2012-09-25T13:27:47-05:00 2011-12-31 050456296 LEFKOWITZ GARFINKEL ET AL PC TEN WEYBOSSET STREET - SUITE 700 PROVIDENCE RI 02903 990 2011-01-01 510183476 BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC BLAC 4017290080 42 PARK PLACE PAWTUCKET RI 02860 RAYMOND J LAVOIE 4017290080 2012-09-18 1 LYNN O'MARRA ESQUIRE P00821716 4014214800 2011 2016-02-24 21:20:13Z RAYMOND J LAVOIE 42 PARK PLACE PAWTUCKET RI 02860 10766037 0 X WWW.BLACKSTONECHC.ORG X 1984 RI BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. (THE CENTER) OPERATES HEALTHCARE CENTERS IN CENTRAL FALLS AND PAWTUCKET, RHODE ISLAND. THE CENTER PROVIDES A BROAD RANGE OF HEALTH, DENTAL, AND SOCIAL SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION. 8 8 115 45 0 0 3976240 3041644 7304477 7503981 11000 910 43357 82701 11335074 10629236 0 0 0 0 6515196 6693113 0 0 0 4168459 3903950 10683655 10597063 651419 32173 9742650 12000593 1167381 3393151 8575269 8607442 X BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. IS COMMITTED TO PROVIDING HIGH QUALITY, ACCESSIBLE, AFFORDABLE, COMPREHENSIVE HEALTH CARE AVAILABLE FOR THE RESIDENTS OF THE LOWER BLACKSTONE VALLEY. THE CENTER USES A MODEL OF PRIMARY CARE THAT STRESSES PREVENTION, EDUCATION, AND PATIENT EMPOWERMENT. 0 0 8198860 7520751 OPERATED A COMMUNITY HEALTHCARE CENTER WHICH SERVED APPROXIMATELY 55,000 ENCOUNTERS DURING THE YEAR ENDED DECEMBER 31, 2011. 8198860 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 37 0 1 115 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 RI X X RAYMOND J LAVOIE 4017290080 42 PARK PLACE PAWTUCKET RI 02860 RONALD WINTER 1.00 X 0 0 0 JOHN LEFRONCOIS 1.00 X 0 0 0 MICHELLE ENOS 1.00 X 0 0 0 JEAN KUGEL 1.00 X 0 0 0 WARREN BREER 1.00 X 0 0 0 CARLOS DEBRITO 1.00 X 0 0 0 WILLIAM MCCUSKER 1.00 X 0 0 0 ELIZABETH MORAIS 1.00 X 0 0 0 RAYMOND J LAVOIE 40.00 X 170710 0 8223 JERALD C FINGERUT 40.00 X 202611 0 17296 WILLIAM RUSH 40.00 X 95334 0 4229 KUNJBALA SHARMA 40.00 X 154921 0 8188 KARLA KIKER 40.00 X 146080 0 7765 HEATHER BUDD 40.00 X 129031 0 13122 LALITA BHATTACHARYA 40.00 X 131059 0 13315 AMERICA FOSTER 40.00 X 124953 0 22914 1154699 0 95052 12 0 1 0 CASE CONSTRUCTION 225 WAMPANOAG TRAIL EAST PROVIDENCE RI 02915 CONSTRUCTION 1412442 NEXTGEN 18111 VON KARMAN AVENUE IRVINE CA 92612 EMR SOFTWARE SERVICES 629236 WOMEN'S CARE INC 407 EAST AVENUE SUITE 150 PAWTUCKET RI 02860 OBSTETRICS 370305 ARCADIA SOLUTIONS 3500 AMERICAN BLVD WEST SUITE 350 BLOOMINGTON MN 55431 REPORT WRITING & IT CONSULTATION 119453 4 3022689 18955 3041644 MEDICAID 900099 5966615 5966615 SELF-PAY 900099 555553 555553 OTHER THIRD PARTY 900099 536432 536432 MEDICARE 900099 445381 445381 7503981 910 910 10200 10567 -367 -367 -367 192532 126234 66298 66298 MISCELLANEOUS INCOME 900099 16770 16770 16770 10629236 7520751 0 66841 498403 219907 278496 4707973 3808852 899121 236309 236309 874565 866250 8315 375863 284200 91663 1776252 1459460 316792 5698 5698 321122 273220 47902 149515 114431 35084 111397 66223 45174 784918 571482 213436 73109 73109 BAD DEBTS 356602 356602 REPAIRS AND MAINTENANCE 96295 82413 13882 TELEPHONE 87131 38198 48933 DUES AND SUBSCRIPTIONS 47241 9226 38015 94670 48396 46274 10597063 8198860 2398203 0 2701 2896 2256693 1761319 310651 263487 532656 924646 7702 8797 149048 187353 11812165 3155867 6463207 