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COMMUNITY HEALTH SERVICES INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH SERVICES INC (EIN 06-0863942)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-09-13
IRS object ID
201332569349301208
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-09-13T15:23:15-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN221478099EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1COHNREZNICK LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1180 GLASTONBURY BOULEVARDAddressLine1
CityGLASTONBURYCity
StateCTState
ZIP Code06033ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN060863942EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone8602499625Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 ALBANY AVENUEAddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06120ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGREGORY L STANTONName
TitleCPATitle
Phone8602499625Phone
Date Signed2013-09-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
PTINP00852868PTIN
Phone8606333000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGREGORY L STANTONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 ALBANY AVENUEAddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06120ZIPCode
FieldValueIRS element (for citing)
Gross Receipts17059993GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHSHARTFORD.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1967YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionTO 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees177TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year8776058ContributionsGrantsPriorYear
Contributions Grants Current Year6050041ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11854001ProgramServiceRevenuePriorYear
Program Service Revenue CY10552652ProgramServiceRevenueCY
Investment Income Prior Year774InvestmentIncomePriorYear
Investment Income Current Year624InvestmentIncomeCurrentYear
Other Revenue Prior Year14551OtherRevenuePriorYear
Other Revenue Current Year456676OtherRevenueCurrentYear
Total Revenue Prior Year20645384TotalRevenuePriorYear
Total Revenue Current Year17059993TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10471692SalariesEtcPriorYear
Salaries Etc Current Year10596592SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5553104OtherExpensePriorYear
Other Expenses Current Year4943028OtherExpensesCurrentYear
Total Expenses Prior Year16024796TotalExpensesPriorYear
Total Expenses Current Year15539620TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4620588RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1520373RevenuesLessExpensesCY
Total Assets BOY18588181TotalAssetsBOY
Total Assets EOY20446737TotalAssetsEOY
Total Liabilities BOY1785254TotalLiabilitiesBOY
Total Liabilities EOY2123437TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY16802927NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY18323300NetAssetsOrFundBalancesEOY
Mission DescriptionTO 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense11244756Expense
Revenue10935152Revenue
DescriptionPROVIDE QUALITY HEALTH CARE SERVICES TO PATIENTS WHO ARE LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA. THERE WERE 88,864 PATIENT VISITS IN 2012.Description
Total Program Service Expense11244756TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109637NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees177NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledCTStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSCOTT BRABANTNamePerson
Telephone Number8602499625TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1500 ALBANY AVENUEAddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06120ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
AIGNER MITCHELL
CHAIRPERSON1.00XX000
JABER ASLANZADEH
VICE CHAIRMAN1.00XX000
MISHONE DONELSON
TREASURER1.00XX000
JACQUELINE MCDERMOTT-SELMAN
SECRETARY1.00XX000
KHADIJA ABDUL-SALAAM
DIRECTOR0.50X000
KRISTEN CLARK
DIRECTOR0.50X000
TAWANA DILLARD
DIRECTOR0.50X000
SHERWOOD LEWIS
DIRECTOR0.50X000
RICHARD ORDER
DIRECTOR0.50X000
FLOYD PAULLING
DIRECTOR0.50X000
EVELYN RICHARDSON
DIRECTOR0.50X000
CLORINDA SOLDEVILA
DIRECTOR0.50X000
MICHAEL WILLIAMS
DIRECTOR0.50X000
KENNETH GREEN
CHIEF EXECUTIVE OFFICER (THROUGH JANUARY 2013)40.00X162692024105
JOHVONNE CLAYBOURNE DO
CHIEF MEDICAL OFFICER40.00X206444033292
ANDREA MONTGOMERY
CHIEF OPERATING OFFICER AND ACTING CEO40.00X12295606193
SCOTT BRABANT
CHIEF FINANCIAL OFFICER40.00X69157017072
RITU DUTTA
DIRECTOR OF WOMEN'S HEALTH40.00204639016063X
MONTRESSOR UPSHAW
DIRECTOR OF DENTISTRY40.0014828807816X
TULIKA KAUSHIK
DENTIST40.00144218022828X
SHARJEEL AHMAD
ASSOCIATE DIRECTOR OF ADULT MEDICINE40.00137829012573X
DAVID ZALUSKI
DENTIST40.0013054101156X
JULIE EAPEN
PEDIATRICIAN40.0012540804592X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1452172TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation145690TotalOtherCompensation
Number Individuals GT100 K16NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
OR&L CONSTRUCTION
2 SUMMIT PLACEBRANFORDCT06405CONSTRUCTION MANAGEMENT268398
QUALITY SYSTEMS INC
PO BOX 809390CHICAGOIL60680SOFTWARE INSTALLATION & IMPLEMENTATION241421
STAFF CARE
PO BOX 281923ATLANTAGA30384HEALTHCARE STAFFING189816
SUCCESS EHS
ONE METROPLEX DRIVE SUITE 500BIRMINGHAMAL35209SOFTWARE SERVICE FEES164500
DIVERSIFIED BUILDING SERVICES INC
340 QUINNIPIAC STREETWALLINGFORDCT06492JANITORIAL SERVICES113237
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Government Grants5933957GovernmentGrants
All Other Contributions116084AllOtherContributions
Noncash Contributions335823NoncashContributions
Total Contributions6050041TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICEDescription
Business Code620000BusinessCode
Total Revenue Column10552652TotalRevenueColumn
Related Or Exempt Function Income10552652RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue10552652TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column624TotalRevenueColumn
Exclusion$624ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real48163Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real48163Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column48163TotalRevenueColumn
Exclusion$48,163ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
MEANINGFUL USE REVENUE900099382500382500
OTHER REVENUE90009926013$26,013
FieldValueIRS element (for citing)
Total Other Revenue408513TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column17059993TotalRevenueColumn
Related Or Exempt Function Income10935152RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$74,800ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total854304Total
Program Services316490ProgramServices
Management And General537814ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7855780Total
Program Services5731334ProgramServices
Management And General2124446ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total85143Total
Program Services61220ProgramServices
Management And General23923ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1188744Total
Program Services778300ProgramServices
Management And General410444ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total612621Total
Program Services390448ProgramServices
Management And General222173ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total57040Total
