2013-09-13T15:23:15-05:00 2012-12-31 221478099 COHNREZNICK LLP 180 GLASTONBURY BOULEVARD GLASTONBURY CT 06033 990 2012-01-01 060863942 COMMUNITY HEALTH SERVICES INC COMM 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 GREGORY L STANTON 8602499625 2013-09-06 1 P00852868 8606333000 2012 2016-02-24 21:20:13Z GREGORY L STANTON 500 ALBANY AVENUE HARTFORD CT 06120 17059993 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. 13 13 177 10 0 0 8776058 6050041 11854001 10552652 774 624 14551 456676 20645384 17059993 0 0 0 0 10471692 10596592 0 0 0 5553104 4943028 16024796 15539620 4620588 1520373 18588181 20446737 1785254 2123437 16802927 18323300 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 11244756 10935152 PROVIDE 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. 11244756 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 37 0 1 177 1 0 0 0 0 0 0 0 0 0 0 X 13 13 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 AIGNER MITCHELL 1.00 X X 0 0 0 JABER ASLANZADEH 1.00 X X 0 0 0 MISHONE DONELSON 1.00 X X 0 0 0 JACQUELINE MCDERMOTT-SELMAN 1.00 X X 0 0 0 KHADIJA ABDUL-SALAAM 0.50 X 0 0 0 KRISTEN CLARK 0.50 X 0 0 0 TAWANA DILLARD 0.50 X 0 0 0 SHERWOOD LEWIS 0.50 X 0 0 0 RICHARD ORDER 0.50 X 0 0 0 FLOYD PAULLING 0.50 X 0 0 0 EVELYN RICHARDSON 0.50 X 0 0 0 CLORINDA SOLDEVILA 0.50 X 0 0 0 MICHAEL WILLIAMS 0.50 X 0 0 0 KENNETH GREEN 40.00 X 162692 0 24105 JOHVONNE CLAYBOURNE DO 40.00 X 206444 0 33292 ANDREA MONTGOMERY 40.00 X 122956 0 6193 SCOTT BRABANT 40.00 X 69157 0 17072 RITU DUTTA 40.00 X 204639 0 16063 MONTRESSOR UPSHAW 40.00 X 148288 0 7816 TULIKA KAUSHIK 40.00 X 144218 0 22828 SHARJEEL AHMAD 40.00 X 137829 0 12573 DAVID ZALUSKI 40.00 X 130541 0 1156 JULIE EAPEN 40.00 X 125408 0 4592 1452172 0 145690 16 0 1 0 OR&L CONSTRUCTION 2 SUMMIT PLACE BRANFORD CT 06405 CONSTRUCTION MANAGEMENT 268398 QUALITY SYSTEMS INC PO BOX 809390 CHICAGO IL 60680 SOFTWARE INSTALLATION & IMPLEMENTATION 241421 STAFF CARE PO BOX 281923 ATLANTA GA 30384 HEALTHCARE STAFFING 189816 SUCCESS EHS ONE METROPLEX DRIVE SUITE 500 BIRMINGHAM AL 35209 SOFTWARE SERVICE FEES 164500 DIVERSIFIED BUILDING SERVICES INC 340 QUINNIPIAC STREET WALLINGFORD CT 06492 JANITORIAL SERVICES 113237 6 5933957 116084 335823 6050041 PATIENT SERVICE 620000 10552652 10552652 10552652 624 624 48163 0 48163 48163 48163 MEANINGFUL USE REVENUE 900099 382500 382500 OTHER REVENUE 900099 26013 26013 408513 17059993 10935152 0 74800 854304 316490 537814 7855780 5731334 2124446 85143 61220 23923 1188744 778300 410444 612621 390448 222173 57040 57040 48000 48000 864618 690929 173689 691934 657075 34859 109313 90317 18996 927242 687765 239477 20790 10444 10346 68982 34655 34327 35708 28174 7534 787782 578862 208920 137141 100771 36370 OTHER EXPENSES 335912 281669 54243 VACCINES 335823 335823 OUTSIDE SERVICES 300755 248492 52263 BAD DEBT 221988 221988 15539620 11244756 4294864 0 1006086 2874504 772256 721433 1081537 681697 250609 170357 154883 165881 22598567 6784743 15313309 15813824 9501 8908 0 10133 18588181 20446737 1103212 1523677 669311 599760 12731 0 1785254 2123437 X 16753259 18315827 49668 7473 16802927 18323300 18588181 20446737 1520373 0 X X 0 1 X 1 1 1 X 4749427 5819655 6143203 8776058 6050041 31538384 4749427 5819655 6143203 8776058 6050041 31538384 31538384 1402 735 518 774 624 4053 20702 34084 48802 48166 408513 560267 32102704 51429051 0.98240 0.99950 X SCHEDULE 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 133022 133022 18313036 4682079 13630957 268398 268398 3288345 2102664 1185681 595766 595766 15813824 X 16838005 -221988 -221988 17059993 0 17059993 15317632 -221988 -221988 15539620 0 15539620 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. X X X 0 0 0 0 0 0 0 0 0 KENNETH GREEN 162692 0 0 0 0 0 6800 0 17305 0 186797 0 0 0 JOHVONNE CLAYBOURNE DO 206444 0 0 0 0 0 8700 0 24592 0 239736 0 0 0 RITU DUTTA 204639 0 0 0 0 0 8309 0 7754 0 220702 0 0 0 MONTRESSOR UPSHAW 148288 0 0 0 0 0 0 0 7816 0 156104 0 0 0 TULIKA KAUSHIK 144218 0 0 0 0 0 0 0 22828 0 167046 0 0 0 SHARJEEL AHMAD 137829 0 0 0 0 0 5605 0 6968 0 150402 0 0 0 X 1 335823 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 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 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 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. 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 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 IN THE OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.