EXECUTIVE DIRECTOR

2013-05-07T14:29:48-05:00 2012-06-30 232932984 PARENTEBEARD LLC SUITE 200 221 W PHILADELPHIA ST YORK PA 174012993 990 2011-07-01 232180889 WAYNE MEMORIAL COMMUNITY HEALTH CENTERS WAYN 5702516676 601 PARK STREET HONESDALE PA 18431 FREDERICK JACKSON EXECUTIVE DIRECTOR 5702516676 2013-05-07 1 JULIUS GREEN CPA P00350393 7178467000 2011 2016-02-25 16:41:14Z FREDERICK JACKSON 601 PARK STREET HONESDALE PA 18431 10186937 0 X WWW.WMH.ORG X 1981 PA MEDICAL, DENTAL, AND BEHAVIORAL HEALTH SERVICES TO THE RESIDENTS OF THE WAYNE & PIKE COUNTIES OF PA. 12 12 134 12 0 0 1861805 2549782 6920515 7565970 394 2389 13183 40004 8795897 10158145 0 0 0 0 6763195 7567793 0 0 0 2358211 2533422 9121406 10101215 -325509 56930 3405099 3634594 2712145 2884710 692954 749884 X THE MISSION IS TO PROVIDE MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO ALL THE RESIDENTS OF WAYNE & PIKE COUNTIES PENNSYLVANIA WITH A SPECIFIC EMPHASIS ON THE UNDERSERVED, LOW INCOME AND UNINSURED. 0 0 8963469 7597876 SERVING ALL MEMBERS OF THE COMMUNITY WITH A FOCUS ON THE UNDERSERVED AND DISADVANTAGED, THE WAYNE MEMORIAL COMMUNITY HEALTH CENTERS WILL CREATE AND SUSTAIN A HEALTHY COMMUNITY BY PROVIDING HIGH QUALITY PRIMARY MEDICAL, DENTAL, AND BEHAVIORAL HEALTH CARE IN AN ACCESSIBLE, AFFORDABLE AND NONDISCRIMINATORY MANNER. IN THE YEAR ENDING JUNE 30, 2012 WMCHC PROVIDED 30,955 MEDICAL ENCOUNTERS, 14,619 DENTAL ENCOUNTERS, AND 4,006 BEHAVIORAL ENCOUNTERS TO THE RESIDENTS OF WAYNE AND PIKE COUNTIES, PENNSYLVANIA. THE CENTER HAS THIRTEEN OFFICES PROVIDING CARE IN THIS SERVICE AREA. WMCHC CONTINUES TO GROW AND ADD PRACTITIONERS AND SERVICE LOCATIONS IN ORDER TO PROVIDE QUALITY MEDICAL, DENTAL, AND BEHAVIORAL HEALTH SERVICES. THE OPERATIONS OF WMCHC RELIEVE GOVERNMENT BURDEN BY PROVIDING CARE TO MEDICAID AND UNINSURED INDIVIDUALS WHO WOULD BE DESTITUTE AND LACKING PROPER CARE WITHOUT INTERVENTION. IN FISCAL 2012, THE CENTERS PROVIDED CARE ON A SLIDING FEE IN THE AMOUNT OF $288,343 FOR QUALIFYING PATIENTS. 8963469 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 24 0 1 134 1 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 1 0 PA X FREDERICK JACKSON 5702516676 601 PARK STREET HONESDALE PA 18431 X PETER ROGERS CHAIRMAN 1.00 X X 0 0 0 MICHAEL CLIFFORD TREASURER 1.00 X X 0 0 0 SUSAN GABRIELSON SECRETARY 1.00 X X 0 0 0 STEVE BURLEIN VICE CHAIRMAN 1.00 X X 0 0 0 DOREEN FITZGERALD BOARD MEMBER 1.00 X 0 0 0 ANN FOSTER BOARD MEMBER 1.00 X 0 0 0 WILLIAM KERL BOARD MEMBER 1.00 X 0 0 0 DAVID HOFF BOARD MEMBER 1.00 X 0 0 0 MORRIS BROOKE BOARD MEMBER 1.00 X 0 0 0 WILLIAM SCHWEIGHOFER BOARD MEMBER 1.00 X 0 0 0 STEVE TOURJE BOARD MEMBER 1.00 X 0 0 0 JUSTIN O'DONNELL BOARD MEMBER 1.00 X 0 0 0 FREDERICK JACKSON CEO 40.00 X 139255 0 22397 ROBERT DOHNOR PHYSICIAN 40.00 X 160590 