8656298 82700 19992 113097 9742650 12000593 1167381 2028994 1364157 1167381 3393151 X 8485269 8517442 90000 90000 8575269 8607442 9742650 12000593 32173 0 X X 0 1 1 X 1 1 X 2641278 3399839 3195598 3976240 3041644 16254599 2641278 3399839 3195598 3976240 3041644 16254599 16254599 210610 29132 12167 14999 11110 278018 8189 84703 7235 8468 16770 125365 16657982 0.97580 0.93410 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 906566 906566 4381606 1269008 3112598 3372654 1880167 1492487 3151339 6692 3144647 8656298 10629236 10597063 32173 32173 10766037 136801 136801 10629236 0 10629236 10733864 136801 136801 10597063 0 10597063 PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 10,567. COST OF GOODS SOLD INCLUDED IN REVENUE 126,234. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 10,567. COST OF GOODS SOLD INCLUDED IN REVENUE 126,234. X X X 0 0 0 0 0 0 0 0 0 RAYMOND J LAVOIE 170710 0 0 0 0 0 6970 0 1253 0 178933 0 0 0 JERALD C FINGERUT 202611 0 0 0 0 0 8925 0 8371 0 219907 0 0 0 KUNJBALA SHARMA 154921 0 0 0 0 0 6935 0 1253 0 163109 0 0 0 KARLA KIKER 146080 0 0 0 0 0 6512 0 1253 0 153845 0 0 0 RI HEALTH AND EDUCATIONAL BUILDNG CORPORATION 521300173 2011-08-02 6450000 CONSTRUCTION OF NEW MEDICAL BUILDING 0 0 0 6450000 75000 1333261 30896 5010843 2012 0 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 SCHEDULE K SUPPLENTAL INFORMATION OTHER UNSPENT PROCEEDS ARE NOT REFLECTED ON THE ORGANIZATION'S BOOKS AND RECORDS AS THE PROCEEDS ARE NOT UNDER ITS DIRECT CONTROL. AS OF DECEMEBER 31, 2011 ISSUANCE COSTS OF $30,896 HAVE BEEN DISBURSED AND THE BALANCE ALLOCATED TO THESE COSTS IS NOT REFLECTED ON THE ORGANIZATION'S BOOKS AND RECORDS PER THE ABOVE FOR OTHER UNSPENT PROCEEDS. FORM 990, PART I, LINE 6: VOLUNTEERS PLAYED AN INTEGRAL PART IN ALLOWING THE CENTER TO PARTICIPATE IN VARIOUS HEALTH FESTIVALS AND FAIRS THAT PROMOTE HEALTH, WELLNESS, AND SAFETY. FORM 990, PART VI, SECTION B, LINE 11 INTERNAL MANAGEMENT DOES A DETAILED LINE BY LINE REVIEW OF THE FORM 990 PRIOR TO IT BEING FILED. ANY QUESTIONS FROM THIS REVIEW ARE DISCUSSED AND RESOLVED WITH THE PREPARER PRIOR TO BEING SHARED WITH THE BOARD. THE FORM 990 WILL ONLY BE RELEASED ONCE ALL QUESTIONS RAISED BY INTERNAL STAFF AND THE BOARD HAVE BEEN RESOLVED. FORM 990, PART VI, SECTION B, LINE 12C IF WE BECOME AWARE OF A POTENTIAL CONFLICT OF INTEREST THROUGH SELF DISCLOSURE OR SOME OTHER MANNER, WE WOULD IMMEDIATELY FOLLOW-UP TO DETERMINE IF A CONFLICT TRULY EXISTS. IF A CONFLICT DOES EXIST WE WOULD TAKE APPROPRIATE ACTION THAT MAY INCLUDE TERMINATION, WHERE WARRANTED. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S COMPENSATION IS APPROVED BY THE BOARD CHAIRMAN. TO ASSIST IN DETERMINING THE EXECUTIVE DIRECTOR'S COMPENSATION LEVEL, THE BOARD CHAIR LOOKS AT JOB DUTIES, JOB PERFORMANCE, ACCOMPLISHMENTS, NEW GOALS AND OBJECTIVES, AND SALARY INFORMATION OF OTHER HEALTH CENTERS OF SIMILAR SIZE AND SCOPE. THE EXECUTIVE DIRECTOR APPROVES THE COMPENSATION FOR ALL OTHER OFFICERS. IN DETERMINING THE COMPENSATION LEVEL OF EACH OFFICER, THE EXECUTIVE DIRECTOR WILL REVIEW JOB DUTIES, JOB PERFORMANCE, ACCOMPLISHMENTS, NEW GOALS AND OBJECTIVES, AND SALARY INFORMATION OF OTHER HEALTH CENTERS OF SIMILAR SIZE AND SCOPE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF INDEPENDENT ACCOUNTANTS.