2022-05-12T15:59:05-05:00 2021-06-30 111986323 MARCUM LLP 555 LONG WHARF DRIVE NEW HAVEN CT 06511 990 2020-07-01 061436620 NORWALK COMMUNITY HEALTH CENTER NORW 2038991770 120 CONNECTICUT AVENUE NORWALK CT 06854 KENNETH WALLER CHIEF EXECUTIVE OFFICER 2038991770 2022-05-12 1 KENNETH WALLER 999009999 MARY ANTONETTI P00431862 2037819600 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KENNETH WALLER 120 CONNECTICUT AVENUE NORWALK CT 06854 13465663 0 X WWW.NORWALKCHC.ORG X 1999 CT TO PROVIDE QUALITY, INNOVATIVE CARE THAT ENRICHES THE LIVES OF OUR PATIENTS. 11 11 109 0 0 0 4848934 7127694 4986128 6261342 2345 1912 73378 74715 9910785 13465663 0 0 0 0 6037937 7065567 0 0 0 4338264 4160750 10376201 11226317 -465416 2239346 4587775 5602930 3996900 2772709 590875 2830221 TO PROVIDE QUALITY, INNOVATIVE CARE THAT ENRICHES THE LIVES OF OUR PATIENTS. 0 0 9434265 6261342 TO ESTABLISH, DEVELOP, MAINTAIN, MANAGE AND OPERATE A NONPROFIT OUTPATIENT CLINIC PROVIDING COMPREHENSIVE PRIMARY CARE TO THE NORWALK, CT COMMUNITY. 9434265 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 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 19 0 1 109 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 CT X JOHN J GETTINGS III 2038991770 120 CONNECTICUT AVENUE NORWALK CT 06854 ADRIANA FIELDS DIRECTOR 1.00 X 0 0 0 ALICIA BRIGGS DIRECTOR 1.00 X 0 0 0 CAROLYN C FULLER DIRECTOR TERM EXPIRED 11/2020 1.00 X 0 0 0 DARLENE YOUNG CHAIRMAN 3.00 X X 0 0 0 JAMES WHITING TREASURER 2.50 X X 0 0 0 JOSEPH E MANN VICE CHAIRMAN 2.50 X X 0 0 0 LENORE JORDAN SECRETARY 2.50 X X 0 0 0 LISETTE FORD DIRECTOR 1.00 X 0 0 0 LUNDA ASMANI DIRECTOR 1.00 X 0 0 0 PETER KORZENIK DIRECTOR 1.00 X 0 0 0 THANA VAN ROOYEN DIRECTOR 1.00 X 0 0 0 YVONNE RODRIGUEZ DIRECTOR 1.00 X 0 0 0 JOHN J GETTINGS III CFO 40.00 X 196918 0 18671 KENNETH WALLER CEO 40.00 X 58673 0 0 ELIZABETH THOMAS PROVIDER 40.00 X 178626 0 14393 GERALDINE SIMPLICE PROVIDER 40.00 X 113960 0 24855 JILL GOLDBERG PROVIDER 40.00 X 121296 0 19696 KATHLEEN PUNDY PROVIDER 40.00 X 125184 0 9200 MERYL HERTZ DENTIST 40.00 X 132668 0 29919 VASUNDARA TUMMALA PROVIDER 20.00 X 137337 0 0 MARCELYN MOLLOY FORMER CMO 40.00 X 233212 0 8050 BEVERLY LYON DIRECTOR OF NURSING (FORMER) 40.00 X 112598 0 0 1410472 0 124784 9 1 1 0 NORWALK HOSPITAL ASSOCIATION 24 STEVENS STREET NORWALK CT 06850 PRIMARY CARE MEDICAL PROVIDERS 643928 CHG HEALTHCARE SERVICES INC PO BOX 730 MIDVALE UT 84047 LOCUM PROVIDERS 154461 SALLY R BERGWERK MD 35 RIDGEFIELD ROAD PO BOX 725 WILTON CT 06897 PROVIDER 151053 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 LOCUM PROVIDERS 131771 US COMPUTER CONNECTION LLC 933 HOPE STREET STAMFORD CT 06907 IT CONSULTANTS 115218 5 5691454 1436240 420865 7127694 PATIENT SERVICES 621110 6261342 6261342 6261342 1912 1912 74715 0 74715 74715 74715 13465663 6261342 0 76627 593813 224840 368973 5366678 4549333 817345 61188 49010 12178 590404 472896 117508 453484 371653 81831 11945 11945 31909 31909 301865 279685 22180 4912 4912 206848 