2016-09-09T16:48:07-05:00 2015-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL SUITE 201 PITTSFORD NY 14534 990 2015-01-01 205244339 AMERICAN THROMBOSIS AND HEMOSTASIS NETWORK INC AMER 8476079479 72 TREASURE LANE RIVERWOOD IL 60015 MS DIANE J ASCHMAN PRESIDENT AND CEO 8476079479 2016-09-07 1 NANCY J SNYDER P01340545 5853811000 2015 2017-02-10 21:41:12Z MS DIANE J ASCHMAN 72 TREASURE LANE RIVERWOOD IL 60015 10089705 0 X WWW.ATHN.ORG X 2006 GA NON-PROFIT ORGANIZATION DEDICATED TO ADVANCE AND IMPROVE THE CARE OF INDIVIDUALS WITH BLEEDING AND CLOTTING DISORDERS. 15 14 21 14 0 0 7851868 9499129 0 0 26572 38409 34946 40622 7913386 9578160 3933121 4157889 0 0 2003150 2194095 0 0 56575 3095350 2330681 9031621 8682665 -1118235 895495 5830460 7096289 781287 1202930 5049173 5893359 ATHN PROVIDES STEWARDSHIP OF A SECURE NATIONAL DATABASE, ADHERENT TO ALL PRIVACY GUIDELINES, WHICH WILL BE USED TO SUPPORT CLINICAL OUTCOMES ANALYSIS, RESEARCH, ADVOCACY AND PUBLIC HEALTH REPORTING IN THE HEMOSTASIS AND THROMBOSIS COMMUNITY. 0 0 4123759 3547993 40622 CDC SURVEILLANCE - THIS CENTER FOR DISEASE CONTROL COOPERATIVE AGREEMENT FUNDS THE COMMUNITY COUNTS CDC PUBLIC HEALTH SURVEILLANCE PROJECT TO CREATE A UNIFORM SET OF DEMOGRAPHIC AND HEALTH SERVICES UTILIZATION DATA CHARACTERIZING THE POPULATION WITH BLEEDING AND CLOTTING DISORDERS AND TO MONITOR HEALTH INDICATORS OF THESE POPULATIONS. COMMUNITY COUNTS CONSISTS OF THREE PARTS, HTC POPULATION PROFILE, MORTALITY REPORTING, AND THE REGISTRY FOR BLEEDING DISORDERS SURVEILLANCE. 1619618 ATHN SYSTEMS - THIS PROGRAM COMPRISES THE SOFTWARE SYSTEMS AND CAPABILITIES REQUIRED AS A STEWARD OF A SECURE NATIONAL DATABASE USED TO SUPPORT CLINICAL OUTCOMES ANALYSIS, RESEARCH, AND PUBLIC HEALTH WITH REPORTING BY OVER 135 TREATMENT CENTERS, GOVERNMENT ENTITIES, AND RESEARCHERS. 548877 HRSA MCHB - THIS HEMOPHILIA NATIONAL COORDINATING CENTER PROGRAM IS A COOPERATIVE AGREEMENT WHICH FUNDS THE FIRST NATIONAL HEMOPHILIA PROGRAM COORDINATING CENTER. THE PROJECT CREATES A NATIONAL NETWORK TO OPTIMIZE THE CARE FOR PATIENTS WITH BLEEDING AND THROMBOTIC DISORDERS OVER THEIR LIFETIME AND ACROSS GENERATIONS AND EXTENDS ATHN'S LEADERSHIP FROM THE HTCS AND REGIONS TO A BROADER GROUP OF STAKEHOLDERS SUCH AS PROFESSIONAL ORGANIZATIONS, PATIENT ADVOCACY GROUPS, PAYERS, AND GOVERNMENT PARTNERS. 