BRISTOL HEALTH CARE INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- BRISTOL HEALTH CARE INC (EIN 22-2577731)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-15
- IRS object ID
- 202312279349303731
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-15T15:08:39-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1570 FRUITVILLE PIKE SUITE 400 | AddressLine1Txt |
| City | LANCASTER | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222577731 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRISTOL HEALTH CARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BRIS | BusinessNameControlTxt |
| Phone | 8605843400 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 NORTH MAIN STREET | AddressLine1Txt |
| City | BRISTOL | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06010 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KURT BARWIS | PersonNm |
| Person Title | PRESIDENT, CEO & CFO | PersonTitleTxt |
| Phone | 8605843400 | PhoneNum |
| Signature | 2023-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KURT | PersonFirstNm |
| Person Last | BARWIS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KERRI N BOGDA CPA | PreparerPersonNm |
| PTIN | P00760402 | PTIN |
| Phone | 7177404863 | PhoneNum |
| Preparation | 2023-08-14 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KURT BARWIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 NORTH MAIN STREET | AddressLine1Txt |
| City | BRISTOL | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06010 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,945,008 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BRISTOLHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | CT | LegalDomicileStateCd |
| Activity Or Mission | SHORT/LONG TERM REHAB & SKILLED NURSING CARE TO ENHANCE QUALITY OF LIFE AND PHYSICAL FUNCTIONING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 243 | TotalEmployeeCnt |
| Total Volunteers | 21 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $75,432 | PYContributionsGrantsAmt |
| CY Contributions Grants | $87,948 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,155,821 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,840,640 | CYProgramServiceRevenueAmt |
| PY Investment Income | $22,958 | PYInvestmentIncomeAmt |
| CY Investment Income | $548 | CYInvestmentIncomeAmt |
| PY Other Revenue | $34,973 | PYOtherRevenueAmt |
| CY Other Revenue | $15,872 | CYOtherRevenueAmt |
| PY Total Revenue | $13,289,184 | PYTotalRevenueAmt |
| CY Total Revenue | $13,945,008 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,213,610 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,231,119 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,256,077 | PYOtherExpensesAmt |
| CY Other Expenses | $7,772,098 | CYOtherExpensesAmt |
| PY Total Expenses | $13,469,687 | PYTotalExpensesAmt |
| CY Total Expenses | $18,003,217 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$180,503 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,058,209 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,125,805 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,197,182 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,401,018 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,531,014 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,724,787 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$333,832 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE QUALITY AND COMPREHENSIVE HEALTH CARE ACCORDING TO RESIDENT NEEDS, INCLUDING SHORT-TERM REHABILITATIVE CARE, SKILLED NURSING CARE, AND LONG-TERM CARE, WHILE BEING ATTENTIVE TO QUALITY OF LIFE AND PRESERVATION OF INDIVIDUAL DIGNITY IN A HOME-LIKE SETTING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,058,708 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $13,840,640 | RevenueAmt |
| Desc | NURSING HOME AND LONG-TERM CARE FACILITY PROVIDING HEALTH CARE AND COMMUNITY HEALTH EDUCATION FOR THE ELDERLY AND OTHERS. | Desc |
| Total Program Service Expenses | $15,058,708 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 243 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIMOTHY AJAYI | PersonNm |
| Phone | 8605853000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 41 BREWSTER ROAD | AddressLine1Txt |
