2024-11-15T14:16:38-06:00 2023-12-31 420714325 RSM US LLP 80 CITY SQUARE BOSTON MA 02129 990 2023-01-01 260100022 BOSTON'S COMMUNITY MEDICAL GROUP INC BOST 6176387062 30 NORTHAMPTON STREET BOSTON MA 02118 MIHIR SHAH CFO 6176387062 2024-11-15 1 0 KAREN LO P01434915 6179129000 2023 2024-10-15 13:58:12Z COMMONWEALTH COMMUNITY CAREINC CHRISTOPHER D PALMIERI 30 NORTHAMPTON STREET BOSTON MA 02118 10942890 0 X WWW.COMMONWEALTHCOMMUNITYCARE.ORG X 2004 MA BOSTON'S COMMUNITY MEDICAL GROUP, INC. (BCMG) IS A MEDICAL PRACTICE THAT BRINGS MEDICAL CARE TO INDIVIDUALS WITH COMPLEX AND SEVERE PHYSICAL DISABILITIES AND/OR SERIOUS MENTAL ILLNESS. 7 5 0 6 0 0 0 0 28462509 10888167 0 -141 54723 54723 28517232 10942749 0 0 0 0 8681399 8850390 0 0 0 19358346 1879352 28039745 10729742 477487 213007 52817258 63966300 60631907 71567942 -7814649 -7601642 X BOSTON'S COMMUNITY MEDICAL GROUP, INC. (BCMG) IS A MEDICAL PRACTICE THAT BRINGS MEDICAL CARE TO INDIVIDUALS WITH COMPLEX AND SEVERE PHYSICAL DISABILITIES AND/OR SERIOUS MENTAL ILLNESS. 0 0 10729742 10942891 BOSTON'S COMMUNITY MEDICAL GROUP, INC. (BCMG) IS A MEDICAL GROUP PRACTICE THAT SERVES A POPULATION OF MEDICAID-SUPPORTED INDIVIDUALS WITH COMPLEX AND SEVERE PHYSICAL DISABILITY AND/OR SERIOUS MENTAL ILLNESS. THIS INCLUDES AN AGREEMENT WITH NEIGHBORHOOD HEALTH PLAN AND A SUB-CONTRACT WITH COMMONWEALTH CARE ALLIANCE TO PROVIDE PRIMARY CARE TO SENIORS WITH SERIOUS DISABILITIES AND PRIMARY CARE/OR CARE MANAGEMENT SERVICES TO PEOPLE ENROLLED IN A DEMONSTRATION PROGRAM THAT PROVIDES INTENSIVE MULTIDISCIPLINARY CARE MANAGEMENT INDIVIDUALS WHO ARE ENROLLED IN BOTH MEDICAID AND MEDICARE DUE TO SERIOUS DISABILITIES. BCMG'S NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS, PHYSICIANS, OCCUPATIONAL AND PHYSICAL THERAPISTS, SOCIAL WORKERS AND BEHAVIORAL HEALTH SPECIALISTS MAKE HOME VISITS TO THESE PATIENTS, PROVIDING PRIMARY CARE, COUNSELING, MANAGEMENT OF LONG TERM SERVICES AND SUPPORTS, HOME EVALUATIONS AND ADAPTIVE EQUIPMENT, AND OCCUPATIONAL THERAPY, AND CLOSELY COORDINATES CARE WITH SPECIALISTS AND OTHER PROVIDERS. 10729742 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X ELIZABETH CAHN GOODMAN SEC & CLERK CHIEF LEGAL OFFICER 6174260600 30 WINTER STREET BOSTON MA 02108 CHRISTOPHER D PALMIERI PRESIDENT & CEO, DIRECTOR 10.00 30.00 X X 0 1981900 754490 HANY ABDELAAL DIRECTOR (AS OF JUNE 2023) 1.00 39.00 X 0 377471 134540 JULIE FINE DIRECTOR 1.00 0.00 X 0 0 0 DANIEL HENDERSON DIRECTOR 1.00 1.00 X 0 0 0 BILJANA SIMIKIC DIRECTOR 1.00 1.00 X 0 0 0 KATHLEEN STILLO DIRECTOR (UNTIL JULY 2023) 1.00 1.00 X 0 0 0 ALYSA VEIDIS DIRECTOR 1.00 0.00 X 0 0 0 SUSAN WOOD DIRECTOR (AS OF NOVEMBER 2023) 1.00 1.00 X 0 0 0 ELIZABETH GOODMAN SEC CLERK CHIEF LEGAL OFFICER 10.00 30.00 X 0 630281 181194 FRANK SCALISE TREASURER & CFO (AS OF JULY 2023) 10.00 30.00 X 0 267100 90342 MARY HAMILTON INTERIM TREASURER & CFO (UNTIL JULY 2023) 10.00 30.00 X 0 321481 8225 LISA FLEMING FORMER SEC CLERK, CHIEF LEGAL OFFICER 0.00 40.00 X 0 447708 47275 0 