2023-10-19T11:30:17-05:00 2022-12-31 351178661 BLUE & CO LLC 12800 N MERIDIAN STREET SUITE 400 CARMEL IN 46032 990 2022-01-01 010945309 JANE PAULEY COMMUNITY HEALTH CENTER INC JANE 3173558704 8931 E 30TH STREET INDIANAPOLIS IN 46219 MICHAEL DALE CFO 3179340751 2023-10-18 1 MICHAEL DALE 999009999 0 TYLER K GREENE CPA P00057872 3178488920 2023-10-18 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARC HACKETT CEO 8931 E 30TH STREET INDIANAPOLIS IN 46219 33425641 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 13 313 14 0 0 5171866 8413890 26037704 24614291 1099 -394316 382886 390555 31593555 33024420 0 0 0 0 20081437 21105175 0 0 0 9265533 11172340 29346970 32277515 2246585 746905 21892790 27648803 18165256 23174364 3727534 4474439 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 23864950 24839342 JANE PAULEY CHC PROVIDED PRIMARY HEALTH CARE SERVICES TO APPROXIMATELY 24,600 INDIVIDUALS INCLUDING APPROXIMATELY 4,100 UNINSURED INDIVIDUALS. WE PROVIDED APPROXIMATELY 1,000 PATIENTS ACCESS TO FREE OR REDUCED PRESCRIPTION MEDICATIONS. 23864950 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 13 0 1 313 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 3179340751 1503 N MITTHOEFFER AVE INDIANAPOLIS IN 46229 AUGUST ZEHNER TREASURER 1.00 0.00 X X 0 0 0 CYNTHIA PARKES DIRECTOR 1.00 0.00 X 0 0 0 ERIN KUROIWA DIRECTOR 1.00 0.00 X 0 0 0 HOWARD DORSEY DIRECTOR 1.00 0.00 X 0 0 0 KATHY KRUSIE DIRECTOR - BEGAN FEB '22 1.00 0.00 X 0 0 0 KELLY DILLON SECRETARY 2.00 0.00 X X 0 0 0 KRYSTAL HUTCHINSON DIRECTOR 1.00 0.00 X 0 0 0 BILL KALER DIRECTOR 1.00 0.00 X 0 0 0 RACHEL BURKE CHAIRMAN 2.00 0.00 X X 0 0 0 ROSALINE BARYOH DIRECTOR 1.00 0.00 X 0 0 0 STEPHANIE MORAN VICE-CHAIR 1.00 0.00 X X 0 0 0 TIM HANSON DIRECTOR 1.00 0.00 X 0 0 0 VICKIE BANNON DIRECTOR 1.00 0.00 X 0 0 0 DR JAMES BIEN CMO 40.00 0.00 X 163703 0 17810 DR SCHERI-LYN MAKOMBE CMO 40.00 0.00 X 64623 0 8220 MARC HACKETT CEO 40.00 0.00 X 258393 0 41219 MICHAEL DALE CFO 40.00 0.00 X 129908 0 39741 PATRICK WOOTEN COO 40.00 0.00 X 130986 0 24732 DR SUZANNE HANSEN PHYSICIAN 40.00 0.00 X 265893 0 11008 DR DANIEL FRICK PHYSICIAN 40.00 0.00 X 254398 0 55994 DR NILES CARTER PHYSICIAN 40.00 0.00 X 349232 0 31155 DR JASON HUA DENTIST 40.00 0.00 X 251772 0 57036 DR MUALLA AKISIK PHYSICIAN 40.00 0.00 X 251040 0 14972 DR EMMANUEL MENTOR FORMER PHYSICIAN 40.00 0.00 X 138737 0 31674 2258685 0 333561 37 1 1 0 REFLECTIONS UNLIMITED LLC 4811 S NEW COLUMBUS ROAD ANDERSON IN 46013 FACILITIES CLEANING SERVICES 386885 1 7735380 678510 149414 8413890 NET PATIENT SERVICE REVENUE 621400 20686517 20686517 340B PROGRAM 900099 3927774 3927774 24614291 6905 6905 225051 0 225051 225051 225051 401221 -401221 -401221 -401221 OTHER REVENUE 900099 165504 165504 165504 33024420 24839342 0 -228812 879335 879335 15015766 12649690 2366076 636564 476154 160410 3470099 