| City | BRISTOL | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06010 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| BRADFORD MEACHAM | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| GLENN HEISER | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| JARRE BETTS | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFFREY KAYE MD | ||||||||
| MEDICAL STAFF REPRESENTATIVE | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| JENNIFER MCCALLISTER MD | ||||||||
| MEDICAL STAFF REPRESENTATIVE | 2.00 | 40.00 | Yes (X) | $0 | $416,917 | $1,462 | ||
| JOHN LODOVICO JR | ||||||||
| CHAIRMAN OF THE BOARD | 2.00 | 10.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JOSEPH LOCKWOOD | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| KURT BARWIS | ||||||||
| PRESIDENT, CEO & CFO | 2.00 | 38.00 | Yes (X) | $0 | $961,118 | $161,004 | Yes (X) | |
| LEXIE MANGUM | ||||||||
| SECRETARY/TREASURER | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LISA CASEY | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| LOUIS AULETTA | ||||||||
| VICE CHAIRMAN | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MICHAEL HEIMBACH | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| SHARON ADLER MD | ||||||||
| MEDICAL STAFF REP.(UNTIL JAN. 2022) | 2.00 | 6.00 | Yes (X) | $0 | $38,000 | $0 | ||
| WILLIAM HAMZY | ||||||||
| DIRECTOR (UNTIL OCT. 2021) | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| YONG-SUNG CHYUN MD | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| IRENE BASSOCK | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| KATARZYNA LESSARD | ||||||||
| DIRECTOR | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHELE NORMANDIN MD | ||||||||
| MEDICAL STAFF REPRESENTATIVE | 2.00 | 6.00 | Yes (X) | $0 | $394,453 | $148 | ||
| RUPALINI RAWAL-DHINGRA MD | ||||||||
| MEDICAL STAFF REPRESENTATIVE | 2.00 | 46.00 | Yes (X) | $0 | $344,178 | $148 | ||
| ASHLEY JESSICA SOYKA | ||||||||
| ADMINISTRATOR | 40.00 | 0.00 | $129,778 | $0 | $21,878 | Yes (X) | ||
| GORDON AVERY | ||||||||
| NURSING SUPERVISOR | 40.00 | 0.00 | $125,454 | $0 | $12,000 | Yes (X) | ||
| MARSHA TUPAS | ||||||||
| NURSING SUPERVISOR | 40.00 | 0.00 | $100,827 | $0 | $11,315 | Yes (X) | ||
| MIRZETA ADILI | ||||||||
| RN NURSING POOL | 40.00 | 0.00 | $105,537 | $0 | $2,095 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $461,596 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,154,666 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $210,050 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SYMBRIA REHAB | |||||
| 28100 TORCH PARKWAY SUITE 600 | WARRENVILLE | IL | 60555 | PHYSICAL THERAPY SERVICES | $733,836 |
| UNITEX TEXTILE RENTAL SERVICE | |||||
| 401 SOUTH MACQUESTEN PKWY | MT VERNON | NY | 105501700 | LAUNDRY SERVICES | $150,598 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $87,948 | GovernmentGrantsAmt |
| Total Contributions | $87,948 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 623110 | BusinessCd |
| Total Revenue Column | $13,840,640 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,840,640 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,840,640 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $548 | TotalRevenueColumnAmt |
| Exclusion | $548 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS | 900099 | $13,196 | $13,196 |
| CAFE MEALS | 722210 | $2,676 | $2,676 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $15,872 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,945,008 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,840,640 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $16,420 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,919,552 | TotalAmt |
| Program Services | $6,782,368 | ProgramServicesAmt |
| Management And General | $137,184 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,297 | TotalAmt |
| Program Services | $67,019 | ProgramServicesAmt |
| Management And General | $4,278 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,307,492 | TotalAmt |
| Program Services | $2,169,042 | ProgramServicesAmt |
| Management And General | $138,450 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $932,778 | TotalAmt |
| Program Services | $876,811 | ProgramServicesAmt |
| Management And General | $55,967 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,771 | TotalAmt |
| Management And General | $24,771 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,434,507 | TotalAmt |
| Program Services | $1,319,062 | ProgramServicesAmt |