Management And General57040ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total48000Total
Management And General48000ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total864618Total
Program Services690929ProgramServices
Management And General173689ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total691934Total
Program Services657075ProgramServices
Management And General34859ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total109313Total
Program Services90317ProgramServices
Management And General18996ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total927242Total
Program Services687765ProgramServices
Management And General239477ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total20790Total
Program Services10444ProgramServices
Management And General10346ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total68982Total
Program Services34655ProgramServices
Management And General34327ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total35708Total
Program Services28174ProgramServices
Management And General7534ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total787782Total
Program Services578862ProgramServices
Management And General208920ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total137141Total
Program Services100771ProgramServices
Management And General36370ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
OTHER EXPENSES33591228166954243
VACCINES335823335823
OUTSIDE SERVICES30075524849252263
BAD DEBT221988221988

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15539620Total
Program Services11244756ProgramServices
Management And General4294864ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1006086BOY
EOY2874504EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY772256BOY
EOY721433EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1081537BOY
EOY681697EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY250609BOY
EOY170357EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY154883BOY
EOY165881EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis22598567LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6784743LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY15313309BOY
EOY15813824EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY9501BOY
EOY8908EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY10133EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY18588181BOY
EOY20446737EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1103212BOY
EOY1523677EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY669311BOY
EOY599760EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY12731BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1785254BOY
EOY2123437EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY16753259BOY
EOY18315827EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY49668BOY
EOY7473EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16802927BOY
EOY18323300EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18588181BOY
EOY20446737EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses1520373ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4749427CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5819655CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6143203CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8776058CurrentTaxYearMinus1Year
Current Tax Year6050041CurrentTaxYear
Total31538384Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4749427CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5819655CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6143203CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8776058CurrentTaxYearMinus1Year
Current Tax Year6050041CurrentTaxYear
Total31538384Total
FieldValueIRS element (for citing)
Public Support Total17031538384PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1402CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years735CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years518CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year774CurrentTaxYearMinus1Year
Current Tax Year624CurrentTaxYear
Total4053Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years20702CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years34084CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years48802CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year48166CurrentTaxYearMinus1Year
Current Tax Year408513CurrentTaxYear
Total560267Total
FieldValueIRS element (for citing)
Total Support32102704TotalSupport
Gross Receipts From Admissions Etc51429051GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.98240PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99950PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
General ExplanationSCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2008 AMOUNT: $ 20,702. 2009 AMOUNT: $ 34,084. 2010 AMOUNT: $ 48,802. 2011 AMOUNT: $ 48,166. 2012 AMOUNT: $ 408,513.GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis133022OtherCostOrOtherBasis
Book Value133022BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis18313036OtherCostOrOtherBasis
Depreciation4682079Depreciation
Book Value13630957BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis268398OtherCostOrOtherBasis
Book Value268398BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3288345OtherCostOrOtherBasis
Depreciation2102664Depreciation
Book Value1185681BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis595766OtherCostOrOtherBasis
Book Value595766BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings15813824TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt16838005TotRevenueEtcAuditedFinclStmt
Other Revenues-221988OtherRevenues
Revenue Not Rptd F990-221988RevenueNotRptdF990
Revenue Subtotal17059993RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99017059993TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt15317632TotExpensesEtcAuditedFinclStmt
Other Expenses Included-221988OtherExpensesIncluded
Expenses Not Rptd F990-221988ExpensesNotRptdF990
Expenses Subtotal15539620ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99015539620TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2012. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2009 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:BAD DEBT EXPENSE -221,988.
PART XII, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE -221,988.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KENNETH GREEN
CHIEF EXECUTIVE OFFICER (THROUGH JAN1626920000068000173050186797000
JOHVONNE CLAYBOURNE DO
CHIEF MEDICAL OFFICER2064440000087000245920239736000
RITU DUTTA
DIRECTOR OF WOMEN'S HEALTH204639000008309077540220702000
MONTRESSOR UPSHAW
DIRECTOR OF DENTISTRY148288000000078160156104000
TULIKA KAUSHIK
DENTIST1442180000000228280167046000
SHARJEEL AHMAD
ASSOCIATE DIRECTOR OF ADULT MEDICINE137829000005605069680150402000

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990335823NoncashContribsRptdF990
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE FINANCE DEPARTMENT ALONG WITH THE ACTING 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 12CCOMMUNITY 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 15THE 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. SHE 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 19COMMUNITY 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 IN THE OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.