4025941 1216066 0 1 1 0 0 ENROLLEE FEES 621300 10888167 10888167 10888167 141 -141 -141 -141 MISCELLANEOUS 900099 54723 54723 54723 10942749 10942890 0 -141 6728459 6728459 2121931 2121931 129614 129614 153266 153266 1064 1064 1182467 1182467 96424 96424 694 694 65396 65396 MEDICAL SUPPLIES 168984 168984 DUES AND SUBSCRIPTIONS 22279 22279 EDUCATION & TRAINING 4813 4813 MEALS & ENTERTAINMENT 1191 1191 53160 53160 10729742 10729742 0 0 22383 38564 113438 85285 26794 2217279 2101018 130851 116261 52562558 63687424 52817258 63966300 57728 14778 60574179 71553164 60631907 71567942 X -7814649 -7601642 -7814649 -7601642 52817258 63966300 213007 0 X 0 1 X 1 0 X 1186784 1080368 106416 442755 442755 0 587740 577895 9845 116261 DUE FROM COMMONWEALTH CARE ALLIANCE, INC. 62330268 DUE FROM COMMONWEALTH CLINICAL ALLIANCE, INC. 12769 RIGHT OF USE LIABILITY - SHORT TERM 659585 RIGHT OF USE LIABILITY - LONG TERM 684802 63687424 DUE TO COMMONWEALTH CLINICAL ALLIANCE, INC. 902550 DUE TO COMMONWEALTH CARE ALLIANCE, INC. 68881039 OTHER LIABILITIES 268837 RIGHT OF USE LIABILITY - SHORT TERM 727467 RIGHT OF USE LIABILITY - LONG TERM 773271 71553164 X PART X, LINE 2: THE ORGANIZATION IS REQUIRED TO ASSESS UNCERTAIN TAX POSITIONS AND HAS DETERMINED THAT THERE WERE NO SUCH POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. 0 1 0 0 0 0 0 0 0 CHRISTOPHER D PALMIERI PRESIDENT & CEO, DIRECTOR 0 1031000 0 618660 0 332240 0 735560 0 18930 0 2736390 0 112500 ELIZABETH GOODMAN SEC CLERK CHIEF LEGAL OFFICER 0 543336 0 84107 0 2838 0 144192 0 37002 0 811475 0 0 HANY ABDELAAL DIRECTOR (AS OF JUNE 2023) 0 375943 0 0 0 1528 0 130501 0 4039 0 512011 0 0 LISA FLEMING FORMER SEC CLERK, CHIEF LEGAL OFFICER 0 359068 0 81610 0 7030 0 12675 0 34600 0 494983 0 0 FRANK SCALISE TREASURER & CFO (AS OF JULY 2023) 0 264587 0 0 0 2513 0 87692 0 2650 0 357442 0 0 MARY HAMILTON INTERIM TREASURER & CFO (UNTIL JULY 2023) 0 219844 0 100000 0 1637 0 3988 0 4237 0 329706 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON COMMONWEALTH CARE ALLIANCE, A RELATED ORGANIZATION, THAT USED ONE OR MORE OF THE METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. PART I, LINE 4B COMMONWEALTH CARE ALLIANCE, A RELATED ORGANIZATION, PROVIDES MR. PALMIERI WITH A LONG-TERM BENEFIT, WHICH IF EARNED IN FULL HAS A TARGET VALUE OF $450,000. MR. PALMIERI IS ENTITLED TO PAYMENTS UNDER THIS AWARD PURSUANT TO A VESTING SCHEDULE WHICH COMBINES BOTH TIME AND PERFORMANCE BASED TARGET. UNDER THIS AWARD, MR. PALMIERI RECEIVED $112,500 IN NOVEMBER 2023, PROVIDED THAT HE WAS EMPLOYED AS CCA'S CEO AT THE TIME OF PAYOUT. THE REMAINING AMOUNT OF THE AWARD IS SUBJECT TO ACHIEVEMENT OF LONG-TERM PERFORMANCE GOALS WHICH WERE SET BASED ON THRESHOLD, TARGET AND MAXIMUM CRITERIA BY THE BOARD IN ADVANCE. THE FINAL TRANCHE VESTED ON NOVEMBER 3, 2023 AND MR. PALMIERI WAS PAID AN AMOUNT BASED ON ACHIEVEMENT OF THE PERFORMANCE GOALS. ON DECEMBER 1, 2023, MR. PALMIERI WAS PAID $281,250 (LESS APPLICABLE TAX WITHHOLDING) UPON VESTING OF