2022-08-15T10:13:10-05:00 2021-09-30 042571780 AAFCPAS INC 50 WASHINGTON STREET WESTBOROUGH MA 01581 990 2020-10-01 042678774 CODMAN SQUARE HEALTH CENTER INC CODM 6178259660 637 WASHINGTON STREET DORCHESTER MA 02124 SANDRA COTTERELL CEO 6178259660 2022-08-11 1 SANDRA COTTERELL XXX-XX-XXXX CHARLES J WEBB CPA P01584539 5083669100 2022-08-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SANDRA COTTERELL 637 WASHINGTON STREET DORCHESTER MA 02124 64321010 0 X WWW.CODMAN.ORG X 1975 MA TO SERVE AS A RESOURCE FOR IMPROVING THE PHYSICAL, MENTAL AND SOCIAL WELL-BEING OF THE COMMUNITY. 16 16 377 40 0 0 8307993 18663419 31444304 33257923 274487 2978867 469979 1077725 40496763 55977934 0 0 0 0 22679367 23260291 43182 0 0 17294122 23401067 40016671 46661358 480092 9316576 52055151 53827018 16655128 11118988 35400023 42708030 X TO SERVE AS A RESOURCE FOR IMPROVING THE PHYSICAL, MENTAL AND SOCIAL WELL-BEING OF THE COMMUNITY. 0 0 6423831 14938942 THE 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. 1389096 1472999 OUR 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. 1535143 3281000 OUR 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. 26556740 14438283 OTHER PROGRAMS THAT SUPPORT THE MISSION. 26556740 14438283 35904810 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 0 0 0 1 86 0 1 377 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 16 16 1 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X YI JUNG CFO 6178259660 637 WASHINGTON STREET DORCHESTER MA 02124 ARDIS VAUGHAN PRESIDENT 1.00 X X 0 0 0 STEPHEN WEYMOUTH ESQ PRESIDENT ELECT 1.00 X X 0 0 0 ROBERT J MACEACHERN VICE PRESIDENT 1.00 X X 0 0 0 MARVA SEROTKIN TREASURER 1.00 X X 0 0 0 THABITI BROWN CLERK 1.00 X X 0 0 0 CHARLES O'HARA BOARD MEMBER 1.00 X 0 0 0 JULIA CHARLEY BOARD MEMBER 1.00 X 0 0 0 EGOBUDIKE J EZEDI JR BOARD MEMBER 1.00 X 0 0 0 ISAAC COLBERT BOARD MEMBER 1.00 X 0 0 0 SANDRA WARREN BOARD MEMBER 1.00 X 0 0 0 EMMETT SCHMARSOW BOARD MEMBER 1.00 X 0 0 0 KATHERINE BOWES BOARD MEMBER 1.00 X 0 0 0 REV GARVIN WARDEN BOARD MEMBER 1.00 X 0 0 0 DESIREE OTENTI BOARD MEMBER 1.00 X 0 0 0 TASHA KITTY BOARD MEMBER 1.00 X 0 0 0 CHRISTINE AMENT BOARD MEMBER 1.00 X 0 0 0 SANDRA COTTERELL CHIEF EXECUTIVE OFFICER 41.00 X 295041 0 53632 PHILIP SEVERIN CHIEF MEDICAL OFFICER 41.00 X 257806 0 32530 YI JUNG CHIEF FINANCIAL OFFICER 41.00 X 196651 0 33214 TARSHA WEAVER CHIEF OPERATING OFFICER 41.00 X 180743 0 27125 ANTHONY STANKIEWICZ CHIEF OF STAFF/ADVANCEMENT 41.00 X 186015 0 501 IVETTE ARIAS CHIEF HUMAN RESOURCES OFFI 40.00 X 149797 0 35320 STEPHENSON TOBIERRE PHYSICIAN 42.00 X 212845 0 32289 STEPHEN TRINGALE PHYSICIAN 40.00 X 211659 0 13508 SALVATORE MOLICA PHYSICIAN 40.00 X 185222 0 35778 FUCHSIA MITCHELL PEDIATRICIAN 40.00 X 170513 0 35663 PAMELA ADELSTEIN PHYSICIAN 37.00 X 185681 0 5418 2231973 0 304978 48 0 1 0 CPA MEDICAL BILLING LLC 388 EAST MAIN STREET BRANFORD CT 06405 BILLING SERVICES 1343131 OCHIN INC 55 FRUIT STREET ACC 812 BOSTON MA 02114 EMR & PM SERVICES 865206 DOTHOUSE HEALTH INC 1452 DORCHESTER AVENUE DORCHESTER MA 02122 SHARED IT SERVICES 825515 BU FAMILY MEDICINE ASSOCIATES DOWLING 5 ONE BOSTON MEDICAL CENTER PLACE BOSTON MA 02118 PHYSICIAN SERVICES 644344 BOSTON MEDCIAL CENTER DEPT OF LABORATOTY ONE BOSTON MEDICAL CENTER PL BOSTON MA 02118 COVID TESTING KITS 582540 35 10326050 8337369 51290 18663419 PATIENT SERVICE REVENUE 621400 33254469 33254469 MEDICAL RECORD FEES 621400 3454 3454 33257923 151301 151301 204424 0 204424 204424 204424 11170642 8343076 2827566 2827566 2827566 MISC. REVENUE 900099 873301 873301 873301 55977934 34131224 0 3183291 1457119 168294 1288825 17831010 16134720 1696290 375218 351069 24149 2258192 1354196 903996 1338752 1140050 198702 95588 95588 106804 2700 104104 51666 51666 16296 12246 4050 50922 24405 26517 678776 298377 380399 937885 57230 880655 9498 674 8824 21724 21724 1340177 337576 1002601 192217 56357 135860 CONTRACTED SERVICES 8584555 5314841 3269714 PHARMACY 8460520 8460520 MEDICAL SUPPLIES 1508650 1508650 MISCELLANEOUS 792175 441707 350468 553614 241198 312416 46661358 35904810 10756548 0 1759 1759 20628542 21145126 1248754 1275817 1682879 2385499 149687 0 664819 344294 30511715 12890286 17604196 17621429 9316576 10240238 757939 812856 52055151 53827018 5636930 4978775 1203329 440213 3987200 5827669 5700000 16655128 11118988 X 33389217 39933578 2010806 2774452 35400023 42708030 52055151 53827018 9316576 -2008569 0 X X 0 1 X 1 1 1 X 6105806 6908089 7323827 8318743 18663419 47319884 6105806 6908089 7323827 8318743 18663419 47319884 92290 47227594 294744 489576 459500 330092 355725 1929637 873301 873301 50122822 158975335 0.94220 0.92590 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2020 AMOUNT: $ 873,301. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1332986 1332986 15793931 3364497 12429434 586673 101885 484788 12798125 9423904 3374221 17621429 REFUNDABLE ADVANCE 5700000 5700000 X 53989199 -2008569 71500 -1937069 55926268 51666 51666 55977934 46681192 71500 71500 46609692 51666 51666 46661358 PART X, LINE 2: THE 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. X X X X X X 0 0 0 0 0 0 0 0 0 SANDRA COTTERELL CHIEF EXECUTIVE OFFICER 295041 0 0 0 0 0 24039 0 29593 0 348673 0 0 0 PHILIP SEVERIN CHIEF MEDICAL OFFICER 257806 0 0 0 0 0 5264 0 27266 0 290336 0 0 0 STEPHENSON TOBIERRE PHYSICIAN 212845 0 0 0 0 0 4375 0 27914 0 245134 0 0 0 YI JUNG CHIEF FINANCIAL OFFICER 196651 0 0 0 0 0 4075 0 29139 0 229865 0 0 0 STEPHEN TRINGALE PHYSICIAN 211659 0 0 0 0 0 4247 0 9261 0 225167 0 0 0 SALVATORE MOLICA PHYSICIAN 185222 0 0 0 0 0 3874 0 31904 0 221000 0 0 0 TARSHA WEAVER CHIEF OPERATING OFFICER 180743 0 0 0 0 0 3741 0 23384 0 207868 0 0 0 FUCHSIA MITCHELL PEDIATRICIAN 170513 0 0 0 0 0 0 0 35663 0 206176 0 0 0 PAMELA ADELSTEIN PHYSICIAN 185681 0 0 0 0 0 3732 0 1686 0 191099 0 0 0 ANTHONY STANKIEWICZ CHIEF OF STAFF/ADVANCEMENT 186015 0 0 0 0 0 0 0 501 0 186516 0 0 0 IVETTE ARIAS CHIEF HUMAN RESOURCES OFFI 149797 0 0 0 0 0 3205 0 32115 0 185117 0 0 0 X PATIENT CARE KITS 4550 36400 MARKET COST FOR LIKE X PPE - MASKS 8000 12000 MARKET COST FOR LIKE X VACCINATION INCENTIVE 49 2450 CASH VALUE OF GC X BLOOD PRESSURE SELF-MONITORING 20 440 MARKET COST FOR LIKE 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 TWO OF THE DIRECTORS ARE SIBLINGS: KATHERINE BOWES AND EMMETT SCHMARSOW. FORM 990, PART VI, SECTION A, LINE 7A EXPLANATION: 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 11B THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND MEMBERS OF THE BOARD MUST COMPLETE ANNUAL SIGN OFFS ON THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION 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 19 CODMAN 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. CODMAN EYE CARE AFFILIATES - SOUTH SHORE INC 637 WASHINGTON STREET DORCHESTER MA 02124 825132976 EYE CARE MA CODMAN SQUARE HEALTH CENTER C 487724 516618 1.00000 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 CODMAN EYE CARE AFFILIATES - SOUTH SHORE INC D 397580 AMOUNT DUE FROM CECA CODMAN EYE CARE AFFILIATES - SOUTH SHORE INC B 415276 BOOK VALUE