2011-04-11T18:42:19-05:00 2010-06-30 ParenteBeard LLC 46 Public Square Suite 400 WilkesBarre PA 18701 990 2009-07-01 237354899 CHESPENN HEALTH SERVICES INC CHES 6104853800 2600 WEST 9TH STREET 2 NORTH CHESTER PA 19013 Michael G Lucas 6104853800 2011-03-31 1 Julius Green CPA 5708200100 2009 2016-02-24 21:20:13Z MICHAEL G LUCAS 2600 WEST 9TH STREET 2 NORTH CHESTER PA 19013 8677262 0 X WWW.CHESPENN.COM X 1973 PA OPERATES FOUR COMPREHENSIVE HEALTH CENTERS LOCATED IN CHESTER AND DELAWARE COUNTIES. 17 17 104 0 0 0 2247223 2856071 5303293 5798455 18067 22736 0 7568583 8677262 0 0 4235885 4717145 0 8917 2767604 3242467 7003489 7959612 565094 717650 4462017 5087449 773400 681182 3688617 4406267 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 FEE SCALE. CHESPENN HEALTH SERVICES STRIVES TO MEET THE UNIQUE HEALTH NEEDS IN ITS COMMUNITIES IN LINGUISTICALLY AND CULTURALLY COMPETENT WAYS. 0 0 6646023 5798455 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. 6646023 1 1 0 0 0 0 0 0 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 20 0 1 104 1 0 0 0 0 0 0 0 17 17 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 0 PA X Daniel A Caplan 6104853800 2600 West 9th Street 2 North Chester PA 19013 WILLIE MAE WELLS 1.00 X X 0 0 0 MITCHELL A KAMINSKI MD 1.00 X X 0 0 0 RAE ROEDER 1.00 X X 0 0 0 JOAN RICHARDS 1.00 X X 0 0 0 SHANA M HIGGS 1.00 X 0 0 0 NEYDARY ZAMBRANO 1.00 X 0 0 0 REGINA HORTON 1.00 X 0 0 0 KAREN LOCKE 1.00 X 0 0 0 ANTHONY HALL 1.00 X 0 0 0 DONNA LAWLER 1.00 X 0 0 0 CAROL ALLEN 1.00 X 0 0 0 ELAINE GREENE-UPTON 1.00 X 0 0 0 ERNESTINE DENNIS 1.00 X 0 0 0 C DALE DICKERSON 1.00 X 0 0 0 JEFFREY GREEN 1.00 X 0 0 0 GWEN SMITH 1.00 X 0 0 0 LAVADA DRIGGINS 1.00 X 0 0 0 MICHAEL G LUCAS 40.00 X 178110 0 22544 REKHA YAGNIK MD 40.00 X 196139 0 15874 SALUD TIRO MD 40.00 X 138046 0 13118 MARINA SIGIDIN MD 40.00 X 145914 0 16524 RAQUIBUL ISLAM MD 40.00 X 133430 0 15534 SARWAT JAHAN MD 40.00 X 129820 0 12247 921459 0 95841 6 0 1 0 Coordinated Care Network 300 Penn Center Blvd Pittsburgh PA 15235 Contracted Pharmacy Services 685090 Health Access Network One Medical Center Blvd Upland PA 19013 Contracted Physician Services 232305 Crozer-Keystone Health System 100 West Sproul Rd Pavilion II Management Financial PA 19064 Management & Financial Services Agreemen 181986 McKesson Medical PO Box 933027 Atlanta GA 31193 Medical Equipment & Suplies 121449 4 81818 2141754 632499 2856071 Net Patient Service Re 621400 5798455 5798455 5798455 22736 22736 8677262 5798455 0 22736 200654 200654 3706938 3344583 355134 7221 151140 133568 17194 378 364548 311728 51957 863 293865 259816 33594 455 181986 181986 6541 6541 41490 41490 399989 339615 60374 3842 3842 357877 289532 68345 180862 62074 118788 705902 627160 78742 41048 26319 14729 1173 1173 256969 243273 13696 12080 7313 4767 PATIENT CARE 834598 828681 5917 PROVISION FOR DOUBTFUL 155377 155377 DUES AND SUBSCRIPTIONS 40209 5708 34501 MISCELLANEOUS 11951 9410 2541 SERVICE CHARGES 8748 1061 7687 1825 805 1020 7959612 6646023 1304672 8917 45128 60190 1438087 1809306 137322 179471 211580 195385 43993 32490 64612 70915 4439735 1995639 2320431 2444096 200864 295596 4462017 5087449 689744 664932 20000 16250 63656 773400 681182 X 3688617 4406267 3688617 4406267 4462017 5087449 X 0 1 1 X 1 1 X 1976050 1979522 2167512 2247223 2856071 11226378 1976050 1979522 2167512 2247223 2856071 11226378 11226378 15853 33851 23262 18067 22736 113769 11340147 22107333 0.99000 0.99070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100838 100838 2663637 831211 1832426 344194 29434 314760 1265245 1105968 159277 65821 29026 36795 2444096 SECURITY DEPOSITS 7525 Estimated third-party payor settlements 288071 295596 8677262 7959612 717650 0 717650 8677262 0 8677262 0 8677262 7959612 0 7959612 0 7959612 Part X: Description of Uncertain Tax Positions Under FIN 48: The Corporation is a not-for-profit entity as described in Section 501(c) (3) of the Internal Revenue Code and is exempt from federal income taxes on its exempt income under Section 501(a) of the Internal Revenue Code. The Corporation is also exempt from state and local income taxes under similar statutes. Accordingly, no provision for income taxes has been recorded in the accompanying financial statements. 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 UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2010. X X X 0 0 0 0 0 0 0 0 0 MICHAEL G LUCAS 157260 0 20850 0 0 0 10742 0 11802 0 200654 0 0 0 REKHA YAGNIK MD 193958 0 2181 0 0 0 9807 0 6067 0 212013 0 0 0 SALUD TIRO MD 136484 0 1562 0 0 0 6902 0 6216 0 151164 0 0 0 MARINA SIGIDIN MD 144305 0 1609 0 0 0 7296 0 9228 0 162438 0 0 0 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 PRESENTED 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 15a 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 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 market compensation. 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 XI, LINE 2C: THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT IS RESPONSIBLE FOR OVERSIGHT DURING THE AUDIT As well as for the SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. 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 fiscal year 2011.