North East Medical Services

What do they do? North East Medical Services provides primary and specialty care, pharmacy, dental and behavioral-health services, with language access and coverage assistance. Its liver-health program monitors hepatitis and helps patients obtain appropriate care and medications. Donations go to a separate Foundation that supports clinical facilities and programs. More

Why this approach interests us

• Navigation could help patients complete clinically appropriate care despite language, scheduling, coverage and follow-up barriers.
• Existing liver-health expertise and clinical infrastructure make additional monitoring feasible, while also providing a strong no-gift baseline.
• Original filings and a current donation route allow us to examine the recipient, operating resources and possible philanthropic uses.

Our main reservations

• No reviewed source supplies an additional restricted HBV funding offer, Foundation allocation or local capacity commitment.
• The external health model contains unresolved inconsistencies; local monitoring response and finite timing remain conditional judgments, not measured effects.
• Patient fees, travel, lost take-home pay and avoided illness costs can change welfare, but their net marginal impact and the ordinary-gift total remain unknown.

What do you get for your dollar? Our conditional HBV program estimate is about $120K per DALY, using one modeled equivalent year. It implies roughly $1,086 per discounted additional monitoring person-year under a hypothetical twenty-year care commitment—not per unique patient or treatment course. We assess signed household-resource effects separately: illustrative net gains of $20 per monitoring year give $118K per DALY, while a $250 loss gives $166K. These are conditional scenarios, not measured income effects or an unrestricted Foundation-gift return. More

What they do

North East Medical Services provides primary and specialty care, pharmacy, dental and behavioral-health services, with language access and coverage assistance. Its liver-health program monitors hepatitis and helps patients obtain appropriate care and medications. Donations go to a separate Foundation that supports clinical facilities and programs.

The official support route still instructs checks payable to North East Medical Services Foundation. Its linked campaign identifies EIN 94-3171797, whereas the operating returns identify EIN 94-1722562. Foundation property leasing and grants can enable operating care but are not an observed allocation to a navigator. Foundation rent from the operator and grants back to it require elimination before financial consolidation. Neither Foundation expense divided by all operator patients nor summed entity expense is a legitimate marginal cost.

Fresh official-page review confirms existing liver-health services and patient payment/coverage arrangements. NEMS charges uncovered fees and copayments and requires annual sliding-fee enrollment. Free HBV/HCV screening does not establish that subsequent treatment, travel and household burdens are free. Existing service availability and reimbursement are part of the counterfactual.

The campaign describes a broad portfolio and historical uses, including vaccination and mold mitigation. Those observations identify mechanisms but provide no donor-created patient count. Its displayed fundraising goal and total are not a reconciled funding gap. NEMS also operates in Nevada; Bay share is therefore unknown for the ordinary gift. The conditional model's Bay share of one means an explicitly assumed Bay-restricted cohort, not an empirical whole-organization allocation. SF share stays unknown; a separate SF-cohort scenario requires an explicit local cohort restriction.

All six original 2022–2024 Form 990 HTML documents were freshly retrieved with native read-only fetch (HTTP 200), and numerical fields were inspected directly. The newer 2025 audit remains indexed but its underlying download returned 403; it was not inspected. No 2025 original return was located. These are the latest three comparable original returns inspected, not a claim that 2024 finances are current liquidity.

Monitoring and information sharing

Useful monitoring would link deduplicated eligible local people to invitations, completed annual assessments, appropriate treatment, continued care and outcomes, comparing these with care available without new philanthropy. Existing services, campaign fundraising and all-patient counts do not identify additional patients caused by a gift. A clinically inactive hepatitis-B patient is not simply an administratively inactive record. Patient-level follow-up, missingness, alternative providers, eligibility and attrition would be needed to replace the conditional panel assumptions.

Current official pages and original returns support ongoing operations. They do not demonstrate spare staff capacity, how the Foundation allocates a new gift, or a currently priced recurring navigation commitment. Household monitoring should also measure fees, travel, missed work, caregiving costs and avoided illness spending; favorable activity counts alone cannot establish positive net income.

Clinical evidence and transfer

The retained central input is a 2,500-person closed panel, an assumed 10-percentage-point increase in annual appropriate monitoring, and 50% gift additionality. This yields 125 additional monitoring person-years per funded year, or 2,500 person-years across twenty funded years, under the diagnostic's constant-panel convention. The count is a model assumption, not measured NEMS output or a verified capacity offer; repeated people across years are not unique additional patients or completed antiviral courses. Actual cohort mortality, moves and alternative-care retention could reduce this native count, and an attrition-adjusted local care cascade remains unknown. The causal-transfer factor applies to the downstream health bridge, not again to the native monitoring count.

