2013-08-06T14:14:25-05:00 2012-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2011-10-01 060250773 THE WILLIAM W BACKUS HOSPITAL % DANIEL E LOHR WILL 8608898331 326 WASHINGTON STREET NORWICH CT 06360 DANIEL E LOHR 2013-08-15 true Jim Still 8162216300 2011 2016-02-24 21:20:13Z DAVID WHITEHEAD 326 WASHINGTON STREET NORWICH CT 06360 314928667 false X WWW.BACKUSHOSPITAL.ORG X 1891 CT BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH-QUALITY HEALTHCARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT. 14 9 2063 484 2161879 69663 1296004 1179014 271933218 285997171 5938478 4525194 1609862 1628784 280777562 293330163 692681 752684 0 0 135892894 146148497 0 0 325071 113381675 115188670 249967250 262089851 30810312 31240312 358349465 393284501 195793905 195088980 162555560 198195521 X SEE SCHEDULE O false false 210491948 752684 287011997 IN FISCAL YEAR 2011, BACKUS HOSPITAL HAD 10,974 ADMISSIONS, 68,102 EMERGENCY DEPARTMENT VISITS, AND 440,605 OUTPATIENT VISITS. THE HOSPITAL DELIVERED 919 BABIES AND 6,968 SAME DAY SURGICAL PROCEDURES. BACKUS PERFORMED 122,132 OUTPATIENT IMAGING EXAMS, 7,707 MRI EXAMINATIONS, 9,443 PSYCHIATRIC CLINICAL VISITS, AND 7,914 PSYCHIATRIC PARTIAL HOSPITAL VISITS. 210491948 true true false true false false false false false true true false false false true false true true false false false false false false true false true true true true true true false false false false false false false false false true false false false false false true true true false false true 156 0 true 2063 true true true false false false false true true false false false false X 14 9 true false false false true true true true true false false true true true true true true true true true false X X DANIEL E LOHR 8608898331 326 WASHINGTON STREET NORWICH CT 06360 X DAVID WHITEHEAD 40.0 X X 762221 0 43852 ROBERT RAMSDELL 6.0 X X JOSEPH FATONE 6.0 X X ANTHONY JOYCE 6.0 X X JOHN F BILDA 2.0 X ELIZABETH CONWAY 2.0 X BERT A COPPOTELLI MD 2.0 X PETER MANERI 2.0 X DEBORAH MONAHAN 2.0 X LYNNE QUINTAL-HILL 2.0 X MARK TRAMONTOZZI MD 12.25 X 53700 0 STEPHEN T BRIGGS MD 2.0 X PAUL MAXFIELD 2.0 X DONNA ROMITO DO 2.0 X DANIEL E LOHR 40.0 X 514728 37462 PETER SHEA 40.0 X 492797 36733 SERGIO CASILLAS MD 40.0 X 496355 14287 ROBERT SIDMAN MD 40.0 X 409425 36502 MARK TOUSIGNANT MD 40.0 X 335264 36733 JUAN ESCALON MD 40.0 X 346171 36733 WILLIAM HORGAN MD 40.0 X 322581 33135 THOMAS P PIPICELLI 0.0 X 3777778 37462 7511020 0 312899 139 true true false EXECUTIVE HEALTH RESOURCES CONSULTING 799847 ALLIANCE HEALTHCARE SERVICES MEDICAL SERVICES 3204696 HURON CONSULTING GROUP CONSULTING 3308146 YALE NH HOSPITAL MEDICAL SERVICES 2255899 NAVIN HAFTY ASSOCIATES CONSULTING 571116 35 95705 3225 614920 465164 3179 1179014 Inpatient 900099 126151493 126151493 Outpatient 900099 108882771 108882771 Emergency Department 900099 45998119 45998119 Lab courier service 621500 2187372 2187372 E.H.R. REVENUE 722320 2777416 2777416 285997171 3731395 3731395 0 0 1025860 2126333 -1100473 -1100473 -50079 -1050394 19678400 184772 18855065 214308 823335 -29536 793799 793799 32160 95705 49496 -17336 -17336 0 469919 353302 116617 116617 Cafeteria 624410 1166526 1166526 Child care 900099 398545 398545 OTHER MISC REVENUE 900099 1064905 1040319 24586 2629976 293330163 284850118 2161879 5139152 740184 740184 12500 12500 0 0 5580387 587917 4992470 0 108559950 97665139 10798732 96079 9850231 8865208 985023 13862551 12476296 1386255 8295378 7465840 829538 0 2167582 2167582 415616 415616 51213 51213 0 132898 132898 20320485 15235141 5084844 500 188256 166829 21427 6060614 4152449 1905902 2263 3398561 353216 3045345 0 5578019 553635 5024384 255725 108125 147600 0 31175 5560 25560 55 3008114 3008114 0 16954609 8344451 8610158 1720586 1295901 424685 MEDICAL SUPPLIES 