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STAMFORD HEALTH MEDICAL GROUP INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
STAMFORD HEALTH MEDICAL GROUP INC (EIN 27-1648289)
Tax period
2014-10-01 to 2015-09-30
Filed
2016-08-11
IRS object ID
201612249349302736
Schema version
2014v6.0
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

FieldValueIRS element (for citing)
Return2016-08-11T16:23:34-05:00ReturnTs
Tax Period End2015-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1111 MONUMENT CIRCLE STE 4000AddressLine1Txt
CityINDIANAPOLISCityNm
State AbbreviationINStateAbbreviationCd
ZIP46204ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN271648289EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STAMFORD HEALTH MEDICAL GROUP INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% FORTRELLA CUMMINGSInCareOfNm
Business Name ControlSTAMBusinessNameControlTxt
Phone2032767447PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11111 Summer Street 3rd FLAddressLine1Txt
CityStamfordCityNm
State AbbreviationCTStateAbbreviationCd
ZIP06905ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonFORTRELLA CUMMINGSPersonNm
Person TitleCFOPersonTitleTxt
Signature2016-08-11SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCHRISTOPHER B BOGGSPreparerPersonNm
PTINP00032493PTIN
Phone3176817000PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
Principal OfficerDr Rodrigo AcostaPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11111 Summer StreetAddressLine1Txt
CityStamfordCityNm
State AbbreviationCTStateAbbreviationCd
ZIP06905ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$51,178,723GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.STAMFORDHEALTHMEDICALGROUP.ORG/SHMGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2009FormationYr
Legal Domicile StateCTLegalDomicileStateCd
Activity Or MissionSUPPORTS THE PROVISION OF THE PHYSICIAN SERVICES AND OTHER HEALTH PRACTITIONER SVCS TO THE RESIDENTS OF THE COMMUNITIES SERVED BY STAMFORD HOSPITAL AND AFFILIATED ORGANIZATIONS.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee514TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$39,036,419PYProgramServiceRevenueAmt
CY Program Service Revenue$44,698,443CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$4,747,001PYOtherRevenueAmt
CY Other Revenue$6,480,280CYOtherRevenueAmt
PY Total Revenue$43,783,420PYTotalRevenueAmt
CY Total Revenue$51,178,723CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$52,643,776PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$59,352,196CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$20,536,362PYOtherExpensesAmt
CY Other Expenses$23,801,780CYOtherExpensesAmt
PY Total Expenses$73,180,138PYTotalExpensesAmt
CY Total Expenses$83,153,976CYTotalExpensesAmt
PY Revenues Less Expenses-$29,396,718PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$31,975,253CYRevenuesLessExpensesAmt
Total Assets BOY$14,852,342TotalAssetsBOYAmt
Total Assets EOY$23,202,925TotalAssetsEOYAmt
Total Liabilities BOY$13,631,800TotalLiabilitiesBOYAmt
Total Liabilities EOY$23,172,991TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,220,542NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$29,934NetAssetsOrFundBalancesEOYAmt
MissionSUPPORTS THE PROVISION OF THE PHYSICIAN SERVICES AND OTHER HEALTH, PRACTITIONER SERVICES TO THE RESIDENTS OF THE COMMUNITIES SERVED BY, STAMFORD HOSPITAL AND AFFILIATED ORGANIZATIONS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$66,986,099ExpenseAmt
Grant$0GrantAmt
Revenue$51,055,809RevenueAmt
DescSTAMFORD HEALTH MEDICAL GROUP INC. PROVIDES A COMPREHENSIVE ARRAY OF MANAGEMENT SERVICES IN SUPPORT OF PHYSICIAN PRACTICES.Desc
Total Program Service Expenses$66,986,099TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document83IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee514EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonFORTRELLA CUMMINGSPersonNm
Phone2032761000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11111 SUMMER STREETAddressLine1Txt
CitySTAMFORDCityNm
State AbbreviationCTStateAbbreviationCd
ZIP06905ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Craig Olin MD
Treasurer40.00.0Yes (X)Yes (X)$601,896$0$7,318
