2017-05-12T15:11:57-05:00 2016-06-30 061354191 VISCONTI & ASSOCIATES PC 444 FOXON ROAD FL RD EAST HAVEN CT 065132037 990 2015-07-01 223036666 COMMUNITY HEALTH CENTER ASSOCIATION OF CONNECTICUT INC COMM 8606677820 1484 HIGHLAND AVE NO 2 CHESHIRE CT 06410 EVELYN BARNUM CHIEF EXECUTIVE OFFICER 8606677820 2017-05-12 1 JOHN J VISCONTI P00027180 2038652927 2017-05-12 2015 2021-01-29 14:40:06Z EVELYN BARNUM 1484 HIGHLAND AVE CHESHIRE CT 06410 8139303 0 X WWW.CHCACT.ORG X 1989 CT PROMOTING QUALITY HEALTH CARE AND SOCIAL SERVICES TO CONNECTICUT'S UNDERSERVED POPULATIONS. 16 16 58 0 0 0 5446823 8135801 0 0 2865 702 2916 2800 5452604 8139303 0 0 0 0 1615759 2155889 0 0 0 3809309 5930172 5425068 8086061 27536 53242 3021681 3733333 2034843 2693253 986838 1040080 PROVIDED TECHNICAL AND EDUCATIONAL ASSISTANCE TO COMMUNITY HEALTH CENTERS IN CONNECTICUT. 0 0 7160693 PROVIDED TECHNICAL AND EDUCATIONAL ASSISTANCE TO COMMUNITY HEALTH CENTERS IN CONNECTICUT. 7160693 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 1 0 0 0 0 0 1 0 0 0 1 38 0 1 58 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CT X X DEBORAH AMODIO-GROSS 8606677820 1484 HIGHLAND AVE SUITE 2 CHESHIRE CT 06410 EUGENE MARKET DIRECTOR 1.00 X 0 0 0 ARVIND SHAW DIRECTOR 1.00 X 0 0 0 LUDWIG SPINELLI DIRECTOR 1.00 X 0 0 0 DONALD THOMPSON DIRECTOR 1.00 X 0 0 0 KATHERINE YACAVONE SECRETARY 1.00 X X 0 0 0 CRAIG GLOVER TREASURER 1.00 X X 0 0 0 JENNIFER E GRANGER DIRECTOR 1.00 X 0 0 0 JAMES H MALONEY BOARD CHAIR 1.00 X X 0 0 0 MICHAEL TAYLOR DIRECTOR 1.00 X 0 0 0 SUZANNE LAGARDE MD BOARD VICE CHAIR 1.00 X X 0 0 0 GREGORY STANTON DIRECTOR 1.00 X 0 0 0 JOANNE BORDUAS DIRECTOR 1.00 X 0 0 0 DR DOUGLAS BRUCE DIRECTOR 1.00 X 0 0 0 NICHELLE MULLINS DIRECTOR 1.00 X 0 0 0 SUSAN WALKAMA DIRECTOR 1.00 X 0 0 0 KIMBERLY BEAUREGARD DIRECTOR 1.00 X 0 0 0 EVELYN A BARNUM CHIEF EXECUTIVE OFFICER 37.50 X 203126 0 47197 MOLLIE MELBOURNE CHIEF OPERATING OFFICER 37.50 X 134658 0 37779 PHILIP RENDA CHIEF INFORMATAION OFFICER 37.50 X 134806 0 7647 JEFFREY HUGHES CHIEF FINANCIAL OFFICER 37.50 X 45064 0 11162 517654 0 103785 3 0 1 0 0 187500 7584350 363951 6000 8135801 702 702 OTHER 900099 2800 2800 2800 8139303 2800 0 702 776878 561800 215078 977282 843458 133824 401729 315649 86080 3871 1428 2443 107132 33139 73993 91747 68830 22917 63033 40629 22404 18180 3485 14695 CONTRACTUAL AGREEMENTS 4163263 4163263 CONSULTANT AND PROFESSI 1033000 751972 281028 CONSUMABLE SUPPLIES 288444 246550 41894 TELEPHONE 46985 46943 42 114517 83547 30970 8086061 7160693 925368 0 1144754 800539 359130 253572 746615 1458325 16463 2953 38876 37619 1346774 194934 684612 1151840 31231 28485 3021681 3733333 915400 1737170 395091 193515 724352 762568 2034843 2693253 X 986838 1040080 986838 1040080 3021681 3733333 53242 0 X X 0 1 X 1 1 1 X 3922039 4345214 4962778 5210817 7852043 26292891 3922039 4345214 4962778 5210817 7852043 26292891 26292891 1319 1603 3121 2866 702 9611 147147 233273 176182 238921 280558 1076081 27378583 0.96030 0.96190 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: CONTRACTED SERVICES REVENUE - 2011 AMOUNT: $ 147,147. 2012 AMOUNT: $ 233,273. 2013 AMOUNT: $ 176,182. 2014 AMOUNT: $ 238,921. 2015 AMOUNT: $ 280,558. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 69784 69784 69784 8016277 8086061 554303 138576 0 0 404504 421253 554303 1380060 2070090 56147 53042 69784 178973 101126 105313 138576 345015 517523 PART II A- LINE 1 $65,038 WAS PAID TO A QUALIFIED CONSULTING FIRM FOR LOBBYING AND GOVERNMENTAL RELATIONS SERVICES RELATED TO THE MONITORING OF LEGISLATION THAT AFFECTS PRIMARY HEALTH CARE. THE REMAINING $4,746 REPRESENTS AN ALLOCATION OF STAFF WAGES FOR TIME SPENT ON SIMILAR ACTIVITIES 1059150 26817 1032333 11776 11776 0 248349 128842 119507 27499 27499 0 1151840 X 8139303 0 8139303 0 8139303 8086061 0 8086061 0 8086061 PART X, LINE 2: MANAGEMENT IS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS TAKEN BY CHCACT. THE TAX YEARS ENDED JUNE 30, 2013 THROUGH JUNE 30, 2016 REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS, X 1 1 X X 0 1 0 0 0 0 0 0 0 EVELYN A BARNUM CHIEF EXECUTIVE OFFICER 203126 0 0 0 0 0 11390 0 35807 0 250323 0 0 0 MOLLIE MELBOURNE CHIEF OPERATING OFFICER 134658 0 0 0 0 0 5043 0 32736 0 172437 0 0 0 PART I, LINE 1A WRITTEN POLICY REGARDING TAX INDEMNIFICATION ADHERED TO BY MANAGEMENT. EVELYN BARNUM CEO CEO IS ON THE BOARD OF CHN. CHCACT HAS NO CONTROL OR INTEREST IN CHN. NONE OF SIGNIFICANCE. 0 FORM 990, PART VI, SECTION A, LINE 6 FIFTEEN MEMBERS OF THE ORGANIZATION ARE FEDERALLY QUALIFIED HEALTH CENTERS AND ONE MEMBER HAS FEDERALLY QUALIFIED LOOK A LIKE STATUS. ALL MEMBERS ARE LOCATED IN CONNECTICUT FORM 990, PART VI, SECTION A, LINE 7A THE CHIEF EXECUTIVE OFFICER OF EACH OF ITS MEMBER HEALTH CENTERS IS A BOARD MEMBER OF CHCACT. FORM 990, PART VI, SECTION B, LINE 11 THE 990 RETURN IS REVIEWED BY MANAGEMENT AND THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE CHIEF FINANCIAL OFFICER IS RESPONSIBLE FOR MONITORING AND ENFORCING COMPLIANCE WITH THE POLICY AND UPDATING RELATED DOCUMENTATION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PREPARES A WRITTEN REVIEW OF THE CEO'S PERFORMANCE EACH YEAR. THE COMMITTEE THEN USES THAT PERFORMANCE REVIEW, THE AGENCY'S ESTABLISHED RANGES FOR THAT PAY GRADE LEVEL, AND AVAILABLE SALARY SURVEY RESOURCES TO DETERMINE HER COMPENSATION. THE CEO SIMILARLY DETERMINES THE COMPENSATION OF THE CFO, CIO & COO BASED ON AN ANNUAL WRITTEN PERFORMANCE REVIEW & THE ESTABLISHED AGENCY PAY GRADE RANGES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST WITH THE APPROVAL OF THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VII EUGENE MARKET - 94 CONNECTICUT BOULEVARD, EAST HARTFORD, CT 06108. ARVIND SHAW - 40 MANSFIELD AVENEUE, WILLIMANTIC, CT 06226. LUDWIG SPINELLI - 471 BARNUM AVENUE, BRIDGEPORT, CT 06608. DONALD THOMPSON - 80 PHOENIX AVENUE, WATERBURY, CT 06702. KATHERINE YACAVONE - 46 ALBION STREET, BRIDGEPORT, CT 06605. CRAIG GLOVER - 120 CONNECTICUT AVENUE, NORWALK, CT 06854. JENNIFER E GRANGER - 34 EAST TOWN ST., NORWICH, CT 06360. JAMES H. MALONEY - 120 MAIN STREET, 4TH FLOOR, DANBURY, CT 06810. MICHAEL TAYLOR - 400-428 COLUMBUS AVENUE, NEW HAVEN, CT 06519. SUZANNE LAGARDE, MD - 374 GRAND AVENUE, NEW HAVEN, CT 06513. GREGORY STANTON - 500 ALBANY AVENUE, HARTFORD, CT 06120. JOANNE BORDUAS - 459 MIGEON AVENUE, TORRINGTON, CT 06790. DR. DOUGLAS BRUCE - 400-428 COLUMBUS AVENUE, NEW HAVEN, CT 06519. NICHELLE MULLINS - 21 GRAND STREET, HARTFORD, CT 06106. SUSAN WALKAMA - 10 NORTH MAIN STREET, BRISTOL, CT 06010. KIMBERLY BEAUREGARD - 281 MAIN STREET, EAST HARTFORD, CT 06108. FORM 990, PART XII, LINE 2C: THE FINANCE/AUDIT COMMITTEE REVIEWS AND APPROVES THE AUDITED FINANCIAL STATEMENTS AND RECOMMENDS ACCEPTAANCE TO THE FULL BOARD. COMMUNITY HEALTH NETWORK OF CT 11 FAIRFIELD BOULEVARD WALLINGFORD CT 06492 061429341 ADMINISTRATIVE SERVICES ORGANIZATION FOR MEDICAID POPULATION OF CT. CT 501(C)(4) N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMUNITY HEALTH NETWORK OF CT C 15000 FAIR MARKET VALUE COMMUNITY HEALTH NETWORK OF CT N 6000 FAIR MARKET VALUE