2022-04-20T16:01:20-05:00 2021-06-30 390758449 WIPFLI LLP 170 NORTH RADNOR-CHESTER ROAD SUITE 200 RADNOR PA 19087 990 2020-07-01 391919806 COMMUNITY HEALTH SYSTEMS INC COMM 6083610311 74 ECLIPSE BOULEVARD BELOIT WI 535116214 STEPHEN W SMITH CHIEF EXECUTIVE OFFICER 6083610311 2022-04-20 1 STEPHEN SMITH 999009999 SOLOMON MARDAKHAEV P01806552 6105653930 2022-04-14 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEPHEN W SMITH 74 ECLIPSE BOULEVARD BELOIT WI 535116214 9104247 0 X WWW.CHSOFWI.ORG X 1997 WI OUR MISSION IS TO PROVIDE HEALTH AND SOCIAL SERVICES THAT WILL PROMOTE COMFORT, HEALING, AND PREVENTION OF ILLNESSES AND INJURIES. OUR SERVICES ARE CULTURALLY COMPETENT AND SENSITIVE, COMMUNITY ORIENTED, AND PROVIDED REGARDLESS OF INCOME. 12 12 96 14 0 0 3116100 4427042 4223528 4675651 18170 1554 2545 0 7360343 9104247 0 0 0 0 5329290 5636658 0 0 0 2658700 2984076 7987990 8620734 -627647 483513 4148741 4341272 1681748 1390766 2466993 2950506 OUR MISSION IS TO PROVIDE HEALTH AND SOCIAL SERVICES THAT WILL PROMOTE COMFORT, HEALING, AND PREVENTION OF ILLNESSES AND INJURIES. OUR SERVICES ARE CULTURALLY COMPETENT AND SENSITIVE, COMMUNITY ORIENTED, AND PROVIDED REGARDLESS OF INCOME. 0 0 5830409 0 4675651 COMMUNITY HEALTH SYSTEMS, INC. OPERATES ONE SITE, WHICH OFFERS A COMPLIMENT OF MEDICAL, BEHAVIORAL HEALTH, AND DENTAL SERVICES IN BELOIT, WISCONSIN. DURING FISCAL YEAR 2021, THERE WERE 30,800 VISITS. IN RESPONSE TO THE SARS-COV-2 PANDEMIC, THE CLINIC WAS ABLE TO SHIFT SERVICES TO THE TELEHEALTH/VIRTUAL VISIT MODEL TO MAINTAIN CAPACITY. 5830409 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 12 0 96 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X STEPHEN W SMITH 6083610311 74 ECLIPSE BOULEVARD BELOIT WI 535116214 MEGGE CASIQUE CHAIR 0.50 X X 0 0 0 PATRICK KUELZ VICE CHAIR 0.50 X X 0 0 0 RUTH GRAY SECRETARY 0.50 X X 0 0 0 LINDA GARZA SECRETARY (THRU 1/21) 0.50 X X 0 0 0 KRISTIN LOEHR TREASURER 0.50 X X 0 0 0 LANA TASHA BELL DIRECTOR 0.50 X 0 0 0 JEREMY BROWN DIRECTOR 0.50 X 0 0 0 KATHARINE CLARK DIRECTOR 0.50 X 0 0 0 CECILIA GILLHOUSE DIRECTOR 0.50 X 0 0 0 GINNA ISUNZA DIRECTOR 0.50 X 0 0 0 DORIS MULDER DIRECTOR 0.50 X 0 0 0 ANDRE SAYLES DIRECTOR 0.50 X 0 0 0 JAROD SCHUT DIRECTOR 0.50 X 0 0 0 BRIAN WILSON DIRECTOR (THRU 5/21) 0.50 X 0 0 0 STEPHEN W SMITH CHIEF OPERATING OFFICER/INTERIM CEO (FROM 6/21) 45.00 X 106682 0 12770 MARY E JOHNSON CHIEF EXECUTIVE OFFICER (THRU 6/21) 45.00 X 160704 0 16208 CARYN DAVIS DIRECTOR OF FINANCE 45.00 X 71459 0 27601 DR TROY DOETCH CHIEF MEDICAL OFFICER 40.00 X 176646 0 19376 DR CYNTHIA RIFFLE DENTAL DIRECTOR 45.00 X 152858 0 2617 DR CHRIS GREENWALDT DENTIST 40.00 X 127654 0 15239 DR FARHANA HAMID-SCANLIN NURSE PRACTITIONER 40.00 X 122808 0 5771 DR JOHN TRAN DENTIST 40.00 X 119990 0 7295 1038801 0 106877 7 0 1 0 OCHIN INC 1881 SW NAITO PARKWAY PORTLAND OR 97201 COMPUTER SOFTWARE SERVICE AND SUPPORT 189221 1 4396563 30479 4427042 PATIENT SERVICE REVENUE 621300 4657561 4657561 18090 18090 4675651 1554 1554 9104247 4675651 0 1554 363498 240330 123168 3292180 2159675 1132505 68000 68000 1584699 1162748 421951 328281 224596 103685 16866 16866 668094 293355 374739 40431 17619 22812 38621 14767 23854 284066 261059 23007 367379 245799 121580 3175 262 2913 34373 22976 11397 44483 44610 -127 241327 115382 125945 1725 1725 MEDICAL & PHARMACY SUPP 566157 561080 5077 BAD DEBT EXPENSE 394110 394110 EQUIPMENT & MAINTENANCE 205894 