2017-07-17T15:22:56-05:00 2016-12-31 560574444 CHERRY BEKAERT LLP 1111 Metropolitan Ave Ste 1000 Charlotte NC 28204 990 2016-01-01 201184743 Patient Access Network Foundation PATI 2023479272 1331 F STREET No 975 WASHINGTON DC 20004 DANIEL KLEIN PRESIDENT & CEO 2023479272 2017-07-07 1 Amanda Adams P00748038 7043771678 38.142.98.34 2017-07-07 13:55:28 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 18694F53AD11E15FFCEA276DE93F63B2E746D691 2016 2021-01-29 14:40:06Z DANIEL KLEIN 1331 F STREET No 975 WASHINGTON DC 20004 1526047162 0 X www.panfoundation.org X 2004 DC To help underinsured people with life-threatening, chronic and rare diseases get the medications and treatment they need by paying for their out-of-pocket costs and advocating for improved access and affordability. 13 12 21 13 0 0 801155793 582541219 0 0 18270217 -4916537 0 0 819426010 577624682 942172470 784840353 0 0 2972248 3245715 0 0 1194500 22783959 33513090 967928677 821599158 -148502667 -243974476 556249582 376824646 233201039 293898181 323048543 82926465 X To help underinsured people with life-threatening, chronic and rare diseases get the medications and treatment they need by paying for their out-of-pocket costs and advocating for improved access and affordability. 0 0 813920279 784840353 At the PAN Foundation, we envision a nation in which everyone can get the health care they need. We work toward this goal by helping underinsured people with life-threatening, chronic and rare diseases get access to necessary medications and treatment. Partnering with generous donors, healthcare providers and pharmacies, PAN covers out-of-pocket costs for underinsured patients, providing access to the therapies they need to best manage their conditions and improve their quality of life. In 2016, the PAN Foundation assisted a total of 263,238 patients. Of that total, 191,835 were patients seeking and receiving assistance from the PAN Foundation for the first time. In the same year, PAN paid more than 1,500,000 claims related to patients' out-of-pocket prescription drug expenses and received over 600,000 phone calls. PAN's reach includes partnerships with over 1,673 specialty pharmacies and more than 132,050 providers across the USA. 813920279 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 991 0 1 21 1 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 DC X X SCOTT SCHLENOFF 2026618080 1331 F STREET NW SUITE 975 WASHINGTON DC 20004 Donald Barone CHAIRMAN 3.00 X X 12000 0 0 Miriam Atkins DIRECTOR 3.00 X 4000 0 0 MARTIN BIEBER dIRECTOR 3.00 X 12000 0 0 Jonas De Souza DIRECTOR 3.00 X 8000 0 0 Constance Garcia DIRECTOR 3.00 X 12000 0 0 grant lawless DIRECTOR 3.00 X 12000 0 0 Michael O'Grady DIRECTOR 3.00 X 12000 0 0 Susan Rucker DIRECTOR 3.00 X 12000 0 0 William Scanlon DIRECTOR 3.00 X 4000 0 0 Fred Schnell DirECTOR 3.00 X 12000 0 0 Ian Spatz DIRECTOR 3.00 X 12000 0 0 Norrie Thomas DIRECTOR 3.00 X 