Ryan Annual Report 2007-2008 - The William F. Ryan Community ...

40 YEARS OF HEALTHCARE, 40 YEARS OF HEALTHY NEW YORKERS2007–2008 ANNUAL REPORT

WILLIAM F. RYANBOARD OF DIRECTORSBobbie Maniece-Harrison, EdD, ChairGeorge Dunbar, TreasurerAlan Goldstein, DDS, SecretaryE. Ronald Guy, Vice ChairArnaldo BarronAnne CantyHarriet Chan King, EsqAnn MaldonadoHope Mason, MPAHector PereiraAngel Roman, MBAValeria Spann, MSSWMilta Zeno, CSWRYAN/CHELSEA-CLINTONBOARD OF DIRECTORSWalter Delacruz, Esq, ChairDeidre Anderson, SecretaryBeth Goldstein-McCusker, TreasurerMichael Williams, MSW, Vice ChairAnne CantyE. Ronald GuyBobbie Maniece-Harrison, EdDHector PereiraSherrie Santore, RNMISSIONThe William F. Ryan Community Health Network is dedicatedto providing high quality, affordable, comprehensive,linguistically appropriate and culturally competent healthcareservices to medically underserved populations.All patients are treated equally with dignity, respect,courtesy, confidentiality, and concern for safety.“Healthcare is a right, not a privilege.”VISIONThe William F. Ryan Community Health Network is committedto maintaining its role as an essential community-based providerand leader in the Community Health Center movement. As a teamof dedicated individuals, the staff of the William F. Ryan CommunityHealth Network is responsive to the needs of the community andcontinually enhances and improves services in order to ensurethe highest quality of care.

FIRSTPAGE A TRADITION OF COMMUNITY-BASED LEADERSHIPDEAR FRIENDS,The William F. Ryan Community Health Network marked a major milestonethis year, celebrating its 40th year of service to New Yorkers in need! On thisspecial occasion, we proudly look back on where we began, and how ourfounding principles live on in our work today:• Offering High Quality Healthcare• Meeting Community Needs• Creating Healthy NeighborhoodsThe Ryan Center began in 1967 as the Mid-West Side Neighborhood HealthCouncil, a small clinic on the Upper West Side of Manhattan. Its establishmentwas a bold act, demonstrating the power of a community taking direct steps toimprove life for its residents.Forty years later, the Ryan Network has grown to encompass 16 sites inManhattan, making it one of the largest Community Health Center networksin the nation and amodel of culturallyand linguisticallycompetent, quality,cost effectivehealthcare. Servicesites include threemajor healthcenters, fiveSchool-BasedHealth Centers,William F. Ryan & Ryan-NENA Communityfive CommunityHealth Center Board of DirectorsHealth OutreachProgram homelessclinics, and two fully-equipped medical vans. Every expansion Ryan hasundertaken was to meet the needs of our communities, which includeUpper Manhattan, Chelsea-Clinton and the Lower East Side.The patients we serve not only turn to us for their own healthcare needs,but also participate as members of our Board of Directors and AdvisoryCommittees. Our single most important mandate is to uphold Ryan’s visionthat healthcare is a right,not a privilege.We are so pleased to havethis opportunity to tell theRyan story — of ourpatients, our Board, ourstaff, our communities,and our supporters —all working together toimprove access to careand to improve quality oflife in the neighborhoodswhere we live and work.Ryan/Chelsea-Clinton CommunityEvery day, we incorporateHealth Center Board of Directorsour core values ofInnovation, Dignity, Education, Community and Loyalty into each and everyactivity we undertake. These values touched the lives of more than 42,000individuals this past year, an increase of2,000 patients since 2007.Ryan’s President & CEO,Barbra E. MinchJoin us now as we celebrate 40 years ofservice and help us chart the path for thenext 40! While our needs have never beengreater, the spirit of Ryan’s original visionlives on every day for each child, familyand neighborhood we serve.Thank you for being part of the RyanNetwork Family.

“HEALTHCARE IS A RIGHT, NOT A PRIVILEGE“These are the words of Ryan’s namesake, the late Congressman William F.Ryan. At the foundation of its mission, the Ryan Network provides qualityhealthcare to whomever walks in the door, regardless of his or her ability to pay,and with regard to the patient as a person – not as a number or a disease.The Ryan Center is one of the nation’s largest and oldest Community HealthCenters, serving thousands of patients annually. Ryan dedicates itself to servinghard-to-reach individuals, those with few financial resources, those who donot speak English, and those with multiple and special healthcare needs.THE RYAN NETWORKFederally-qualified Community Health Centers provide high quality primary and preventive healthcare services,including medical, dental, eye, and specialty services, to medically underserved and uninsured children, adultsand seniors.School-Based Health Centers provide primary healthcare, individual and group mental health services, socialwork, and health education to youth enrolled in local public schools.Community Health Outreach Program homeless clinics provide primary healthcare, substance abusecounseling, HIV counseling and testing, and individual and group mental health services to homeless familiesand single adults at local shelters.Special Health Outreach to Urban Teens (SHOUT) Mobile Medical Van provides primary healthcare, counselingand testing, case management, mental health counseling, and health education to HIV positive and at-riskyouth ages 13-24.Health on the Move Mobile Medical Van is a “medical center on wheels” that provides local communities withconvenient, one-stop primary and preventive healthcare services.The Ryan Annex houses Ryan’s Prevention Education and Outreach Services, HIV Support Services, MentalHealth Department, and Nutrition and WIC (Women, Infants and Children) Program.Thelma Adair Medical/Dental Center – coming Summer 2009!The Women and Children’s Health Center –coming early 2010!

