2017-10-16T21:00:29-05:00 2016-12-31 221478099 COHNREZNICK LLP 1301 AVENUE OF THE AMERICAS NEW YORK NY 10019 990 2016-01-01 133083068 COMMUNITY HEALTHCARE NETWORK COMM 2125452404 60 MADISON AVENUE NEW YORK NY 10010 ALAN WENGROFSKY CFO AND VP OF FINANCE 2125452404 2017-10-16 1 THOMAS LANNING P00851654 2122970400 2017-10-16 209.3.217.20 2017-10-16 16:36:51 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 90CC17281F34CD083B051E620E31C1B2A26173FC 2016 2021-01-29 14:40:06Z robert hayes 60 MADISON AVENUE NEW YORK NY 10010 88849407 0 X www.chnnyc.org X 1978 NY COMMUNITY HEALTHCARE NETWORK, INC ("CHN") OPERATES FREESTANDING DIAGNOSTIC AND TREATMENT CENTERS, DESIGNATED AS A FEDERALLY QUALIFIED HEALTH CENTER, LICENSED UNDER ARTICLE 28 AND ARTICLE 31 OF THE NEW YORK STATE HEALTH LAW, LOCATED THOUGHOUT NEW YORK CITY. CHN PROVIDES A BROAD RANGE OF HEALTH SERVICES INCLUDING BUT NOT LIMITED TO PRIMARY AND PREVENTATIVE CARE, AND MENTAL HEALTH SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION. 17 17 866 17 0 0 16600052 20404682 48698049 54595029 345380 592651 926293 1682579 66569774 77274941 0 0 0 0 41861838 51158895 0 0 0 20541627 25022705 62403465 76181600 4166309 1093341 85150288 89831306 13964453 17021405 71185835 72809901 CHN PROVIDES A BROAD RANGE OF HEALTH SERVICES INCLUDING BUT NOT LIMITED TO PRIMARY and PREVENTATIVE CARE, AND MENTAL HEALTH SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION. 0 0 65115769 55728938 CHN PROVIDES A BROAD RANGE OF HEALTH SERVICES INCLUDING BUT NOT LIMITED TO PRIMARY AND PREVENTATIVE CARE, AND MENTAL HEALTH SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION. CHN PROVIDED HEALTH CARE SERVICES FOR 232,790 HEALTH CARE VISITS FOR THE CALENDAR YEAR ENDED DECEMBER 31, 2016. 65115769 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 91 0 1 866 1 0 0 0 0 0 1 1 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X ALAN Wengrofsky 2125452481 60 MADISON AVE NEW YORK NY 10010 Brenda Merritt Board Member 1.00 X 0 0 0 Caroline Dorsen Board Member 1.00 X 0 0 0 Denise Gordon Board Member 1.00 X 0 0 0 Donna Anderson Board Member 1.00 X 0 0 0 Eleanora Sottilaro Secretary 1.00 X X 0 0 0 Elizabeth Kellner Chairperson 1.00 X X 0 0 0 Erika Lindsey Board Member 1.00 X 0 0 0 Greta Elysee Board Member 1.00 X 0 0 0 Harlem J Gunness Board Member 1.00 X 0 0 0 Jennifer Ramirez Board Member 1.00 X 0 0 0 Josephine Diaz Board Member 1.00 X 0 0 0 June Niklus Vice Chairperson 1.00 X X 0 0 0 Kristin Manzolillo Board Member 1.00 X 0 0 0 Nancy Rapoport Treasurer 1.00 X X 0 0 0 Peter Gee Board Member 1.00 X 0 0 0 Ralph Aquila Board Member 1.00 X 0 0 0 Randy Siller Board Member 1.00 X 0 0 0 Alan Wengrofsky CFO/VP Finance 35.00 X 260369 0 38574 Robert Hayes President/CEO 35.00 X 373764 0 36998 Matthew Weissman VP Medical Affairs 35.00 X 320990 0 34250 Grace Chow Physician 35.00 X 198042 0 31229 Hafiz Maje Physician 35.00 X 229929 0 31250 Jillian Cohen Physician 35.00 X 197061 0 15056 Lawrence Kramer Associate Medical Director 35.00 X 218222 0 29452 Sharon Griffith Medical Director of Womens Services 35.00 X 207116 0 34080 2005493 0 250889 71 0 1 0 Relevant Healthcare Technologies 222 Broadway 19th Floor NEW YORK NY 10038 Health Home Billing Services 252857 ADVANCED MEDICAL BILLING SYSTEMS 18 WOODHAVEN DRIVE nEW YORK NY 10956 Medical Billing Services 252467 COHNREZNICK LLP 1212 AVE OF the AMERICAS NEW YORK NY 10036 