2013-10-15T14:48:42-05:00 2012-12-31 453994797 LGC&D LLP TEN WEYBOSSET STREET - SUITE 700 PROVIDENCE RI 02903 990 2012-01-01 510183476 BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC BLAC 4017290080 39 EAST AVENUE PAWTUCKET RI 02860 RAYMOND J LAVOIE 4017290080 2013-10-01 1 GERALD IADELUCA P00247569 4014214800 2012 2016-02-25 16:41:14Z X RAYMOND J LAVOIE 39 EAST AVENUE PAWTUCKET RI 02860 12245299 0 X WWW.BLACKSTONECHC.ORG X 1984 RI BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. (THE CENTER) OPERATES HEALTHCARE CENTERS IN CENTRAL FALLS AND PAWTUCKET, RHODE ISLAND. THE CENTER PROVIDES A BROAD RANGE OF HEALTH, DENTAL, AND SOCIAL SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION. 10 10 114 45 0 0 3041644 3683828 7503981 8259490 910 759 82701 144932 10629236 12089009 0 0 0 0 6693113 7758445 0 0 0 3903950 3722207 10597063 11480652 32173 608357 12000593 16777011 3393151 7561212 8607442 9215799 X BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. IS COMMITTED TO PROVIDING HIGH QUALITY, ACCESSIBLE, AFFORDABLE, COMPREHENSIVE HEALTH CARE AVAILABLE FOR THE RESIDENTS OF THE LOWER BLACKSTONE VALLEY. THE CENTER USES A MODEL OF PRIMARY CARE THAT STRESSES PREVENTION, EDUCATION, AND PATIENT EMPOWERMENT. 0 0 8515464 8274399 OPERATED A COMMUNITY HEALTHCARE CENTER WHICH SERVED APPROXIMATELY 57,000 ENCOUNTERS DURING THE YEAR ENDED DECEMBER 31, 2012. 8515464 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 40 0 1 114 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 RI X X RAYMOND J LAVOIE 4017290080 39 EAST AVENUE PAWTUCKET RI 02860 RONALD WINTER 1.00 X 0 0 0 JOHN LEFRONCOIS 1.00 X 0 0 0 JEAN KUGEL 1.00 X 0 0 0 MICHELLE ENOS 1.00 X 0 0 0 WARREN BREER 1.00 X 0 0 0 CARLOS DEBRITO 1.00 X 0 0 0 JOHN T GANNON ESQ 1.00 X 0 0 0 ROSALINA LIMARDO 1.00 X 0 0 0 WILLIAM MCCUSKER 1.00 X 0 0 0 ELIZABETH MORAIS 1.00 X 0 0 0 RAYMOND J LAVOIE 40.00 X 176247 0 10904 JERALD C FINGERUT 40.00 X 211046 0 20223 CHRISTINE GREY 40.00 X 26826 0 1718 ANITA KURBIEC 40.00 X 60439 0 20234 HEATHER BUDD 40.00 X 140348 0 15104 LALITA BHATTACHARYA 40.00 X 134686 0 15191 AMERICA FOSTER 40.00 X 135972 0 25569 KARLA KIKER 40.00 X 149079 0 9457 KUNJBALA SHARMA 40.00 X 154962 0 9788 WILLIAM RUSH 40.00 X 65264 0 3492 NEELAM THAPA 40.00 X 142048 0 2609 1396917 0 134289 11 0 1 0 CASE CONSTRUCTION 225 WAMPANOAG TRAIL EAST PROVIDENCE RI 02915 CONSTRUCTION 4942571 WOMEN'S CARE INC 407 EAST AVENUE SUITE 150 PAWTUCKET RI 02860 OBSTETRICS 450345 ARCADIA SOLUTIONS 3500 AMERICAN BLVD WEST SUITE 350 BLOOMINGTON MN 55431 REPORT WRITING & IT CONSULTATION 334160 NEXTGEN 18111 VON KARMAN AVENUE IRVINE CA 92612 EMR SOFTWARE SERVICES 246880 QUALITY SYSTEMS INC 18111 VON KARMAN AVENUE IRVINE CA 92612 EMR SOFTWARE SERVICES 245873 5 3683828 3683828 MEDICAID 900099 6532623 6532623 SELF-PAY 900099 628837 628837 MEDICARE 900099 574957 574957 OTHER THIRD PARTY 900099 523073 523073 8259490 759 759 10200 10200 0 276113 146090 130023 130023 MISCELLANEOUS INCOME 900099 14909 14909 14909 12089009 8274399 0 130782 X 751924 231269 520655 5306829 4345047 961782 213502 213502 1054330 966325 88005 431860 317492 114368 1773579 1348996 424583 1345 1345 268569 225291 43278 162357 126209 36148 115037 30559 84478 20655 20655 812890 566394 246496 86701 86701 BAD DEBTS 242390 242390 REPAIRS AND MAINTENANCE 59850 49492 10358 TELEPHONE 57760 33974 23786 DUES AND SUBSCRIPTIONS 52479 13813 38666 68595 18213 50382 11480652 8515464 2965188 0 2896 3000 1761319 1635194 263487 477864 924646 477367 8797 7450 187353 324804 17704013 3975754 8656298 13728259 82700 82700 113097 40373 12000593 16777011 2028994 1286879 1364157 6274333 3393151 7561212 X 8517442 9215799 90000 0 8607442 9215799 12000593 16777011 608357 0 X X 0 1 X 1 1 1 X 3399839 3195598 3976240 3041644 3683828 17297149 3399839 3195598 3976240 3041644 3683828 17297149 17297149 29132 12167 14999 11110 10959 78367 84703 7235 8468 16770 14909 132085 17507601 0.98800 0.97580 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1019166 1019166 11225614 1539491 9686123 4351702 2424217 1927485 1107531 12046 1095485 13728259 12245299 156290 156290 12089009 0 12089009 11636942 156290 156290 11480652 0 11480652 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 10,200. COST OF GOODS SOLD INCLUDED IN REVENUE 146,090. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE OFFSET AGAINST RENTAL INCOME 10,200. COST OF GOODS SOLD INCLUDED IN REVENUE 146,090. X X X 1 0 0 0 0 0 0 0 0 RAYMOND J LAVOIE 176247 0 0 0 0 0 8812 0 2092 0 187151 0 0 0 JERALD C FINGERUT 211046 0 0 0 0 0 10552 0 9671 0 231269 0 0 0 HEATHER BUDD 140348 0 0 0 0 0 7017 0 8087 0 155452 0 0 0 AMERICA FOSTER 135972 0 0 0 0 0 6799 0 18770 0 161541 0 0 0 KARLA KIKER 149079 0 0 0 0 0 7454 0 2003 0 158536 0 0 0 KUNJBALA SHARMA 154962 0 0 0 0 0 7748 0 2040 0 164750 0 0 0 WILLIAM RUSH 65264 0 0 0 0 0 3263 0 229 0 68756 0 0 0 PART I, LINE 4A WILLIAM RUSH, FORMER FINANCE DIRECTOR RECEIVED SEVERANCE PAY INCLUDED IN HIS W-2 GROSS INCOME OF $65,264. A RI HEALTH AND EDUCATIONAL BUILDNG CORPORATION 521300173 2011-08-02 6450000 CONSTRUCTION OF NEW MEDICAL BUILDING 0 0 0 A 6450000 75000 6274333 100667 2012 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 1 1 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION OTHER UNSPENT PROCEEDS ARE NOT REFLECTED ON THE ORGANIZATION'S BOOKS AND RECORDS AS THE PROCEEDS ARE NOT UNDER ITS DIRECT CONTROL. AS OF DECEMBER 31, 2012 ISSUANCE COSTS OF $30,896 HAVE BEEN DISBURSED AND THE BALANCE ALLOCATED TO THESE COSTS IS NOT REFLECTED ON THE ORGANIZATION'S BOOKS AND RECORDS PER THE ABOVE FOR OTHER UNSPENT PROCEEDS. SCHEDULE K, PART IV , ARBITRAGE: THE ORGANIZATION BY ITS TAX REGULATORY AGREEMENT DATED AUGUST 2, 2011 IS REQUIRED TO CALCULATE ANY REBATE DUE EVERY FIVE YEARS SUBSEQUENT TO THE DATE OF THE AGREEMENT. FORM 990, PART I, LINE 6: VOLUNTEERS PLAYED AN INTEGRAL PART IN ALLOWING THE CENTER TO PARTICIPATE IN VARIOUS HEALTH FESTIVALS AND FAIRS THAT PROMOTE HEALTH, WELLNESS, AND SAFETY. FORM 990, PART VI, SECTION B, LINE 11 INTERNAL MANAGEMENT DOES A DETAILED LINE BY LINE REVIEW OF THE FORM 990 PRIOR TO IT BEING FILED. ANY QUESTIONS FROM THIS REVIEW ARE DISCUSSED AND RESOLVED WITH THE PREPARER PRIOR TO BEING SHARED WITH THE BOARD. THE FORM 990 WILL ONLY BE RELEASED ONCE ALL QUESTIONS RAISED BY INTERNAL STAFF AND THE BOARD HAVE BEEN RESOLVED. FORM 990, PART VI, SECTION B, LINE 12C IF THE BOARD BECOMES AWARE OF A POTENTIAL CONFLICT OF INTEREST THROUGH SELF DISCLOSURE OR SOME OTHER MANNER, THE BOARD WOULD IMMEDIATELY FOLLOW-UP TO DETERMINE IF A CONFLICT TRULY EXISTS. IF A CONFLICT DOES EXIST THE BOARD WOULD TAKE APPROPRIATE ACTION THAT MAY INCLUDE TERMINATION, WHERE WARRANTED. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S COMPENSATION IS APPROVED BY THE BOARD CHAIRMAN. TO ASSIST IN DETERMINING THE EXECUTIVE DIRECTOR'S COMPENSATION LEVEL, THE BOARD CHAIR LOOKS AT JOB DUTIES, JOB PERFORMANCE, ACCOMPLISHMENTS, NEW GOALS AND OBJECTIVES, AND SALARY INFORMATION OF OTHER HEALTH CENTERS OF SIMILAR SIZE AND SCOPE. THE EXECUTIVE DIRECTOR APPROVES THE COMPENSATION FOR ALL OTHER OFFICERS. IN DETERMINING THE COMPENSATION LEVEL OF EACH OFFICER, THE EXECUTIVE DIRECTOR WILL REVIEW JOB DUTIES, JOB PERFORMANCE, ACCOMPLISHMENTS, NEW GOALS AND OBJECTIVES, AND SALARY INFORMATION OF OTHER HEALTH CENTERS OF SIMILAR SIZE AND SCOPE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 1,348,996. MANAGEMENT AND GENERAL EXPENSES 424,583. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,773,579. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF INDEPENDENT ACCOUNTANTS.