50697 155197 DUES 52803 9932 42871 24572 11412 13160 8620734 5830409 2790325 0 102675 237272 1490138 1504227 216516 317629 429101 530564 20394 20394 101621 106260 3494215 1935052 1722533 1559163 65763 65763 4148741 4341272 468146 512706 143458 58013 1070144 820047 1681748 1390766 X 2466993 2950506 2466993 2950506 4148741 4341272 483513 0 X 0 1 X 1 1 1 X 2582302 2393196 2558254 3116100 4427042 15076894 2582302 2393196 2558254 3116100 4427042 15076894 15076894 722 1448 29519 20715 1554 53958 15130852 25265805 0.99640 0.99590 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1350292 436443 913849 899924 614860 285064 1243999 883749 360250 1559163 CAPITAL LEASE OBLIGATION 820047 820047 8710137 -394110 -394110 9104247 0 9104247 8226624 0 8226624 394110 394110 8620734 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -394,110. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 394,110. X X 0 0 0 0 0 0 0 1 0 DR TROY DOETCH CHIEF MEDICAL OFFICER 176646 0 0 0 0 0 0 0 19376 0 196022 0 0 0 MARY E JOHNSON CHIEF EXECUTIVE OFFICER (THRU 6/21) 147844 0 10000 0 2860 0 4743 0 11465 0 176912 0 0 0 DR CYNTHIA RIFFLE DENTAL DIRECTOR 152858 0 0 0 0 0 0 0 2617 0 155475 0 0 0 PART I, LINE 6 MARY E. JOHNSON WAS ELIGIBLE FOR A BONUS BASED ON ACHIEVING A SET OF STATED GOALS AND PERFORMANCE REVIEW BY THE BOARD OF DIRECTORS. THE BONUS WAS NOT TO EXCEED $10,000 AND WAS APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 8B THE CORPORATION'S GOVERNING BODY DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE PREPARED FORM 990 IS REVIEWED AND APPROVED BY THE MEMBERS OF THE GOVERNING BODY AND MANAGEMENT BEFORE THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C CONFLICTS OF INTEREST MAY INCLUDE, BUT ARE NOT LIMITED TO RELATIONSHIPS, ASSOCIATIONS, OR BUSINESS DEALINGS WITH VENDORS, SUPPLIERS, OTHER HEALTHCARE ORGANIZATIONS, OR INDIVIDUALS. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMUNITY HEALTH SYSTEM, INC.'S (CHS) EXECUTIVE TEAM MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE GOVERNING BOARD OR CHS EXECUTIVE TEAM SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR CHS EXECUTIVE TEAM SHALL DETERMINE WHETHER CHS CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT ISN'T REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR CHS EXECUTIVE TEAM SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN CHS' BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. IF THE GOVERNING BOARD OR CHS EXECUTIVE TEAM HAS REASONABLE CAUSE TO BELIEVE A MEMBER/EMPLOYEE HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE BOARD MEMBER/EMPLOYEE OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE BOARD MEMBER'S/EMPLOYEE'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR CHS EXECUTIVE TEAM WILL DETERMINE IF THE BOARD MEMBER/EMPLOYEE HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AND SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 ON AN ANNUAL BASIS, THE CORPORATION'S HUMAN RESOURCE MANAGER PROVIDES THE MEMBERS OF THE GOVERNING BODY WITH COMPENSATION DATA FOR COMPARABLE POSITIONS AT SIMILAR ORGANIZATIONS FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) LATEST COMPENSATION SURVEYS. THE GOVERNING BODY ALSO PERFORMS AN ANNUAL PERFORMANCE REVIEW OF THE CORPORATION'S CHIEF EXECUTIVE OFFICER. THE MEMBERS OF THE GOVERNING BODY DETERMINE AND VOTE TO APPROVE THE COMPENSATION AMOUNTS FOR THE YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.