2012-04-23T18:22:52-07:00 2011-08-31 DIAZ & CANDELARIA PSC SUITE 112 PMB-294 10O GRAN BULEVAR SAN JUAN PR 00926 990 2010-09-01 660434923 COSSMA INC COSS 7877398182 PO BOX 1330 CIDRA PR 00739 Claribel Lara 7877398182 2012-04-23 1 CRISTINO ARIEL DIAZ-LOPEZ 7873994556 2012-04-23 2010 2016-02-24 21:20:13Z X ISOLINA MIRANDA CARR 172 KM 13-5 CIDRA PR 00739 21461605 0 X WWW.COSSMAPR.ORG X 1987 PR TO PROVIDE PRIMARY HEALTH CARE SERVICES TO MEDICALLY UNDERSERVED POPULATION, AGRICULTURAL MIGRANTS AND SEASONAL FARM WORKERS AS TO THEIR DEPENDENTS 9 0 214 0 0 0 6324779 5709290 8433639 15728700 9730 15237 19625 8378 14787773 21461605 0 0 5397752 5891977 0 0 9301909 13734434 14699661 19626411 88112 1835194 19310416 23234549 11489953 13578892 7820463 9655657 TO PROVIDE AND PROMOTE INTEGRATED PRIMARY HEALTH CARE SERVICES WITH A COMMUNITY FOCUS THAT SUPPORTS THE PHYSICAL, MENTAL AND SOCIAL WELL BEING OF THE INDIVIDUAL WITH THE COMMITMENT TO IMPROVE THEIR LIVES. 0 0 15859868 0 15728700 Health Services During the current year the Corporation provide primary health services with a total of 150,939 encounters. 284266 0 0 Education and Prevention 337818 0 0 Housing and Community Services 0 0 0 16481952 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 214 0 0 0 0 0 0 0 X 9 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 1 1 1 0 PR X CLARIBEL LARA 7877398182 AVE EL JIBARO CARR 172 INT KM 13 5 CIDRA PR 00739 EDUARDO MUNOZ OQUENDO 1 X 0 0 0 MARIA T FRET MERCADO 1 X 0 0 0 TEOFILA RIOS ORTIZ 1 X 0 0 0 ADA COTTO CARTAGENA 1 X 0 0 0 ISOLINA MIRANDA 38 X 96596 0 0 MARIA LACOMBA 38 X 71745 0 0 EDGARDO SOTO 38 X 91480 0 0 CLARIBEL LARA 38 X 33100 0 0 292921 0 0 0 0 0 0 QUEST DIAGNOSTICS 3 Giralda Farms Madison NJ 07940 LABORATORY SERVICES 480352 FELDESMAN TUCKER LEIFER FIDELL LLP PO BOX 1330 CIDRA PR 00739 PROFESIONAL SERVICES 327122 COMA COOP PO BOX 1330 CIDRA PR 00739 CONSTRUCTION 283090 PHARMACY ADVISORY GROUP PO BOX 1330 CIDRA PR 00739 CONSULTING 264788 CONSTRUCCIONES APONTE INC PO BOX 1330 CIDRA PR 00739 CONSTRUCTION 246770 7 0 0 0 0 5709290 0 0 5709290 Capitation - Health Reform 621498 7279152 7279152 0 0 Patient Services Fees 621498 1696705 1696705 0 0 Pharmacy 424210 3416223 3416223 0 0 LAWSUIT PR HEALTH DEPARTMENT 621498 3336620 3336620 0 0 0 0 0 0 15728700 15237 15237 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8378 8378 0 0 8378 21461605 15752315 0 0 0 0 0 0 0 0 0 0 292921 91480 201441 0 0 0 0 0 4551392 3757107 794285 554317 449716 104601 493347 429158 64189 15386 15386 351498 351498 0 1530717 1450623 80094 22594 22594 131670 100001 31669 0 954413 232197 722216 68101 21326 46775 44837 22154 22683 357760 4331 353429 468736 109493 359243 86856 7015 79841 MEDIC PLAN RECLAMATIONS 7559716 7559716 0 0 Prescribed Drugs and Medications 1216176 1216176 0 0 OTHER EXPENSES 515058 352354 162704 0 Bad Debt Expenses 111380 111380 0 0 Non-Capitalized Equipment 299536 193633 105903 19626411 16481952 3144459 0 1472472 6029681 734780 602254 1720503 227993 7569 59450 73854 47726 72255 17297802 1518483 15248994 15779319 26491 441624 19310416 23234549 4012798 6516903 171578 62805 6399977 6056463 905600 942721 11489953 13578892 X 7820463 9655657 0 0 0 0 7820463 9655657 19310416 23234549 1835194 0 X 1 1 1 X 1 1 X 11494771 12088081 12033867 14758418 21437990 71813127 11494771 12088081 12033867 14758418 21437990 71813127 71813127 46051 29409 8583 9730 8378 102151 10650 9261 8289 19625 15237 63062 71978340 0.99770 0.9968 X _ 2193814 0 2193814 12929848 0 1055101 11874747 614845 0 20980 593865 1466495 0 352472 1114023 92800 0 89930 2870 15779319 0 Reserve for Incurred But Not Reported Health Services Claims 942721 942721 21461605 19626411 1835194 0 0 0 0 0 0 1835194 21437990 0 0 0 0 0 21437990 0 23615 23615 21461605 19626411 0 0 0 0 0 19626411 0 0 0 19626411 SchD_P12_S00_L04b Schedule D, Part XII, Line 4b _ F990_P00_S00_L0B Form 990, Header, Line B The return was amended to include the audit adjustments and to be in accordance with the audited financial statements that were issued on April 2012. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b All questions related to Governance, management and disclosures were asked to the Board members by the Executive Director. Form 990 was presented to the Management by the CPA Firm and Management present this to the Board. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The Salary of the Executive Director is determined and approved by the Board of Directors based on performance and comparability data from others similar organizations in Puerto Rico. Others Key officers salaries are determined by the Executive Director based on performance and comparability salaries. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The policy of the Corporation to follow the following rules to fulfill the requirements of the public statements mentioned above. A. A copy of the forms will be provided to any person that requests in person to inspect those forms during regular business hours. The Finance Director is responsible for keeping a copy and for making it available to the public. B. For requests received by mail, the Corporation will request payment in advance for the costs of copies & shipping charges. If the request does not include payment, the Corporation will notify the person by phone or by mail of its prepayment policy within the seven days after receiving the original request. C. The cost per copy will be $1.00 for the first copy and $0.15 for each additional page. All copies will send to the person that requests them by priority mail within 30 days of receiving the request. This is an ammended return, original return was submitted before January 15, 2012.