WHO WE SERVEThe Ryan Network service area is characterized by ethnic, cultural, and racialdiversity and includes some of the poorest neighborhoods in New York—Upper Manhattan, Chelsea-Clinton and theLower East Side of Manhattan.Ryan’s neighborhoods are home to largenumbers of Latino, African American,Caribbean, and East African people ofcolor. In addition, countless numbersof newly arrived immigrants from theDominican Republic, Mexico, Haiti, China,ESoutheast Asia, the Caribbean, Africa, and Central and South America, many ofwhom are undocumented, also utilize the Network’s services.Most of Ryan’s patients are among the most disadvantaged members ofthe surrounding communities. Almost 90 percent of the patients fall below200 percent of the federally defined poverty level and 35 percent are uninsured.At a time when rapidly increasing unemployment has led to massive loss ofinsurance coverage, Ryan becomes a lifeline. Patient Patrick Fanelli, wholost his health insurance as a result of a corporate merger, considers “Ryana blueprint for healthcare in America, because anyone can walk through thedoor and get the care they deserve.”PATIENTSVISITS20,00015,00010,0005,0000MALE0-195,953PATIENT AGE & GENDER2008FEMALE0-196,678MALE20+11,450FEMALE20+ TOTAL17,997 42,07845,00040,00035,00030,00025,00020,00015,00010,0005,000034,592 42,0782005 2008220,000200,000180,000160,000140,000120,000100,00080,00060,00040,00020,00002213,342 219,7502005 2008WHITE19%AFRICAN-AMERICAN22%ETHNIC COMPOSITION OF RYAN’S PATIENTS2008ASIAN3%OTHER7%LATINO49%IUNINSURED34.6%PRIVATE7.1%INSURANCE COVERAGE2008OTHER PUBLIC1.9%MEDICAID45.4%MEDICARE11%

INNOVATIONHIGH-QUALITY MEDICAL HOMESThe Ryan Network’s three Community Health Centers are patient-centeredmedical homes, which are healthcare settings where the practitioner, asthe patient’s first point of contact in the health system, provides coordinatedand comprehensive care. Ryan’s practitioners across the Network saw morethan 42,000 patients last year.Constantly seeking out new ways to deliver coordinated and comprehensivecare is the cornerstone of Ryan’s approach to its patients and the services itprovides. “Innovation is crucial if we are to provide our patients the bestpossible medical care,” says Dr. Daniel Baxter, the Network’s Chief MedicalOfficer. “Electronic health records, improving ‘patient flow’ in our clinics,and empowering patients to become their own advocates—encouragingpatient self-management—are just a few of the ways we try to remain atthe forefront of care at Ryan.”Throughout Ryan’s Network of 16 sites, Performance Improvement Initiativesdrive the staff to strive to increase the patients’ quality of care. Two initiativespresently underway are increasing routine screening rates for cervical, breastand colon cancer and improving pediatric health indicators by decreasinglow birth weights, increasing tests for lead poisoning and increasing thenumber of children who are up to date on their immunizations.Underlying all innovations is Ryan’s facility-wide accreditation by the JointCommission, a widely recognized national healthcare accreditation body.“Joint Commission accreditation speaks volumes to the level of care Ryanprovides throughout the communities we serve,” said Gladys Ramos, RN, theNetwork’s Quality Improvement Manager. “All of us strive to bring the besthealthcare to those who would otherwise go without. We are the healthcaresafety net.”In the aftermath of 9/11, the Ryan Network defined the crucial role thatCommunity Health Centers around the country should play in patient safetyand emergency preparedness. Disaster and biological (avian influenza, SARSand other highly contagious diseases) drills impacted not only Ryan’s patients,but also thousands more in its surrounding neighborhoods.INTEGRATING MENTAL HEALTH AND PRIMARY CAREDental Director Steve Platt, DDS, also chairs theNetwork’s Emergency Preparedness Committee.1967 – A demonstration project funded by the federal Office of Economic Opportunity,the St. Luke’s Hospital Neighborhood Health Services Program opens. Paul Torrens,a Harvard Medical School graduate, is appointed the administrator.“We’ve always been about innovation and about being on the cutting edge,”says Ryan’s President and CEO, Barbra E. Minch. “We started homeless healthcareprograms before there was funding. We decided to address mental health issueswhen others thought it was too big of a challenge. Now, the Health Resourcesand Services Administration is encouraging all the Community Health Centersthroughout the nation to develop and integrate their mental health services withtheir medical practices. We were there at the beginning!”1968 – On the Lower East Side, the NENA Health Council, an independent Community HealthCenter with its own Board of Directors, opens its doors.

