2019-10-02T10:19:56-05:00 2018-12-31 221478099 COHNREZNICK LLP 4 BECKER FARM ROAD ROSELAND NJ 07068 990 2018-01-01 132813103 OPEN DOOR FAMILY MEDICAL CENTER INC OPEN 9145021470 165 MAIN STREET OSSINING NY 10562 LINDSAY C FARRELL PRESIDENT & CEO 9145021470 2019-09-03 1 LORI ROTHE YOKOBOSKY CPA P01273422 9732283500 2019-08-30 209.59.242.22 2019-09-03 14:28:00 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F9BA0E82A6D947CC92540FBC56E8B73643681DA5 2018 2020-01-14 16:20:31Z LINDSAY C FARRELL 165 MAIN STREET OSSINING NY 10562 90995188 0 X WWW.OPENDOORMEDICAL.ORG X 1975 NY OPEN DOOR FAMILY MEDICAL CENTER PROVIDES QUALITY PRIMARY HEALTH CARE AND HUMAN SERVICES AT AFFORDABLE PRICES TO THE COMMUNITY, PARTICULARLY LOW-INCOME, UNDER-SERVED RESIDENTS AND THOSE LACKING ACCESS TO HEALTH CARE. 14 14 612 210 0 167539 15451895 16139421 46424263 39747260 1722182 2926470 3856309 4417522 67454649 63230673 0 0 0 0 37428648 39117724 0 0 1000 17628476 19722353 55057124 58840077 12397525 4390596 114043445 114044469 9117420 9004426 104926025 105040043 THE MISSION OF THE OPEN DOOR FAMILY MEDICAL CENTER, INC. IS TO PROVIDE QUALITY PRIMARY HEALTH CARE AND HUMAN SERVICES AT AFFORDABLE PRICES TO THE COMMUNITY, PARTICULARLY LOW-INCOME, UNDER-SERVED RESIDENTS AND THOSE LACKING ACCESS TO HEALTH CARE. 0 0 40608274 34558120 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 67,023 MEDICAL PATIENTS THAT GENDERATED 194,129 VISITS IN 2018.ADDITIONAL FUNDING FOR THIS PROGRAM IS PROVIDED THROUGH FEDERAL GRANTS, AS SHOWN ON FORM 990, PART VIII, LINE 1E. 6732597 7134685 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 19,865 DENTAL PATIENTS THAT GENDERATED 49,923 VISITS IN 2018.ADDITIONAL FUNDING FOR THIS PROGRAM IS PROVIDED THROUGH FEDERAL GRANTS, AS SHOWN ON FORM 990, PART VIII, LINE 1E. 2171054 2471977 OPEN DOOR FAMILY MEDICAL CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER WHICH SERVED APPROXIMATELY 9,644 MENTAL HEALTH PATIENTS THAT GENDERATED 25,964 VISITS IN 2018.ADDITIONAL FUNDING FOR THIS PROGRAM IS PROVIDED THROUGH FEDERAL GRANTS, AS SHOWN ON FORM 990, PART VIII, LINE 1E. 49511925 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 1 1 0 0 1 39 0 1 612 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MARIA MAZZOTTA 9145021470 165 MAIN STREET OSSINING NY 10562 ANDRES VALDESPINO VICE-CHAIRMAN 1.00 X X 0 0 0 ANTONIO MEJIAS BOARD MEMBER 1.00 X 0 0 0 BARBARA ILARDI FROM 518 BOARD MEMBER 1.00 X 0 0 0 CHARLES CHEHEBAR BOARD MEMBER 1.00 X 0 0 0 DANIEL ROSS CHAIRMAN 1.00 X X 0 0 0 DAVID WHITLINGER SECRETARY 1.00 X X 0 0 0 DAYSI BRIONES FROM 518 BOARD MEMBER 1.00 X 0 0 0 DONNA WADE THRU 518 CHAIRWOMAN 1.00 X X 0 0 0 DORIAN LINDSAY BOARD MEMBER 1.00 X 0 0 0 HOWARD S SCHRADER BOARD MEMBER 1.00 1.00 X 0 0 0 LORETTA MOLINARI BOARD MEMBER 