PLAINFIELD (NEIGHBORHOOD) HEALTH CENTER

Additional Data
Software ZD: Software Version: BIN: 22-1927742 Name: Neighborhood Health Center Corporation

Form 99O, Part VH - Section Aaa

<c)
Position (check all that apply) CB) Average hours per week {DJ Reportable compensation from the organization (W2/1099MISC)
(E)
(F)

Highest compensated! emtfotee 1 Kej, employee

(A)

Name and Title

Tl

Reportable compensation from related organizations {W- 2/1099MISC)

Estimated amount of other compensation from the organization and related organizations

Individual Trtisteft or Ciwetor

Institutional Thioted

SIDDEEQ EL-AMIN , Immediate past chairpers CELESTE ROBERTS-SANG, CHAIRPESON FLORA DUNN , board MEMBER CARMEN SALAVARRIETA , board MEMBER ULYSSES RICE JR , Vice Chair Person OLIVER BARTLETT , board MEMBER emeritus ^"Nen SALAVARRIETA , board .BER DARA AQUILA GOVAN , board MEMBER ROSE 1 3EAN-BAPTISTE , board MEMBER CHARLENE MASON-REESE , board MEMBER KRISHNA H GARLIC , board MEMBER HORACE BALDWIN , board MEMBER Dr Daniel Williams , SecretARY Ron Matan , TrEASURER minam cohen , board MEMBER anges maddox , board MEMBER john maltory , board MEMBER terry young jr , board MEMBER Rudme Smith , President and CEo Susan Walsh , VP/ Chief medical Office Derrick Williams , Acting VP/ Chief Qperati A Eugene baucum , vp/ Chief developemntOf SEBIKA BASU MD , CHIef PEDIATRIC MARSHA M TRIPATHI MD , CHIEFINTERNAL MED NIMISH PATELMD, PEDIATRICIAN/HC sHAHEDA SULTANA ALI MD , INTERN IST/HC MARIA JUSTINE BIROTTE SA , FAMILY !*~>CnONER/HC ,GARETV MURRAY-SOBER, CHIEF (L/tflTAL SERVICES/HC

100 100 100

X X X X X X X X X
X

0
X

6 0 0 0 0 0 0 0 0 0 0

0 0
0

0 0 0 0 0
0 0 0 0
0 0 0 0 0 0 0 0

1 00
100 100 100 100 100 100
1 00 1 00 1 00 1 00 100 1 00

0 0 0 0 0 0 0 0

X X X X X

0
0 0 0 0 0 0 0 0 0

X X

0 0 0 0 0 0

X
X
X

1 00
1 00 5000 50 00 5000 5000 3500 3500 3500 35 00 3500 3500

X X X X
X

167.228 151,106 108,994 115,558 169,013 158,851 125,147 125,147 116,440 120,736

7,828 2,500 6,800 1,333 1,845 9,127

0 0 0 0

a
0 0 0 0 0

X X

X
X

NEIGHBORHOOD HEALTH SERVICES CORPORATION ORM 990 x DESCRIPTION SPECIAL EVENT EXPENSE NETTED AGAINST SPECIAL EVENT REVENUE TOTAL TO FORM 990, PART I V-A OTHER REVENUE NOT INCLUDED ON FORM 990

22-1927742 STATEMENT AMOUNT 61,786. 61,786. 6

FORM 990 DESCRIPTION

OTHER EXPENSES NOT INCLUDED ON FORM 990

STATEMENT AMOUNT

SPECIAL EVENT EXPENSE NETTED AGAINST SPECIAL EVENT REVENUE TOTAL TO FORM 990, PART IV-B

61,786. 61,786.

FORM 990

PART V-A - LIST OF CURRENT OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES

STATEMENT

" ME AND ADDRESS SIDDEEQ EL-AMIN 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE ROBERTS-SANG 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 AGNES MADDOX 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SALAVARRIETA 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

TITLE AND AVRG HRS/WK

COMPENSATIOKF

EMPLOYEE BEN PLAN EXPENSE CQNTRIB ACCOUNT

IMMEDIATE PAST CHAIRPERSON 0.25 0. CHAIRPERSON 0.25 BD MEMBER 0.25 BD MEMBER 0.25 BD MEMBER 0.25

0.

0.

0.

0.

0.

0.

14480514 759915 6352251

21 STATEMENT(S) 6, 7, I 2007.07090 NEIGHBORHOOD HEALTH SERVICE 63522511

NEIGHBORHOOD HEALTH SERVICES CORPORATION HORACE BALDWIN 1700-58 MYRTLE AVENUE NJ 07063 ULYSSES RICE, JR. 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 WILBERT O. 6 1 1 1*. 1700-58 MYRTLE AVENUE PLAINFIELD, J 07063 OLIVER BARTLETT 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 MIRIAM COHEN 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ROSE J. JEAN-BAJPTISTE 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CHARLENE MASON-REESE 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 KRISHNA H. GARLIC -00-58 MYRTLE AVENUE AINFIELD, NJ 07063 LAURELL JOHNSON 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 DR. DANIEL E. WILLIAMS 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARLOS J. ALMA 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JOHN MALLORY 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 RON M&TAN 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 BD MEMBER 0.25 VICE CHAIR PERSON 0.25 BD MEMBER 0.25 BD MEMBER EMERITUS 0.25 BD MEMBER 0.25 BD MEMBER 0.25 BD MEMBER 0.25 SECRETARY 0.25 BD MEMBER 0.25 BD MEMBER 0.25 TREASURER

22-1927742

0.

