2017-05-11T15:43:12-05:00 2016-09-30 135565207 KPMG LLP ONE FINANCIAL PLAZA 755 MAIN STREET HARTFORD CT 06103 990 2015-10-01 066042500 BRIDGEPORT HOSPITAL AUXILIARY INC BRID 2037273412 267 GRANT STREET BRIDGEPORT CT 06610 LINDA B ANTIGNANI TREASURER 2037273412 2017-05-11 0 MARY-EVELYN ANTONETTI P00431862 8602976085 2015 2021-01-29 14:40:06Z LINDA B ANTIGNANI 267 GRANT STREET BRIDGEPORT CT 06610 527486 0 X NONE X 1960 CT TO PROVIDE SUPPORT SERVICES TO BRIDGEPORT HOSPITAL AND ITS PATIENTS. 23 23 0 54 0 0 132070 96600 0 0 376 287 183761 202927 316207 299814 295874 89570 0 0 92702 99446 0 0 0 42552 54795 431128 243811 -114921 56003 482361 442119 119280 23035 363081 419084 TO PLAN, SUPPORT, AND IMPLEMENT FUNDRAISING PROJECTS THAT ASSIST BRIDGEPORT HOSPITAL IN ITS HEALTH AND WELFARE MISSION. 0 0 89570 89570 0 THE BRIDGEPORT HOSPITAL AUXILIARY, INC. IS INCORPORATED AS A NOT-FOR-PROFIT NON-STOCK CORPORATION UNDER THE NON-STOCK CORPORATION ACT OF THE STATE OF CONNECTICUT. THE AUXILIARY'S PURPOSE IS TO SUPPLEMENT BRIDGEPORT HOSPITAL'S INTERNAL SERVICES AND ACTIVITIES TO PATIENTS AND PERSONNEL UNDER THE SUPERVISION OF THE HOSPITAL ADMINISTRATION, PROMOTE GOOD PUBLIC RELATIONS BETWEEN THE HOSPITAL AND THE COMMUNITY, AND INITIATE FUND-RAISING PROJECTS FOR THE BENEFIT OF THE HOSPITAL, SUBJECT TO APPROVAL OF THE BOARD OF DIRECTORS OF THE HOSPITAL. THE AUXILIARY'S PRIMARY SOURCES OF SUPPORT ARE A GIFT SHOP OPERATED IN THE BRIDGEPORT HOSPITAL AND TWO FUND RAISING EVENTS. OTHER SOURCES OF SUPPORT INCLUDE MEMBERSHIP FEES AND DONATIONS. 89570 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 23 23 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CT X CAROL ROBISON 2033843331 267 GRANT STREET BRIDGEPORT CT 06610 X BONNIE MOLLOY PRESIDENT/BOARD MEMBER 2.00 0.00 X X 0 0 0 JOYCE LAPONTE TREASURER/BOARD MEMBER 2.00 0.00 X X 0 0 0 BERNADETTE JACKEL THRU 616 SECRETARY/BOARD MEMBER 2.00 0.00 X X 0 0 0 AMPARO CASTILLO SECRETARY/BOARD MEMBER 2.00 0.00 X X 0 0 0 MARIA WATSON ASST TREASURER/BOARD MEMBER 2.00 0.00 X X 0 0 0 ANNE PAPPAS PHILLIPS VP/BOARD MEMBER 2.00 0.00 X X 0 0 0 SHIRLEY ALEXAY BOARD MEMBER 2.00 0.00 X 0 0 0 SHAUN AMBERG BOARD MEMBER 2.00 0.00 X 0 0 0 ULLA ATWEH BOARD MEMBER 2.00 0.00 X 0 0 0 ARLENE BATTISTELLI BOARD MEMBER 2.00 0.00 X 0 0 0 RITA CRISPINO BOARD MEMBER 2.00 0.00 X 0 0 0 JOAN CROSSMAN BOARD MEMBER 2.00 0.00 X 0 0 0 THERESA DONNELLY BOARD MEMBER 2.00 0.00 X 0 0 0 MARLENE FISHER BOARD MEMBER 2.00 0.00 X 0 0 0 PATRICIA HANSEN BOARD MEMBER 2.00 0.00 X 0 0 0 ANITA JANSON-BOWER BOARD MEMBER 2.00 0.00 X 0 0 0 VIRGINIA LOCH BOARD MEMBER 2.00 0.00 X 0 0 0 DENISE LOEB EFF 216 BOARD MEMBER 2.00 0.00 X 0 0 0 NANCY LYONS BOARD MEMBER 2.00 0.00 X 0 0 0 KIM MIRANTI BOARD MEMBER 2.00 0.00 X 0 0 0 PEG PERILLIE BOARD MEMBER 2.00 0.00 X 0 0 0 MARY ANN PETERSON BOARD MEMBER 2.00 0.00 X 0 0 0 MORAG VANCE BOARD MEMBER 2.00 0.00 X 0 0 0 SUSAN ZAVERUHA BOARD MEMBER 2.