2022-10-31T10:05:38-05:00 2021-12-31 221478099 COHNREZNICK LLP 1301 AVENUE OF THE AMERICAS NEW YORK NY 10019 990 2021-01-01 132739694 CHARLES B WANG COMMUNITY HEALTH CENTER INC CHAR 2123796988 268 CANAL STREET NEW YORK NY 10013 KAUSHAL CHALLA CEO 2123796988 2022-10-31 1 KAUSHAL CHALLA 999009999 LORI ROTHE YOKOBOSKY CPA P01273422 2122970400 2022-10-07 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z KAUSHAL CHALLA 268 CANAL STREET NEW YORK NY 10013 118467923 0 X WWW.CBWCHC.ORG X 1972 NY PROVIDE HIGH QUALITY AND AFFORDABLE HEALTH CARE TO THE UNDERSERVED, WITH A FOCUS ON ASIAN AMERICANS. 16 15 615 20 0 0 14437767 25347980 41021157 49661019 1316195 40256764 3709740 3202160 60484859 118467923 0 0 0 0 45186342 48811445 0 0 0 13438553 14610333 58624895 63421778 1859964 55046145 53115826 110483270 15717126 17090123 37398700 93393147 PROVIDE HIGH QUALITY AND AFFORDABLE HEALTH CARE TO THE UNDERSERVED, WITH A FOCUS ON ASIAN AMERICANS. 0 0 54127369 52863179 THE ORGANIZATION OPERATED A FEDERALLY QUALIFIED HEALTH CENTER, WHICH HAD 258,607 VISITS IN 2021. 54127369 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0 0 1 1 0 0 0 1 32 0 1 615 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X LYNN D SHERMAN 2123796988 268 CANAL STREET NEW YORK NY 10013 CHUEN L YEE MD BOARD MEMBER 2.00 X 0 0 0 EMILY WOO OUTGOING BOARD MEMBER 2.00 X 0 0 0 HYOSEONG N KIM DEPUTY CHIEF MEDICAL OFFICER 35.00 X X 245562 0 15803 IRENE CHU BOARD MEMBER 2.00 X 0 0 0 JEANNE LEE JACKSON OUTGOING BOARD MEMBER 2.00 X 0 0 0 JIMING LIANG OUTGOING CHAIRPERSON 3.00 1.00 X X 0 0 0 KENNY CHIN ESQ BOARD MEMBER 2.00 X 0 0 0 KITTY CHEN BOARD MEMBER 2.00 X 0 0 0 LESLIE CHUANG MD BOARD MEMBER 2.00 X 0 0 0 LINH MY AN BOARD MEMBER 2.00 X 0 0 0 MARIE LAM VICE-CHAIRPERSON 3.00 1.00 X X 0 0 0 MARY AGNES PAN TREASURER 3.00 X X 0 0 0 OWH KIAN ONG CHAIRPERSON 4.00 X X 0 0 0 PAULINE TSE BOARD MEMBER 2.00 X 0 0 0 PHILIP CHONG JR BOARD MEMBER 2.00 X 0 0 0 REGINA LEE BOARD MEMBER 2.00 X 0 0 0 YVONNE GHAW BOARD MEMBER 2.00 X 0 0 0 SOPHIA NG TSAO BOARD MEMBER 2.00 X 0 0 0 STEPHANIE CHENG SECRETARY 3.00 X X 0 0 0 VICKI TSE MD BOARD MEMBER 2.00 X 0 0 0 VICTOR LEE BOARD MEMBER 2.00 1.00 X 0 0 0 BETTY K CHENG EXECUTIVE VP & COO 35.00 X 286703 0 41932 DE YOUNG CHAN CFO 35.00 X 214039 0 15603 KAUSHAL CHALLA CHIEF EXECUTIVE OFFICER 34.00 1.00 X 404492 0 18112 KENNETH SHIEH CHIEF STRATEGY OFFICER 35.00 X 228091 0 17106 LYNN D SHERMAN EVP FINANCE, IT, CAPITAL PROJECTS & HR 34.00 1.00 X 332154 0 42866 PERRY PONG MD EXECUTIVE VP & CMO 35.00 X 326440 0 42549 CHRISTINE J SHEN MD SENIOR PEDIATRICIAN LEVEL II 35.00 X 303943 0 32866 DU CHU WU MD SENIOR INTERNIST LEVEL II 35.00 X 320828 0 39030 JIAN-PING CHEN MD DIRECTOR OF MENTAL HEALTH 35.00 X 356258 0 40969 JIEYING SHEN MD SENIOR PEDIATRICIAN LEVEL II 35.00 X 379039 0 34395 SAMUEL CWONG MD CHIEF OF OB/GYN, QUEENS 35.00 X 281028 0 40483 3678577 0 381714 53 0 1 0 COHNREZNICK LLP 1301 AVENUE OF THE AMERICAS 7TH FL NEW YORK NY 10019 AUDIT/TAX SERVICES 120067 AFRICAN SERVICES COMMITTEE INC 429 WEST 127TH ST NEW YORK NY 10027 HEP B SCREENING AND EDUCATION 104200 2 22920375 2427605 1479043 25347980 NEW YORK STATE MEDICAID MANAGED C 621400 20895000 20895000 MANAGED CARE PLANS 621400 10973053 10973053 PRIVATE INSURANCE 621400 9651103 9651103 NEW YORK STATE UNCOMPENSATED CARE 621400 3016830 3016830 MEDICAID 621400 2963842 2963842 2161191 2161191 49661019 136764 136764 40120000 0 40120000 40120000 40120000 HEALTH PLAN QUALITY DISTRIBUTION 900099 2760346 2760346 MANAGEMENT SERVICES FEES 900099 256666 256666 METROCARD REIMBURSEMENT 900099 91449 91449 93699 93699 3202160 118467923 52863179 0 40256764 2231453 1913316 318137 36963991 31694056 5269935 1627966 1395868 232098 6050596 5187967 862629 1937439 1661219 276220 88137 88137 136550 136550 1009826 430340 579486 665547 570661 94886 4490973 3882093 608880 102847 79429 23418 61087 47176 13911 62954 62954 1136171 982131 154040 201260 58333 142927 PHARMACEUTICALS 1786706 1786706 DONATED VACCINES 1479043 1479043 CONSUMABLE SUPPLIES 1205080 1058051 147029 EQUIPMENT RENTAL AND MA 657576 569597 87979 1526576 1331383 195193 63421778 54127369 9294409 0 631547 1197665 19880184 75119500 1829985 1858058 6841377 6346605 498583 628643 32038622 21828643 10685238 10209979 4814402 5818313 7934510 9304507 53115826 110483270 8316235 8585757 7400891 8504366 15717126 17090123 X 35665367 91325147 1733333 2068000 37398700 93393147 53115826 110483270 55046145 948302 0 X X 0 1 X 1 1 1 X 11305626 9956616 23642685 14437767 25347980 84690674 50998159 51043741 49091404 41021157 49661019 241815480 62303785 61000357 72734089 55458924 75008999 326506154 45000 134130 546000 30020 755150 0 45000 134130 546000 30020 755150 325751004 196358 241293 249235 115181 136764 938831 196358 241293 249235 115181 136764 938831 3664723 3990292 4027809 3709740 3202160 18594724 66164866 65231942 77011133 59283845 78347923 346039709 0.94140 0.93610 0.00270 0.00310 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: HEALTH PLAN QUALITY DISTRIBUTION - 2017 AMOUNT: $ 2,796,726. 2018 AMOUNT: $ 3,349,768. 2019 AMOUNT: $ 3,269,299. 2020 AMOUNT: $ 3,244,295. 2021 AMOUNT: $ 2,760,346. MEANINGFUL USE INCENTIVE - 2017 AMOUNT: $ 212,500. MANAGEMENT SERVICES FEES - 2017 AMOUNT: $ 259,436. 2018 AMOUNT: $ 264,939. 2019 AMOUNT: $ 238,903. 2020 AMOUNT: $ 257,532. 2021 AMOUNT: $ 256,666. METROCARD REIMBURSEMENT - 2017 AMOUNT: $ 319,091. 2018 AMOUNT: $ 306,053. 2019 AMOUNT: $ 277,343. 2020 AMOUNT: $ 107,899. 2021 AMOUNT: $ 91,449. MEDICAL RECORDS CHARGES - 2017 AMOUNT: $ 45,559. 2018 AMOUNT: $ 54,190. 2019 AMOUNT: $ 62,910. 2020 AMOUNT: $ 40,454. 2021 AMOUNT: $ 42,273. OTHER - 2017 AMOUNT: $ 31,411. 2018 AMOUNT: $ 15,342. 2019 AMOUNT: $ 179,354. 2020 AMOUNT: $ 59,560. 2021 AMOUNT: $ 51,426. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 21013357 11835803 9177554 10578572 9992840 585732 446693 446693 10209979 SECURITY DEPOSITS 1055506 DEFERRED COMPENSATION ACCOUNT 8249001 9304507 DEFERRED COMPENSATION PAYABLE 8249001 DEFERRED RENT 255365 8504366 X 119430996 948302 14771 963073 118467923 0 118467923 63492438 70660 70660 63421778 0 63421778 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2021. THE CENTER'S FEDERAL AND STATE INCOME TAX RETURNS PRIOR TO FISCAL YEAR 2018 ARE CLOSED, AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. THE CENTER RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH TAX MATTERS AS OPERATING EXPENSES AND INCLUDES ACCRUED INTEREST AND PENALTIES WITH ACCRUED EXPENSES IN THE STATEMENT OF FINANCIAL POSITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: RELATED ORGANIZATION REVENUE 14,771. PART XII, LINE 2D - OTHER ADJUSTMENTS: RELATED ORGANIZATION EXPENSES 70,660. PART XII, LINE 4B - OTHER ADJUSTMENTS: DONATIONS TO HEALTHVIEW CBWCHC INC X X X X 0 0 0 0 0 0 0 0 0 KAUSHAL CHALLA CHIEF EXECUTIVE OFFICER 404252 0 0 0 240 0 17400 0 712 0 422604 0 0 0 JIEYING SHEN MD SENIOR PEDIATRICIAN LEVEL II 378007 0 0 0 1032 0 9746 0 24649 0 413434 0 0 0 JIAN-PING CHEN MD DIRECTOR OF MENTAL HEALTH 355226 0 0 0 1032 0 17400 0 23569 0 397227 0 0 0 LYNN D SHERMAN EVP FINANCE, IT, CAPITAL PROJECTS & 330570 0 0 0 1584 0 17400 0 25466 0 375020 0 0 0 PERRY PONG MD EXECUTIVE VP & CMO 324856 0 0 0 1584 0 17400 0 25149 0 368989 0 0 0 DU CHU WU MD SENIOR INTERNIST LEVEL II 319796 0 0 0 1032 0 12221 0 26809 0 359858 0 0 0 CHRISTINE J SHEN MD SENIOR PEDIATRICIAN LEVEL II 303391 0 0 0 552 0 9297 0 23569 0 336809 0 0 0 BETTY K CHENG EXECUTIVE VP & COO 284078 0 0 0 2625 0 17259 0 24673 0 328635 0 0 0 SAMUEL CWONG MD CHIEF OF OB/GYN, QUEENS 280476 0 0 0 552 0 16914 0 23569 0 321511 0 0 0 HYOSEONG N KIM DEPUTY CHIEF MEDICAL OFFICER 245202 0 0 0 360 0 14564 0 1239 0 261365 0 0 0 KENNETH SHIEH CHIEF STRATEGY OFFICER 227731 0 0 0 360 0 13649 0 3457 0 245197 0 0 0 DE YOUNG CHAN CFO 213007 0 0 0 1032 0 12690 0 2913 0 229642 0 0 0 CENTRE COURT HOLDINGS LLC IRENE CHU, BOARD MEMBER, HAS FINANCIAL INTEREST IN CENTRE COURT HLDNGS LLC 714268 RENT 0 X 1 1479043 FMV 0 0 0 PART I, COLUMN (B): COLUMN B REPRESENTS NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION B, LINE 11B COPIES OF THE FORM 990 ARE DISTRIBUTED THE BOARD OF DIRECTORS. IT IS REVIEWED BY SENIOR MANAGEMENT, INCLUDING THE CEO AND CFO, AND DISTRIBUTED TO THE BOARD OF DIRECTORS BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S DIRECTORS, OFFICERS AND KEY EMPLOYEES SIGN DISCLOSURE STATEMENTS ANNUALLY. THE BOARD DEVELOPMENT COMMITTEE AND AUDIT COMMITTEE ARE RESPONSIBLE FOR MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IN THE EVENT A CONFLICT EXISTS, THE INDIVIDUAL WITH THE CONFLICT MUST RECUSE HIMSELF/HERSELF FROM ANY DELIBERATION AND VOTING REGARDING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A ANNUALLY, THE COMPENSATION COMMITTEE OF THE BOARD REVIEWS AND EVALUATES THE PRESIDENT AND CEO AND DECIDES ON COMPENSATION. INFORMATION FROM OUTSIDE CONSULTANTS ON COMPARABLE SALARIES OF SIMILAR ORGANIZATIONS MAY BE USED IN THEIR DETERMINATION. SALARIES FOR OTHER OFFICERS & KEY EMPLOYEES ARE DETERMINED BY THE PRESIDENT AND CEO, USING SALARY SURVEYS WITH INFORMATION FROM OTHER HEALTH CENTERS, AS WELL AS EMPLOYEE ANNUAL EVALUATIONS. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR PERIOD PROCESS. HEALTHVIEW CBWCHC INC 268 CANAL STREET NEW YORK NY 10013 822560880 PROVIDE SUPPORT TO CHARLES B. WANG COMMUNITY HEALTH CENTER, INC. NY 501(C)(3) LINE 12A, I CHARLES B WANG COMMUNITY HEALTH CENTER INC 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0