2024-09-16T14:37:35-05:00 2023-10-31 593204548 JAMES MOORE & COPL 121 EXECUTIVE CIRCLE DAYTONA BEACH FL 321141180 990 2022-11-01 550799729 NORTHEAST FLORIDA HEALTH SERVICES INC NORT 3862026025 1205 S WOODLAND BLVD 3 DELAND FL 327207464 LAURIE ASBURY CEO 3862026025 2024-09-09 1 1 JAMES A HALLERAN P00005496 3862574100 2024-09-09 2022 2024-08-08 14:25:15Z FAMILY HEALTH SOURCE LAURIE ASBURY 1205 S WOODLAND BLVD 3 DELAND FL 327207464 12945508 0 X WWW.FAMILYHEALTHSOURCE.ORG X 2004 FL TO PROVIDE QUALITY PRIMARY HEALTH CARE SERVICES, ACCESSIBLE TO ALL PERSONS IN PIERSON, DELAND, DAYTONA, AND DELTONA, FLORIDA, BY PROMOTING INDIVIDUAL HEALTH WELLNESS SERVICES, EDUCATION, AND RESOURCES. WE ARE DEDICATED TO PROVIDING QUALITY CARE TO ALL, REGARDLESS OF AGE, RACE, INCOME, EMPLOYMENT OR INSURANCE. SERVICES ARE RENDERED REGARDLESS OF ABILITY TO PAY. 7 7 130 7 0 0 3831970 3531292 8822868 9367367 152 -16923 0 36900 12654990 12918636 11000 96524 0 0 6894141 7080451 0 0 0 4364972 4891082 11270113 12068057 1384877 850579 6518060 11629271 991954 5252586 5526106 6376685 X TO PROVIDE QUALITY PRIMARY HEALTH CARE SERVICES, ACCESSIBLE TO ALL PERSONS IN PIERSON, DELAND, DAYTONA, AND DELTONA, FLORIDA, BY PROMOTING INDIVIDUAL HEALTH WELLNESS SERVICES, EDUCATION, AND RESOURCES. WE ARE DEDICATED TO PROVIDING QUALITY CARE TO ALL, REGARDLESS OF AGE, RACE, INCOME, EMPLOYMENT OR INSURANCE. SERVICES ARE RENDERED REGARDLESS OF ABILITY TO PAY. 0 0 8387106 96524 9391367 FAMILY HEALTH SOURCE MEETS THE PEDIATRIC THRU GERIATRIC PRIMARY CARE NEEDS OF VOLUSIA COUNTY RESIDENTS. OUR MEDICAL CENTERS ARE IN PIERSON, DELTONA, DELAND, AND DAYTONA AND ARE OPERATED BY NORTHEAST FLORIDA HEALTH SERVICES, INC. DBA FAMILY HEALTH SOURCE. OUR SERVICES INCLUDE (BUT ARE NOT LIMITED TO): ADULT PRIMARY MEDICAL CARE AND SCREENINGS (INCLUDING ADULT PHYSICALS), BEHAVIORAL HEALTH INTEGRATION SERVICES, OBSTETRICS (PRENATAL/POSTPARTUM CARE), CONTRACEPTION, DENTAL SERVICES, PHARMACY SERVICES, TRANSLATION, TRANSPORTATION, CASE MANAGEMENT, ELIGIBILITY AND OUTREACH, AFTER HOURS, DIAGNOSTIC LAB, GYNECOLOGICAL CARE, VETERAN'S CHOICE PROGRAMS, PEDIATRICS, OUTPATIENT SERVICES AND PROCEDURES, PERSCRIPTION DISCOUNT, SPORTS PHYSICALS, WELL CHILD, WELL WOMAN, MENOPAUSAL MANAGEMENT, CARE FOR HYPERTENSION, HYPERLIPIDEMIA, DIGESTIVE, UROLOGICAL, MUSCULAR/SKELETAL, AND PULMONARY DISEASE. THE ORGANIZATION HAS A POLICY OF PROVIDING CHARITY CARE TO PATIENTS WHO ARE UNABLE TO PAY. SUCH PATIENTS ARE CHARGED FEES BASED UPON A SLIDING FEE SCHEDULE BASED UPON POVERTY GUIDELINES. SINCE MANAGEMENT DOES NOT EXPECT PAYMENT FOR CHARITY CARE, THE ESTIMATED SERVICE CHARGES ARE EXCLUDED FROM PATIENT SERVICE REVENUES. THESE SERVICES AMOUNTED TO APPROXIMATELY $1,300,000 FOR THE YEAR ENDED OCTOBER 31, 2023.THE ORGANIZATION ALSO AWARDED SCHOLARSHIPS TO TWELVE STUDENTS ATTENDING AREA HIGH SCHOOLS. 