2014-11-13T08:43:39-07:00 2013-12-31 990 2013-01-01 061181226 JOSEPH P ADDABBO FAMILY HEALTH CENTER INC JOSE 7189457150 6200 BEACH CHANNEL DRIVE ARVERNE NY 11692 MARIA IMELDA MAMBA ACTING CHIEF FINANCIAL OFFICER 7189457150 2014-11-12 2013 2015-11-30 17:44:51Z ALFONSO YU CHAN 6200 BEACH CHANNEL DRIVE ARVERNE NY 11692 38118460 0 X WWW.ADDABBO.ORG X 1987 NY THE ORGANIZATION OPERATES A FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER (FQHC), UNDER HRSA/BPHC, WITH 6 SITES IN QUEENS & BROOKLYN, NEW YORK CITY. IT PROVIDES A BROAD RANGE OF PRIMARY HEALTH SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION. DURING 2013, 37,308 PATIENTS WERE SERVED WITH 192,554 PATIENT VISITS. 13 13 417 0 0 0 6171190 6109284 29148327 31681164 1865 323 193917 327689 35515299 38118460 0 0 0 0 25223317 26886568 0 0 0 8721874 10630543 33945191 37517111 1570108 601349 31871968 34459038 12574168 14559889 19297800 19899149 THE ORGANIZATION OPERATES A FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER (FQHC), UNDER HRSA BPHC, WITH 6 SITES IN QUEENS & BROOKLYN, NEW YORK CITY. IT PROVIDES A BROAD RANGE OF PRIMARY HEALTH SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION. DURING 2013, 37,308 PATIENTS WERE SERVED WITH 192,554 PATIENT VISITS. 0 0 32238185 0 31681164 THE ORGANIZATIONS ONLY PROGRAM IS THAT OF PROVIDING PRIMARY HEALTH CARE SERVICES AND THIS IS DONE UNDER THE DIRECT SUPERVISION OF THE FEDERAL GOVERNMENT, DEPARTMENT OF HEALTH AND HUMAN SERVICES(HHS), HEALTH RESOURCES SERVICES ADMINISTRATION(HRSA). FOR 2013, OUR ORGANIZATION PROVIDED 167,222 MEDICAL, 20,713 DENTAL AND 4,619 MENTAL HEALTH VISITS. THE PAYOR SOURCE WERE 6% MEDICAID(STATE), 13% COMMERCIAL, 11% SELF PAY/UNINSURED, 5% MEDICARE(FEDERAL) AND 65% MANAGED CARE. THE 20,401 SELF PAY AND UNINSURED VISITS ARE PROVIDED AT A DEEPLY DISCOUNTED AND IN MANY INSTANCES, A FREE BASIS AS WE ARE NOT ALLOWED TO TURN AWAY PATIENTS BECAUSE OF OUR FQHC STATUS, WE ARE REIMBURSED FOR THESE LOSSES BY A GRANT FROM THE FEDERAL GOVERNMENT AND A CHARITY CARE GRANT FROM THE NEW YORK STATE DEPARTMENT OF HEALTH. 0 0 0 32238185 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 20 0 1 417 1 0 0 0 0 0 0 X 13 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Alfonso Yu Chan Acting CEO 7189457150 6200 BEACH CHANNEL DRIVE ARVERNE NY 11692 SYLVESTER OKONKWO BOARD CHAIRPERSON 1 X X 0 0 0 BETTY LEON BOARD 1ST VICE CHAIRPERSON 1 X X 0 0 0 CALDINE REY BOARD 2ND VICE CHAIRPERSON 1 X X 0 0 0 HARVEY GORDON BOARD TREASURER 1 X X 0 0 0 SAYWALAH KESSELLY BOARD SECRETARY 1 X X 0 0 0 BEATRICE BYRD BOARD MEMBER 1 X 0 0 0 GLENN DRESTO BOARD MEMBER 1 X 0 0 0 CAMILLE EADDY BOARD MEMBER 0 X 0 0 0 PATRICIA GILLESPIE BOARD MEMBER 1 X 0 0 0 GLENN GREENIDGE BOARD MEMBER 1 X 0 0 0 DIANNE MOORE