BRISTOL HOSPITAL MULTI-SPECIALTY GROUP: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- BRISTOL HOSPITAL MULTI-SPECIALTY GROUP (EIN 06-1466555)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-12
- IRS object ID
- 201912249349301296
- Schema version
- 2017v2.2
- 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 | 2019-08-12T14:32:51-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 175 POWDER FOREST DRIVE | AddressLine1Txt |
| City | SIMSBURY | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06089 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 061466555 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Bristol Hospital Multi-Specialty Group Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BRIS | BusinessNameControlTxt |
| Phone | 8605853469 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 Main Street | AddressLine1Txt |
| City | Bristol | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06010 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Richard Braam | PersonNm |
| Person Title | Vice President & CFO | PersonTitleTxt |
| Signature | 2019-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KRISTIN ANDERSON | PreparerPersonNm |
| PTIN | P01231300 | PTIN |
| Phone | 8606789200 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kurt Barwis | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 Main Street | AddressLine1Txt |
| City | Bristol | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06010 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,178,956 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BRISTOLHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | CT | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HIGH QUALITY, SUSTAINABLE, PATIENT-CENTERED HEALTH CARE IN THE COMMUNITY AND RESPOND TO THE EVOLVING HEALTH CARE NEEDS OF THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 303 | TotalEmployeeCnt |
| Total Volunteers | 2 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,527,055 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,675,013 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $21,059,892 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $23,494,343 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$18,151 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $9,600 | PYOtherRevenueAmt |
| CY Other Revenue | $9,600 | CYOtherRevenueAmt |
| PY Total Revenue | $27,578,396 | PYTotalRevenueAmt |
| CY Total Revenue | $30,178,956 | 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 | $27,185,545 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,425,762 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,684,419 | PYOtherExpensesAmt |
| CY Other Expenses | $6,162,495 | CYOtherExpensesAmt |
| PY Total Expenses | $32,869,964 | PYTotalExpensesAmt |
| CY Total Expenses | $34,588,257 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$5,291,568 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,409,301 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,046,535 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,050,946 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,800,291 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,651,893 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $246,244 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,399,053 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE ACCESSIBLE, HIGH QUALITY, SUSTAINABLE, PATIENT-CENTERED HEALTH CARE IN THE COMMUNITY, AND TO RESPOND TO THE EVOLVING HEALTH CARE NEEDS OF THE COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $31,991,061 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $23,494,343 | RevenueAmt |
| Desc | THE BRISTOL HOSPITAL MULTISPECIALTY GROUP WAS FORMED TO DELIVER A FULL RANGE OF HEALTH AND SPECIALTY CARE SERVICES AT CONVENIENT LOCATIONS THROUGHOUT BRISTOL, CONNECTICUT AND THE SURROUNDING TOWNS TO PROVIDE ACCESSIBLE, HIGH QUALITY, EVIDENCE-BASED, STATE-OF THE-ART, COST-EFFECTIVE, COMPASSIONATE AND PATIENT-CENTERED HEALTH CARE IN THE COMMUNITIES SERVED BY BRISTOL HOSPITAL; TO RESPOND APPROPRIATELY TO EVOLVING COMMUNITY HEALTH CARE NEEDS AND TO CHANGES IN TECHNOLOGY AND THE HEALTH CARE SYSTEM; AND TO ASSURE A SUSTAINABLE LEGACY OF HEALTH CARE SERVICE EXCELLENCE IN THOSE COMMUNITIES. SUCH SERVICES WILL BE AVAILABLE TO ALL PERSONS, WITHOUT REGARD TO THEIR ABILITY TO PAY FOR SUCH SERVICES, AND TO OPERATE AT ALL TIMES IN FURTHERANCE OF THE TAX-EXEMPT CHARITABLE MISSIONS OF BRISTOL HOSPITAL AND HEALTH CARE GROUP, INC. THE ORGANIZATION'S PHYSICIANS PROVIDE FREQUENT COMMUNITY WIDE EDUCATION SUCH AS SEMINARS, ARTICLES IN THE LOCAL NEWSPAPERS, AND SESSIONS AT THE SENIOR CENTERS AND SCHOOLS. THESE COMMUNITY EVENTS ALSO PROVIDE THE PUBLIC THE OPPORTUNITY TO INTERACT WITH THE PHYSICIANS AT NO COST. | Desc |
| Total Program Service Expenses | $31,991,061 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 41 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 303 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | Yes (true) | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Patricia Levandoski | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8605853680 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 Main Street | AddressLine1Txt |
| City | Bristol | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06010 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| KURT BARWIS | ||||||||
| PRESIDENT & CEO | 8.0 | 69.0 | Yes (X) | Yes (X) | $0 | $559,736 | $34,820 | |
| LIRAN BLUM MD | ||||||||
| Chairman of the Board | 40.0 | 8.0 | Yes (X) | Yes (X) | $412,117 | $0 | $22,031 | |
| VIJAY JOSHI MD | ||||||||
| SECRETARY | 40.0 | 8.0 | Yes (X) | Yes (X) | $231,394 | $0 | $0 | |
