FALLON HEALTH WEINBERG INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- FALLON HEALTH WEINBERG INC (EIN 16-1580245)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-15
- IRS object ID
- 201623209349316852
- Schema version
- 2015v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-15T15:27:44-07:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161580245 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fallon Health Weinberg Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FALL | BusinessNameControlTxt |
| Phone | 7168101867 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 North Forest Road | AddressLine1Txt |
| City | Getzville | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14068 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Courtney Fasolino | PersonNm |
| Person Title | Executive Director | PersonTitleTxt |
| Phone | 7168106920 | PhoneNum |
| Signature | 2016-11-15 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Richard Burke | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Chestnut Place | AddressLine1Txt |
| City | Worcester | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01608 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,603,223 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.fallonweinberg.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | Fallon Health Weinberg consists of a managed long-term care program (MLTC) and a Medicare Advantage Special Needs Program (DSNP). The mission of the Fallon Health Weinberg programs is to address the long-term care needs for those Medicaid or dually eligible (Medicare and Medicaid) individuals in the WNY community who are chronically ill or who have disabilities. The programs are designed to keep participants living safely and independently in the comfort of their own home as long as possible. Each participant's highly trained care team coordinates a plan of care that is personalized and developed to meet each participant's specific needs. The care team continually monitors participant's health status to update the care plan to ensure the participant is receiving the highest quality of care while remaining in the community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 35 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,342,111 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,598,462 | CYProgramServiceRevenueAmt |
| PY Investment Income | $648 | PYInvestmentIncomeAmt |
| CY Investment Income | $635 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,195 | PYOtherRevenueAmt |
| CY Other Revenue | $4,126 | CYOtherRevenueAmt |
| PY Total Revenue | $4,345,954 | PYTotalRevenueAmt |
| CY Total Revenue | $6,603,223 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,141,635 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,978,420 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,541,380 | PYOtherExpensesAmt |
| CY Other Expenses | $6,357,394 | CYOtherExpensesAmt |
| PY Total Expenses | $6,683,015 | PYTotalExpensesAmt |
| CY Total Expenses | $8,335,814 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,337,061 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,732,591 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,894,495 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,921,590 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,187,786 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,553,243 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,706,709 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,368,347 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Fallon Health Weinberg consists of a managed care long-term program (MLTC) and a Medicare Advantage Special Needs Program (DSNP). The mission of the Fallon Health Weinberg programs is to address the long-term care needs for those Medicaid or dually eligible (Medicare and Medicaid) individuals in the WNY community who are chronically ill or who have disabilities. The programs are designed to keep participants living safely and independently in the comfort of their own home as long as possible. Each participant's highly trained care team coordinates a plan of care that is personalized and developed to meet each participant's specific needs. The care team continually monitors participant's health status to update the care plan to ensure the participant is receiving the highest quality of care while remaining in the community. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,587,807 | ExpenseAmt |
| Revenue | $6,011,258 | RevenueAmt |
| Desc | The MLTC program provides services to Medicaid eligible individuals in the WNY community who are chronically ill or who have disabilities. The Fallon Health Weinberg MLTC program is designed to keep participants living safely at their highest level of independence and in the comfort of their own home as long as possible. Through the coordination of personalized care plans, a participant has access to an array of health care services that they receive either in their home or in a day care setting. A majority of the services provided to participants are at no cost to the participant and are covered either by the program or by Medicare or Medicaid fee-for-service. The services provided by The Fallon Health Weinberg MLTC program include care management, nursing home care, private duty nursing, home health care, home care aide, physical, occupational, and speech therapy, home delivered meals, personal care, nutrition, audiology, dentistry, optometry, personal emergency response systems, and transportation. During 2015, Fallon Health Weinberg serviced over 324 members in the community through the managed long term care program. Of the 264 members enrolled in the program at the end of 2015, 188 members maintained a need for services that qualify them for nursing facility level of care however remain in the community as a result of the program. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $510,705 | ExpenseAmt |