1716602 609897 1716602 609897 8008856 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 9 0 21 1 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X DIANE ASCHMAN 8476079479 72 TREASURE LANE RIVERWOOD IL 60015 SUZANNE L KAPICA MA PLC BOARD MEMBER 1.00 X 0 0 0 SUSAN CUTTER MSW MPA SECRETARY 1.00 X X 0 0 0 PATRICIA DOMINIC TREASURER 1.00 X X 0 0 0 SARAH O'BRIEN MD BOARD MEMBER 1.00 X 0 0 0 MARK W SKINNER JD BOARD MEMBER 1.00 X 0 0 0 LAUREL J MCKERNAN RN BOARD MEMBER 1.00 X 0 0 0 LESLIE RAFFINI MD BOARD MEMBER 1.00 X 0 0 0 MICHAEL RECHT MD PHD CHAIR-ELECT 1.00 X X 0 0 0 CHRSTOPHER E WALSH MD BOARD MEMBER 1.00 X 0 0 0 DIANE J ASCHMAN MS PRESIDENT AND CEO 40.00 X X 277965 0 14380 CHRIS GUELCHER APRN BC PNP CPON BOARD MEMBER 1.00 X 0 0 0 JANNA JOURNEYCAKE MD BOARD MEMBER 1.00 X 0 0 0 BARBARA A KONKLE MD IMMEDIATE PAST CHAIR 1.00 X X 0 0 0 STEVEN PIPE MD CHAIR 1.00 X X 0 0 0 DIANE NUGENT MD BOARD MEMBER 1.00 X 0 0 0 LINDA MAGLIOCCO DIRECTOR OF FINANCE 40.00 X 130894 0 6912 CRYSTAL WATSON DIRECTOR OF OPERATIONS 40.00 X 147676 0 7791 556535 0 29083 3 0 1 0 MILES AHEAD LLC 3336 ROUGHCREEK DRIVE WOODSTOCK GA 30189 CONSULTING 194480 EARTH VECTORS INC 780 MAGNOLIA STREET DENVER CO 80220 CONSULTING 192000 KVG COMMUNICATION INC 185 EAST MAIN STREET LITTLE COMPTON RI 02837 CONSULTING 191224 3 4537000 4962129 9499129 44152 44152 505802 511545 -5743 -5743 -5743 OTHER REVENUE 900099 40622 40622 40622 9578160 40622 0 38409 X 4157889 4157889 582196 474082 53605 54509 1309187 1161149 148038 302712 266772 35940 2921 2921 15300 15300 16889 16889 817440 734192 83248 77397 23354 54043 206805 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CAPACITY RESEARCH UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL 55 LAKE AVENUE NORTH WORCESTER MA 01655 043167352 501(C)(3) 246062 CDC SURVEILLANCE GRANT ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI 1 GUSTAVE L LEVY PLACE NEW YORK NY 10029 136171197 501(C)(3) 286673 CDC SURVEILLANCE GRANT CHILDREN'S HOSPITAL OF PHILADELPHIA 3615 CIVIC CENTER BLVD PHILADELPHIA PA 19104 231352166 501(C)(3) 394215 CDC SURVEILLANCE GRANT THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUSTON 7000 FANNIN UCT 1006 HOUSTON TX 77030 741761309 501(C)(3) 433390 CDC SURVEILLANCE GRANT UNIVERSITY OF NORTH CAROLINA CHAPEL HILL 104 AIRPORT DR SUITE 2200 CHAPEL HILL NC 27599 566001393 501(C)(3) 253859 CDC SURVEILLANCE GRANT HEMOPHILIA OF GEORGIA INC 8800 ROSWELL RD SUITE 170 ATLANTA GA 30350 581175625 501(C)(3) 318146 CDC SURVEILLANCE GRANT HEMOPHILIA FOUNDATION OF MICHIGAN 1921 W MICHIGAN AVE YPSILANTI MI 48197 381905673 501(C)(3) 491667 CDC SURVEILLANCE GRANT GREAT LAKES HEMOPHILIA FOUNDATION 638 N 18TH ST SUITE 108 