0.

0.

0.

Q.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.25
BD MEMBER 0.25 BD MEMBER 0.25

0.

0.

0.

0.

0.

0.

0.

14480514 759915 6352251

22 STATEMENT(S) 8 2007.07090 NEIGHBORHOOD HEALTH SERVICE 63522511

NEIGHBORHOOD HEALTH SERVICES CORPORATION DARA. AQUIL& GOVAN 1700-58 MYRTLE AVENUE , NJ 07063 RODINE SMITH 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 SUSAN WALSH 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 DERRICK WILLIAMS 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 EOCENE BAUCUM 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 BD MEMBER 0.25 PRESIDENT & CEO 40.00
0

22-1927742
0.

167,228.

6,694.

6,000.

VP/OHIEF MEDICAL OFFICER 4.0 00 1477 9,1.

890 ,9.

4,800

ACTING VP/CHIEF OPERATING OFFICER 40.00 107,474. 7,771. VP/CHIEF DEVELOPMENT OFFICER 40.00 115,163. 1,576.

3,600.

4,800.

TOTALS INCLUDED ON FORM 990, PART V-A

584,582.

25,031. 19,200

SCHEDULE A

OTHER INCOME 2006 AMOUNT 38,209. 38,209. 2005 AMOUNT 0. 0. 2004 AMOUNT

STATEMENT 2003 AMOUNT 0. 0.

""^SCRIPTION MISC. INCOME TOTAL TO SCHEDULE A, LINE 22

0. 0.

14480514 759915 6352251

23 STATEMENT(S) 8, 9 2Q07.07090 NEIGHBORHOOD HEALTH SERVICE 63522511

Additional Data
Software ID: Software Version:
EIN: 22-1927742

Name:

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES CORPORATION

Form 990, Part V-A - Current Officers, Directors, Trustees, and Key Employees:
(A ) Name and address (B) Title and average hours per week devoted to position (C) Compensation (If not paid, enter -0-

.)
0

(D) Contributions to employee benefit plans & deferred compensation plans

(E) Expense account and other allowances

IMMEDIATE PAST CHAIRPERSON

SIDDEEQ EL-AMIN 1700-58 MYRTLE A V E N U E PLAINFIELD, N3 07063 CELESTE ROBERTS-SANG 1700-53 MYRTLE A V E N U E PLAINFIELD, N3 07063

0 25
CHAIRPERSON 0 0

0 25
BD MEMBER 0 0

AGNES M A D D O X 1700-58 MYRTLE A V E N U E PLA1NFIELD,NJ 0 7 0 6 3 FLORA DUNN 1700-S8 MYRTLE A V E N U E PLAINFIELD.NJ 07063

0 25
BD MEMBER 0 0

0 25
BD MEMBER 0 0

CARMEN SALAVARRIETA 1700-38 MYRTLE A V E N U E PLAINFIELD, N3 07063

0 25
BD MEMBER

HORACE BALDWIN 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07053

ULYSSES RICE 3R 1700-58 MYRTLE A V E N U E PLAINFIELD, NJ 07063 WILBERTO GILL 1700-58 MYRTLE A V E N U E PLAINFIELD, N3 07063 OLIVER BARTLETT 1700-58 MYRTLE A V E N U E PLAINFIELD, NJ 07063 MIRIAM C O H E N 1700-58 MYRTLE A V E N U E , Tf NFIELD,NJ 0 7 0 6 3

0 25
VICE CHAIR PERSON 0 0 0

0 25
BD MEMBER 0 0 0

0 25
BD MEMBER EMERITUS
0 0 0

0 25
BD MEMBER

0 25

\.

"}

Form 990, Part V-A - Current Officers, Directors, Trustees, and Key Employees:
(A ) Name and address (B) Title and average hours per week devoted to posit Eon BO MEMBER 0 25
BD MEMBER 0 25

(C) Compensation (If not paid, enter -00

0

(D) Contributions to employee benefit plans & deferred compensation plans

0

(E) Expense account and ot her allowances

0

ROSE 3 JEAN-BAPTISTE 1700-58 MYRTLE A V E N U E PLAINFIELD ( NJ 07063 CHARLENE MASON-REESE 1700-58 MYRTLE A V E N U E PLAINFIELD.N3 07063 KRISHNA H GARLIC 1700-58 MYRTLE A V E N U E PLAINFIELD,NJ 07063 LAURELL J O H N S O N 1700-S8 MYRTLE A V E N U E PLA1NFIELD ( NJ 07063

SECRETARY 0 25 BD MEMBER 0 25 BD MEMBER 0 25 TREASURER 0 25 BD MEMBER 0 25 BD MEMBER 0 25 BD MEMBER 0 25 PRESIDENT &CEO 35 00