34428304 34428304 BAD DEBT 7950269 7949694 575 MAINTENANCE/SERVICE CONTRACT 5345541 3840244 1505297 LAB EXPENSES 4338527 4338527 2842576 1906788 731041 204747 262089851 210491948 51272832 325071 2802148 3816199 90659933 103907072 101211 31723 32373122 32015340 0 0 0 0 100023 74517 3757730 3602936 4493355 5066915 240354654 149000168 89983664 91354486 133516829 147043829 12632 12632 0 0 0 0 548818 6358852 358349465 393284501 22318404 23583670 0 0 0 0 61230000 59265000 0 0 0 0 1183176 1126557 0 0 111062325 111113753 195793905 195088980 X 153706889 187548862 1399547 2890743 7449124 7755916 162555560 198195521 358349465 393284501 X 31240312 4399649 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 51213 false false false 51213 false 5396859 5226 5226 5396859 5320786 5000 76505 0 0 5432 5396859 4841631 358064 505259 0 378271 5897 5320786 3871631 970000 142089 0 135254 6835 4841631 1.00000 false false 0 2229795 2229795 10381267 46448280 33861382 22968165 80846314 45668172 35178142 98659140 69428410 29230730 1747654 1747654 91354486 0 Tax exempt bond premium, net 667276 Due to 3rd parties 18193420 Employee related obligations 75571071 Self-insured prof liability 9685357 Capital lease obligations 6344367 Other liabilities 652262 111113753 293330163 262089851 31240312 10067106 -365321 -5302136 4399649 35639961 305112306 10067106 10067106 295045200 365321 -2080358 -1715037 293330163 264141267 2205365 2205365 261935902 153949 153949 262089851 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE MEANT TO PROVIDE LONG-TERM SUPPORT FOR CAPITAL AND OPERATING PROGRAMS FOR THE HOSPITAL IN ACCORDANCE WITH THE DONOR'S WISHES. UNCERTAIN TAX POSITIONS DISCLOSURE SCHEDULE D, PART X, LINE 2 ASC 740-10, Uncertain Tax Positions, prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. This interpretation also provides guidance on derecognition, classification, interest and penalties, accounting in interim periods, and disclosure requirements for uncertain tax positions. Management has evaluated the implications of ASC 740-10 and determined that its impact on the financial statements is not significant. RECONCILIATION OF CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 K-1 LOSS 892 TRANSFER TO AFFILIATES (1,248,123) INCREASE IN NET ASSETS HELD IN TRUST 306,792 CHANGE IN PENSION FUNDING (4,361,697) ------------ TOTAL $(5,302,136) RECONCILIATION OF REVENUE- OTHER ADJUSTMENTS SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF REVENUES- OTHER ADJUSTMENTS SCHEDULE D, PART XII, LINE 4B AUXILIARY INCOME 125,899 K-1 LOSS ( 892) LOSS ON FIXED ASSETS ( 29,536) RENTAL EXPENSE (2,126,333) TEMPORARILY RESTRICTED INCOME ( 49,496) ------------ TOTAL $(2,080,358) RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTS SCHEDULE D, PART XIII, LINE 2D RENTAL EXPENSE 2,126,333 GOLF TOURNAMENT EXPENSE 49,496 LOSS ON FIXED ASSETS 29,536 ---------- TOTAL $2,205,365 RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTS SCHEDULE D, PART XIII, LINE 4B AUXILIARY EXPENSE $ 153,949 GOLF TOURNAMENT 90515 67715 22800 0 5136 20118 3265 0 11609 SEDER GOLF 37350 27990 9360 0 1560 4680 0 0 3128 0 0 0 0 0 0 0 0 0 0 127865 95705 32160 0 6696 24798 3265 0 14737 49496 -17336 true true true X 250. true X true true false false 3313006 1038468 2274538 0.00900 55952799 39553595 16399204 0.06450 59265805 40592063 18673742 0.07350 96 41062 658308 12340 645968 0.00250 17 4531 275274 2250 273024 0.00110 22476 5140665 5140665 0.02020 1 24431 24431 0.00010 22 23 669064 669064 0.00260 136 68092 6767742 14590 6753152 0.02650 136 68092 66033547 40606653 25426894 0.10000 8 69051 69051 0.00030 1 1848 1848 2 18320 18320 0.00010 1 510 510 1 100 100 13 89829 89829 0.00040 false 3308653 3143316 62914770 90995950 -28081180 X true true 1 1 WILLIAM W BACKUS HOSPITAL

