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CODMAN SQUARE HEALTH CENTER INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
CODMAN SQUARE HEALTH CENTER INC (EIN 04-2678774)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-08-15
IRS object ID
202242279349302204
Schema version
2020v4.2
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)
Return2022-08-15T10:13:10-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN042571780PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1AAFCPAS INCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line150 WASHINGTON STREETAddressLine1Txt
CityWESTBOROUGHCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01581ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN042678774EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CODMAN SQUARE HEALTH CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCODMBusinessNameControlTxt
Phone6178259660PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1637 WASHINGTON STREETAddressLine1Txt
CityDORCHESTERCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02124ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSANDRA COTTERELLPersonNm
Person TitleCEOPersonTitleTxt
Phone6178259660PhoneNum
Signature2022-08-11SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstSANDRAPersonFirstNm
Person LastCOTTERELLPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCHARLES J WEBB CPAPreparerPersonNm
PTINP01584539PTIN
Phone5083669100PhoneNum
Preparation2022-08-11PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSANDRA COTTERELLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1637 WASHINGTON STREETAddressLine1Txt
CityDORCHESTERCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02124ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$64,321,010GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CODMAN.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1975FormationYr
Legal Domicile StateMALegalDomicileStateCd
Activity Or MissionTO SERVE AS A RESOURCE FOR IMPROVING THE PHYSICAL, MENTAL AND SOCIAL WELL-BEING OF THE COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body16VotingMembersGoverningBodyCnt
Voting Members Independent16VotingMembersIndependentCnt
Total Employee377TotalEmployeeCnt
Total Volunteers40TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$8,307,993PYContributionsGrantsAmt
CY Contributions Grants$18,663,419CYContributionsGrantsAmt
PY Program Service Revenue$31,444,304PYProgramServiceRevenueAmt
CY Program Service Revenue$33,257,923CYProgramServiceRevenueAmt
PY Investment Income$274,487PYInvestmentIncomeAmt
CY Investment Income$2,978,867CYInvestmentIncomeAmt
PY Other Revenue$469,979PYOtherRevenueAmt
CY Other Revenue$1,077,725CYOtherRevenueAmt
PY Total Revenue$40,496,763PYTotalRevenueAmt
CY Total Revenue$55,977,934CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$22,679,367PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$23,260,291CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$43,182PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$17,294,122PYOtherExpensesAmt
CY Other Expenses$23,401,067CYOtherExpensesAmt
PY Total Expenses$40,016,671PYTotalExpensesAmt
CY Total Expenses$46,661,358CYTotalExpensesAmt
PY Revenues Less Expenses$480,092PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$9,316,576CYRevenuesLessExpensesAmt
Total Assets BOY$52,055,151TotalAssetsBOYAmt
Total Assets EOY$53,827,018TotalAssetsEOYAmt
Total Liabilities BOY$16,655,128TotalLiabilitiesBOYAmt
Total Liabilities EOY$11,118,988TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$35,400,023NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$42,708,030NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO SERVE AS A RESOURCE FOR IMPROVING THE PHYSICAL, MENTAL AND SOCIAL WELL-BEING OF THE COMMUNITY.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$6,423,831ExpenseAmt
Revenue$14,938,942RevenueAmt
DescTHE LARGEST PROGRAM BY EXPENSE IS OUR PRIMARY CARE DEPARTMENT. THIS IS THE BACKBONE OF OUR PATIENT CENTERED MEDICAL HOME EFFORTS. PROVIDERS CARE FOR PATIENTS THROUGHOUT ALL STAGES OF LIFE, INCLUDING BOTH WELLNESS APPOINTMENTS AND VISITS REQUIRING ATTENTION TO A SPECIFIC ILLNESS OR INJURY. THE HEALTH CENTER CARES FOR BOTH THE INDIVIDUAL AND HIS/HER FAMILY THROUGH THE INTEGRATION OF BIOLOGICAL, CLINICAL AND BEHAVIORAL SCIENCES. OUR APPROACH IS INTEGRATED AND HOLISTIC, AND ADDRESSES BOTH THE CLINICAL AND NON-CLINICAL (SOCIAL SERVICES, COMMUNITY BASED PROGRAMS). WHEN SPECIALTY SERVICES ARE NEEDED WE COORDINATE THAT CARE. THE HEALTH CENTER RECORDED 73,803 VISITS IN FY 2021.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,389,096ExpenseAmt