| Revenue | $591,330 | RevenueAmt |
| Desc | The Fallon Health Weinberg DSNP Plan is a Medicare Advantage Special Needs Plan for individuals 21 years of age or older who have Medicare and Medicaid benefits and need additional coordination of primary and specialty medical care as well as long-term services and support. The goal of the plan is to help members stay healthy and continue living safely at home in the community through the coordination of care by a highly experienced Care Team. The Care Team is led by a Navigator, the single person of contact for the plan. The Navigator is in communication with the member's health care professionals in order to coordinate and monitor each members health and to ensure any post hospital care is in place in order to reduce hospital readmissions. The services provided by the Fallon Health Weinberg DSNP includes emergency and urgent care, outpatient health services, inpatient hospital care, primary and specialty care, behavioral health services, skilled nursing facility, outpatient surgery, home health services, and preventive care and screenings. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $0 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $6,098,512 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 35 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kelly L Voigt | PersonNm |
| Phone | 7168101867 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 461 John James Audubon Parkway | AddressLine1Txt |
| City | Amherst | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14228 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Robert T Mayer | |||||||||
| Director - Secretary | 1 | 39 | Yes (X) | Yes (X) | $0 | $302,251 | $91,168 | ||
| David Dunkelman | |||||||||
| Director | 1 | 39 | Yes (X) | Yes (X) | $0 | $680,376 | $21,700 | ||
| Richard Burke | |||||||||
| Director - Board Chairman | 1 | 49 | Yes (X) | Yes (X) | $0 | $448,049 | $64,782 | ||
| Robert S Walker | |||||||||
| Director - Treasurer | 1 | 47 | Yes (X) | Yes (X) | $0 | $458,106 | $59,331 | ||
| Gregory Epstein | |||||||||
| Director | 1 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Lisa Price-Stevens | |||||||||
| Director | 0 | 50 | Yes (X) | $0 | $217,353 | $10,874 | |||
| Mary Ritter | |||||||||
| Director (Ended 2/15) | 0 | 50 | Yes (X) | $0 | $185,030 | $4,326 | |||
| Courtney Fasolino | |||||||||
| Executive Director | 40 | 0 | $163,412 | $0 | $13,125 | Yes (X) | |||
| Keith Curtis | |||||||||
| Program Director | 40 | 0 | $107,154 | $0 | $745 | Yes (X) | |||
| Kelly Voigt | |||||||||
| Finance Director | 40 | 0 | $107,841 | $0 | $5,515 | Yes (X) | |||
| Laura Zulla | |||||||||
| Program Director | 40 | 1 | $110,077 | $0 | $6,099 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $488,484 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,291,165 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $277,665 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Menorah Licensed Home Care | |||||
| 2700 North Forest Road | Getzville | NY | 14068 | Aide service | $330,600 |
| CVS Caremark | |||||
| 2700 North Forest Road | Getzville | NY | 14068 | Pharmaceuticals | $188,495 |
| DeVito Verdi | |||||
| 121 State Street | Albany | NY | 122071693 | Advertising | $238,148 |
| IPC Healthcare | |||||
| PO Box 844929 | Los Angeles | CA | 900844929 | Medical Directorship | $110,000 |
| Willcare | |||||
| 346 Delaware Avenue | Buffalo | NY | 14202 | Aide Services | $107,527 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Premium Revenue | Desc |
| Business | 524114 | BusinessCd |
| Total Revenue Column | $6,598,462 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,598,462 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,598,462 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $635 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $635 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,126 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,126 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,126 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,603,223 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,602,588 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $635 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,653,712 | TotalAmt |
| Program Services | $968,735 | ProgramServicesAmt |
| Management And General | $684,977 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,562 | TotalAmt |
| Program Services | $153,933 | ProgramServicesAmt |
| Management And General | $41,629 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,146 | TotalAmt |
| Program Services | $111,081 | ProgramServicesAmt |
| Management And General | $18,065 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $373,654 | TotalAmt |
| Management And General | $373,654 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,039 | TotalAmt |