TAKING HEALTHCARE TO THE STREETSThe Health on the Move Medical Van is a “medical center on wheels,”according to Charles Shorter, Director of Special Projects at Ryan/Chelsea-Clinton. “We provide people who live, work, or study in our neighborhoodwith convenient, one-stop healthcare services. By collaborating with localcommunity organizations, we strive to maximize healthcare access for themedically-underserved, including seniors, students and the homeless.”“I walked by one day and felt dizzy. I saw they had ahealth fair going on — it was a blessing in disguise. I wasscreened for diabetes right then. If I hadn’t come to Ryanthat day, I’d probably be six feet under. I’m so grateful forthe day I met Dr. Gotlin; he saved my life.“— Michael Whitely, patient at Ryan/Chelsea-Clinton,with Andrew Gotlin, MD, Ryan/Chelsea-Clinton’sMedical Director.The SHOUT (Special Health Outreach to Urban Teens) Van targets at-riskteenagers to make sure they stay healthy. The SHOUT Van provides primaryhealthcare, HIV counseling and testing, case management, mental healthcounseling and health education to HIV-positive and at-risk youth ages 13 to24. “I know that what we’re doing has a strong impact on teens,” says VirginiaKotsonis, a Peer Specialist/Outreach Worker.The Health on the Move Mobile Medical Van.1975 – Janice Robinson, Psychiatric Registered Nurse, is named Director of the St. Luke’sNeighborhood Health Services Program. Soon after, Arnold Braithwaite, a Harvard graduatewith a degree in chemistry and a background in civil rights, becomes president of the Program’sBoard of Directors, which becomes known as the Mid-West Side Neighborhood Health Council.Michael lives in the Bronx but works in the Chelsea-Clinton neighborhoodas a fire safety director. He considers the care he receives at Ryan to beexcellent and wouldn’t go anywhere else. “The staff makes you feel sorelaxed. No one has ever been rude or arrogant—I’ve wondered if they’vebeen handpicked because they are so polite.”1977 – After a decade of growth, the Mid-West Side Neighborhood Health Council and St. Luke’schange their relationship. The Mid-West Side Neighborhood Health Council becomes a separatenonprofit organization, a free-standing healthcare provider governed by its own community-controlledBoard of Directors.

DIGNITYRESPECTING THE MOST VULNERABLE“Our patients come first,” explains Jackie Kingston, RN, the Adult Unit Managerat William F. Ryan. “We set the example. If we care about our patients’ healthand well-being, they will care as well. We want them to have the very bestexperience so that they’re committed to leading and living healthier lives.” TheRyan Network is committed to providing integrated healthcare (physical andmental health). Those with mental illness die on average 25 years earlier thanthe general population, but Ryan works to ensure that the healthcare needs ofindividuals who are suffering from mental illness are addressed. Our patientsroutinely tell us that they like to come to Ryan, because “we are family,” saysFern Fleckman, LCSW, William F. Ryan’s Director of Mental Health. “They feelheard and cared about.”SHOUT Van patients share a smile with actorColin Egglesfield, founder of Shout Out! clothing.THE HOMELESS“We’re committed to providing the most comprehensive care to the homelesspopulation. Everyone deserves to be treated with respect and receive qualityhealthcare, including mental health services,” says William Murphy, Ryan’sSenior Director for Program Services. “Four of our five homeless sites arefamily shelters where there are lots of families with kids. We’re helping thosefamilies stabilize through routine healthcare. We connect them with theWomen, Infants & Children Program, we get the kids immunized so they cango to school, and we help the parents make healthcare a routine part of theirlives again.”Women’s healthcare and pediatrics work closely togetherto keep both moms and their kids happy and healthy.One woman who was an IV drug user and living on the streets entered thecity’s homeless system and ended up pregnant while at a shelter. By enrolling1988 – At the request of the New York State Attorney General and in consultation with federal officials, Ryan assumes management of NENA.The State’s selection of the Ryan Center as the Receiver was a tribute to the Center’s stability, as well as the quality and effectiveness of Board leadership.

in Ryan’s Women’s Health Program, she received the pre-natal care sheneeded and had a healthy baby. Ryan also helped her find work so she couldmove out of the shelter. She now lives on her own in the Bronx and has turnedher life around.“I can’t remember when I’ve heard of case managersgoing to your home, showing genuine concern. The folksat Ryan-NENA have been a wonderful help. They put meon the right track. They’ve even helped me reconnect withmy family.“—Carla Balentine, a patient at Ryan-NENA, picturedwith Marva Greer, NENA’s Director of Prevention,Education, and Outreach.AT-RISK YOUTHAt Ryan’s five School-Based Health Centers, practitioners and staff work withelementary, middle and high school-aged children, teaching them to respecttheir bodies and their health. Ryan’s program reaches over 2,000 students,helping them get regular primary care from providers they trust. “Most ofthe teens we see have questions about their health,” says Linda Mikolay, FNP,the School Health Supervisor. “Many have Chlamydia and other sexuallytransmittedillnesses. It’s our job to provide both treatment and education,to help them make healthy choices and protect themselves.”For many patients, it is the little things that happen when they visit a RyanHealth Center. Paulino Diaz, a patient at Ryan-NENA whose lymphoma wasdiscovered by his primary care provider, says “When I come here, I feel likeI’m going to get taken care of, that they’re going to help me. They return mycalls. I trust them.”When another Ryan-NENA patient, Iris Leon, was diagnosed with HIV she reallybegan to feel what it is to be part of the Ryan family. “They know you by yourname, not a chart number. From the minute I found out about my status, theywere there for me 24/7. Ryan has been with me every step of the way. Mymorale has gone up and I’ve gone back to school to be a medical assistant.I’d love to work at Ryan. They’ve been so wonderful.”“They’ve always treated me like an adult,” said Carla. “I never felt likethings were happening around me here but that I was always a part ofwhat was going on. I’ve always been a part of my treatment...any healthissues that come up have been addressed immediately. I’m afraid otherswill realize how good it is here and then they’ll be swamped.”1988 – Ryan moves to a new state-of the-art facilityon West 97th Street. Bobbie Maniece-Harrison becomesChair of the William F. Ryan Board of Directors.1989 – Organization revenues increase to $10 million. 1994 – The NENA Health Council becomes a formal satellite of theRyan Center and is renamed the Ryan-NENA Community Health Center.Kathy Gruber is promoted to Project Director.