THE FINAL TRANCHE UNDER THE 2020 LONG TERM INCENTIVE. THE CEO PARTICIPATES IN THE COMMONWEALTH CARE ALLIANCE SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (SERP), A NONQUALIFIED DEFERRED COMPENSATION PLAN EFFECTIVE JANUARY 1, 2022. $154,710 WAS CONTRIBUTED TO THE PLAN IN 2023 AND HAS BEEN REPORTED IN PART II, COLUMN (C) AS DEFERRED COMPENSATION. THE CEO ALSO PARTICIPATES IN AN DEFINED BENEFIT PLAN IN WHICH $566,000 WAS CONTRIBUTED IN 2023 WHICH IS REPORTED IN PART II, COLUMN C. CERTAIN OFFICERS AND KEY EMPLOYEES PARTICIPATE IN THE COMMONWEALTH CARE ALLIANCE EXECUTIVE RETENTION PLAN, A NONQUALIFIED DEFERRED COMPENSATION PLAN WHICH IN 2020 WAS OFFERED TO CERTAIN MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM AND SUBSEQUENTLY OFFERED TO NEWER EMPLOYEES. PAYMENTS WILL BE MADE TO THE EXECUTIVE ONLY IF THE EXECUTIVE STAYS WITH THE ORGANIZATION THROUGH THE FIVE-YEAR VESTING PERIOD AS THE PRIMARY PURPOSE OF THIS PLAN IS TO PROVIDE FOR THE RETENTION OF THE PARTICIPANTS. THE MARKET FOR EXECUTIVE TALENT IN THIS COUNTRY IS FIERCELY COMPETITIVE AND WE RECRUIT INDIVIDUALS FROM ACROSS THE COUNTRY AND FROM VARIOUS INDUSTRIES. DUTIES ARE BOTH EXTENSIVE AND COMPLEX AND REQUIRE SUBSTANTIAL AND DIVERSE EXPERIENCE AND SKILL SETS TO EXECUTE SUCCESSFULLY. PAYMENTS WILL BE MADE AT THE END OF A FIVE-YEAR PERIOD BASED ON ROLLING EFFECTIVE DATES IN AN AMOUNT EQUAL TO 90% OF THE EXECUTIVE'S BASE SALARY AS OF THE END OF THE YEAR PRIOR TO PAYOUT. ELIGIBLE PARTICIPANTS HAVE 18% OF THEIR SALARY ACCRUED FOR EACH YEAR FOR THE FIVE-YEAR PERIOD. CERTAIN EXECUTIVES PARTICIPATE IN THE EXECUTIVE SERP PLAN. ELIGIBLE PARTICIPANTS HAVE 15% OF THEIR SALARY ACCRUED FOR EACH YEAR WITH A FIVE-YEAR VESTING PERIOD. IN 2023, 15% OF BASE SALARY FOR ELIZABETH GOODMAN WAS ACCRUED AND HAS BEEN INCLUDED AS DEFERRED COMPENSATION IN (SCHEDULE J, PART II, COLUMN C). FORM 990, PART VI, SECTION A, LINE 6 BCMG HAS ONE CORPORATE MEMBER WHO IS COMMONWEALTH CARE ALLIANCE, INC. FORM 990, PART VI, SECTION A, LINE 7A IN ACCORDANCE WITH THE BCMG'S BYLAWS, THE CORPORATE MEMBER HAS THE POWERS AND AUTHORITY TO APPOINT ADDITIONAL MEMBERS AND ELECT BCMG'S DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B IN ACCORDANCE WITH THE BCMG'S BYLAWS, THE CORPORATE MEMBER HAS THE POWERS AND AUTHORITY TO ADOPT AND APPROVE BYLAWS AND AMENDMENTS TO THE ARTICLES OF ORGANIZATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS REVIEW THE FORM 990 BEFORE THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE. THE BOARD ALSO REVIEWS THE FINANCIAL STATEMENTS ON A QUARTERLY BASIS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF BOSTON'S COMMUNITY MEDICAL GROUP FOLLOWS THE CONFLICT OF INTEREST POLICY OF COMMONWEALTH CARE ALLIANCE ("CCA"), A RELATED ORGANIZATION. THE FOLLOWING ARE THE PROCEDURES THAT CCA TAKES TO MONITOR AND ENFORCE COMPLIANCE WITH THE POLICY. THE ANNUAL COMPLIANCE POLICY AND CONFLICT OF INTEREST FORMS ARE DISTRIBUTED TO THE BOARD AND OFFICERS AND THE COMPLIANCE DEPARTMENT MONITORS FOR