8387106 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 26 0 1 130 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X LAURIE ASBURY 3862026025 1205 S WOODLAND BLVD 3 DELAND FL 327207464 CARMEN RIVERA-SPELORZI CHAIR 1.00 X X 0 0 0 VIVIAN CAMPBELL SECRETARY 1.00 X X 0 0 0 CATHY CORTES TREASURER 1.00 X X 0 0 0 REGINA SANTILLI BOARD MEMBER 1.00 X 0 0 0 NIGEL HINDS BOARD MEMBER 1.00 X 0 0 0 SHERKILA SHAW BOARD MEMBER, AS OF 10/2023 1.00 X 0 0 0 JOHN DAVIS BOARD MEMBER, AS OF 10/2023 1.00 X 0 0 0 HIPOLITO VALDEZ CFO 40.00 X 169844 0 29993 LAURIE ASBURY CEO 40.00 X 224062 0 18999 JOHN MICHAEL HAM-YING MD CMO/MD 40.00 X 231139 0 17568 TERESA ROJAS-SANCHEZ PROVIDER 40.00 X 176693 0 28930 BRUNO MANCINI PROVIDER 40.00 X 197821 0 28821 MICHELLE MOLL PHARMACY DIRECTOR 40.00 X 146271 0 33372 LEONEL TORRES DENTAL DIRECTOR 40.00 X 180236 0 9285 ROBERT RODRIGUEZ PROVIDER 40.00 X 116467 0 24849 1442533 0 191817 9 0 1 0 DELTONA WELLNESS LP CO WEISSMAN CORP 17 COPPERBEECH LANE LAWRENCE NY 11559 RENT 314075 SWANN LANDING LLC 2441 SLEEPY OAK LANE DELAND FL 32720 RENT 254474 ECLINICALWORKS LLC PO BOX 847950 BOSTON MA 02284 IT SERVICES 190711 ONE 4 ALL CLEANING SERVICE LLC 2070 ONEIDA CT DELTONA FL 32728 CLEANING SERVICES 150912 HORIZON MIRAGE LLC 1307 S INTERNATIONAL PKWY STE 1091 LAKE MARY FL 32746 RENT 105056 6 3531292 3531292 PATIENT SERVICE REVENUE 621400 7929066 7929066 340B CONTRACT REVENUE 621400 1437053 1437053 MEDICAL RECORDS 621400 1248 1248 9367367 9949 9949 12900 0 12900 12900 12900 26872 -26872 -26872 -26872 MENTORING SERVICES 900099 24000 24000 24000 12918636 9391367 0 -4023 96524 96524 675320 564217 111103 5264880 3033125 2231755 61603 42282 19321 593975 411727 182248 484673 292837 191836 40550 28424 12126 74116 49202 24914 402339 284456 117883 25760 25760 237271 166063 71208 93191 65427 27764 777163 497111 280052 102312 71696 30616 11453 8017 3436 398567 330860 67707 76090 63155 12935 MEDICAL DRUGS & SUPPLIE 1730790 1730790 REPAIRS & MAINTENANCE 371918 210219 161699 MEDICAL RECORD & BILLIN 223112 156178 66934 BAD DEBT EXPENSE 191678 191678 134772 93118 41654 12068057 8387106 3680951 0 2807549 3627871 503373 713322 470996 454314 44225 44965 88836 111831 4726286 1759047 2554176 2967239 3660824 48905 48905 6518060 11629271 852571 1475937 139383 82297 0 3694352 991954 5252586 X 5526106 6376685 5526106 6376685 6518060 11629271 850579 0 X 0 1 X 1 1 1 X 2418242 3633477 3467295 3831970 3531292 16882276 2418242 3633477 3467295 3831970 3531292 16882276 16882276 722 885 230 152 9949 11938 16894214 38889579 0.99930 0.99980 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 451540 272099 179441 2855580 1081365 1774215 693082 405583 287499 726084 726084 2967239 FINANCE LEASE LIABILITY 114400 OPERATING LEASE LIABILITY 3579952 3694352 X 12736158 9200 9200 12726958 191678 191678 12918636 11885579 9200 9200 11876379 191678 191678 12068057 PART X, LINE 2: THE ORGANIZATION IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, INCOME EARNED IN THE FURTHERANCE OF THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS EXEMPT FROM FEDERAL INCOME TAXES AND THE FINANCIAL STATEMENTS CONTAIN NO PROVISION OR LIABILITY FOR INCOME TAXES. THE ORGANIZATION FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. THE ORGANIZATION'S RETURNS FOR THE PAST THREE YEARS ARE SUBJECT TO EXAMINATIONS BY TAX AUTHORITIES AND MAY CHANGE UPON EXAMINATION. THE ORGANIZATION HAS REVIEWED AND EVALUATED THE RELEVANT TECHNICAL MERITS OF EACH OF ITS TAX POSITIONS IN ACCORDANCE WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, AND DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT WOULD HAVE A MATERIAL IMPACT ON THE FINANCIAL STATEMENTS OF THE ORGANIZATION. THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES IN OPERATING EXPENSES. DURING THE YEAR ENDED OCTOBER 31, 2023, THERE WERE NO INTEREST AND PENALTIES INCURRED. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX 191,678. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX 191,678. 1 CITY OF DELTONA 2345 PROVIDENCE BOULEVARD DELTONA FL 32725 593348665 115(1) 16000 0 YOUTH BASKETBALL AND TURKEY GIVEAWAY DELAND CHAMBER OF COMMERCE 122 S AMELIA AVENUE DELAND FL 32724 590217110 501(C)(6) 11050 0 COMMUNITY SUPPORT DELTONA STRONG PO BOX 390424 DELTONA FL 32725 831491162 501(C)(3) 10500 0 CANCER CHARITY EVENT WEST VOLUSIA REGIONAL CHAMBER OF COMMERCE 184 TREEMONTE DRIVE ORANGE CITY FL 32763 262530925 501(C)(6) 5075 0 CHAMBER CHARITY CHAMPIONS T-DEWITT TAYLOR MIDDLE-HIGH SCHOOL 100 E WASHINGTON AVENUE PIERSON FL 32180 115(1) 5300 0 SCHOLARSHIPS AND COMMUNITY SUPPORT 3 2 PART I, LINE 2: THE ORGANIZATION MAINTAINS RECORDS OF THE STUDENTS SELECTED BY THE SCHOOLS TO RECEIVE THE SCHOLARSHIPS. THE ORGANIZATION IS CURRENTLY WORKING WITH THE SCHOOLS TO PROVIDE REPORTS FROM THE STUDENTS AFTER THEIR FIRST SEMESTER OF COLLEGE WHICH WILL PROVIDE A STATEMENT OF HOW THE SCHOLARSHIP HAS HELPED THEM IN THEIR PURSUIT OF HIGHER EDUCATION. X X X 0 0 0 0 0 0 0 0 0 JOHN MICHAEL HAM-YING MD CMO/MD 226694 0 4445 0 0 0 0 0 17568 0 248707 0 0 0 LAURIE ASBURY CEO 191906 0 25978 0 6178 0 6178 0 12821 0 243061 0 0 0 BRUNO MANCINI PROVIDER 188916 0 3704 0 5201 0 5200 0 23621 0 226642 0 0 0 TERESA ROJAS-SANCHEZ PROVIDER 162691 0 3190 0 10812 0 10812 0 18118 0 205623 0 0 0 HIPOLITO VALDEZ CFO 158052 0 3167 0 8625 0 8625 0 21368 0 199837 0 0 0 LEONEL TORRES DENTAL DIRECTOR 175495 0 3441 0 1300 0 1300 0 7985 0 189521 0 0 0 MICHELLE MOLL PHARMACY DIRECTOR 131685 0 2582 0 12004 0 12004 0 21368 0 179643 0 0 0 PART I, LINE 3 THE CEO IS EVALUATED ANNUALLY BY THE BOARD OF DIRECTORS AND COMPENSATION IS BASED ON THE RESULTS OF THAT EVALUATION. OFFICER COMPENSATION ALSO INCLUDES COMPARABILITY DATA PRIMARILY WITHIN THE FQHC SPACE ASSOCIATED WITH MARKET CAPITALIZATION. SOME OFFICERS ADDITIONALLY HAVE WRITTEN EMPLOYMENT CONTRACTS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CEO, CFO, AND THE EXECUTIVE COMMITTEE BEFORE SUBMISSION TO THE IRS. THE FORM 990 IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR BOARD APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR A RELATED PARTY LETTER IS SENT TO EACH BOARD MEMBER DURING THE AUDIT. IF A RESPONSE INDICATES A CONFLICT OF INTEREST, IT IS DIRECTED TO THE CEO AND CFO. ALSO, EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS EVALUATED ANNUALLY BY THE BOARD OF DIRECTORS AND COMPENSATION IS BASED ON THE RESULTS OF THAT EVALUATION. OFFICER COMPENSATION ALSO INCLUDES COMPARABILITY DATA PRIMARILY WITHIN THE FQHC SPACE ASSOCIATED WITH MARKET CAPITALIZATION. SOME OFFICERS ADDITIONALLY HAVE WRITTEN EMPLOYMENT CONTRACTS. THE MEDICAL STAFF ARE ANNUALLY REVIEWED BY THE CEO AND WAGES ARE DETERMINED BASED ON THAT REVIEW. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.