2015-11-11T12:35:17-06:00 2014-12-31 221478099 COHNREZNICK LLP 1212 AVENUE OF THE AMERICAS NEW YORK NY 10036 990 2014-01-01 133083068 COMMUNITY HEALTHCARE NETWORK COMM 2125452404 60 MADISON AVENUE NEW YORK NY 10010 ALAN WENGROFSKY CFO/VP 2125452404 2015-11-11 1 THOMAS LANNING P00851654 2122970400 2014 2016-02-25 16:41:14Z ROBERT HAYES 60 MADISON AVENUE NEW YORK NY 10010 66361229 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. 15 15 606 0 0 0 14920234 15982200 44899280 46679213 79017 1052129 1889077 2647687 61787608 66361229 0 0 0 0 31494382 36194833 0 0 0 15637468 17017203 47131850 53212036 14655758 13149193 58720729 73228107 4343106 5768448 54377623 67459659 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 42969105 48051428 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 246,320 HEALTH CARE VISITS FOR THE CALENDAR YEAR ENDED DECEMBER 31, 2014. 42969105 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 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 73 0 1 606 1 0 0 0 0 0 0 0 0 0 0 X 15 15 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 DONNA ANDERSON BOARD MEMBER 1.00 X 0 0 0 DR ERIC GROSSMAN 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 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 JOSEPHINE DIAZ BOARD MEMBER 1.00 X 0 0 0 JUNE NIKLUS VICD 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 RACQUEL HALL BOARD MEMBER 1.00 X 0 0 0 RALPH SALAMANCA BOARD MEMBER 1.00 X 0 0 0 RANDY SILLER BOARD MEMBER 1.00 X 0 0 0 ALAN WENGROFSKY CFO/VP OF FINANCE 35.00 X 265500 0 26568 CATHERINE ABATE PRESIDENT/CEO 35.00 X 238602 0 759412 CHRISTOPHER QUINONES VP OF ADMINISTRATION 35.00 X 208194 0 20568 CONSTANCE YOUNG ASSOCIATE MEDICAL DIRECTOR 35.00 X 197291 0 0 HAFIZ MAJE PHISICIAN 35.00 X 192481 0 23415 JEAN BIEN-AIME PSYCHIATRIST 35.00 X 198463 0 17110 MATTHEW WEISSMAN CMO/VP OF MEDICAL AFFAIRS 35.00 X 311883 0 29882 1612414 0 876955 48 0 1 0 COHNREZNICK LLP 1212 AVE OF THE AMERICAS NEW YORK NY 10036 ACCOUNTING & TAX 179167 JACOB HODES 70 S ELLIOT PLACE BROOKLYN NY 11217 DATA ANALYST 178369 2 13860151 2122049 864262 15982200 MEDICAID 623000 36002531 36002531 NEW YORK STATE UNCOMPENSATED CARE 623000 8111327 8111327 SELF-PAY 623000 1372734 1372734 PRIVATE INSURANCE 623000 809186 809186 PHARMACY 623000 215718 215718 167717 167717 46679213 126289 126289 1875 0 1875 1875 1875 925840 0 925840 925840 925840 LIFE INSURANCE PROCEEDS 900099 1273597 1273597 MEANINGFUL USE 623000 556750 556750 ADMIN FEES 900099 267672 267672 547793 547793 2645812 66361229 48051428 0 2327601 1290083 454705 835378 26787558 22038382 4749176 518952 426947 92005 5251061 4320099 930962 2347179 1931046 416133 91868 91868 181707 181707 1880079 1521683 358396 1835859 1338617 497242 37428 36263 1165 2897534 2144175 753359 115823 78760 37063 243055 165277 77778 2304757 1705520 599237 196881 145692 51189 MEDICAL SUPPLIES 3980528 3980528 BAD DEBT 1000000 1000000 LICENSES AND FEES 470031 292959 177072 PERSONNEL RECRUITMENT 419313 330931 88382 1362340 1057521 304819 53212036 42969105 10242931 0 17248013 5318796 20349606 42475378 2652581 2522934 5742007 10120438 785601 465581 27552597 16967033 11336124 10585564 164138 376447 442659 1362969 58720729 73228107 3710195 5102216 632911 666232 4343106 5768448 X 54377623 67459659 54377623 67459659 58720729 73228107 X 13149193 18121 -85278 X X 0 1 X 1 1 1 X 13847283 14395337 16482638 14920234 1598200 61243692 13847283 14395337 16482638 14920234 1598200 61243692 61243692 21238 48224 56123 82142 128164 335891 21881 59956 669662 1917735 2645812 5315046 66894629 174378202 0.91550 0.96190 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2010 AMOUNT: $ 21,881. 2011 AMOUNT: $ 15,831. 2012 AMOUNT: $ 32,162. 2013 AMOUNT: $ 101,533. 2014 AMOUNT: $ 103,552. FUNDRAISING REVENUE - 2011 AMOUNT: $ 44,125. 2013 AMOUNT: $ 30,000. MEANINGFUL USE - 2012 AMOUNT: $ 637,500. 2013 AMOUNT: $ 1,186,750. 2014 AMOUNT: $ 556,750. 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. QCCP REVENUE - 2014 AMOUNT: $ -36,877. EXPENSE WRITE OFF - 2014 AMOUNT: $ 150,000. LIFE INSURANCE PROCEEDS - 2014 AMOUNT: $ 1,273,597. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 37931 37931 12337835 6454311 5883524 6683828 3521157 3162671 7015989 6078626 937363 1477014 912939 564075 10585564 DEFERRED RENT 666232 666232 X 65275951 -1000000 -1000000 66275951 85278 85278 66361229 52193915 -18121 -18121 52212036 1000000 1000000 53212036 PART X, LINE 2: CHN HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2014. CHN'S FEDERAL AND STATE INCOME TAX RETURNS PRIOR TO FISCAL YEAR 2011 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 -1,000,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: TAX ADJUSTMENT QUEENS COORDINATED CARE PARTNERS LLC 32,391. TAX ADJUSTMENT COMMUNITY CARE MANAGEMENT PARTNERS LLC 52,887. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED GAIN -18,121. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,000,000. X X 1 0 0 0 0 0 0 1 0 ALAN WENGROFSKY CFO/VP OF FINANCE 245320 0 20000 0 180 0 5398 0 21170 0 292068 0 0 0 CATHERINE ABATE PRESIDENT/CEO 237967 0 0 0 635 0 737391 0 22021 0 998014 0 0 0 CHRISTOPHER QUINONES VP OF ADMINISTRATION 188086 0 20000 0 108 0 1808 0 18760 0 228762 0 0 0 CONSTANCE YOUNG ASSOCIATE MEDICAL DIRECTOR 196818 0 0 0 473 0 0 0 0 0 197291 0 0 0 HAFIZ MAJE PHISICIAN 192314 0 0 0 167 0 3905 0 19510 0 215896 0 0 0 JEAN BIEN-AIME PSYCHIATRIST 197671 0 0 0 792 0 0 0 17110 0 215573 0 0 0 MATTHEW WEISSMAN CMO/VP OF MEDICAL AFFAIRS 291775 0 20000 0 108 0 6301 0 23581 0 341765 0 0 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 TO MS. ABATE'S ESTATE IN 2015. SHE HAD SERVED AS CHN PRESIDENT AND CHIEF EXECUTIVE OFFICER FROM 1999 TO HER DEATH IN 2014. 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 864262 COST 0 0 0 PART I, COLUMN (B): COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS. 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 -32,391. TAX ADJUSTMENT COMMUNITY CARE MANAGEMENT PARTNERS LLC -52,887. FORM 990, PART XII, LINE 2C: THE SELECTION AND OVERSIGHT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.