COMMUNITY HEALTH CENTER OF RICHMOND INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH CENTER OF RICHMOND INC (EIN 51-0567466)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-13
IRS object ID
201223189349302937
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-13T14:02:04-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN232932984EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PARENTEBEARD LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11650 MARKET STREET SUITE 4500AddressLine1
CityPHILADELPHIACity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN510567466EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH CENTER OF RICHMOND INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone7189242254Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1235 PORT RICHMOND AVENUEAddressLine1
CitySTATEN ISLANDCity
StateNYState
ZIP Code10302ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameHENRY THOMPSONName
TitleCEOTitle
Phone7189242254Phone
Date Signed2012-11-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJULIUS GREEN CPAName
PTINP00350393PTIN
Phone2159720701Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonHENRY THOMPSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1235 PORT RICHMOND AVENUEAddressLine1
CitySTATEN ISLANDCity
StateNYState
ZIP Code10302ZIPCode
FieldValueIRS element (for citing)
Gross Receipts7060248GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteCHCRICHMOND.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2006YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionPROVIDE PRIMARY CARE SERVICES WITH AN EMPHASIS ON SERVING THE POOR AND UNDERINSURED.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees50TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2803070ContributionsGrantsPriorYear
Contributions Grants Current Year4095323ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3181478ProgramServiceRevenuePriorYear
Program Service Revenue CY2769815ProgramServiceRevenueCY
Investment Income Prior Year3881InvestmentIncomePriorYear
Investment Income Current Year2830InvestmentIncomeCurrentYear
Other Revenue Prior Year26OtherRevenuePriorYear
Other Revenue Current Year175825OtherRevenueCurrentYear
Total Revenue Prior Year5988455TotalRevenuePriorYear
Total Revenue Current Year7043793TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3041965SalariesEtcPriorYear
Salaries Etc Current Year2997470SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2736064OtherExpensePriorYear
Other Expenses Current Year2410104OtherExpensesCurrentYear
Total Expenses Prior Year5778029TotalExpensesPriorYear
Total Expenses Current Year5407574TotalExpensesCurrentYear
Revenues Less Expenses Prior Year210426RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1636219RevenuesLessExpensesCY
Total Assets BOY3411015TotalAssetsBOY
Total Assets EOY6576276TotalAssetsEOY
Total Liabilities BOY786477TotalLiabilitiesBOY
Total Liabilities EOY2315519TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2624538NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4260757NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF THE COMMUNITY HEALTH CENTER OF RICHMOND IS TO PROVIDE QUALITY PRIMARY CARE THAT IS ACCESSIBLE, AFFORDABLE AND RESPECTFUL TO ALL OF THE COMMUNITIES IT SERVES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense3214898Expense
Revenue2769815Revenue
DescriptionPROVIDING PRIMARY CARE SERVICES TO RESIDENTS OF STATEN ISLAND, NEW YORK WITH PARTICULAR EMPHASIS PLACED ON SERVING THE POOR AND UNDER-INSURED WITHIN THE COMMUNITY. THERE WERE 22,235 VISITS FOR 2011. CHCR HAS PROVIDED SERVICES TO 9,821 PATIENTS OF WHICH 3,727 WERE UNINSURED AND 7,417 WERE AT OR BELOW THE FEDERAL POVERTY GUIDELINE. THERE WERE 19.92 MEDICAL PROVIDER FTES WHO DELIVERED THE SERVICES DURING THE YEAR.Description
Total Program Service Expense3214898TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109630NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees50NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Excess Business Holdings0ExcessBusinessHoldings
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonHENRY THOMPSONNamePerson
Telephone Number7189242254TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1235 PORT RICHMOND AVENUEAddressLine1
CitySTATEN ISLANDCity
StateNYState
ZIP Code10302ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
MARIBEL SANSONE
PRESIDENT1.00XX000
GONZALO MERCADO
VICE-PRESIDENT1.00XX000
JACK DE SANTIS
TREASURER1.00XX000
CHRISTINE HOLLIE
SECRETARY1.00XX000
TERRY TROIA
MEMBER1.00X000
PATRICIA KARNATSKI
MEMBER1.00X000
RICHARD YOUNGE MD
MEMBER1.00X000
FERN ZAGOR
MEMBER1.00X000
URSULA CZYSZKIEWICZ
MEMBER1.00X000
ELIZABETH LOPEZ
MEMBER1.00X000
NAYELI SOTO
MEMBER1.00X000
CAMILIA RANGEL
MEMBER1.00X000
RONALD SPEIGHT JR
MEMBER1.00X000
NORMA JUAREZ
MEMBER1.00X000
HENRY THOMPSON
CHIEF EXECUTIVE OFFICER40.00X168369014300
ROSALINDA ROSARIO-LIPKA DO
CHIEF MEDICAL OFFICER40.00X16001609600
KUDUVALLI OMPRAKASH MD
PHYSICIAN40.00143500014610X
JESSIE PITA MD
PHYSICIAN40.0013608708170X
ELAINE CLARKE MD
PHYSICIAN40.00111136012670X
FieldValueIRS element (for citing)
Total Reportable Comp From Org719108TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation59350TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HENRICH GROUP LLC
125-28 QUEENS BLVD SUITE 617KEW GARDENSNY11415PROJECT MANAGEMENT159853
MJCL ARCHITECTS PLLC
1416 AVENUE M SUITE 401BROOKLYNNY11230ARCHITECTURAL DESIGN140819
HERZOG GROUP LLP
1855 RICHMOND AVESTATEN ISLANDNY10302OB/GYN SERVICES117238
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants4095323GovernmentGrants
Noncash Contributions286893NoncashContributions
Total Contributions4095323TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REDescription