326 WASHINGTON ST NORWICH CT 06360

X X X WILLIAM W BACKUS HOSPITAL 1 true true 250. true 400. true X X X X X X true true X X X X true false true X false false 11 BACKUS OUTPATIENT CARE CENTER

111 SALEM TURNPIKE NORWICH CT 06360

OUTPATIENT SERVICES MEDICAL OFFICE BUILDING

330 WASHINGTON STREET NORWICH CT 06360

RADIATION THERAPY/LAB COLCHESTER BACKUS HEALTH CENTER

163 BROADWAY COLCHESTER CT 06415

RADIOLOGY/LAB/PRIMARY CARE MONTVILLE BACKUS HEALTH CARE

80 NORWICH/NEW LONDON TURNPIKE UNCASVILLE CT 06382

RADIOLOGY/LAB/PRIMARY CARE PAIN MANAGEMENT

112 LAFAYETTE STREET NORWICH CT 06360

PAIN MANAGEMENT CLINIC LEDYARD BACKUS HEALTH CENTER

743 COLONEL LEDYARD HWY LEDYARD CT 06339

LAB/PRIMARY CARE JEWETT CITY PATIENT SERVICE CENTER

70 MAIN STREET JEWETT CITY CT 06351

LAB INFECTIOUS DISEASE CLINIC

107 LAFAYETTE STREET NORWICH CT 06360

CLINIC NORTH STONINGTON BACKUS HEALTH CENTER

82 NORWICH-WESTERLY ROAD NORTH STONINGTON CT 06359

PRIMARY CARE NORWICHTOWN BACKUS PATIENT SERVICE CNTR

55 TOWN STREET NORWICH CT 06360

LAB PLAINFIELD EMERGENCY CENTER

582 NORWICH ROAD PLAINFIELD CT 06374

LAB/RADIOLOGY/EMERGENCY SRVCS FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 FROM OCTOBER 2011 THROUGH SEPTEMBER OF 2012 THE WILLIAM W. BACKUS HOSPITAL SUPPORTED 146 PROGRAMS THAT SERVED 68,101 PEOPLE, TOTALING A COMMUNITY BENEFIT OF $6,859,351. PROGRAMS IMPROVED THE HEALTH AND WELLNESS OF THE COMMUNITY, ADDRESSING STRATEGIC COMMUNITY HEALTH PRIORITY AREAS. SUCH PRIORITY HEALTH AREAS INCLUDE REDUCING OBESITY, AUTISM, DRUG AND ALCOHOL USE, AND INCREASING ACCESS TO HEALTH CARE. PROGRAMS ALSO INCLUDED CLINICAL SERVICES PROVIDED BY THE HOSPITAL AT A FINANCIAL LOSS (SUBSIDIZED SERVICES). THESE SERVICES, IF DISCONTINUED, WOULD NOT BE AVAILABLE TO THE COMMUNITY OR WOULD FALL TO ANOTHER NOT-FOR-PROFIT OR GOVERNMENT AGENCY TO PROVIDE. HEALTH PROFESSIONAL EDUCATION WAS ALSO ENHANCED, THROUGH MENTORSHIPS, INTERNING OPPORTUNITIES, AND STUDENT ROTATIONS THROUGH THE FACILITY. THE HOSPITAL ALSO SUPPORTED COMMUNITY PARTNERSHIPS THROUGH CASH AND IN-KIND DONATIONS. SUCH SUPPORT INCLUDED ASSISTING A LOCAL FEDERALLY-QUALIFIED LOOK-ALIKE IN SUSTAINING A GYNECOLOGY SERVICES PROGRAM FOR UNDERSERVED AND UNINSURED WOMEN, AS WELL AS DONATING A BUILDING TO ESTABLISH A SATELLITE FQHC FACILITY TO PROVIDE PRIMARY CARE IN AN UNDERSERVED COMMUNITY. LASTLY, THE HOSPITAL COMMITTED RESOURCES TO FINDING "NOT-FOR-PROFIT" RESEARCH OPPORTUNITIES (IN OTHER WORDS, THOSE RESEARCH OPPORTUNITIES IN WHICH THE HOSPITAL HAS NO FINANCIAL INCENTIVE) TO HELP IMPROVE CLINICAL CARE AVAILABLE TO THE RESIDENTS OF EASTERN CONNECTICUT. SCHEDULE H, PART I, LINE 7 THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THE COLUMN IS $7,950,269. SCHEDULE H, PART I LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II Backus Hospital conducts and sponsors 10 support groups that provide ongoing education and counseling for a wide array of health-related issues, from infant child loss to cancer. Hospital employees volunteer their service on dozens of community not-for-profit organizations, many of which has healthcare as a primary or major focus. Examples include THE HEALTH CARE COUNCIL OF EASTERN CONNECTICUT, THE FOUNDATION OF THREE RIVERS COMMUNITY COLLEGE (WHICH PROVIDEDS FUNDING FOR NURSING STUDENT EDUCATION AND EQUIPMENT), THE REGION'S NON-PROFIT HOSPICE ORGANIZATION, THE NORWHICH CHAMBER OF COMMERCE HEALTH CARE COMMITTEE, UNITED WAY OF SOUTHEASTERN CONNECTICUT (WHICH PROVIDES FUNDING FOR MANY REGIONAL HUMAN SERVICES, INCLUDING THOSE THAT ARE HEALTH-RELATED); AS WELL AS SERVICE AND BOARD MEMBERSHIPS ON THE REGION'S TWO FEDERALLY QUALIFIED HEALTH CENTERS. Additionally, Backus personnel volunteer on other boards and organizations that advance the quality of life and economic well-being of the region, including the local library, family support and social service organizations, the regional Chamber of Commerce, numerous civic and governmental bodies, and various volunteer fire companies and ambulance services. Members of the administrative staff routinely submit government testimony on behalf of regional not-for-profit health-related organizations, and provide research and advocacy for the healthcare access. BAD DEBT EXPENSE SCHEDULE H, PART III, LINES 4, 8 AND 9B THE HOSPITAL PROVIDES SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE, SUCH SERVICES ARE NOT REPORTED AS NET REVENUE. THE HOSPITAL'S CHARITY CARE POLICY UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE. FOR PATIENTS WHO DO NOT APPLY OR DO NOT QUALIFY, THE UNCOLLECTED AMOUNTS ARE RECOGNIZED AS BAD DEBT EXPENSE. ESTIMATED COST OF BAD DEBT IS BASED ON THE RATIO OF COST TO CHARGES AS DETERMINED BY HOSPITAL SPECIFIC DATA. MEDICARE SHORTFALL SCHEDULE H, PART III, LINE 8 THE MEDICARE SHORTFALL WAS NOT INCLUDED IN THE COMMUNITY BENEFIT COST. THE COSTING METHODOLOGY CONSISTED OF INFORMATION FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM AS WELL AS COSTS FROM THE MEDICARE COST REPORT. COLLECTION POLICY SCHEDULE H, PART III, LINE 9B IN THE SELF-PAY POLICY, SECTION II, B STATES THAT THE MEDICAL BUREAU OF ECONOMICS ("MBE") RECEIVES A WEEKLY LIST OF PATIENTS WHO WERE SENT FINANCIAL ASSISTANCE APPLICATIONS FROM BACKUS STAFF. THIS INFORMATION IS FROM THE PATIENT ACCOUNTS OR FINANCIAL COUNSELING DEPARTMENTS. MBE'S COLLECTION ACTIVITY ON THESE PATIENTS IS HALTED UNTIL IT HAS BEEN DETERMINED IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE HOSPTIAL'S POLICY, BY THE HOSPITAL FINANCIAL COUNSELING UNIT. COLLECTION ACTION IS ONLY RESUMED ONCE IT IS DETERMINED THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE. AVAILABILITY OF FINANCIAL ASSISTANCE SCHEDULE H, PART V, LINES 13G, 17E THE WILLIAM W. BACKUS HOSPITAL PROVIDES FINANCIAL ASSISTANCE FOR CERTAIN QUALIFIED PATIENTS WHO ARE