BOARD MEMBER 1 X 0 0 0 MERRIL WRIGHT BOARD MEMBER 1 X 0 0 0 SANFORD BERNSTEIN BOARD MEMBER 1 X 0 0 0 JR PETER NELSON PHD CHIEF EXECUTIVE OFFICER 35 X 20256 0 1418 ROBERT FLIEGEL CPA ACTING CHIEF EXECUTIVE OFFICER 35 X 227585 0 15931 ALFONSO YU CHAN MD CHIEF MEDICAL OFFICER 35 X 273175 0 19122 JINPIN YING PHD CHIEF INFORMATION OFFICER 35 X 214732 0 15031 SANDRA FOGG CHIEF OPERATING OFFICER 35 X 133208 0 9325 CHARITY NELSON ABDI JD CORPORATE COMPLIANCE OFFICER 35 X 136651 0 9566 MARIA IMELDA MAMBA ACTING CHIEF FINANCIAL OFFICER 35 X 112704 0 7889 NATHALIE RIGAUD MD ASSOCIATE MEDICAL DIRECTOR 35 X 208454 0 14592 CHIN SONG CHEN MD MD FAMILY PRACTICE 35 X 246245 0 17237 ABDUL AKHAND MD MD FAMILY PRACTICE 35 X 223683 0 15658 ROBERTA HELLMAN MD MD PSYCHIATRIST 35 X 194747 0 13632 EDDIE GO MD MD INFECTIOUS DISEASE 35 X 189698 0 13279 MALLIKHARJANUDU KALEPU MD MD FAMILY PRACTICE 35 X 186403 0 13048 2367541 0 165728 46 0 1 0 GALCON ENTERPRISE INC 145 West 25th Suite 1002 New York NY 10001 CONSTRUCTION SERVICES 822652 BAKER TILLY VIRCHOW KRAUSE LLP 125 Baylis Road Melville NY 11747 AUDITING SERVICES 135000 ALMS HEALTHCARE MANAGEMENT INC PO Box 44 Bronxville NY 10708 CONSULTANT 117738 0 0 0 0 0 6109284 0 0 6109284 Patient Revenue 621400 31681164 31681164 0 0 0 0 0 0 31681164 323 0 0 323 0 0 0 0 0 0 0 0 96905 0 0 0 96905 0 96905 96905 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 RESIDENCY PROGRAM 900099 176000 176000 0 0 PATIENT TRANSPORTATION REIMBURSEMENT 900099 47662 47662 0 0 MEDICAL RECORDS FEE 900099 7122 7122 0 0 0 0 0 0 230784 38118460 32008853 0 323 0 0 0 0 0 0 0 0 1402560 1192176 210384 0 0 0 0 0 18923411 16379381 2544030 0 1405781 1215281 190500 0 3486431 3013977 472454 0 1668385 1442299 226086 0 471770 163268 308502 0 105291 0 105291 0 85000 0 85000 0 0 0 0 0 0 0 0 0 209967 209967 0 0 0 0 0 0 484810 204774 280036 0 0 0 0 0 0 0 0 0 566562 489786 76776 0 0 0 0 0 0 0 0 0 95261 29801 65460 0 477545 412832 64713 0 0 0 0 0 890422 769756 120666 0 233180 201581 31599 0 PHARMACEUTICALS 2764014 2764014 0 0 SUPPLIES-CLINICAL, OFFICE, FACILITY 1143818 890808 253010 0 PROVISION FOR BAD DEBTS 2619404 2619404 0 0 EQUIPMENT RENTAL AND REPAIRS 273153 93525 179628 0 210346 145555 64791 0 37517111 32238185 5278926 0 2147410 5229821 4974868 4527039 74666 57696 32280 118272 30239383 6870291 22659828 23369092 1982916 1157118 31871968 34459038 2492874 2801223 375548 320099 9218570 10997547 487176 441020 0 0 12574168 14559889 X 19297800 19899149 0 0 0 0 19297800 19899149 31871968 34459038 601349 0 0 0 0 0 X 0 1 X 1 1 1 X 6019119 5962892 6383942 6171190 6109284 30646427 0 0 0 0 0 0 0 0 0 0 0 0 6019119 5962892 6383942 6171190 6109284 30646427 30646427 61347 96389 98762 121642 97228 475368 90969 504078 70668 74140 230784 970639 32092434 125479555 0.95494 0.95528 X Schedule A, Part II, Line 10 GENERAL EXPLANATION-THE ORGANIZATION OPERATES AS FEDERALLY QUALIFIED HEALTH CENTER. OTHER INCOME OF $230,784 WHICH HAS BEEN PREVIOUSLY DISCLOSED ON FORM 990, PART VIII, LINES 11A-11C CONSIST OF RESIDENCY PROGRAM INCOME OF $176,000, PATIENT TRANSPORTATION REIMBURSEMENT OF $47,662 AND MEDICAL RECORDS FESS OF $7,122. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 125 125 0 Schedule C, Part II-B, Line 1 TWO THIRDS OF THE JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC. ARE MEMBERS OF THE 1199/SEIU, CERTAIN CONTRIBUTION AMOUNTS THAT WOULD BE OTHERWISE BE PAYABLE TO THE EMPLOYEE'S PENSION FUND ARE INSTEAD ALLOCATED BY THIS UNION TO THE LABOR MANAGEMENT INITIATIVE (LMI). THE UNION LABOR MANAGEMENT INITIATIVE (LMI) ALLOCATES A PORTION OF ITS FUND FOR LOBBYING PURPOSES IN CONNECTION WITH THE NEW YORK STATE AND FEDERAL POLICY ISSUES. THE UNION ALLOCATED THESE LOBBYING EXPENSES BASED ON EACH EMPLOYER'S TOTAL PENSION FUND CONTRIBUTION FOR THE YEAR. THE AMOUNT OF $125.00 REPRESENTS THE JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC. ALLOCATION FOR 2013. 0 1023465 1023465 0 21775149 3726918 18048231 0 213608 111770 101838 0 3548933 2663874 885059 0 3678228 367729 3310499 23369092 PRIMARY CARE AND DEVELOPMENT CORP-DEBT RESERVE 968111 SECURITY DEPOSITS 40566 A/R-OTHERS 148441 1157118 0 0 X 38118460 0 0 0 0 0 38118460 0 0 0 38118460 37517111 0 0 0 0 0 37517111 0 0 0 37517111 Schedule D, Part X, Line 2 MANAGEMENT HAS EVALUATED THE CENTERS TAX POSITION AND CONCLUDED THAT THE CENTER HAS NOT TAKEN ANY UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS OR DISCLOSURE TO THE FINANCIAL STATEMENTS. GENERALLY, THE CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION BY UNITED STATES FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR THE YEARS BEFORE 2010, WHICH IS THE STATDARD STATUTE OF LIMITATIONS LOOK-BACK PERIOD. 1 1 X 1 X 1 X 1 1 1 0 0 7035209 3385764 3649445 0.0011 25649153 22163690 3485463 0.0011 0 0 32684362 25549454 7134908 0.0022 0 0 0 0 0 0.0000 0 0 32684362 25549454 7134908 0.0022 1 2619404 2619404 901325 901325 0 X 1 1 5 1 JOSEPH P ADDABBO FAMILY HC SITE 1 6200 BEACH CHANNEL DRIVE ARVERNE NY 11692 COMMUNITY HEALTH CENTER (FEDERAL FQHC AND NY STATE ARTICLE 28 CLINIC) 2 JOSEPH P ADDABBO FAMILY HC SITE 2 1288 CENTRAL AVENUE FAR ROCKAWAY NY 11691 COMMUNITY HEALTH CENTER (FEDERAL FQHC AND NY STATE ARTICLE 28 CLINIC). 3 JOSEPH P ADDABBO FAMILY HC SITE 3 114-39/49 SUTPHIN BOULEVARD JAMAICA NY 11434 COMMUNITY HEALTH CENTER (FEDERAL FQHC AND NY STATE ARTICLE 28 CLINIC). 4 JOSEPH P ADDABBO FAMILY HC SITE 5 118-11 GUY BREWER BOULEVARD JAMAICA NY 11434 COMMUNITY HEALTH CENTER (FEDERAL FQHC AND NY STATE ARTICLE 28 CLINIC). 