MILWAUKEE WI 53233 237367636 501(C)(3) 375950 CDC SURVEILLANCE GRANT UNIVERSITY OF COLORADO DENVER 13001 E 17TH PLACE AURORA CO 80045 841179794 501(C)(3) 183479 CDC SURVEILLANCE GRANT THE CENTER FOR COMPREHENSIVE CARE & DIAGNOSIS OF INHERITED BLOOD DISORDERS 1310 W STEWART DR SUITE 606 ORANGE CA 92868 270179192 501(C)(3) 396930 CDC SURVEILLANCE GRANT OREGON HEALTH AND SCIENCE UNIVERSITY 0690 BANCROFT ST L106SPA PORTLAND OR 97239 931176109 501(C)(3) 167621 CDC SURVEILLANCE GRANT BLOODWORKS NW 921 TERRY AVE SEATTLE WA 98106 911019655 501(C)(3) 24212 CDC CARDIOVASCULAR GRANT ALBANY MEDICAL CENTER 47 NEW SCOTLAND AVENUE ALBANY NY 12208 141338310 501(C)(3) 14250 DATA MANAGEMENT CAPACITY RESEARCH REGENTS UNIVERSITY OF MICHIGAN 3003 S STATE ST RM 1054 ANN ARBOR MI 48109 386006309 501(C)(3) 10000 CDC CARDIOVASCULAR GRANT EAST TENESEE COMPREHENSIVE HEMOPHILIA CENTER 1928 ALCOA HIGHWAY SUITE B-214 KNOXVILLE TN 37920 311626179 501(C)(3) 5200 DATA MANAGEMENT CAPACITY RESEARCH INTERMOUNTAIN HEMOPHILIA AND THROMBOSIS CENTER PO BOX 57828 SALT LAKE CITY UT 84157 876000525 501(C)(3) 9150 DATA MANAGEMENT CAPACITY RESEARCH OHIO STATE UNIVERSITY 1960 KENNY ROAD COLUMBUS OH 43210 316025986 501(C)(3) 18050 DATA MANAGEMENT CAPACITY RESEARCH AND CDC CARDIO-VASCULAR GRANT PROMEDICA TOLEDO CHILDREN'S HOSPITAL 3949 SUN FOREST COURT SUITE 203 TOLEDO OH 43623 344428256 501(C)(3) 30000 DATA MANAGEMENT CAPACITY RESEARCH REGENTS UNIVERSITY OF CALIFORNIA 9500 GILMAN DRIVE LA JOLLA CA 92093 956006144 501(C)(3) 20600 DATA MANAGEMENT CAPACITY RESEARCH ST JOSEPH'S CHILDREN'S HOSPITAL TAMPA 4600 NORTH HABANA AVENUE SUITE 23 TAMPA FL 33614 590774199 501(C)(3) 6650 DATA MANAGEMENT CAPACITY RESEARCH ST LOUIS UNIVERSITY 3700 WEST PINE MALL ROOM 368 ST LOUIS MO 63108 430654872 501(C)(3) 7050 DATA MANAGEMENT CAPACITY RESEARCH UNIVERSITY OF ARIZONA PO BOX 210158 TUSCON AZ 85721 742652689 501(C)(3) 11150 DATA MANAGEMENT CAPACITY RESEARCH UNIVERSITY OF IOWA 85 JESSUP HALL IOWA CITY IA 52242 426004813 501(C)(3) 7350 DATA MANAGEMENT CAPACITY RESEARCH LURIE'S CHILDREN'S 225 E CHICAGO AVE CHICAGO IL 60611 362170833 501(C)(3) 12500 DATA MANAGEMENT CAPACITY RESEARCH THE RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL 700 CHILDRENS DRIVE COLUMBUS OH 432052664 316056230 501(C)(3) 6000 DATA MANAGEMENT CAPACITY RESEARCH ST JUDE CHILDREN'S RESEARCH HOSPITAL INC 262 DANNY THOMAS PLACE MEMPHIS TN 381053678 620646012 501(C)(3) 7500 DATA MANAGEMENT CAPACITY RESEARCH WASHINGTON UNIVERSITY SCHOOL OF MEDICINE 700 ROSE DALE AVENUE