DR DANIEL E WILLIAMS 1700-S8 MYRTLE A V E N U E PLAINFIELD,N: 07063

CARLOS J ALMA 1700-58 MYRTLE A V E N U E PLAINFIELO.NJ 07063 JOHN MALLORY 1700-58 MYRTLE A V E N U E PLAINFIELD.NJ 07063 RON M A T A N 1700-58 MYRTLE A V E N U E PLAINFIELD,NJ 07063

DARA AQUILA GOVAN 1700-58 MYRTLE AVENUE PLAINFIELD.N: 07063

RUDINE SMITH 1700-58 MYRTLE A V E N U E PLAINFIELD,NJ 07063

167,337

5,842

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V-A - CURRENT OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER ALLOWANCES NONE

SIDDEEQ EL-AMIN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE ROBERTS-SANG C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 AGNES MADDOX C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANNIE HATCHEL C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SALAVARRIETA C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 COUNCILMAN CARLOS J. ALMA

CHAIRPERSON 1 HR/MTH NONE VICE CHAIRPESON 1 HR/MTH NONE SD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE NONE NONE NONE NONE NONE NONE NONE NONE NONE NONE NONE NONE

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V-A - CURRENT OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 HORACE BALDWIN C/0 PLAINFIELD 1700-58 MVRTLE AVENUE PLAINFIELD, NJ 07063 TOMAS PORTURAS C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ULYSSES RICE, JR. C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 PALETZA M. O'LOUGHLIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 WILBERT 0. GILL C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 OLIVER BARTLETT C/0 PLAINFIELD 1700-58 MYRTLE AVENUE

TITLE AND TIME DEVOTED TO POSITION BD MEMBER 1 HR/MTH

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT' AND OTHER ALLOWANCES

NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE SECRETARY 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE TREASURER 1 HR/MTH NONE BD MEMBER EMERITUS 1 HR/MTH

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

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THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V-A - CURRENT OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT* AND OTHER ALLOWANCES

NONE BD MEMBER 1 HR/MTH NONE BD MEMSER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE 3D MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE IMMEDIATE PAST CHAIR 1 HR/MXH

JOHN MALLORY C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 MIRIAM COHEN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ROSE J. JEAN-BAPTISTE C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CHARLENE MASON-REESE C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 KRISHNA H. GARLIC C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 LAURELL JOHNSON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

NONE

NONE

NONE

NONE

NONE

NONE

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NONE

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NONE

n / m o / o n m nft.ii.ni nc_.o i

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THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V-A - CURRENT OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER ALLOWANCES NONE

DR. DANIEL E. WILLIAMS C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 RUDINE SMITH C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

BD MEMBER 1 HR/MTH 160,800. CEO 35 HRS/WK 4,824. NONE

GRAND TOTALS

160,800.

4,824.

NONE

innn n/ /no /JAA-I

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THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS SIDDEEQ EL-AMIN C/O PLAINFXELD 1700-58 MYRTLE AVENUE PIAINFIELD, NJ 07063 CELESTE ROBERTS-SANG C/O PLAXNFXELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 AGNES MADDQX C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANNIE HATCHEL C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SALAVARRXETA C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 COUNCILMAN CARLOS J. ALMA

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER ALLOWANCES NONE

'

CHAIRPERSON 1 HR/MTH NONE VICE CHAIRPESON 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE NONE NONE NONE NONE NONE NONE NONE NONE NONE NONE NONE NONE

229765 707R 05/11/2006 14:36:26 V04-8

Y71-000

STATEMEr

The, 'PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JULIE A, JEROME C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CLOVIS A. HUSSEY C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ULYSSES RICE, JR. C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 PALETZA M. O'LOUGHLIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 WILBERT O. GILL C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 0 0 3 76 OLIVER BARTLSTT C/O PLAINFIELD 1700-58 MYRTLE AVENUE

TITLE AND TIME DEVOTED TO POSITION BD MEMBER 1 HR/MTH

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE TREASURER 1 HR/MTH NONE BD MEMBER 1 HR/MTH

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

Z29765 707R 05/11/2006 14:36:26 V04-8

' yi-000

STATEME?'

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

DAINE A. GREY C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 DARA AQUILA GOVAN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ROSS J. JSAN-BAPTISTE C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CHARLENE MASON-REESE C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 KRISHNA H. GARLIC C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAXNFIELD, NJ 07063 LAURELL JOHNSON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE BD MEMBER 1 HR/MTH NONE IMMEDIATE PAST CHAIR 1 HR.MTH

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

Z29765 707R 05/11/2006 14:36:26 V04-8

'$71-000

STATEME*, 9

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS JULANS MILLER C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 PATTI ROSE C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION 115,385

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER ALLOWANCES NONE

EXECUTIVE DIRECTOR 40 HR/WEEK 85,354 EXECUTIVE DIRECTOR 40 HR/WEEK NONE 1,732.

GRAND TOTALS

200,739

NONE

1,732.