5 JOSEPH P ADDABBO FAMILY HC SITE 6 120 RICHARDS STREET BROOKLYN NY 11321 COMMUNITY HEALTH CENTER (FEDERAL FQHC AND NY STATE ARTICLE 28 CLINIC). JOSEPH P ADDABBO FAMILY HC SITE 1 1 1 X 11 1 1 1 X X X X X 1 0 1 1 100 1 200 1 X X X X 1 1 X X X X X 1 0 1 0 1 JOSEPH P ADDABBO FAMILY HC SITE 3 3 1 X 11 1 1 1 X X X X X 1 0 1 1 100 1 200 1 X X X X 1 1 X X X X X 1 0 1 0 1 JOSEPH P ADDABBO FAMILY HC SITE 5 4 1 X 11 1 1 1 X X X X X 1 0 1 1 100 1 200 1 X X X X 1 1 X X X X X 1 0 1 0 1 JOSEPH P ADDABBO FAMILY HC SITE 6 5 1 X 11 1 1 1 X X X X X 1 0 1 1 100 1 200 1 X X X X 1 1 X X X X X 1 0 1 0 1 JOSEPH P ADDABBO FAMILY HC SITE 2 2 1 X 11 1 1 1 X X X X X 1 0 1 1 100 1 200 1 X X X X 1 1 X X X X X 1 0 1 0 1 Schedule H, Part V, Section B, Line 1-JOSEPH P ADDABBO FAMILY HC SITE 1 COMMUNITY NEEDS AND SITE LOCATIONS ARE DETERMINED AND APPROVED BY THE FEDERAL GOVERNMENT. ALL HEALTH CENTER LOCATIONS MUST BE LOCATED IN COMMUNITIES DESIGNATED AS EITHER BEING A MEDICALLY UNDER SERVED AREA (MUSA) OR A HEALTH PROVIDER SHORTAGE AREA (HPSA). Schedule H, Part V, Section B, Line 1-JOSEPH P ADDABBO FAMILY HC SITE 2 COMMUNITY NEEDS AND SITE LOCATIONS ARE DETERMINED AND APPROVED BY THE FEDERAL GOVERNMENT. ALL HEALTH CENTER LOCATIONS MUST BE LOCATED IN COMMUNITIES DESIGNATED EITHER BEING A MEDICALLY UNDER SERVED AREA (MUSA) OF A HEALTH PROVIDER SHORTAGE AREA (HPSA). Schedule H, Part V, Section B, Line 1-JOSEPH P ADDABBO FAMILY HC SITE 3 COMMUNITY NEEDS AND SITE LOCATIONS ARE DETERMINED AND APPROVED BY THE FEDERAL GOVERNMENT. ALL HEALTH CENTER LOCATIONS MUST BE LOCATED IN COMMUNITIES DESIGNATED AS EITHER BEING A MEDICALLY UNDER SERVED AREA (MUSA) OF A HEALTH PROVIDER SHORTAGE AREA (HPSA). Schedule H, Part V, Section B, Line 1-JOSEPH P ADDABBO FAMILY HC SITE 5 COMMUNITY NEEDS AND SITE LOCATIONS ARE DETERMINED AND APPROVED BY THE FEDERAL GOVERNMENT. ALL HEALTH CENTER LOCATIONS MUST BE LOCATED IN COMMUNITIES DESIGNATED AS EITHER BEING A MEDICALLY UNDER SERVED AREA (MUSA) OF A HEALTH PROVIDER SHORTAGE AREA (HPSA). Schedule H, Part V, Section B, Line 1-JOSEPH P ADDABBO FAMILY HC SITE 6 COMMUNITY NEEDS AND SITE LOCATIONS ARE DETERMINED AND APPROVED BY THE FEDERAL GOVERNMENT. ALL HEALTH CENTER LOCATIONS MUST BE LOCATED IN COMMUNITIES DESIGNATED AS EITHER BEING A MEDICALLY UNDER SERVED AREA (MUSA) OF A HEALTH PROVIDER SHORTAGE AREA (HPSA). Schedule H, Part V, Section B, Line 3-JOSEPH P ADDABBO FAMILY HC SITE 1 AS A FEDERALLY QUALIFIED HEALTH CENTER, FIFTY ONE PERCENT (51%) OF OUR BOARD MEMBERS ARE REQUIRED TO BE MEMBERS OF THE COMMUNITY WE SERVE AND PATIENTS OF OUR HEALTH CENTER. AS SUCH, THESE COMMUNITY MEMBERS BRING COMMUNITY NEEDS TO OUR MONTHLY BOARD MEETINGS AND SUBSEQUENTLY, THE MANAGEMENT TEAM IS INSTRUCTED TO ACT UPON THIS NEEDS. Schedule