Rodrigo Acosta MD
CEO, President and Chairman40.00.0Yes (X)Yes (X)$549,665$0$11,510
Angelo Mallozzi MD
Director40.00.0Yes (X)$421,191$0$9,010
Joseph Costanzo MD
Physician40.00.0Yes (X)$363,261$0$9,439
Bismruta Misra MD
Physician40.00.0Yes (X)$229,139$0$7,091
Gerald Rakos MD
Physician1.036.0Yes (X)$0$483,570$9,054
Jeffrey Green MD
Director32.08.0Yes (X)$703,683$0$11,510
Kevin Miller MD
Director40.00.0Yes (X)$507,285$0$9,010
Michael Zucker MD
Director40.00.0Yes (X)$420,108$0$31,631
Cynthia Fitzgerald
VP & Chief Operating Officer40.00.0Yes (X)$0$408,524$34,108
William Hines MD
Chief Medical Officer40.00.0Yes (X)$439,288$0$7,275
Charles Rosenstein MD
PHYSICIAN40.00.0$884,480$0$7,318Yes (X)
Arghiris Barbadimos MD
PHYSICIAN40.00.0$718,388$0$6,271Yes (X)
Brian Hines MD
PHYSICIAN35.05.0$650,716$0$3,295Yes (X)
Edward Schuster MD
Physician36.04.0$617,972$0$30,454Yes (X)
Helen Pass MD
Physician20.020.0$593,193$0$8,898Yes (X)
Roberto Debara MD
FORMER CEO0.00.0$164,028$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$7,864,293TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$892,094TotReportableCompRltdOrgAmt
Total Other Compensation$203,192TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K109IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ASHFORTH PROPERTIES CONSTRUCTION
707 SUMMER STStamfordCT06901Construction$5,277,646
COASTAL CARE MEDICAL MANAGEMENT
10 DAVOL SQUARE SUITE 400PROVIDENCERI02903BILLING CONSULTING$2,279,393
ECLINICALWORKS LLC
PO BOX 847950BOSTONMA02284IS Sup EMed Rec&Bill$1,398,490
MEDVICE INC
4709 FOREST AVE SE SUITE 200MERCER ISLANDWA98040MGMT CONSULTING$1,139,309
EXECUTIVE CONSULTING GROUP LLC
1111 THIRD AVESEATTLEWA98101IS CONSULTING SVCS$672,258
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K35CntrctRcvdGreaterThan100KCnt
Fundraising$0FundraisingAmt
Noncash Contributions$0NoncashContributionsAmt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
Medicare621110$16,565,243$16,565,243$0$0
Physician Billing621110$28,133,200$28,133,200$0$0
FieldValueIRS element (for citing)
Total Program Service Revenue$44,698,443TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$122,914RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$122,914RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$122,914TotalRevenueColumnAmt
Exclusion$122,914ExclusionAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
INTERCOMPANY STAFFING REIMBURSEMENTS900099$5,168,654$5,168,654$0$0
MEANINGFUL USE INCOME900099$1,055,432$1,055,432$0$0
MISCELLANEOUS INCOME900099$133,280$133,280$0$0
FieldValueIRS element (for citing)
Other Revenue Total$6,357,366OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$51,178,723TotalRevenueColumnAmt
Related Or Exempt Func Income$51,055,809RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$122,914ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$6,470,297TotalAmt
Program Services$5,296,410ProgramServicesAmt
Management And General$1,173,887ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$46,398,267TotalAmt
Program Services$39,680,072ProgramServicesAmt
Management And General$6,718,195ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$4,012,471TotalAmt
Program Services$3,487,580ProgramServicesAmt
Management And General$524,891ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,471,161TotalAmt
Program Services$2,139,597ProgramServicesAmt
Management And General$331,564ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$127,786TotalAmt
Program Services$0ProgramServicesAmt
Management And General$127,786ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$404,777TotalAmt
Program Services$644ProgramServicesAmt
Management And General$404,133ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$64,821TotalAmt
Program Services$0ProgramServicesAmt
Management And General$64,821ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt
Fundraising$0FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,649,422TotalAmt
Program Services$6,835,901ProgramServicesAmt
Management And General$1,813,521ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$269,174TotalAmt
Program Services$4,434ProgramServicesAmt
Management And General$264,740ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,974,590TotalAmt
Program Services$2,869,897ProgramServicesAmt
Management And General$1,104,693ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$8,077TotalAmt
Program Services$1,495ProgramServicesAmt
Management And General$6,582ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,986,877TotalAmt
Program Services$3,913,346ProgramServicesAmt
Management And General$1,073,531ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$136,373TotalAmt
Program Services$70,683ProgramServicesAmt
Management And General$65,690ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,273,777TotalAmt
Program Services$643,697ProgramServicesAmt
Management And General$630,080ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,918,303TotalAmt
Program Services$1,743,798ProgramServicesAmt
Management And General$174,505ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
SERVICE CONTRACTS$1,471,908$149$1,471,759$0
NON COLLEGE EDUCATION$256,735$62,307$194,428$0
DUES AND MEMBERSHIPS$108,290$86,891$21,399$0
LICENSE FEES$92,256$90,584$1,672$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$58,614TotalAmt
Program Services$58,614ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$83,153,976TotalAmt
Program Services$66,986,099ProgramServicesAmt
Management And General$16,167,877ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Joint Costs TotalJointCostsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,574,812BOYAmt
EOY$2,768,486EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,893,288BOYAmt
EOY$5,821,442EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$334,227BOYAmt
EOY$298,906EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$16,964,360LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,755,868LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$6,300,745BOYAmt
EOY$14,208,492EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$749,270BOYAmt
EOY$105,599EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$14,852,342BOYAmt
EOY$23,202,925EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$8,821,837BOYAmt
EOY$15,992,189EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$147,934BOYAmt
EOY$147,589EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,662,029BOYAmt
EOY$7,033,213EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,631,800BOYAmt
EOY$23,172,991EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,220,542BOYAmt
EOY$29,934EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,220,542BOYAmt
EOY$29,934EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,852,342BOYAmt
EOY$23,202,925EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$31,975,253ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$30,784,645OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,821,031CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20,551,170CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$29,900,055CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$43,626,293CurrentTaxYearMinus1YearAmt
Current Tax Year$50,922,529CurrentTaxYearAmt
Total$153,821,078TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$500CurrentTaxYearMinus3YearsAmt
Total$500TotalAmt

Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,821,031CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20,551,670CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$29,900,055CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$43,626,293CurrentTaxYearMinus1YearAmt
Current Tax Year$50,922,529CurrentTaxYearAmt
Total$153,821,578TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$153,821,578PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,000CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,309CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$49,286CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$32,631CurrentTaxYearMinus1YearAmt
Current Tax Year$122,914CurrentTaxYearAmt
Total$225,140TotalAmt

Post1975 UBTI Post1975UBTIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,000CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,309CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$49,286CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$32,631CurrentTaxYearMinus1YearAmt
Current Tax Year$122,914CurrentTaxYearAmt
Total$225,140TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$192CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$36,038CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$124,496CurrentTaxYearMinus1YearAmt
Current Tax Year$133,280CurrentTaxYearAmt
Total$294,006TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,834,031CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20,559,171CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$29,985,379CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$43,783,420CurrentTaxYearMinus1YearAmt
Current Tax Year$51,178,723CurrentTaxYearAmt
Total$154,340,724TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99664PublicSupportCY509Pct
Public Support PY5090.00000PublicSupportPY509Pct
Investment Income CY0.00146InvestmentIncomeCYPct
Investment Income PY0.00000InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp
BuildingsBuildingsGrp

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,399,223OtherCostOrOtherBasisAmt
Depreciation$963,225DepreciationAmt
Book Value$8,435,998BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,071,738OtherCostOrOtherBasisAmt
Depreciation$1,792,643DepreciationAmt
Book Value$4,279,095BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,493,399OtherCostOrOtherBasisAmt
Book Value$1,493,399BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$14,208,492TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE TO AFFILIATES - SHI$4,751,982
LT LANDLORD LEASEHOLD IMPROVEMENT$2,281,231
FieldValueIRS element (for citing)
Total Liability$7,033,213TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (17 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Craig Olin MD
Treasurer$524,062$0$59,718$0$18,116$0$0$0$7,318$0$609,214$0$0$0
Rodrigo Acosta MD
CEO, President and Chairman$487,237$0$38,667$0$23,761$0$0$0$11,510$0$561,175$0$0$0
Charles Rosenstein MD
PHYSICIAN$865,560$0$13,000$0$5,920$0$0$0$7,318$0$891,798$0$0$0
Arghiris Barbadimos MD
PHYSICIAN$669,524$0$18,000$0$30,864$0$0$0$6,271$0$724,659$0$0$0
Brian Hines MD
PHYSICIAN$609,684$0$0$0$41,032$0$0$0$3,295$0$654,011$0$0$0
Angelo Mallozzi MD
Director$373,425$0$38,667$0$9,099$0$0$0$9,010$0$430,201$0$0$0
Cynthia Fitzgerald
VP & Chief Operating Officer$0$315,777$0$76,138$0$16,609$0$11,871$0$22,237$0$442,632$0$0
William Hines MD
Chief Medical Officer$376,602$0$39,642$0$23,044$0$0$0$7,275$0$446,563$0$0$0
Joseph Costanzo MD
Physician$305,187$0$38,161$0$19,913$0$0$0$9,439$0$372,700$0$0$0
Bismruta Misra MD
Physician$205,327$0$16,149$0$7,663$0$0$0$7,091$0$236,230$0$0$0
Gerald Rakos MD
Physician$0$419,972$0$43,050$0$20,548$0$0$0$9,054$0$492,624$0$0
Edward Schuster MD
Physician$583,916$0$11,012$0$23,044$0$0$0$30,454$0$648,426$0$0$0
Helen Pass MD
Physician$447,147$0$137,570$0$8,476$0$0$0$8,898$0$602,091$0$0$0
Jeffrey Green MD
Director$670,710$0$12,833$0$20,140$0$0$0$11,510$0$715,193$0$0$0
Kevin Miller MD
Director$442,972$0$59,302$0$5,011$0$0$0$9,010$0$516,295$0$0$0
Michael Zucker MD
Director$319,028$0$51,553$0$49,527$0$0$0$31,631$0$451,739$0$0$0
Roberto Debara MD
FORMER CEO$164,028$0$0$0$0$0$0$0$0$0$164,028$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART I, LINE 1FormAndLineReferenceDesc
ExplanationGas and imputable tax benefit Cynthia Fitzgerald; Rodrigo Acosta, MD Taxable benefit included in boxes 1, 3 and 5 SCHEDULE J, PART I, LINE 3 Cynthia Fitzgerald is paid by Stamford Hospital. IT IS THE POLICY OF SHMG TO PAY EMPLOYEES FAIR AND COMPETITIVE WAGES. SHMG HAS ADOPTED A WAGE AND SALARY PROGRAM TO ENSURE THAT ALL EMPLOYEES ARE PAID IN RELATION TO THE VALUE OF THE WORK THEY PERFORM. THIS PROGRAM IS REVIEWED ANNUALLY. EXECUTIVE COMPENSATION IS SUBJECT TO A MORE COMPREHENSIVE REVIEW, INCLUDING AN ANNUAL BENCHMARKING ANALYSIS. SCHEDULE J, PART I, LINE 4A ROBERTO DEBARA, MD - TERMINATION DATE 03/20/13; 15 MONTHS SEVERANCE.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, LINE 3STAMFORD HEALTH MEDICAL GROUP CONTRACTED WITH THE ADVISORY BOARD COMPANY FOR THE PROFESSIONAL SERVICES OF MR. DAVID TKACH, CPA MBA WHO IS INTERIM CFO AND PERFORMS ALL RELATED DUTIES OF THE POSITION. FORM 990, PART VI, LINE 6 STAMFORD HEALTH MEDICAL GROUP ('SHMG') IS A CONNECTICUT NONSTOCK CORPORATION. SHMG HAS TWO CLASSES OF MEMBERS. CLASS A MEMBERS ARE THE PHYSICIANS EMPLOYED BY SHMG. THE CLASS B MEMBER IS STAMFORD HOSPITAL. FORM 990, PART VI, LINE 7A THE BOARD OF DIRECTORS SHALL TOTAL NINE MEMBERS. THE INITIAL BOARD WAS SELECTED BY THE INCORPORATOR, AND THEREAFTER THE BOARD WILL BE ELECTED AS FOLLOWS: (A) EIGHT MEMBERS OF THE BOARD OF DIRECTORS SHALL BE ELECTED BY THE CLASS A MEMBERS, SUBJECT TO THE APPROVAL OF THE CLASS B MEMBER, AND (B) ONE MEMBER OF THE BOARD OF DIRECTORS SHALL BE APPOINTED BY THE CLASS B MEMBER. FORM 990, PART VI, LINE 7B ALL POWERS OF SHMG SHALL BE EXERCISED BY AND UNDER THE AUTHORITY OF THE BOARD OF DIRECTORS, EXCEPT THAT THE CLASS B MEMBER SHALL HAVE THE SOLE AUTHORITY TO AMEND THE BYLAWS OF SHMG AND SELECT THE AUDITORS OF SHMG. FORM 990, PART VI, LINE 11B STAMFORD HEALTH MEDICAL GROUP (SHMG) HAS A COMPREHENSIVE REVIEW PROCESS IN PLACE RELATING TO THE REVIEW OF FORM 990. PRIOR TO FINALIZATION OF THE 990, MANAGEMENT PROVIDES THE DRAFT OF THE FORM 990 TO THE BOARD OF DIRECTORS. THE FORM 990 IS ALSO PRESENTED TO THE STAMFORD HEALTH, INC. BOARD PRIOR TO FILING THE RETURN. PRESENTATION OF THE FORM IS MADE TO THE STAMFORD HEALTH, INC. BOARD WITH A COMPLETE COPY OF THE FILING ORGANIZATION'S FORM 990. SHMG'S EXTERNAL TAX ACCOUNTANTS ADDRESS ANY SPECIFIC CONCERNS OR QUESTIONS WITH MANAGEMENT AND THE BOARD. THIS REVIEW PROCEDURE HELPS TO ASSURE SOUND REPORTING AND COMPLIANCE WITH TAX LAW. FORM 990, PART VI, LINE 12C SHMG, AS A WHOLLY OWNED SUBSIDIARY OF THE STAMFORD HOSPITAL, FOLLOWS THE HOSPITAL'S CONFLICT OF INTEREST POLICY. IT IS THE POLICY TO PROHIBIT ITS EMPLOYEES AND OTHER ASSOCIATES FROM ENGAGING IN ANY ACTIVITY, PRACTICE, OR ACT WHICH CONFLICTS WITH, OR APPEARS TO CONFLICT WITH, THE INTERESTS OF THE ORGANIZATION. EMPLOYEES ARE EXPECTED TO CONDUCT THE BUSINESS OF SHMG TO THE BEST OF THEIR ABILITY AND FOR THE BENEFIT OF SHMG AND ITS PATIENTS. THE POLICY ALSO REQUIRES BOARD MEMBERS, OFFICERS, SENIOR LEADERS, MEDICAL STAFF LEADERS, COMMITTEE MEMBERS AND OTHER INDIVIDUALS AS APPROPRIATE TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST THEY OR THEIR IMMEDIATE FAMILY MAY HAVE ON AN ANNUAL BASIS. SURVEYS ARE DISTRIBUTED ANNUALLY AND TIMELY RECEIPT IS MONITORED BY THE HOSPITAL'S COMPLIANCE DEPARTMENT. FORM 990, PART VI, LINES 15A & 15B IT IS THE POLICY OF SHMG TO PAY EMPLOYEES FAIR AND COMPETITIVE WAGES. SHMG HAS ADOPTED A WAGE AND SALARY PROGRAM TO ENSURE THAT ALL EMPLOYEES ARE PAID IN RELATION TO THE VALUE OF THE WORK THEY PERFORM. THIS PROGRAM IS REVIEWED ANNUALLY. EXECUTIVE COMPENSATION IS SUBJECT TO A MORE COMPREHENSIVE REVIEW, INCLUDING AN ANNUAL BENCHMARKING ANALYSIS. FORM 990, PART VI, LINE 19 SHMG MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9 EQUITY TRANSFER FROM STAMFORD HOSPITAL DEBT FORGIVENESS - $30,784,645
FORM 990 PART IX LINE 11GDESCRIPTION:INTERCOMPANY STAFFING FEES TOTAL FEES:1028040
FORM 990 PART IX LINE 11GDESCRIPTION:COLLECTION FEES TOTAL FEES:2179157
FORM 990 PART IX LINE 11GDESCRIPTION:PHYSICIAN FEES TOTAL FEES:1491108
FORM 990 PART IX LINE 11GDESCRIPTION:CONSULTING SERVICE TOTAL FEES:2632954
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES TOTAL FEES:991961
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER TOTAL FEES:326202

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
Stamford Health Inc
30 Shelburne RDStamfordCT06902222476636HOSP PARENTCT501(C)(3)11, Type InAfalse
The Stamford Hospital Foundation
30 Shelburne RDStamfordCT06902222478748FundraisingCT501(C)(3)9SHIYes (true)
Stamford Hospital
30 Shelburne RDStamfordCT06902060646917HospitalCT501(C)(3)3SHIYes (true)

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
SOUTHWEST CONNECTICUT RADIOLOGY
30 Shelburne RDStamfordCT06904453801216RadiologyCTSHIS Corp$0$0Yes (true)
Healthstar Indemnity Co Limited
Self InsuranceTSHC Corp$0$0Yes (true)FB Perry Building 400 Church StHamiltionBermudaBDNABD
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (5 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
The Stamford Hospital
o$127,785Book Value
The Stamford Hospital
c$30,784,645Book Value
The Stamford Hospital
k$482,882Book Value
Stamford Health INC
b$645,432Book Value
Stamford Health INC
k$735,385Book Value