2018-11-15T09:19:02-06:00 2017-12-31 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2017-01-01 060863942 COMMUNITY HEALTH SERVICES INC COMM 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 GREGORY L STANTON CEO 8602499625 2018-11-14 1 PAUL BALLASY P00852868 9592007000 2018-11-14 209.3.217.20 2018-11-14 14:54:19 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2E21FB21392521276ECBCA71CE173B16B4563FDE 2017 2019-02-21 02:37:17Z GREGORY L STANTON 500 ALBANY AVENUE HARTFORD CT 06120 21395504 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 9 215 80 0 0 6898440 6912223 13309269 14232150 4400 5857 182836 245094 20394945 21395324 0 0 0 0 13410152 14919180 0 0 0 6851833 7834816 20261985 22753996 132960 -1358672 18250119 16949933 1665099 1723585 16585020 15226348 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 17045538 14462944 PROVIDE QUALITY HEALTH CARE SERVICES TO PATIENTS WHO ARE LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA. THERE WERE 91,851 PATIENT VISITS IN 2017. 17045538 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 51 0 1 215 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 CT X DIANNA KULMACZ 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 HEATHER WOODWARD DIRECTOR 0.50 X 0 0 0 JOHN SODIPO OUTGOING DIRECTOR 0.50 X 0 0 0 JUDITH BURCHELL DIRECTOR 0.50 X 0 0 0 LUIS MIGUEL AYALA OUTGOING DIRECTOR 1.00 X 0 0 0 NYANDAH ROBINSON 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 ROBERT A MICHALIK JR DIRECTOR 0.50 X 0 0 0 ROBERT HARRIS OUTGOING DIRECTOR 1.00 X 0 0 0 ROSEMARY TATE SECRETARY 0.50 X X 0 0 0 STACY JIMENEZ DIRECTOR 0.50 X 0 0 0 TRUDI MCKENNA TREASURER 1.00 X X 0 0 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 40.00 X 202657 0 15285 RICHARD NANKEE CHIEF FINANCIAL OFFICER 40.00 X 148679 0 26642 ZEEV HAREL INTERIM CMO 40.00 X 258537 0 29686 AVINDER UPADHYAY DIRECTOR OF DENTAL 40.00 X 162645 0 6004 CYNTHIA ELIS DIRECTOR OF WOMEN'S HEALTH 40.00 X 197552 0 33860 ELIZABETH REYNOLDS PHYSICIAN 40.00 X 164926 0 7985 JAIRO MONTEZUMA DIRECTOR OF ADULT MEDICINE 40.00 X 194862 0 31279 ZAHRA PUJANI STAFF DENTIST 40.00 X 147340 0 12828 1477198 0 163569 24 0 1 0 OPTIV SECURITY INC POBOX 28216 NETWORK PLACE CHICAGO IL 60673 IT PRODUCTS AND PROFESSIONAL SERVICES 329493 QUALITY SYSTEMS INC PO BOX 809390 CHICAGO IL 60680 E.H.R PRODUCTS AND SERVICES 271195 RICOH USA INC PO BOX 41564 PHILADELPHIA PA 19101 IMAGE SCANNING SERVICES 192705 UCONN HEALTH CENTER 263 FARMINGTON AVENUE FARMINGTON CT 06030 CONTRACTED DENTAL PROVIDERS 122186 MCCARTER AND ENGLISH LLP FOUR GATEWAY CENTER 100 MULBERRY ST NEWARK NJ 07102 LEGAL SERVICES 121317 8 6824146 88077 764590 6912223 MEDICAID 621400 9220978 9220978 PHARMACY REVENUE 621400 1376382 1376382 MEDICARE 621400 1256300 1256300 PATIENTS 621400 1194537 1194537 THIRD-PARTY PAYORS 621400 1183953 1183953 14232150 279 279 14300 0 14300 14300 14300 5758 0 180 5758 -180 5578 5578 MEANINGFUL USE 900099 157250 157250 OTHER REVENUE 900099 73544 73544 