2023-08-15T15:04:47-05:00 2022-09-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2021-10-01 821663577 BRISTOL HOME CARE AND HOSPICE AGENCY INC BRIS 8605853000 41 BREWSTER ROAD BRISTOL CT 06011 KURT BARWIS PRESIDENT, CEO & CFO 8605853000 2023-08-15 1 KURT BARWIS XXX-XX-XXXX KERRI N BOGDA CPA P00760402 7177404863 2023-08-15 X 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KURT BARWIS 41 BREWSTER ROAD BRISTOL CT 06011 7214293 0 X WWW.BRISTOLHOSPITAL.ORG X 2017 CT TO PROVIDE THE HIGHEST QUALITY OF CARE TO PATIENTS USING THE MOST CURRENT STANDARDS OF PRACTICE. 8 2 73 16 0 0 15313 3612 5531342 7209138 0 0 0 1543 5546655 7214293 0 0 0 0 4432759 4747860 0 0 0 1696376 2098259 6129135 6846119 -582480 368174 232654 550181 2384006 2336906 -2151352 -1786725 X BRISTOL HOME CARE AND HOSPICE IS COMMITTED TO PROVIDING THE HIGHEST QUALITY OF CARE TO PATIENTS USING THE CURRENT STANDARDS OF PRACTICE, WITH A FOCUS ON EDUCATION, PREVENTION AND SUPPORTING A SAFE HOME ENVIRONMENT. THE CLINICAL STAFF WILL PROVIDE SERVICES IN ACCORDANCE WITH STATE AND FEDERAL REGULATIONS. BRISTOL HOME CARE AND HOSPICE AGENCY FOLLOWS BRISTOL HOSPITAL'S ORGANIZATIONAL VALUES OF CEO (COMMUNICATION, EMPATHY, AND OWNERSHIP). 0 0 5628175 0 7209138 FOUNDED ON THE PREMISE THAT MOST PATIENTS WOULD PREFER TO RECUPERATE AT HOME AMIDST THE WARMTH AND SUPPORT OF FAMILY, THE APPLICANT'S HOME CARE AGENCY EMPLOYS SKILLED NURSES, THERAPISTS, SOCIAL WORKERS, AIDES AND OTHER HEALTH PROVIDERS TO PROVIDE HOME CARE TO THE GREATER BRISTOL RESIDENTS. ALL CARE IS COORDINATED BY SKILLED NURSES WITH A WIDE RANGE OF EXPERTISE, INCLUDING CARDIAC CARE, WOUND CARE, PALLIATIVE CARE AND CHRONIC DISEASE MANAGEMENT. THE APPLICANT'S NURSING STAFF, WORKING WITH THE ATTENDING PHYSICIAN AND OTHER HEALTH CARE TEAM MEMBERS, DEVELOP A PERSONALIZED PLAN OF CARE FOR EACH PATIENT, DESIGNED TO OPTIMIZE RECOVERY AND AVOID UNNECESSARY HOSPITALIZATION. HOME CARE SERVICES INCLUDE:-SKILLED NURSING,-PRIVATE DUTY AIDE SERVICES,- PALLIATIVE CARE,- OCCUPATIONAL THERAPY,- SPEECH AND LANGUAGE PATHOLOGY SERVICES,- MEDICAL SOCIAL SERVICES, - NUTRITIONAL COUNSELING,- CERTIFIED WOUND CARE; AND- LIFELINE EMERGENCY CALL SYSTEM.THE ORGANIZATION'S HOSPICE PROGRAM PROVIDES CARE AND SUPPORT TO PERSONS WITH LIFE-ENDING ILLNESSES. THE APPLICANT PRIMARILY PROVIDES HOSPICE CARE IN HOME SETTINGS, BUT ALSO IN SKILLED NURSING FACILITIES AND, WHERE MEDICALLY APPROPRIATE, IN HOSPITALS. HOSPICE CARE IS PROVIDED BY AN INTERDISCIPLINARY TEAM OF PROFESSIONALS AND VOLUNTEERS WORKING TOGETHER TO CARE FOR THE PATIENT'S PHYSICAL, PSYCHOLOGICAL, SOCIAL AND SPIRITUAL NEEDS. AVAILABLE SERVICES INCLUDE:- MEDICAL CARE FOCUSED ON PATIENT COMFORT,- PAIN MANAGEMENT AND SYMPTOM CONTROL. 5628175 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 11 0 73 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X TIMOTHY AJAYI 8605853000 41 BREWSTER ROAD BRISTOL CT 06011 KURT BARWIS PRESIDENT, CEO & CFO 2.00 38.00 X X 0 961118 161004 EDWARD HENRY DIRECTOR/VP ADMIN SVSC & ED BHMSG 1.00 39.00 X 0 292437 51398 CHRIS ANN MEANEY DIRECTOR/SVP, COO & CNO 5.00 35.00 X X 0 342746 29771 CHRISTINE LAPRISE DIRECTOR/VP OPERATIONS 2.00 38.00 X 0 263403 42741 GLENN HEISER CHAIRMAN OF THE BOARD 2.00 6.00 X X 0 0 0 JOHN LODOVICO JR DIRECTOR 2.00 10.00 X 0 0 0 CAREN CHALFANT SEC./TREASURER/DIR. HOME CARE & HOSPICE 40.00 0.00 X X 117293 0 102 NANCY LAMONICA DIRECTOR/VP & CNO 2.00 40.00 X 0 170440 21011 SOPHIE WHITLOCK REGISTERED NURSE 40.00 0.00 X 103763 0 20204 221056 2030144 326231 2 0 1 0 NETSMART TECHNOLOGIES INC 11100 NALL AVE OVERLAND PARKS KS 66211 BILLING SERVICES 124543 1 3612 3612 PATIENT SERVICE REV. 623110 7209138 7209138 7209138 MISCELLANEOUS REVENUE 900099 1543 1543 1543 7214293 7209138 0 1543 X 3624090 3352043 272047 49140 44226 4914 806744 726070 80674 267886 241097 26789 516 516 1600359 766839 833520 1752 1752 48616 48616 8569 8569 128480 128480 63320 