Revenue$1,472,999RevenueAmt
DescOUR DENTAL DEPARTMENT PROVIDES PREVENTATIVE AND RESTORATIVE TREATMENT. THIS INCLUDES EXAMS, CLEANINGS, FILLINGS, ROOT CANAL TREATMENT, CROWNS, AND ORAL SURGERY PROCEDURES. OUR STATE-OF-THE-ART DENTAL CLINIC HAS 7 DENTAL OPERATORIES FULLY EQUIPPED WITH DIGITAL RADIOGRAPHY & AUTOMATIC DENTAL CHAIRS. WE ALSO HAVE A PEDIATRIC DENTAL SUITE EMBEDDED IN THE PEDIATRIC DENTAL CLINIC, DESIGNED SPECIFICALLY FOR PEDIATRIC DENTAL CARE. DENTRIX IS THE DENTAL PRACTICE MANAGEMENT SOFTWARE SYSTEM UTILIZED IN THE PRACTICE TO STORE DIGITAL X-RAYS, INTRAORAL PICTURES, PATIENT MEDICAL HISTORY, CLINICAL NOTES AND DENTAL BENEFIT INFORMATION. THE DENTAL STAFF INCLUDES GENERAL DENTISTS, HYGIENISTS, A PERIODONTIST (GUM SPECIALIST) AND ENDODONTIST (ROOT CANAL SPECIALIST). TREATMENT IS AVAILABLE TO ALL MEMBERS IN THE COMMUNITY INCLUDING UNINSURED PATIENTS, PATIENTS WITH MEDICAID, MEDICARE, MASS HEALTH, AS WELL AS COMMERCIALLY INSURED PATIENTS. WE ALSO SERVE AS AN EDUCATIONAL SITE FOR DENTAL STUDENT EXTERNS AND RESIDENTS FROM BOSTON UNIV., TUFTS UNIV. DENTAL SCHOOLS AND NYU LUTHERAN ADVANCED EDUCATION IN GENERAL DENTISTRY RESIDENCY PROGRAM. THE DENTAL DEPARTMENT RECORDED 9,508 VISITS IN FY 2021.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$1,535,143ExpenseAmt
Revenue$3,281,000RevenueAmt
DescOUR URGENT CARE DEPARTMENT PROVIDES SAME DAY TREATMENT FOR ILLNESSES OR CONDITIONS THAT NEED IMMEDIATE ATTENTION. OUR STAFF IS COMPRISED OF PHYSICIANS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, NURSES AND MEDICAL ASSISTANTS. URGENT CARE IS OFTEN A GATEWAY FOR PATIENTS TO BECOME A PART OF THE PATIENT CENTERED MEDICAL HOME, AND OUR STAFF IS TRAINED TO IDENTIFY THOSE INDIVIDUALS THAT NEED A PRIMARY CAREGIVER. URGENT CARE IS OPEN SEVEN DAYS A WEEK AND IS A KEY RESOURCE IN THE COMMUNITY TO ADDRESS URGENT NEEDS THAT SHOULD NOT REQUIRE A VISIT TO A HOSPITAL EMERGENCY ROOM. THE URGENT CARE DEPARTMENT RECORDED 17,112 VISITS IN FY 2021.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$26,556,740ExpenseAmt
Revenue$14,438,283RevenueAmt
DescOTHER PROGRAMS THAT SUPPORT THE MISSION.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$26,556,740TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$14,438,283TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$35,904,810TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document86IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee377EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members16GoverningBodyVotingMembersCnt
Independent Voting Member16IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonYI JUNG CFOPersonNm
Phone6178259660PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1637 WASHINGTON STREETAddressLine1Txt
CityDORCHESTERCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02124ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
ARDIS VAUGHAN
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
STEPHEN WEYMOUTH ESQ
PRESIDENT ELECT1.00Yes (X)Yes (X)$0$0$0
ROBERT J MACEACHERN
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
MARVA SEROTKIN
TREASURER1.00Yes (X)Yes (X)$0$0$0
THABITI BROWN
CLERK1.00Yes (X)Yes (X)$0$0$0
CHARLES O'HARA
BOARD MEMBER1.00Yes (X)$0$0$0
JULIA CHARLEY
BOARD MEMBER1.00Yes (X)$0$0$0
EGOBUDIKE J EZEDI JR
BOARD MEMBER1.00Yes (X)$0$0$0
ISAAC COLBERT
BOARD MEMBER1.00Yes (X)$0$0$0
SANDRA WARREN
BOARD MEMBER1.00Yes (X)$0$0$0
EMMETT SCHMARSOW
BOARD MEMBER1.00Yes (X)$0$0$0
KATHERINE BOWES
BOARD MEMBER1.00Yes (X)$0$0$0
REV GARVIN WARDEN
BOARD MEMBER1.00Yes (X)$0$0$0
DESIREE OTENTI
BOARD MEMBER1.00Yes (X)$0$0$0
TASHA KITTY
BOARD MEMBER1.00Yes (X)$0$0$0
CHRISTINE AMENT
BOARD MEMBER1.00Yes (X)$0$0$0
SANDRA COTTERELL
CHIEF EXECUTIVE OFFICER41.00Yes (X)$295,041$0$53,632
PHILIP SEVERIN
CHIEF MEDICAL OFFICER41.00Yes (X)$257,806$0$32,530
YI JUNG
CHIEF FINANCIAL OFFICER41.00Yes (X)$196,651$0$33,214
TARSHA WEAVER
CHIEF OPERATING OFFICER41.00Yes (X)$180,743$0$27,125
ANTHONY STANKIEWICZ
CHIEF OF STAFF/ADVANCEMENT41.00Yes (X)$186,015$0$501
IVETTE ARIAS
CHIEF HUMAN RESOURCES OFFI40.00Yes (X)$149,797$0$35,320
STEPHENSON TOBIERRE
PHYSICIAN42.00$212,845$0$32,289Yes (X)
STEPHEN TRINGALE
PHYSICIAN40.00$211,659$0$13,508Yes (X)
SALVATORE MOLICA
PHYSICIAN40.00$185,222$0$35,778Yes (X)
FUCHSIA MITCHELL
PEDIATRICIAN40.00$170,513$0$35,663Yes (X)
PAMELA ADELSTEIN
PHYSICIAN37.00$185,681$0$5,418Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,231,973TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$304,978TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K48IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CPA MEDICAL BILLING LLC
388 EAST MAIN STREETBRANFORDCT06405BILLING SERVICES$1,343,131
OCHIN INC
55 FRUIT STREET ACC 812BOSTONMA02114EMR & PM SERVICES$865,206
DOTHOUSE HEALTH INC
1452 DORCHESTER AVENUEDORCHESTERMA02122SHARED IT SERVICES$825,515
BU FAMILY MEDICINE ASSOCIATES DOWLING 5
ONE BOSTON MEDICAL CENTER PLACEBOSTONMA02118PHYSICIAN SERVICES$644,344
BOSTON MEDCIAL CENTER DEPT OF LABORATOTY
ONE BOSTON MEDICAL CENTER PLBOSTONMA02118COVID TESTING KITS$582,540
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K35CntrctRcvdGreaterThan100KCnt
Government Grants$10,326,050GovernmentGrantsAmt
All Other Contributions$8,337,369AllOtherContributionsAmt
Noncash Contributions$51,290NoncashContributionsAmt
Total Contributions$18,663,419TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE621400$33,254,469$33,254,469
MEDICAL RECORD FEES621400$3,454$3,454
FieldValueIRS element (for citing)
Total Program Service Revenue$33,257,923TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$151,301TotalRevenueColumnAmt
Exclusion$151,301ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$204,424RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$204,424RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$204,424TotalRevenueColumnAmt
Exclusion$204,424ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$11,170,642SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$8,343,076SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$2,827,566SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,827,566TotalRevenueColumnAmt
Exclusion$2,827,566ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISC. REVENUEDesc
Business900099BusinessCd
Total Revenue Column$873,301TotalRevenueColumnAmt
Related Or Exempt Func Income$873,301RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$873,301OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$55,977,934TotalRevenueColumnAmt
Related Or Exempt Func Income$34,131,224RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$3,183,291ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,457,119TotalAmt
Program Services$168,294ProgramServicesAmt
Management And General$1,288,825ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$17,831,010TotalAmt
Program Services$16,134,720ProgramServicesAmt
Management And General$1,696,290ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$375,218TotalAmt
Program Services$351,069ProgramServicesAmt
Management And General$24,149ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,258,192TotalAmt
Program Services$1,354,196ProgramServicesAmt
Management And General$903,996ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,338,752TotalAmt
Program Services$1,140,050ProgramServicesAmt
Management And General$198,702ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$95,588TotalAmt
Management And General$95,588ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$106,804TotalAmt
Program Services$2,700ProgramServicesAmt
Management And General$104,104ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$51,666TotalAmt
Management And General$51,666ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$16,296TotalAmt
Program Services$12,246ProgramServicesAmt
Management And General$4,050ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$50,922TotalAmt
Program Services$24,405ProgramServicesAmt
Management And General$26,517ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$678,776TotalAmt
Program Services$298,377ProgramServicesAmt
Management And General$380,399ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$937,885TotalAmt
Program Services$57,230ProgramServicesAmt
Management And General$880,655ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$9,498TotalAmt
Program Services$674ProgramServicesAmt
Management And General$8,824ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$21,724TotalAmt
Management And General$21,724ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,340,177TotalAmt
Program Services$337,576ProgramServicesAmt
Management And General$1,002,601ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$192,217TotalAmt
Program Services$56,357ProgramServicesAmt
Management And General$135,860ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
CONTRACTED SERVICES$8,584,555$5,314,841$3,269,714
PHARMACY$8,460,520$8,460,520
MEDICAL SUPPLIES$1,508,650$1,508,650
MISCELLANEOUS$792,175$441,707$350,468

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$553,614TotalAmt
Program Services$241,198ProgramServicesAmt
