOUNDATION, INC. MARIA MAZZOTTA WORKED 1.8 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 278724 12000 1.00000 0 1 0 1 0 0 0 0 0 1 1 0 1 1 0 1 0 0 OPEN DOOR LEASING CORP J 257528 COST