2016-11-14T14:56:15-06:00 2015-12-31 221478099 COHNREZNICK LLP 1212 Avenue of the Americas New York NY 10036 990 2015-01-01 133083068 COMMUNITY HEALTHCARE NETWORK COMM 2125452404 60 MADISON AVENUE NEW YORK NY 10010 ALAN WENGROFSKY CFO AND VP OF FINANCE 2125452404 2016-11-10 1 THOMAS LANNING P00851654 2122970400 2015 2017-02-10 21:41:12Z robert hayes 60 MADISON AVENUE NEW YORK NY 10010 69698623 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 17 708 0 0 0 15982200 16600052 46679213 48698049 1052129 345380 2647687 926293 66361229 66569774 0 0 0 0 36194833 41861838 0 0 0 17017203 20541627 53212036 62403465 13149193 4166309 73228107 85150288 5768448 13964453 67459659 71185835 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 51051004 49644103 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 220,430 HEALTH CARE VISITS FOR THE CALENDAR YEAR ENDED DECEMBER 31, 2015. 51051004 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 87 0 1 708 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 ENRIQUE VELA outgoing BOARD MEMBER 1.00 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 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 L MANZOLILO Board Member 1.00 X 0 0 0 NANCY RAPOPORT Treasurer 1.00 X X 0 0 0 PETER TADAO GEE Board Member 1.00 X 0 0 0 Ralph Aquila Board Member 1.00 X 0 0 0 Ralph Salamanca outgoing BOARD MEMBER 1.00 X 0 0 0 Randy Siller Board Member 1.00 X 0 0 0 Alan Wengrofsky CFO and VP of Finance 35.00 X 262997 0 30572 Robert Hayes CEO 35.00 X 317887 0 31236 Matthew Weissman VP Medical Affairs 35.00 X 308640 0 30160 Daniel Napolitano Medical Director 35.00 X 225274 0 24113 Grace Chow Physician 35.00 X 179136 0 24755 Gregory Taddeo dentist 35.00 X 178499 0 13715 Hafiz Maje Physician 35.00 X 225003 0 28119 Lawrence Kramer Associate Medical Director 35.00 X 205145 0 25261 Catherine Abate Former CEO 0.00 X 887390 0 0 2789971 0 207931 58 1 1 0 Advanced Medical Billing Systems 18 woodhaven drive nEW YORK NY 10956 DATA ANALYST 293204 COHNREZNICK LLP 1212 AVE OF the AMERICAS NEW YORK NY 10036 ACCOUNTING & TAX 168750 2 252779 14379726 1967547 763309 16600052 Medicaid and Medicaid managed car 623000 27034015 27034015 Health home revenue 623000 12969166 12969166 Self-pay 623000 3306709 3306709 New York State uncompensated care 623000 3104564 3104564 Private insurance 623000 1682164 1682164 601431 601431 48698049 618996 618996 3500 0 3500 3500 3500 2770372 3043988 -273616 -273616 -273616 61600 252779 84861 -23261 -23261 meaningful use 623000 391000 391000 CCMP 900099 195691 195691 QARR HIV REVNUE 900099 90021 90021 269342 269342 946054 66569774 49644103 0 325619 981492 792552 188940 31158295 25160223 5998072 499293 403178 96115 6619930 5345572 1274358 2602828 2101775 501053 68841 68841 147950 147950 2214492 1788175 426317 61347 61347 2121929 1531956 589973 71914 69444 2470 3009485 2265316 744169 125324 86474 38850 214440 147963 66477 2541923 1906442 635481 206082 154562 51520 medical supplies 4443304 4443304 bad debt 2943455 2943455 laboratory 516562 516562 LICENSES AND FEES 493424 240552 252872 1361155 1092152 269003 62403465 51051004 11352461 0 5318796 1730463 42475378 28583242 2522934 3688426 10120438 7429915 465581 404682 29285192 19508955 10585564 9776237 13990913 376447 657345 1362969 18889065 73228107 85150288 5102216 5732735 7484362 666232 747356 5768448 13964453 X 67459659 71185835 67459659 71185835 73228107 85150288 X 4166309 -514564 74431 X X 0 1 X 1 1 1 X 14395337 16482638 14920234 15982200 16600052 78380461 14395337 16482638 14920234 15982200 16600052 78380461 78380461 48224 56123 82142 128164 622496 937149 59956 669662 1917735 2645812 1007654 6300819 85618429 197909814 0.91550 0.91550 X Schedule A, Part II, Line 10, Explanation of Other Income: MISCELLANEOUS INCOME - 2011 Amount: $ 15,831. 2012 Amount: $ 32,162. 2013 Amount: $ 101,533. 2014 Amount: $ 103,552. 2015 Amount: $ 196,257. FUNDRAISING REVENUE - 2011 Amount: $ 44,125. 2013 Amount: $ 30,000. 2015 Amount: $ 61,600. 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. QCCP REVENUE - 2014 Amount: $ -36,877. 2015 Amount: $ 73,085. EXPENSE WRITE OFF - 2014 Amount: $ 150,000. LIFE INSURANCE PROCEEDS - 2014 Amount: $ 1,273,597. qarr hiv revenue - 2015 Amount: $ 90,021. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 73500 73500 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 12807556 7346463 5461093 7167185 4528569 2638616 7664646 6483981 1180665 1607874 1149942 457932 9776237 security deposits 414043 SUBVENTION RECEIVABLE 1000000 Restricted CD-Letter of Credit 207350 total assets limited as to use 17000000 due from affiliated party 267672 18889065 Deferred Rent 747356 747356 X 63271047 -514564 -2943455 -3458019 66729066 -159292 -159292 66569774 59544871 84861 84861 59460010 2943455 2943455 62403465 Part X, Line 2: CHN has no unrecognized tax benefits at December 31, 2015. CHN's Federal and state income tax returns prior to fiscal year 2012 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 include accrued interest and penalties with accrued expenses in the statements of financial position. Part XI, Line 2d - Other Adjustments: BAD DEBT EXPENSE -2,943,455. Part XI, Line 4b - Other Adjustments: tax adjustment queens coordinated care partners llc -147,516. tax adjustment community care management partners llc 73,085. fundraising direct expenses -84,861. Part XII, Line 2d - Other Adjustments: fundraising direct expenses 84,861. Part XII, Line 4b - Other Adjustments: BAD DEBT EXPENSE 2,943,455. GALA 317179 252779 64400 403 46800 35033 2625 317179 252779 64400 403 46800 35033 2625 84861 -20461 SCHEDULE G, PART II: CONTRIBUTIONS were RECEIVED IN ADVANCE OF THE EVENT in 2014, these contributions of $2,800 are reported on schedule G as gross fundraising revenue, but not on Form 990, Part VIII as they were received and reported in prior year. X X 1 0 0 0 0 0 0 1 0 Alan Wengrofsky CFO and VP of Finance 252817 0 10000 0 180 0 5348 0 25224 0 293569 0 0 0 Robert Hayes CEO 317227 0 0 0 660 0 6462 0 24774 0 349123 0 0 0 Matthew Weissman VP Medical Affairs 308520 0 0 0 120 0 6236 0 23924 0 338800 0 0 0 Daniel Napolitano Medical Director 225154 0 0 0 120 0 0 0 24113 0 249387 0 0 0 Grace Chow Physician 179016 0 0 0 120 0 3591 0 21164 0 203891 0 0 0 Gregory Taddeo dentist 178379 0 0 0 120 0 3615 0 10100 0 192214 0 0 0 Hafiz Maje Physician 224823 0 0 0 180 0 4555 0 23564 0 253122 0 0 0 Lawrence Kramer Associate Medical Director 204353 0 0 0 792 0 4097 0 21164 0 230406 0 0 0 Catherine Abate Former CEO 0 0 0 0 887390 0 0 0 0 0 887390 0 737391 0 Part I, Line 4a THE AMOUNT ON SCHEDULE J PART II COLUMN C FOR CATHERINE ABATE RELATES TO A LIFE INSURANCE POLICY. CHN RECEIVED THIS $737,391 AS PROCEEDS FROM FIRST AMERITUS LIFE INSURANCE CORP. OF NEW YORK FOLLOWING MS. ABATE'S DEATH ON MAY 17TH 2014. CHN'S BOARD OF DIRECTORS HAD AUTHORIZED THE PURCHASE OF THESE CONTRACTS IN 2010 THRU 2013, FOR THE PURPOSE OF PROVIDING PERFORMANCE BASED DEFERRED COMPENSATION FOR MS. ABATE WITH THE EXPECTATION THAT FOLLOWING HER RETIREMENT SHE WOULD DRAW THE INCOME AS AN ANNUITY OVER THE COURSE OF HER RETIREMENT. MS ABATE PASSED AWAY PRIOR TO HER RETIREMENT, AND PER THE POLICY TERMS, A LUMP SUM WAS PAID TO CHN AS THE HOLDER OF THE CONTRACT. CHN THEN paid the proceeds as follows in 2015: The Estate of Catherine Abate $ 679,520 Kyle Kliegerman (beneficary of the The Estate of Catherine Abate ) $ 207,870 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 2 763309 COST 0 0 0 Part I, Column (b): column b represents the number of contributions. Form 990, Part VI, Section B, line 11 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 form 990 of other organizations. Form 990, Part VI, Section C, line 19 The documents are available upon request. Form 990, Part XI, line 9: tax adjustment queens coordinated care partners llc -73,085. tax adjustment community care management partners llc 147,516. 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.