1.00 X 0 0 0 MARGOTH PILLA TREASURER 1.00 X X 0 0 0 SHIRLEY BUONTEMPO BOARD MEMBER 1.00 X 0 0 0 TYLER BEEBE BOARD MEMBER 1.00 X 0 0 0 WALTER EDGE BOARD MEMBER 1.00 X 0 0 0 LINDSAY C FARRELL PRESIDENT & CEO 35.50 2.00 X 390109 20533 20209 MARIA MAZZOTTA CHIEF FINANCE OFFICER 35.50 2.00 X 238653 12561 9857 DAREN WU CHIEF MEDICAL OFFICER 37.50 X 356684 0 9625 JANET BOZZONE CHIEF DENTAL OFFICER 37.50 X 225599 0 10506 BRUCE M SHAFFER PODIATRIST 37.50 X 243468 0 32421 JAY ABRAM ZASLOW FAMILY PRACTICE PHYSICIAN 37.50 X 271950 0 37937 KAREN MURRAY OB/GYN PHYSICIAN 37.50 X 312214 0 30172 REBECCA COLLINS FAMILY PRACTICE PHYSICIAN 37.50 X 231815 0 27506 THOMAS YUEN FAMILY PRACTICE PHYSICIAN 37.50 X 253769 0 39612 2524261 33094 217845 90 0 1 0 THE MEDCOR GROUP INC 1801 W OLYMPIC BLVD PASADENA CA 911992259 BILLING SERVICES 776700 COMPREHENSIVE EYE SERVICES PO BOX 187 ARMONK NY 10504 EYE CLINIC 627923 HITCH INC 2 CHURCH STREET SUITE 110 OSSINING NY 10562 CSP SERVICES 585878 ECLINICAL WORKS 110 TURNPIKE ROAD SUITE 308 WESTBOROUGH MA 01581 ECW SUPPORT 480118 MANNATT PHELPS & PHILLIPS 11355 WEST OLYMPIC BOULEVARD LOS ANGELES CA 900641614 LEGAL 405978 13 367284 12830889 2941248 16139421 MEDICAID MANAGED CARE PLAN 621400 11331064 11331064 NYS MANAGED CARE WRAPAROUND 621400 8517486 8517486 MEDICAID 621400 7100588 7100588 NYS SAFETY NET FUNDS 621400 5100846 5100846 SELF-PAY 621400 4348825 4348825 3348451 3348451 39747260 1662687 1662687 29028298 27764515 1263783 1263783 1263783 REIMBURSED SALARIES & FRINGE 900099 2564584 2564584 340 PHARMACY REVENUE 900099 1140901 1140901 MEDICAL MEANINGFUL USE 900099 555900 555900 156137 156137 4417522 63230673 44164782 0 2926470 1259378 1064592 194786 31632841 26556664 5076177 587674 581354 6320 3158734 3124762 33972 2479097 2452434 26663 121491 121491 224985 224985 408827 408827 5015501 3196170 1819331 2991811 2721180 270631 299787 156612 143175 1723403 1508402 215001 149430 94941 54489 207923 132104 75819 139079 132425 6654 2188615 1915577 273038 257368 203480 53888 BAD DEBTS 1471106 1471106 PHARMACEUTICALS 1388398 1388398 REPAIRS & MAINTENANCE 1151864 1008164 143700 LABORATORY FEE 368924 368924 1613841 1434636 178205 1000 58840077 49511925 9327152 1000 7574603 2031367 5326608 38072 1612689 5590929 4439956 7780871 908458 1060883 49874318 22045163 27253126 27829155 66239768 69261835 688237 451357 114043445 114044469 6731076 5040307 77564 88051 1657518 3701057 651262 175011 9117420 9004426 X 104899775 105025043 26250 15000 104926025 105040043 114043445 114044469 4390596 -4276578 0 X X 0 1 X 1 1 1 X 10087522 10431943 11820630 15451895 16139421 63931411 10087522 10431943 11820630 15451895 16139421 63931411 63931411 902137 1157164 1062692 1228572 1662687 6013252 301875 1045922 1364335 3856309 4417522 10985963 80930626 177516689 0.79000 0.83620 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2014 AMOUNT: $ 27,789. 