181914 24934 301272 301272 1151980 924003 227977 4354 4354 21457 21457 6821 6821 214100 186515 27585 77759 62283 15476 PURCHASED SERVICES 928486 928486 DONATED VACCINES 420862 420862 CLINICAL/DENTAL SUPPLIE 224085 224085 MISCELLANEOUS 170039 151946 18093 82056 67938 14118 11226317 9434265 1792052 0 2143680 3214116 123984 19387 341309 509674 147782 124030 4767881 3032158 1831020 1735723 4587775 5602930 620603 721918 86084 189926 420738 31373 2869475 1829492 3996900 2772709 X 590875 2830221 590875 2830221 4587775 5602930 2239346 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3088720 1534849 1553871 1679161 1497309 181852 1735723 DEFERRED LEASE LIABILITY 1829492 1829492 X 13465663 0 13465663 0 13465663 11226317 0 11226317 0 11226317 PART X, LINE 2: NCHC HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON BUSINESS RELATED INCOME. NCHC ACCOUNTS FOR UNCERTAIN TAX PROVISIONS UNDER FASB ASC 740, INCOME TAXES, WHICH PROVIDES A FRAMEWORK FOR HOW ENTITIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. NCHC MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. NCHC DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2021 AND 2020. AS OF JUNE 30, 2021 AND 2020, NCHC DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. X X 0 0 0 0 0 0 0 1 0 MARCELYN MOLLOY FORMER CMO 230000 0 3212 0 0 0 8050 0 0 0 241262 0 0 0 JOHN J GETTINGS III CFO 196208 0 710 0 0 0 0 0 18671 0 215589 0 0 0 ELIZABETH THOMAS PROVIDER 172992 0 5634 0 0 0 5270 0 9123 0 193019 0 0 0 BEVERLY LYON DIRECTOR OF NURSING (FORMER) 111840 0 758 0 0 0 0 0 0 0 112598 0 0 0 PART I, LINE 7 M. MOLLOY RECEIVED $2,500 AS PART OF SIGN ON BONUS. E. THOMAS RECEIVED $2,500 AS PART OF SIGN ON BONUS AND $2,389.42 AS PART OF PROVIDER INCENTIVE PLAN. ALL EMPLOYEES RECEIVED SMALL THANK YOU BONUS AND CHRISTMAS BONUS. X 1 420865 FMV 0 0 0 PART I, COLUMN (B): SCHEDULE M PART 1 LINE 20 VACCINES: THE ORGANIZATION RECEIVED DONATEED VACCINES THROUGHOUT THE YEAR. THE NUMBER LISTED IS ONE BECAUSE ALL VACCINES COME THROUGH ONE IMMUNICATION GRANT. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE OF MANAGEMENT. A FINAL DRAFT OF THE RETURN IS REVIEWED AND FINALIZED BY THE CFO PRIOR TO DISTRIBUTION TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH PROHIBITS CONFLICT OF INTEREST OR THE APPEARANCE OF CONFLICT OF INTEREST BY BOARD MEMBERS, EMPLOYEES, AND THOSE WHO PROVIDE SERVICES OR FURNISH GOODS TO THE ORGANIZATION. ON AN ANNUAL BASIS, THE BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE WHICH IS REVIEW BY NCHC LEADERSHIP. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES BOARD APPROVED SALARY RANGES THAT UTILIZED DATA FROM NACHC, CHCACT, MGMA AND OTHER SOURCES TO DETERMINE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT AND STAFF. THE BOARD APPROVES THE COMPENSATION OF THE CEO, AND THE CEO HAS THE AUTHORITY TO APPROVE COMPENSATION OF ALL OTHER EMPLOYEES. SUCH APPROVAL IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: AT THIS TIME THERE ARE NO CHANGES FROM PRIOR YEAR.