2016-02-05T14:52:05-06:00 2015-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2014-07-01 237354899 CHESPENN HEALTH SERVICES INC CHES 6104853800 2600 WEST 9TH STREET 2 NORTH CHESTER PA 19013 MICHAEL G LUCAS FINANCE DIRECTOR 6104853800 2016-02-02 1 JULIUS GREEN CPA P00350393 2159720701 2014 2016-04-25 22:37:26Z DANIEL CAPLAN 2600 WEST 9TH STREET 2 NORTH CHESTER PA 19013 11304943 0 X WWW.CHESPENN.COM X 1972 PA CHESPENN HEALTH SERVICES OPERATES FOUR COMPREHENSIVE HEALTH CENTERS LOCATED IN CHESTER AND DELAWARE COUNTIES. 15 15 136 15 0 0 3029337 3859067 5971117 7443999 2118 1877 0 0 9002572 11304943 0 0 0 0 5301196 6577960 0 0 27864 4153837 4373563 9455033 10951523 -452461 353420 5214441 5700686 1639277 1419212 3575164 4281474 X CHESPENN HEALTH SERVICES IS A NETWORK OF NON-PROFIT, FEDERALLY QUALIFIED HEALTH CENTERS THAT PROVIDES COMPREHENSIVE PRIMARY AND PREVENTIVE HEALTH CARE AND SOCIAL SERVICES TO MEDICALLY UNDERSERVED FAMILIES AND INDIVIDUALS ON A SLIDING SCALE. CHESPENN HEALTH SERVICES STRIVES TO MEET THE UNIQUE HEALTH NEEDS IN ITS COMMUNITIES IN LINGUISTICALLY AND CULTURALLY COMPETENT WAYS. 1 0 8975182 7443999 SINCE 1973, CHESPENN HEALTH SERVICES HAS PROVIDED COMPREHENSIVE FAMILY MEDICAL AND DENTAL CARE TO THE RESIDENTS OF CHESTER, PA AND NEIGHBORING COMMUNITIES. IN 2005, CHESPENN EXPANDED THESE HEALTH CARE SERVICES TO THE COATESVILLE AREA, AND IN 2009, CHESPENN OPENED THE CENTER FOR FAMILY HEALTH IN UPPER DARBY, PA. ADDITIONAL SERVICES THAT ARE OFFERED INCLUDE HOMELESS HEALTH CARE, FAMILY PLANNING SERVICES, OB/GYN, HIV/AIDS CARE AND AN IN-HOUSE PHYSICIAN DISPENSARY. CHESPENN IS PRINCIPALLY FUNDED BY GRANTS FROM THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. DURING THE 2014 TAX YEAR, CHESPENN RECEIVED TOTAL GRANT REVENUE OF $2,889,437.DURING THE 2014 TAX YEAR, CHESPENN HAD TOTAL ENCOUNTERS OF 55,342, OF WHICH 51,128 WERE BILLABLE. THE BILLABLE ENCOUNTERS CONSISTED OF THE FOLLOWING IN CHESTER, PA: 9,287 PEDIATRIC ENCOUNTERS, 13,366 ADULT ENCOUNTERS, AND 6,555 DENTAL ENCOUNTERS. IN ADDITION, THERE WERE 8,277 ENCOUNTERS AT THE UPPER DARBY CENTER FOR FAMILY HEALTH AND 13,643 ENCOUNTERS IN THE COATESVILLE SERVICE AREA. NON BILLABLE ENCOUNTERS CONSISTED OF 4,214 NURSE ONLY VISITS.CHESPENN PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE AMOUNTS DETERMINED TO BE CHARITY CARE ARE NOT REPORTED AS REVENUES. DURING THE 2014 TAX YEAR, CHESPENN PROVIDED CHARITY CARE OF APPROXIMATELY $1,063,494 TO PATIENTS. 8975182 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 19 0 136 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 PA X DANIEL A CAPLAN 6104853800 2600 WEST 9TH STREET 2 NORTH CHESTER PA 19013 WILLIE MAE WELLS PRESIDENT 1.00 X X 0 0 0 RAE ROEDER SECRETARY 1.00 X X 0 0 0 JOAN RICHARDS TREASURER 1.00 X X 0 0 0 SHANA M HIGGS BOARD MEMBER 1.00 X 0 0 0 CHRISTINE DONAHUE HENRY BOARD MEMBER 1.00 X 0 0 0 KAREN VESELY BOARD MEMBER 1.00 X 0 0 0 ANTHONY HALL BOARD MEMBER 1.00 X 0 0 0 DONNA LAWLER BOARD MEMBER 1.00 X 0 0 0 CAROL ALLEN BOARD