2014-05-15T14:46:49-05:00 2013-06-30 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2012-07-01 363088628 ERIE FAMILY HEALTH CENTER INC ERIE 3126663494 1701 W SUPERIOR STREET CHICAGO IL 60622 LEE FRANCIS 3126663494 2014-05-15 1 KIMBERLY A HAUMANN P00546491 3122071040 2014-05-15 2012 2015-11-30 17:44:51Z LEE FRANCIS 1701 W SUPERIOR STREET CHICAGO IL 60622 39442702 0 X WWW.ERIEFAMILYHEALTH.ORG X 1970 IL OPERATE A HEALTHCARE CENTER TO SERVE A LARGELY MEDICALLY UNDERSERVED POPULATION IN CHICAGO. 23 23 482 99 0 0 15418861 18683641 18121102 20686871 24361 27836 -23415 -6546 33540909 39391802 0 0 0 0 22641956 25556088 179443 111605 501801 7105852 9735710 29927251 35403403 3613658 3988399 25644724 30745854 5325144 6437875 20319580 24307979 X ERIE FAMILY MEDICAL CENTER'S (ERIE) MISSION IS TO PROVIDE AFFORDABLE, ACCESSIBLE HIGH-QUALITY CARE TO THOSE IN NEED. IT ACCOMPLISHES THIS OBJECTIVE BY SERVING AS A MEDICAL HOME FOR THE MORE THAN 50,000 PATIENTS EACH YEAR AND CONTINUOUSLY EVOLVING TO RESPOND TO THE NEEDS OF EACH COMMUNITY IT SERVES. 0 0 25223519 18952776 ERIE FAMILY HEALTH CENTER PROVIDES COMPREHENSIVE PRIMARY CARE SERVICES AT THIRTEEN SITES IN CHICAGO AND THE NORTHERN SUBURBS, INCLUDING: SIX LARGE PRIMARY HEALTH CARE CENTERS, ONE ADOLESCENT-ONLY HEALTH CENTER, FIVE SCHOOL-BASED HEALTH CENTERS, AND THREE DENTAL HEALTH CENTERS. ERIE'S PRIMARY CARE MEDICAL SERVICES INCLUDE PEDIATRICS, INTERNAL MEDICINE, FAMILY MEDICINE, AND WOMEN'S HEALTH. IN ADDITION, ERIE PROVIDES ORAL HEALTH SERVICES, PODIATRY, HIV/AIDS CARE, EYE CARE, BEHAVIORAL HEALTH COUNSELING, CASE MANAGEMENT SERVICES AND HEALTH EDUCATION. EIGHTY-FIVE PERCENT OF ERIE'S PATIENTS LIVE AT OR BELOW TWO-HUNDRED PERCENT OF THE FEDERAL POVERTY LEVEL AND THIRTHY PERCENT ARE UNINSURED. ERIE'S HIGHLY SKILLED PROVIDERS, INNOVATIVE PARTNERSHIPS AND FORWARD-THINKING APPROACH MAKE IT A NATIONAL LEADER FOR THE PROVISION OF COMMUNITY-BASED HEALTH CARE. 2824573 1734095 ERIE'S AWARD-WINNING ORAL HEALTH PROGRAM SERVES MORE THAN 9,000 LOW-INCOME CHICAGOANS PER YEAR, INCLUDING CHILDREN AND THEIR NUCLEAR FAMILY MEMBERS, DIABETICS, INDIVIDUALS WITH HIV/AIDS AND PREGNANT WOMEN. SERVICES PROVIDED INCLUDE ROUTINE CLEANINGS, X-RAYS, SEALANTS, FILLINGS, CROWNS, ROOT CANALS AND TOOTH EXTRACTIONS. ERIE FOCUSES NOT ONLY ON TREATING, BUT ALSO ON PREVENTING ORAL HEALTH PROBLEMS. ORAL CARE IS INTEGRATED INTO THE PRIMARY MEDICAL CARE OFFERED AT ALL ERIE LOCATIONS. IN ADDITION, ERIE PROVIDES ORAL HEALTH EDUCATION TO MORE THAN 2,500 COMMUNITY MEMBERS ANNUALLY. TO CONTINUE TO MEET THE GROWING COMMUNITY NEED FOR AFFORDABLE HIGH-QUALITY CARE, ERIE PLANS TO DOUBLE ITS DENTAL CARE CAPACITY WITHIN THE NEXT FIVE YEARS. 