2015 AMOUNT: $ 34,842. 2016 AMOUNT: $ 17,756. 2017 AMOUNT: $ 12,687. 2018 AMOUNT: $ 156,137. REIMBURSED SALARIES FRINGE - 2014 AMOUNT: $ 274,086. 2015 AMOUNT: $ 231,564. 2016 AMOUNT: $ 342,632. 2017 AMOUNT: $ 2,780,694. 2018 AMOUNT: $ 2,564,584. MEDICAID MEANINGFUL USE INCENTIVE - 2015 AMOUNT: $ 412,250. 2016 AMOUNT: $ 195,600. 2017 AMOUNT: $ 200,004. 2018 AMOUNT: $ 555,900. 340B PHARMACY - 2015 AMOUNT: $ 367,266. 2016 AMOUNT: $ 808,347. 2017 AMOUNT: $ 862,924. 2018 AMOUNT: $ 1,140,901. 1740016 1740016 16338195 1943681 14394514 17548614 10648757 6899857 6056685 3748533 2308152 8190808 5704192 2486616 27829155 DUE TO RELATED PARTY 175011 175011 X 57645394 -4276578 144500 1520210 -2611868 60257262 408827 2564584 2973411 63230673 57382653 144500 278009 422509 56960144 408827 1471106 1879933 58840077 PART X, LINE 2: THE CORPORATION HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2018. THE CORPORATION'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2015 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CORPORATION HAD UNRELATED BUSINESS INCOME TAXES, IT WILL RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE CONSOLIDATED STATEMENT OF FINANCIAL POSITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY ELIMINATIONS -1,372,304. REVENUE OF RELATED ENTITIES 4,363,620. PROVISION FOR BAD DEBTS -1,471,106. PART XI, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED SALARIES & FRINGE 2,564,584. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES OF RELATED ENTITIES 4,214,897. INTERCOMPANY ELIMINATIONS -1,372,304. REIMBURSED SALARIES & FRINGE -2,564,584. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,471,106. X X X 0 0 0 0 0 1 0 1 0 LINDSAY C FARRELL PRESIDENT & CEO 336496 17711 50087 2636 3526 186 9153 473 10086 497 409348 21503 0 0 MARIA MAZZOTTA CHIEF FINANCE OFFICER 220268 11593 17100 900 1285 68 8356 432 1036 33 248045 13026 0 0 DAREN WU CHIEF MEDICAL OFFICER 314897 0 40000 0 1787 0 9625 0 0 0 366309 0 0 0 JANET BOZZONE CHIEF DENTAL OFFICER 212820 0 10600 0 2179 0 7915 0 2591 0 236105 0 0 0 BRUCE M SHAFFER PODIATRIST 233993 0 7075 0 2400 0 8880 0 23541 0 275889 0 0 0 JAY ABRAM ZASLOW FAMILY PRACTICE PHYSICIAN 230854 0 39250 0 1846 0 9625 0 28312 0 309887 0 0 0 KAREN MURRAY OB/GYN PHYSICIAN 269391 0 41100 0 1723 0 9625 0 20547 0 342386 0 0 0 REBECCA COLLINS FAMILY PRACTICE PHYSICIAN 192233 0 38190 0 1392 0 7396 0 20110 0 259321 0 0 0 THOMAS YUEN FAMILY PRACTICE PHYSICIAN 220635 0 31700 0 1434 0 9300 0 30312 0 293381 0 0 0 PART I, LINE 6 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED INCENTIVE BONUSES, WHICH ARE BASED ON INDIVIDUAL AND SITE PERFORMANCE, DURING THE YEAR ENDED 