2022-11-15T16:38:13-06:00 2021-12-31 352102008 CNA TAX PROFESSIONALS INC 10475 CROSSPOINT BOULEVARD SUITE 200 INDIANAPOLIS IN 46256 990 2021-01-01 061645027 SHALOM HEALTH CARE CENTER INC % MICHAEL NINO CFO SHAL 3172917422 3400 LAFAYETTE ROAD 200 INDIANAPOLIS IN 46222 LEONARDO R ORTEGA MD MPH CEO/EXEC DIRECT 3172917422 2022-11-15 1 LEONARDO ORTEGA MD MPH 999009999 SHAWN D DREIMAN CPA P00380913 3178413393 2022-11-15 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z LEONARDO R ORTEGA MD MPH 3400 LAFAYETTE ROAD 200 INDIANAPOLIS IN 46222 11735660 0 X WWW.SHALOMHEALTHCENTER.ORG X 2002 IN TO PROVIDE A FULL RANGE OF PRIMARY AND PREVENTIVE HEALTH CARE SERVICES TO ALL RESIDENTS, REGARDLESS OF THE ABILITY FOR PAYMENT. 11 11 147 20 -157406 0 6042335 5768528 4524288 4287791 322 725 -66307 1290695 10500638 11347739 0 0 0 0 6005555 7542408 0 0 0 2964233 2986718 8969788 10529126 1530850 818613 4180777 5349705 2888549 3450431 1292228 1899274 TO PROVIDE A FULL RANGE OF PRIMARY AND PREVENTIVE HEALTH CARE SERVICES TO ALL RESIDENTS, REGARDLESS OF THE ABILITY FOR PAYMENT. 0 0 9134226 4287791 PRIMARY AND PREVENTIVE HEALTH CARE SERVICES: WE ARE HERE AT SHALOM HEALTH CARE CENTER SUPPORT OUR MISSION OF PROVIDING PRIMARY HEALTH CARE TO THE UNDESERVED POPULATION THAT LIVE NEAR THE LAFAYETTE SQUARE AREA (WEST SIDE OF INDIANAPOLIS). IN 2021, SHALOM SERVED 12,804 PATIENTS AND HAD 64,020 PATIENTS VISIT OUR PRIMARY CARE CENTERS AND TWENTY-NINE SCHOOL BASED CLINICS. OUR DEMOGRAPHIC DATA SHOWS THAT 77.82% OF THE PATIENTS ARE MINORITY, MANY OF THEM APPRECIATE THE FACT THAT WE OFFER BILINGUAL SERVICES TO THM AT NO ADDITIONAL COST. SCHOOL BASED CLINICS. 9134226 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 1 0 0 0 0 1 20 0 1 147 1 1 1 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 1 1 1 1 0 IN X MICHAEL NINO CFO 3172917422 3400 LAYFAYETTE RD STE 200 INDIANAPOLIS IN 46222 EUGINA LONG CHAIR 1.00 X X 0 0 0 CESAR ROMAN VICE CHAIR 1.00 X X 0 0 0 VIRNA DIAZ BOARD 1.00 X 0 0 0 CRISTIAN GUANDIQUE TREASURER 1.00 X X 0 0 0 LUCIIA RAPIER BOARD 1.00 X 0 0 0 DENNIS STOVER BOARD 1.00 X 0 0 0 FRIEDA THOMPSON BOARD 1.00 X 0 0 0 KENDREA DERRICK SECRETARY 1.00 X X 0 0 0 HANS BERNABE BOARD 1.00 X 0 0 0 ROBYN CLAYBORNE BOARD 1.00 X 0 0 0 ARIELLE ZERGER BOARD 1.00 X 0 0 0 LEONARDO R ORTEGA MD MPH CEO 40.00 X 203598 0 0 MICHAEL NINO CFO 40.00 X 124584 0 6254 DR MARGARITA WIERSEMA CMO 40.00 X 186515 0 13077 DR HEMALATHA HEMACHANDRA MEDICAL DIRECTOR 40.00 X 189847 0 19500 LYNDSEY FURRY CHIEF CLINICAL OFFICER 40.00 X 124939 0 11362 TERESA DRISKELL CNO 40.00 X 125840 0 12508 MYRIAM BERESKY CNO 40.00 X 110893 0 5338 1066216 0 68039 7 0 1 0 VALIC FINANCIAL ADVISORS 500 W MADISON ST 2850 CHICAGO IL 60661 FINANCIAL 285880 WAYNE BANK AND TRUST 500 S A ST RICHMOND IN 47374 FINANCIAL 255439 HENRY SCHEIN INC 5445 GUION RD INDIANAPOLIS IN 46254 SUPPLIES 174892 ECLINICAL WORKS 2 TECHNOLOGY DR WESTBOROUGH MA 01581 TECHNOLOGY 171174 C GARCIA CONSTRUCTION 6002 MICHIGAN RD INDIANAPOLIS IN 46228 CONSTRUCTION 142021 5 4824559 943969 943969 5768528 NET PATIENT SERVICE 621400 3107700 3107700 SCHOOL CLINICS 621400 1012930 1012930 PHARMACY SALES 621400 167161 167161 4287791 725 725 230515 387921 -157406 -157406 -157406 FORGIVENESS OF DEBT 900099 1276025 1276025 OTHER INCOME 900099 172076 172076 1448101 11347739 4287791 -157406 1448826 1054966 924840 130126 6487442 5687239 800203 4602 4602 126569 126569 343632 238555 105077 334787 218836 115951 25382 3231 22151 94116 94116 35801 2388 33413 MEDICAL SUPPLIES & PHAR 1227799 1227799 OTHER 499970 224201 275769 LEASE & RENTALS 372012 332063 39949 PLANT OPERATIONS 98270 49787 48483 -176222 -176222 10529126 9134226 1394900 0 1252951 2283718 143203 164087 584088 319726 33400 59790 4860028 2337644 2167135 2522384 4180777 5349705 390394 508301 209094 178079 2289061 1951450 0 812601 2888549 3450431 X 1292228 1899274 1292228 1899274 4180777 5349705 818613 -211567 0 X 0 1 X 1 1 1 X 4666601 3910870 3354917 6042335 5768528 23743251 3384154 3112679 5212939 4524288 4287791 20521851 8050755 7023549 8567856 10566623 10056319 44265102 0 0 0 44265102 136 258 286 322 725 1727 136 258 286 322 725 1727 11593 62959 102958 75504 172076 425090 8062484 7086766 8671100 10642449 10229120 44691919 0.99040 0.99380 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 344000 344000 1815410 411661 1403749 1047179 728258 318921 1251262 973345 277917 402177 224380 177797 2522384 REFUNDABLE ADVANCE 812601 812601 11911882 176222 387921 564143 11347739 0 11347739 11093269 176222 387921 564143 10529126 0 10529126 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 0 0 0 0 0 0 0 0 0 DR HEMALATHA HEMACHANDRA MEDICAL DIRECTOR 189847 0 0 0 0 0 19500 0 0 0 209347 0 0 0 LEONARDO R ORTEGA MD MPH CEO 203598 0 0 0 0 0 0 0 0 0 203598 0 0 0 DR MARGARITA WIERSEMA CMO 186515 0 0 0 0 0 13077 0 0 0 199592 0 0 0 X 913969 FMV X OTHER 0 30000 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: SHALOM HEALTH CARE CENTER, INC.'S FORM 990 AND ALL RELATED SCHEDULES, STATEMENTS AND ATTACHMENTS ARE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS CHAIRPERSON, EXECUTIVE DIRECTOR, CFO AND APPROPRIATE OTHER REPRESENTATIVE(S) FROM THE BOARD OF DIRECTOR'S FINANCIAL COMMITTEE PRIOR TO FINALIZING THESE TAX RETURNS. THE FORM 990 IS ALSO REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: SHALOM HEALTH CARE CENTER, INC. ANNUALLY REQUESTS EACH OFFICER AND MEMBER OF THE BOARD OF DIRECTORS TO COMPLETE A CONFLICT OF INTEREST POLICY QUESTIONNAIRE. THE POLICY INCLUDES STATEMENTS REGARDING OTHER EMPLOYMENT, BEING RELATED TO ANYONE ON THE BOARD AND OTHER ITEMS THAT MAY CREATE AN APPEARANCE OF A POTENTIAL INDEPENDENCE ISSUE. THE IDENTIFICATION, EVALUATION AND RESOLUTION OF THOSE ISSUES ARE DISCUSSED WITH THE APPROPRIATE LEVEL OF MANAGEMENT OR MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 REVIEW OF CEO OR TOP MANAGEMENT OFFICIAL COMPENSATION: SHALOM HEALTH CARE CENTER, INC.'S BOARD OF DIRECTORS' FINANCE COMMITTEE APPROVES THE PAY SCALES FOR ALL POSITIONS, WHICH ARE BASED ON A SALARY SURVEY DONE AT PERIODIC INTERVALS. THE FINANCE COMMITTEE SUBMITS THE PAY SCALES AT A BOARD MEETING AND THE MINUTES WILL REFLECT THE BOARD OF DIRECTORS APPROVAL. COMPENSATION FOR THE CEO AND TOP MANAGEMENT OFFICIAL WAS LAST REVIWED IN FEBRUARY 2020. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: SHALOM HEALTH CARE CENTER, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, AS APPLICABLE, AVAILABLE TO THE PUBLIC BY APPOINTMENT WITH THE EXECUTIVE DIRECTOR. SHALOM HEALTH CARE CENTER, INC.'S INFORMATION IS ALSO AVAILABLE VIA THE INTERNET. SHALOM LLC 3400 LAFAYETTE ROAD STE 200 INDIANAPOLIS IN 46222 471828555 HOLDING CO IN -157406 2394890 SHALOM HEALTH