2023-11-15T16:26:08-06:00 2022-12-31 352102008 CNA TAX PROFESSIONALS INC 10475 CROSSPOINT BOULEVARD SUITE 200 INDIANAPOLIS IN 46256 990 2022-01-01 061645027 SHALOM HEALTH CARE CENTER INC SHAL 3172917422 3400 LAFAYETTE ROAD 200 INDIANAPOLIS IN 46222 LEONARDO R ORTEGA MD MPH CEO/PRESIDENT 3172917422 2023-11-15 1 LEONARDO ORTEGA MD MPH 999009999 1 SHAWN D DREIMAN CPA P00380913 3178413393 2023-11-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X LEONARDO R ORTEGA MD MPH 3400 LAFAYETTE ROAD 200 INDIANAPOLIS IN 46222 11739127 0 X WWW.SHALOMHEALTHCENTER.ORG X 2002 IN TO PROVIDE A FULL RANGE OF PRIMARY AND PREVENTIVE HEALTH CARE SERVICES TO ALL RESIDENTS, REGARDLESS OF THE ABILITY FOR PAYMENT. 11 11 138 0 -132942 0 5768528 6379151 4287791 4790806 725 2639 1290695 190668 11347739 11363264 0 0 0 0 7542408 8000684 0 0 0 2986718 3268000 10529126 11268684 818613 94580 5349705 5738853 3450431 3752791 1899274 1986062 TO PROVIDE A FULL RANGE OF PRIMARY AND PREVENTIVE HEALTH CARE SERVICES TO ALL RESIDENTS, REGARDLESS OF THE ABILITY FOR PAYMENT. 0 0 9486174 4790806 PRIMARY AND PREVENTIVE HEALTH CARE SERVICES: WE ARE HERE AT SHALOM HEALTH CARE CENTER SUPPORT OUR MISSION OF PROVIDING PRIMARY HEALTH CARE TO THE UNDESERVED POPULATION THAT LIVE NEAR THE LAFAYETTE SQUARE AREA (WEST SIDE OF INDIANAPOLIS). IN 2021, SHALOM SERVED 14,567 PATIENTS AND HAD 91,052PATIENTS VISIT OUR PRIMARY CARE CENTERS AND TWENTY-NINE SCHOOL BASED CLINICS. OUR DEMOGRAPHIC DATA SHOWS THAT 84.78% OF THE PATIENTS ARE MINORITY, MANY OF THEM APPRECIATE THE FACT THAT WE OFFER BILINGUAL SERVICES TO THM AT NO ADDITIONAL COST. SCHOOL BASED CLINICS. 9486174 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 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 15 0 1 138 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X MICHAEL NINO CFO 3172917422 3400 LAYFAYETTE RD STE 200 INDIANAPOLIS IN 46222 EUGINA LONG BOARD 1.00 X X 0 0 0 CESAR ROMAN BOARD 1.00 X X 0 0 0 VIRNA DIAZ SECRETARY 1.00 X 0 0 0 CRISTIAN GUANDIQUE BOARD 1.00 X X 0 0 0 CASSANDRA HOOKS BOARD 1.00 X 0 0 0 RICHARD PROCTOR II BOARD 1.00 X 0 0 0 FRIEDA THOMPSON BOARD 1.00 X 0 0 0 KENDREA DERRICK VICE CHAIR 1.00 X X 0 0 0 HANS BERNABE TREASURER 1.00 X 0 0 0 HANAKO GAVIA BOARD 1.00 X 0 0 0 ARIELLE ZERGER CHAIR 1.00 X 0 0 0 LEONARDO R ORTEGA MD MPH CEO 40.00 X 226273 0 0 MICHAEL NINO CFO 40.00 X 117367 0 6596 DR MARGARITA WIERSEMA CMO 40.00 X 180219 0 20500 DR HEMALATHA HEMACHANDRA MEDICAL DIRECTOR 40.00 X 176053 0 20500 LYNDSEY FURRY CHIEF CLINICAL OFFICER 40.00 X 120229 0 11362 TERESA DRISKELL CNO 40.00 X 121353 0 13192 MYRIAM BERESKY CNO 40.00 X 107142 0 5696 LYLE CORTEZ PHYSICIAN 40.00 X 171035 0 0 SCOTT CURTISS CHIEF INFORMATION OFFICER 40.00 X 112104 0 0 STACI WALTERS CHIEF QUALITY AND COMPLIANCE OFFICER 40.00 X 101139 0 5423 1432914 0 83269 10 0 1 0 BRUEGMANN MANAGEMENT CORP 14400 CIVIC DR WALNUT OAK CA 94596 RENT 182246 ARTHUR GALSTIAN 9240 NORTH MERIDIAN ST STE 180 INDIANAPOLIS IN 46260 OBGYN CONTRACT SERVICES 102600 2 5373345 1005806 1005806 6379151 NET PATIENT SERVICE 621400 3399091 3399091 SCHOOL CLINICS 621400 1265355 1265355 PHARMACY SALES 621400 126360 126360 4790806 2639 2639 242921 375863 -132942 -132942 -132942 OTHER INCOME 900099 323610 323610 323610 11363264 4790806 -132942 326249 1715205 1424445 290760 6285479 5219969 1065510 12902 12902 86919 86919 424073 276345 147728 