UNABLE TO PAY ALL OR PART OF THEIR BILL FOR INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES RENDERED AT THE HOSPITAL. IF YOU ARE COPING WITH A FINANCIAL HARDSHIP AND ARE FACING DEBTS OWED TO THE WILLIAM W. BACKUS HOSPITAL, FINANCIAL ASSISTANCE SUCH AS FREE CARE OR A SLIDING SCALE DISCOUNT MAY BE AVAILABE TO YOU. THE FINANCIAL COUNSELING PROCESS WILL INDICATE WHAT OPTIONS EXIST TO ASSIST YOU WITH YOUR OUTSTANDING BALANCE. FINANCIAL ASSISTANCE APPLIES TO BACKUS HOSPITAL BILLS ONLY. IT DOES NOT APPLY TO RADIOLOGISTS, PATHOLOGISTS, ANESTHESIOLOGISTS OR OTHER PROFESSIONAL SERVICES INVOLVED IN YOUR CARE THAT ARE BILLED SEPARATELY. TO APPLY PLEASE SUBMIT THE ATTACHED APPLICATION FOR FINANCIAL ASSISTANCE AND THE FOLLOWING VERIFICATIONS OF INCOME INFORMATION: - Most recent Federal tax return and W-2 - Most recent 3 payroll checks - Copies of unemployment checks - Copies of any pension, alimony, child support or other sources of income - Copies of Social Security earnings, if any - Any other pertinent information. Proof of income or earnings is required with application or the application will not be considered. Please allow 3 to 4 weeks for processing time; you will be notified by mail of the outcome of your application. If you have any questions please contact Customer Service: Monday thru Friday, 9:00 am to 4:00 pm (860) 823-6394 / Fax: (860) 892-6902. Further, as detailed in the Hospitals Bad Debt Write Off Policy, a series of statements, all indicating the availability of financial assistance (per the letter described previously) are sent out prior to collecting on the open account. The bad-debt collections and write off policy is described below: I Self Pay Accounts Collection Process (Accounts that do not qualify for MBE outsource) A Initial letter is sent 5 days after discharge. B Statement #1 is sent 30 days later. C Statement # 2 is sent 30 days later. D Precollect Letter is sent 15 days later (by Medconn). E Account will be written off to bad debt 45 days later. II Self Pay balances after insurance (Accounts that do not qualify for MBE outsource) A Statement # 1 is sent 15 day after account goes to self pay. B Statement # 2 is sent 30 days later. C Statement # 3 is sent 21 days later. D Precollect Letter is sent 21 days later. E Account will be written off to bad debt 45 days later. III All final billed accounts with self-pay balances only will be outsourced to Medical Bureau of Economics (MBE). (refer to Self Pay Collections policy) A Statement # 1 is sent at placement with MBE. (5 days after discharge) B Statement # 2 is sent 30 days later. C Statement # 3 is sent 30 days later. D Final Statement sent 15 days later. E Account closed and returned to WWBH for bad debt process 45 days later 1 Accounts with balances of $1000 or more. a. If time permits the staff will attempt to contact the patient to attempt to determine if they may qualify for free bed funds, charity care or a payment contract. b. If the patient may qualify, and application is sent and the account is not sent to bad debt, pending a response within 14 days. If no response is received the account will be sent to bad debt in the next weekly processing cycle. C. THE ACCOUNT WILL BE PLACED ON "BAD DEBT HOLD". A NOTE IS PLACED ON THE ACCOUNT INDICATING THE APPLICATION FOR FREE BED AND CHARITY CARE. d. A reminder will be set up to review the account in 14 days. If the application is received the hold will be removed and the account will be processed according to the free Bed/charity care policy. If the patient does not qualify, the hold will be removed and the account will go to bad debt in the next weekly processing cycle. If the application is not received back in 14 days the hold will be removed and the account will go to bad debt in the next weekly processing cycle. e. If time permits the staff will attempt to process the accounts through Passport One/SSI to determine if Medicaid coverage has been established for the patient. If so, the account will be updated and Medicaid billed. updated and Medicaid billed. COMMUNITY HEALTH NEEDS ASSESSMENT SCHEDULE H, PART V, SECTION B (a) In addition to conducting its own research, Backus Hospital collaborates with local and regional health care organizations to determine the need for health-related programs and services. (b) In 2010, the Hospital commissioned a comprehensive community health needs assessment conducted by Holleran, a professional research firm. The assessment consisted of 1,109 BRFSS telephone surveys which were conducted throughout the Hospital's service region (both New London and Windham Counties). The assessment also included a detailed analysis of secondary data sources, as well as two comprehensive focus groups to gain qualitative data on identified priority health areas. The needs assessment was presented and distributed, and can be accessed at www.backushospital.org/healthsurvey. Subsequently the Hospital has developed a Community Needs Strategic Plan which identifies and outlines top priority health needs as determined by the needs assessment. Priority health areas include obesity and overweight, autism, smoking, alcohol and substance abuse, mental health, chronic lower respiratory diseases, and access to healthcare. This plan has guided Hospital's outreach efforts for the last two fiscal years. A second needs assessment was undertaken in the fourth quarter of FY 2012 to measure the Hospital's progress, and augment existing research. Based on the Holleran survey, the Hospital partnered with United Way of Southeastern Connecticut to create the New London County Food Policy Council, which is using the data to address obesity and other food-related issues, as well as Norwich Technical High School, to focus on adolescent health issues such as self-esteem, depression, and