| Management And General | $2,115,445 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,718 | TotalAmt |
| Program Services | $56,180 | ProgramServicesAmt |
| Management And General | $86,538 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,988 | TotalAmt |
| Program Services | $4,695 | ProgramServicesAmt |
| Management And General | $92,293 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $517,291 | TotalAmt |
| Program Services | $376,755 | ProgramServicesAmt |
| Management And General | $140,536 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,071 | TotalAmt |
| Program Services | $1,947 | ProgramServicesAmt |
| Management And General | $124 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $446 | TotalAmt |
| Program Services | $326 | ProgramServicesAmt |
| Management And General | $120 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,135 | TotalAmt |
| Management And General | $146,135 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $2,220,830 | $2,220,830 | |
| MEDICAL SUPPLIES | $757,927 | $757,927 | |
| FOOD & NUTRITION | $425,746 | $425,746 | |
| DUES AND SUBSCRIPTIONS | $2,668 | $2,668 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,003,217 | TotalAmt |
| Program Services | $15,058,708 | ProgramServicesAmt |
| Management And General | $2,944,509 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,323 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,845 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,002,435 | BOYAmt |
| EOY | $3,205,819 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,137 | BOYAmt |
| EOY | $63,348 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,240 | BOYAmt |
| EOY | $49,481 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,040,190 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,870,194 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,101,270 | BOYAmt |
| EOY | $1,169,996 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,264 | BOYAmt |
| EOY | $18,854 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,806,291 | BOYAmt |
| EOY | $689,684 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,125,805 | BOYAmt |
| EOY | $5,197,182 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,037,558 | BOYAmt |
| EOY | $2,376,239 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $400,410 | BOYAmt |
| EOY | $292,826 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $963,050 | BOYAmt |
| EOY | $2,861,949 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,401,018 | BOYAmt |
| EOY | $5,531,014 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,705,523 | BOYAmt |
| EOY | -$352,686 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,264 | BOYAmt |
| EOY | $18,854 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,724,787 | BOYAmt |
| EOY | -$333,832 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,125,805 | BOYAmt |
| EOY | $5,197,182 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,058,209 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$410 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $18,665 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus2 Years | $852,541 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $75,432 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $87,948 | CurrentTaxYearAmt |
| Total | $1,034,586 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,809,330 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,492,587 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,262,452 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,155,821 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,840,640 | CurrentTaxYearAmt |
| Total | $66,560,830 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,827,995 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,492,587 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,114,993 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,231,253 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,928,588 | CurrentTaxYearAmt |
| Total | $67,595,416 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $67,595,416 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $52,339 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $71,365 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $22,958 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $548 | CurrentTaxYearAmt |
| Total | $147,210 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $52,339 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $71,365 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $22,958 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $548 | CurrentTaxYearAmt |
| Total | $147,210 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,817 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $51,732 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $29,460 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $34,973 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,872 | CurrentTaxYearAmt |
| Total | $136,854 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,885,151 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,615,684 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,144,453 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,289,184 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,945,008 | CurrentTaxYearAmt |
| Total | $67,879,480 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99580 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99580 | PublicSupportPY509Pct |
| Investment Income CY | 0.00220 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00220 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | EMPLOYEE MEALS AND VENDING - 2017 AMOUNT: $ 4,817. 2018 AMOUNT: $ 1,148. 2019 AMOUNT: $ 1,250. 2020 AMOUNT: $ 400. CAFE MEALS - 2018 AMOUNT: $ 4,620. 2019 AMOUNT: $ 3,716. 2020 AMOUNT: $ 1,677. 2021 AMOUNT: $ 2,676. MISCELLANEOUS INCOME - 2018 AMOUNT: $ 334. 2019 AMOUNT: $ 6,741. 2020 AMOUNT: $ 32,710. 2021 AMOUNT: $ 13,196. MEDICAL RECORD FEES - 2018 AMOUNT: $ 566. 2019 AMOUNT: $ 50. PURCHASE DISCOUNTS - 2018 AMOUNT: $ 8. 2019 AMOUNT: $ 62. 2020 AMOUNT: $ 186. INCENTIVE PAYMENTS - 2018 AMOUNT: $ 45,056. 2019 AMOUNT: $ 6,880. UHC DIVIDEND - 2019 AMOUNT: $ 9,360. THERAPY SCREENING - 2019 AMOUNT: $ 1,401. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $343,035 | OtherCostOrOtherBasisAmt |
| Book Value | $343,035 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,673,811 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,196,098 | DepreciationAmt |
| Book Value | $477,713 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,003,048 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,674,096 | DepreciationAmt |
| Book Value | $328,952 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,296 | OtherCostOrOtherBasisAmt |
| Book Value | $20,296 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,169,996 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM AFFILIATES | Desc |
| Book Value | $689,684 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $689,684 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFLIATES | $2,009,297 |
| INSURANCE CLAIM PAYABLE | $68,600 |
| WORKERS COMPENSATION PAYABLE | $784,052 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,861,949 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $11,723,768 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$2,221,240 | OtherRevenueAmt |
| Revenue Not Reported | -$2,221,240 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,945,008 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,945,008 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,782,387 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,782,387 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,220,830 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,220,830 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,003,217 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE COMPANY ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. THE COMPANY MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE COMPANY DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2022 AND 2021. IT IS THE COMPANY'S POLICY TO RECORD PENALTIES AND INTEREST ASSOCIATED WITH UNCERTAIN TAX PROVISIONS AS A COMPONENT OF OPERATING EXPENSES. AS OF SEPTEMBER 30, 2022 AND 2021, THE COMPANY DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE COMPANY'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE COMPANY DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN EQUITY INTEREST IN THE NET ASSETS OF THE FOUNDATION -410. BAD DEBT EXPENSE -2,220,830. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 2,220,830. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KURT BARWIS | ||||||||||||||
