2014-11-17T20:43:58-06:00 2013-12-31 521511275 RAFFA PC 1899 L STREET NW SUITE 900 WASHINGTON DC 20036 990 2013-01-01 341985248 DIVINE MERCY CARE DIVI 7039345552 11096-A LEE HIGHWAY NO 101 FAIRFAX VA 22030 JOHN T BRUCHALSKI MD CHAIRMAN & PRESIDENT 7039345552 2014-11-17 1 FRANK H SMITH P00639053 2028225000 2014-11-17 2013 2015-11-30 17:44:51Z JOHN T BRUCHALSKI MD 11096-A LEE HIGHWAY NO 101 FAIRFAX VA 22030 3487981 0 X WWW.DIVINEMERCYCARE.ORG X 2000 VA TO TRANSFORM HEARTS THROUGH HEALTHCARE. 6 5 41 46 0 0 614007 559411 4354676 2886802 282 284 -17910 -45151 4951055 3401346 0 0 0 0 2123126 2276973 0 0 123463 2722862 879207 4845988 3156180 105067 245166 506172 754299 268596 269165 237576 485134 X OUR MISSION IS TO CONVEY THE HEALING PRESCENCE OF CHRIST THROUGH EXCELLENT MEDICAL CARE WHICH RESPECTS THE CONSCIENCES OF PATIENTS AND PROVIDERS, SERVES THE POOR, AND UPHOLDS THE SANCTITY OF LIFE AT ALL STAGES. WE LOVINGLY CARE FOR ALL PATIENTS, RICH OR POOR, INSURED OR UNINSURED, REGARDLESS OF FAITH TRADITION, ETHNICITY, NATIONAL ORIGIN OR BACKGROUND. 0 0 2567375 2886802 PROVIDING CULTURE OF LIFE AND CHARITABLE MEDICAL CARE, THROUGH THE TEPAYAC FAMILY CENTER LLC, TO APPROXIMATELY 15,000 WOMEN, INCLUDING INDIGENT WOMEN AND THOSE IN CRISIS PREGNANCIES. 2567375 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 10 0 1 41 1 0 0 0 0 0 1 1 0 0 0 0 X 6 5 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X JOHN T BRUCHALSKI MD 7039345552 11096-A LEE HIGHWAY NO 101 FAIRFAX VA 22030 JOHN T BRUCHALSKI MD CHAIRMAN & PRESIDENT 40.00 X X 202534 0 15919 ADO A MACHIDA VICE CHAIRMAN 1.00 X X 0 0 0 KATHRYN A DOHERTY PHD SECRETARY 3.00 X X 0 0 0 MARY JULIANNE O'DONNELL SECRETARY (UNTIL 1/2013) 3.00 X X 0 0 0 J PATRICK KEARNS TREASURER 1.00 X X 0 0 0 JOSEPH G COSBY MEMBER 1.00 X 0 0 0 EDWARD J GROGAN MEMBER 1.00 X 0 0 0 KAREN CASSIDY CHIEF OPERATIONS OFFICER 60.00 X 99640 0 6520 MARIE ANDERSON OB/GYN 40.00 X 226505 0 14777 DANIEL FISK OB/GYN 40.00 X 219449 0 18967 LORNA CVETKOVICH OB/GYN 40.00 X 193326 0 11500 MIRIAM PEREIRA OB/GYN 40.00 X 233267 0 20014 1174721 0 87697 5 0 1 0 0 134344 425067 14531 559411 PROFESSIONAL FEES 621110 2865103 2865103 SPEAKING EVENTS 900099 21699 21699 2886802 284 284 39302 134344 86635 -47333 -47333 OTHER INCOME 900099 2182 2182 2182 3401346 2886802 0 -44867 804311 750924 25601 27786 1238559 1169603 11334 57622 14031 12719 83 1229 97773 91036 1664 5073 122299 113363 2854 6082 774 774 45370 37255 8115 1761 1761 270 50 220 84707 60120 4976 19611 29564 20555 9009 258347 208782 49565 56 56 94166 7531 86635 42621 23264 19357 231804 231804 PATIENT/INS/MEDICAL EXP 74895 74895 LICENSES & PERMITS 9205 1834 7371 MISCELLANEOUS 5667 5667 OVERHEAD ALLOCATION 0 -231364 312215 -80851 3156180 2567375 465342 123463 236481 238169 70531 72666 50317 216777 20433 12346 265486 134051 26888 131435 5146 4552 94876 76854 1500 