2015-04-22T10:18:51-05:00 2014-06-30 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2013-07-01 223160873 STAYWELL HEALTH CARE INC STAY 2037568021 80 PHOENIX AVENUE NO 201 WATERBURY CT 06702 DONALD J THOMPSON JR CHIEF EXECUTIVE OFFICER 2037568021 2015-04-11 1 PAUL BALLASY P00852868 9592007000 2013 2016-03-07 17:11:31Z DONALD J THOMPSON JR 80 PHOENIX AVENUE WATERBURY CT 06702 14644462 0 X WWW.STAYWELLHEALTH.ORG X 1992 CT PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 12 12 188 1 -19995 -19995 3873910 3843233 9578320 10417146 4124 2278 146715 156999 13603069 14419656 0 0 0 0 10365110 11484066 0 0 0 3162194 2655897 13527304 14139963 75765 279693 9616179 10639337 2131836 2875301 7484343 7764036 PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. 0 0 10212653 10561646 MEDICAL CLINIC, HEALTHY START, AND DENTAL CLINIC WHICH PROVIDE MEDICAL, PRENATAL, AND CHILDCARE FOR INNER CITY RESIDENTS AND UNINSURED RESIDENTS AND RESTORATIVE DENTAL CARE FOR INNER CITY CHILDREN. THE TOTAL NUMBER OF VISITS DURING FISCAL YEAR 2014 WAS 75,201. 10212653 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 47 0 1 188 1 1 1 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CT X LULE TRACEY 2037568021 80 PHOENIX AVENUE SUITE 201 WATERBURY CT 06702 MIGDALIA ROSARIO MEMBER 2.00 X 0 0 0 MARK BRIGGS CHAIRPERSON 2.00 X X 0 0 0 ANGIE MEDINA SECRETARY 2.00 X X 0 0 0 ARLENE M ARIAS LCSW MEMBER 2.00 X 0 0 0 SANDRA J SOREL-LEDUC VICE CHAIR 2.00 X X 0 0 0 KATHY MATTEO MEMBER 2.00 X 0 0 0 KAREN WILKIE MEMBER 2.00 X 0 0 0 REV CHRISTOPHER KING MEMBER 2.00 X 0 0 0 WALTER R MACHNICZ MEMBER 2.00 X 0 0 0 CAROLYN A HIGHSMITH TREASURER 2.00 X X 0 0 0 JUDY A ACOSTA MEMBER 2.00 X 0 0 0 THOMAS JOHNSON MEMBER 2.00 X 0 0 0 DONALD J THOMPSON JR CEO/PRESIDENT 40.00 X 208755 0 43929 LULE TRACEY CFO 40.00 X 170081 0 29866 SUNIL D'CUNHA CMO 40.00 X 245388 0 5513 AMIT PATEL DENTAL DIRECTOR 40.00 X 198531 0 18429 ADNA SADIQ INTERNIST 40.00 X 147214 0 19469 LUIS LEON INTERNIST 40.00 X 156744 0 6211 PHILIPPE CHAIN INTERNIST 40.00 X 142621 0 19469 1269334 0 142886 15 0 1 0 GREENWAY HEALTH 100 GREENWAY BLVD CARROLLTON GA 30117 HEALTH INFORMATION TECHNOLOGY 142882 1 35473 12889 3355729 439142 436291 3843233 PATIENT SERVICE 621400 9658444 9658444 PHARMACY 446110 758702 758702 10417146 2278 2278 165881 218919 -53038 -53038 -19995 -33043 4915 12889 5887 -972 -972 MEANINGFUL USE INCENTIVE 900099 144500 144500 OTHER REVENUE 900099 66509 55512 10997 211009 14419656 10617158 -19995 -20740 509436 361394 148042 8065014 5721321 2343693 88076 62481 25595 2126345 1508429 617916 695195 493171 202024 70058 70058 47275 47275 9000 9000 612749 464646 148103 44517 31580 12937 38157 27069 11088 15088 15088 211241 208478 2763 39354 27918 11436 25503 18092 7411 49253 47219 2034 229890 203356 26534 36739 32854 3885 CLINIC SUPPLIES 537056 382693 154363 VACCINES 436291 436291 OTHER 89440 68122 21318 DUES, LICENSES, & MEMBE 83051 58916 24135 81235 58623 22612 14139963 10212653 3927310 0 1147528 