CHIEF EXECUTIVE OFFICER

2012-10-12T08:57:34-05:00 2011-12-31 221478099 COHNREZNICK LLP 180 GLASTONBURY BOULEVARD GLASTONBURY CT 06033 990 2011-01-01 060863942 COMMUNITY HEALTH SERVICES INC COMM 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 KENNETH M GREEN CHIEF EXECUTIVE OFFICER 8602499625 2012-10-09 1 PAUL BALLASY P00852868 8606333000 2011 2016-02-24 21:20:13Z KENNETH M GREEN 500 ALBANY AVENUE HARTFORD CT 06120 20697449 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. 15 15 172 12 0 0 6143203 8776058 11806712 11854001 518 774 48802 14551 17999235 20645384 0 0 0 0 11207622 10471692 0 0 0 5184729 5553104 16392351 16024796 1606884 4620588 14021894 18588181 1833704 1785254 12188190 16802927 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 12723044 0 11902167 PROVIDE QUALITY HEALTH CARE SERVICES TO OVER 18,000 PATIENTS WHO ARE LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA. 12723044 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 19 0 1 172 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CT X SCOTT BRABANT 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 JACQUELINE MCDERMOTT-SELMAN CHAIRWOMAN 0.50 X X 0 0 0 AIGNER MITCHELL VICE CHAIRWOMAN 0.50 X X 0 0 0 MISHONE DONELSON TREASURER 0.50 X X 0 0 0 RICHARD ORDER SECRETARY 0.50 X X 0 0 0 KHADIJA ABDUL-SALAAM DIRECTOR 0.50 X 0 0 0 BIREE ANDEMARIAM DIRECTOR 0.50 X 0 0 0 JABER ASLANZADEH DIRECTOR 0.50 X 0 0 0 KRISTEN CLARK DIRECTOR 0.50 X 0 0 0 MARC A DIBELLA DIRECTOR 0.50 X 0 0 0 TAWANA DILLARD DIRECTOR 0.50 X 0 0 0 PATRICIA GIBBS DIRECTOR 0.50 X 0 0 0 SHERWOOD LEWIS DIRECTOR 0.50 X 0 0 0 EVELYN RICHARDSON DIRECTOR 0.50 X 0 0 0 FLOYD PAULLING DIRECTOR 0.50 X 0 0 0 CLORINDA SOLDEVILA DIRECTOR 0.50 X 0 0 0 KENNETH GREEN CHIEF EXECUTIVE OFFICER 40.00 X 153653 0 15010 ANDREA MONTGOMERY CHIEF OPERATING OFFICER 40.00 X 121867 0 6274 JOHVONNE CLAYBOURNE DO CHIEF MEDICAL OFFICER 40.00 X 154004 0 20371 RITU DUTTA DIRECTOR OF WOMEN'S HEALTH 40.00 X 183977 0 13738 KATHLEEN CUSICK PHYSICIAN 40.00 X 180983 0 15952 TULIKA KAUSHIK DENTIST 40.00 X 146074 0 20382 TERESITA FLYNN FORMER CFO 40.00 X 112891 0 7784 GRETCHEN ALLEN FORMER MEDICAL DIRECTOR 40.00 X 159210 0 15497 1212659 0 115008 16 1 1 0 SUFFOLK CONSTRUCTION 99 CONIFER HILL DRIVE DANVERS MA 01923 CONSTRUCTION MANAGEMENT 3661689 STAFF CARE PO BOX 281923 ATLANTA GA 30384 HEALTHCARE STAFFING 214174 DENTURE CENTER LLC 38 FLEETWOOD RD NEWINGTON CT 06111 DENTAL SUPPLIES 173592 UCONN HEALTH CENTER SCHOOL OF DENTAL MED 263 FARMINGTON AVENUE FARMINGTON CT 06030 DENTAL SERVICES 120779 DIVERSITIES BUILDING SERVICES LLC 340 QUINNIPIAC STREET WALLINGFORD CT 06492 JANITORIAL SERVICES 107303 12 26219 8165258 584581 308623 8776058 PATIENT SERVICE 620000 11854001 11854001 11854001 774 774 18450 26219 52065 -33615 -33615 OTHER REVENUE 900099 48166 48166 48166 20645384 11902167 0 -32841 1482572 1146547 336025 7145503 5554114 1591389 159279 116752 42527 1031523 755943 275580 652815 478513 174302 134318 134318 65765 65765 851787 826227 25560 8766 7258 1508 820424 748484 71940 156180 114168 42012 481913 352278 129635 29208 12589 16619 35789 15425 20364 37066 27080 9986 738262 539374 198888 160491 117255 43236 BAD DEBT 1221494 1221494 OUTSIDE SERVICES 472569 361093 111476 VACCINES 308623 308623 OTHER EXPENSES 25407 16464 8943 5042 3363 1679 16024796 12723044 3301752 0 689890 1006086 185928 772256 1397438 1081537 141822 250609 58238 154883 21310270 5996961 11536793 15313309 11785 9501 14021894 18588181 1023920 1103212 735523 669311 74261 12731 1833704 1785254 X 12158190 16753259 30000 49668 12188190 16802927 14021894 18588181 X 4620588 -5851 X X 0 1 1 X 1 1 X 5802065 4749427 5819655 6143203 8776058 31290408 5802065 4749427 5819655 6143203 8776058 31290408 31290408 11184 1402 735 518 774 14613 31305021 0.99950 0.99340 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 133022 133022 13001617 4161972 8839645 2641302 1834989 806313 5534329 5534329 15313309 SHORT-TERM LEASE PAYABLE 12731 12731 20645384 16024796 4620588 -5851 -5851 4614737 20691598 -5851 52065 46214 20645384 0 20645384 16076861 52065 52065 16024796 0 16024796 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2011. THE CENTER'S U.S. FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2008 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 XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE 52,065. PART XIII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 52,065. 2011 GALA 44669 26219 18450 9940 42125 44669 26219 18450 9940 42125 52065 -33615 X X X 0 0 0 0 0 0 0 0 0 KENNETH GREEN 153653 0 0 0 0 0 3138 0 11872 0 168663 0 0 0 JOHVONNE CLAYBOURNE DO 154004 0 0 0 0 0 6574 0 13797 0 174375 0 0 0 RITU DUTTA 183977 0 0 0 0 0 7200 0 6538 0 197715 0 0 0 KATHLEEN CUSICK 180983 0 0 0 0 0 7665 0 8287 0 196935 0 0 0 TULIKA KAUSHIK 146074 0 0 0 0 0 0 0 20382 0 166456 0 0 0 TERESITA FLYNN 112891 0 0 0 0 0 0 0 7784 0 120675 0 0 0 GRETCHEN ALLEN 159210 0 0 0 0 0 0 0 15497 0 174707 0 0 0 X 1 308623 COST 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE DEPARTMENT ALONG WITH THE CEO REVIEWS THE FORM 990 IS THEN FORWARDED TO THE FINANCE COMMITTEE WHO REVIEWS THE 990. 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 TO 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -5,851. FORM 990, PART XII, LINE 2C NO CHANGES FROM THE PRIOR YEAR.