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 2705 91233 2662 1197 96600 287 287 13200 91233 27267 -14067 -14067 417399 200405 216994 216994 299814 0 0 203214 89570 89570 85415 85415 1415 1415 12616 12616 750 750 10865 10865 606 606 19201 19201 PROMOTION EVENT 13398 13398 BANK FEE 9975 9975 243811 89570 154241 0 306655 256342 27283 27283 79206 93879 201314 136699 69217 64615 482361 442119 20265 23035 50000 0 49015 0 119280 23035 X 363081 419084 363081 419084 482361 442119 56003 0 X 0 1 X 1 0 X X 1 BRIDGEPORT HOSPITAL 060646554 3 1 89570 0 1 89570 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 201314 136699 64615 64615 X PART X, LINE 2: THE CONSOLIDATED FINANCIAL STATEMENTS OF BRIDGEPORT HOSPITAL AND SUBSIDIARIES INCLUDE THE FOOTNOTE AS FOLLOWS: THE HOSPITAL AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. PROPERTIES IS A TAX-EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(2) OF THE CODE AND ALSO IS NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED "UNRELATED BUSINESS INCOME AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. SPRING EVENT 96991 83791 13200 23037 FASHION SHOW 7442 7442 4230 104433 91233 13200 27267 27267 -14067 1 BIRDGEPORT HOSPITAL 267 GRANT STREET BRIDGEPORT CT 06610 060646554 501(C)(3) 89570 TO SUPPORT THE HOSPITAL IN ACCORDANCE WITH THE ORGANIZATION MISSION. 1 0 PART I, LINE 2: THE FINANCIAL COORDINATOR FOR THE BRIDGEPORT HOSPITAL AUXILIARY MAINTAINS RECORDS FOR ALL AUXILIARY GRANT EXPENDITURES, AND IS ASSISTED IN MONITORING THE USE OF GRANT FUNDS BY THE BRIDGEPORT HOSPITAL FOUNDATION. THE FOUNDATION ACTS AS AN INTERMEDIARY IN DISTRIBUTING AUXILIARY GRANT FUNDS TO NURSING SCHOLARSHIP RECIPIENTS AND PROGRAMS TO SERVE BRIDGEPORT HOSPITAL PATIENTS, SUCH AS THE BREAST FEEDING CLASSES FOR SPANISH SPEAKING PATIENTS. THE FOUNDATION MANAGES GRANT FUNDS THROUGH A RESTRICTED PROCESS ENSURING ALL PAYMENTS ARE MADE IN ACCORDANCE WITH AUXILIARY GRANT AWARDS. FORM 990, PART VI PART I, LINE 4 & PART VI, LINE 1B NUMBER OF INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY THE ORGANIZATION SOUGHT TO CONFIRM THE INDEPENDENCE OF EACH VOTING MEMBER OF ITS GOVERNING BODY BY REQUESTING THAT EACH SUCH VOTING MEMBER RESPOND TO A QUESTIONNAIRE CONTAINING THE PERTINENT INSTRUCTIONS AND DEFINITIONS AND DESIGNED TO ELICIT THE INFORMATION NECESSARY TO DETERMINE INDEPENDENCE. BASED ON RESPONSES TO THE QUESTIONNAIRES RECEIVED BY THE ORGANIZATION AND ANNUAL