2015-09-18T09:18:05-05:00 2014-12-31 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2014-01-01 060863942 COMMUNITY HEALTH SERVICES INC COMM 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 GREGORY L STANTON CEO 8602499625 2015-09-04 1 PAUL BALLASY P00852868 9592007000 2014 2016-04-25 22:37:26Z GREGORY L STANTON 500 ALBANY AVENUE HARTFORD CT 06120 18028816 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 12 200 30 0 0 5810745 5701781 8775958 11939265 -66963 2327 74931 385443 14594671 18028816 0 0 0 0 11347469 12437181 0 0 0 5068036 5856689 16415505 18293870 -1820834 -265054 18591617 17936788 2089151 1699376 16502466 16237412 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 13631721 12278568 PROVIDE QUALITY HEALTH CARE SERVICES TO PATIENTS WHO ARE LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA. THERE WERE 83,453 PATIENT VISITS IN 2014. 13631721 1 1 0 0 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 39 0 1 200 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 LAURA BEAUDOIN 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 AIGNER MITCHELL DIRECTOR/OUTGOING CHAIR 0.50 X 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 JABER ASLANZADEH VICE CHAIR 1.00 X X 0 0 0 JACQUELINE MCDERMOTT-SELMAN SECRETARY 1.00 X X 0 0 0 JOHN SODIPO DIRECTOR 0.50 X 0 0 0 KAYMARA JUBREY OUTGOING DIRECTOR 0.50 X 0 0 0 MISHONE DONELSON CHAIR /OUTGOING TREASURER 1.00 X X 0 0 0 ROBERT HARRIS TREASURER 1.00 X X 0 0 0 ROSEMARY TATE DIRECTOR 0.50 X 0 0 0 SHERWOOD LEWIS DIRECTOR 0.50 X 0 0 0 TAWANA DILLARD DIRECTOR 0.50 X 0 0 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 40.00 X 164728 0 11835 SCOTT BRABANT CHIEF FINANCIAL OFFICER 40.00 X 152674 0 25002 ZEEV HAREL DIRECTOR PEDS & ADOL 40.00 X 221996 0 33580 ANN-MARIE SURETTE PROVIDER 40.00 X 182267 0 16170 GORDON HOLDER PROVIDER 40.00 X 142437 0 5680 KATHLEEN TUMMILLO DIRECTOR OF ADULT MEDICINE 40.00 X 168453 0 14975 ANNA GEORGE PROVIDER 40.00 X 159849 0 6400 RITU DUTTA DIRECTOR OF WOMEN'S HEALTH 40.00 X 196123 0 15402 1388527 0 129044 11 0 1 0 QUALITY SYSTEMS INC PO BOX 809390 CHICAGO IL 60680 SOFTWARE INSTALLATION & IMPLEMENTATION 305771 DIVERSIFIED BUILDERS 340 QUINNIPIAC STREET WALLINGFORD CT 06492 CONSTRUCTION MANAGEMENT 117814 COMPHEALTH PO BOX 972651 DALLAS TX 75397 HEALTHCARE STAFFING 110669 3 5556447 145334 453778 5701781 PATIENT SERVICE 621400 11939265 11939265 11939265 527 527 46140 0 46140 46140 46140 1800 0 1800 1800 1800 MEANINGFUL USE 900099 318750 318750 OTHER REVENUE 900099 20553 20553 339303 18028816 12278568 0 48467 1104268 772988 331280 8976944 6283861 2693083 155738 109017 46721 1501651 1051155 450496 698580 489006 209574 103609 103609 47500 47500 1011711 860884 150827 119190 83433 35757 413517 321617 91900 52283 26141 26142 43933 30753 13180 1078806 787528 291278 141863 103560 38303 PROVISION FOR BAD DEBTS 1222605 1222605 PROGRAM ACTIVITIES 682333 682333 VACCINES 456375 456375 EQUIPMENT RENTAL 413006 301494 111512 69958 48971 20987 18293870 13631721 4662149 0 1205195 929476 610039 1123149 210430 283702 491176 659807 242135 208316 162932 159762 22691787 8143227 15647495 14548560 12082 13883 10133 10133 18591617 17936788 1105034 836508 984117 862868 2089151 1699376 X 16490925 16195984 11541 41428 16502466 16237412 18591617 17936788 -265054 0 X X 0 1 X 1 1 1 X 6143203 8776058 6050041 5810745 5701781 32481828 6143203 8776058 6050041 5810745 5701781 32481828 32481828 518 774 48787 44649 46667 141395 48802 66616 408513 27657 339303 890891 33514114 54928588 0.96920 0.98000 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2010 AMOUNT: $ 48,802. 2011 AMOUNT: $ 48,166. 2012 AMOUNT: $ 408,513. 2013 AMOUNT: $ 27,657. 2014 AMOUNT: $ 339,303. FUNDRAISING INCOME - 2011 AMOUNT: $ 18,450. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 133022 133022 18330846 5902901 12427945 4198466 2210873 1987593 29453 29453 0 14548560 X 16806211 -1222605 -1222605 18028816 0 18028816 17071265 0 17071265 1222605 1222605 18293870 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2014 AND 2013. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2011 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 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -1,222,605. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,222,605. X X X 0 0 0 0 0 0 0 1 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 164728 0 0 0 0 0 4597 0 7238 0 176563 0 0 0 SCOTT BRABANT CHIEF FINANCIAL OFFICER 152674 0 0 0 0 0 2600 0 22402 0 177676 0 0 0 ZEEV HAREL DIRECTOR PEDS & ADOL 206996 0 15000 0 0 0 8000 0 25580 0 255576 0 0 0 ANN-MARIE SURETTE PROVIDER 182267 0 0 0 0 0 7400 0 8770 0 198437 0 0 0 KATHLEEN TUMMILLO DIRECTOR OF ADULT MEDICINE 168453 0 0 0 0 0 6800 0 8175 0 183428 0 0 0 ANNA GEORGE PROVIDER 159849 0 0 0 0 0 6400 0 0 0 166249 0 0 0 RITU DUTTA DIRECTOR OF WOMEN'S HEALTH 195623 0 500 0 0 0 7692 0 7710 0 211525 0 0 0 X 1 453778 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 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.