2019-11-07T13:41:54-06:00 2018-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2018-01-01 010945309 JANE PAULEY COMMUNITY HEALTH CENTER INC JANE 3173558704 8931 E 30TH STREET INDIANAPOLIS IN 46219 MICHAEL DALE CFO 3173558704 2019-11-07 1 MARGOT BURKE P01588992 3176334705 2019-11-07 47.227.233.166 2019-11-07 13:01:18 ES P 83E1B0699C3BE8FACAD698BF554F0BD5582B4561 B19D0506B86ED19F1A0FD2AFEEB91090E576B51F 2018 2020-03-31 21:24:44Z MARC HACKETT 8931 E 30TH STREET INDIANAPOLIS IN 46219 25075787 0 X JANEPAULEYCHC.COM X 2009 IN TO PROMOTE A HEALTHY COMMUNITY THROUGH THE PROVISION OF ACCESSIBLE, RESPECTFUL AND COLLABORATIVE PRIMARY HEALTH CARE WITH LOCAL PARTNERS TO ANY AND ALL INDIVIDUALS AND FAMILIES REGARDLESS OF INSURANCE STATUS. 13 13 240 13 0 0 3941529 4355302 18252771 20012654 556 1012 162524 706819 22357380 25075787 0 0 0 0 11875850 13561289 0 39203 39203 12279597 10442132 24155447 24042624 -1798067 1033163 20015611 22461466 20848801 22261493 -833190 199973 TO PROMOTE A HEALTHY COMMUNITY THROUGH THE PROVISION OF ACCESSIBLE, RESPECTFUL AND COLLABORATIVE PRIMARY HEALTH CARE WITH LOCAL PARTNERS TO ANY AND ALL INDIVIDUALS AND FAMILIES REGARDLESS OF INSURANCE STATUS. 0 0 18478892 20144206 JANE PAULEY CHC PROVIDED PRIMARY HEALTH CARE SERVICES TO APPROXIMATELY 25,400 INDIVIDUALS INCLUDING APPROXIMATELY 4,100 UNINSURED INDIVIDUALS. WE PROVIDED APPROXIMATELY 1,000 PATIENTS ACCESS TO FREE OR REDUCED PRESCRIPTION MEDICATIONS. 18478892 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 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 0 0 0 0 1 5 0 1 240 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X X MICHAEL DALE 3173558704 1503 N MITTHOEFFER AVE INDIANAPOLIS IN 46229 BILL KALER CHAIRMAN 2.00 X X 0 0 0 ANNE MURPHY VICE-CHAIR 2.00 X X 0 0 0 NICKEY MORRIS SECRETARY 2.00 X X 0 0 0 RACHEL BURKE TREASURER 2.00 X X 0 0 0 PAT NOLTING DIRECTOR 1.00 X 0 0 0 ROSALINE BARYOH DIRECTOR 1.00 X 0 0 0 DENNIS MCCONNAUGHHAY DIRECTOR 1.00 X 0 0 0 TIM HANSON DIRECTOR 1.00 X 0 0 0 HOWARD DORSEY DIRECTOR 1.00 X 0 0 0 STEPHANIE MORAN DIRECTOR 1.00 X 0 0 0 CINDY WEIDNER DIRECTOR 1.00 X 0 0 0 AUGUST ZEHNER DIRECTOR 1.00 X 0 0 0 ROBIN BRUNNER DIRECTOR 1.00 X 0 0 0 KIMBERLY NEWLIN DIRECTOR OF OPERATIONS 40.00 X 88477 0 5633 DEMETRIUS DILLARD DIRECTOR OF IS & QUALITY 40.00 X 106186 0 2632 MICHAEL DALE CFO 40.00 X 108866 0 4058 DR JOHN FLEMING MEDICAL DIRECTOR 40.00 X 260704 0 15949 MARC HACKET EXECUTIVE DIRECTOR 40.00 X 229609 0 7681 DR DENISE REHFUSS PHYSICIAN 40.00 X 388722 0 16500 DR SUZANNE HANSEN PHYSICIAN 40.00 X 265387 0 15923 DR JASON HUA DENTIST 40.00 X 235606 0 14250 DR MUALLA AKISIK PHYSICIAN 40.00 X 200774 0 12046 DR ELIZABETH SIMPSON DENTIST 40.00 X 174958 0 1342 2059289 0 96014 25 0 1 0 DR JOSEPH COPELAND 467 SADDLEBROOK LN NAPLES FL 34110 PHYSICIAN 525000 REFLECTIONS UNLIMITED LLC 4811 S NEW COLUMBUS ROAD ANDERSON IN 46013 FACILITIES CLEANING SERVICES 135326 2 3738000 617302 4355302 PATIENT SERVICE REVENUE 621400 20012654 20012654 20012654 1012 1012 131552 0 131552 131552 131552 340B REVENUE 900099 397450 397450 177817 177817 575267 25075787 20144206 0 576279 X 829795 829795 9480393 7937237 1543156 2545453 1959602 585851 705648 543239 162409 80589 62041 18548 120622 92860 27762 39203 39203 4047672 3116076 931596 158659 122143 36516 403464 310604 92860 1059753 815845 243908 1824612 1404667 419945 147338 113427 33911 43505 33492 10013 636418 489943 146475 698730 537913 160817 249943 192417 57526 MEDICAL SUPPLIES 818833 630374 188459 DUES & SUB. 81720 62912 18808 70274 54100 16174 24042624 18478892 5524529 