EDUCATIONPATIENT EDUCATIONWhen Fred Siefer first walked through the doors of William F. Ryan, he hadalready lost 30 lbs. in six weeks, had tingling throughout his body and blurredvision. Another health provider gave him a cancer diagnosis but could notpinpoint where it was. A neighbor told Fred to go to Ryan and after a completework-up, Fred found out that he had diabetes, not cancer.Once Fred received his diagnosis, he worked with Ryan’s practitioners andeducators to learn how to manage his condition. “I started going to diabetesclasses. My classmates were old hands at what to do so we focused mostly onme and my issues. Gladys Ramos, the registered nurse who runs the classes, hasbeen an enormous help. Anytime I have a question she either knows the answeror will walk me over to the right person who will give me the answer I need.”Jarrett Kaczmarski, RPA-C, Clinical Care Coordinator at Ryan-NENA,counsels patients to help meet their self-management goals.Fred’s diabetes self-management regimen is part of the Chronic Care Model thatthe Ryan Network employs for patients with diseases such as diabetes, obesity,hypertension, and HIV. Ryan’s Chronic Care Model is integral to the primary carepartnership the practitioners have with all of their patients. The PerformanceImprovement goal for the diabetes Chronic Care Model is to help 45 percent ofpatients maintain a hemoglobin A1c level of less than seven percent, the standardfor successful control of blood glucose. Ryan met and, in most cases, exceededits Diabetes Clinical Indicators in 2008.Debbie Manasseh, RN, Adult Clinical Unit Coordinator, Maria Taveras,Data Entry Clerk, and Elupina Alcantara, Patient Accounts Clerk, at Ryan-NENA.1995 – Barbra E. Minch is appointed Executive Director.Ryan Center’s annual budget grows to $26 million and itspatient population increases to 25,000.1995 – The Special Health Outreach to Urban Teens(SHOUT) Medical Van is launched.1995 – The William F. Ryan Community Health Centeris awarded the Johnson & Johnson Community Health CareProgram Crystal Award, a symbol of excellence in thecommunity health field.

EDUCATING FUTURE HEALTHCARE LEADERS AND PROVIDERSSupporting employees who want to further their own education is integralto the Ryan Network’s philosophy. When Junior Olivera, a Peer Specialistwho promotes HIV/AIDS awareness in the community, first came to Ryanin 2002, he was trying to finish up his bachelor’s degree in social work.“Ryan was very flexible when it came to going to school,” says Junior. “Mysupervisor was willing to work with my schedule, which allowed me to goto school and get my degree. I want to stay here for some time.”“xxxxI came to Ryan and they saved my life. This is areally good place to be part of a family... these folkskeep me on track.“— Fred Siefer, a diabetic patient at William F. Ryan,pictured with Gladys Ramos, RN, William F. Ryan’sDirector of Quality Improvement.In addition, Ryan’s Community HealthCorps and AmeriCorps*VISTA programsgive young adults with an interest in healthcare the opportunity to makea real difference in people’s lives while gaining valuable work experience.Program members assist uninsured women with enrollment in free cancerscreening programs, encourage diabetic patients to set self-managementgoals, participate in outreach events, and enhance services in many otherNetwork programs.Just as the Community HealthCorps and AmeriCorps*VISTA programs helpprospective healthcare providers make their career choices, the Ryan Networkis also a place for medical students and residents to get some of the best onthe ground training. Ryan/Chelsea-Clinton was the first Community HealthCenter in the State to acquire a major teaching hospital’s adult medicineclinic and is now a rotation site for the Roosevelt Hospital Residency Program.“This collaboration between Ryan on the one hand, and Roosevelt Hospitalon the other, shows the kind of long-term, community-oriented thinking thatguides the Ryan Network,” says Walter Delacruz, Esq., Chair of the Ryan/Chelsea-Clinton Board of Directors. “Not only does the Residency programexpand access to care, but it also teaches community health values to a newgeneration of doctors.”1997 – Property for the Ryan/Chelsea-Clinton siteis acquired, and planning begins.1998 – The Entertainment Industry Foundation, which co-sponsorsthe annual Revlon Run/Walk for Women Event, selects Ryan as oneof a small number of grantees. This is the beginning of a decade-longrelationship that continues today.1998 – Ryan is accredited with commendation by the JointCommission, a nationally recognized survey with the higheststandards of quality patient care.