Business Code623000BusinessCode
Total Revenue Column2769815TotalRevenueColumn
Related Or Exempt Function Income2769815RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue2769815TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2830TotalRevenueColumn
Exclusion$2,830ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events27157GrossIncomeFundraisingEvents
Fundraising Direct Expenses16455FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column10702TotalRevenueColumn
Exclusion$10,702ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
PHARMACY SALES AT COST446110164837$164,837
MISCELLANEOUS900099286$286
FieldValueIRS element (for citing)
Total Other Revenue165123TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7043793TotalRevenueColumn
Related Or Exempt Function Income2769815RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$178,655ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total322285Total
Program Services174262ProgramServices
Management And General148023ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2076453Total
Program Services1122755ProgramServices
Management And General953698ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total66578Total
Program Services35999ProgramServices
Management And General30579ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total346263Total
Program Services185349ProgramServices
Management And General160914ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total185891Total
Program Services100513ProgramServices
Management And General85378ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total47980Total
Management And General47980ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total38145Total
Management And General38145ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total785337Total
Program Services256298ProgramServices
Management And General529039ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total13067Total
Management And General13067ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total852588Total
Program Services689504ProgramServices
Management And General163084ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total3708Total
Program Services3708ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total273857Total
Program Services273857ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total33892Total
Program Services26534ProgramServices
Management And General7358ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total142510Total
Program Services142510ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total5641Total
Program Services3627ProgramServices
Management And General2014ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
REPAIRS AND MAINTENANCE5760757607
BAD DEBT EXPENSE5508155081
MEALS AND ENTERTAINMENT2632026320
RECRUITING EXPENSE2415024150

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total50221Total
Program Services36824ProgramServices
Management And General13397ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total5407574Total
Program Services3214898ProgramServices
Management And General2192676ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY250BOY
EOY250EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY339852BOY
EOY418770EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY55580EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY693731BOY
EOY845797EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY26565BOY
EOY35281EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis4135071LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec307943LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2332231BOY
EOY3827128EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY18386BOY
EOY1393470EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3411015BOY
EOY6576276EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY786477BOY
EOY741158EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY1574361EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY786477BOY
EOY2315519EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2624538BOY
EOY4260757EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2624538BOY
EOY4260757EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3411015BOY
EOY6576276EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses1636219ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1144312CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4256220CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2929979CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2803070CurrentTaxYearMinus1Year
Current Tax Year3808430CurrentTaxYear
Total14942011Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years144312CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1896766CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2655394CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3181478CurrentTaxYearMinus1Year
Current Tax Year2769816CurrentTaxYear
Total10647766Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1288624CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6152986CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5585373CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5984548CurrentTaxYearMinus1Year
Current Tax Year6578246CurrentTaxYear
Total25589777Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50925589777PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10273CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12708CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3990CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3881CurrentTaxYearMinus1Year
Current Tax Year2830CurrentTaxYear
Total33682Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10273CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12708CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3990CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3881CurrentTaxYearMinus1Year