| Management And General | $138,039 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,000 | TotalAmt |
| Management And General | $10,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,692,338 | TotalAmt |
| Program Services | $4,566,651 | ProgramServicesAmt |
| Management And General | $125,687 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $437,783 | TotalAmt |
| Management And General | $437,783 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,143 | TotalAmt |
| Management And General | $84,143 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,284 | TotalAmt |
| Management And General | $71,284 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,582 | TotalAmt |
| Program Services | $136,582 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,364 | TotalAmt |
| Management And General | $27,364 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,102 | TotalAmt |
| Program Services | $364 | ProgramServicesAmt |
| Management And General | $23,738 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,997 | TotalAmt |
| Management And General | $8,997 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,045 | TotalAmt |
| Program Services | $159,045 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,850 | TotalAmt |
| Management And General | $108,850 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Dues and Subscriptions | $20,063 | $0 | $20,063 | $0 |
| Recruiting Expenses | $37,920 | $0 | $37,920 | $0 |
| Employee Entertainment Expense | $27,230 | $2,121 | $25,109 | $0 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,335,814 | TotalAmt |
| Program Services | $6,098,512 | ProgramServicesAmt |
| Management And General | $2,237,302 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,732,867 | BOYAmt |
| EOY | $3,528,588 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,412 | BOYAmt |
| EOY | $568,287 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,438 | BOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,793 | BOYAmt |
| EOY | $10,636 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,996,229 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $252,492 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,899,345 | BOYAmt |
| EOY | $3,743,737 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $224,640 | BOYAmt |
| EOY | $1,037,362 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $32,980 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,894,495 | BOYAmt |
| EOY | $8,921,590 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,187,786 | BOYAmt |
| EOY | $1,553,243 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,187,786 | BOYAmt |
| EOY | $1,553,243 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,706,709 | BOYAmt |
| EOY | $7,368,347 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,706,709 | BOYAmt |
| EOY | $7,368,347 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,894,495 | BOYAmt |
| EOY | $8,921,590 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,732,591 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$5,771 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Investment Expense | $0 | InvestmentExpenseAmt |
| Prior Period Adjustments | $0 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $3,400,000 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $140 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $140 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,512,869 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,142,925 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,191,150 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,345,306 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,602,588 | CurrentTaxYearAmt |
| Total | $23,794,838 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,512,869 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,143,065 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,191,150 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,345,306 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,602,588 | CurrentTaxYearAmt |
| Total | $23,794,978 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $23,794,978 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,325 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,216 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $648 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $635 | CurrentTaxYearAmt |
| Total | $8,824 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $0 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,325 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,216 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $648 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $635 | CurrentTaxYearAmt |
| Total | $8,824 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $0 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Total | $0 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,518,194 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,143,065 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,193,366 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,345,954 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,603,223 | CurrentTaxYearAmt |
| Total | $23,803,802 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99963 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99935 | PublicSupportPY509Pct |
| Investment Income CY | 0.00037 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00065 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $272,979 | OtherCostOrOtherBasisAmt |
| Book Value | $272,979 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $3,577,022 | OtherCostOrOtherBasisAmt |
| Depreciation | $209,677 | DepreciationAmt |
| Book Value | $3,367,345 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $146,228 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,815 | DepreciationAmt |
| Book Value | $103,413 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,743,737 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Escrow Balance | Desc |
| Book Value | $1,037,362 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $1,037,362 | TotalBookValueProgramRltdAmt |
| Total Rev Etc Audited Fincl Stmt | $9,997,452 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$5,771 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Recoveries Prior Year Grants | $0 | RecoveriesPriorYearGrantsAmt |
| Other Revenue | $3,400,000 | OtherRevenueAmt |
| Revenue Not Reported | $3,394,229 | RevenueNotReportedAmt |
| Revenue Subtotal | $6,603,223 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $0 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $6,603,223 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,335,814 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $0 | DonatedServicesUseFcltsAmt |
| Prior Year Adjustments | $0 | PriorYearAdjustmentsAmt |
| Losses Reported | $0 | LossesReportedAmt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $8,335,814 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $0 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $8,335,814 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part XI, Line 2d | FormAndLineReferenceDesc |
| Explanation | Per the Member Agreement between Fallon Community Heath Plan, Inc. and Menorah Campus, Inc., Fallon Community Health Plan Inc. was required to make a cash contribution of $3.4M prior to December 31, 2015 to meet additional reserve and operation requirements that occurred during the first year of operations as Fallon Health Weinberg, Inc. Fallon Health Weinberg (formally known as Total Aging in Place Program) was acquired by Fallon Community Health Plan, Inc. in 2014 as a result of a change-in-control event. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | Yes (1) | InitialContractExceptionInd |
| Rebuttable Presumption Proc | Yes (1) | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert S Walker | ||||||||||||||
| Director - Treasurer | $0 | $370,963 | $0 | $80,634 | $0 | $6,509 | $0 | $34,098 | $0 | $25,233 | $0 | $517,437 | $0 | $30,634 |
| Richard Burke | ||||||||||||||
| Director - Board Chairman | $0 | $357,164 | $0 | $81,678 | $0 | $9,207 | $0 | $38,005 | $0 | $26,777 | $0 | $512,831 | $0 | $31,678 |
| Robert T Mayer | ||||||||||||||
| Director - Secretary | $0 | $188,727 | $0 | $0 | $0 | $113,524 | $0 | $85,000 | $0 | $6,168 | $0 | $393,419 | $0 | $113,524 |
| David Dunkelman | ||||||||||||||
| Director | $0 | $679,111 | $0 | $0 | $0 | $1,265 | $0 | $0 | $0 | $21,700 | $0 | $702,076 | $0 | $0 |
| Lisa Price-Stevens | ||||||||||||||
| Executive Director | $0 | $295,460 | $0 | $37,141 | $0 | $10,836 | $0 | $10,382 | $0 | $18,848 | $0 | $372,667 | $0 | $37,141 |
| Courtney Fasolino | ||||||||||||||
| Executive Director | $163,412 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,125 | $0 | $176,537 | $0 | $0 | $0 |
| Mary Ritter | ||||||||||||||
| Director (Ended 2/15) | $0 | $39,065 | $0 | $0 | $0 | $145,965 | $0 | $1,532 | $0 | $2,794 | $0 | $189,356 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 4 | David Dunkleman, President of Menorah Campus, Inc. and Robert Mayer, VP of Finance of Menorah Campus, Inc. participate in an nonqualified supplemental retirement plan. During 2015, Robert Mayer accrued deferred compensation in the amount of $85,000 but no contributions were made in 2015. As of 12/31/2015, only David Dunkleman was substantially vested in the Plan. During 2015, Robert Mayer received payments from the plan of $113,524, which were part of amounts contributed to the plan in previous years. |
| Schedule J, Part I, Line 8 | All directors, officers, and key employees of the Company have agreed to receive a fixed salary each year through a written employment contract. To determine the compensation of the directors, officers, and key employees, the Board of Directors relied on compensation studies and comparisons and required the approval of Board of Directors to determine compensation reasonableness. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 2 | Effective January 1, 2015, Fallon Health Weinberg began offering the Fallon Health Weinberg Dual Special Needs program (DSNP). The Fallon Health Weinberg DSNP Plan is a Medicare Advantage Special Needs Plan for individuals 21 years of age or older who have Medicare and Medicaid benefits and need additional coordination of primary and specialty medical care as well as long-term services and support. The goal of the plan is to help members stay healthy and continue living safely at home in the community through the coordination of care by a highly experienced Care Team. The Care Team is led by a Navigator, the single person of contact for the plan. The Navigator is in communication with the member's health care professionals in order to coordinate and monitor each members health and to ensure any post hospital care is in place in order to reduce hospital readmissions. The services provided by the Fallon Health Weinberg DSNP includes emergency and urgent care, outpatient health services, inpatient hospital care, primary and specialty care, behavioral health services, skilled nursing facility, outpatient surgery, home health services, and preventive care and screenings. |