CB 1034 ST LOUIS MO 63112 430653611 501(C)(3) 5500 DATA MANAGEMENT CAPACITY RESEARCH CHILDREN'S HOSPITAL OF LOS ANGELES 4650 SUNSET BLVD 54 LOS ANGELES CA 90027 951690977 501(C)(3) 8042 DATA MANAGEMENT CAPACITY RESEARCH PART I, LINE 2: ATHN HAS A FORMAL PROCESS FOR APPLYING, SELECTING, AWARDING, SUBSTANTIATING THE AMOUNTS OF GRANTS AWARDED AND TRACKING ACHIEVEMENT OF MILESTONES FUNDED BY THE GRANTS. THE ATHNDATA.QUALITY.COUNTS APPLICATION PROCESS IS AN ONLINE SUBMISSION PROCESS USING A STANDARD APPLICATION TEMPLATE, WITH SPECIFIC FUNDING REQUIREMENTS AND SUBMISSION DEADLINES ANNOUNCED TO ALL ATHN AFFILIATES. PROPOSALS ARE REVIEWED BY A MULTI-DISCIPLINARY GRANT REVIEW PANEL. EACH PROPOSAL IS WEIGHTED BASED ON CRITERIA ESTABLISHED FOR THAT ROUND OF FUNDING AND APPROPRIATENESS OF FINANCIAL REQUEST. UPON SELECTION OF THE SUBSET OF WINNING PROPOSALS, THE PROPOSED AWARDEES AND AMOUNTS OF EACH AWARD ARE REVIEWED BY FINANCE COMMITTEE FOR REASONABLENESS AND CONSISTENCY WITH BUDGET, AND APPROVED BY THE ATHN BOARD. LETTER AGREEMENTS CONFIRMING THE AWARDED AMOUNT AND REQUIREMENTS ARE PROVIDED AND EXECUTED BY EACH AWARDEE. PAYMENTS ARE ISSUED IN FOUR PARTS: $2,500 UPFRONT AND THE REMAINING PAYMENTS MADE EVERY SUBSEQUENT FOUR MONTHS UPON SUBMISSION INTERIM PROJECT REPORTS AT A RATE OF $50 FOR UPDATING CORE DATA ELEMENTS PER PATIENT. AWARDEES THAT HAVE EXHIBITED GOOD FAITH EFFORTS TO ACHIEVE MILESTONES BUT ARE BEHIND SCHEDULE MAY REQUEST A NO-COST EXTENSION TO USE THE FUNDS BEYOND THE END OF THE PROJECT PERIOD. X X X 0 0 0 0 0 0 0 0 0 DIANE J ASCHMAN MS PRESIDENT AND CEO 277965 0 0 0 0 0 14380 0 0 0 292345 0 0 0 CRYSTAL WATSON DIRECTOR OF OPERATIONS 147676 0 0 0 0 0 7791 0 0 0 155467 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS EMAILED TO ALL BOARD MEMBERS FOR THEIR REVIEW PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C ATHN REQUIRES ALL BOARD MEMBERS AND OFFICERS TO COMPLETE CONFLICT OF INTEREST STATEMENTS ON A YEARLY BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT/CEO'S COMPENSATION IS REVIEWED BY THE EXECUTIVE COMMITTEE AND APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 ALL REQUIRED PUBLIC DISCLOSURE DOCUMENTS ARE MADE AVAILABLE AT THE CEO/PRESIDENT'S OFFICE UPON REQUEST DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICE FEES: PROGRAM SERVICE EXPENSES 734,192. MANAGEMENT AND GENERAL EXPENSES 83,248. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 817,440. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED IN THE CURRENT YEAR.