2022-11-10T20:58:51-06:00 2021-12-31 351178661 BLUE & CO LLC 12800 N MERIDIAN STREET SUITE 400 CARMEL IN 46032 990 2021-01-01 010945309 JANE PAULEY COMMUNITY HEALTH CENTER INC JANE 3173558704 8931 E 30TH STREET INDIANAPOLIS IN 46219 MICHAEL DALE CFO 3173558704 2022-11-10 1 MICHAEL DALE 999009999 NATHAN A RODGERS CPA P01568275 3178488920 2022-11-10 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MARC HACKETT CEO 8931 E 30TH STREET INDIANAPOLIS IN 46219 31593555 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. 12 12 328 15 0 0 9032335 5171866 21040635 26037704 -102966 1099 283168 382886 30253172 31593555 0 0 0 0 19800261 20081437 6490 0 0 8623522 9265533 28430273 29346970 1822899 2246585 21923922 21892790 20442973 18165256 1480949 3727534 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 21931648 26284533 JANE PAULEY CHC PROVIDED PRIMARY HEALTH CARE SERVICES TO APPROXIMATELY 25,600 INDIVIDUALS INCLUDING APPROXIMATELY 4,900 UNINSURED INDIVIDUALS. WE PROVIDED APPROXIMATELY 1,000 PATIENTS ACCESS TO FREE OR REDUCED PRESCRIPTION MEDICATIONS. 21931648 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 12 0 1 328 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 1 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 RACHEL BURKE CHAIRMAN 2.00 X X 0 0 0 STEPHANIE MORAN VICE-CHAIR 1.00 X X 0 0 0 AUGUST ZEHNER TREASURER-BEGAN FEB '21 1.00 X X 0 0 0 KELLY DILLON SECRETARY 2.00 X X 0 0 0 BILL KALER CHAIRMAN-ENDED JULY '21 2.00 X X 0 0 0 ANNE MURPHY VICE-CHAIR-ENDED DEC '21 2.00 X X 0 0 0 VICKIE BANNON DIRECTOR-BEGAN JAN '21 1.00 X 0 0 0 ROSALINE BARYOH DIRECTOR 1.00 X 0 0 0 HOWARD DORSEY DIRECTOR-BEGAN JAN '21 1.00 X 0 0 0 TIM HANSON DIRECTOR 1.00 X 0 0 0 KRYSTAL HUTCHINSON DIRECTOR-BEGAN OCT '21 1.00 X 0 0 0 ERIN KUROIWA DIRECTOR 1.00 X 0 0 0 CYNTHIA PARKES DIRECTOR 1.00 X 0 0 0 LISHA WATTS DIRECTOR 1.00 X 0 0 0 PATRICK WOOTEN COO 40.00 X 124247 0 16658 MICHAEL DALE CFO 40.00 X 122655 0 28343 MARC HACKETT CEO 40.00 X 262455 0 22873 DR SCHERI-LYN MAKOMBE CMO 40.00 X 286750 0 28818 DEMETRIUS DILLARD CIO-ENDED APR '21 40.00 X 34721 0 5052 DR SUZANNE HANSEN PHYSICIAN 40.00 X 266093 0 10406 DR JASON HUA DENTIST 40.00 X 252954 0 44764 DR DENISE REHFUSS PHYSICIAN 40.00 X 344979 0 37716 DR SARAH SCOTT PHYSICIAN 40.00 X 395752 0 46602 DR EMMANUEL MENTOR PHYSICIAN 40.00 X 259090 0 42686 2349696 0 283918 37 0 1 0 REFLECTIONS UNLIMITED LLC 4811 S NEW COLUMBUS ROAD ANDERSON IN 46013 FACILITIES CLEANING SERVICES 387156 1 4427742 744124 54175 5171866 NET PATIENT SERVICE REVENUE 621400 23996849 23996849 340B PROGRAM 900099 2028206 2028206 MEDICARE ELECTRONIC HEALTH RECORD 900099 12649 12649 26037704 1099 1099 246829 0 246829 246829 246829 136057 136057 136057 31593555 26284533 0 137156 892798 892798 14432327 12080965 2351362 698170 522176 175994 3027543 2264365 763178 1030599 770807 259792 82336 82336 104891 104891 1994765 1628725 366040 234153 60524 173629 178755 43948 134807 1384439 618891 765548 1924391 1428108 496283 119983 88379 31604 65246 2106 63140 573585 488713 84872 885734 485521 400213 93891 72296 21595 MEDICAL SUPPLIES 1164993 1164993 MINOR EQUIPMENT 268174 76243 191931 DUES & SUB. 91507 59384 32123 98690 75504 23186 29346970 21931648 7415322 0 2720560 2688674 63594 3920747 2801353 1741067 325911 276714 12733314 4547387 8925293 8185927 7087211 5079661 21923922 21892790 755342 864370 19687631 17300886 20442973 18165256 X 1480949 3727534 1480949 3727534 21923922 21892790 2246585 0 X X 0 1 X 1 1 1 X 3941529 4355302 3921912 9032335 5153121 26404199 18252771 20012654 20303605 21040635 26037704 105647369 22194300 24367956 24225517 30072970 31190825 132051568 3895224 3895224 0 3895224 3895224 128156344 556 1012 3202 1314 1099 7183 556 1012 3202 1314 1099 7183 162524 575267 110593 61185 136057 1045626 22357380 24944235 24339312 30135469 31327981 133104377 0.96280 0.92960 0.00010 0.00170 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: REIMBURSED EXPENSES - 2017 AMOUNT: $ 80,250. 2018 AMOUNT: $ 177,817. QUALITY CARE BONUS - 2017 AMOUNT: $ 52,895. MISCELLANEOUS INCOME - 2017 AMOUNT: $ 29,379. 2019 AMOUNT: $ 110,593. 2020 AMOUNT: $ 61,185. 2021 AMOUNT: $ 136,057. 340B REVENUE - 2018 AMOUNT: $ 397,450. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6024551 1487191 4537360 4232727 1514548 2718179 2476036 1545648 930388 8185927 OTHER ASSETS 40000 THIRD PARTY RECEIVABLE 5039661 5079661 X 31628985 35430 35430 31593555 0 31593555 29382400 35430 35430 29346970 0 29346970 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, 2021 AND 2020, 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 0 0 0 0 0 0 0 0 0 DR SARAH SCOTT PHYSICIAN 348203 0 47000 0 549 0 17400 0 29202 0 442354 0 0 0 DR DENISE REHFUSS PHYSICIAN 292518 0 52150 0 311 0 15365 0 22351 0 382695 0 0 0 DR SCHERI-LYN MAKOMBE CMO 285991 0 500 0 259 0 11620 0 17198 0 315568 0 0 0 DR EMMANUEL MENTOR PHYSICIAN 258203 0 500 0 387 0 13484 0 29202 0 301776 0 0 0 DR JASON HUA DENTIST 252078 0 500 0 376 0 15562 0 29202 0 297718 0 0 0 MARC HACKETT CEO 225346 0 36175 0 934 0 6041 0 16832 0 285328 0 0 0 DR SUZANNE HANSEN PHYSICIAN 265000 0 500 0 593 0 10406 0 0 0 276499 0 0 0 MICHAEL DALE CFO 121941 0 500 0 214 0 6050 0 22293 0 150998 0 0 0 X LAB SERVICES 0 54175 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 JANE PAULEY COMMUNITY HEALTH CENTER, INC. SIMPLIFIED ITS MISSION STATEMENT BY REMOVING MARION COUNTY FROM ITS RECIPIENTS OF THE CHARITABLE PURPOSE AND LEAVING THE RECIPETS AS RESIDENCES OF CENTRAL INDIANA. JANE PAULEY COMMUNITY HEALTH CENTER, INC. UPDATED THE BOARD OF DIRECTOR'S INDIVIDUAL RESPONSIBILITIES INCLUDING A REQUIRMENT TO BE PREPARED FOR BOARD MEETINGS. FORMALLY, FAILURE TO ATTEND THREE CONSECUTIVE MEETINGS OR FAILURE TO ATTEND SIX MEETINGS ANNUALLY RESULTED IN MANDATORY EXPULSION. THE CORPORATION BYLAW UPDATES INTRODUCE AN EXCEPTION TO THE MANDATORY EXPULSION IF A LEAVE OF ABSENCE IS APPROVED. REGARDING BOARD OF DIRECTOR'S VACANCIES, JANE PAULEY COMMUNITY HEALTH CENTER, INC. REQUIRES THE REPLACING BOARD MEMBER TO HAVE A THREE YEAR TERM. FORMALLY, THE NEW BOARD MEMBER WOULD FINISH THE FORMER BOARD MEMBER'S TERM OR HAVE A THREE YEAR TERM. IF A VACANCY OCCURS FOR THE JANE PAULEY COMMUNITY HEALTH CENTER, INC. OFFICERS, THE REPLACEMENT OFFICER WILL HOLD A TWO YEAR TERM. JANE PAULEY COMMUNITY HEALTH CENTER, INC. BOARD OF DIRECTOR'S COMMITTEES HAS SEVERAL UPDATES. THE NOMINATING COMMITTEE HAS BEEN REDUCED FROM 4 MEMBERS TO 3 MEMBERS. THE PERSONNEL COMMITTEE HAS AN ADDITIONAL DUTY TO HEAR APPEALS. THE NEW THREE MEMBER ONBOARDING COMMITTEE WILL ESTABLISH RELATIONSHIPS AND PROVIDE/PLAN TRAINING AND RESOURCES FOR NEW DIRECTORS. THE NEW THREE MEMBER POLICY COMMITTEE WILL REVIEW ALL POLICIES, ASSURE POLICIES ARE ALIGNED WITH EACH OTHER AND THE BYLAWS, AND PRESENT FINAL POLICY RECOMMENDATIONS TO THE BOARD OF DIRECTORS. 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, FORM XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. JPCHC REAL ESTATE LLC 1503 N MITTHOEFFER RD INDIANAPOLIS IN 46229 320442001 REAL ESTATE HOLDING & MANAGEMENT IN 765325 4779644 JANE PAULEY COMMUNITY HEALTH CENTER INC 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 JPCHC REAL ESTATE LLC J 518472 FMV JPCHC REAL ESTATE LLC O 167589 FMV