2023-10-27T10:34:42-05:00 2022-12-31 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2022-01-01 455239655 COMMUNITY HEALTH NETWORK OF CONNECTICUT HOLDINGS INC COMM 2039494000 11 FAIRFIELD BOULEVARD WALLINGFORD CT 06492 SYLVIA B KELLY PRESIDENT & CEO 2039494000 2023-10-27 1 SYLVIA KELLY 999009999 1 LORI ROTHE YOKOBOSKY CPA P01273422 9592007000 2023-10-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SYLVIA B KELLY 11 FAIRFIELD BOULEVARD WALLINGFORD CT 06492 763675 0 X N/A X 2011 CT MOST SIGNIFICANT ACTIVITIES ARE PROVIDING SUPPORT, STRATEGIC PLANNING, AND FACILITIES FOR 501(C)(3) FEDERALLY QUALIFIED HEALTH CENTERS. 7 7 1 7 0 0 0 0 794705 763675 -668859 0 0 0 125846 763675 3000 0 0 0 247131 252477 0 0 0 520528 513253 770659 765730 -644813 -2055 6025480 6038519 101160 116254 5924320 5922265 THE CORPORATION HAS NOT ADOPTED A SEPARATE MISSION STATEMENT. HOWEVER, THE CORPORATION'S CHARITABLE PURPOSE IS TO SUPPORT 501(C)(3) TAX-EXEMPT FEDERALLY QUALIFIED HEALTH CENTERS. 0 0 STRATEGIC PLANNING ACTIVITY - THE CORPORATION PERFORMS PLANNING AND COORDINATING SERVICES FOR CHNCT. THE CORPORATION'S DIRECTORS AND OFFICERS DEVELOP LONG-RANGE STRATEGIC PLANS FOR BOTH THE CORPORATION AND CHNCT. THIS ACTIVITY INCLUDES OVERSIGHT RESPONSIBILITY FOR THE PHILOSOPHY, MISSION AND BUDGET OF BOTH ORGANIZATIONS, AS WELL AS REVIEW AND APPROVAL OF THE OBJECTIVES AND MAJOR POLICIES OF THE SUPPORTED CHNCT. 509098 503940 FACILITIES MAINTENANCE ACTIVITY - THE CORPORATION OWNS AND MAINTAINS PROPERTY FOR CHNCT TO USE IN FURTHERANCE OF ITS TAX-EXEMPT ACTIVITIES. THE CORPORATION FORMED A SINGLE MEMBER LIMITED LIABILITY COMPANY, FOUNDERS ASSOCIATES, LLC TO PURCHASE 4 FAIRFIELD BOULEVARD IN WALLINGFORD, CT AND LEASE IT TO CHNCT. THE PROPERTY WAS PURCHASED IN SEPTEMBER 2013. 256632 259735 IN FURTHERANCE OF THE SUPPORT OF THE CHARITABLE ACTIVITIES OF CHNCT, CHNCT HOLDINGS, INC. HAS DEVELOPED AND IMPLEMENTED A PLAN TO ESTABLISH A TELEHEALTH PROGRAM TO IMPROVE HEALTHCARE ACCESS TO THE MEDICALLY UNDERSERVED POPULATION OF CONNECTICUT THROUGH FEDERALLY QUALIFIED HEALTH CENTERS IN THE STATE OF CONNECTICUT. SERVICES PROVIDED IN THIS TELEHEALTH PROGRAM INCLUDE DIABETIC RETINOPATHY SCREENING, SPECIALIST ECONSULTS, BEHAVIORAL HEALTH AND PRIMARY CARE VIRTUAL VISITS, REMOTE PATIENT MONITORING AND CHRONIC CONDITION MANAGEMENT. 765730 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 6 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 0 0 1 0 X SYLVIA B KELLY 2039494000 11 FAIRFIELD BOULEVARD WALLINGFORD CT 06492 ARVIND SHAW CHAIR 1.00 2.50 X X 0 0 0 DON THOMPSON TREASURER 1.00 X X 0 0 0 MICHAEL R TAYLOR DIRECTOR 1.00 X 0 0 0 MOLLIE MELBOURNE DIRECTOR 1.00 X 0 0 0 NICHELLE MULLINS SECRETARY 1.00 X X 0 0 0 SUZANNE LAGARDE MD VICE CHAIR 1.00 X X 0 0 0 KAREN A DALEY DIRECTOR 1.00 X 0 0 0 SYLVIA B KELLY MPA PRESIDENT & CEO 1.00 42.00 X 0 611690 15126 RICHARD ALBRECHT TELEHEALTH NETWORK DIRECTOR 40.00 X 205909 0 41813 205909 611690 56939 1 0 1 0 0 PROGRAM SERVICE REVENU 531120 763675 763675 763675 763675 763675 0 0 240070 240070 12407 12407 15437 15437 6723 6723 662 