1500 506172 754299 173238 251351 95358 0 0 17814 268596 269165 X 222536 464262 15040 20872 237576 485134 506172 754299 245166 -594 2986 0 X 1 X 0 0 0 X 797493 736826 678649 614007 598713 3425688 4992762 4231248 3816177 4392426 2886802 20319415 5790255 4968074 4494826 5006433 3485515 23745103 19000 19000 0 19000 19000 23726103 19655 1218 266 151 284 21574 19655 1218 266 151 284 21574 3213 5129 2182 10524 5809910 4969292 4498305 5011713 3487981 23777201 0.99790 0.97770 0.00090 0.00880 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2011 AMOUNT: $ 3,213. 2012 AMOUNT: $ 5,129. 2013 AMOUNT: $ 2,182. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10056 7415 2641 231981 117914 114067 23449 8722 14727 131435 DEFERRED RENT 17814 17814 DINNER & AUCTION 173646 134344 39302 45317 18460 22858 173646 134344 39302 45317 18460 22858 86635 -47333 X X X 0 0 0 0 0 0 0 0 0 JOHN T BRUCHALSKI MD CHAIRMAN & PRESIDENT 202534 0 0 0 0 0 6128 0 9791 0 218453 0 0 0 MARIE ANDERSON OB/GYN 226505 0 0 0 0 0 6308 0 8469 0 241282 0 0 0 DANIEL FISK OB/GYN 219449 0 0 0 0 0 10800 0 8167 0 238416 0 0 0 LORNA CVETKOVICH OB/GYN 193326 0 0 0 0 0 11500 0 0 0 204826 0 0 0 MIRIAM PEREIRA OB/GYN 233267 0 0 0 0 0 11500 0 8514 0 253281 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A IF THE OFFICE OF ANY DIRECTOR OR DIRECTORS BECOMES VACANT, THE REMAINING DIRECTORS, THOUGH LESS THAN A QUORUM, SHALL BE AUTHORIZED TO SELECT A SUCCESSOR OR SUCCESSORS, WHO SHALL BE APPOINTED UPON THE AFFIRMATIVE VOTE OF A THREE-FOURTHS MAJORITY OF THE REMAINING DIRECTORS OF THE CORPORATION TO SERVE THE UNEXPIRED TERMS OF THE VACATED DIRECTORSHIPS. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED FORM 990 IS PREPARED AND REVIEWED BY THE ORGANIZATION'S INDEPENDENT TAX ACCOUNTANT. THE 990 IS THEN SUBMITTED TO THE AUDIT REVIEW COMMITTEE, WHICH CONSISTS OF BOARD MEMBERS, FOR REVIEW AND REVISIONS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S BOARD OF DIRECTORS MEET QUARTERLY AND DISCUSS ANY CONFLICTS OF INTEREST AT THAT TIME. ADHERENCE TO THE WRITTEN POLICY IS CONFIRMED ANNUALLY BY THE ORGANIZATION'S INDEPENDENT AUDITORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE ORGANIZATION'S CHAIRMAN, EXECUTIVE DIRECTOR, AND KEY EMPLOYEES IS REVIEWED ON AN ANNUAL BASIS BY THE COMPENSTION COMMITTEE, WHICH INCLUDES INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. COMPENSATION IS EVALUATED IN LIGHT OF COMPARABILITY DATA FOR NORTHEN VIRGINIA. THE DELIBERATIONS AND DECISIONS OF THE INDEPENDENT COMMITTEE ARE DOCUMENTED IN THE ORGANIZATION'S MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. TEPEYAC FAMILY CENTER LLC 11096-A LEE HIGHWAY SUITE 101 FAIRFAX VA 22030 201963116 OB/GYN SERVICES VA 2871204 590747 DIVINE MERCY CARE DMC PHARMACY LLC 11096-A LEE HIGHWAY SUITE 101 FAIRFAX VA 22030 261906293 PHARMACEUTICAL SERVICES VA 0 0 DIVINE MERCY CARE