63320 10141 10141 DRUGS 199847 199847 MEDICAL SUPPLIES 29355 29355 DUES AND SUBSCRIPTIONS 5737 5737 EDUCATION 1564 1564 3 3 6846119 5628175 1217944 0 201715 505734 14006 21699 35683 24108 16933 11575 0 11173 232654 550181 841449 741072 512373 0 1030184 1595834 2384006 2336906 X -2151352 -1786725 -2151352 -1786725 232654 550181 X 368174 -3547 X 0 1 X 1 0 X 230997 15313 3612 249922 1142672 1206974 5333921 5531342 7209138 20424047 1142672 1206974 5564918 5546655 7212750 20673969 0 3714 3714 3714 3714 20670255 1543 1543 1142672 1206974 5564918 5546655 7214293 20675512 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2021 AMOUNT: $ 1,543. 35683 24108 11575 11575 DUE TO AFFILIATES 1585223 CASH OVERDRAFT 10611 1595834 X 7210743 -3550 -3550 7214293 0 7214293 6846116 0 6846116 3 3 6846119 PART X, LINE 2: THE CORPORATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FASB ASC 740, INCOME TAXES, WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION 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 CORPORATION DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2022 AND 2021. IT IS THE CORPORATION'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 CORPORATION DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE CORPORATION'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE CORPORATION DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. PART XI, LINE 2D - OTHER ADJUSTMENTS: OTHER CHANGES -3,547. BAD DEBT EXPENSE -3. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3. 0 1 0 0 0 0 0 0 0 KURT BARWIS PRESIDENT, CEO & CFO 0 618324 0 94080 0 248714 0 141000 0 20004 0 1122122 0 248714 CHRIS ANN MEANEY DIRECTOR/SVP, COO & CNO 0 302263 0 40483 0 0 0 28574 0 1197 0 372517 0 0 EDWARD HENRY DIRECTOR/VP ADMIN SVSC & ED BHMSG 0 265601 0 26836 0 0 0 29001 0 22397 0 343835 0 0 CHRISTINE LAPRISE DIRECTOR/VP OPERATIONS 0 238763 0 24640 0 0 0 25808 0 16933 0 306144 0 0 NANCY LAMONICA DIRECTOR/VP & CNO 0 163760 0 6680 0 0 0 3951 0 17060 0 191451 0 0 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. THE FOLLOWING INDIVIDUALS ALSO PARTICIPATE IN HOSPITAL'S 457(F) PLAN AND HAD THE FOLLOWING CONTRIBUTIONS MADE FOR THE YEAR: EDWARD HENRY - $20,715 CHRIS ANN MEANEY - $22,650 CHRISTINE LAPRISE - $18.750 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE MEMBER, WHICH IS BRISTOL HOSPITAL AND HEALTH CARE GROUP, INC. 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 THE OTHER RIGHTS, POWERS AND PRIVILEGES ACCORDED TO MEMBERS OF A NON-STOCK 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 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 FIX THE NUMBER AND APPOINT AND REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS AT ANY TIME. (E) TO APPROVE OR CHANGE THE MISSION, ROLE, AND PURPOSE OF THIS CORPORATION. (F) TO AMEND THE BYLAWS AND CERTIFICATE OF INCORPORATION OF THIS CORPORATION. (G) 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. 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 EXISTS, 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 STATEMENT AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 742,345. MANAGEMENT AND GENERAL EXPENSES 833,520. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,575,865. CONSULTING FEES: PROGRAM SERVICE EXPENSES 24,494. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,494. FORM 990, PART XI, LINE 9: OTHER CHANGES -3,547. 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 INC 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 N/A 0 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 INC 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 INC 0 BRISTOL HEALTH CARE INC 41 BREWSTER ROAD BRISTOL CT 06010 222577731 NURSING HOME CT 501(C)(3) LINE 10 BRISTOL HOSPITAL AND HEALTH CARE GROUP INC 0 BRISTOL HOSPITAL EMS LLC PO BOX 977 BRISTOL CT 06010 061547648 EMERGENCY MEDICAL SERVICES CT N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0