H, Part V, Section B, Line 3-JOSEPH P ADDABBO FAMILY HC SITE 2 AS A FEDERALLY QUALIFIED HEALTH CENTER, FIFTY ONE PERCENT (51%) OF OUR BOARD MEMBERS ARE REQUIRED TO BE MEMBERS OF THE COMMUNITY WE SERVE AND PATIENTS OF OUR HEALTH CENTER. AS SUCH, THESE COMMUNITY MEMBERS BRING COMMUNITY NEEDS TO OUR MONTHLY BOARD MEETINGS AND SUBSEQUENTLY, THE MANAGEMENT TEAM IS INSTRUCTED TO ACT UPON THIS NEEDS. Schedule H, Part V, Section B, Line 3-JOSEPH P ADDABBO FAMILY HC SITE 3 AS A FEDERALLY QUALIFIED HEALTH CENTER, FIFTY ONE PERCENT (51%) OF OUR BOARD MEMBERS ARE REQUIRED TO BE MEMBERS OF THE COMMUNITY WE SERVE AND PATIENTS OF OUR HEALTH CENTER. AS SUCH, THESE COMMUNITY MEMBERS BRING COMMUNITY NEEDS TO OUR MONTHLY BOARD MEETINGS AND SUBSEQUENTLY, THE MANAGEMENT TEAM IS INSTRUCTED TO ACT UPON THIS NEEDS. Schedule H, Part V, Section B, Line 3-JOSEPH P ADDABBO FAMILY HC SITE 5 AS A FEDERALLY QUALIFIED HEALTH CENTER, FIFTY ONE PERCENT (51%) OF OUR BOARD MEMBERS ARE REQUIRED TO BE MEMBERS OF THE COMMUNITY WE SERVE AND PATIENTS OF OUR HEALTH CENTER. AS SUCH, THESE COMMUNITY MEMBERS BRING COMMUNITY NEEDS TO OUR MONTHLY BOARD MEETINGS AND SUBSEQUENTLY, THE MANAGEMENT TEAM IS INSTRUCTED TO ACT UPON THIS NEEDS. Schedule H, Part V, Section B, Line 3-JOSEPH P ADDABBO FAMILY HC SITE 6 AS A FEDERALLY QUALIFIED HEALTH CENTER, FIFTY ONE PERCENT (51%) OF OUR BOARD MEMBERS ARE REQUIRED TO BE MEMBERS OF THE COMMUNITY WE SERVE AND PATIENTS OF OUR HEALTH CENTER. AS SUCH, THESE COMMUNITY MEMBERS BRING COMMUNITY NEEDS TO OUR MONTHLY BOARD MEETINGS AND SUBSEQUENTLY, THE MANAGEMENT TEAM IS INSTRUCTED TO ACT UPON THIS NEEDS. Schedule H, Part V, Section B, Line 4-JOSEPH P ADDABBO FAMILY HC SITE 1 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTER'S OPERATING FACILITIES. Schedule H, Part V, Section B, Line 4-JOSEPH P ADDABBO FAMILY HC SITE 2 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTER'S OPERATING CERTIFICATE. Schedule H, Part V, Section B, Line 4-JOSEPH P ADDABBO FAMILY HC SITE 3 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTER'S OPERATING FACILITES. Schedule H, Part V, Section B, Line 4-JOSEPH P ADDABBO FAMILY HC SITE 5 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTER'S OPERATING FACILITIES Schedule H, Part V, Section B, Line 4-JOSEPH P ADDABBO FAMILY HC SITE 6 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTER'S OPERATING FACILITIES. Schedule H, Part V, Section B, Line 14-JOSEPH P ADDABBO FAMILY HC SITE 1 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTERS OPERATING FACILITIES Schedule H, Part V, Section B, Line 14-JOSEPH P ADDABBO FAMILY HC SITE 2 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTER'S OPERATING FACILITIES Schedule H, Part V, Section B, Line 14-JOSEPH P ADDABBO FAMILY HC