| JOHN LODOVICO JR | ||||||||
| TREASURER | 2.0 | 10.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN FRAZIER MD | ||||||||
| PAST SECRETARY | 30.0 | 0 | Yes (X) | Yes (X) | $228,659 | $0 | $0 | |
| DOUGLAS DEVNEW JR | ||||||||
| Director | 2.0 | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| RAINER BAGDASARIAN MD | ||||||||
| DIRECTOR | 40.0 | 0 | Yes (X) | $417,838 | $0 | $23,460 | ||
| DAVID RUBINS MD | ||||||||
| DIRECTOR | 40.0 | 0 | Yes (X) | $793,535 | $0 | $18,036 | ||
| Richard Braam | ||||||||
| VP of Finance/ CFO | 40.0 | 82.0 | Yes (X) | $0 | $110,569 | $6,240 | ||
| EDWARD HENRY | ||||||||
| Executive Director | 40.0 | 80.0 | Yes (X) | $0 | $222,716 | $18,019 | ||
| CHRISTOPHER BETZ | ||||||||
| Physician | 40.0 | 0 | $593,626 | $0 | $0 | Yes (X) | ||
| Makram Gedeon MD | ||||||||
| PHYSICIAN | 40.0 | 0 | $474,478 | $0 | $8,613 | Yes (X) | ||
| VANESSA MALIT MD | ||||||||
| Physician | 40.0 | 0 | $464,793 | $0 | $750 | Yes (X) | ||
| ASHISH UPADHYAY | ||||||||
| Physician | 40.0 | 0 | $659,322 | $0 | $0 | Yes (X) | ||
| RICHARD ZWEIG MD | ||||||||
| PHYSICIAN | 40.0 | 0 | $528,743 | $0 | $17,931 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,804,505 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $893,021 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $149,900 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 72 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Saint Francis Medical Group Inc | |||||
| 1000 Asylum Ave | Hartford | CT | 06105 | Physician Services | $254,880 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 753972633 | Physician Services | $180,798 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $6,675,013 | RelatedOrganizationsAmt |
| Total Contributions | $6,675,013 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE, NET | 621110 | $23,470,964 | $23,470,964 |
| Other Revenue | 900099 | $23,379 | $23,379 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $23,494,343 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,600 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,600 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,600 | TotalRevenueColumnAmt |
| Exclusion | $9,600 | ExclusionAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,178,956 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,494,343 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $9,600 | ExclusionAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,997,437 | TotalAmt |
| Program Services | $1,719,137 | ProgramServicesAmt |
| Management And General | $278,300 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,465,559 | TotalAmt |
| Program Services | $22,911,616 | ProgramServicesAmt |
| Management And General | $1,553,943 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $694,412 | TotalAmt |
| Program Services | $511,082 | ProgramServicesAmt |
| Management And General | $183,330 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,268,354 | TotalAmt |
| Program Services | $1,177,015 | ProgramServicesAmt |
| Management And General | $91,339 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,728 | TotalAmt |
| Program Services | $35,812 | ProgramServicesAmt |
| Management And General | $23,916 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,250 | TotalAmt |
| Management And General | $2,250 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $779,987 | TotalAmt |
| Program Services | $660,491 | ProgramServicesAmt |
| Management And General | $119,496 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,126 | TotalAmt |
| Program Services | $9,126 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $434,140 | TotalAmt |
| Program Services | $324,529 | ProgramServicesAmt |
| Management And General | $109,611 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $649,811 | TotalAmt |
| Program Services | $546,775 | ProgramServicesAmt |
| Management And General | $103,036 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,463,547 | TotalAmt |
| Program Services | $1,413,232 | ProgramServicesAmt |
| Management And General | $50,315 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,294 | TotalAmt |
| Program Services | $251,615 | ProgramServicesAmt |
| Management And General | $27,679 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,589,446 | TotalAmt |
| Program Services | $1,561,588 | ProgramServicesAmt |
| Management And General | $27,858 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $357,349 | $357,349 | |
| DRUGS | $452,682 | $452,682 | |
| EMPLOYEE PHYSICALS | $22,754 | $18,304 | $4,450 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,381 | TotalAmt |
| Program Services | $40,708 | ProgramServicesAmt |
| Management And General | $21,673 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,588,257 | TotalAmt |
| Program Services | $31,991,061 | ProgramServicesAmt |
| Management And General | $2,597,196 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,278 | BOYAmt |
| EOY | $112,296 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,566,797 | BOYAmt |
| EOY | $2,530,150 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $339,331 | BOYAmt |
| EOY | $277,603 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,033,125 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,966,351 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,026,923 | BOYAmt |
| EOY | $1,066,774 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,206 | BOYAmt |
| EOY | $64,123 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,046,535 | BOYAmt |
| EOY | $4,050,946 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,719,651 | BOYAmt |
| EOY | $2,375,924 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,640 | BOYAmt |
| EOY | $275,969 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,800,291 | BOYAmt |
| EOY | $2,651,893 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $246,244 | BOYAmt |
| EOY | $1,399,053 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $246,244 | BOYAmt |
| EOY | $1,399,053 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,046,535 | BOYAmt |
| EOY | $4,050,946 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,409,301 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $5,562,110 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 | $6,627,818 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,153,741 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,955,477 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,527,055 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,675,013 | CurrentTaxYearAmt |
| Total | $36,939,104 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,484,840 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,927,068 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $20,359,948 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $21,059,892 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $23,494,343 | CurrentTaxYearAmt |
| Total | $98,326,091 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $22,112,658 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,080,809 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $30,315,425 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,586,947 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $30,169,356 | CurrentTaxYearAmt |
| Total | $135,265,195 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,627,818 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,153,741 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,955,477 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,527,055 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,675,013 | CurrentTaxYearAmt |
| Total | $36,939,104 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,627,818 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,153,741 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,955,477 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,527,055 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,675,013 | CurrentTaxYearAmt |
| Total | $36,939,104 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $98,326,091 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $9,600 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,600 | CurrentTaxYearAmt |
| Total | $19,200 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,600 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,600 | CurrentTaxYearAmt |
| Total | $19,200 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $22,112,658 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,080,809 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $30,315,425 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,596,547 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $30,178,956 | CurrentTaxYearAmt |
| Total | $135,284,395 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.7268 | PublicSupportCY509Pct |
| Public Support PY509 | 0.7165 | PublicSupportPY509Pct |
| Investment Income CY | 0.0001 | InvestmentIncomeCYPct |
| Investment Income PY | 0.0001 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $572,432 | OtherCostOrOtherBasisAmt |
| Depreciation | $223,976 | DepreciationAmt |
| Book Value | $348,456 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,402,515 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,705,503 | DepreciationAmt |
| Book Value | $697,012 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $58,178 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,872 | DepreciationAmt |
| Book Value | $21,306 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,066,774 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED WORKER'S COMPENSATION | $269,507 |
| CAPITAL LEASE | $6,462 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $275,969 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | 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 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 September 30, 2018 and 2017. 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, 2018 and 2017, 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 exempt the total amount of unrecognized tax benefits to significantly change in the next twelve months. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | Yes (true) | InitialContractExceptionInd |
| Rebuttable Presumption Proc | Yes (true) | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 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 | $0 | $496,682 | $0 | $39,417 | $0 | $23,637 | $0 | $18,000 | $0 | $16,820 | $0 | $594,556 | $0 | $0 |
| LIRAN BLUM MD | ||||||||||||||
| Chairman of the Board | $354,669 | $0 | $57,448 | $0 | $0 | $0 | $0 | $0 | $22,031 | $0 | $434,148 | $0 | $0 | $0 |
| VIJAY JOSHI MD | ||||||||||||||
| SECRETARY | $226,890 | $0 | $4,505 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $231,394 | $0 | $0 | $0 |
| JOHN FRAZIER MD | ||||||||||||||
| PAST SECRETARY | $224,328 | $0 | $4,331 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $228,659 | $0 | $0 | $0 |
| RAINER BAGDASARIAN MD | ||||||||||||||
| DIRECTOR | $383,706 | $0 | $34,132 | $0 | $0 | $0 | $0 | $0 | $23,460 | $0 | $441,298 | $0 | $0 | $0 |
| DAVID RUBINS MD | ||||||||||||||
| DIRECTOR | $678,246 | $0 | $115,289 | $0 | $0 | $0 | $0 | $0 | $18,036 | $0 | $811,571 | $0 | $0 | $0 |
| EDWARD HENRY | ||||||||||||||
| Executive Director | $0 | $210,296 | $0 | $12,420 | $0 | $0 | $0 | $0 | $0 | $18,019 | $0 | $240,735 | $0 | $0 |
| CHRISTOPHER BETZ | ||||||||||||||
| Physician | $515,384 | $0 | $78,242 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $593,626 | $0 | $0 | $0 |
| Makram Gedeon MD | ||||||||||||||
| PHYSICIAN | $464,589 | $0 | $9,889 | $0 | $0 | $0 | $0 | $0 | $8,613 | $0 | $483,091 | $0 | $0 | $0 |
| VANESSA MALIT MD | ||||||||||||||
| Physician | $451,992 | $0 | $12,801 | $0 | $0 | $0 | $0 | $0 | $750 | $0 | $465,543 | $0 | $0 | $0 |
| ASHISH UPADHYAY | ||||||||||||||
| Physician | $650,105 | $0 | $9,217 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $659,322 | $0 | $0 | $0 |
| RICHARD ZWEIG MD | ||||||||||||||
| PHYSICIAN | $519,158 | $0 | $9,585 | $0 | $0 | $0 | $0 | $0 | $17,931 | $0 | $546,674 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 | The organization's CEO, Kurt Barwis, is compenated by a related organization, Bristol Hospital, Inc. which uses the following methods to establish his compensation: Compensation Committee, Independent Compensation Consultant, Compensation Survey or Study, and Approval by the Board or Compensation Committee. |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | KURT BARWIS, BOARD MEMBER, PARTICIPATES IN THE 457(F) DEFINED CONTRIBUTION PLAN OF RELATED ORGANIZATION, BRISTOL HOSPITAL INC. AMOUNT DEFERRED IN CALENDAR YEAR 2017 WAS $18,000 AND IS INCLUDED ON SCHEDULE J, COLUMN D. |
| Schedule J, Part I, Line 8 Payments on contract that is subject to the initial contract exception | AMOUNTS WERE PAID BY A RELATED ORGANIZATION (BRISTOL HOSPITAL) TO KURT BARWIS PURSUANT TO A CONTRACT WITH THE HOSPITAL THAT WAS SUBJECT TO THE INITIAL CONTRACT EXCEPTION DESCRIBED IN REGS. SECTION 53.4958-4(A)(3). THE HOSPITAL FOLLOWED THE REBUTTABLE PRESUMPTION PROCEDURE DESCRIBED IN REGS. SECTION 53.4958-6(C). |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 15 | The organization's CEO, Kurt Barwis, the organization's Executive Director, Edward Henry, and the organization's CFO, Richard Braam, are compensated by a related organization, Bristol Hospital, Inc. In accordance with IRS instructions, Part VI, Lines 15a and 15b are therefore marked No. However, the related organization, Bristol Hospital, Inc., used a process for determining compensation of these individuals which included review and approval of independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. This process last occurred on November 30, 2017. Other officers of the organization, Liran Blum, Chairman of the Board, and Vijay Joshi, Secretary, receive compensation from the organization for their services as physicians. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | The organization has a sole member, which is Bristol Hospital and Health Care Group, Inc. The member has the right to elect the members of the governing body, approve significant decisions of the governing body, and receive the organization's net assets upon the organization's dissolution. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | The organization has a sole member, and there are no classes of members. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | Certain decisions, considered "Major Actions" require the approval of the sole member, Bristol Hospital and Health Care Group, Inc. These actions include the adoption of the organization's annual budget, as well as other major actions. The sole member has full voting rights. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | A COMPLETED 990 IS PROVIDED TO EACH BOARD MEMBER BEFORE IT 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, Line 12c Conflict of interest policy | 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 interests 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 re-credentialing 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 exits, 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, Line 19 Required documents available to the public | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | TRANSFER FROM BRISTOL HOSPITAL AND HEALTH CARE GROUP - 5562110; |
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 |
|---|---|---|---|---|---|---|---|---|---|---|
| BRISTOL HOSPITAL INC | ||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06010 | 060646559 | SHORT-TERM ACUTE CARE COMMUNITY HOSPITAL | CT | 501(c)(3) | 3 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | false |
| BRISTOL HOSPITAL AND HEALTH CARE GROUP INC | ||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06010 | 222577726 | HEALTHCARE PARENT COMPANY | CT | 501(c)(3) | Type II | NA | false |
| BRISTOL HOSPITAL DEVELOPMENT FOUNDATION INC | ||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06010 | 222577740 | FUNDRAISING | CT | 501(c)(3) | 7 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | false |
| BRISTOL HEALTH CARE INC | ||||||||||
| 400 NORTH MAIN STREET | BRISTOL | CT | 06010 | 222577731 | NURSING HOME | CT | 501(c)(3) | 9 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | false |
| BRISTOL HOME CARE AND HOSPICE AGENCY INC | ||||||||||
| 41 BREWSTER ROAD | BRISTOL | CT | 06101 | 821663577 | HOME CARE AND HOSPICE | CT | 501(c)(3) | 10 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | false |
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 Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRISTOL HOSPITAL AND HEALTH CARE GROUP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C Corporation | EntityTypeTxt |
| Share Of Total Income | $0 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $0 | ShareOfEOYAssetsAmt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS CORP OR TRUST | FormAndLineReferenceDesc |
| Explanation | NAME OF RELATED ORGANIZATION: BRISTOL HOSPITAL EMS, LLC DIRECT CONTROLLING ENTITY: BRISTOL HOSPITAL AND HEALTH CARE GROUP | ExplanationTxt |