substance abuse. (c) The hospital identifies health problems in the community through indicators and measures of health risk, disease prevalence, disease management and outcomes using sources such as birth and mortality records, census data, Behavioral Risk Factor Survey data, Robert Wood Johnson County Health Rankings, and other datasets. Priority areas were ranked utilizing a methodology which determined the severity of the problem and the Hospital's ability to impact it. (d) The hospital partners with two regional Federally Qualified Health Centers ("FQHC") - United Community and Family Services, and Generations Healthcare. Managers from the hospital and FQHCs meet to determine unmet community needs to develop educational, outreach and preventative health programs to meet these needs. (e) The hospital conducts follow-up surveys with all participants in its free educational programs. The surveys assess participants' satisfaction with the program, and solicit information about other needs. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 (a) Notification about charitable care and assistance programs is available at all registration areas, on and off the main hospital campus, in waiting areas, in the patient handbook, on our website, on prominently placed signs (in English and Spanish). Additionally, Care Management Social Workers meet with patients, family, clergy and others as appropriate to discuss assistance programs and services that may be available. In addition to the complete Financial Assistance Policy and Application for Financial Assistance, here is the information included on the Hospitals website: Financial Assistance Backus Hospital provides financial assistance programs for certain qualified patients who are unable to pay all or part of their bill for inpatient, outpatient and emergency services rendered at the Hospital. If you are coping with a financial hardship, and are facing debts owed to Backus Hospital, financial assistance may be available to you. Income Verification Backus requests income information from the applicant. Verification of reported income should be included within the application package. Appropriate verification sources include: - Most recent Federal tax return and W-2 - Most recent 3 payroll checks - Copies of unemployment checks - Copies of any pension, alimony, child support or other sources of income - Copies of Social Security earnings, if any - Any other pertinent information If the applicant has no income a statement detailing the current method of support will be accepted. Proof of income or earnings is required with application or the application will not be considered. Financial Assistance Options The level of financial assistance that you may be eligible to receive will be based upon the criteria defined in the Financial Assistance Policy. The William W. Backus Hospital considers Financial Assistance awards on a case-by-case basis. Please contact us if you have questions regarding eligibility. Financially Indigent Financially Indigent is defined as an individual whose total gross annual income is less than or equal to 250% of the Federal Poverty Guidelines (FPG). Patients at or below 250% FPG are eligible for a 100% discount off of their outstanding balances. Individuals above 250% up to 400% FPG are eligible for a discount based on their total gross annual income. Medically Indigent Backus Hospital considers an individual to be Medically Indigent if their total annual gross income is above 400% FPG and their outstanding medical obligations are greater than 50% of their total annual gross income. These individuals may be eligible for a discount separate from traditional financial assistance. Please refer to the Financial Assistance Policy for details regarding eligibility and the discount schedule. MEDICALLY INDIGENT IS DEFINED BY THE IRS AS: 'Persons whom the organization has determined are unable to pay some or all of their medical bills because their medical bills exceed a certain percentage of their family or household income or assets (for example, due to catastrophic costs or conditions), even though they have income or assets that otherwise exceed the generally applicable eligibility requirements for free or discounted care under the organizations financial assistance policy.' Backus Hospital treats each application individually. If you have any questions about your specific situation, please contact our customer service representatives at 860-889-8331, ext. 2917, Monday through Friday from 7:30 am to 4 pm. Financial Assistance Letter The William W. Backus Hospital provides financial assistance for certain qualified patients who are unable to pay all or part of their bill for inpatient, outpatient and emergency services rendered at the hospital. If you are coping with a financial hardship and are facing debts owed to The William W. Backus Hospital, financial assistance such as free care or a sliding scale discount may be available to you. The financial counseling process will indicate what options exist to assist you with your outstanding balance. Financial assistance applies to Backus Hospital bills only. It does not apply to Radiologists, Pathologists, Anesthesiologists or other professional services involved in your care that are billed separately. Frequently Asked Questions 1. DOES THE HOSPITAL HAVE A FINANCIAL ASSISTANCE POLICY? The William W. Backus Hospital does have a written financial assistance policy that defines the discount structure and programs available to qualifying patients. The William W. Backus Hospital bases all financial assistance on the most current Federal Poverty Guidelines (FPG), which are based on the gross income and household size. Backus grants 100% charity care to those applicants whose gross household income is at or below 250% FPG. A sliding discount is available to those patients who have gross income up to 400% FPG. Currently, the Federal government defines 100% of poverty as an individual earning a gross income of $10,890 per year. The William W. Backus Hospital Financial Assistance Policy grants 100% Charity Care to a family of one earning up to $21,780 per year, or 250% FPG. Income thresholds increase relative to household size. A discount is available for applicants earning up to 400% FPG. 2. WHAT SERVICES DOES THE FINANCIAL ASSISTANCE POLICY COVER? The William W. Backus Hospitals Financial Assistance Policy covers services rendered at the William W. Backus Hospital, including inpatient, emergency, and outpatient procedures. Financial assistance may not be granted for some procedures, such as elective procedures or some special situations, such as that of an individual who is eligible for insurance but has refused to apply or funds are available through another source for payment (i.e. settlements, State Funded programs). Financial assistance applies to Backus Hospital bills only. It does not apply to Radiologists, Pathologists, Anesthesiologists or other professional services involved in your care that are billed separately. 3. DOES THE HOSPITAL PROVIDE PERSONNEL TO HELP WITH APPLICATIONS AND TO ANSWER QUESTIONS? The William W. Backus Hospital employs Financial Counselors to help patients apply for Financial Assistance, Medicaid, and other State health programs. The Hospital also has resources to help with applications for State Nutritional Assistance Programs (SNAP) and pharmacy assistance programs. Financial Counselors can help to determine appropriate referrals to these resources. The William W. Backus Hospital provides language translation via Cyracom and MARTTI Language Lines. 4. DOES THE HOSPITAL COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THE COMMUNITY? The William W. Backus Hospital believes it is important to communicate the availability of financial assistance to the communities it serves. Therefore, a notice of the availability of financial assistance is included with the paper bill sent to the patients home, is posted in all main registration areas, is available on the Hospitals website, and upon request of Hospital staff or representatives. 5. DOES THE HOSPITAL EVER DENY CARE BASED ON INABILITY TO PAY? The William W. Backus Hospital will never delay or deny emergency care or necessary services due to an inability to pay. 6. DOES THE HOSPITAL HAVE A PROGRAM FOR PATIENTS WHO DONT QUALIFY FOR TRADITIONAL FINANCIAL ASSISTANCE BUT INCUR CATASTROPHIC MEDICAL DEBTS? The Hospital has a written policy that covers Catastrophic Financial Assistance for the Medically Indigent. The policy is included in the financial assistance policy, is available on the website, and upon request. (b) The hospital provides two Access to Care Specialists (both first and second shift) in its Emergency Departments and two health centers, who provides free insurance eligibility screenings to uninsured clients seeking care. The Specialists work with uninsured patients to connect them with a primary medical home, so they can receive preventative care, rather than using costly emergency services for illnesses that are not medical emergencies. Significant one-on-one follow-up is provided through phone calls or letters to make appointments to screen patients and help them fill out applications for HUSKY or Charter Oak applications. uninsured patients to connect them with a primary medical home, so they can receive preventative care, rather than using costly emergency services for illnesses that are not medical emergencies. Significant one-on-one follow-up is provided through phone calls or letters to make appointments to screen patients and help them fill out applications for HUSKY or Charter Oak applications. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 The William W. Backus Hospital is located in Norwich, 45 minutes southeast of Hartford. In the past decade, the region has undergone major economic changes, due to the operation of two Native American-owned casinos both among the largest casinos in the world. These gambling and entertainment venues bring bringing an average of 40,000 visitors into the region each day. The casinos are the largest employers, and are experiencing layoffs and cutbacks as the economy continues to decline. The hospitals primary service area has an estimated population of about 118,000. The secondary service area consists of larger communities, such as New London and Groton, and smaller lower-density rural communities. The total population of the secondary service area is about 123,000. The service areas contain municipalities in New London and Windham Counties. The fastest growing segment of the regions population is the elderly. For the last decennial census, the regions elderly population grew at 10 times the rate of growth for the total population. The regions lack of affordable housing began to emerge as a critical issue even before the economic downturn. Homelessness is a growing concern, as the number of mortgage foreclosures grow. Further, the 2012 Robert Wood Johnson County Health Rankings reported that in New London and Windham Counties between 12-15% of children are living in poverty, and 31-32% are living in single parent households. Unemployment in the regional labor market (per the 2012 Robert Wood Johnson County Health Ranking) stands at 8.7-10.3% in New London and Windham Counties, hovering around state average of 9.1%, and well above the national average of 5.4%. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 a) The hospital is governed by a volunteer community Board of Directors/Trustees. These individuals represent an array of professions and backgrounds. B) THE HOSPITAL HAS 110 CORPORATORS - VOLUNTEER MEMEBERS CHOSEN FROM ALL THE COMMUNITIES IN OUR PRIMARY AND SECONDARY service areas. In addition to their official capacity as nominators of Board members, the Corporators serve as the hospitals eyes and ears throughout its service area. C) THE HOSPITAL OWNS AND OPERATES A MOBILE HEALTH RESOURCE CENTER - a 40-foot van that travels to various locations in eastern Connecticut offering health education, counseling, and screenings. The van makes regularly scheduled stops at senior citizens centers, soup kitchens, elderly housing complexes and homeless shelters. Not-for-profit groups are encouraged to request the van and its services at their functions or offices. d) The hospital provides individuals who do not identify as having a primary medical home with a follow up visit post discharge from to become link these individuals with a primary care physician in the community. This is facilitated through the My Health Direct program, a web-based tool that allows hospital staff to access blocked appointments for physicians in the community. From 10/1/11 to 9/30/12 the Hospital linked 582 individuals with primary care. e) The hospital provides free community prostate screenings, diabetes education, backpack safety, HIV education/testing, blood pressure tests, skin cancer screenings, nutrition education and many others services. f) The hospital provides a comprehensive medical library, which is open to all staff. The library has subscriptions to hundreds of major scientific and clinical journals, as well as an on-staff librarian to help with specific research requests. g) The hospital provides free website access to complete and current medical information to answer clinical questions, through UpToDate.com, a peer-reviewed online medical reference. UpToDate covers more than 7,400 topics in 13 medical specialties and includes more than 76,000 pages of text, graphics, links to Medline abstracts, more than 254,000 references, and a drug database. h) The hospital provides free medication cards to help patients keep track of their current medications, and its pharmacists offer free regular medication reviews to check for possible interactions and expired medications. i) The hospital offers free wireless internet (wi-fi) use throughout the campus, and provides free computer use to visitors. j) The hospital publishes a monthly consumer health magazine. The publication contains information about health issues and trends, a calendar of free healthcare education and screenings, and contact information for healthcare providers. 44,000 copies are distributed monthly. publication contains information about health issues and trends, a calendar of free healthcare education and screenings, and contact information for healthcare providers. 44,000 copies are distributed monthly. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 THE HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE CONNECTICUT OFFICE OF THE HEALTH ADVOCATE ("OHA"). true HOSPICE OF SE CONNECTICUT 222667260 501(C)(3) 8500 SPONSORSHIP AMERICAN HEART ASSOC 135613797 501(C)(3) 7500 SPONSORSHIP UNITED COMMUNITY & FAMILY SERVICES 060653142 501(C)(3) 200000 WOMEN'S HEALTH CHAMBER OF COMMERCE 060475490 501(C)(6) 6500 SPONSORSHIP THREE RIVERS COLLEGE 237303151 501(C)(3) 16000 SPONSORSHIP BROADWAY KIDS 5100 SPONSORSHIP UNITED COMMUNITY & FAMILY SERVICES 060653142 501(C)(3) 410000 APPRAISAL BUILDING PRIMARY CARE 5 2 SCHOLARSHIPS 5 12500 Procedures for Monitoring the use of grant funds in the U.S. SCHEDULE I, PART I, LINE 2 DONATIONS MADE FOR LOCAL EVENTS, SUCH AS SPONSORSHIPS, ARE TYPICALLY ATTENDED BY HOSPITAL EMPLOYEES. FIVE SCHOLARSHIPS IN THE AMOUNT OF $2,500 EACH ARE AWARDED TO STUDENTS WHO WILL ATTEND SCHOOL EITHER FOR NURSING OR IN THE MEDICAL FIELD. THE APPLICANTS ARE REVIEWED BY THE SCHOLARSHIP COMMITTEE OF THE AUXILIARY AND WINNERS ARE CHOSEN BASED ON ACADEMICS AS WELL AS COMMUNITY SERVICE. X false true X X X X X false true false false false false false true false DAVID WHITEHEAD 740686 0 0 0 21535 0 20580 0 23272 0 806073 0 DANIEL E LOHR 491649 0 23079 20580 16882 552190 PETER SHEA 491146 0 1651 13230 23503 529530 SERGIO CASILLAS MD 378355 118000 0 13230 1057 510642 ROBERT SIDMAN MD 296400 96525 16500 13230 23272 445927 MARK TOUSIGNANT MD 265264 70000 0 13230 23503 371997 JUAN ESCALON MD 341282 0 4889 13230 23503 382904 THOMAS P PIPICELLI 608153 0 3169625 20580 16882 3815240 2782763 WILLIAM HORGAN MD 252291 58890 11400 9632 23503 355716 GROSS-UP PAYMENTS SCHEDULE J, PART I, LINE 1A THE FORMER PRESIDENT RECEIVED GROSS-UP PAYMENTS ON SELECTED EXPENSES. THEY WERE PROPERLY INCLUDED IN HIS W-2 WAGES. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B DAVID WHITEHEAD, DANIEL E LOHR AND PETER SHEA PARTICIPATE IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, HOWEVER THERE WERE NO ACCRUALS OR CONTRIBUTIONS THAT WERE MADE TO THE PLAN DURING THE REPORTING PERIOD. NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 BASE COMPENSATION FOR EXECUTIVES IS APPROVED BASED ON THE CRITERIA LISTED IN PART I, LINE 3, HOWEVER A PORTION OF THAT IS HELD BACK AND SUBSEQUENTLY DISTRIBUTED BASED ON EVALUATION OF THE INDIVIDUALS PERFORMANCE AND ACCOMPLISHMENT OF THE GOALS SET AT THE BEGINNING OF THE YEAR BY AN INDEPENDENT COMPENSATION COMMITTEE. PHYSICIAN BONUSES ARE BASED ON MEETING PREESTABLISHED GOALS. RETIREMENT AND OTHER DEFERRED COMPENSATION EXPLANATION SCHEDULE J, PART II, COLUMN C COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS GENERALLY REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS PAID TO THE INDIVIDUAL. AS A RESULT OF THE REPORTING REQUIREMENT, AN ORGANIZATION COULD BE REQUIRED TO REPORT THE SAME COMPENSATION ON FORM 990 IN TWO DIFFERENT YEARS. ADDITIONAL