1731595 2257654 2440973 240833 378057 849597 901223 177305 206329 7065730 2601936 4513972 4463794 429290 517366 9616179 10639337 979848 1841374 7653 7633 110101 267527 1034234 758767 2131836 2875301 X 5931961 6175338 1552382 1588698 7484343 7764036 9616179 10639337 279693 0 X X 0 1 X 1 1 1 X 3639556 3170165 3403013 3873910 3843233 17929877 3639556 3170165 3403013 3873910 3843233 17929877 17929877 213300 184403 171660 175368 168159 912890 4613 271 4884 2211 281818 155316 215924 655269 19502920 49541184 0.91930 0.98920 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MEANINGFUL USE INCENTIVE - 2011 AMOUNT: $ 276,250. 2012 AMOUNT: $ 127,500. 2013 AMOUNT: $ 144,500. MISCELLANEOUS - 2010 AMOUNT: $ 2,211. 2011 AMOUNT: $ 5,568. 2012 AMOUNT: $ 21,211. 2013 AMOUNT: $ 10,997. FUNDRAISING - 2012 AMOUNT: $ 6,605. 2013 AMOUNT: $ 4,915. PROGRAM RELATED - 2013 AMOUNT: $ 55,512. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 9000 0 0 9000 0 PART II-B, LINE 1: PAID $9,000 TO LEVIN, POWERS & BRENNAN LLC 384297 384297 5537905 1734301 3803604 996330 867635 128695 147198 147198 4463794 X 14644462 224806 224806 14419656 0 14419656 14364769 224806 224806 14139963 0 14139963 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2014 AND 2013. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2011 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CORPORATION 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: RENT EXPENSES 218,919. DIRECT FUNDRAISING EXPENSES 5,887. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSES 218,919. DIRECT FUNDRAISING EXPENSES 5,887. FUNDRAISING 17804 12889 4915 350 3710 600 1227 17804 12889 4915 350 3710 600 1227 5887 -972 X X X 0 1 0 0 0 0 0 1 0 DONALD J THOMPSON JR CEO/PRESIDENT 206622 0 0 0 2133 0 25500 0 18429 0 252684 0 0 0 LULE TRACEY CFO 169740 0 0 0 341 0 9250 0 20616 0 199947 0 0 0 SUNIL D'CUNHA CMO 245388 0 0 0 0 0 0 0 5513 0 250901 0 0 0 AMIT PATEL DENTAL DIRECTOR 198531 0 0 0 0 0 0 0 18429 0 216960 0 0 0 ADNA SADIQ INTERNIST 147214 0 0 0 0 0 0 0 19469 0 166683 0 0 0 LUIS LEON INTERNIST 149994 0 6750 0 0 0 0 0 6211 0 162955 0 0 0 PHILIPPE CHAIN INTERNIST 142621 0 0 0 0 0 0 0 19469 0 162090 0 0 0 PART I, LINE 4B DONALD J. THOMPSON, JR, 457 (F), $25,500 LULE TRACEY, 457 (F), $9,250 PART I, LINE 7 THE CENTER PROVIDED AN ANNUAL PROFIT SHARING BONUS. X 1 436291 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 WILL BE REVIEWED AND ACCEPTED BY THE BOARD BEFORE STAYWELL SUBMITS. FORM 990, PART VI, SECTION B, LINE 12C DONALD THOMPSON, CEO, MONITORS CONFLICT OF INTEREST POLICY BY REVIEWING AND ADDRESSING ANY POTENTIAL CONFLICTS AND FOLLOWING UP EACH YEAR FOR ANY CHANGES. FORM 990, PART VI, SECTION B, LINE 15A INFORMATION FROM NATIONAL AND STATEWIDE SURVEYS ARE USED AS CRITERIA TO DETERMINE THE SALARY OF THE CEO. THIS INFORMATION IS GIVEN TO THE PERSONNEL COMMITTEE FOR REVIEW. THE PERSONNEL COMMITTEE NEGOTIATES AND APPROVES THE SALARY OF THE CEO. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.