Z29765 707R 05/11/2006 14:36:26 V04-8

yn-ooo

STATEMF

10

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS LAURELL JOHNSON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 SIDDEEQ EL-AMIN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE ROBERTS-SANG C/O PLAINFIELD 1700-S8 MYRTLE AVENUE PLAINFIELD, NJ 07063 RONALD E. WEST C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAtNFIELD, NJ 07063 ANNIE HATCHEL C/O PLAINFIELD 1.700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SALAVARRIETA

TITLE AND TIME DEVOTED TO POSITION SECRETARY 1HR/MONTH

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE AGCT AND OTHERALLOWANCES NONE

CHAIRPERSON 1HR/MONTH

NONE

NONE

NONE

VICE CHAIRPESON 1HR/MONTH

NONE

NONE

NONE

BD MEMBER 1KR/MONTH

NONE

NONE

NONE

BD MEMBER 1HR/MONTH

NONE

NONE

NONE

SD MEMBER 1HR/MONTH

NONE

NONE

NONE

BD MEMBER 1HR/MQNTH

NONE

NONE

NONE

Z29765 707R 12/14/2004 08:37:14 V03-8

26971-000

STATEMENT

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS G/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 DONNA VOSE C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANTONIA MAROTTA-BRINTON C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CLOVIS A. HUSSEY C/O PLAINFIELD 1700-56 MYRTLE AVENUE PLAINFIELD, NJ 07063 ULYSSES RICE, JR. C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 PALETZA M. O'LOUGHLIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 WILBERT O. GILL C/O PLAINFIELD 1700-58 MYRTLE AVENUE

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

BD MEMBER 1HR/MONTH

NONE

NONE

NONE

BD MEMBER 1KR/MONTH

NONE

NONE

NONE

BD MEMBER 1KR/MONTH

NONE

NONE

NONE

BD MEMBER 1HR/MONTK

NONE

NONE

NONE

BD MEMBER 1HR/MONTH

NONE

NONE

NONE

TREASURER 1HR/MONTH

NONE

NONE

NONE

Z29765 707R 12/14/2004 08:37:14 V03-8

26971-000

STATEMENT

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER* ALLOWANCES

OLIVER BARTLETT C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JULANE MILLER-AMBRISTER C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 DAINE A. GREY C/O PLAINFIELO 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 IVAN J. SALAVARRIETA C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 DARA AQUILA GOVAN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ROSE J. JEAN-BAPTISTE C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

BD MEMBER 1KR/MONTH

NONE

NONE

NONE

EXECUTIVE! DIRECTOR 35.KRS/WK

125,916.

2,482.

NONE

BD MEMBER 1HR/MONTH

NONE

NONE

NONE

BD MEMBER 1HR/MONTH

NONE

NONE

NONE

BD MEMBER 1HR/MONTH

NONE

NONE

NONE

BD MEMBER 1BR/MONTH

NONE

NONE

NONE

Z29765 707R 12/14/2004 08:37:14 V03-8

STATEMENT

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS CHARLENE MASON-REESE C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 KRISHNA H. GARLIC C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 HORACE BALDWIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION BD MEMBER 1HR/MONTH

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE'ACCT AND OTHER ALLOWANCES NONE

BD MEMBER 1HR/MONTH

NONE

NONE

NONE

BD MEMBER 1HR/MONTH

NONE

NONE

NONE

GRAND TOTALS

125,916.

2,482.

NONE

Z29765 707R 12/14/2004 08:37:14 V03-8

971-000

STATED

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER" ALLOWANCES N< NONE

LAURELL JOHNSON C/O PLAINFIELD 1700-58 MYRTLE AVENUE P. PLAINFIELD, NJ 07063 g |

rn
S3

PRESIDENT 1 HR/MON.

VICE CHAIR 1 HR/MON.

8S
OTS

SIDDEEQ EL-AMXN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE GIPSON C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 RONALD E. WEST C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANNIE HATCHEL C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SALAVARRIETA

NONE

NONE

N NONE

SECRETARY 1 HR/MON.

NONE

NONE

NONE N<

BD MEMBER .5 HR/MON.

NONE

NONE

N NONE

BD MEMBER 1 HR/MON.

NONE

NONE

N< NONE

BD MEMBER 1 HR/MON.

NONE

NONE

NONE

BD MEMBER 1 HR/MON.

NONE

NONE

N< NONE

Z29765 9388 04/28/2004 13:50:52 V02-8.1

26971-000

STATEMENT

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

TITLE AND TIME NAME AND ADDRESS C/O PLAINFIELD K 1700-58 MYRTLE AVENUES PLAINFIELD, NJ 07063 Hit DONNA VOSE <g> C/O PLAINFIELD S | 1700-58 MYRTLE AVENUE & PLAINFIELD, NJ 07063 i JOHN KOPICKI C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANTONIA MAROTTA-BRINTON C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ADRIAN MAPP C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 SAL BADALAMENTI C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ROBERT SCHLOSSER C/O PLAINFIELD 1700-58 MYRTLE AVENUE BD MEMBER 1 HR/MON. NONE

CONTRIBUTIONS TO EMPLOYEE

EXPENSE ACCT AND OTHER'

NONE

N NONE

BD MEMBER 1 HR/MON.

NONE

NONE

N NONE

BD MEMBER 1 HR/MON.

NONE

NONE

N NONE

BD MEMBER 1 HR/MON.

NONE

NONE

N NONE

TREASURER 1 HR/MON.

NONE

NONE

N NONE

BD MEMBER 1 HR/MON.