| Form 990, Part VI, Section A, Line 6 | According to the Member Agreement between Fallon Community Health Plan and Menorah Campus, Inc., Fallon Community Health Plan and Menorah Campus, Inc. shall be the only Members of Fallon Health Weinberg. The Members shall have the sole authority to elect the members of the Board of Directors. Fallon Community Health Plan is entitled to 4 voting members and Menorah Campus, Inc. is entitled to elect 2 voting members to the Company's Board of Directors. |
| Form 990, Part VI, Section A, Line 7a | According to the Member Agreement between Fallon Community Health Plan and Menorah Campus, Inc., Fallon Community Health Plan and Menorah Campus, Inc. shall be the only Members of Fallon Health Weinberg. The Members shall have the sole authority to elect the members of the Board of Directors. Fallon Community Health Plan is entitled to 4 voting members and Menorah Campus, Inc. is entitled to elect 2 voting members to the Company's Board of Directors. |
| Form 990, Part VI, Section B, Line 11b | A draft of the Form 990 was prepared internally using information from the organization including audited financial statements, compensation records, governing documents, and compliance policies. The draft was then reviewed by independent accountants for accuracy and completeness. The final Form 990 is prepared and then provided to each board member for his or her review before filing with the IRS. |
| Form 990, Part VI, Section B, Line 12c | A Conflict of Interest disclosure Statement is furnished to each Director, Officer, and Management employee annually. Fallon Health Weinberg has general conflict of interest policies that require reporting of potential conflicts and management approval of these transactions. These policies are enforced by executive management, including the Chief Compliance Officer. Each new Director, Officer and Management employee is advised of this policy upon undertaking his or her perspective duties. |
| Form 990, Part VI, Section B, Line 15 | To determine the compensation structure of management and key employees, the Board Members rely on compensation studies and comparisons. The Board of Directors then vote to approve the compensation for each member of the executive group. The executive group have written employment contracts that set their fixed salary per year. |
| Form 990, Part VI, Section C, Line 18 | Fallon Health Weinberg's Form 990 and the audited financial statements are available to the general public on the website www.guidestar.org as well as upon request. |
| Form 990, Part VI, Section C, Line 19 | The organization makes its governing documents, Conflict of Interest Policy, and its financial statements available to the public upon request. |
| Form 990, Part IX, Line 11g | Other Fee-for-Service expenses include Program Service Medical Expenses, payments made to independent contractors for medical services provided to members that include but not exclusive of Clinical Nursing, Home Health services, Personal Care Aides, Transportation, Day Care, Personal Response Services, Podiatry, Audiology, Optometry and meals: $4,418,640 Professional Fees including independent contractors who provided support to clinical staff: $144,422 Professional Fees including independent contractors who provided support to Administration: $80,482 Consulting Services $40,304 Purchased Services $5,709 Physician services for employee physicals $2,781 |
| Form 990, Part XI, Line 9 | Per the Member Agreement between Fallon Community Health Plan and Menorah Campus, Inc., Fallon Community Health Plan was required to make a cash contribution of $3.4 million prior to December 31, 2015 to meet additional reserve and operation requirements that occurred during the first year operations as Fallon Health Weinberg, Inc. Fallon Health Weinberg (formally known as Total Aging in Place Program) was acquired by Fallon Community Health Plan in 2014 as a result of a change-in-control event. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Fallon Total Care Inc | |||||||||||
| 10 Chestnut Place | Worcester | MA | 01608 | 455591420 | Healthcare | MA | 501(c)(3) | 9 | Fallon Community Health Plan Inc | 0 | |
| Summit Living Inc | |||||||||||
| 10 Chestnut Place | Worcester | MA | 01608 | 261836279 | Healthcare | MA | 501(c)(3) | 9 | Fallon Community Health Plan | 0 | |
| Fallon Community Health Plan | |||||||||||
| 10 Chestnut Place | Worcester | MA | 01608 | 237442369 | Healthcare | MA | 501(c)(3) | 9 | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Fallon Health & Life Assurance Inc | ||||||||||||
| 10 Chestnut Place | Worcester | MA | 01608 | 043169246 | Health and Life | MA | N/A | C | $0 | $0 | 0 | 0 |
| Ultrabenefits Inc | ||||||||||||
| 29 East Mountain Street | worcester | MA | 01608 | 043525752 | Healthcare | MA | N/A | C | $0 | $0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Extensions have been filed by the applicable deadlines and therefore, filing is deemed to be submitted on time. | ExplanationTxt |