MEMBER 1.00 X 0 0 0 ELAINE GREENE-UPTON BOARD MEMBER 1.00 X 0 0 0 DAVID KEITH BOARD MEMBER 1.00 X 0 0 0 CATHERINE CARR BOARD MEMBER 1.00 X 0 0 0 JEFFREY GREEN BOARD MEMBER 1.00 X 0 0 0 GWEN SMITH BOARD MEMBER 1.00 X 0 0 0 LAVADA DRIGGINS BOARD MEMBER 1.00 X 0 0 0 MICHAEL LUCAS PRESIDENT/CEO 40.00 X 199397 0 19702 REKHA YAGNIK MD MEDICAL DIRECTOR 40.00 X 211128 0 17125 SALUD TIRO MD PHYSICIAN 32.00 X 131010 0 12771 RAQUIBUL ISLAM MD PHYSICIAN 40.00 X 138447 0 19198 KEVIN MCCABE MD PHYSICIAN 40.00 X 147073 0 8487 MICHAEL KANE DENTIST 40.00 X 125203 0 7439 952258 0 84722 9 0 1 0 HEALTH ACCESS NETWORK ONE MEDICAL CENTER BLVD UPLAND PA 19013 CONTRACTED PHYSICIAN SERVICES 862554 COORDINATED CARE NETWORK 300 PENN CENTER BLVD PITTSBURGH PA 15235 CONTRACTED PHARMACY SERVICES 480399 CROZER-KEYSTONE HEALTH SYSTEM 100 WEST SPROUL RD PAVILION II MANAGEMENT FINANCIAL PA 19064 MANAGEMENT & FINANCIAL SERVICES AGREEMEN 298538 CHILD GUIDANCE RESOURCE CTRS 200 OLD WEST CHESTER PIKE HAVERTOWN PA 19083 CONTRACTED PHYSICIAN SERVICES 209315 4 171064 2833406 854597 3859067 NET PATIENT SERVICE REVENUE 621400 7443999 7443999 7443999 1877 1877 11304943 7443999 0 1877 X 240605 240605 5135724 4383642 726210 25872 174930 153754 20746 430 592197 505695 85197 1305 434504 415310 18937 257 134067 134067 10245 10245 79470 14226 65244 1330054 1247162 82892 5635 4108 1527 361456 302415 59041 322368 5145 317223 967309 876607 90702 55713 42776 12937 242191 206553 35638 29683 20685 8998 PATIENT CARE 606126 601558 4568 PROVISION FOR DOUBTFUL 102735 102735 DUES AND SUBSCRIPTIONS 51638 50496 1142 EQUIPMENT RENTAL 36069 21655 14414 38804 20660 18144 10951523 8975182 1948477 27864 76520 195798 1357031 419340 266692 340353 294489 275282 30398 46773 55535 107875 4473274 2909005 1745592 1564269 1388184 2750996 5214441 5700686 1569552 1280034 69725 139178 1639277 1419212 X 3575164 4281474 3575164 4281474 5214441 5700686 X 353420 352890 X 0 1 X 1 1 1 X 3487000 3107773 2753950 3029337 3859067 16237127 5955200 5625571 5242581 5871117 7443999 30138468 9442200 8733344 7996531 8900454 11303066 46375595 0 0 0 46375595 16729 9377 5454 2118 1877 35555 16729 9377 5454 2118 1877 35555 9458929 8742721 8001985 8902572 11304943 46411150 0.99920 0.99870 0.00080 0.00130 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100838 100838 2663637 1485844 1177793 349794 208039 141755 1310533 1166650 143883 48472 48472 0 1564269 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2750996 2750996 X 11657833 352890 352890 11304943 0 11304943 10951523 0 10951523 0 10951523 PART X, LINE 2: THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2015 AND 2014. THE CORPORATION DOES NOT PERFORM ANY ACTIVITIES THAT WOULD BE SUBJECT TO UNRELATED BUSINESS INCOME TAX; THEREFORE, IT HAS NOT FILED FORM 990-T, EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN. PART XI, LINE 2D - OTHER ADJUSTMENTS: INHERENT CONTRIBUTION 352,890. X X X 0 0 0 0 0 0 0 0 0 MICHAEL LUCAS PRESIDENT/CEO 183479 0 15918 0 0 0 10356 0 9346 0 219099 