NONE

NONE

N NONE

Z29765 9388 04/28/2004 13:50:32 V02-8.1 , "6971-000

MPTE

THE PIAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS PLAINFIELD, NJ 07063 CHAUNTE B. ABDELLLAH C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ULYSSES RICE, JR. C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 PALETZA M. O'LOUGHLIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 GILBERT O. GILL C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 OLIVER BARTLETT C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

')

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

C tj S *

BD MEMBER 1 HR/MON.

NONE

NONE

NONE

BD MEMBER 1 HR/MON.

NONE

NONE

NONE

BD MEMBER 1 HR/MON.

NONE

NONE

NONE

BD MEMBER 1 HR/MON.

NONE

NONE

NONE

BD MEMBER 1 HR/MON.

NONE

NONE

NONE

JULANE MILLER-AMSRISTER C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NY 07063

EXECUTIVE 35 HRS/WK.

124,088.

2,482.

NONE

22976S 9388 04/28/2004 13:50:52 V02-8.1/ ^6971-000

M~

THE PIAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

C>

NAME AND ADDRESS DAINE A. GREY * C/O PIAINFIELD 1700-58 MYRTLE PIAINFIELD, NY 07063 IVAN J. SALAVARRIETA C/O PIAINFIELD 1700-58 MYRTLE AVENUE PIAINFIELD, NY 07063 DARA AQUIIA GOVAN C/O PIAINFIELD 1700-58 MYRTLE AVENUE PIAINFIELD, NY 07063 ROSE J. JEAN-BAPTISTE C/O PLAINFIELD 1700-58 MYRTLE AVENUE PIAINFIELD, NY 07063 CLOVIS A. HUSS C/O PIAINFIELD 1700-58 MYRTLE AVENUE PIAINFIELD, NY 07063

<&

TITLE AND TIME DEVOTED TO POSITION BD MEMBER 1 HR/MON.

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHERS ALLOWANCES N NONE

1 0

BD MEMBER 1 HR/MON.

NONE

NONE

N NONE

BD MEMBER 1 HR/MON.

NONE

NONE

N NONE

BD MEMBER 1 HR/MON.

NONE

NONE

V NONE

BD MEMBER I HR/MON.

NONE

NONE

K NONE

GRAND TOTALS

124,088

2,482.

NONE

Z29765 9388 04/28/2004 13:50:52 V02-8.1 , ^6971-000

STATEM^'T

C i

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AMD ADDRESS LAURELL JOHNSON C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 0 0 3 76 SIDDEEQ EL-AMIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CLOVIS A HUSSEV C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE GIPSON C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 RONALD fi. WEST C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANNIE HATCHEL

TITLE AND TIME DEVOTED TO POSITION PRESIDENT . 5/MQNTH

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER . ALLOWANCES NONE

1
VICE CHAIR . 5/MONTH NONE NONE NONE

BD MEMBER . 5/MONTH

NONE

NONE

NONE

SECRETARY . 5/MONTH

NONE

NONE

NONE

BD MEMBER .S/MONTH

NONE

NONE

NONE

BD MEMBER . 5/MONTH

NONE

NONE

NONE

BD MEMBER . 5/MONTH

NONE

NONE

NONE

Z2976S 9388 01/30/2003 15:48:47 V01-7

26971-000

STATEMENT

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AMD ADDRESS C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SALAVARRIETA C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 DONNA VOSE C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JOHN KOPICKI C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANTONIA MAROTTA-BRINTON C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ADRIAN MAPP C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 SAL BADALAMENTI C/O PLAINFIELD 1700-53 MYRTLE AVENUE

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

BD MEMBER . 5 /MONTH

NONE

NONE

NONE

BD MEMBER . 5/MONTH

NONE

NONE

NONE

BD MEMBER . 5/MONTH

NONE

NONE

NONE

BD MEMBER .S/MONTH

NONE

NONE

NONE

BD MEMBER . 5/MONTH

NONE

NONE

NONE

TREASURER . 5/MONTH

NONE

NONE

NONE

Z29765 9388 01/30/2003 15:48:47 V01-7

26971-000

STATEMENT

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 390, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS PLAINFIELD, NJ 07063 ROBERT SCHLOSSER C/0 PLAINFIEtD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CHAUNTE B. ABDELLLAH C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ULYSSES RICE, JR. C/O PLAINFIELD 1700-56 MYRTLE AVENUE PLAINFIELD, NJ 07063 PALETZA M. O'LQUGHLIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 WILBERT 0. GILL C/0 PLAINFIELD 1700-50 MYRTLE AVENUE PLAINFIELD, NJ 07063 OLIVER BARTLETT C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHEK ALLOWANCES

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD DIRECTOR .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE;

NONE

BD MEMBER .S/MOMTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

S29765 9386 01/30/2003 15:48:47 V01-7

/*971-000

STATEMEK"

10

THE PLAINFIELD NEIGHBORHOOD HEALTH FORM 990, PART V - LIST OP OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS JULANE MILLER-AMBRISTER C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NY 0 0 3 76 ROSE J. JEAN-BAPTISTE C/O PLAINFIELD 1700-56 MYRTLE AVENUE PLAINFIELD, NY 07063 DAINE A. GREY C/O PLAINFIELD 1700-56 MYRTLE AVENUE PLAINFIELD, NY 07063 IVAN J. SALAVARRXETA C/O PLAINFIELD 1700-S8 MYRTLE AVENUE PLAINFIELD, NY 07063 DARA AQUXXA GQVAN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NY 07063

TITLE AND TIME DEVOTED TO POSITION EXECUTIVE DIRECTOR 35/WEEK

COMPENSATION 108,462

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS 2,169.

