2020-11-13T07:37:17-06:00 2019-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2019-01-01 351948768 RAPHAEL HEALTH CENTER RAPH 3178603961 401 E 34TH ST INDIANAPOLIS IN 46205 SHERRY GRAY CEO 3178603961 2020-11-13 1 NATHAN A RODGERS CPA P01568275 3176334705 2020-11-13 76.245.71.191 2020-11-13 06:49:07 ES P 668E3E4A1B31A83BC20F15E14B7D011B91900C56 50BA67CF2BE9AFE4130FCD26086E06618A5B98E5 2019 2021-01-29 14:40:06Z SHERRY GRAY 401 E 34TH ST INDIANAPOLIS IN 46205 6052437 0 X WWW.RAPHAELHC.ORG X 1994 IN TO PROVIDE COMMUNITY-BASED, FULL-SERVICE HEALTHCARE OF THE HIGHEST QUALITY WITH RESPECT AND DIGNITY FOR ALL PEOPLE INCLUDING THE UNDERSERVED AND UNINSURED WITHIN A SETTING THAT SHARES THE LOVE AND HEALING OF JESUS CHRIST. 13 13 67 13 0 0 3559974 3090650 3265230 2922973 24145 24037 0 14777 6849349 6052437 0 0 0 0 5157532 4907060 0 0 153094 1581241 1728784 6738773 6635844 110576 -583407 4745639 4988251 2327250 778667 2418389 4209584 TO PROVIDE COMMUNITY-BASED, FULL-SERVICE HEALTHCARE OF THE HIGHEST QUALITY WITH RESPECT AND DIGNITY FOR ALL PEOPLE INCLUDING THE UNDERSERVED AND UNINSURED WITHIN A SETTING THAT SHARES THE LOVE AND HEALING OF JESUS CHRIST. 0 0 5105346 0 2937750 PROVIDING MEDICAL, DENTAL, VISION AND MENTAL HEALTH SERVICES TO INDIGENT INDIVIDUALS. 5105346 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 56 0 1 67 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X X PAUL UTTERBACK CFO 3179261507 401 E 34TH ST INDIANAPOLIS IN 46205 DR STANLEY REED PRESIDENT 2.00 2.00 X X 0 0 0 JANELL GURNEY VICE PRESIDENT 2.00 1.00 X X 0 0 0 SHANA PAULA SECRETARY 2.00 1.00 X X 0 0 0 SHARON MARSHALL TREASURER 2.00 1.00 X X 0 0 0 DANIELLE STILES-POLK DIRECTOR - BEGAN 10/'19 1.00 0.00 X 0 0 0 SANFORD GARNER DIRECTOR - BEGAN 04/'19 1.00 0.00 X 0 0 0 DR ROBERT WELLER DIRECTOR 1.00 0.00 X 0 0 0 JANICE WILLIAMSON-COX DIRECTOR 1.00 0.00 X 0 0 0 THOMAS SPRADLING DIRECTOR 1.00 2.00 X 0 0 0 JANICE HICKS-SLAUGHTER DIRECTOR - BEGAN 10/'19 1.00 0.00 X 0 0 0 PAT CASANOVA DIRECTOR - BEGAN 09/'19 1.00 0.00 X 0 0 0 JACQUIE GREEN DIRECTOR 1.00 0.00 X 0 0 0 STEPHANIE CARAWAY DIRECTOR - TERM BEGAN 08/19 1.00 1.00 X 0 0 0 SHERRY GRAY CEO 40.00 2.00 X 136780 0 7619 TERRY TURMAN INTERIM CFO - ENDED 01/'20 40.00 2.00 X 44954 0 0 PAUL UTTERBACK CFO - BEGAN 12/19 40.00 2.00 X 3654 0 0 VICTORIA DOWNS CFO - ENDED 05/19 40.00 2.00 X 40057 0 1602 NATHAN V ROTH PHYSICIAN 40.00 0.00 X 182812 0 12204 RACHEL ZIEGLER BEHAVIORAL HEALTH SUPERVISOR 40.00 0.00 X 118073 0 9334 SUZANNE MONTGOMERY PHYSICIAN 40.00 0.00 X 163081 0 10146 DOROTHY BOERSMA PHYSICIAN 40.00 0.00 X 134112 0 5365 823523 0 46270 5 0 1 0 0 2591698 498952 214835 3090650 PATIENT SERVICES 621300 2922973 2922973 2922973 24037 24037 MISCELLANEOUS REVENUE 900099 14777 14777 14777 6052437 2937750 0 24037 185388 146298 35189 3901 3551921 2656684 824392 70845 107232 80424 24663 2145 782127 586603 179882 15642 280392 210294 64490 5608 114758 