2020-10-28T11:59:42-05:00 2019-12-31 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2019-01-01 060863942 COMMUNITY HEALTH SERVICES INC COMM 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 GREGORY L STANTON CEO 8602499625 2020-10-26 1 LORI ROTHE YOKOBOSKY CPA P01273422 9592007000 2020-10-14 209.59.242.37 2020-10-26 11:25:10 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F9BA0E82A6D947CC92540FBC56E8B73643681DA5 2019 2021-01-29 14:40:06Z GREGORY L STANTON 500 ALBANY AVENUE HARTFORD CT 06120 20769452 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. 10 10 228 0 0 0 6641012 6416673 14730244 14282396 -3849 8588 160717 61795 21528124 20769452 0 0 0 0 15701095 15929271 0 0 0 6564956 6062012 22266051 21991283 -737927 -1221831 16052031 14933118 1563610 1666528 14488421 13266590 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 16129450 14331441 PROVIDE QUALITY HEALTH CARE SERVICES TO PATIENTS WHO ARE LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA. THERE WERE 96,271 PATIENT VISITS IN 2019. 16129450 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 40 0 1 228 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CT X DIANNA KULMACZ 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 JUDITH BURCHELL VICE CHAIR 0.50 X X 0 0 0 LILLARD LEWIS JR DIRECTOR 0.50 X 0 0 0 MARISA BELGRAVE DIRECTOR 0.50 X 0 0 0 MIGUEL RODRIGUEZ DIRECTOR 0.50 X 0 0 0 RAICHEEN BLANKS DIRECTOR 0.50 X 0 0 0 RANDY MCKENNEY CHAIR 1.00 X X 0 0 0 REBECCA ADDAI DIRECTOR 0.50 X 0 0 0 ROBERT A MICHALIK JR DIRECTOR 0.50 X 0 0 0 ROSEMARY TATE SECRETARY 0.50 X X 0 0 0 TRUDI MCKENNA TREASURER 0.50 X X 0 0 0 DIANNA KULMACZ CHIEF FINANCIAL OFFICER 40.00 X 147658 0 36537 GREGORY STANTON CHIEF EXECUTIVE OFFICER 40.00 X 223978 0 21014 ZEEV HAREL INTERIM CMO 40.00 X 249292 0 44710 AVINDER UPADHYAY DIRECTOR OF DENTAL 40.00 X 165452 0 11168 CASEY GODSHALL DIRECTOR OF INFECTIOUS DIS 40.00 X 174808 0 12704 CYNTHIA ELIS DIRECTOR OF WOMEN'S HEALTH 40.00 X 233072 0 43731 ELIZABETH REYNOLDS PHYSICIAN 40.00 X 167371 0 12788 ORETT BROWN PHYSICIAN 40.00 X 158307 0 38835 1519938 0 221487 26 0 1 0 QUALITY SYSTEMS INC PO BOX 809390 CHICAGO IL 60680 E.H.R PRODUCTS AND SERVICES 274512 UCONN HEALTH CENTER 263 FARMINGTON AVENUE FARMINGTON CT 06030 CONTRACTED DENTAL PROVIDERS 246137 DIVERSIFIED BUILDERS PO BOX 4658 WALLINGFORD CT 06492 BUILDING MAINTENANCE 117701 IT SAVVY LLC PO BOX 3296 GLEN ELLYN IL 60138 IT MAINTENANCE 109489 4 6298383 118290 431259 6416673 MEDICAID 621400 9312010 9312010 THIRD-PARTY PAYORS 621400 1438185 1438185 MEDICARE 621400 1429455 1429455 PHARMACY REVENUE 621400 1265213 1265213 PATIENTS 621400 837533 837533 14282396 378 378 12750 0 12750 12750 12750 8210 0 8210 8210 8210 MEDICARE COST REPORT REIMBURSEMEN 900099 28886 28886 OTHER REVENUE 900099 14298 14298 USAC REIMBURSEMENT 900099 5861 5861 49045 20769452 14331441 0 21338 723189 506232 216957 11331850 7932295 3399555 323175 226222 96953 2497761 1748434 749327 1053296 737307 315989 39799 39799 54334 54334 1697824 1354551 343273 121864 85305 36559 389746 309120 80626 111815 55908 55907 10587 7411 3176 1067475 779257 288218 104380 76197 28183 PROGRAM ACTIVITIES 791132 791132 PROVISION FOR BAD DEBTS 692170 692170 VACCINES 431259 431259 EQUIPMENT RENTAL 397026 289829 107197 152601 106821 45780 21991283 16129450 5861833 0 2051154 1625414 1128500 1315115 299442 232323 588185 803405 432239 346351 284050 291068 23073919 12796414 11234733 10277505 18521 26731 15207 15206 16052031 14933118 1270959 1569872 292651 96656 1563610 1666528 X 14429096 13243680 59325 22910 14488421 13266590 16052031 14933118 -1221831 0 X X 0 1 X 1 1 1 X 6173497 6898440 6912223 6641012 6416673 33041845 6173497 6898440 6912223 6641012 6416673 33041845 33041845 14233 19360 14579 11038 13128 72338 232496 163786 230794 150217 49045 826338 33940521 69291255 0.97350 0.96360 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2015 AMOUNT: $ 19,996. 2016 AMOUNT: $ 19,286. 2017 AMOUNT: $ 73,544. 2018 AMOUNT: $ 5,976. 2019 AMOUNT: $ 14,298. MEANINGFUL USE - 2015 AMOUNT: $ 212,500. 2016 AMOUNT: $ 144,500. 2017 AMOUNT: $ 157,250. MEDICARE COST REPORT REIMBURSEMENT - 2018 AMOUNT: $ 29,161. 2019 AMOUNT: $ 28,886. EPI PEN SETTLEMENT - 2018 AMOUNT: $ 28,196. USAC REIMBURSEMENT - 2018 AMOUNT: $ 86,884. 2019 AMOUNT: $ 5,861. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 133022 133022 18609550 8980130 9629420 4246594 3742162 504432 84753 74122 10631 10277505 X 20769452 0 20769452 0 20769452 21991283 0 21991283 0 21991283 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2019 AND 2018. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2016 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CENTER HAD 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 STATEMENTS OF FINANCIAL POSITION. X X X 0 0 0 0 0 0 0 1 0 DIANNA KULMACZ CHIEF FINANCIAL OFFICER 147658 0 0 0 0 0 1516 0 35021 0 184195 0 0 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 223978 0 0 0 0 0 7293 0 13721 0 244992 0 0 0 ZEEV HAREL INTERIM CMO 235592 0 13700 0 0 0 8400 0 36310 0 294002 0 0 0 AVINDER UPADHYAY DIRECTOR OF DENTAL 164952 0 500 0 0 0 6608 0 4560 0 176620 0 0 0 CASEY GODSHALL DIRECTOR OF INFECTIOUS DIS 174808 0 0 0 0 0 7192 0 5512 0 187512 0 0 0 CYNTHIA ELIS DIRECTOR OF WOMEN'S HEALTH 227297 0 5775 0 0 0 7412 0 36319 0 276803 0 0 0 ELIZABETH REYNOLDS PHYSICIAN 166871 0 500 0 0 0 0 0 12788 0 180159 0 0 0 ORETT BROWN PHYSICIAN 158307 0 0 0 0 0 0 0 38835 0 197142 0 0 0 PART I, LINE 7 VARIOUS HIGHLY COMPENSATED EMPLOYEES RECEIVED A CALENDAR YEAR APPROVED BONUS WHICH IS REFLECTED IN THEIR 2019 W2. X 1 431259 FMV 0 0 0 PART I, COLUMN (B): THE AMOUNT IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION B, LINE 11B 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 15A 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.