EXPENSE ACCT AND OTHER ALLOWANCES NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

3D MEMBER .5/MONTH

NONE

NONE

NONE

GRAND TOTALS

108,462.

2,169

NONE

Z29765 9388 01/30/2003 13:48:47 VO1-7

26971-000

STATEMENT

11

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS LAURELL JOHNSON C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 SIDDEEQ EL-AMIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CLOVIS A. KUSSEY C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE GIPSON C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 RONALD E. WEST C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANNIE HATCHEL

TITLE AND TIME DEVOTED TO POSITION CHAIRPERSON .5/MONTH

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER ALLOWANCES NONE

VICE CHAIR.5/MONTH

NONE

NONE

NONE

TREASURER .5/MONTH

NONE

NONE

NONE

SECRETARY .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE:

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

OSPSLP ' "TO

Z29765 9368 04/11/2002 09:18:24 VO.07.01

'71-000

STATEMEB

10

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS C/0 PLAINFIEL.D 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SAIAVARRIETA C/0 PLAINFIELD 1700-5B MYRTLE AVENUE PLAINFIELD, NJ 07063 DONNA VOSE C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JOHN KOPICKI C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANTONIA MAROTTA-ERINTON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ADRIAN MAPP C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 SAL BADALAMENTI C/O PLAINFIELD 1700-58 MYRTLE AVENUE

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACC? AND OTHER ALLOWANCES

ED MEMBER . 5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BRD MEMBER.5/MONTH

NONE

NONE

NONE

OSPSlNfiOQB

Z29765 9388 04/11/2002 09:18:24 V O . 0 7 , 0 1 /

V71-000

STATEME;

ii

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS PLAINFIELD, NJ 07063 ROBERT SCKLQSSER C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JQFFREY HILL C/0 PLAINFIELD 1700-56 MYRTLE AVENUE PLAINFIELD, NJ 07063 ULVSSES RICE, JR. C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 PALETZA M. O'LOUGHLIN C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARLOS CUSTODIO C/O PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 OLIVER BARTLETT C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER * ALLOWANCES

TREASURER .5/MONTK

NONE

NONE

NONE

BD DIRECTOR .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTK

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

OSPSLN a ooo

Z29765 9388 04/11/2002 09:18:24 VQ.07.01 ?"<m-QQO

STATEMENT

12

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS JULANE MILLER-AMBRISTER C/O PLAINFIELD 1700-58 MYRTLE AVENUE PIAINFIELD, NY 07063

TITLE AND TIME DEVOTED TO POSITION EXECUTIVE DIRECTOR 35/WEEK

COMPENSATION 99,022

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS 1,980.

EXPENSE ACCT AND OTHER ALLOWANCES NONE

GRAND TOTALS

99,022

1,960.

NONE

OSPSLWSWO

Z29765 9388 04/18/2002 13:57:05 VO.07.01 /

>71-000

STATEMEW'

13

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS LAURELL JOHNSON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIEI.D, NJ 07063 SIDDEEQ EL-AMIN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CLOVIS A. HUSSEY C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE GIPSON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 RONALD E. WEST C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN C/0 PLAINFIELD 1700-56 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANNIE HATCHEL

TITLE AND TIME DEVOTED TO POSITION CHAIRMAN .5 /MONTH

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER ALLOWANCES NONE

VICE CHAIR .5 /MONTH

NONE

NONE

NONE

TREASURER ,5 /MONTH

NONE

NONE

NONE

SECRETARY .5 /MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

KONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

SSPSLNJOM

229765 9388 01/17/2001 16:43:26 V9.08.01 26971-000

STATEMENT

11

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990 , FART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SALAVARRIETA C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 DONNA VOSE C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JOHN KOPICKI C/0 PLAIKFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANTONIA MARQTTA-BRINTON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 LINDA GRAVES C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ADRIAN MAPP C/0 PLAINFIELD 1700-58 MYRTLE AVENUE

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

BD MEMBER . S/MONTH

NONE

NONE

HONE

BD MEMBER .5 /MONTH

NONE

NONE

NONE

BD MEMBER .S/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NOKE

NONE

NONE

SSPBLNZOW

Z29765 9388 01/17/2001 16:43:28 VS.08.01 26971-000

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORK 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS PLAtNFIELD, NJ 07063 SAL BADALAMENTI C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 OLIVER BARLETT C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ROBERT SCHLOSSER C/O PLAINFIELD 1700-SB MYRTLE AVENUE PLAINFIELD, NJ 07063 JOFFREY RILL C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ULYSSES RICE, JR. C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JAY CASTILLO C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

TITLE AND TIKE DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER' ALLOWANCES