91806 22952 23743 19439 2536 1768 126144 103276 13474 9394 148897 121905 15904 11088 308856 249300 54312 5244 28247 23126 3017 2104 62194 62194 127865 102292 23016 2557 28856 23085 5194 577 OTHER MEDICAL EXPENSES 409064 409064 DUES & SUB. 84721 69363 9049 6309 STAFF DEVELOPMENT 72376 59255 7731 5390 LAB/X-RAYS 51765 51765 141298 101367 29409 10522 6635844 5105346 1377404 153094 583515 278797 535307 466448 86217 359556 506384 304076 0 16885 88065 33735 1830153 1508452 2919985 321701 26166 3207053 4745639 4988251 402428 399051 1424822 0 500000 379616 2327250 778667 X 2357482 4209584 60907 0 2418389 4209584 4745639 4988251 -583407 16386 2358216 0 X X 0 1 X 1 1 1 X 2116787 2509162 2526515 3559974 2875815 13588253 2116787 2509162 2526515 3559974 2875815 13588253 13588253 39360 31183 31327 24145 24037 150052 14777 14777 13753082 0.98800 0.98670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1830153 1508452 321701 321701 INVESTMENT IN RAPHAEL REALTY 3207053 3207053 ESTIMATED THIRD-PARTY SETTLEMENTS 379616 379616 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CENTER AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2019 AND 2018, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. X 0 0 0 0 0 0 0 0 0 NATHAN V ROTH PHYSICIAN 182812 0 0 0 0 0 7604 0 4600 0 195016 0 0 0 SUZANNE MONTGOMERY PHYSICIAN 163081 0 0 0 0 0 6693 0 3453 0 173227 0 0 0 X 1 214835 FMV X MISCELLANEOUS 1 120 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B RAPHAEL HEALTH CENTER, INC.'S FORM 990 IS REVIEWED BY THE FINANCE COMITTEE. FORM 990, PART VI, SECTION B, LINE 12C RAPHAEL HEALTH CENTER PASSES OUT A QUESTIONNAIRE ABOUT CONFLICT OF INTEREST TO BE FILLED OUT AND RETURNED BY EACH DIRECTOR, OFFICER AND STAFF MEMBER. THE POLICY INCLUDES STATEMENTS ABOUT OTHER EMPLOYMENT AND BEING RELATED TO ANYONE ON THE BOARD OF DIRECTORS AND OTHER ITEMS THAT MAY BE AN ISSUE. POTENTIAL ISSUES ARE IDENTIFIED, EVALUATED AND DISCUSSED WITH THE APPROPRIATE LEVEL OF MANAGEMENT OR MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 RAPHAEL HEALTH CENTER, INC.'S BOARD OF DIRECTORS' HR COMMITTEE ESTABLISH ALL STAFFING COMPENSATION PLANS AFTER A THOROUGH REVIEW OF ALL RELATED ISSUES, CONSULTATION WITH INDEPENDENT PERSONS, REVIEW OF COMPARABLE DATA AND DELIBERATION. IT ALSO CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE OTHER OFFICERS AND KEY EMPLOYEES IN CONSIDERING THEIR COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 RAPHAEL HEALTH CENTER, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, AS APPLICABLE, AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST MADE TO THE ATTENTION OF OUR CHIEF EXECUTIVE OFFICER (CEO) AND RECEIVED AT OUR CORPORATE OFFICE ADDRESS. RAPHAEL REALTY 401 EAST 34TH STREET INDIANAPOLIS IN 46205 743093941 REAL ESTATE IN 501(C)(2) 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 RAPHAEL REALTY INC K 130500 BOOK RAPHAEL REALTY INC R 848837 CASH