ACCOUNTING & TAX 213910 2 148353 16403226 3853103 724106 20404682 Medicaid and Medicaid managed car 623000 33002721 33002721 Health home revenue 623000 13760893 13760893 New York State uncompensated care 623000 2389431 2389431 Self-pay 623000 1897788 1897788 Private insurance 623000 1887806 1887806 1656390 1656390 54595029 698036 698036 11415032 11520417 -105385 -105385 -105385 14200 148353 54049 -39849 -39849 QCCP 900099 634192 634192 CCMP 900099 564315 564315 other patient revenue 900099 498566 498566 25355 25355 1722428 77274941 56317457 0 552802 1064945 911026 153919 37716840 32289227 5427613 603881 513299 90582 8435590 7170251 1265339 3337639 2836993 500646 8845 8845 246810 246810 72000 72000 3861893 3414796 447097 87452 87452 2388542 1859462 529080 58228 57035 1193 3374392 2564538 809854 150218 127685 22533 241057 204899 36158 2607152 1981436 625716 213108 161962 51146 medical supplies 5698417 5698417 bad debt 1860477 1860477 License and fees 1012746 440791 571955 Health Home Fees 824500 824500 2316868 2039523 277345 76181600 65115769 11065831 0 1730463 1688511 28583242 41443486 3688426 3233198 7429915 11966806 404682 280509 31055182 22116107 9776237 8939075 13990913 19960733 657345 904883 18889065 1414105 85150288 89831306 5732735 7952640 7484362 8301141 747356 767624 13964453 17021405 X 71185835 72809901 71185835 72809901 85150288 89831306 X 1093341 1467157 -936432 X X 0 1 X 1 1 1 X 16482638 14920234 15982200 16600052 20404682 84389806 16482638 14920234 15982200 16600052 20404682 84389806 84389806 56123 82142 128164 622496 630463 1519388 669662 1917735 2645812 1007654 1148109 7388972 93298166 225676594 0.90450 0.91550 X Schedule A, Part II, Line 10, Explanation of Other Income: MISCELLANEOUS INCOME - 2012 Amount: $ 32,162. 2013 Amount: $ 101,533. 2014 Amount: $ 103,552. 2015 Amount: $ 196,257. FUNDRAISING REVENUE - 2013 Amount: $ 30,000. 2015 Amount: $ 61,600. 2016 Amount: $ 14,200. MEANINGFUL USE - 2012 Amount: $ 637,500. 2013 Amount: $ 1,186,750. 2014 Amount: $ 556,750. 2015 Amount: $ 391,000. ADMIN FEES - 2013 Amount: $ 161,952. 2014 Amount: $ 267,672. HEALTH REVENUE - 2013 Amount: $ 437,500. QUALITY INCENTIVE - 2014 Amount: $ 160,132. CCMP REVENUE - 2014 Amount: $ 170,986. 2015 Amount: $ 195,691. 2016 Amount: $ 564,315. QCCP REVENUE - 2014 Amount: $ -36,877. 2015 Amount: $ 73,085. 2016 Amount: $ 45,673. EXPENSE WRITE OFF - 2014 Amount: $ 150,000. LIFE INSURANCE PROCEEDS - 2014 Amount: $ 1,273,597. qarr hiv revenue - 2015 Amount: $ 90,021. 2016 Amount: $ 25,355. Other patient revenue - 2016 Amount: $ 498,566. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 72000 72000 0 Part II-B, Line 1: THE LOBBYING ACTIVITIES INCLUDE RETENTION OF CONSULTANTS TO ADVISE CHN ON POLICY INITIATIVES AND ON OPPORTUNITIES TO SECURE SUPPORT FOR NEEDED COMMUNITY HEALTHCARE SERVICES INCLUDING A MOBILE OPTOMETRY CENTER AND ADDITIONAL CLINIC SPACE. 