BRD MEMBER .5 /MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTK

NONE

NONE

NONE

TREASURER . 5 /MO NTH

NONE

NONE

NONE

BD DIRECTO .5 /MONTH

NONE

NONE

NONE

BD MEMBER .5 /MONTH

NONE

NONE

NONE

BD MEMBER .5 /MONTH

NONE

NONE

NONE

OSPSLNSOOO

Z29765 9388 01/17/2001 16:43:28 V9.08.01 26971-000

STATEMENT

13

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LXST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS HXLENA WILSON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 {CATHERINE MXCKEL C/0 PLAIHFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, HJ 07063 JULANE MILLER-AMBRISTER C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, KY 07063

TITLE AND TIME DEVOTED TO POSITION BD MEMBER .5 /MONTH

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACGT AND OTHER ALLOWANCES NONE

BD MEMBER .5 /MONTH

NONE

NONE

NONE

EXECUTIVE 35/WEEK

97,783.

NONE

NONE

GRAND TOTALS

97,783

NONE
eetsesetccseee

NONE
ss e avsssasz is ts e

6SPSINZOM

Z29765 9386 01/17/2001 16:43:28 V9.0B .01 ' 26971-000

STATEMEN

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 980. PART V - LIST OF OFFICERS. DIRECTORS, AMD TRUSTEES

22-1927742

NAME AND ADDRESS

TITLE AND TIME DEVOTED TO POSITION CHAIRMAN .5/MONTH

COMPENSATION NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AND OTHER ^ ALLOWANCES NONE'

LAURELL JOHNSON C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD. NJ 07063 SIDDEEQ EL-AIN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD. NJ 07063 CLOVIS A. HUSSEY C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE GIPSON C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD. NJ 07063 RONALD E. WEST C/0 PLAINFIELD 1700r58 MYRTLE AVENUE PLAINFIELD. NJ 07033 FLORA DUNN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD. NJ 07063 ANNIE HATCHEL

VICE CHAIRPERSON ,5/MONTH

NONE

NONE

NONE

TREASURER ,S/MONTH

NONE

NONE

NONE

SECRETARY .6/MONTH

NONE

NONE

NONE

BD MEMBER .6/MONTH

NONE

NONE

NONE

BD MEMBER .6/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

6SPSLNUna

Z2S765 9388 11/24/1999 08:53:32 VS.09.01 26971-000

STATEMENT

11

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

22-1327742

NAME AND ADDRESS C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 CARMEN SALAVARRIETA C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 DONNA VOSE C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 JOHN KOPiCKI C/0 PLAINFIELD 1700-88 MYRTLE AVENUE PLAfNPIELD, NJ 07063 ANTON IA MAROTTA C/0 PLAINF16LD 1700-68 MYRTLE AVENUE PLAINFIELD. NJ 07063 LINDA GRAVES C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 ADRIAN MAPP C/0 PLAINFIELD 1700-B8 MYRTLE AVENUE

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND QTHER ALLOWANCES

BD MEMBER .6/MONTH

NONE

NOME

NONE

BD MEMBER ,6/MONTH

NONE

NONE

NONE

BD MEMBER .6/MONTH

NONE

NONE

NONE

BD MEMBER ,6/MONTH

NONE

NONE

NONE

BD MEMBER ,5/MONTH

NONE

NONE

NONE

BD MEMBER .6/MONTH

NONE

NONE

NONE

SSPSLN 1 0 0 .0

229765 9388 11/24/1999 08:53:32 VS.09.01 26971-000

STATEMENT

12

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990. PART V - LIST OF OFFICERS. DIRECTORS. AMD TRUSTEES

22-1927742

NAME AND ADDRESS PLAINFIELD, NJ 07063 DELORES JOHNSON. MD C/0 PLAINFiELD 1700-68 MYRTLE AVENUE PLAINFIELD. NJ 07063 SAL BADALAMENTI C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD. KJ 07063 JOHN KOLAYA C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD. NJ 07063 KENNETH TURNBALL C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAtNFlELD. NJ 07063 ROBERT SCHLOSSER C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JOFFREY HILL C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND QTKER * ALLOWANCES

BD MEMBER .6/MONTH

NONE

NONE

NONE

BRD MEMBER .6/MONTH

NONE

NONE

NONE

BD MEMBER 5/MONTH

NONE

NONE

NONE

BD MEMBER .5/MONTH

NONE

NONE

NONE

TREASURER .5/MONTH

NONE

NONE

NONE

BD DIRECTOR .5/MONTH

NONE

NONE

NONE

S F I 100 S S H .0

Z29765 9388 11/24/1998 08:63:32 V8.09.01 26971-000

STATEMENT

13

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990. PART V - LIST OF OFFICERS, DIRECTORS, AMD TRUSTEES

22-1927742

NAME AND ADDRESS

TITLE AND TIME DEVOTED TO POSITION BD MEMBER .B/MONTH

COMPENSATION NONE

COMTRIBUTIONS TO EMPLOYEE BENEFIT PLANS NONE

EXPENSE ACCT AMD OTHER ALLOWANCES NONE

ROBIN MlSHOE C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIBLD, NJ 07063 JAY CASTILLO C/0 PLAINFIELD 170Q-B8 MYRTLE AVENUE PLAINF1ELD, NJ 07063 Ml LENA WILSON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 OLIVER BARTLETT C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JULAHE MILLER C/0 PLAINFIELD 1700T-S8 MYRTLE AVENUE PLAINFIELD. NY 07063

BD MEMBER .5/MONTH

NONE

NONE

NONE

BD MEMBER .B/MQHTH

NONE

NONE

NONE

BD MEMBER EMERITUS .5/MONTH

NONE

NONE

NONE

EXECUTIVE DIRECTOR 35/WEEK

94,182

NONE

NONE

GRAND TOTALS

94,182.