28048092 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 42 0 1 482 1 0 0 0 0 0 1 1 0 0 0 0 X 23 23 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X GARY RAJU 3124322725 1701 WEST SUPERIOR STREET CHICAGO IL 60622 BRIAN P MARSELLA 2.00 X X 0 0 0 ANA MARIA SOTO 1.50 X X 0 0 0 ERIC MAYEDA 2.00 X X 0 0 0 DEBORAH B WRIGHT-POWELL 1.50 X X 0 0 0 WILLIAM KISTNER 2.00 X 0 0 0 DANIEL J TOUNSEL III 1.00 X 0 0 0 ROSALIE ALICEA 1.50 X 0 0 0 CELESTE CASTILLO 1.50 X 0 0 0 MICHAEL COLE 1.00 X 0 0 0 LINDA CUSHMAN 0.50 X 0 0 0 PILAR GONZALEZ 0.50 X 0 0 0 MARIA HERNANDEZ 0.50 X 0 0 0 REVEREND ED SARDEN 1.00 X 0 0 0 DARYL TOM 1.00 X 0 0 0 HUMBERTO URIBE 1.00 X 0 0 0 KATHERINE WILSON 1.00 X 0 0 0 JULIE ZERWIC 1.00 X 0 0 0 MATT AARONSON 1.00 X 0 0 0 JILL SIMON SVOBODA 1.50 X 0 0 0 JACQUELINE CERVANTES 1.00 X 0 0 0 AMELIA MADRIGAL 1.00 X 0 0 0 JUAN FERNANDO JAUREGI 1.00 X 0 0 0 JUAN LILIA VIVAR 1.00 X 0 0 0 LEE FRANCIS 40.00 X X 208062 0 6475 DAVID R BUCHANAN 40.00 X 198213 0 14342 ILIANA MORA 40.00 X 173419 0 3477 RAMON BARAJAS 40.00 X 242192 0 8691 DEBORAH L EDBERG 40.00 X 211590 0 11463 MIRIAH D PLAWER-VOLMERDING 40.00 X 203326 0 3891 FRANK CASTILLO 40.00 X 175953 0 10460 FRED RACHMAN 40.00 X 193826 0 6462 1606581 0 65261 8 0 1 0 LAB CORP PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 808593 MCKESSON MEDICAL SURGICAL PO BOX 93302 ATLANTA GA 31193 MEDICAL SUPPLIES 634187 TRINIDAD CONSTRUCTION 9449 S KEDZIE AVE SUITE 147 EVERGREEN PARK IL 60805 CONSTRUCTION 597781 ALLIANCE OF CHICAGO 215 W OHIO ST 4TH FLOOR CHICAGO IL 60654 SUPPORT SERVICES 516297 TYPANI INC 25550 NETWORK PLACE CHICAGO IL 60673 IT CONSULTING 316419 29 150600 6138824 12394217 18683641 MEDICARE/MEDICAID PAYMENTS 624100 17822606 17822606 SELF-PAY 624100 2151810 2151810 KID CARE/HEALTHY MOM 624100 546817 546817 ALLIANCE EQUITY INCOME 624100 139250 139250 MEDICAL RECORD FEES 624100 17736 17736 8652 8652 20686871 27836 27836 44354 150600 50900 -6546 -6546 39391802 20686871 0 21290 612968 358559 254409 21085641 17375334 3416935 293372 234629 171982 62647 2153012 1477009 637811 38192 1469838 1056082 392451 21305 177348 177348 111605 111605 534560 433560 79287 21713 64212 51322 12890 665278 556739 107196 1343 1342896 718711 624185 33216 20637 11403 1176 204192 126866 75671 1655 69175 69175 1639427 1191765 441824 5838 182508 156245 26263 CONTRACTED DIAGNOSTIC S 825861 825861 EQUIPMENT RENTAL & MAIN 783461 502341 281120 MEDICAL AND LAB SUPPLIE 770289 770289 BAD DEBT 616511 616511 1826776 1638279 182895 5602 35403403 28048092 6853510 501801 4287556 5576029 4444807 4463123 2246543 4619261 3274264 2473064 357305 446434 22656276 10290994 10420891 12365282 466365 640198 146993 162463 25644724 30745854 2661080 4087868 220363 22259 1611591 1493224 832110 834524 5325144 6437875 X 19919892 21285597 399688 3022382 20319580 24307979 25644724 30745854 3988399 0 X 0 1 X 1 1 1 X 10716883 11249810 13455508 15418861 18546525 69387587 40830 42883 40002 13586 17736 155037 10757713 11292693 13495510 15432447 18564261 69542624 69542624 74238 17624 18134 24361 27836 162193 40830 42883 40002 13586 17736 155037 69859854 85445381 0.99550 0.99360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 2184 2184 35403403 35405587 1000000 250000 0 0 1000000 1000000 1000000 3000000 4500000 7500 2184 9684 250000 250000 250000 750000 1125000 77800 77800 5165854 2397942 2767912 8622832 3106803 5516029 3971067 2517123 1453944 4818723 2269126 2549597 12365282 THIRD-PARTY PAYOR LIABILITY 834524 834524 X 39307020 480829 50900 531729 38775291 616511 616511 39391802 35318621 480829 50900 531729 34786892 616511 616511 35403403 