Annual navigator, allocated supervision and analyst anchors remain $65,000, $22,900 and $3,593.44 in year one/$2,524.88 later, multiplied by 1.5. The full recurring cost is charged against the closed initial cohort, without free replacement entrants or staffing savings after attrition. Present-value cost is $2,019,496.97 for the modeled twenty-year panel. Native cost is approximately $1,086 per discounted additional monitoring person-year; first-year undiscounted spending is $137,090.16 and subsequent annual spending is $135,637.32. This is a hypothetical donor navigation budget, excluding additional tests, medications and other externally financed resources.

The primary economic-model XML was retrieved fresh and confirms the 1,871,632 minus 1854238.00 lifetime discounted QALY totals, 65.35% navigation monitoring assumption, and salary/supervision anchors. The source begins with clinically inactive HBV, not every inactive administrative record. The earlier local conference-abstract critique is retained as prior evidence and was not freshly reread in this bounded pass.

Finite health remains explicitly conditional: 0.17 lifetime QALYs per initial person, scaled by 0.10/0.2835, 0.5 causal transfer, 0.5 funding additionality and a twenty-of-thirty-five-year weighted timing fraction. Those local response, transfer, attribution and timing values are reasoned priors inherited for comparability, not measured effects. They express the possibility of incremental monitoring above existing care, reduced transportability and replacement financing; their weaknesses are exposed by null, harm and duration cases. No evidence warrants retuning them merely to change the price.

The conditional panel produces 16.81 QALYs and preserves $120K per DALY. A five-year funding window gives $390K and a one-year window $1.2M. The timing method allocates an already discounted lifetime total; it is not a disease-state reconstruction or a validated withdrawal model. Benefits beyond the funded window are uncredited under the heuristic; the actual clinical carryover remains unresolved. No additional language-access, trust, other-care or survivor-health bonus is added on top of this pathway.

An independent fresh XML review confirmed the navigation QALY totals, but also identified inconsistent published ICERs ($8,416 in the abstract versus $9,025 in results). A 37% baseline monitoring rate rising to 55.3% cannot represent the stated 29% relative increase: 37% × 1.29 is 47.73%. These issues weaken the source; they do not identify a specific corrected navigation coefficient. The retained anchor is therefore an explicitly unvalidated conditional prior, not a verified clinical prediction.

Qualitative assessment

Language access, trust and continuity can make care more usable, and a large existing clinical platform may support meaningful additional services. The liver-care mechanism is concrete enough to investigate: improve appropriate monitoring, detect treatment eligibility, then complete effective care. However, a functioning provider is not automatically a marginal donation opportunity; reimbursement, current staffing and existing care matter in the counterfactual.

Our assessment supports further investigation of a specified care tranche, rather than a general giving recommendation based on the conditional number. The broader clinical and Foundation portfolio may have important benefits outside this model. We neither set those benefits to zero nor add an invented residual. The most informative evidence would connect an actual funding commitment to additional local completed care and net household resources.

What do you get for your dollar?

Our conditional HBV program estimate is about $120K per DALY, using one modeled equivalent year. It implies roughly $1,086 per discounted additional monitoring person-year under a hypothetical twenty-year care commitment—not per unique patient or treatment course. We assess signed household-resource effects separately: illustrative net gains of $20 per monitoring year give $118K per DALY, while a $250 loss gives $166K. These are conditional scenarios, not measured income effects or an unrestricted Foundation-gift return.

The native service is an additional appropriate monitoring person-year. Earlier identification of treatment eligibility may reduce later liver disease, but an extra appointment is not itself a cured infection or an averted death. The twenty-year comparison buys recurring hypothetical staff capacity; $100,000 is a scaling unit rather than a requested gift size. The full modeled cost and quantified benefit refer to the same closed cohort and funding period.

There is no evidence here that NEMS navigation adds a fixed amount of actual household net income or consumption. The central cash ledger is therefore unknown, separately from the conditional numerical health component. Net resources can rise through lower out-of-pocket illness costs or saved take-home pay, or fall through new fees, travel, missed work and caregiver expenditure. Gross survivor earnings, GDP, provider payroll, reimbursed charges and the value of insurance are not household income benefits.

The executable packet allows a row-specific net resource change per additional monitoring person-year. Each mechanism must first be net of its associated costs. A positive row's independent share then removes overlap with the health pathway; negative rows remain fully counted regardless of that positive overlap factor. Only after that row-level crediting are dollars summed and passed once into the income-equivalence function. Thus a $100 net avoided-illness-cost hypothesis at 50% independent share, minus $10 travel and $20 lost take-home pay/caregiver burden, credits $20, not $35 or a separately transformed collection of nonlinear benefits. Broader consumption consequences are not appended without a distinct, nonoverlapping mechanism.

The existing shared comparison uses $50,000 annual baseline household resources and a $100,000 value per healthy-year equivalent. That baseline is a comparison prior, not the mean resources of NEMS patients. Cash flows occur annually only within the funded window, discounted annually; this prevents one care event buying lifelong earnings. The annual additional monitoring people are repeated recipients, so recurring cash consequences are flows rather than newly counted unique people. The diagnostic assumes the same recipient group faces the specified average net resource rows; actual heterogeneous recipient burdens require separate groups, not an average log treated as measured welfare. Cash welfare equivalents are not clinical QALYs.

Diagnostics include unknown cash, explicit zero cash, positive net cash, adverse cash (-$250), severe adverse cash (-$2,000), cash-only, complete null, replacement-associated harm, and negative effects with positive overlap set to zero. Dollar scenarios are decision hypotheses, not confidence intervals or observed household impacts. Negative health is subtracted after positive health overlap adjustment; negative cash is never discounted by a positive overlap factor. Financial distress severe enough to exhaust baseline resources is rejected rather than producing undefined logarithms.

Income uses the Coefficient Giving-inspired comparison implemented in our shared engine: logarithmic resource changes relative to a $50,000 annual baseline, with $100,000 per healthy-year equivalent. Those are explicit comparison assumptions, not measured patient resources or clinical QALYs. Health and signed resource components stay visible separately, and the central unknown-income case is not silently replaced with the zero-cash scenario. No probabilities have been elicited for these cases.

Funding and previous grants

The public donation route names North East Medical Services Foundation. Its current campaign describes multiple uses and reports past vaccination and mold-mitigation support; those are possible mechanisms, not proof that an additional donation funds HBV navigation. The Foundation's grants and property support can enable clinical operations, but the recipient and operator must remain separate unless intercompany flows are eliminated.

A useful funding offer would state the recurring amount, eligible Bay cohort, staffing and complementary resources, expected additional completed monitoring, follow-up period and alternative financing. Treatment, tests and medication financed by public programs or insurers are excluded from the hypothetical navigation donor budget; a full social-resource estimate would need them without double counting. No ordinary-gift allocation, comprehensive portfolio return or verified marginal capacity is currently established.

Spending breakdown and financial appendix

Calendar years, dollars. Program/management/fundraising reconcile to functional expense. Broader known expense adds separately netted rental and gaming costs, not securities cost basis; it is accounting expense rather than a complete cash/resource budget.

Operator program mix, within-program denominator (never added to functional shares): managed care / medical / pharmacy / other are $41,692,681 / $52,149,433 / $21,113,006 / $21,109,857 in 2022; $96,188,631 / $67,295,764 / $27,668,386 / $39,603,373 in 2023; and $132,122,348 / $75,830,507 / $38,610,487 / $36,593,988 in 2024. Broader whole-expense program shares are 73.95%, 75.46% and 79.86%, with management shares 25.91%, 24.46% and 20.07%. Remaining shares are identified rental/gaming addbacks. Foundation broader program shares are 46.37%, 59.25% and 58.17%; management shares are 46.83%, 35.57% and 41.83%, with rental addbacks making up the remainder. These describe resources, not donor additionality or health efficiency.

Reported revenue less functional expense is $58,935,854 / $21,479,463 / $30,810,546 for the operator and $645,961 / $633,253 / $693,581 for the Foundation. Because rental/gaming revenue is already netted, subtracting the expense addbacks from those reported surpluses again would misstate surplus unless gross revenue were correspondingly reconstructed. An accounting surplus does not prove spendable marginal capacity, and is not beneficiary income. The 2024 Foundation program revenue includes $936,305 rent from NEMS; its domestic grants expense is $153,988. Neither is an HBV funding quote.

Original source filings: operator 2022, 2023, 2024; Foundation 2022, 2023, 2024. Fresh original retrieval date: October 4, 2026 UTC. 2025 audit index: underlying download inaccessible, not reviewed.

Revision record and model appendix

The earlier conditional clinical estimate was $120K per DALY; it remains $120K after reviewing current original finances and clinical-source limitations. The unchanged coefficient reflects no newly established empirical correction, not an assumption that income is zero. The current model adds native care units, finite signed income scenarios, explicit overlap, harms, delay and geography guards. A combined central estimate and ordinary Foundation-gift total remain unknown.

All original source artifacts, model scenarios, diagnostics and allocation variants are frozen unchanged for comparison. The current scenarios are unweighted hypotheses, not confidence intervals or verified funding offers. Actual author, modeling, independent-source-review and report-writing intervals are recorded separately; QA, integration and deployment are excluded.