SITE 3 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTER'S OPERATING FACILITIES. Schedule H, Part V, Section B, Line 14-JOSEPH P ADDABBO FAMILY HC SITE 5 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTER'S OPERATING FACILITIES Schedule H, Part V, Section B, Line 14-JOSEPH P ADDABBO FAMILY HC SITE 6 NEEDS ASSESSMENT WAS CONDUCTED WITH ALL FIVE OF THE CENTERS OPERATING FACILITIES Schedule H, Part V, Section B, Line 22-JOSEPH P ADDABBO FAMILY HC SITE 1 THE STANDARD GROSS CHARGE OF $195.00 IS CHARGED TO ALL PATIENTS. CONTRACTUAL ALLOWANCES AS REQUIRED BY CERTAIN THIRD PARTY PAYORS ( SUCH AS MEDICARE AND MEDICAID), IS APPLIED AND IN THE CASE OF UNINSURED PATIENTS, THE SLIDING FEE SCALE ALLOWANCE, BASED ON THE POVERTY GUIDELINE IS APPLIED. Schedule H, Part V, Section B, Line 22-JOSEPH P ADDABBO FAMILY HC SITE 2 THE STANDARD GROSS CHARGE OF $195.00 IS CHARGED TO ALL PATIENTS. CONTRACTUAL ALLOWANCES AS REQUIRED BY CERTAIN THIRD PARTY PAYORS (SUCH AS MEDICARE AND MEDICAID) ARE APPLIED AND IN THE CASE OF UNINSURED PATIENTS, THE SLIDING FEE SCALE ALLOWANCE, BASED ON THE POVERTY GUIDELINE IS APPLIED. Schedule H, Part V, Section B, Line 22-JOSEPH P ADDABBO FAMILY HC SITE 3 THE STANDARD GROSS CHARGE OF $195.00 IS CHARGED TO ALL PATIENTS. CONTRACTUAL ALLOWANCES, AS REQUIRED BY SOME THIRD PARTY PAYORS (SUCH AS MEDICARE AND MEDICAID) ARE APPLIED AND IN THE CASE OF UNINSURED PATIENTS, THE SLIDING FEE SCALE ALLOWANCE, BASED ON THE POVERTY GUIDELINE IS APPLIED. Schedule H, Part V, Section B, Line 22-JOSEPH P ADDABBO FAMILY HC SITE 5 THE STANDARD GROSS CHARGE OF $195.00 IS CHARGED TO ALL PATIENT. CONTRACTUAL ALLOWANCES AS REQUIRED BY CERTAIN THIRD PARTY PAYORS (SUCH AS MEDICARE AND MEDICAID) ARE APPLIED AND IN THE CASE OF UNINSURED PATIENTS, THE SLIDING FEE SCALE ALLOWANCE, BASED ON POVERTY GUIDELINE IS APPLIED. Schedule H, Part V, Section B, Line 22-JOSEPH P ADDABBO FAMILY HC SITE 6 THE STANDARD GROSS CHARGE OF $195.00 IS CHARGED TO ALL PATIENTS. CONTRACTUAL ALLOWANCES AS REQUIRED BY CERTAIN THIRD PARTY PAYORS (SUCH AS MEDICARE AND MEDICAID) ARE APPLIED AND IN THE CASE OF UNINSURED PATIENTS, THE SLIDING FEE SCALE ALLOWANCE, BASED ON POVERTY GUIDELINE IS APPLIED. Schedule H, Part I, Line 7 THIS INFORMATION HAS BEEN EXTRACTED FROM FOOTNOTE #9 OF THE ORGANIZATIONS 2013 AUDITED FINANCIAL STATEMENTS. Schedule H, Part I, Line 7, Column f THE AMOUNT OF BAD DEBT EXPENSE FOR 2013 IS $2,619,404 INCLUDED IN FORM 990, PART IX STATEMENT OF FUNCTIONAL EXPENSES, LINE 25 HAS NOT BEEN SUBTRACTED OR REFLECTED ON SCHEDULE H, PART I LINE 7. Schedule H, Part I, Line 7g ALL BENEFIT COST ARE REPORTED ON LINES 7A AND 7B Schedule H, Part III, Section A, Line 4 ALLOWANCE FOR DOUBTFUL ACCOUNTS-PATIENT SERVICES RECEIVABLE IS REPORTED AT ITS OUTSTANDING BALANCE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIVITY OF THE PATIENT SERVICES RECEIVABLE, THE CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBT. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WITH THIRD-PARTY COVERAGE, MEDICAID, MEDICARE, THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS TO DETERMINE THE ADEQUATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLE ASSOCIATED WITH SELF-PAY PATIENTS, THE CENTER RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY A PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE CONTRACTUAL RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE EFFORTS ARE EXHAUSTED ARE CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Section B, Line 8 MEDICARE COST OF $901,325.00 WAS OBTAINED FROM THE 2013 MEDICARE COST REPORT SUBMITTED TO CMS. FOR 2013, OUR ORGANIZATION PROVIDED SERVICES TO 8,802 MEDICARE PATIENTS AT A STANDARD CHARGE OF $195.00 PER VISIT. MEDICARE WAS BILLED $2,182,922.00 OF WHICH WE COLLECTED $569,234.00 FROM MEDICARE (80%) AND THE MEDICARE PATIENT (20% CO-PAY). THE NET LOSS OF $815,065 WAS REPORTED AS A COMMUNITY BENEFIT ON SCHEDULE H, PART I, LINE 7A. Schedule H, Part III, Section C, Line 9b THE HEALTH CENTER SUPPORTS A PROGRAM TO ENROLL THESE INDIVIDUALS INTO PUBLIC INSURANCE PROGRAMS. Schedule H, Part VI, Line 2 AS A FEDERALLY QUALIFIED HEALTH CENTER, FIFTY ONE PERCENT (51%) OF OUR BOARD MEMBERS ARE REQUIRED TO BE MEMBERS OF THE COMMUNITY WE SERVE AND PATIENTS OF OUR HEALTH CENTER. AS SUCH, THESE COMMUNITY MEMBERS BRING COMMUNITY NEEDS TO OUR MONTHLY BOARD MEETINGS AND SUBSEQUENTLY, THE MANAGEMENT TEAM IS INSTRUCTED TO ACT UPON THIS NEEDS. Schedule H, Part VI, Line 3 THE CENTER SUPPORTS A PROGRAM CALLED "CONSUMER ASSISTANCE FOR THE NY HEALTH BENEFIT EXCHANGE: IN PERSON ASSISTORS AND NAVIGATORS. THIS PROGRAM ASSIST PATIENTS IN ENROLLING IN AVAILABLE PUBLIC INSURANCE PROGRAMS. Schedule H, Part VI, Line 4 AS A FEDERALLY QUALIFIED HEALTH CENTER, THE COMMUNITIES SERVED BY THE HEALTH CENTER IS DETERMINED BY THE FEDERAL GOVERNMENT, DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS). ALL HEALTH CENTER LOCATIONS MUST BE LOCATED IN COMMUNITIES DESIGNATED AS EITHER BEING A MEDICALLY UNDERSERVED AREA (MUSA) OR A HEALTH PROVIDER SHORTAGE AREA (HPSA). X X X X 0 0 0 0 0 0 0 0 0 ROBERT FLIEGEL CPA ACTING CHIEF EXECUTIVE OFFICER 217585 0 20000 0 0 0 14531 0 4064 0 256180 0 228154 0 ALFONSO YU CHAN MD CHIEF MEDICAL OFFICER 273175 0 0 0 0 0 19122 0 4064 0 296361 0 288724 0 JINPIN YING PHD CHIEF INFORMATION OFFICER 214732 0 0 0 0 0 15031 0 4064 0 233827 0 227407 0 CHARITY NELSON ABDI JD CORPORATE COMPLIANCE OFFICER 136651 0 0 0 0 0 9566 0 4064 0 150281 0 136779 0 NATHALIE RIGAUD MD ASSOCIATE MEDICAL DIRECTOR 