662 100164 100164 130 130 35 35 312989 312989 20352 20352 REPAIRS & MAINTENANCE 56731 56731 MEMBERSHIP 30 30 765730 765730 0 0 2773419 3129981 58078 17143 36229 36722 5099224 2251632 3150446 2847592 1000 1000 6308 6081 6025480 6038519 35905 29679 23135 44070 42120 42505 101160 116254 X 5924320 5922265 5924320 5922265 6025480 6038519 -2055 0 X 0 0 0 X X 1 COMMUNITY HEALTH NETWORK 061429341 10 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV SECTION A LINE 1 THE CORPORATION'S CERTIFICATE OF INCORPORATION PROVIDES THAT THE CORPORATION SHALL BE OPERATED EXCLUSIVELY FOR 501(C)(3) CHARITABLE PURPOSES AS A TYPE I SUPPORTING ORGANIZATION FOR THE CORPORATION'S MEMBERS. THE CORPORATION'S CERTIFICATE OF INCORPORATION ALSO PROVIDES THAT MEMBERSHIP IN THE CORPORATION IS LIMITED TO FEDERALLY QUALIFIED HEALTH CENTERS THAT: (A) HAVE FACILITIES LOCATED IN CONNECTICUT; (B) ARE TAX-EXEMPT ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE; (C) ARE PUBLICLY SUPPORTED ORGANIZATIONS DESCRIBED IN CODE SECTION 509(A)(1) OR (2); AND (D) MEET THE OTHER QUALIFICATIONS SET FORTH IN THE BYLAWS OF THE CORPORATION. IN ADDITION, THE BYLAWS OF THE CORPORATION SPECIFICALLY LIST BY NAME THE FEDERALLY QUALIFIED HEALTH CENTERS THAT ARE THE SUPPORTED ORGANIZATIONS OF THE CORPORATION. FORM SCHEDULE A PART I LINE 12G ALTHOUGH THE SUPPORTED ORGANIZATION IS A C(4) ORGANIZATION, LINE 10 IS SELECTED IN COLUMN III. PLEASE SEE THE ATTACHED SCHEDULE O FOR A DESCRIPTION OF THE SUPPORTED ORGANIZATION'S C(3) ACTIVITIES. 418600 418600 2912481 906105 2006376 1768143 1345527 422616 2847592 SECURITY DEPOSIT PAYABLE 37518 DUE TO AFFILIATES 4987 42505 0 0 0 0 0 0 0 1 0 SYLVIA B KELLY MPA PRESIDENT & CEO 0 495273 0 69969 0 46448 0 10675 0 4451 0 626816 0 0 RICHARD ALBRECHT TELEHEALTH NETWORK DIRECTOR 173453 0 18851 0 13605 0 6560 0 35253 0 247722 0 0 0 PART I, LINE 7 IN 2022, THE COMPANY ISSUED QUARTERLY INCENTIVE BONUS PAYMENTS TO ITS SOLE EMPLOYEE, THE TELEHEALTH DIRECTOR, AS PER THE INCENTIVE PLAN THAT WAS ESTABLISHED IN 2020 BY THE TELEHEALTH PROGRAM COMMITTEE, THE PERSONNEL AND COMPENSATION COMMITTEE AND THE BOARD OF DIRECTORS. THE PURPOSE OF THE INCENTIVE PLAN IS TO ALIGN THE TELEHEALTH DIRECTOR'S WORK EFFORT WITH THE OBJECTIVES AND ACCOMPLISHMENTS OF THE TELEHEALTH PROGRAM. ON A QUARTERLY BASIS, THE TELEHEALTH PROGRAM COMMITTEE REVIEWS AND EVALUATES THE PROGRAM'S ACCOMPLISHMENTS AS COMPARED TO ITS OBJECTIVES AND DETERMINES THE ISSUANCE OF AN INCENTIVE BONUS PAYMENT FOR THE TELEHEALTH DIRECTOR VALUED AT 10% OF BASE SALARY. ON A QUARTERLY BASIS, THE TELEHEALTH PROGRAM COMMITTEE PRESENTS ITS FINDINGS AND RECOMMENDATION TO THE PERSONNEL AND COMPENSATION COMMITTEE FOR APPROVAL OF THE ISSUANCE OF THE INCENTIVE BONUS PAYMENT FOR THE TELEHEALTH DIRECTOR. THE MEMBERS OF THE TELEHEALTH PROGRAM COMMITTEE AND THE MEMBERS OF THE PERSONNEL AND COMPENSATION COMMITTEE ARE MEMBERS OF THE COMPANY'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SINGLE CLASS OF MEMBERS. THERE ARE SEVEN MEMBERS IN THE SINGLE CLASS OF MEMBERS. EACH MEMBER IS A FEDERALLY QUALIFIED HEALTH CENTER