12000 0 0 KENNETH WELLS DIRECTOR 3.00 X 8000 0 0 Daniel Klein President & CEO 40.00 X 377572 0 16695 SCOTT SCHLENOFF CFO & Treasurer 40.00 X 172997 0 32326 JOHN CROUT COO & GENERAL COUNSEL 40.00 X 222433 0 49029 Bruce Barth CTO 40.00 X 153845 0 10812 Margaret Figley Director of Communications 40.00 X 148361 0 31757 Amy Niles Vice President, External Affairs 40.00 X 211542 0 23682 RICHARD GOLDSTEIN FORMER CFO 0.00 X 106010 0 0 1524760 0 164301 7 1 1 0 LASH GROUP AMERISOURCE BERGEN CONSULTING 1800 Innovation Point Kingsley Park Ft Mill SC 29715 Patient Services 20614657 CoreSource Inc 62923 Collection Center Drive Chicago IL 60693 Patient Services 4309889 CareMetx LLC 6931 Arlington Road Suite 308 BETHESDA MD 20814 SOFTWARE DEVELOPMENT 3116605 Milliman 111 Monument Circle Suite 601 Indianapolis IN 46204 Actuaries 790241 Schaner & Lubitz PLLC 6931 Arlington Road Suite 200 BETHESDA MD 20814 LEGAL SERVICES 321099 13 582541219 582541219 9527137 9527137 933978806 948422480 -14443674 -14443674 -14443674 577624682 0 0 -4916537 784840353 784840353 1167709 312393 633863 221453 1645145 489185 770869 385091 48141 28829 17992 1320 214237 51991 152303 9943 170483 50494 80926 39063 26758435 26758435 520789 112403 399311 9075 278471 278471 1373202 1373202 1219272 656241 507281 55750 203868 41956 156371 5541 287402 82136 181259 24007 234776 234776 161256 52598 94438 14220 80696 15334 64433 929 1400009 1400009 26705 26705 113183 1420 111338 425 Actuarial Expenses 850103 422420 427683 TRAINING 4923 4091 832 821599158 813920279 6484379 1194500 134791857 86443241 53205000 53305500 147977 333017 3331840 78573 99138 3253267 368005610 233489621 556249582 376824646 16001134 9096457 65209235 217199905 219592489 233201039 293898181 X 17488104 12776299 305560439 70150166 323048543 82926465 556249582 376824646 -243974476 3852398 0 X X 0 1 X 1 0 X 179458330 313390449 659303125 801155793 582541219 2535848916 179458330 313390449 659303125 801155793 582541219 2535848916 1723395980 812452936 4656432 7150342 11816149 11741797 9527137 44891857 2580740773 0.31480 0.31100 X PATIENT ACCESS NETWORK FOUNDATION MEETS THE FACTS AND CIRCUMSTANCES TEST PROVIDED IN TREASURY REGULATIONS SECTION 1.170A-9(F)(3) AS FOLLOWS:1. THE FOUNDATION'S PUBLIC SUPPORT PERCENTAGE IS AT LEAST 10%.2. THE FOUNDATION MAINTAINS A CONTINUOUS AND BONA FIDE PROGRAM FOR SOLICITATION OF FUNDS FROM THE GENERAL PUBLIC, INCLUDING PARTICULARLY THE MEDICAL COMMUNITY.3. AT 31%, THE FOUNDATION'S PUBLIC SUPPORT PERCENTAGE FOR 2016 IS WELL ABOVE THE MINIMUM REQUIREMENT OF 10% AND NARROWLY FALLS SHORT OF THE NORMAL REQUIREMENT OF 33 1/3%.4. THE FOUNDATION NORMALLY RECEIVES SUPPORT FROM A LARGE NUMBER OF UNRELATED DONORS. DURING THE PERIOD 2012-2016, THE FOUNDATION RECEIVED SUPPORT FROM 60+ DONORS. 