| PRESIDENT, CEO & CFO | $0 | $618,324 | $0 | $94,080 | $0 | $248,714 | $0 | $141,000 | $0 | $20,004 | $0 | $1,122,122 | $0 | $248,714 |
| JENNIFER MCCALLISTER MD | ||||||||||||||
| MEDICAL STAFF REPRESENTATIVE | $0 | $395,992 | $0 | $20,925 | $0 | $0 | $0 | $0 | $0 | $1,462 | $0 | $418,379 | $0 | $0 |
| MICHELE NORMANDIN MD | ||||||||||||||
| MEDICAL STAFF REPRESENTATIVE | $0 | $311,953 | $0 | $82,500 | $0 | $0 | $0 | $0 | $0 | $148 | $0 | $394,601 | $0 | $0 |
| RUPALINI RAWAL-DHINGRA MD | ||||||||||||||
| MEDICAL STAFF REPRESENTATIVE | $0 | $322,475 | $0 | $21,703 | $0 | $0 | $0 | $0 | $0 | $148 | $0 | $344,326 | $0 | $0 |
| ASHLEY JESSICA SOYKA | ||||||||||||||
| ADMINISTRATOR | $125,038 | $0 | $4,740 | $0 | $0 | $0 | $2,699 | $0 | $19,179 | $0 | $151,656 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | KURT BARWIS, THE ORGANIZATION'S PRESIDENT, CEO AND CFO, IS PAID BY A RELATED ORGANIZATION, BRISTOL HOSPITAL, INC., WHICH USED A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH HIS COMPENSATION. |
| PART I, LINE 4B | KURT BARWIS, THE ORGANIZATION'S PRESIDENT, CEO AND CFO, PARTICIPATES IN THE HOSPITAL'S 457(F) DEFINED CONTRIBUTION PLAN. $141,000 WAS DEFERRED DURING CALENDAR YEAR 2021, AND IS INCLUDED IN SCHEDULE J, COLUMN C. $248,714 FROM PRIOR YEAR DEFERRED CONTRIBUTIONS VESTED AND IS INCLUDED IN TAXABLE COMPENSATION AS OTHER REPORTABLE COMPENSATION. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE IS COMPRISED OF THE PRESIDENT OF THE MEDICAL STAFF OF THE HOSPITAL AND ADDITIONAL MEMBERS, ALL OF WHOM ARE ON THE GOVERNING BODY. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ANY BUSINESS OF THE CORPORATION REQUIRING ACTION DURING THE INTERIM BETWEEN REGULAR MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES OR EXPRESS WISHES OF THE BOARD AND FURTHER PROVIDED THAT THE EXECUTIVE COMMITTEE SHALL REPORT ALL MATTERS ON WHICH IT ACTS TO THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS A SOLE MEMBER, WHICH IS BRISTOL HOSPITAL AND HEALTH CARE GROUP. THERE ARE NO CLASSES OF MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER HAS THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF THE CORPORATION AND HAS ALL OF THE OTHER RIGHTS, POWERS AND PRIVILEGES ACCORDED TO MEMBERS OF A NONSTOCK NONPROFIT CORPORATION UNDER CONNECTICUT LAW. |
| FORM 990, PART VI, SECTION A, LINE 7B | IN ADDITION TO SUCH OTHER RIGHTS, POWERS AND PRIVILEGES UNDER CONNECTICUT LAW, THE SOLE MEMBER HAS THE FOLLOWING RIGHTS, POWERS AND PRIVILEGES: (A) TO ACCEPT, AMEND OR REJECT, AFTER APPROVAL BY THE BOARD OF DIRECTORS, THE ANNUAL BUSINESS PLAN AND OPERATING AND CAPITAL BUDGETS OF THE CORPORATION. (B) TO APPROVE ANY PROGRAMS AND EXPENDITURES REQUIRING CERTIFICATE OF NEED APPROVAL BY APPROPRIATE GOVERNMENTAL BODIES AND PLANS THAT MATERIALLY AFFECT THE GROWTH AND DEVELOPMENT OF THE CORPORATION. (C) TO APPROVE SIGNIFICANT AFFILIATION AGREEMENTS BETWEEN THE CORPORATION AND OTHER INSTITUTIONS, SIGNIFICANT FUND RAISING PROGRAMS PROPOSED TO BE CONDUCTED BY THE CORPORATION, THE SALE OR DISPOSITION OF ANY ASSETS OF THE CORPORATION NOT IN THE ORDINARY COURSE OF BUSINESS, AND THE INCURRENCE OF ANY INDEBTEDNESS FOR BORROWED MONEY NOT IN ACCORDANCE WITH AN APPROVED OPERATING OR CAPITAL BUDGET. (D) TO REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS AT ANY TIME, REGARDLESS OF THE TERM FOR WHICH SUCH DIRECTOR MAY HAVE BEEN ELECTED. (E) TO VOTE UPON ALL MATTERS ON WHICH MEMBERS ARE ENTITLED TO VOTE UNDER THE ACT. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COMPLETED 990 IS PROVIDED TO EACH BOARD MEMBER BEFORE THE RETURN IS FILED. THIS PROVIDES AN OPPORTUNITY FOR MEMBERS TO ASK QUESTIONS AND FOLLOW UP WITH THE FINANCE TEAM REGARDING ANY ISSUES OR CONCERNS. THE 990 IS ALSO REVIEWED INTERNALLY BY MEMBERS OF THE FINANCE AND MANAGEMENT TEAMS PRIOR TO BEING FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE PARENT ORGANIZATION, BRISTOL HOSPITAL AND HEALTH CARE GROUP, HAS THREE CONFLICT OF INTEREST POLICIES-ONE FOR THE BOARD OF DIRECTORS AND COMMITTEE MEMBERS, ONE FOR NON-MEDICAL STAFF EMPLOYEES, AND ONE FOR MEDICAL STAFF MEMBERS. BOARD OF DIRECTORS AND COMMITTEE MEMBERS EACH OF THE ABOVE LISTED PERSONS RECEIVES, READS AND SIGNS A STATEMENT ONCE ANNUALLY AGREEING TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. IF ANY ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES, THE PERSON SHALL MAKE FULL DISCLOSURE OF SUCH ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST, WITHIN