2595658 874441 1103411 825359 278052 100838 100838 92576 92576 2637677 2469829 167848 335614 14578 321036 188751 56083 132668 1717333 825536 891797 2456367 1731912 724455 145121 94992 50129 201426 45878 155548 505417 33185 472232 928337 536722 391615 111130 111130 MEDICAL SUPPLIES 1268676 1258164 10512 MINOR EQUIPMENT 222431 78245 144186 DUES & SUBSCRIPTIONS 87456 47424 40032 173190 125541 47649 32277515 23864950 8412565 0 2688674 5513584 3920747 1887386 1741067 1402394 276714 276922 13873608 5144371 8185927 8729237 5079661 9839280 21892790 27648803 864370 1094984 17300886 22079380 18165256 23174364 X 3727534 4474439 3727534 4474439 21892790 27648803 746905 0 X X 0 1 X 1 1 1 X 4355302 3921912 9032335 5153121 8413890 30876560 20012654 20303605 21040635 26037704 24627340 112021938 24367956 24225517 30072970 31190825 33041230 142898498 0 0 0 142898498 1012 3202 1314 1099 6905 13532 1012 3202 1314 1099 6905 13532 575267 110593 61185 136057 152455 1035557 24944235 24339312 30135469 31327981 33200590 143947587 0.99270 0.96280 0.00010 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: REIMBURSED EXPENSES - 2018 AMOUNT: $ 177,817. QUALITY CARE BONUS - MISCELLANEOUS INCOME - 2019 AMOUNT: $ 110,593. 2020 AMOUNT: $ 61,185. 2021 AMOUNT: $ 136,057. 2022 AMOUNT: $ 152,455. 340B REVENUE - 2018 AMOUNT: $ 397,450. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7637636 1832458 5805178 3602512 1684379 1918133 2633460 1627534 1005926 8729237 OTHER ASSETS 20000 THIRD PARTY RECEIVABLE 2484153 LEASE RIGHT-OF-USE ASSETS 7335127 9839280 X 33461071 35430 35430 33425641 -401221 -401221 33024420 32714166 35430 401221 436651 32277515 0 32277515 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, 2022 AND 2021, 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN/LOSS ON SALE OF EQUIPMENT -401,221. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN/LOSS ON SALE OF EQUIPMENT 401,221. X X 0 0 0 0 0 0 0 0 0 DR NILES CARTER PHYSICIAN 321630 0 27300 0 302 0 10153 0 21002 0 380387 0 0 0 DR DANIEL FRICK PHYSICIAN 252220 0 1800 0 378 0 14508 0 41486 0 310392 0 0 0 DR JASON HUA DENTIST 251096 0 300 0 376 0 15550 0 41486 0 308808 0 0 0 MARC HACKETT CEO 225515 0 31934 0 944 0 9360 0 31859 0 299612 0 0 0 DR SUZANNE HANSEN PHYSICIAN 265000 0 300 0 593 0 11008 0 0 0 276901 0 0 0 DR MUALLA AKISIK PHYSICIAN 240000 0 9535 0 1505 0 14972 0 0 0 266012 0 0 0 DR JAMES BIEN CMO 162346 0 300 0 1057 0 3110 0 14700 0 181513 0 0 0 DR EMMANUEL MENTOR FORMER PHYSICIAN 138529 0 0 0 208 0 8562 0 23112 0 170411 0 0 0 MICHAEL DALE CFO 129370 0 300 0 238 0 7882 0 31859 0 169649 0 0 0 PATRICK WOOTEN COO 130583 0 300 0 103 0 0 0 24732 0 155718 0 0 0 X LAB SERVICES 1 149414 FMV 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, FORM XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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