0 0 0 REKHA YAGNIK MD MEDICAL DIRECTOR 211128 0 0 0 0 0 10619 0 6506 0 228253 0 0 0 RAQUIBUL ISLAM MD PHYSICIAN 138447 0 0 0 0 0 7304 0 11894 0 157645 0 0 0 KEVIN MCCABE MD PHYSICIAN 147073 0 0 0 0 0 7354 0 1133 0 155560 0 0 0 FORM 990, PART III, LINE 2 EEFECTIVE JULY 1, 2014 THE CORPORATION ENTERED INTO AN AFFILIATION AGREEMENT WITH CHESTER COUNTY COMMUNITY DENTAL CENTER (COMMUNITY DENTAL) AND OBTAINED CONTROL OF COMMUNITY DENTAL'S OPERATIONS AND ASSETS. FOR THE FISCAL YEAR ENDED JUNE 30, 2015 TOTAL ENCOUNTERS FOR THIS LOCATION WERE 4,289. FORM 990, PART VI, SECTION A, LINE 1 KEY FINANCIAL DECISIONS AND REPORTS ARE APPROVED BY THE FINANCE COMMITTEE AND THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. MEMBERS OF THE FINANCE COMMITTEE ARE ALSO MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 CROZER KEYSTONE HEALTH SYSTEM PROVIDES FISCAL, LEGAL AND HEALTH SERVICES VIA THE MANAGEMENT CONSULTING AND ADMINISTRATIVE AGREEMENT. FORM 990, PART VI, SECTION B, LINE 11 THE FINAL 990 RETURN WAS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE ALONG WITH THE BOARD OF DIRECTORS OF CHESPENN HEALTH SERVICES. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS MUST ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY. BOARD MEMBERS ARE ALSO REQUIRED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR AND MUST REFRAIN FROM DISCUSSING, AS WELL AS VOTING ON, SUCH MATTERS THAT PERTAIN TO THE CONFLICT. EMPLOYEES OF THE ORGANIZATION ARE ALSO REQUIRED TO REPORT ANY POTENTIAL OR ACTUAL CONFLICT TO THE PRESIDENT/CEO. THE PRESIDENT/CEO IS RESPONSIBLE FOR MONITORING AND RESOLVING ANY CONFLICT OF INTEREST THAT MAY ARISE WITHIN THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 TO DETERMINE THE SALARY OF THE CEO, CHESPENN HEALTH SERVICES RELIES ON SURVEY INFORMATION FROM TWO SOURCES. THE FIRST SOURCE IS AN ANNUAL SURVEY CONDUCTED BY THE HOSPITAL AND THE HEALTHCARE COMPENSATION SERVICE FOR THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS WHICH CATEGORIZES ALL COMMUNITY HEALTH CENTERS BY SERVICE LEVEL, GEOGRAPHY AND, BUDGET. THE SECOND SOURCE IS THE IRS FORM 990 IN WHICH A COMPENSATION SURVEY OF REGIONAL COMMUNITY HEALTH CENTERS IS CONDUCTED. BOTH SOURCES OF INFORMATION ARE USED BY CHESPENN HEALTH SERVICES' BOARD OF DIRECTORS TO DETERMINE THE COMPENSATION LEVEL. THIS COMPENSATION REVIEW IS CONDUCTED ON AN ANNUAL BASIS TO ASSURE THAT COMPENSATION IS IN LINE WITH FAIR MARKET VALUE, AND THE PROCESS IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIANS, DENTAL, INTERPRETING: PROGRAM SERVICE EXPENSES 1,247,162. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,247,162. GRANT WRITING & CONSULTING, BILLING, IT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 82,892. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 82,892. FORM 990, PART XI, LINE 9: INHERENT CONTRIBUTION 352,890. FORM 990, PART VI, SECTION B, LINE 13: THE ORGANIZATION IS CURRENTLY DEVELOPING A WHISTLEBLOWER POLICY WHICH IS EXPECTED TO BE APPROVED BY THE BOARD IN 2016.