37931 37931 13540553 8169123 5371430 7423891 5613605 1810286 8139377 6921459 1217918 1913430 1411920 501510 8939075 Deferred Rent 767624 767624 X 75999238 1467157 -1860477 -393320 76392558 882383 882383 77274941 74375172 54049 54049 74321123 1860477 1860477 76181600 Part X, Line 2: CHN has no unrecognized tax benefits at December 31, 2016. CHN's federal and state income tax returns prior to fiscal year 2013 are closed and management continually evaluates expiring statutes of limitations, audits, proposed settlements, changes in tax law and new authoritative rulings. CHN recognizes interest and penalties associated with tax matters as operating expenses and includes accrued interest and penalties with accrued expenses in the statement of financial position. Part XI, Line 2d - Other Adjustments: PROVISION FOR BAD DEBTS -1,860,477. Part XI, Line 4b - Other Adjustments: Fundraising Direct Expenses -54,049. TAX ADJUSTMENT COMMUNITY CARE MANAGEMENT PARTNERS LLC 347,913. TAX ADJUSTMENT QUEENS COORDINATED CARE PARTNERS LLC 588,519. Part XII, Line 2d - Other Adjustments: fundraising direct expenses 54,049. Part XII, Line 4b - Other Adjustments: PROVISION FOR BAD DEBTS 1,860,477. GALA 162553 148353 14200 14650 34584 1250 3565 162553 148353 14200 14650 34584 1250 3565 54049 -39849 X 0 0 0 0 0 0 0 1 0 Alan Wengrofsky CFO/VP Finance 260231 0 0 0 138 0 5300 0 33274 0 298943 0 0 0 Robert Hayes President/CEO 358368 0 15000 0 396 0 5300 0 31698 0 410762 0 0 0 Matthew Weissman VP Medical Affairs 320930 0 0 0 60 0 5300 0 28950 0 355240 0 0 0 Grace Chow Physician 197974 0 0 0 68 0 4011 0 27218 0 229271 0 0 0 Hafiz Maje Physician 229781 0 0 0 148 0 4681 0 26569 0 261179 0 0 0 Jillian Cohen Physician 196965 0 0 0 96 0 3972 0 11084 0 212117 0 0 0 Lawrence Kramer Associate Medical Director 217826 0 0 0 396 0 4359 0 25093 0 247674 0 0 0 Sharon Griffith Medical Director of Womens Services 207116 0 0 0 0 0 4226 0 29854 0 241196 0 0 0 Part I, Line 7 THE AMOUNTS INCLUDED ON PART II, B(II), REPRESENT bonuses that were approved by the board. These amounts were included in the individuals W2. X 1 724106 COST 0 0 0 Part I, Column (b): column b represents the number of contributors. Form 990, Part VI, Section B, line 11b Form 990 is prepared by independent accountant and reviewed by management. It is then reviewed by the chair of the board and the finance committee and distributed to the entire board of directors before filling with the IRS. Form 990, Part VI, Section B, line 12c ALL MANAGEMENT AND EMPLOYEES WHO ARE IN A POSITION TO INFLUENCE ANY SUBSTANTIVE BUSINESS DECISIONs SHALL, AT LEAST ANNUALLY, FILE A CONFLICT OF INTEREST DISCLOSURE STATEMENTS AND CONSULT WIth OUTSIDE COUNSEL, AS NECESSARY, CONCERNING ANY POTENTIAL PrOBLEMS OR POSSIBLE CONFLICTS OF INTEREST. IN ADDITION, TO COMPLETING THE ANNUAL DISCLOSURE STATEMENT, ALL EMPLOYEES MUST AlsO IMMEDIATELY DISCLOSE TO THE COMPLIANCE OFFICER ANY POSSIBLE CONFLICTS OF INTEREST AS THEY ARISE. THE COMPLIANCE OFFICER, AS NECESSARY, WILL THEN CONSULT WITH OUTSIDE COUNSEL. Form 990, Part VI, Section B, line 15a The board of directors determines and approves compensation of the CEo based on recomensations from exacutive commitee, Form 990, Part VI, Section C, line 19 The documents are available upon request. Form 990, Part XI, line 9: tax adjustment community care management partners llc -347,913. tax adjustment QUEENS COORDINATED CARE PARTNERS LLC -588,519. form 990, part xii, line 2c: The selection and oversight process has not changed from the prior year. 990, part IV, line 20A: The organization is licensed under article 28 of New York State Public Health Law. However, subsection 10 of article 28 excludes certain healthcare facilities from the definition of general hospital. Therefore, the organization is not including schedule H in the current year form 990 as they do not meet this definition.