COMPLETION ANNUALLY. THE BOARD AND OFFICERS ALSO RECEIVE ANNUAL TRAINING ON CONFLICT OF INTEREST. THE COMPANY'S CONFLICT OF INTEREST POLICY COVERS CCA EMPLOYEES, OFFICERS AND DIRECTORS. THE POLICY CALLS FOR CONFLICT OF INTEREST ANALYSIS AND ACTUAL CONFLICTS ARE REVIEWED AND CONFLICTS DETERMINATIONS ARE MADE FOR EMPLOYEES OF DIRECTOR LEVEL AND ABOVE (DIRECTOR, SENIOR DIRECTOR, VICE PRESIDENT, SENIOR VICE PRESIDENT). WHERE AN ACTUAL OR PERCEIVED CONFLICT OF INTEREST INVOLVING A TRANSACTION IS DETERMINED, THE EMPLOYEE IS PROHIBITED FROM PARTICIPATING IN EITHER MANAGEMENT'S OR THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). IN ADDITION, THE FORM 990 WITHOUT SCHEDULE B IS AVAILABLE VIA CANDID FORMERLY KNOWN AS GUIDSTAR AND THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. COMMONWEALTH CARE ALLIANCE 30 WINTER STREET BOSTON MA 02108 043756900 SUPPORT FOR CARE DELIVERANCY MA 501(C)(3) LINE 10 N/A 0 COMMONWEALTH CLINICAL ALLIANCE 30 WINTER STREET BOSTON MA 02108 562382058 CLINCAL SERVICES MA 501(C)(3) LINE 10 COMMONWEALTH CARE ALLIANCE 0 THE CENTER TO ADVANCE CONSUMER PARTNERSHIP INC 30 WINTER STREET BOSTON MA 02108 822810261 NATIONAL INNOVATION HUB FOR DEVELOPMENT IN THE QUALITY OF CARE AND HEALTH MA 501(C)(3) LINE 12A, I COMMONWEALTH CARE ALLIANCE 0 COMMUNITY INTENSIVE CARE INC 30 WINTER STREET BOSTON MA 02108 933780796 MEDICAL SERVICE MA 501(C)(3) PENDING COMMONWEALTH CARE ALLIANCE 0 CCA FOUNDATION INC 30 WINTER STREET BOSTON MA 02108 934772832 INACTIVE MA 501(C)(3) PENDING COMMONWEALTH CARE ALLIANCE 0 VOICE CARE TECH HOLDINGS LLC 30 WINTER STREET BOSTON MA 02108 882835914 HOLDING COMPANY MA N/A 0 0 CCA ACO LLC 23900 ORCHARD LAKE RD SUITE 210 FARMINGTON MI 48336 461262045 MEDICARE SHARED SAVINGS PROGRAM ACO MI N/A 0 0 RELIANCE NEXT GEN ACO LLC 23900 ORCHARD LAKE RD SUITE 210 FARMINGTON MI 48336 812185714 MEDICARE FEE FOR SERVICE NEXGEN ACO MI N/A 0 0 COMMONWEALTH CARE ALLIANCE MASSACHUSETTS INC 30 WINTER STREET BOSTON MA 02108 854228186 MEDICARE ADVANTAGE PRODUCTS MA N/A C 0 COMMONWEALTH CARE ALLIANCE RHODE ISLAND INC 30 WINTER STREET BOSTON MA 02108 854310885 MEDICARE ADVANTAGE PRODUCTS MA N/A C 0 COMMONWEALTH CARE ALLIANCE INDIANA LLC 30 WINTER STREET BOSTON MA 02108 873317576 MEDICARE ADVANTAGE PRODUCTS IN N/A C 0 COMMONWEALTH CARE ALLIANCE MICHIGAN LLC 30 WINTER STREET BOSTON MA 02108 872560730 HOLDING COMPANY MI N/A C 0 CCA HEALTH MICHIGAN INC 23900 ORCHARD LAKE RD SUITE 210 FARMINGTON MI 48336 814977640 MEDICAL SERVICES TO PERSONS IN MICHIGAN MI N/A C 0 CCA PO INC 23900 ORCHARD LAKE RD SUITE 210 FARMINGTON MI 48336 813685900 PHYSICIAN CONTRACTING ORGANIZATION MI N/A C 0 COMMONWEALTH CARE ALLIANCE CALIFORNIA LLC 30 WINTER STREET BOSTON MA 02108 873361607 HOLDING COMPANY CA N/A C 0 CCA HEALTH PLANS OF CALIFORNIA (FKA VITALITY HEALTH PLAN OF CALIFORNIA INC) 18000 STUDEBAKER RD STE 150 CERRITOS CA 90703 814822508 ARRANGES FOR HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES CA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 1