230794 21395324 14462944 0 20157 689684 482779 206905 10672749 7470924 3201825 274947 192463 82484 2266708 1586696 680012 1015092 710565 304527 242417 242417 69608 69608 1969387 1709282 260105 117567 82297 35270 332980 265636 67344 109721 54861 54860 26261 18383 7878 1209375 882844 326531 97089 70875 26214 PROVISION FOR BAD DEBTS 1721443 1721443 VACCINES 716893 716893 PROGRAM ACTIVITIES 712298 712298 EQUIPMENT RENTAL 348518 254418 94100 161259 112881 48378 22753996 17045538 5708458 0 2352370 1810157 1126247 1134831 509440 305775 613584 714993 446961 423225 204317 248127 23106796 10832085 12969917 12274711 17150 22908 10133 15206 18250119 16949933 1116491 1240069 548608 483516 1665099 1723585 X 16527712 15210746 57308 15602 16585020 15226348 18250119 16949933 -1358672 0 X X 0 1 X 1 1 1 X 5810745 5701781 6173497 6898440 6912223 31496686 5810745 5701781 6173497 6898440 6912223 31496686 31496686 44649 46667 14233 19360 14579 139488 27657 339303 232496 163786 230794 994036 32630210 46761688 0.96530 0.95790 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2013 AMOUNT: $ 27,657. 2014 AMOUNT: $ 20,553. 2015 AMOUNT: $ 19,996. 2016 AMOUNT: $ 19,286. 2017 AMOUNT: $ 73,544. MEANINGFUL USE - 2014 AMOUNT: $ 318,750. 2015 AMOUNT: $ 212,500. 2016 AMOUNT: $ 144,500. 2017 AMOUNT: $ 157,250. 133022 133022 18552945 7736045 10816900 4336076 3044038 1292038 84753 52002 32751 12274711 X 19673881 -1721443 -1721443 21395324 0 21395324 21032553 0 21032553 1721443 1721443 22753996 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2017 AND 2016. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO CALENDAR YEAR 2014 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 -1,721,443. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,721,443. X X X 0 0 0 0 0 0 0 1 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 202657 0 0 0 0 0 6300 0 10973 0 219930 0 0 0 RICHARD NANKEE CHIEF FINANCIAL OFFICER 148679 0 0 0 0 0 0 0 28405 0 177084 0 0 0 ZEEV HAREL INTERIM CMO 232504 0 26033 0 0 0 8100 0 23743 0 290380 0 0 0 AVINDER UPADHYAY DIRECTOR OF DENTAL 160245 0 2400 0 0 0 6004 0 2104 0 170753 0 0 0 CYNTHIA ELIS DIRECTOR OF WOMEN'S HEALTH 191007 0 6545 0 0 0 7217 0 28799 0 233568 0 0 0 ELIZABETH REYNOLDS PHYSICIAN 164926 0 0 0 0 0 0 0 10123 0 175049 0 0 0 JAIRO MONTEZUMA DIRECTOR OF ADULT MEDICINE 187662 0 7200 0 0 0 6288 0 27148 0 228298 0 0 0 ZAHRA PUJANI STAFF DENTIST 147340 0 0 0 0 0 4425 0 10477 0 162242 0 0 0 PART I, LINE 7 VARIOUS HIGHLY COMPENSATED EMPLOYEES RECEIVED A CALENDAR YEAR APPROVED BONUS WHICH IS REFLECTED IN THEIR 2017 W2. X 1 716893 FMV X LIGHTING 1 47697 FMV 0 0 0 PART I, COLUMN (B): COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION B, LINE 11B THE CEO REVIEWS THE FORM 990 PRIOR TO THE SUBMISSION OF THE FILING. AFTER THE FILING OF THE FORM, IT WILL BE RATIFIED BY THE BOARD OF DIRECTORS DURING THE REGULARLY SCHEDULED BOARD OF DIRECTORS MEETING IN NOVEMBER 2018. 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.