39203 416752 626174 500000 563402 10109787 2992245 1108694 1108694 803072 240409 9226892 2111926 7077306 7114966 0 9815576 20015611 22461466 4189568 4499478 16505367 17662015 153866 100000 20848801 22261493 X -833190 199973 -833190 199973 20015611 22461466 1033163 0 X 0 1 X 1 1 1 X 2179196 2279370 3405573 3941529 4355302 16160970 5742014 9270662 15100403 18252771 20012654 68378504 7921210 11550032 18505976 22194300 24367956 84539474 1953867 2059243 3099620 3895224 11007954 92653 67664 160317 2046520 2059243 3167284 3895224 11168271 73371203 797 35250 202431 556 1012 240046 797 35250 202431 556 1012 240046 15632 322044 162524 575267 1075467 7937639 11585282 19030451 22357380 24944235 85854987 0.85460 0.79480 0.00280 0.00060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: REIMBURSED EXPENSES - 2017 AMOUNT: $ 80,250. 2018 AMOUNT: $ 177,817. MEANINGFUL USE BONUS - 2016 AMOUNT: $ 318,750. QUALITY CARE BONUS - 2016 AMOUNT: $ 1,743. 2017 AMOUNT: $ 52,895. MISCELLANEOUS INCOME - 2014 AMOUNT: $ 15,632. 2016 AMOUNT: $ 1,551. 2017 AMOUNT: $ 29,379. 340B REVENUE - 2018 AMOUNT: $ 397,450. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4648606 574997 4073609 2412541 419711 1992830 1697370 1034568 662802 468375 82650 385725 7114966 OTHER ASSETS 100000 THIRD PARTY RECEIVABLE 9715576 9815576 LINE OF CREDIT 100000 100000 X 25075787 0 25075787 0 25075787 24042624 0 24042624 0 24042624 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CENTER AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2018 AND 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. X X 1 HEALTH MANAGEMENT ASSOCIATES 10 W MARKET ST SUITE 2350 INDIANAPOLIS IN 46204 ASSISTED WITH HRSA GRANT APPLICATION 0 3182278 39203 3143075 3182278 39203 3143075 X X 0 0 0 0 0 0 0 0 0 DR JOHN FLEMING MEDICAL DIRECTOR 255488 0 0 0 5216 0 15949 0 0 0 276653 0 0 0 MARC HACKET EXECUTIVE DIRECTOR 192858 0 36000 0 751 0 7681 0 0 0 237290 0 0 0 DR DENISE REHFUSS PHYSICIAN 317431 0 71000 0 291 0 16500 0 0 0 405222 0 0 0 DR SUZANNE HANSEN PHYSICIAN 265000 0 0 0 387 0 15923 0 0 0 281310 0 0 0 DR JASON HUA DENTIST 235380 0 0 0 226 0 14250 0 0 0 249856 0 0 0 DR MUALLA AKISIK PHYSICIAN 200000 0 0 0 774 0 12046 0 0 0 212820 0 0 0 DR ELIZABETH SIMPSON DENTIST 174812 0 0 0 146 0 1342 0 0 0 176300 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B JANE PAULEY COMMUNITY HEALTH CENTER, INC.'S FORM 990 ARE PRESENTED TO THE BOARD, AND REVIEWED AND APPROVED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C JANE PAULEY COMMUNITY HEALTH CENTER, INC. HAS A WRITTEN CONFLICT OF INTEREST POLICY, WHICH EVERYBODY IS REQUIRED TO REVIEW AND SIGN ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 JANE PAULEY COMMUNITY HEALTH CENTER, INC. USES MARKET DATA, AND NATIONAL ASSOCIATION DATA TO ENSURE THAT COMPENSATION IS FAIR AND EQUITABLE FOR THE POSITIONS. JANE PAULEY COMMUNITY HEALTH CENTER, INC. HAS ALSO DEVELOPED A PAY RANGE SCALE BASED ON POSITION CATEGORIES, WHICH HAS BEEN BOARD APPROVED. JANE PAULEY COMMUNITY HEALTH CENTER, INC. ENSURES THAT ALL SALARIES ARE WITHIN THE APPROVED RANGES FOR THE POSITION. FORM 990, PART VI, SECTION C, LINE 19 JANE PAULEY COMMUNITY HEALTH CENTER, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, AS APPLICABLE, AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,116,076. MANAGEMENT AND GENERAL EXPENSES 931,596. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,047,672. JPCHC REAL ESTATE LLC 1503 N MITTHOEFFER RD INDIANAPOLIS IN 46229 320442001 REAL ESTATE HOLDING & MANAGEMENT IN 131552 4108752 JANE PAULEY COMMUNITY HEALTH CENTER INC