0 21868 BRIAN BROWN PHYSICIAN 40.00 X 155473 0 14443 ROBERT GORRELL PHYSICIAN 40.00 X 297443 0 22920 SEAN MCVEIGH PHYSICIAN 40.00 X 269087 0 30191 HOON YOO PHYSICIAN 40.00 X 261270 0 20646 BRIAN LENCZEWSKI PHYSICIAN 40.00 X 257323 0 21720 JOHN D ZIMMERLY PHYSICIAN 40.00 X 250494 0 7515 1790935 0 161700 16 0 1 0 VIRTUAL OFFICEWARE INC 111 RYAN COURT SUITE 200 PITTSBURGH PA 15205 COMPUTER SYSTEM 286842 WAYNE MEMORIAL HEALTH SYSTEM 601 PARK STREET HONESDALE PA 18431 ADMINISTRATIVE AND ACCOUNTING FEES 114852 COMPHEALTH MEDICAL STAFFING PO BOX 9726 DALLAS TX 753972670 MEDICAL STAFFING 112712 RIVIERA FINANCE PO BOX 535213 ATLANTA GA 303535213 MEDICAL STAFFING 108305 4 843818 1705964 2549782 NET PATIENT SERVICE RE 621110 7565970 7565970 7565970 2389 2389 36890 28792 8098 8098 8098 MEDICAL BILLING SERVIC 561000 30895 30895 PURCHASE DISCOUNTS 900099 1011 1011 31906 10158145 7597876 0 10487 524991 479180 45811 5704388 5212857 491531 163110 149113 13997 790922 708258 82664 384382 347559 36823 23004 23004 143532 143532 567050 507142 59908 12275 11750 525 652997 602104 50893 421566 411898 9668 7113 6310 803 50554 50554 200339 105343 94996 133637 118371 15266 BAD DEBT EXPENSE 229648 229648 OUTSIDE TRAINING 41804 33330 8474 DUES 32541 23244 9297 REPAIRS AND MAINTENANCE 14398 14398 2964 2964 10101215 8963469 1137746 0 103025 141355 699140 782991 67750 61109 1484981 546129 877182 938852 1658002 1710287 3405099 3634594 1164402 1109151 1449922 1449922 97821 325637 2712145 2884710 X 687029 749884 5925 0 692954 749884 3405099 3634594 56930 0 X X 0 1 1 X 1 1 X 1607794 1498593 1964355 1861805 2549782 9482329 1803223 3803803 6484068 6920515 7565970 26577579 3411017 5302396 8448423 8782320 10115752 36059908 0 0 0 36059908 25111 16107 14225 19304 39279 114026 25111 16107 14225 19304 39279 114026 16 6387 10155 9401 31906 57865 3436144 5324890 8472803 8811025 10186937 36231799 0.99530 0.00310 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1250 1250 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: WAYNE MEMORIAL COMMUNITY HEALTH CENTERS PAYS ANNUAL MEMBERSHIP DUES TO PENNSYLVANIA ASSOCIATION OF COMMUNITY HEALTH CENTERS (PACHC). THE ORGANIZATION IS NOTIFIED EACH YEAR THAT A PORTION OF THE MEMBERSHIP DUES IS USED FOR LOBBYING ACTIVITES. FOR THE FISCAL YEAR ENDED JUNE 30, 2012, THE PORTION OF DUES PAID REPRESENTING LOBBYING EXPENDITURES WAS $1,250. 373904 64231 309673 1111077 481898 629179 938852 ESTIMATED THIRD-PARTY SETTLEMENTS 1710287 1710287 DUE TO WAYNE MEMORIAL HOSPITAL 325637 325637 10158145 10101215 56930 56930 10186937 0 10186937 -28792 -28792 10158145 10130007 28792 28792 10101215 0 10101215 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2011 AND 2010. THE CORPORATION'S FEDERAL RETURNS OF ORGANIZATION EXEMPT FROM INCOME TAX FOR THE YEARS ENDED PRIOR TO JUNE 30, 2010 ARE NO LONGER SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -28,792. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 28,792. X X X X 0 0 0 0 0 0 0 0 0 FREDERICK JACKSON 139255 0 0 0 0 0 8477 0 13920 0 161652 0 0 0 ROBERT DOHNOR 160590 0 0 0 0 0 9777 0 12091 0 182458 0 0 0 BRIAN BROWN 155473 0 0 0 0 0 9363 0 5080 0 169916 0 0 0 ROBERT GORRELL 297443 0 0 0 0 0 9000 0 13920 0 320363 0 0 0 SEAN MCVEIGH 269087 0 0 0 0 0 16271 0 13920 0 299278 0 0 0 HOON YOO 261270 0 0 0 0 0 8555 0 12091 0 281916 0 0 0 BRIAN LENCZEWSKI 257323 0 0 0 0 0 7800 0 13920 0 279043 0 0 0 JOHN D ZIMMERLY 250494 0 0 0 0 0 7515 0 0 0 258009 0 0 0 FORM 990, PART VI SECTION A, LINE 2: A QUESTIONNAIRE IS SENT TO EVERY BOARD MEMBER TO DETERMINE IF THERE ARE ANY BUSINESS OR FAMILY RELATIONSHIPS. NO SUCH RELATIONSHIPS WERE NOTED BETWEEN THE ORGANIZATION'S CURRENT OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 11 AN E-MAIL IS DISTRIBUTED TO ALL BOARD MEMBERS BEFORE THE 990 IS FILED FOR THEIR REVIEW. THE 990 WILL BE DISCUSSED AND REVIEWED AT THE FOLLOWING FULL BOARD MEETING PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EVERY BOARD MEMBER AND MANAGER ANNUALLY. EACH INDIVIDUAL SIGNS AND RETURNS THE STATEMENTS TO THE ADMINISTRATION OFFICE. THE EXECUTIVE SECRETARY IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH ANY CONFLICT OF INTEREST THROUGHOUT THE YEAR. IF A CONFLICT ARISES, THE PERSON WITH THE CONFLICT WILL RECUSE THEMSELVES FROM VOTING AND/OR DISCUSSING THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 WAYNE MEMORIAL COMMUNITY HEALTH CENTERS UTILIZE A COMMITTEE OF THE BOARD CALLED THE EXECUTIVE COMMITTEE TO SET COMPENSATION FOR ITS CEO. FOR OTHER KEY EMPLOYEES (DOCTORS) WAYNE MEMORIAL COMMUNITY HEALTH CENTERS USES WRITTEN EMPLOYMENT AGREEMENTS FOR THEIR COMPENSATION. THESE AGREEMENTS ARE APPROVED BY THE BOARD OR EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE IS MADE UP OF INDEPENDENT DIRECTORS, WHO, USE DATA FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS FOR COMPARATIVE PURPOSES. THE COMMITTEE USES THE SALARY DATA AND COMPARATIVE REVENUE, COMPLEXITY, SIZE OF FQHC, AND THE GEOGRAPHIC REGION TO DETERMINE A REASONABLE SALARY FOR THE CEO. THE EXECUTIVE COMMITTEE KEEPS MINUTES TO DOCUMENT THE DELIBERATION AND DECISION MAKING PROCESS. THE PROCESS NORMALLY OCCURS IN OCTOBER OF THE YEAR THE COMPENSATION CHANGE IS GRANTED. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO PUBLIC UPON REQUEST. FORM 990, PART VII: THE FOLLOWING BOARD MEMBERS ARE EMPLOYED BY AN UNRELATED ORGANIZATION, WAYNE HEALTH SYSTEM, TO WHICH ADMINISTRATIVE AND ACCOUNTING FEES ARE PAID: MICHAEL CLIFFORD DAVID HOFF FORM 990, PART XII, LINE 2C: THE PROCESSES USED BY THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR.