2019-10-31T14:22:32-05:00 2018-12-31 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2018-01-01 060863942 COMMUNITY HEALTH SERVICES INC COMM 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 GREGORY L STANTON CEO 8602499625 2019-10-29 1 PAUL BALLASY P00852868 9592007000 2019-10-29 209.59.242.22 2019-10-29 12:14:29 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 3A16AF227DFFBEB6A54D665AEE301AB9EC7A606C 2018 2019-02-21 02:37:17Z GREGORY L STANTON 500 ALBANY AVENUE HARTFORD CT 06120 21532511 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. 9 9 230 80 0 0 6912223 6641012 14232150 14730244 5857 -3849 245094 160717 21395324 21528124 0 0 0 0 14919180 15701095 0 0 0 7834816 6564956 22753996 22266051 -1358672 -737927 16949933 16052031 1723585 1563610 15226348 14488421 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 16563283 14880461 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 2018. 16563283 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 31 0 1 230 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 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 HEATHER WOODWARD OUTGOING DIRECTOR 0.50 X 0 0 0 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 NYANDAH ROBINSON OUTGOING 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 STACY JIMENEZ OUTGOING DIRECTOR 0.50 X 0 0 0 TRUDI MCKENNA TREASURER 0.50 X X 0 0 0 DIANNA KULMACZ CHIEF FINANCIAL OFFICER 40.00 X 139830 0 32717 GREGORY STANTON CHIEF EXECUTIVE OFFICER 40.00 X 224897 0 20213 ZEEV HAREL INTERIM CMO 40.00 X 248670 0 43713 AVINDER UPADHYAY DIRECTOR OF DENTAL 40.00 X 163200 0 10277 CASEY GODSHALL DIRECTOR OF INFECTIOUS DISEASE 40.00 X 172500 0 9812 CYNTHIA ELIS DIRECTOR OF WOMEN'S HEALTH 40.00 X 222903 0 46544 GABRIELLA GRECO PSYCHIATRIST 40.00 X 217639 0 20910 JAIRO MONTEZUMA DIRECTOR OF ADULT MEDICINE 40.00 X 211189 0 47178 1600828 0 231364 25 0 1 0 QUALITY SYSTEMS INC PO BOX 809390 CHICAGO IL 60680 E.H.R PRODUCTS AND SERVICES 247256 UCONN HEALTH CENTER 263 FARMINGTON AVENUE FARMINGTON CT 06030 CONTRACTED DENTAL PROVIDERS 233447 CARDINAL HEALTH 5303 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 PHARMACEUTICALS 219101 MCCARTER AND ENGLISH LLP FOUR GATEWAY CENTER 100 MULBERRY ST NEWARK NJ 07102 LEGAL SERVICES 132542 DIVERSIFIED BUILDERS PO BOX 4658 WALLINGFORD CT 06492 BUILDING MAINTENANCE 109461 7 6374060 266952 837109 6641012 MEDICAID 621400 10044598 10044598 MEDICARE 621400 1676030 1676030 THIRD-PARTY PAYORS 621400 1383367 1383367 PHARMACY REVENUE 621400 1336837 1336837 PATIENTS 621400 289412 289412 14730244 538 538 10500 0 10500 10500 10500 4387 -4387 -4387 -4387 USAC REIMBURSEMENT 900099 86884 86884 MEDICARE COST REPORT REIMBURSEMEN 900099 29161 29161 EPI PEN SETTLEMENT 900099 28196 28196 5976 5976 150217 21528124 14880461 0 6651 710040 497028 213012 11292251 7904576 3387675 310043 217030 93013 2414486 1690140 724346 974275 681993 292282 120480 120480 71790 71790 1214450 1061846 152604 105358 73751 31607 378186 300523 77663 110605 55303 55302 19113 13379 5734 1166890 851830 315060 100559 73408 27151 PROVISION FOR BAD DEBTS 1252409 1252409 VACCINES 837109 837109 PROGRAM ACTIVITIES 701312 701312 EQUIPMENT RENTAL 365326 266688 98638 121369 84958 36411 22266051 16563283 5702768 0 1810157 2051154 1134831 1128500 305775 299442 714993 588185 423225 432239 248127 284050 23233707 11998974 12274711 11234733 22908 18521 15206 15207 16949933 16052031 1240069 1270959 483516 292651 1723585 1563610 X 15210746 14429096 15602 59325 15226348 14488421 16949933 16052031 -737927 0 X X 0 1 X 1 1 1 X 5701781 6173497 6898440 6912223 6641012 32326953 5701781 6173497 6898440 6912223 6641012 32326953 32326953 46667 14233 19360 14579 11038 105877 339303 232496 163786 230794 150217 1116596 33549426 66948124 0.96360 0.96530 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2014 AMOUNT: $ 20,553. 2015 AMOUNT: $ 19,996. 2016 AMOUNT: $ 19,286. 2017 AMOUNT: $ 73,544. 2018 AMOUNT: $ 5,976. MEANINGFUL USE - 2014 AMOUNT: $ 318,750. 2015 AMOUNT: $ 212,500. 2016 AMOUNT: $ 144,500. 2017 AMOUNT: $ 157,250. MEDICARE COST REPORT REIMBURSEMENT - 2018 AMOUNT: $ 29,161. EPI PEN SETTLEMENT - 2018 AMOUNT: $ 28,196. USAC REIMBURSEMENT - 2018 AMOUNT: $ 86,884. 133022 133022 18572624 8357205 10215419 4443308 3578707 864601 84753 63062 21691 11234733 X 20275715 -1252409 -1252409 21528124 0 21528124 21013642 0 21013642 1252409 1252409 22266051 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2018 AND 2017. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2015 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -1,252,409. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,252,409. X X X 0 0 0 0 0 0 0 1 0 DIANNA KULMACZ CHIEF FINANCIAL OFFICER 139830 0 0 0 0 0 1195 0 31522 0 172547 0 0 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 224897 0 0 0 0 0 7329 0 12884 0 245110 0 0 0 ZEEV HAREL INTERIM CMO 233608 0 15062 0 0 0 8250 0 35463 0 292383 0 0 0 AVINDER UPADHYAY DIRECTOR OF DENTAL 160492 0 2708 0 0 0 6528 0 3749 0 173477 0 0 0 CASEY GODSHALL DIRECTOR OF INFECTIOUS DISEASE 170000 0 2500 0 0 0 7100 0 2712 0 182312 0 0 0 CYNTHIA ELIS DIRECTOR OF WOMEN'S HEALTH 218736 0 4167 0 0 0 7482 0 39062 0 269447 0 0 0 GABRIELLA GRECO PSYCHIATRIST 217639 0 0 0 0 0 8753 0 12157 0 238549 0 0 0 JAIRO MONTEZUMA DIRECTOR OF ADULT MEDICINE 207064 0 4125 0 0 0 8250 0 38928 0 258367 0 0 0 PART I, LINE 7 VARIOUS HIGHLY COMPENSATED EMPLOYEES RECEIVED A CALENDAR YEAR APPROVED BONUS WHICH IS REFLECTED IN THEIR 2018 W2. X 1 837109 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.