434360 298981 135379 14346 -743 15089 123100 123100 33744 4027 29717 MEDICAL SUPPLIES & PHAR 1278019 1278019 OTHER 578120 374508 203612 LEASE & RENTALS 357309 314012 43297 PLANT OPERATIONS 97173 73690 23483 -172065 -172065 11268684 9486174 1782510 0 2283718 862636 164087 325036 319726 1082966 59790 65907 5082125 2560120 2522384 2522005 0 880303 5349705 5738853 508301 969016 178079 134657 1951450 1746315 812601 902803 3450431 3752791 X 1899274 1986062 1899274 1986062 5349705 5738853 94580 -7792 0 X 0 1 X 1 1 1 X 3910870 3354917 6042335 5768528 6379151 25455801 3112679 5212939 4524288 4287791 4790806 21928503 7023549 8567856 10566623 10056319 11169957 47384304 0 0 0 47384304 258 286 322 725 2639 4230 258 286 322 725 2639 4230 62959 102958 75504 172076 190668 604165 7086766 8671100 10642449 10229120 11363264 47992699 0.98730 0.99040 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 344000 344000 1821381 493276 1328105 1175206 776866 398340 1087576 775285 312291 653962 514693 139269 2522005 RIGHT OF USE ASSET 880303 880303 REFUNDABLE ADVANCE 22500 LEASE LIABILITY 880303 902803 11911192 172065 375863 547928 11363264 0 11363264 11816612 172065 375863 547928 11268684 0 11268684 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 0 0 0 0 0 0 0 0 0 LEONARDO R ORTEGA MD MPH CEO 226273 0 0 0 0 0 0 0 0 0 226273 0 0 0 DR MARGARITA WIERSEMA CMO 180219 0 0 0 0 0 0 0 0 0 180219 0 0 0 DR HEMALATHA HEMACHANDRA MEDICAL DIRECTOR 176053 0 0 0 0 0 0 0 0 0 176053 0 0 0 LYLE CORTEZ PHYSICIAN 171035 0 0 0 0 0 0 0 0 0 171035 0 0 0 X 1005806 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: SHALOM HEALTH CARE CENTER, INC.'S FORM 990 AND ALL RELATED SCHEDULES, STATEMENTS AND ATTACHMENTS ARE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS CHAIRPERSON, EXECUTIVE DIRECTOR, CFO AND APPROPRIATE OTHER REPRESENTATIVE(S) FROM THE BOARD OF DIRECTOR'S FINANCIAL COMMITTEE PRIOR TO FINALIZING THESE TAX RETURNS. THE FORM 990 IS ALSO REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: SHALOM HEALTH CARE CENTER, INC. ANNUALLY REQUESTS EACH OFFICER AND MEMBER OF THE BOARD OF DIRECTORS TO COMPLETE A CONFLICT OF INTEREST POLICY QUESTIONNAIRE. THE POLICY INCLUDES STATEMENTS REGARDING OTHER EMPLOYMENT, BEING RELATED TO ANYONE ON THE BOARD AND OTHER ITEMS THAT MAY CREATE AN APPEARANCE OF A POTENTIAL INDEPENDENCE ISSUE. THE IDENTIFICATION, EVALUATION AND RESOLUTION OF THOSE ISSUES ARE DISCUSSED WITH THE APPROPRIATE LEVEL OF MANAGEMENT OR MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 REVIEW OF CEO OR TOP MANAGEMENT OFFICIAL COMPENSATION: SHALOM HEALTH CARE CENTER, INC.'S BOARD OF DIRECTORS' FINANCE COMMITTEE APPROVES THE PAY SCALES FOR ALL POSITIONS, WHICH ARE BASED ON A SALARY SURVEY DONE AT PERIODIC INTERVALS. THE FINANCE COMMITTEE SUBMITS THE PAY SCALES AT A BOARD MEETING AND THE MINUTES WILL REFLECT THE BOARD OF DIRECTORS APPROVAL. COMPENSATION FOR THE CEO AND TOP MANAGEMENT OFFICIAL WAS LAST REVIWED IN FEBRUARY 2020. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: SHALOM HEALTH CARE CENTER, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, AS APPLICABLE, AVAILABLE TO THE PUBLIC BY APPOINTMENT WITH THE EXECUTIVE DIRECTOR. SHALOM HEALTH CARE CENTER, INC.'S INFORMATION IS ALSO AVAILABLE VIA THE INTERNET. SHALOM LLC 3400 LAFAYETTE ROAD STE 200 INDIANAPOLIS IN 46222 471828555 HOLDING CO IN -132942 2349992 SHALOM HEALTH