NONE

NONE

espsut 1,000

229765 8388 11/24/1989 08:S3;32 VS.09.01 26971-000

STATEMENT

14

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 980. PART V - LIST OF OFFICERS. DIRECTORS, AND TRUSTEES

22-1927742

NAME AND ADDRESS

TITLE AND TIME DEVOTED TO POSITION COMPENSATION CHAIRMAN .6 NONE

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

RONALD WEST C/Q PLAINFIELD 1700-68.MYRTLE AVENUE PLAINFIELD, NJ 07063 DONNA VOSE C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINF1ELD, NJ 07003 LAURELL JOHNSON C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 CELESTE GfPSON C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 SIDDEEQ EL-AMIN C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 OLIVER BARTLETT C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 JOHN KOPtCKI

NONE

NONE

BRD MEMBER .6

NONE

NONE

NONE

VICE CHMN .6

NONE

NONE

NONE

SECRETARY .5

NONE

NONE

NONE

BD MEMBER .5

NONE

NbNE

NONE

BD MEMBER .5

NONE

NONE

NONE

BD MEMBER .6

NONE

NONE

NONE

SPSLfJX 2.000

Z2S766

9388

V707

71-PN

STATEMF

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES
saiBgccaBiss8saaTi=

22-1927742

NAME AND ADDRESS C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 JULIA COHEN C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 FLORA DUNN C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PL A INF. I ELD, NJ 07063 M. JOHN RICHARD C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 ANTON IA MAROTTA C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIEJ.D, NJ 07063 CLOVIS HUSSEY C/0 PLAtNFJELD 1700-B8.MYRTLE AVENUE PLAINFIELD, NJ 07063 ANNIE HATCHEL C/0 PLAINFIELD 1700-58 .MYRTLE AVENUE

TITLE AND TIME DEVOTED TO POSITION

COMPENSATION

CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

BD MEMBER .5

NONE

NONfc

NONE

BD MEMBER .5

NONE

NOfoE

NONE

BD MEMBER .5

NONE

NONE

NONE

BD MEMBER .5

NONE

NONE

NONE

BD MEMBER .5

NONE

NONE

NONE

BD MEMBER .6

NONE

NONE

NONE

SPSLKK 2.000

Z29765

9388

V707

*fcl*

10

THE PLAINFIEUD NEIGHBORHOOD HEALTH SERVICES FORM 990. PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES
iLsgiBSSSjgs-aaaagaaggBgs' r i i ' I fjuimgrr* r"*Btati~is8iS8888itsg5B5BKasBSnmBBB86flufc8!Siatssss

22-1927742

CONTRIBUTIONS

NAME AND ADDRESS PLAINFIELD, NJ 07063

TITLE AND TIME DEVOTED TO POSITION

JO EMPLOYEE
COMPENSATION BENEFIT PLANS

EXPENSE ACCT AND OTHER ALLOWANCES

BD MEMBER
.6

CARMEN SALAVARRI ETTA C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 JAY CASTILLO C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 MILT CAMPBELL C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 UNO A GRAVES C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 ' EDWARD SITAR C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 JULANE MILLER C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063

NONE

NONE

NONE

BRD MEMBER .6

NONE

NONE

NONE

BD MEMBER .5

NONE

NONE

NONE

BD MEMBER .5

NONE

NONE

NONE

TREASURER .6

NONE

NONE

NONE

EXEC DER 40

99,843,

NONE

NONE

SPSLHV9,000

Z29765

9388

V707

71-PN

STATEMtf

11

THE PLAINFIELD NEIGHBORHOOD HEALTH SERVICES FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES
Btl..1^.F.i.>..,.1p-.p-f ^ |__ i

22-1927742

NAME AND ADDRESS

TITLE AND CONTRIBUTIONS 'TIME DEVOTED TO EMPLOYEE . TO POSITION COMPENSATION BENEFIT PLANS
3D MEMBER .5 NONE NONE

EXPENSE ACCT AND OTHER . ALLOWANCES

DELQKES JOHNSON. MD C/0 PUAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 MARILYN JOSEPH C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD, NJ 07063 ADRIAN MAPP C/0 PLAINFIELD 1700-68 MYRTLE AVENUE PLAINFIELD, NJ 07063 ROBIN M1SHOE C/0 PLAINFIELD 1700-58 MYRTLE AVENUE PLAINFIELD. NJ 07063

NONE

BD MEMBER ,5

NONE

NONE

NONE

BD MEMBER .5

NONE

NONE

NONE

BD MEMBER .5

NONE

NONE

NONE

GRAND TOTALS

99,843.

NONE

NONE

1.000

Z29766

9388

V707

71-PN

STATEMtT

12