COMMUNITYVOLUNTEER BOARDSThe Board of Directors is what makes a Community Health Center unique.51 percent of board members have to be patients of the Center. Of the 13board members who sit on the Board of the William F. Ryan and Ryan-NENACenters, eight are patients. At Ryan/Chelsea-Clinton, five of the nine boardmembers are patients.“As board members, and patients, we serve as the voice of the community,”says Bobbie Maniece-Harrison, Ed.D., who has served as President of WilliamF. Ryan’s board for the past sixteen years. “Because we live or work in thecommunity, we see what’s going on, what the needs of our community are—we give voice to those needs. We are the stakeholders.”Board members are known in their neighborhoods for facilitating connectionsbetween the three Centers and their communities, and for strengtheningthe Centers’ commitment to serving the uninsured, the underinsured andthe underserved. “I wanted to get involved with Ryan because we provideaffordable, high quality healthcare to the community,” says board memberHector Pereira. “Ryan fights to provide affordable healthcare, affordableprescriptions. We’ve been here for a very long time and most people knowand trust Ryan.”Ryan’s Revlon Run Walk Team of 144 participants raisednearly 40 percent more in 2008 than in the previous year.Then-U.S. Senator and current Secretary of StateHillary Clinton visits with Ryan patients.PART OF THE COMMUNITIES WE SERVEThe Ryan Network has been providing comprehensive primary and preventivecare for over forty years. A multi-cultural and multi-lingual approach has helpedintegrate the Ryan Network into the fabric of the communities it has servedover four decades. “Our patients see us in their neighborhoods, in their schools,at their churches, and at their community events. They know we’ll always bepartners in their healthcare and their quality of life,” says Ryan’s President & CEO,Barbra E. Minch.Collaborating with other community-based organizations has been essential toRyan’s success. Throughout its history, Ryan has always been at the table withother community groups to make lives better for everyone they serve. Whetherproviding health screenings at a community fair or developing best practice inconjunction with national advocacy groups, Ryan’s staff works with otherstowards a common end—creating healthier communities.2001 – Ryan/Chelsea-Clinton CommunityHealth Center, an affiliate of the Ryan Center,opens its doors to the public.2001 – In response to 9/11, the William F. Ryan Community Health Centerestablishes its Crisis Recovery Team, which offered counseling and medicaltreatment to displaced workers and residents, rescue workers and othersaffected by the attacks.2001 – The following appointments are made:Barbra E. Minch, President & CEO of the Ryan Network.Kathy Gruber, Executive Director of Ryan-NENA CHC.Walter Delacruz, Esq., Chair of the Ryan-Chelsea-Clinton Board.

Valuing the individual and the community was the impetus for Ryan-NENA tochange the way its neighborhood viewed HIV/AIDS. “When Ryan came to theLower East Side in 1988, people did not want to talk about HIV—there wasprejudice and fear. We embarked on a huge education process, to promotethe message that if we are not infected, we are still affected because HIV/AIDSis here in our neighborhoods. Our approach has made a world of differencein how our community now tackles the epidemic, from getting tested, tomaintaining drug regimens, to educating others,” says Kathy Gruber, Ryan-NENA’s Executive Director.“xxx I wanted to be involved in how we can make thingsbetter at the Ryan Center. The Consumer Advisory Grouphas been a vital tool for giving the staff feedback onwhat we hear. They take it to heart. The services are alwaysgetting better.“— William F. Ryan CAG member Michael Street,pictured with Karl Abernathy and Lucille Dolloway.REACHING OUTRyan also strives to give patients a voice in their own care. Each Center hasa Consumer Advisory Group (CAG) which gives patients the opportunity toattend meetings and present concerns to Ryan staff. Members of the CAGsfeel a sense of responsibility to help others connect with the Ryan Centers.“We look at what we can do to serve patients better,” explains Karl Abernathyof the William F. Ryan CAG. “The staff is open-minded, they take the time tolisten. I’m grateful to be a part of this experience— coming to Ryan is the bestthing to ever happen to me.”Arnel Tirado, Deputy Director at Ryan/Chelsea-Clinton, helpsa patient during National Community Health Center Week.2004 – Karen Westervelt is appointed ExecutiveDirector of the Ryan/Chelsea-Clinton CommunityHealth Center.2005 – The Network serves approximately35,000 patients with a budget of $36 million.2006 – The Ryan Center successfully opens its 15th service siteat William T. Harris Elementary School (PS 11)/The Clinton Schoolfor Writers and Artists (MS 260), in the Chelsea/Clinton community.This is the fifth school-based program operated by the Network.