FIFTEEN (15) DAYS OF THE TIME THAT SUCH CONFLICT IS DISCOVERED, OR AT LEAST ONCE ANNUALLY AT THE COMMENCEMENT OF EACH CALENDAR YEAR, WITH REGULAR WRITTEN UPDATES TO ACCORD WITH ANY CHANGE IN CIRCUMSTANCES. THE GOVERNANCE COMMITTEE REVIEWS ALL SUCH DISCLOSURES TO DETERMINE WHETHER AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST EXISTS. DECISIONS PERTAINING TO ACTUAL, APPARENT OR POTENTIAL CONFLICTS OF INTEREST SHALL BE MADE BY THE GOVERNANCE COMMITTEE. THE CORPORATE COMPLIANCE OFFICER (CCO) SHALL BE AVAILABLE TO THE GOVERNANCE COMMITTEE UPON REQUEST. IN THE EVENT THAT IT DETERMINES THAT AN APPARENT OR POTENTIAL CONFLICT OF INTEREST EXITS, THE GOVERNANCE COMMITTEE SHALL INSTITUTE A REASONABLE COMPLIANCE MANAGEMENT PLAN INCLUDING PERIODIC REVIEWS OF RELATIONSHIPS OR ACTIVITIES OF ANY PERSON OR RELATIVE. ANY CHANGES OR MODIFICATIONS IN SUCH RELATIONSHIPS OR ACTIVITIES SHALL BE PERIODICALLY REVIEWED AND EVALUATED BY THE GOVERNANCE COMMITTEE. NON-MEDICAL STAFF EMPLOYEES SAME PROCESS AS OUTLINED ABOVE WITH ONE EXCEPTION: THE OVERSIGHT, REVIEW AND DETERMINATIONS OF DISCLOSURES ARE MADE BY THE CCO. THE BRISTOL HEALTH EXECUTIVE LEADERSHIP GROUP (ELG) SHALL BE AVAILABLE TO THE CCO UPON REQUEST. MEDICAL STAFF MEMBERS MEDICAL STAFF MEMBERS COMPLETE CONFLICT OF INTEREST DISCLOSURE STATEMENTS DURING THE INITIAL CREDENTIALING PROCESS AND SUBSEQUENTLY EVERY TWO YEARS DURING THE RECREDENTIALING PROCESS. ANY NEW RELATIONSHIPS THAT ARISE IN THE INTERIM DEEMED TO BE A POTENTIAL CONFLICT MUST BE DISCLOSED IN A TIMELY MANNER. DISCLOSURES ARE REVIEWED AND DETERMINATIONS ARE MADE BY THE EXECUTIVE COMMITTEE OF THE MEDICAL STAFF (ECMS). THE CCO IS A MEMBER OF THIS COMMITTEE. IN THE EVENT THAT THE ECMS DETERMINES THAT AN APPARENT OR POTENTIAL CONFLICT OF INTEREST EXISTS, A REASONABLE COMPLIANCE MANAGEMENT PLAN INCLUDING PERIODIC REVIEWS OF RELATIONSHIPS OR ACTIVITIES OF ANY PERSON OR RELATIVE WILL BE INSTITUTED. ANY CHANGES OR MODIFICATIONS IN SUCH RELATIONSHIPS OR ACTIVITIES SHALL BE PERIODICALLY REVIEWED AND EVALUATED BY THE ECMS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 92,707. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,707. PHYSICAL THERAPY FEES: PROGRAM SERVICE EXPENSES 1,098,227. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,098,227. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 159,458. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 159,458. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 61,377. MANAGEMENT AND GENERAL EXPENSES 1,240. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,617. SHARED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,021,498. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,021,498. |
| FORM 990, PART XI, LINE 9: | CHANGE IN EQUITY INTEREST IN THE NET ASSETS OF THE FOUNDATION -410. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BRISTOL HOSPITAL INC | |||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06010 | 060646559 | SHORT-TERM ACUTE CARE COMMUNITY HOSPITAL | CT | 501(C)(3) | LINE 3 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | 0 | |
| BRISTOL HOSPITAL AND HEALTH CARE GROUP INC | |||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06010 | 222577726 | HEALTHCARE PARENT COMPANY | CT | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| BRISTOL HOSPITAL DEVELOPMENT FOUNDATION INC | |||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06010 | 222577740 | FUNDRAISING | CT | 501(C)(3) | LINE 7 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | 0 | |
| BRISTOL HOSPITAL MULTISPECIALTY GROUP INC | |||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06010 | 061466555 | HEALTHCARE SERVICES | CT | 501(C)(3) | LINE 10 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | 0 | |
| BRISTOL HOME CARE AND HOSPICE AGENCY INC | |||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06010 | 821663577 | HOME CARE AND HOSPICE | CT | 501(C)(3) | LINE 10 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRISTOL HOSPITAL EMS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 41 BREWSTER ROAD | AddressLine1Txt |
| City | BRISTOL | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06010 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 061547648 | EIN |
| Primary Activities | EMERGENCY MEDICAL SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | CT | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |