2017-10-31T08:44:28-05:00 2016-12-31 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2016-01-01 060863942 COMMUNITY HEALTH SERVICES INC COMM 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 GREGORY L STANTON CEO 8602499625 2017-09-29 1 PAUL BALLASY P00852868 9592007000 209.3.217.20 2017-09-29 11:42:08 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C66C55146026C367619DFB22D8766EF0DA0FDC7C 2016 2018-03-14 21:41:22Z GREGORY L STANTON 500 ALBANY AVENUE HARTFORD CT 06120 20394945 0 X www.chshartford.org X 1967 CT TO PROVIDE MEDICAL SERVICES FOR THE RESIDENTS OF THE GREATER HARTFORD CONNECTICUT AREA. TO PROVIDE QUALITY HEALTH CARE SERVICES TO LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA REGARDLESS OF ABILITY TO PAY. 12 12 206 80 0 0 6173497 6898440 12737196 13309269 -6249 4400 246121 182836 19150565 20394945 0 0 0 0 12950430 13410152 0 0 0 5984665 6851833 18935095 20261985 215470 132960 18135824 18250119 1683764 1665099 16452060 16585020 TO PROVIDE MEDICAL SERVICES FOR THE RESIDENTS OF THE GREATER HARTFORD CONNECTICUT AREA. TO PROVIDE QUALITY HEALTH CARE SERVICES TO LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA REGARDLESS OF ABILITY TO PAY. 0 0 15134550 13473055 Provide quality health care services to patients who are low and moderate income individuals in the greater hartford connecticut area. There were 84,228 patient visits in 2016. 15134550 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 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 46 0 1 206 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CT X RICHARD NANKEE 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 AIGNER MITCHELL outgoing secretary/trustee 0.50 X X 0 0 0 Angela Chambers director 0.50 X 0 0 0 CHARLES WILLIAMS DIRECTOR 0.50 X 0 0 0 CLORINDA SOLDEVILA DIRECTOR 0.50 X 0 0 0 FLOYD PAULING director 0.50 X 0 0 0 Heather Woodward Director 0.50 X 0 0 0 JACQUELINE MCDERMOTT-SELMAN outgoing vice chair/trustee 1.00 X X 0 0 0 JOHN SODIPO DIRECTOR 0.50 X 0 0 0 Luis Miguel Ayala Treasurer 1.00 X X 0 0 0 Ophni Davis Director 0.50 X 0 0 0 Randy McKenney vice chair 1.00 X X 0 0 0 ROBERT HARRIS Chair 1.00 X X 0 0 0 ROSEMARY TATE secretary 0.50 X X 0 0 0 SHERWOOD LEWIS director 0.50 X 0 0 0 Yvonne Addo outgoing vice chair/trustee 0.50 X X 0 0 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 40.00 X 198582 0 14843 Richard Nankee CHIEF FINANCIAL OFFICER 40.00 X 151600 0 28369 ZEEV HAREL Interim CMO 40.00 X 214511 0 33757 cynthia elis Director of women's health 40.00 X 182815 0 32674 Elizabeth reynolds Physician 40.00 X 164005 0 9929 Genea Bell CLHRO 40.00 X 135573 0 32169 Jairo Montezuma Director of Adult Medicine 40.00 X 171509 0 32055 Kate Betancourt CQO 40.00 X 142433 0 24483 1361028 0 208279 8 0 1 0 ITSAVVY LLC PO box 3296 Glen Ellyb IL 60138 Computer Products and Services 252994 DIVERSIFIED BUILDERS po box 4658 WALLINGFORD CT 06492 building maintenance services 107889 2 6746889 151551 612371 6898440 Medicaid 621400 8766335 8766335 pharmacy revenue 621400 1524897 1524897 Medicare 621400 1149027 1149027 Third-party payors 621400 990035 990035 Patients 621400 878975 878975 13309269 310 310 19050 0 19050 19050 19050 4090 0 4090 4090 4090 meaningful use 900099 144500 144500 Other revenue 900099 19286 19286 163786 20394945 13473055 0 23450 645762 452033 193729 9791244 6853871 2937373 231064 161745 69319 1850215 1295150 555065 891867 624306 267561 167632 167632 45320 45320 5000 5000 1419463 1233712 185751 133743 93620 40123 443025 346970 96055 124041 62019 62022 31196 21837 9359 1117534 815800 301734 140804 102787 38017 PROVISION FOR BAD DEBTS 1402413 1402413 program activities 635715 635715 vaccines 612371 612371 equipment rental 456594 333314 123280 116982 81887 35095 20261985 15134550 5127435 0 1691877 2352370 1123595 1126247 474053 509440 693594 613584 398628 446961 137363 204317 22686541 9716624 13593521 12969917 13060 17150 10133 10133 18135824 18250119 975604 1116491 708160 548608 1683764 1665099 X 16408601 16527712 43459 57308 16452060 16585020 18135824 18250119 132960 0 X X 0 1 X 1 1 1 X 6050041 5810745 5701781 6173497 6898440 30634504 6050041 5810745 5701781 6173497 6898440 30634504 30634504 48787 44649 46667 14233 19360 173696 408513 27657 339303 232496 163786 1171755 31979955 57314340 0.95790 0.96360 X Schedule A, Part II, Line 10, Explanation of Other Income: OTHER INCOME - 2012 Amount: $ 26,013. 2013 Amount: $ 27,657. 2014 Amount: $ 20,553. 2015 Amount: $ 19,996. 2016 Amount: $ 19,286. Meaningful Use - 2012 Amount: $ 382,500. 2014 Amount: $ 318,750. 2015 Amount: $ 212,500. 2016 Amount: $ 144,500. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 5000 0 0 5000 0 Part II-B, Line 1: PAYMENT TO the Community Health Center Association of CT FOR LOBBYING COSTS. 133022 133022 18335206 7671954 10663252 3957158 2003728 1953430 261155 40942 220213 12969917 X 18992532 0 18992532 1402413 1402413 20394945 18859572 0 18859572 1402413 1402413 20261985 Part X, Line 2: The Center has no unrecognized tax benefits at December 31, 2016 and 2015. The Center's Federal and state information returns prior to calendar year 2013 are closed and management continually evaluates expiring statutes of limitations, audits, proposed settlements, changes in tax law and new authoritative rulings. If the Center has unrelated business income taxes, it will recognize interest and penalties associated with uncertain tax positions as part of the income tax provision and include accrued interest and penalties with the related tax liability in the statement of financial position. Part XI, Line 4b - Other Adjustments: provision for bad debts 1,402,413. Part XII, Line 4b - Other Adjustments: Provision for bad debts 1,402,413. X X X 0 0 0 0 0 0 0 1 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 198582 0 0 0 0 0 6154 0 10673 0 215409 0 0 0 Richard Nankee CHIEF FINANCIAL OFFICER 151600 0 0 0 0 0 0 0 30485 0 182085 0 0 0 ZEEV HAREL Interim CMO 214511 0 0 0 0 0 7950 0 25807 0 248268 0 0 0 cynthia elis Director of women's health 179075 0 3740 0 0 0 7342 0 27489 0 217646 0 0 0 Elizabeth reynolds Physician 164005 0 0 0 0 0 0 0 12064 0 176069 0 0 0 Genea Bell CLHRO 135573 0 0 0 0 0 4314 0 29915 0 169802 0 0 0 Jairo Montezuma Director of Adult Medicine 171509 0 0 0 0 0 0 0 34200 0 205709 0 0 0 Kate Betancourt CQO 142433 0 0 0 0 0 0 0 26564 0 168997 0 0 0 Part I, Line 7 DIRECTOR OF WOMEN'S HEALTH RECEIVED A CALENDAR YEAR APPROVED BONUS. X 1 612371 FAIR MARKET VALUE 0 0 0 Form 990, Part VI, Section B, line 11b the finance department along with the ceo reviews the form 990 and it is then forwarded to the finance committee for their review. The 990 is then distributed to the full board for approval. Form 990, Part VI, Section B, line 12c community health services, Inc. requires that all employees and board members sign a written conflict of interest policy. this conflict of interest policy is monitored and enforced by the corporate compliance officer and the corporate compliance team which meets on a quarterly basis. Form 990, Part VI, Section B, line 15 the board of directors, in an executive meeting, determines the compensation of the ceo. they use a local nonprofit ceo compensation survey as a guideline. the ceo determines the compensation of the organization's employees. he is guided by state and national guidelines and surveys as well as a survey done yearly for the community health centers in connecticut by the community health center association of connecticut. Form 990, Part VI, Section C, line 19 community health services' governing documents, conflict of interest policy and financial statements are available upon request. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.