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE CENTER'S APPLICATION OF GAAPUSA REGARDING UNCERTAIN TAX POSITIONS HAD NO EFFECT ON ITS FINANCIAL POSITION AS MANAGEMENT BELIEVES THE CENTER HAS NO MATERIAL UNRECOGNIZED INCOME TAX BENEFITS, INCLUDING ANY POTENTIAL RISK OF LOSS OF ITS NOT-FOR-PROFIT TAX STATUS. THE CENTER WOULD ACCOUNT FOR ANY POTENTIAL INTEREST OR PENALTIES RELATED TO POSSIBLE FUTURE LIABILITIES FOR UNRECOGNIZED INCOME TAX BENEFITS AS INCOME TAX EXPENSE. THE CENTER IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR PERIODS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FOR FUNDRAISING EVENTS 50,900. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSES FOR BAD DEBT 616,511. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FOR FUNDRAISING EVENTS 50,900. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES FOR BAD DEBT 616,511. X X X X X X X 1 THE LOEVY CONSULTING GROUP SARA SE 1321 EAST 50TH STREET CHICAGO IL 60615 INTERIM DIRECTOR OF DEVELOPMENT 0 571404 75600 495804 RACHEL KRAUSE 1439 NORTH OAKLEY CHICAGO IL 60622 GRANT WRITING 0 181470 36005 145465 752874 111605 641269 IL GOLDEN TOOTHBRUSH 135765 117171 18594 18362 700 13984 ERIEDESCENCE 59189 33429 25760 15027 2827 194954 150600 44354 33389 700 16811 50900 -6546 X X X X X 0 0 0 0 0 0 0 0 0 LEE FRANCIS 182000 0 26062 0 0 0 4550 0 1925 0 214537 0 0 0 DAVID R BUCHANAN 177000 0 21213 0 0 0 4690 0 9652 0 212555 0 0 0 ILIANA MORA 157000 0 16419 0 0 0 3337 0 140 0 176896 0 0 0 RAMON BARAJAS 237000 0 5192 0 0 0 5925 0 2766 0 250883 0 0 0 DEBORAH L EDBERG 196900 0 14690 0 0 0 4723 0 6740 0 223053 0 0 0 MIRIAH D PLAWER-VOLMERDING 184000 0 19326 0 0 0 3751 0 140 0 207217 0 0 0 FRANK CASTILLO 156639 0 19314 0 0 0 4136 0 6324 0 186413 0 0 0 FRED RACHMAN 193826 0 0 0 0 0 0 0 6462 0 200288 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 ERIE FAMILY HEALTH CENTER (EFHC) USES A THIRD PARTY (INDEPENDENT CPA FIRM) TO PREPARE ITS 990 TAX FORM. UPON THE FORM'S COMPLETION, A COPY IS PROVIDED TO EFHC'S MANAGEMENT FOR REVIEW AND THEN SUBSEQUENTLY REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. ANY NECESSARY CHANGES ARE COMMUNICATED TO THE CPA FIRM AND INCORPORATED AS APPROPRIATE. ONCE THE 990 DRAFT IS FINALIZED A COPY IS MADE AVAILABLE TO THE BOARD OF DIRECTORS. THE THIRD PARTY WILL THEN FILE THE 990 ON EFHC'S BEHALF. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, KEY EMPLOYEES, AND MEMBERS OF THE BOARD ARE ANNUALLY REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM AS A PRECURSOR TO THEIR SERVICE TO THE ORGANIZATION. POTENTIAL CONFLICTS ARE LOGGED WITH AND MONITORED BY EFHC MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 EFHC PERIODICALLY USES AN INDEPENDENT THIRD PARTY TO REVIEW THE CURRENT COMPENSATION FOR MEMBERS OF THE LEADERSHIP TEAM. BASED ON THIS REVIEW, COMPENSATION LEVELS ARE SET FOR EACH LEVEL OF EMPLOYMENT. COMPENSATION REVIEWS BY THIRD PARTIES ARE CONDUCTED EVERY 3 YEARS. THE LAST REVIEW WAS IN 2012. FORM 990, PART VI, SECTION C, LINE 19 EFHC GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE FOR PUBLIC REVIEW UPON REQUEST. REQUESTS ARE REQUIRED TO BE IN WRITING.