LOYALTYTO ITS PATIENTS AND STAFFIn the over 40 years since Ryan first opened its doors as the NeighborhoodHealth Services Program, Ryan has never once wavered in its loyalty to thepeople it serves. For patients from all walks of life, Ryan has consistently beena partner in furthering the health and well being of the whole community. 2008marked the celebration of its 40th anniversary milestone, and, in true Ryanfashion, more than 650 of Ryan’s friends, supporters, staff, patients, communityleaders and elected officials paid tribute to Ryan’s work—past, presentand future.“We wouldn’t be here if it wasn’t for our commitment to the community and thecommunity’s commitment to us,” said Barbra Minch, Ryan’s President & CEO.“Our patients are the foundation of our work and our mission. Without them,Ryan would just be another revolving healthcare door.”This dedication is evident at all levels of Ryan’s staff. In 1969, straight out ofhigh school, Jenny Baez started as an Accounting Clerk at the NeighborhoodHealth ServicesProgram. Fourdecades later,Jenny is nowRyan’s Director ofHuman Resources.“Ryan cares forgenerations offamilies—this iswhere they’vealways come forcare, even if theyno longer live in theRep. Carolyn B. Maloney, Rep. Charles B. Rangel, and Rep. JerroldNadler were honored at Ryan’s 40th Anniversary Celebration;pictured here with Tom Van Coverden, President & CEO, NACHC,Bobbie Maniece-Harrison, Ryan’s Board Chair and Barbra E Minch,Ryan’s President and CEO.2007 – The Network serves over 40,000 patientswith a budget of $41 million.community. Theykeep coming back.”Jenny goes on to speak of Ryan’s strongpartnership with unions. “We are proudto be an 1199/SEIU union shop,” she says.“Over the years we have collaborated onmany projects that are good for the Center,its patients and its employees. Taking careof the well-being of our staff is as importantto us as our patients.”Mia Lynette Murphy’s first visit to Ryan-NENA on the Lower East Side was whenshe was pregnant with her daughterNafisah. That was 16 years ago and herdaughter is now getting ready to go tocollege. A mother of four, Mia works atlocal school PS 15 as a parent coordinator.All of her children are cared for at NENAand she’s always referring PS 15’s parentsthere as well. “I don’t want to send them tosomeplace I don’t feel comfortable,” saysMia. “I feel like I’m part of the NENA family“I love it here,” says Jenny Baez,Director of Human Resources.“When I walk into the patient area,I have to stop and kiss the patientswho have been here since day one.”and when parents come back to thank me, it’s the best feeling. Between God andNENA, I’m able to stand on my feet. I’m grateful they’re a part of my life.”“I can’t see myself doing anything else,” confesses Paul Stabile, William F. Ryan’sDirector of Clinical Care. A former meteorologist, Paul went from environmentalconsulting to upgrading the healthcare environment of his community. “This workmakes me feel great,” he says. “What better mission in life is there than servingpeople with the most need?”THE RYAN NETWORK PAYS TRIBUTE TO LYDIA MARTINEZ FOR 40 YEARSOF DEDICATED SERVICE TO THE RYAN CENTER. SHE WILL BE GREATLY MISSED.2007 – Ryan/Chelsea-Clinton acquires Roosevelt Hospital’s Adult Medicine Outpatient Clinic,the first hospital in New York State to turn its entire primary care practice over to a CommunityHealth Center. The Center also becomes an ambulatory care teaching site for the hospital’sInternal Medicine Residents.

PLANNING FOR THE FUTUREELECTRONIC HEALTH RECORDSInnovation also means keeping up with technology, and Ryan is gearingup to bring electronic health records (EHR) management to its networkof practitioners. With full implementation slated for early 2010, EHR willstreamline the sharing of patient information among practitioners in differentspecialties, and with Ryan’s back-up hospital St. Luke’s Roosevelt HospitalCenter. EHR will also give Ryan the information it needs to more accuratelytrack its Performance Improvement Initiatives, which will improve quality ofpatient care.“Ryan’s EHR project will leverage technology—an integrated electronicmedical record and practice management system—to improve healthcaredelivery for our patients,” says Chief Information Officer Barbara Hood. EHRwill help practitioners monitor clinical outcomes, and address existing healthdisparities through the use of automated tools and clinical decision support.WOMEN AND CHILDREN’S HEALTH CENTERSince 1967, the Ryan Center has been renting space at 160 West 100thStreet from the New YorkCity Department of Healthand Mental Hygiene(NYCDOH&MH) to operatethe Ryan Annex, whichhouses Ryan’s PreventionEducation and OutreachServices, HIV SupportServices, Mental HealthDepartment, and Nutritionand WIC (Women, Infantsand Children) Program.However, the Center wasBobbie Maniece-Harrison and Barbra E. Minch present the HumanitarianAward to Dikembe Mutombo of the Dikembe Mutombo Foundation andof the Houston Rockets; pictured here with Rep. Charles B. Rangel.informed by the NYCDOH&MH that it must vacate the Annex so it couldbe used for new administrative office space. The coordinated relocationof these services to a new site supports the development of an innovativeWomen and Children’s Health Center targeting the specific healthcare andsupportive services needs of the area’s underserved residents. The Womenand Children’s Health Center will co-locate Women’s Health and Pediatricservices with Nutrition/WIC Program services, and at the same time, provideaccess to mental health, case management, HIV counseling and testing, andoutreach services all under one roof! The Center’s opening is planned for late2009/early 2010.Coming soon – The Women and Children’s Health Center2007 – Ryan-NENA becomes as the ambulatorycare teaching site for the Lenox Hill Hospital InternalMedicine Residents.2007 – The Ryan/Chelsea-Clinton Community HealthCenter formally launches its “Health on the Move” MobileHealth Van and it becomes the 16th site of the Network.2007 – Ryan obtains an Article 31 license from the New YorkState Office of Mental Health allowing the Center to expandservices to the community.