208454 0 0 0 0 0 14592 0 2316 0 225362 0 212479 0 CHIN SONG CHEN MD MD FAMILY PRACTICE 221731 0 24514 0 0 0 17237 0 2316 0 265798 0 250485 0 ABDUL AKHAND MD MD FAMILY PRACTICE 223683 0 0 0 0 0 15658 0 0 0 239341 0 243048 0 ROBERTA HELLMAN MD MD PSYCHIATRIST 194747 0 0 0 0 0 13632 0 2316 0 210695 0 212712 0 EDDIE GO MD MD INFECTIOUS DISEASE 189698 0 0 0 0 0 13279 0 900 0 203877 0 197120 0 MALLIKHARJANUDU KALEPU MD MD FAMILY PRACTICE 186403 0 0 0 0 0 13048 0 4064 0 203515 0 198608 0 CHARITY NELSON-ABDI JD DAUGHTER OF FORMER CEO 136651 SALARY & FRINGE FOR CORPORATE COMPLIANCE OFFICER 0 Form 990, Part VI, Section A, Line 2 AS DISCLOSED ON SCHEDULE L, PART VI, CHARITY NELSON-ABDI JD, CORPORATE COMPLIANCE OFFICER, IS THE DAUGHTER OF FORMER CHIEF EXECUTIVE OFFICER, JR PETER NELSON, PHD. Form 990, Part VI, Section B, Line 11b PRIOR TO THE SUBMISSION TO THE INTERNAL REVENUE SERVICE, A COPY OF THE FORM 990 AND SUPPORTING SCHEDULES WERE PROVIDED TO EACH MEMBERS OF THE GOVERNING BODY FOR THEIR REVIEW AND COMMENTS. THE DOCUMENT IS ALSO PROVIDED TO OUR EXTERNAL AUDITORS FOR THEIR REVIEW. AFTER FILING, COPIES ARE PROVIDED TO OUR FEDERAL AND STATE REGULATORS. Form 990, Part VI, Section B, Line 12c THE ORGANIZATION MAINTAINS A CONFLICT OF INTEREST POLICY THAT IS PERIODICALLY DISTRIBUTED TO THE BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES. SUCH POLICY ASKS THAT THE INDIVIDUAL CERTIFY THAT THEY HAVE RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTAND THE POLICY AND AGREES TO COMPLY, POLICY NOT ONLY COVERS THE INDIVIDUAL BUT ALSO ASKS FOR DISCLOSURE AS TO ANY IMMEDIATE FAMILY MEMBERS AND POSSIBLE FINANCIAL RELATIONSHIP OR TRANSACTIONAL CONFLICTS. THESE CERTIFICATIONS ARE KEPT IN THE FILE WITH EITHER HUMAN RESOURCES OR THE EXECUTIVE SECRETARY (FOR BOARD MEMBERS ONLY). Form 990, Part VI, Section B, Line 15 COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER IS DETERMINED BY THE BOARD OF DIRECTORS USING DATA PROVIDED BY INDEPENDENT COMPENSATION CONSULTANTS, THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC), HEALTH CENTER COMPENSATION AND BENEFITS REPORT AND ALSO COMPARATIVE COMPENSATION DATA OBTAINED FROM NEIGHBORING HEALTH CENTERS NOT-FOR-PROFIT FORM 990'S. COMPENSATION FOR OTHER STAFF MEMBERS IS DETERMINED BY THE CHIEF EXECUTIVE OFFICER USING THE SAME DATA. Form 990, Part VI, Section C, Line 19 THE INFORMATION IS AVAILABLE TO ANYONE ON REQUEST. ADDITIONALLY, THE FORM 990 IS FILED WITH THE NEW YORK STATE DEPARTMENT OF LAW WHICH POST THE INFORMATION ON THEIR WEBSITE FOR THE CHARITIES REGISTRATION BUREAU. FURTHERMORE, THIS INFORMATION IS PROVIDED TO OUR BOARD OF DIRECTORS, FIFTY ONE PERCENT OF WHICH ARE REQUIRED BY FEDERAL LAW TO BE MEMBERS OF THE COMMUNITY WE SERVE AND USERS OF THE HEALTH CENTER.