Current Tax Year2830CurrentTaxYear
Total33682Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years1006CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years102239CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year26CurrentTaxYearMinus1Year
Current Tax Year165122CurrentTaxYear
Total268393Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1298897CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6166700CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5691602CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5988455CurrentTaxYearMinus1Year
Current Tax Year6746198CurrentTaxYear
Total25891852Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98830PublicSupportPercentage509
Prior Year Support Percentage0.99300PriorYearSupportPercentage
Investment Income Percentage0.00130InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00160PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis193078OtherCostOrOtherBasis
Depreciation60718Depreciation
Book Value132360BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis163686OtherCostOrOtherBasis
Depreciation61289Depreciation
Book Value102397BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis303631OtherCostOrOtherBasis
Depreciation100359Depreciation
Book Value203272BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3474676OtherCostOrOtherBasis
Depreciation85577Depreciation
Book Value3389099BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3827128TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
SECURITY DEPOSITS69680
ASSETS WHOSE USE IS LIMITED1323790
FieldValueIRS element (for citing)
Total Book Value Other Assets1393470TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionLOAN PAYABLE- PCDCDescription
Amount$1,574,361Amount
FieldValueIRS element (for citing)
Total Of Amounts1574361TotalOfAmounts
Total Revenue7043793TotalRevenue
Total Expenses5407574TotalExpenses
Excess Or Deficit For Year1636219ExcessOrDeficitForYear
Excess Or Deficit Per FS1636219ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt6773355TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal6773355RevenueSubtotal
Other Revenues Not Included270438OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt270438RevenueNotRptdOnFinStmt
Total Revenue Per Form9907043793TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt5137136TotExpensesEtcAuditedFinclStmt
Other Expenses Included16455OtherExpensesIncluded
Expenses Not Rptd F99016455ExpensesNotRptdF990
Expenses Subtotal5120681ExpensesSubtotal
Other Expenses Not Included286893OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt286893ExpensesNotRptdOnFinStmt
Total Expenses Per Form9905407574TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE CENTER ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2011 AND 2010. THE FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR THE ORGANIZATION FOR THE YEARS ENDED DECEMBER 31, 2009 AND 2010 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XII, LINE 4B - OTHER ADJUSTMENTS:DONATED VACCINES 286,893. FUND RAISING EXPENSES -16,455.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:FUND RAISING EXPENSES 16,455.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:DONATED VACCINES 286,893.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GALA NIGHTNameOfEvent1
Gross Receipts Event127157GrossReceiptsEvent1
Gross Revenue Event127157GrossRevenueEvent1
Rent Facility Costs Event111835RentFacilityCostsEvent1
Entertainment Event11350EntertainmentEvent1
Other Direct Expenses Event13270OtherDirectExpensesEvent1
Gross Receipts Total27157GrossReceiptsTotal
Gross Revenue Total Events27157GrossRevenueTotalEvents
Rent Facility Costs Total Events11835RentFacilityCostsTotalEvents
Entertainment Total Events1350EntertainmentTotalEvents
Other Direct Expenses Total Events3270OtherDirectExpensesTotalEvents
Direct Expense Summary Events16455DirectExpenseSummaryEvents
Net Income Summary10702NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
HENRY THOMPSON
168369000008300060000182669000
ROSALINDA ROSARIO-LIPKA DO
160016000009600000169616000
KUDUVALLI OMPRAKASH MD
143500000008610060000158110000

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990286893NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE CEO AND CFO REVIEW THE FORM 990 BEFORE IT IS FILED. THE RETURN IS THEN PRESENTED TO THE FINANCE COMMITTEE FOR REVIEW AND THEN TO THE GENERAL BOARD FOR APPROVAL OF FILING.
FORM 990, PART VI, SECTION B, LINE 12CCHCR PROVIDES BOARD MEMBERS AND STAFF WITH A CONFLICT OF INTEREST STATEMENT WHICH SUMMARIZES THE KEY ELEMENTS OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. THE STATEMENT IS PROVIDED TO AND SIGNED BY BOARD MEMBERS AND STAFF BOTH AT THE TIME OF THE INDIVIDUAL'S INITIAL AFFILIATION WITH THE ORGANIZATION AND ANNUALLY THEREAFTER. THE CEO IS RESPONSIBLE FOR MONITORING THE CONFLICTS. IN THE CASE OF CONFLICT OF INTEREST, THE BOARD MEMBER WILL REPORT THE CONFLICT TO THE FULL BOARD/EMPLOYEE PRIOR TO ANY DISCUSSION OF THE MATTER AND POTENTIALLY RECUSE THEMSELVES FROM VOTING ON THE MATTER.
FORM 990, PART VI, SECTION B, LINE 15OFFICER COMPENSATION IS DETERMINED AND COMPARED BASED ON THE CURRENT MARKET, INDUSTRY STANDARDS AND SURVEYS TAKEN. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE CHIEF EXECUTIVE OFFICER'S SALARY. THERE IS A WRITTEN CONTRACT BETWEEN THE CHIEF EXECUTIVE OFFICER AND THE CENTER, AND IS NEGOTIABLE AT A CERTAIN TIME PERIOD.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
AUDIT COMMITTEETHE PROCESSES USED BY COMMITTEE THAT ASSUMES RESPONSIBLITY FOR THE OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR.

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