2016-05-13T08:44:50-05:00 2015-06-30 061354191 VISCONTI & ASSOCIATES PC 444 FOXON ROAD FL RD EAST HAVEN CT 065132037 990 2014-07-01 223036666 COMMUNITY HEALTH CENTER ASSOCIATION OF CONNECTICUT INC COMM 8606677820 1484 HIGHLAND AVENUE SUITE 2 CHESHIRE CT 06410 MOLLIE MELBOURNE CHIEF OPERATING OFFICER 8606677820 2016-05-13 1 JOHN J VISCONTI P00027180 2038652927 2016-05-13 2014 2016-08-17 19:52:53Z EVELYN BARNUM 1484 HIGHLAND AVE CHESHIRE CT 06410 5452604 0 X WWW.CHCACT.ORG X 1989 CT PROMOTING QUALITY HEALTH CARE AND SOCIAL SERVICES TO CONNECTICUT'S UNDERSERVED POPULATIONS. 13 13 57 0 0 0 5136889 5446823 0 0 3121 2865 2071 2916 5142081 5452604 0 0 0 0 1800060 1615759 0 0 0 3290012 3809309 5090072 5425068 52009 27536 2129694 3021681 1170392 2034843 959302 986838 PROVIDED TECHNICAL AND EDUCATIONAL ASSISTANCE TO COMMUNITY HEALTH CENTERS IN CONNECTICUT. 0 0 4762794 PROVIDED TECHNICAL AND EDUCATIONAL ASSISTANCE TO COMMUNITY HEALTH CENTERS IN CONNECTICUT. 4762794 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 26 0 1 57 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CT X X JEFFREY HUGHES 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 KATHLEEN GRIMAUD DIRECTOR 1.00 X 0 0 0 KATHERINE YACAVONE SECRETARY 1.00 X X 0 0 0 CHUCK SEEMAN DIRECTOR 1.00 X 0 0 0 CRAIG GLOVER TREASURER 1.00 X X 0 0 0 JAMES MALONEY PRESIDENT 1.00 X X 0 0 0 MICHAEL TAYLOR DIRECTOR 1.00 X 0 0 0 SUZANNE LAGARDE MD VICE PRESIDENT 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 EVELYN A BARNUM CHIEF EXECUTIVE OFFICER 37.50 X 196976 0 48586 PATRICIA MORO CHIEF FINANCIAL OFFICER 37.50 X 127043 0 32189 MOLLIE MELBOURNE CHIEF OPERATING OFFICER 37.50 X 114330 0 25420 PHILIP RENDA CHIEF INFORMATAION OFFICER 37.50 X 132635 0 6406 570984 0 112601 4 0 1 0 0 162500 4917328 366995 5446823 2865 2865 OTHER 900099 2480 2480 COBRA REVENUE 900099 436 436 2916 5452604 2916 0 2865 589364 355017 234347 715339 652233 63106 311056 235527 75529 34318 29647 4671 72034 72034 42917 42917 17429 15137 2292 53363 10005 43358 116302 72938 43364 46475 46475 16342 8765 7577 24885 24885 14805 3985 10820 CONTRACTUAL AGREEMENTS 2762896 2762896 CONSULTANT AND PROFESSI 462295 434222 28073 CONSUMABLE SUPPLIES 86091 79632 6459 TELEPHONE 31915 31750 165 27242 24565 2677 5425068 4762794 662274 0 676408 1144754 656264 359130 593626 746615 354 16463 26893 38876 819438 134826 176149 684612 31231 2129694 3021681 809822 915400 360570 395091 724352 1170392 2034843 X 959302 986838 959302 986838 2129694 3021681 27536 0 X X 0 1 X 1 1 1 X 4276147 3922039 4345214 4962778 5210817 22716995 4276147 3922039 4345214 4962778 5210817 22716995 22716995 1057 1319 1603 3121 2866 9966 95280 147147 233273 176182 238921 890803 23617764 0.96190 0.96890 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: CONTRACTED SERVICES REVENUE - 2010 AMOUNT: $ 95,280. 2011 AMOUNT: $ 147,147. 2012 AMOUNT: $ 233,273. 2013 AMOUNT: $ 176,182. 2014 AMOUNT: $ 238,921. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 53042 53042 53042 5372026 5425068 421253 105313 0 0 404504 421253 825757 1238636 56147 53042 109189 101126 105313 206439 309659 PART II A- LINE 1 $50,000 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 $3,042 REPRESENTS AN ALLOCATION OF STAFF WAGES FOR TIME SPENT ON SIMILAR ACTIVITIES 6239 6239 0 147644 106588 41056 665555 21999 643556 684612 X 5452604 0 5452604 0 5452604 5425068 0 5425068 0 5425068 PART X, LINE 2: MANAGEMENT IS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS TAKEN BY CHCACT. THE TAX YEARS ENDED JUNE 30, 2012 THROUGH JUNE 30, 2015 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 191902 0 5074 0 0 0 12297 0 36289 0 245562 0 0 0 PATRICIA MORO CHIEF FINANCIAL OFFICER 118380 0 8663 0 0 0 7644 0 24545 0 159232 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 0 0 FORM 990, PART VI, SECTION A, LINE 6 TWELVE 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. KATHLEEN GRIMAUD - 459 MIGEON AVENUE, TORRINGTON, CT 06790. KATHERINE YACAVONE - 46 ALBION STREET, BRIDGEPORT, CT 06605. CHUCK SEEMAN - 34 TOWN STREET, NORWICH, CT 06360. CRAIG GLOVER - 120 CONNECTICUT AVENUE, NORWALK, CT 06854. JAMES MALONEY - 57 NORTH STREET, 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. 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