2018-05-15T10:54:41-05:00 2017-06-30 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2016-07-01 042610447 NORTH SHORE COMMUNITY HEALTH INC NORT 9788251109 27 CONGRESS ST No 504 SALEM MA 01970 margaret brennan chief executive officer 9788251109 2018-05-14 1 PAUL BALLASY P00852868 9592007000 2018-05-12 209.3.217.20 2018-05-14 16:52:22 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 90CC17281F34CD083B051E620E31C1B2A26173FC 2016 2021-01-29 14:40:06Z margaret brennan 27 CONGRESS ST No 504 SALEM MA 01970 14295525 0 X WWW.NSCHI.ORG X 1977 MA North Shore Community Health's mission is to build healthy communities by providing exceptional care to all. 13 13 169 0 0 0 4722271 5593771 7894174 8473824 111 492 215240 227438 12831796 14295525 0 0 0 0 8372848 9402802 0 0 0 4055584 4483812 12428432 13886614 403364 408911 5400367 5603986 2049507 1844215 3350860 3759771 THE HEALTH CENTER'S MISSION IS TO PROVIDE HIGH QUALITY, COMPREHENSIVE PRIMARY CARE THAT IS ACCESSIBLE, CULTURALLY AND LINGUISTICALLY COMPETENT, AND COMMUNITY DIRECTED FOR ALL RESIDENTS OF MASSACHUSETTS' NORTH SHORE AND CAPE ANN COMMUNITIES REGARDLESS OF ABILITY TO PAY. 0 0 8644942 6929583 MEDICAL SERVICES - MEDICAL SERVICES PROVIDED TO THE RESIDENTS OF SALEM, PEABODY, GLOUCESTER AND SURROUNDING COMMUNITIES. SERVICES INCLUDE MEDICAL SERVICES TO ADULTS AND CHILDREN, HIV COUNSELING AND OTHER. THERE WERE 43,196 MEDICAL VISITS DURING THE TAX YEAR. 2021277 1389211 DENTAL SERVICES - DENTAL SERVICES PROVIDED TO THE RESIDENTS OF SALEM, PEABODY, GLOUCESTER AND SURROUNDING COMMUNITIES. THERE WERE 13,976 DENTAL VISITS DURING THE TAX YEAR. 987664 376468 SCHOOL BASED HEALTH CENTERS - HEALTH SERVICES WERE PROVIDED TO STUDENTS AT SALEM AND PEABODY VETERAN MEMORIAL HIGH SCHOOLS. THERE WERE 3,789 SCHOOL BASED HEALTH CENTER VISITS DURING THE TAX YEAR. 11653883 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 11 0 169 1 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 MA X margaret brennan 9788251109 27 CONGRESS ST No 504 SALEM MA 01970 Charlotte Ohannessian Board Member 2.00 X 0 0 0 Gabrielle Ross Board Member 2.00 X 0 0 0 jack vondras President 2.00 X X 0 0 0 John Belchers Outgoing board Member 2.00 X 0 0 0 Lucy Corchado secretary 2.00 X X 0 0 0 MARION WINFREY immediate past President 2.00 X X 0 0 0 matthew Veno Board Member 2.00 X 0 0 0 Maureen Aylward Board Member 2.00 X 0 0 0 Michael Babb Board Member 2.00 X 0 0 0 Pamela Paine board Member 2.00 X 0 0 0 Rita Badami vice president 2.00 X X 0 0 0 Robert Tolu treasurer 2.00 X X 0 0 0 VENTURA LOREDO Board Member 2.00 X 0 0 0 Christine Malagrida COO 50.00 X 115745 0 2338 faith baigelman cfo 50.00 X 113486 0 8231 MARGARET BRENNAN CEO 50.00 X 187206 0 21733 AZRA ALI Family Practice Physician 50.00 X 183333 0 0 Damian Archer CMO 50.00 X 175023 0 8188 JAMES CHEVERIE FAMILy Practice Physician 50.00 X 195148 0 0 HARRIET SCHEFT PSYCHIATRIST 50.00 X 185996 0 20234 rodrigo rodrigues internal medicine 50.00 X 162616 0 0 1318553 0 60724 18 0 1 0 GE HEALTHCARE IITS USA CORP 15724 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 CENTRICITY EHS VENDOR 135549 insource services inc PO Box 427 newton MA 02464 IT services 122452 HR CONCEPTS LLC 111 CHARLES STREET MANCHESTER NH 03101 CONTRACTED HR SPECIALIST 108702 3 4483579 1110192 5593771 Medicaid 621110 4102944 4102944 Pharmacy revenue 621110 1917044 1917044 Health Safety Net 621110 824611 824611 Third-party payors 621110 724561 724561 Medicare 621110 682355 682355 222309 222309 8473824 492 492 6000 0 6000 6000 6000 Other income 621110 134363 134363 mbhp 621110 87075 87075 221438 14295525 8695262 0 6492 466550 384496 82054 7297695 6014227 1283468 1086253 895211 191042 552304 455169 97135 61330 61330 58000 34071 23929 380348 380348 27313 22397 4916 246477 202111 44366 631777 518057 113720 439956 354122 85834 42551 34892 7659 21289 17457 3832 523106 428947 94159 52082 42707 9375 Pharmacy and related fe 685648 685648 Housekeeping services a 624044 601884 22160 Provision for uncollect 185113 185113 dues and subscriptions 183942 150832 33110 320836 246194 74642 13886614 11653883 2232731 0 689930 177056 205447 205589 593204 1123603 1293141 1741733 37919 37918 28347 210910 5939961 3832784 2552379 2107177 5400367 5603986 1278159 1080450 771348 763765 2049507 1844215 X 2457502 2412040 893358 1347731 3350860 3759771 5400367 5603986 408911 0 X X 0 1 X 1 1 1 X 3384843 3824937 3919087 4722271 5593771 21444909 3384843 3824937 3919087 4722271 5593771 21444909 21444909 5223 7414 10336 6111 6492 35576 290840 338482 170319 209240 221438 1230319 22710804 38571139 0.94430 0.92590 X Schedule A, Part II, Line 10, Explanation of Other Income: OTHER INCOME - 2012 Amount: $ 69,840. 2013 Amount: $ 236,482. 2014 Amount: $ 69,447. 2015 Amount: $ 99,052. 2016 Amount: $ 134,363. EMR Incentive - 2012 Amount: $ 221,000. 2013 Amount: $ 102,000. 2014 Amount: $ 93,500. 2015 Amount: $ 30,158. Medical Records Fees - 2014 Amount: $ 7,372. 2015 Amount: $ 3,546. MBHP - 2015 Amount: $ 76,484. 2016 Amount: $ 87,075. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1415592 947776 467816 2913472 1554934 1358538 1610897 1330074 280823 2107177 X 14147312 36900 -185113 -148213 14295525 0 14295525 13738401 36900 36900 13701501 185113 185113 13886614 Part X, Line 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2017 AND 2016. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2014 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CENTER HAS UNRELATED BUSINESS INCOME TAXES, IT WILL RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE STATEMENTS OF FINANCIAL POSITION. Part XI, Line 2d - Other Adjustments: provision for uncollectible accounts -185,113. Part XII, Line 4b - Other Adjustments: provision for uncollectible accounts 185,113. X X X X 0 0 0 0 0 0 0 0 0 MARGARET BRENNAN CEO 186706 0 500 0 0 0 0 0 21733 0 208939 0 0 0 AZRA ALI Family Practice Physician 182833 0 500 0 0 0 0 0 0 0 183333 0 0 0 Damian Archer CMO 174523 0 500 0 0 0 0 0 8188 0 183211 0 0 0 JAMES CHEVERIE FAMILy Practice Physician 195148 0 0 0 0 0 0 0 0 0 195148 0 0 0 HARRIET SCHEFT PSYCHIATRIST 185496 0 500 0 0 0 0 0 20234 0 206230 0 0 0 rodrigo rodrigues internal medicine 162116 0 500 0 0 0 0 0 0 0 162616 0 0 0 Form 990, Part VI, Section B, line 11b THE FORM 990 INITIAL COMPLETION IS DONE BY OUR AUDITORS. THE FORM 990 IS THEN SENT TO THE NORTH SHORE COMMUNITY HEALTH MANAGEMENT TEAM AND THEN FORWARDED TO THE MEMBERS OF THE BOARD OF DIRECTORS, WHO ARE ABLE TO SUBMIT ANY QUESTIONS, COMMENTS, OR OBSERVATIONS THAT THEY HAVE. THEN MANAGEMENT DISCUSSES ANY CHANGES THEY ARE GOING TO MAKE TO THE 990 FORM. IF CHANGES ARE DEEMED NECESSARY, THEY ARE MADE IMMEDIATELY. THE FORM 990 IS THEN APPROVED FOR SUBMISSION BY THE BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 12c EACH EMPLOYEE, VOLUNTEER, AND BOARD MEMBER WILL ACKNOWLEDGE THAT THEY HAVE READ AND UNDERSTAND NORTH SHORE COMMUNITY HEALTH'S CONFLICT OF INTEREST POLICY UPON BEGINNING THEIR EMPLOYMENT OR TENURE WITH NORTH SHORE COMMUNITY HEALTH BY SIGNING AN ACKNOWLEDGEMENT FORM. THIS IS UPDATED ON A YEARLY BASIS. Form 990, Part VI, Section B, line 15 THE COMPENSATION OF THE HEALTH CENTER'S OFFICERS AND KEY EMPLOYEES IS APPROVED BY THE BOARD OF DIRECTORS UTILIZING A SALARY SURVEY. THE EXECUTIVE DIRECTOR SETS THE OTHER EMPLOYEES' SALARIES BASED ON A SALARY SURVEY IN ACCORDANCE WITH THE HEALTH CENTER'S BUDGET PARAMETERS. Form 990, Part VI, Section C, line 19 NORTH SHORE COMMUNITY HEALTH, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS AVAILABLE TO THE GENERAL PUBLIC THROUGH WWW.GUIDESTAR.ORG. Form 990, Part XII, line 2c: THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.