CONFLICTS OF INTEREST DISCLOSURES, THE ORGANIZATION WAS ABLE TO CONFIRM THAT EIGHTEEN (18) VOTING MEMBERS ARE INDEPENDENT. BASED ON OTHER INFORMATION KNOWN TO THE ORGANIZATION, THE ORGANIZATION HAS NO REASON TO BELIEVE THAT ANY OF THE REMAINING FIVE (5) VOTING MEMBERS ARE NOT INDEPENDENT. FORM 990, PART VI, SECTION A, LINE 6 BRIDGEPORT HOSPITAL IS THE ORGANIZATION'S SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING. ANY QUESTIONS OR COMMENTS FROM THE BOARD ARE ADDRESSED BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BRIDGEPORT HOSPITAL AUXILIARY INC IS COVERED UNDER THE YALE-NEW HAVEN HEALTH SYSTEM CONFLICT OF INTEREST POLICY. THE YALE NEW HAVEN HEALTH SYSTEM CONFLICT OF INTEREST POLICY (CC:R-7) AND INDIVIDUAL ANNUAL DISCLOSURE FORM APPLIES TO A POOL OF EMPLOYEES, BOARD MEMBERS AND NON-BOARD MEMBERS SERVING ON BOARD COMMITTEES. THESE "COVERED INDIVIDUALS" ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT, UPON BEGINNING EMPLOYMENT OR OTHERWISE BECOMING A COVERED INDIVIDUAL AND ANNUALLY THEREAFTER. COVERED INDIVIDUALS ARE ALSO REQUIRED TO IMMEDIATELY REPORT MATERIAL CHANGES TO THEIR MOST RECENTLY COMPLETED DISCLOSURE STATEMENT. THESE DISCLOSURE STATEMENTS AND REPORTS ARE REVIEWED BY THE OFFICE OF PRIVACY AND CORPORATE COMPLIANCE AND/OR THE LEGAL AND RISK SERVICES DEPARTMENT TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF A POTENTIAL CONFLICT ARISES, THE PRESIDENT AND CEO WOULD CONSULT WITH THE BOARD CHAIRPERSON AND THE LEGAL AND RISK SERVICES DEPARTMENT AND TAKE ANY ACTIONS THAT SHE DEEMS REQUIRED OR APPROPRIATE TO MANAGE OR RESOLVE A POTENTIAL CONFLICT OF INTEREST. FOR EXAMPLE, A VOTING BOARD OR COMMITTEE MEMBER WOULD BE REQUIRED TO RECUSE HIMSELF OR HERSELF FROM VOTING ON MATTERS RELATED TO THE POTENTIAL CONFLICT AND THE POTENTIAL CONFLICT WOULD BE DISCLOSED TO OTHER VOTING MEMBERS. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF FORM 990 ARE MAINTAINED IN THE SYSTEM TAX DEPARTMENT. OTHER CORPORATE GOVERNING DOCUMENTS INCLUDING THE CONFLICT OF INTEREST POLICY ARE MAINTAINED BY THE LEGAL AND RISK SERVICES DEPARTMENT AND AVAILABLE TO ALL EMPLOYEES. COPIES OF ALL DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ASSOCIATED SPECIALISTS OF SOUTHEASTERN CONNECTICUT INC 365 MONTAUK AVENUE NEW LONDON CT 06320 208006123 HEALTHCARE SERVICES CT 501C3 LINE 11A, I LAWRENCE & MEMORIAL HOSPITAL 1 BRIDGEPORT HOSPITAL 267 GRANT STREET BRIDGEPORT CT 06610 060646554 HEALTHCARE SERVICES CT 501C3 LINE 3 YALE NEW HAVEN HEALTH SERVICES CORP 0 BRIDGEPORT HOSPITAL FOUNDATION INC 267 GRANT STREET BRIDGEPORT CT 06610 222908698 SYSTEM SUPPORT SERVICES CT 501C3 LINE 7 BRIDGEPORT HOSPITAL 1 BRIDGEPORT HOSPITAL FRIENDS OF PEDIATRICS INC 120 COLUMBINE DRIVE TRUMBULL CT 06611 066048427 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11A, I YALE NEW HAVEN HOSPITAL 1 GREENWICH HEALTH CARE SERVICES INC - MERGED WITH GH 5122016 5 PERRYRIDGE ROAD GREENWICH CT 06830 222593399 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II YALE NEW HAVEN HEALTH SERVICES CORP 0 GREENWICH HOSPITAL 5 PERRYRIDGE ROAD GREENWICH CT 06830 060646659 HEALTHCARE SERVICES CT 501C3 LINE 3 SEE SCHEDULE R PART VII 0 L&M PHYSICIAN ASSOCIATION INC 365 MONTAUK AVENUE NEW LONDON CT 06320 271094375 HEALTHCARE SERVICES CT 501C3 LINE 11A, I LAWRENCE & MEMORIAL COPRORATION 1 LAWRENCE MEMORIAL CORPORATION 365 MONTAUK AVENUE NEW LONDON CT 06320 222553028 PROMOTE HEALCARE CT 501C3 LINE 9 YALE NEW HAVEN HEALTH SERVICES CORP 0 LAWRENCE AND MEMORIAL FOUNDATION INC 365 MONTAUK AVENUE NEW LONDON CT 06320 222553026 FUNDRAISING SERVICES CT 501C3 PF LAWRENCE & MEMORIAL COPRORATION 1 LAWRENCE MEMORIAL HOSPITAL INC 365 MONTAUK AVENUE NEW LONDON CT 06320 060646704 HEALTHCARE SERVICES CT 501C3 LINE 3 LAWRENCE & MEMORIAL COPRORATION 1 LMW HEALTHCARE INC 365 MONTAUK AVENUE NEW HAVEN CT 06320 460543230 HEALTHCARE SERVICES RI 501C3 LINE 3 LAWRENCE & MEMORIAL COPRORATION 1 NORTHEAST MEDICAL GROUP INC 99 HAWLEY LANE STRATFORD CT 06614 061330992 HEALTHCARE SERVICES CT 501C3 LINE 9 YALE NEW HAVEN HEALTH SERVICES CORP 0 NORTHEAST MEDICAL GROUP PLLC 99 HAWLEY LANE STRATFORD CT 06614 352380180 HEALTHCARE SERVICES CT 501C3 LINE 11A, I NORTHEAST MEDICAL GROUP INC 1 PERRYRIDGE CORPORATION 5 PERRYRIDGE ROAD GREENWICH CT 06830 061207316 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II SEE SCHEDULE R PART VII 1 SOUTHERN CONNECTICUT HEALTH SYSTEM PROPERTIES INC 267 GRANT STREET BRIDGEPORT CT 06610 061297708 TITLE HOLDING CT 501C2 BRIDGEPORT HOSPITAL 1 THE GREENWICH HOSPITAL ENDOWMENT FUND INC 5 PERRYRIDGE ROAD GREENWICH CT 06830 061526642 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II SEE SCHEDULE R PART VII 1 THE WESTERLY HOSPITAL FOUNDATION INC 25 WELLS STREET WESTERLY RI 02891 050508064 FUNDRAISING SERVICES RI 501C3 LINE 11A, I LMW HEALTHCARE INC 1 VISITING NURSE ASSOCIATION OF SOUTHEREASTERN CONNECTICUT INC 403 NORTH FRONTAGE ROAD WATERFORD CT 06385 060646616 HOME HEALTHCARE SERVICES CT 501C3 LINE 9 LAWRENCE & MEMORIAL COPRORATION 1 WESTERLY HOSPITAL AUXILIARY INC 25 WELLS STREET WESTERLY RI 02891 222507181 FUNDRAISING ACTIVITIES RI 501C3 LINE 11C, III-FI LMW HEALTHCARE INC 1 YALE NEW HAVEN HEALTH SERVICES CORP 789 HOWARD AVE NEW HAVEN CT 06519 222529464 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11A, I N/A 0 YALE NEW HAVEN HOSPITAL 20 YORK STREET NEW HAVEN CT 06504 060646652 HEALTHCARE SERVICES CT 501C3 LINE 3 YALE NEW HAVEN HEALTH SERVICES CORP 0 YALE-NEW HAVEN CARE CONTINUUM CORP 789 HOWARD AVE NEW HAVEN CT 06519 455235566 NURSING HOME CT 501C3 LINE 3 YALE NEW HAVEN HOSPITAL 1 SHORELINE SURGERY CENTER LLC 111 GOOSE LANE GREENWICH CT 06437 900110459 HEALTHCARE SERVICES CT N/A SSC II LLC 111 GOOSE LANE GUILFORD CT 06437 261709382 HEALTHCARE SERVICES CT N/A ORTHOPAEDIC & NEUROSURGERY CENTER 55 HOLLY HILL LANE GREENWICH CT 06830 273477197 HEALTHCARE SERVICES CT N/A TOTAL HEALTH CONNECTICUT LLC 789 HOWARD AVENUE NEW HAVEN CT 06519 474070024 HEALTHCARE SERVICES CT N/A YALE NEW HAVEN HEALTH SYSTEM INVESTMENT 20 YORK STREET NEW HAVEN CT 06510 271374301 INVESTMENT DE N/A YNHHS-MSO INC 789 HOWARD AVE NEW HAVEN CT 06519 061467717 MANAGEMENT SERVICES CT N/A C 1 YALE NEW HAVEN AMBULATORY SERVICES 40 TEMPLE STREET NEW HAVEN CT 06510 061398526 HEALTHCARE SERVICES CT N/A C 1 MEDICAL CENTER REALTY INC 50 YORK STREET NEW HAVEN CT 06511 061110858 RENTAL SERVICES CT N/A C 1 GREENWICH FERTILITY & IVF PC 5 PERRYRIDGE ROAD GREENWICH CT 06830 300145464 HEALTHCARE SERVICES CT N/A C 1 YORK ENTERPRISES INC 50 YORK STREET NEW HAVEN CT 06511 061110937 TITLE HOLDING CT N/A C 1 YNHH-PHYSICIANS CORP 789 HOWARD AVE NEW HAVEN CT 06519 061202305 ADMINISTRATIVE SERVICES CT N/A C 1 MEDICAL CENTER PHARMACY INC 50 YORK STREET NEW HAVEN CT 06511 061087673 PHARMACY CT N/A C 1 GREENWICH OCCUPATIONAL HEALTH SERVICES OF NY PC 5 PERRYRIDGE ROAD GREENWICH CT 06830 061540101 HEALTHCARE SERVICES NY N/A C 1 GREENWICH OCCUPATIONAL HEALTH SERVICES OF NEW JERSEY 5 PERRYRIDGE ROAD GREENWICH CT 06830 453833883 HEALTHCARE SERVICES NJ N/A C 1 PRIMARYNET OF CONNECTICUT INC- TERMINATED 93016 789 HOWARD AVE NEW HAVEN CT 06519 061463534 HEALTHCARE SERVICES CT N/A C 1 CENTURY FINANCIAL SERVICES INC 23 MAIDEN LANE NORTH HAVEN CT 06473 061110797 DEBT COLLECTION SERVICES CT N/A C 1 CENTURY MANAGEMENT SERVICES INC 23 MAIDEN LANE NORTH HAVEN CT 06473 061303173 RECEIVABLE MANAGEMENT SERVICES CT N/A C 1 L & M SYSTEMS INC 365 MONTAUK AVENUE NEW LONDON CT 06320 222553037 HEALTHCARE RELATED SERVICES CT N/A C 1 L&M HOME CARE SERVICES INC 365 MONTAUK AVENUE NEW LONDON CT 06320 061389272 HOME THERAPY CT N/A C 1 LAWRENCE & MEMORIAL INDEMNITY COMPANY LTD PO BOX 1159 KY1-1102 GRAND CAYMAN CJ 981021436 INSURANCE CJ N/A C 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 BRIDGEPORT HOSPITAL R 446105 TRANSACTION REVIEW BRIDGEPORT HOSPITAL B 89570 TRANSACTION REVIEW PART II (F), DIRECT CONTROLLING ENTITY OF TAX-EXEMPT ORGANIZATIONS: GREENWICH HOSPITAL - GREENWICH HEALTH CARE SERVICES INC. 10/1/15-5/12/16 YALE NEW HAVEN HEALTH SERVICES CORPORATION 5/13/2016- 9/30/16