5. THE FOUNDATION HAS A GOVERNING BODY WHICH REPRESENTS THE BROAD INTERESTS OF THE PUBLIC. THE BOARD OF DIRECTORS INCLUDES INDIVIDUALS FROM THE ACADEMIC, NONPROFIT, and MEDICAL COMMUNITIES AS WELL AS ATTORNEYS AND CPAS.6. THE FOUNDATION'S PROGRAMS PROVIDE GREAT BENEFIT TO THE PUBLIC. SINCE INCEPTION, THE FOUNDATION HAS PROVIDED over $2.6 BILLION IN MEDICAL SUPPORT ASSISTANCE TO OVER 1 MILLION INDIVIDUALS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 29375 23764 5611 3302465 54809 3247656 3253267 CO PAYMENT ASSISTANCE OBLIGATION 219592489 219592489 X 580103878 3852398 3852398 576251480 1373202 1373202 577624682 820225956 0 820225956 1373202 1373202 821599158 Part X, Line 2: THE FOUNDATION IS A NONPROFIT, TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MANAGEMENT BELIEVES THAT THE FOUNDATION CONTINUES TO SATISFY THE REQUIREMENTS OF A TAX EXEMPT ORGANIZATION AND IS NOT SUBJECT TO TAX. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE ACCOMPANYING FINANCIAL STATEMENTS. MANAGEMENT HAS EVALUATED THE EFFECT OF FASB GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS BY PRESCRIBING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE FOUNDATION'S POLICY IS TO RECORD A LIABILITY FOR ANY TAX POSITION TAKEN THAT IS BENEFICIAL TO THE FOUNDATION, INCLUDING ANY RELATED INTEREST AND PENALTIES, WHEN IT IS MORE LIKELY THAN NOT THE POSITION TAKEN BY MANAGEMENT WITH RESPECT TO A TRANSACTION OR CLASS OF TRANSACTIONS WILL BE OVERTURNED BY A TAXING AUTHORITY UPON EXAMINATION. MANAGEMENT BELIEVES THERE ARE NO SUCH POSITIONS AS OF DECEMBER 31, 2016 AND 2015 AND, ACCORDINGLY, NO LIABILITY HAS BEEN ACCRUED. THE FOUNDATION BELIEVES IT IS NO LONGER SUBJECT TO TAX EXAMINATIONS FOR TAX YEARS PRIOR TO 2011. 1 Medication Copay ASSISTANCE 263238 784840353 N/A N/A Part I, Line 2: THESE FUNDS REPRESENT GRANTS MADE FOR THE BENEFIT OF PATIENTS. THROUGH AN APPLICATION PROCESS WHICH INCLUDES INCOME ATTESTATION WITH VERIFICATION AGAINST CRITERIA SET BY THE BOARD and A DOCTOR'S ATTESTATION TO VALIDATE THE PATIENT MEDICAL NEED, PAN ENSURES THAT ALL PATIENTS WHO REQUEST OUR SERVICES MEET THE CRITERIA FOR A DISEASE FUND BEFORE ANY FUNDS ARE DISBURSED. THE PATIENT'S GRANT WILL PROVIDE ASSISTANCE FOR THEIR RESPONSIBILITY (DEDUCTIBLE, CO-PAYMENT, OR COINSURANCE) FOR COVERED MEDICATION SERVICES AFTER PAYMENT FROM THE PRIMARY INSURANCE OR THE AMOUNT AVAILABLE TO EACH PATIENT IS LIMITED BY A CAP SET BY THE BOARD. FUNDS ARE DISBURSED TO THE PHARMACY OR PHYSICIAN'S OFFICE WHEN POSSIBLE, SINCE WE WANT TO ENSURE THAT THE PATIENT DOES NOT NEED TO PROVIDE FUNDS OUT-OF-POCKET FOR THEIR MEDICATIONS. X X X X X X 1 0 0 0 0 0 0 0 0 Daniel Klein President & CEO 332572 0 45000 0 0 0 13360 0 3335 0 394267 0 0 0 SCOTT SCHLENOFF CFO & Treasurer 155372 0 17625 0 0 0 6744 0 25582 0 205323 0 0 0 JOHN CROUT COO & GENERAL COUNSEL 187329 0 35104 0 0 0 9026 0 40003 0 271462 0 0 0 Bruce Barth CTO 143532 0 10313 0 0 0 0 0 10812 0 164657 0 0 0 Margaret Figley Director of Communications 124352 0 24009 0 0 0 6188 0 25569 0 180118 0 0 0 Amy Niles Vice President, External Affairs 169437 0 42105 0 0 0 1900 0 21782 0 235224 0 0 0 RICHARD GOLDSTEIN FORMER CFO 106010 0 0 0 0 0 0 0 0 0 106010 0 0 0 Part I, Line 4a Richard Goldstein, Former CFO, received $106,010 during 2016 which represented a severance payment. CENTRAL GA CANCER CARE Common board member 224467 See Part V 0 Part IV, lINE 1, Column (d) DUring 2016, FREDERICK M. SCHNELL, MD, WAS A BOARD MEMBER OF PATIENT ACCESS NETWORK FOUNDATION ("PANF") AND PRESIDENT OF CENTRAL GEORGIA CANCER CARE. PANF PAID CLAIMS SUBMITTED BY CENTRAL GEORGIA CANCER CARE ON BEHALF OF PATIENTS IN THE AMOUNT OF $224,467. ALL TRANSACTIONS WERE AT ARM'S LENGTH AND FAIR MARKET VALUE. Form 990, Part VI, Section B, line 11b THE 990 IS REVIEWED BY THE FINANCE COMMITTEE. ALL BOARD MEMBERS RECEIVE A COPY OF THE FORM PRIOR TO FILING. Form 990, Part VI, Section B, line 12c As potential Board members or officers are recruited they are asked about possible conflicts of interest. Upon joining PAN, and at least annually, members read and sign the Conflict of Interest Policy. If any conflicts are noted on the form, more information will be gathered and it will be determined if the issue is material. In addition, that member will abstain from all discussions and vote on the matter. If it is material, we involve legal counsel and a detailed follow up and resolution will occur. Form 990, Part VI, Section B, line 15 THE INDEPENDENT BOARD DETERMINES THE COMPENSATION FOR THE PRESIDENT/CEO. THE NEW PRESIDENT/CEO STARTED IN NOVEMBER 2014. HIS COMPENSATION WAS DETERMINED WITH THE HELP OF AN OUTSIDE CONSULTANT WHO USED DATA FROM OTHER ORGANIZATIONS' 990S. ALL OTHER EMPLOYEES SALARIES ARE DETERMINED BY THE PRESIDENT/CEO. A STAFF COMPENSATION STUDY WAS COMPLETED IN 2014 AS WELL AS 2016. THE BOARD REVIEWED FINDINGS AND TOOK THEM INTO CONSIDERATION WHEN DETERMINING COMPENSATION LEVELS. IN ADDITION, PERIODICALLY, THE STAFF REVIEWS FORMS 990 OF ORGANIZATIONS WITH SIMILAR MISSIONS TO HELP DETERMINE COMPENSATION. All discussions are documented in the meeting minutes. Form 990, Part VI, Section C, line 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE POSTED ON ITS WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY MAY BE MADE AVAILABLE UPON REQUEST ON A CASE BY CASE BASIS. form 990, part xii, line 2c THE AUDIT, RISK, OVERSIGHT AND COMPLIANCE COMMITTEE'S (AROCC) PURPOSE IS TO ASSIST THE BOARD IN ITS OVERSIGHT OF THE FOUNDATION'S FINANCIAL AFFAIRS, INCLUDING THE AUDIT PROCESS. IT IS THE COMMITTEE'S RESPONSIBILITY TO SELECT AND DISCHARGE INDEPENDENT AUDITORS AND SUPERVISE AND EVALUATE THE PERFORMANCE OF THE AUDITORS. Form 990, part V, lINE 1 DURING 2016, THE FOUNDATION HIRED CORESOURCE, INC. TO PROCESS ITS PAYMENTS FOR MEDICAL SERVICES. CORESOURCE ISSUES 1099S TO ANY PROVIDERS IT PAYS ON BEHALF OF THE FOUNDATION. THEREFORE, THE NUMBER OF 1099S FILED BY THE FOUNDATION IN 2016 IS SIGNIFICANTLY LESS THAN IN PRIOR YEARS.