PLANNING FOR THE FUTUREEXPANDING MEDICAL CAPACITYExpanded Medical Capacity through the delivery of comprehensive primary andpreventive care services is another primary goal in the coming years. Ryan iscurrently negotiating the second phase of a project with St. Luke’s-RooseveltHospital Center (SLRHC) to acquire the hospitals’ Adult Medicine and PediatricOutpatient Clinics. In “Phase I,” which was completed in March 2007, Ryan/Chelsea-Clinton acquired Roosevelt’s Adult Medicine and Pediatrics OutpatientClinic, and became an internal medicine residency rotation site for SLRHC.“Phase I” has been highly successful, and it is expected that Ryan will be ableto successfully implement “Phase II” of the project, in early 2010, which includesRyan’s acquisition of St. Luke’s Adult Medicine and Pediatric Outpatient Clinics,as well as serving as a rotation site for internal medicine residents. In addition,SLRHC residents will be seeing patients at the Network’s newest site, theThelma C. Davidson Adair Center in Harlem, which is expected to be openunder Ryan’s auspices in July 2009.Furthermore, in its effort to facilitate the expansion of access throughout NewYork City, Ryan was successful in applying for Federal funding for a healthcenter operatingin anotherborough, StatenIsland. Lastly,the Ryan-NENACommunityHealth Center isstrengtheningits relationshipwith Beth IsraelCenter and furthercollaborations areexpected in 2010.Serving more women and childrenremains at the forefront of Ryan’s goals.“ “You wish Baxter were every doctor, and that everyoneyou love could be in his gentle, supremely human care.— The Chicago Tribune, in review of Dr. Baxter’sbook, The Least of These My Brethren.Dr. Daniel Baxter returned as Chief Medical Officer for the RyanCommunity Health Network in January, 2009. Dr. Baxter had previouslyworked at Ryan as its Medical Director from 1997 to 2002, at whichtime he moved to Botswana, where he was a Clinical Advisor to theMinistry of Health and supervised the revision of Botswana’s HIV/AIDSTreatment Guidelines. A highly regarded practitioner, Dr. Baxter isBoard Certified in Internal Medicine and has a wealth of experiencein primary care, with specific expertise and an understanding of thecomplex needs and problems of individuals who live with HIV andAIDS. Dr. Baxter has also been responsible for developing the Center’sin-house, center-wide Disease Management Program for highly prevalentdiseases, such as diabetes, hypertension, and asthma, to enhancethe quality of patient care. In addition, Dr. Baxter is the author ofThe Least of These My Brethren, a book which relates his experienceson an inpatient hospital ward caring for people living with AIDS.

CONSOLIDATED FINANCIAL STATEMENTWILLIAM F. RYAN COMMUNITY HEALTH CENTEROPERATING REVENUE & EXPENSESFISCAL YEAR ENDED DECEMBER 31, 2008 AND 2007REVENUES:2008 2007DHHS Grants & Contract Services $ 17,758,566 $ 13,507,888Patient Service Revenue 21,918,873 24,593,982Other 1,210,241 535,881TOTAL NET REVENUE $ 40,887,680 $ 38,637,751EXPENSES:PROGRAM EXPENSESSalaries & Fringe Benefits $ 20,500,859 $ 19,985,727Other Than Personnel Services 6,445,932 6,842,597Depreciation & Amortization 942,250 1,031,107“When our communities face problems, we all roll up our sleeves. The communityknows we’re fighting together,” says Ryan’s President & CEO, Barbra E. Minch.TOTAL PROGRAM EXPENSES $ 27,889,041 $ 27,859,431GENERAL &ADMINISTRATIVE EXPENSESSalaries & Fringe Benefits $ 5,139,592 $ 5,638,217Other Than Personnel Services 3,997,614 3,840,691Depreciation & Amortization 166,279 181,960TOTAL G&A EXPENSES $ 9,303,485 $ 9,660,868TOTAL EXPENSES $ 37,192,526 $ 37,520,299NET ASSETS $ 27,860,000 $ 24,164,846* Includes 14 sitesFor Kathy Gruber, pictured here with Congressman William F. Ryan’s daughterPolly, serving as Executive Director of Ryan-NENA is more than just a job. “It’s away of acting on my personal beliefs and providing real things to real people.”

CONSOLIDATED FINANCIAL STATEMENTRYAN/CHELSEA-CLINTON COMMUNITY HEALTH CENTEROPERATING REVENUE & EXPENSESFISCAL YEAR ENDED DECEMBER 31, 2008 AND 2007REVENUES:2008 2007DHHS Grants & Contract Services $ 2,799,924 $ 1,899,508Patient Service Revenue 7,383,960 5,384,986Other 248,809 154,523TOTAL NET REVENUE $ 10,432,693 $ 7,439,017EXPENSES:PROGRAM EXPENSESSalaries & Fringe Benefits $ 3,944,342 $ 3.356,626Other Than Personnel Services 2,202,071 2,378,605Depreciation & Amortization 312,780 317,409TOTAL PROGRAM EXPENSES $ 6,459,193 $ 6,052,640“The wonderful thing about working in a community health center is theemphasis we put on ‘community.’ Not only do we have a positive impacton the patients who walk through our doors, but on our entire neighborhood,”says Karen Westervelt, Executive Director at Ryan/Chelsea-Clinton.GENERAL &ADMINISTRATIVE EXPENSESSalaries & Fringe Benefits $ 1,072,542 $ 817,792Other Than Personnel Services 1,528,125 1,910,085Depreciation & Amortization 78,194 79,352TOTAL G&A EXPENSES $ 2,678,861 $ 2,807,229TOTAL EXPENSES $ 9,138,054 $ 8,859,869NET ASSETS $ (3,791,344) $ (5,085,983)* Includes 2 sites

THE LEGACY OF WILLIAM F. RYAN CONTINUES TODAYOur namesake William F. Ryan served New York asa US Congressman from 1961 until his death in1972. Ryan was instrumental in starting thecommunity health services program and securedfederal funds for the program in 1967.Congressman Ryan’s vision was to ensure thataffordable, quality healthcare be available toeveryone. As a tireless fighter for peace, socialjustice, civil rights and a safe environment,Congressman Ryan saw all people as members of one large human family. Hewas also a dedicated community servant who taught constituents their rightsand helped them to meet their individual needs.The William F. Ryan Community Health Network is proud to carry on the visionof Congressman Ryan by making quality, affordable healthcare available forall. The urgent health need recognized by Congressman Ryan still exists today.The Ryan Network is honored that William F. Ryan’s family, several generationsstrong now, continue to be engaged and active supporters of our work.PLEASE JOIN US IN RECOGNIZING THOSE WHO SUPPORT OUR WORK AND VISION THROUGH THEIR GENEROUS CONTRIBUTIONS IN 2008:$3,000,000+Afia Foundation, Inc.Department of Health & Human Services,Health Resources & Services Administration,Bureau of Primary Health CareNew York State Department of Health, Office ofHealth Systems Management, Healthcare Efficiencyand Affordability Law for New Yorkers (HEAL NY)$1,000,000 – $2,000,000New York State Department of Health, AIDS InstituteDepartment of Health & Human Services, HIV/AIDSBureau, HRSA, Ryan White Modernization Act PartA/Public Health Solutions$500,000 – $999,999Department of Health & Human Services, HIV/AIDSBureau, HRSA, Ryan White Modernization Act Part CNew York State Department of Health, Division ofNutrition, Supplemental Food Programs$100,000 – $499,999Centers for Disease Control and PreventionSubstance Abuse and Mental Health ServicesAdministrationEntertainment Industry FoundationIra W. DeCamp FoundationNew York State Department of Health, AIDS Instituteand United Way of New York CityNational Association of Community Health Centers, Inc.,Community HealthCorps GrantNew York State Department of Health, Bureau of Childand Adolescent HealthNew York State Department Of Health, Division of Nutrition,Supplemental Food Programs, WIC Vendor Project$50,000 – $99,999801 Amsterdam, L.L.C.AnonymousCarnegie Corporation of New YorkGreater NYC Affiliate of Susan G. Komen for the Cure, Inc.$10,000 – $49,9991199/S.E.I.U. United HealthcareAvon Foundation Breast Cancer FundBendiner & Schlesinger, Inc.Colliers ABR, Inc.Commerce BankFidelis/CenterCareGotham Constuction Co., LLCHealthFirstHealthPlusHispanic FederationHorowitz Architects, P.C.Littler, Mendelson/Littler Mendelson Foundation, Inc.Millin Associates, Inc.National Association of Community Health Centers,Inc./Community Heath Ventures, Inc.New York University School of Medicine (Title IV)Nixon Peabody, LLPRX Strategies , Inc.Sobel Associates, Inc.St. Luke’s Roosevelt Hospital CenterTD Charitable FoundationThompson & Knight, LLP/Thompson & KnightFoundationWerner E. Tietjen, P.E.$5,000 – $9,999Atlantic Development Group, LLCCicatelli Associates Inc.Community Eye Care Associates, Inc.Community Health Care Association of NYSCTG, IncDan Klores Communication, Inc.Donnelly Mechanical Corp.Dr. Alan GoldsteinEmpire Promotional ProductsFeldesman, Tucker, Leifer, LLPFloss & Sandy FrucherLenox Hill HospitalManatt, Phelps & Phillips, LLPMerrill LynchMetroplus Health Plan, Inc.New York City Health and Hospitals CorporationPerfect Building MaintenancePfizer, IncStrategic Services Group, IncTCBA Watson Rice, LLPThe Council of The City of New York Manhattan DelegationThe Frank-Klurfeld FamilyVillage Care of New York, Inc.Whole FoodsSpecial thanks as well to our many friends (too numerous to list here)who supported our 40 th Anniversary Celebration, general fund and most especially ouractivities for children, including Reach Out and Read and Holiday Celebrations,with gifts under $5,000.

HEALTHCARE SERVICESAdult MedicinePediatricsWomen’s Healthcare CareAdolescent HealthGeriatricsHealth EducationHIV ServicesMental HealthSocial ServicesNutrition ServicesWIC ProgramDental ServicesSpecialties, including:AllergyCardiologyDermatologyEndocrinologyGastroenterologyOptometry/OphthalmologyOrthopedicsNephrologyNeurologyPodiatryUrologyLaboratory ServicesRadiology, SonogramsSpecial Pharmacy ArrangementsMedicaid and other entitlementsEligibility AssistanceTransportation, when medicallyindicatedCOMMUNITY OUTREACHCancer Services ProgramHomeless HealthcareHealth on the Move Mobile Medical VanPrevention, Education & Outreach ProgramReach Out and ReadSchool Based HealthcareSpeakers BureauSpecial Health Outreach to Urban Teens Mobile Medical VanWILLIAM F. RYAN COMMUNITY HEALTH CENTER110 West 97th Street, New York, NY 10025212.749.1820RYAN-NENA COMMUNITY HEALTH CENTER279 East Third Street, New York, NY 10009212.477.8500RYAN/CHELSEA-CLINTON COMMUNITY HEALTH CENTER645 Tenth Avenue, New York, NY 10036212.265.4500WWW.RYANCENTER.ORG