Management And General$312,416ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$46,661,358TotalAmt
Program Services$35,904,810ProgramServicesAmt
Management And General$10,756,548ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,759BOYAmt
EOY$1,759EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$20,628,542BOYAmt
EOY$21,145,126EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,248,754BOYAmt
EOY$1,275,817EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,682,879BOYAmt
EOY$2,385,499EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$149,687BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$664,819BOYAmt
EOY$344,294EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$30,511,715LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$12,890,286LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$17,604,196BOYAmt
EOY$17,621,429EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$9,316,576BOYAmt
EOY$10,240,238EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$757,939BOYAmt
EOY$812,856EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$52,055,151BOYAmt
EOY$53,827,018EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,636,930BOYAmt
EOY$4,978,775EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,203,329BOYAmt
EOY$440,213EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$3,987,200BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,827,669BOYAmt
EOY$5,700,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,655,128BOYAmt
EOY$11,118,988EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$33,389,217BOYAmt
EOY$39,933,578EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,010,806BOYAmt
EOY$2,774,452EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$35,400,023BOYAmt
EOY$42,708,030EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$52,055,151BOYAmt
EOY$53,827,018EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$9,316,576ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$2,008,569NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,105,806CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,908,089CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,323,827CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,318,743CurrentTaxYearMinus1YearAmt
Current Tax Year$18,663,419CurrentTaxYearAmt
Total$47,319,884TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,105,806CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,908,089CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,323,827CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,318,743CurrentTaxYearMinus1YearAmt
Current Tax Year$18,663,419CurrentTaxYearAmt
Total$47,319,884TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$92,290SubstantialContributorsTotAmt
Public Support Total170$47,227,594PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$294,744CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$489,576CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$459,500CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$330,092CurrentTaxYearMinus1YearAmt
Current Tax Year$355,725CurrentTaxYearAmt
Total$1,929,637TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year$873,301CurrentTaxYearAmt
Total$873,301TotalAmt
FieldValueIRS element (for citing)
Total Support$50,122,822TotalSupportAmt
Gross Receipts Rltd Activities$158,975,335GrossReceiptsRltdActivitiesAmt
Public Support CY1700.94220PublicSupportCY170Pct
Public Support PY1700.92590PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationOTHER REVENUE - 2020 AMOUNT: $ 873,301.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,332,986OtherCostOrOtherBasisAmt
Book Value$1,332,986BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,793,931OtherCostOrOtherBasisAmt
Depreciation$3,364,497DepreciationAmt
Book Value$12,429,434BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$586,673OtherCostOrOtherBasisAmt
Depreciation$101,885DepreciationAmt
Book Value$484,788BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,798,125OtherCostOrOtherBasisAmt
Depreciation$9,423,904DepreciationAmt
Book Value$3,374,221BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$17,621,429TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescREFUNDABLE ADVANCEDesc
Amt$5,700,000Amt
FieldValueIRS element (for citing)
Total Liability$5,700,000TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$53,989,199TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$2,008,569NetUnrealizedGainsInvstAmt
Donated Services And Use Fclts$71,500DonatedServicesAndUseFcltsAmt
Revenue Not Reported-$1,937,069RevenueNotReportedAmt
Revenue Subtotal$55,926,268RevenueSubtotalAmt