12/31/18: JANET BOZZONE - $10,600 DAREN WU - $40,000 THOMAS YUEN - $31,700 KAREN MURRAY - $41,100 JAY ABRAM ZASLOW - $39,250 BRUCE M. SHAFFER - $7,075 REBECCA COLLINS - $38,190 PART I, LINE 7 INCLUDED IN PART II COLUMN B(II) ARE AMOUNTS REPRESENTING BONUS PAYMENTS. THESE AMOUNTS WERE APPROVED BY THE BOARD AND INCLUDED IN THE INDIVIDUALS' 2018 W-2S. FORM 990, PART VI, SECTION B, LINE 11B OPEN DOOR FAMILY MEDICAL CENTER ENGAGES THE SERVICES OF AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE ANNUAL FORM 990 IN CONJUNCTION WITH ITS ANNUAL AUDITED FINANCIAL STATEMENTS. THE PRESIDENT/CEO AND CFO REVIEW THE FORM 990 AND SCHEDULES FOR ACCURACY. IN 2018, THE FORM 990, FOR THE YEAR ENDED DECEMBER 31, 2018, WAS PRESENTED TO THE FINANCE COMMITTEE AND BOARD MEMBERS FOR REVIEW PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL THE BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. ALL DISCLOSURE STATEMENTS ARE UPDATED AND REVIEWED ANNUALLY FOR EXISTING OR POTENTIAL CONFLICTS BY THE PRESIDENT/CEO. IF A CONFLICT IS FOUND, THE AFFECTED INDIVIDUAL IS REQUIRED TO RECUSE HIMSELF/HERSELF FROM ANY DECISION MAKING AND VOTING RELATING TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD CONDUCTS PARITY STUDIES TO EVALUATE EXECUTIVE COMPENSATION. THE ENTIRE BOARD GOES INTO EXECUTIVE SESSION TO EVALUATE THE CEO AND DETERMINE COMPENSATION. THE CEO CONDUCTS PARITY STUDIES TO EVALUATE OFFICERS AND KEY EMPLOYEES' SALARIES FOR THE EXECUTIVE COMMITTEE. THESE SALARIES, AND THE SALARIES OF THE ENTIRE ORGANIZATION, ARE PRESENTED TO THE BOARD FOR APPROVAL DURING THE BUDGET APPROVAL PROCESS TOWARD YEAR-END. THERE IS CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION DELIBERATION AND DECISION IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 OPEN DOOR DOES MAKE ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY POSTING ON THE ORGANIZATION'S WEBSITE; PROVIDING COPIES UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D); AND INSPECTION AT AN OFFICE OF THE ORGANIZATION. THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST, AT THE ORGANIZATION'S LOCATION. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AS WELL AS THE SELECTION OF THE INDEPENDENT ACCOUNTANT. OPEN DOOR FOUNDATION INC 165 MAIN STREET OSSINING NY 10562 133598184 FUNDRAISING/DEVELOPMENT NY 501(C)(3) LINE 7 OPEN DOOR FAMILY MEDICAL CENTER INC 1 OPEN DOOR LEASING CORP 165 MAIN STREET OSSINING NY 10562 201726717 LEASING SPACE NY OPEN DOOR FAMILY MEDICAL CENTER INC C 1035167 120000 1.00000 1 EUGENE P HESLIN MD PC DBA BRIDGE STREET FAMILY MEDICINE 12 WEST CHESTNUT ST KINGSTON NY 12401 MEDICAL PRACTICE NY OPEN DOOR FAMILY MEDICAL CENTER INC C 2425280 568674 1 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 1 0 0 0 OPEN DOOR LEASING CORP K 1050629 COST