THAT HAS BEEN DETERMINED BY THE IRS TO BE A TAX-EXEMPT CHARITABLE ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER HAS THE RIGHT TO APPOINT ONE INDIVIDUAL TO THE ORGANIZATION'S BOARD OF DIRECTORS. THE FOLLOWING SIGNIFICANT TRANSACTIONS REQUIRE MEMBER APPROVAL: DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS; CREATION OF A SUBSIDIARY; ENGAGEMENT OF A MANAGEMENT COMPANY; AND/OR AMENDMENT OF THE CERTIFICATE OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B ONCE PREPARED BY OUR THIRD PARTY ACCOUNTANTS, THE 990 FORM IS REVIEWED BY CHNCT'S ASSOCIATE VP OF FINANCE, CHIEF FINANCIAL OFFICER, CHIEF EXECUTIVE OFFICER, SENIOR VICE PRESIDENT OF COMPLIANCE, AND VICE PRESIDENT OF HUMAN RESOURCES. AFTER THIS REVIEW PROCESS IS COMPLETED, THE 990 FORM IS DISTRIBUTED TO EACH MEMBER OF THE CHNCT HOLDINGS BOARD OF DIRECTORS (CHNCT HOLDINGS IS THE SOLE MEMBER OF CHNCT) PRIOR TO FILING OF THE DOCUMENT WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS (EXECUTIVE MANAGEMENT) ARE REQUIRED TO DISCLOSE ANNUAL INTERESTS THAT COULD GIVE RISE TO CONFLICTS TO THE COMPLIANCE OFFICER. FORM 990, PART VI, SECTION B, LINE 15B THE ORGANIZATION HAS ONE EMPLOYEE, THE TELEHEALTH DIRECTOR. THE PROCESS FOR DETERMINING THIS EMPLOYEE'S COMPENSATION WITH RESPECT TO 2022 WAS BASED ON THE GENERAL MARKET FOR SIMILAR POSITIONS. THE RECOMMENDED COMPENSATION LEVEL WAS APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THESE DOCUMENTS WOULD BE MADE AVAILABLE ON THE PREMISES OF THE COMPANY'S CORPORATE LOCATION FOR REVIEW BY THE PUBLIC. FORM 990, PART VI, SECTION B, QUESTION 16: HOLDINGS BOARD OF DIRECTORS EVALUATES ITS PARTICIPATION IN ANY NEW ACTIVITY, INCLUDING POSSIBLE JOINT VENTURES AND SIMILAR ARRANGEMENTS, TO ENSURE THAT SUCH ACTIVITIES FURTHER HOLDINGS' TAX EXEMPT PURPOSE AND SAFEGUARD ITS ASSETS AND EXEMPT STATUS. THIS EVALUATION INCLUDES CONSULTATION WITH CORPORATE AND TAX COUNSEL. IN ADDITION, THE HOLDINGS BOARD OF DIRECTORS WILL BE REVIEWING FOR APPROVAL A DEVELOPED WRITTEN POLICY REQUIRING IT TO EVALUATE ITS PARTICIPATION IN A JOINT VENTURE OR SIMILAR ARRANGEMENT UNDER APPLICABLE TAX LAW AND TAKE STEPS TO SAFEGUARD ITS TAX EXEMPT STATUS WITH RESPECT TO SUCH ARRANGEMENTS. FOUNDERS ASSOCIATES LLC 11 FAIRFIELD BOULEVARD WALLINGFORD CT 06492 371734764 TO PURCHASE & MANAGE REAL ESTATE PROPERTIES ON BEHALF OF CHNCT HOLDINGS CT 503940 5110258 COMMUNITY HEALTH NETWORK OF CONNECTICUT HOLDINGS INC COMMUNITY HEALTH NETWORK OF CONNECTICUT FOUNDATION INC 11 FAIRFIELD BOULEVARD WALLINGFORD CT 06492 200395748 SUPPORTS NONPROFIT ACTIVITIES OF COMMUNITY HEALTH CENTERS AND NONPROFIT ORGS CT 501(C)(3) LINE 7 COMMUNITY HEALTH NETWORK OF CONNECTICUT INC 0 COMMUNITY HEALTH NETWORK OF CONNECTICUT INC 11 FAIRFIELD BOULEVARD WALLINGFORD CT 06492 061429341 TO ARRANGE HEALTH CARE FOR MEDICAID RECIPIENTS IN THE STATE OF CONNECTICUT CT 501(C)(4) COMMUNITY HEALTH NETWORK OF CONNECTICUT HOLDINGS INC 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 COMMUNITY HEALTH NETWORK OF CONNECTICUT INC A 240987 COST COMMUNITY HEALTH NETWORK OF CONNECTICUT INC P 83888 COST