Investment Expenses Not Incld$51,666InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$51,666RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$55,977,934TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$46,681,192TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$71,500DonatedServicesUseFcltsAmt
Expenses Not Reported$71,500ExpensesNotReportedAmt
Expenses Subtotal$46,609,692ExpensesSubtotalAmt
Investment Expenses Not Incld2$51,666InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$51,666ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$46,661,358TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE HEALTH CENTER ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES IN ACCORDANCE WITH ASC TOPIC, INCOME TAXES. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN TAX POSITIONS AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE COMBINING FINANCIAL STATEMENTS REGARDING A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE HEALTH CENTER HAS DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS WHICH QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE COMBINING FINANCIAL STATEMENTS AT SEPTEMBER 30, 2021. THE HEALTH CENTER'S INFORMATION RETURNS ARE SUBJECT TO EXAMINATION BY THE FEDERAL AND STATE JURISDICTIONS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
SANDRA COTTERELL
CHIEF EXECUTIVE OFFICER$295,041$0$0$0$0$0$24,039$0$29,593$0$348,673$0$0$0
PHILIP SEVERIN
CHIEF MEDICAL OFFICER$257,806$0$0$0$0$0$5,264$0$27,266$0$290,336$0$0$0
STEPHENSON TOBIERRE
PHYSICIAN$212,845$0$0$0$0$0$4,375$0$27,914$0$245,134$0$0$0
YI JUNG
CHIEF FINANCIAL OFFICER$196,651$0$0$0$0$0$4,075$0$29,139$0$229,865$0$0$0
STEPHEN TRINGALE
PHYSICIAN$211,659$0$0$0$0$0$4,247$0$9,261$0$225,167$0$0$0
SALVATORE MOLICA
PHYSICIAN$185,222$0$0$0$0$0$3,874$0$31,904$0$221,000$0$0$0
TARSHA WEAVER
CHIEF OPERATING OFFICER$180,743$0$0$0$0$0$3,741$0$23,384$0$207,868$0$0$0
FUCHSIA MITCHELL
PEDIATRICIAN$170,513$0$0$0$0$0$0$0$35,663$0$206,176$0$0$0
PAMELA ADELSTEIN
PHYSICIAN$185,681$0$0$0$0$0$3,732$0$1,686$0$191,099$0$0$0
ANTHONY STANKIEWICZ
CHIEF OF STAFF/ADVANCEMENT$186,015$0$0$0$0$0$0$0$501$0$186,516$0$0$0
IVETTE ARIAS
CHIEF HUMAN RESOURCES OFFI$149,797$0$0$0$0$0$3,205$0$32,115$0$185,117$0$0$0

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)

Non Cash CheckboxNonCashCheckboxIndDescDescContributionContributionCntNoncash Contributions Rpt F990NoncashContributionsRptF990AmtMethod Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)PATIENT CARE KITS4550$36,400MARKET COST FOR LIKE
Yes (X)PPE - MASKS8000$12,000MARKET COST FOR LIKE
Yes (X)VACCINATION INCENTIVE49$2,450CASH VALUE OF GC
Yes (X)BLOOD PRESSURE SELF-MONITORING20$440MARKET COST FOR LIKE
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2TWO OF THE DIRECTORS ARE SIBLINGS: KATHERINE BOWES AND EMMETT SCHMARSOW.
FORM 990, PART VI, SECTION A, LINE 7AEXPLANATION: THE BOARD MEMBERS HAVE THE POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12COFFICERS AND MEMBERS OF THE BOARD MUST COMPLETE ANNUAL SIGN OFFS ON THE CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION OF THE CEO IS DETERMINED AND EVALUATED BY THE BOARD OF DIRECTORS. THE BOARD ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT TO REVIEW AND MAKE RECOMMENDATIONS REGARDING COMPENSATION AND BENEFITS FOR ALL POSITIONS. COMPENSATION OF OTHER OFFICERS AND KEY STAFF MEMBERS IS DETERMINED BY HUMAN RESOURCES, IN CONJUNCTION WITH THE CEO AND EXECUTIVE TEAM. THE MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTER'S ANNUAL SALARY AND COMPENSATION SURVEY IS USED DURING SUCH REVIEWS.
FORM 990, PART VI, SECTION C, LINE 19CODMAN SQUARE HEALTH CENTER MAKES THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2C:THERE HAS BEEN NO CHANGE FROM PRIOR YEARS.

Schedule R IRS990ScheduleR

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CODMAN EYE CARE AFFILIATES - SOUTH SHORE INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1637 WASHINGTON STREETAddressLine1Txt
CityDORCHESTERCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02124ZIPCd
FieldValueIRS element (for citing)
EIN825132976EIN
Primary ActivitiesEYE CAREPrimaryActivitiesTxt
Legal Domicile StateMALegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CODMAN SQUARE HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Share Of Total Income$487,724ShareOfTotalIncomeAmt
Share Of EOY Assets$516,618ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
CODMAN EYE CARE AFFILIATES - SOUTH SHORE INC
D$397,580AMOUNT DUE FROM CECA
CODMAN EYE CARE AFFILIATES - SOUTH SHORE INC
B$415,276BOOK VALUE