INFORMATION SCHEDULE J, PART II, LINE 10 THOMAS PIPICELLI'S COMPENSATION INCLUDES AMOUNTS ESTABLISHED AND PAID PURSUANT TO AN EMPLOYMENT AGREEMENT DATED DECEMBER 15, 2008, UNDER WHICH EMPLOYEE'S EMPLOYMENT WOULD TERMINATE ON DECEMBER 31, 2011. THE AMOUNT OF COMPENSATION RECOGNIZED THE EMPLOYEE'S DECADES-LONG SERVICE TO THE ORGANIZATION AS PRESIDENT AND CEO, AND HIS SERVICES IN TRANSITIONING TO THE ORGANIZATION'S CURRENT MANAGEMENT TEAM. STATE OF CT HEALTH & EDUCATIONAL FACILITIES 060806186 20774LSV3 2005-08-10 28992719 SEE SCHEDULE K, PART V false false false STATE OF CT HEALTH & EDUCATIONAL FACILITIES 060806186 20774UC86 2008-07-02 30168922 SEE SCHEDULE K, PART V false false false 3535000 0 28992719 755086 0 16750062 369723 583673 0 10514252 19923 0 2008 false true true true 2850000 0 30168922 0 0 30100000 68922 0 0 0 0 0 2008 true false true true false false false false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true false false false 0 0 false false true true true UBS AG 29.9 false false false 0 false false SEE SCHEDULE L PART V BUSINESS TRANSACTION INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV (B) DAVID WHITEHEAD, DANIEL E LOHR, AND PETER SHEA ARE OFFICERS, TRUSTEES, DIRECTORS AND/OR KEY EMPLOYEES OF THE WILLIAM W. BACKUS HOSPITAL(WWBH) AND CONNCARE, INC.(CI) (C)/(D)$3,375,000 REIMBURSEMENTS PAID BY CI TO WWBH $ 96,142 PERFORMANCE OF SERVICES BY WWHBH FOR CI $ 367,717 LEASED PROPERTY (E) NO (B) DAVID WHITEHEAD AND DANIEL LOHR ARE OFFICERS OF THE WILLIAM W BACKUS HOSPITAL AND WWB, INC. (C)/(D)$8,017,000 REIMBURSEMENTS PAID BY WWB TO WWBH (E) NO (B) DAVID WHITEHEAD AND DANIEL LOHR ARE OFFICERS OF THE WILLIAM W BACKUS HOSPITAL AND OMNI HOME HEALTH. (C)/(D)$120,000 ACCOUNTING AND MANAGEMENT FEES PAID BY OMNI TO WWBH $ 5,263 PERFORMANCE OF SERVICES BY WWBH FOR OMNI ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 & PART III, LINE 1 THE WILLIAM W. BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH QUALITY HEALTH CARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT. THE HOSPITAL IS COMMITTED TO BEING RESPONSIVE AND ACCOUNTABLE TO THOSE FOR WHOSE BENEFIT IT EXISTS, AND TO IMPROVING THE HEALTH OF ITS COMMUNITIES. INDEPENDENT VOTING MEMBERS FORM 990, PART VI, SECTION A, LINE 1B THE TAXPAYER IS REPORTING SEVERAL MEMBERS OF THE BOARD OF DIRECTORS AS NOT BEING INDEPENDENT, EVEN THOUGH THEY DO NOT MEET ANY OF THE DEFINITIONS FROM THE 990 INSTRUCTIONS FOR DETERMINING INDEPENDENT DIRECTORS. HOWEVER, THEY DO HAVE PRIVILEGES AT THE HOSPITAL WHICH IS WHY THE HOSPITAL CONSIDERS THEM NOT INDEPENDENT. BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 DAVID WHITEHEAD AND DANIEL E LOHR HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVE AS AN OFFICER OR DIRECTOR FOR CONNCARE, INC., WWB CORPORATION, AND BACKUS HOME HEALTH WHICH ARE RELATED FOR PROFIT COMPANIES. MEMBERS FORM 990, PART VI, SECTION A, LINE 6 BACKUS CORPORATION, A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF THE WILLIAM W. BACKUS HOSPITAL. MEMBERS WHO MAY ELECT THE GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A BACKUS CORPORATION, BEING THE SOLE MEMBER OF THE WILLIAM W. BACKUS HOSPITAL, HAS THE RIGHT TO ELECT ALL THE BOARD OF TRUSTEES. DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PART VI, SECTION A, LINE 7B THE ADMINISTRATIVE POWERS OF THE HOSPITAL SHALL BE VESTED IN THE BOARD OF TRUSTEES WHO SHALL HAVE CHARGE, CONTROL AND MANAGEMENT OF THE PROPERTY, AFFAIRS AND FUNDS OF THE HOSPITAL, SHALL BE RESPONSIBLE FOR THE DELIVERY AND MAINTENANCE OF QUALITY PATIENT CARE, THE PROMOTION OF QUALITY IMPROVEMENT, OVERSIGHT OF RISK MANAGEMENT ACTIVITIES, AND WHICH SHALL HAVE THE POWER AND AUTHORITY TO DO AND PERFOM ALL ACTS AND FUNCTIONS NOT INCONSISTENT WITH THE BYLAWS. THE BOARD OF TRUSTEES SHALL MAKE ALL POLICIES AND RULES THAT GOVERN THE HOSPITAL AND SHALL PROVIDE FOR THE ABILITY OF HOSPITAL LEADERSHIP TO ESTABLISH AND IMPLEMENT POLICIES AND TO PROVIDE NECESSARY RESOURCES. 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY THE ACCOUNTING STAFF AND THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN REVIEWED BY THE CFO AND ANY QUESTIONS OR CONCERNS THE CFO MAY HAVE ARE ADDRESSED. THE FINANCE COMMITTEE OF THE BOARD WILL THEN REVIEW THE 990 AND ANY QUESTIONS OR CONCERNS THE FINANCE COMMITTEE HAVE ARE ADDRESSED. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C ALL TRUSTEES, OFFICERS, AND KEY EMPLOYEES OF THE HOSPITAL SHALL COMPLETE AND SIGN A DISCLOSURE STATEMENT. THE STATEMENT WILL INCLUDE AN ITEMIZATION AND DESCRIPTION OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND ALL MATERIAL FACTS RELATED THERETO FOR SUCH TRUSTEE, OFFICER, OR KEY EMPLOYEE BY VIRTUE OF HIS OR HER ACTIVITIES OR THE ACTIVITIES OF RELATED PERSONS. TRUSTEES, OFFICERS, AND KEY EMPLOYEES ARE URGED TO BE INCLUSIVE IN THIS DISCLOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST IS ESSENTIAL TO ENSURING DISCUSSION OF CONFLICT. DISCLOSURE STATEMENTS SHALL BE RETURNED TO THE CORPORATE COMPLIANCE OFFICER. ALL DISCLOSURES MADE WILL BE REVIEWED BY THE COMPLIANCE OFFICER, UNDER THE DIRECTION OF THE CHAIR AND THE PRESIDENT, WHO SHALL EXERCISE GOOD FAITH JUDGEMENT AS TO WHETHER A CONFLICT EXISTS. THE CHAIR AND THE PRESIDENT SHALL BE RESPONSIBLE FOR MONITORING TRANSACTIONS OR ARRANGMENTS IN WHICH A TRUSTEE, OFFICER, OR KEY EMPLOYEE MAY HAVE A CONFLICT OF INTEREST AND FOR ASSURING THAT THE TRUSTEE, OFFICER, OR KEY EMPLOYEE SERVES THE HOSPITAL'S BEST INTERESTS. THE COMPLIANCE OFFICER, THE CHAIR AND/OR PRESIDENT MAY CONSULT WITH ANY TRUSTEE, OFFICER, OR KEY EMPLOYEE AND OBTAIN INFORMATION NECESSARY FOR AN ORDINARILY PRUDENT PERSON TO MAKE A JUDGMENT AS TO WHETHER A CONFLICT EXISTS AND EACH TRUSTEE, OFFICER, AND KEY EMPLOYEE SHALL COOPERATE WITH SUCH REQUESTS. THE COMPLIANCE OFFICER, THE CHAIR, AND/OR THE PRESIDENT SHALL PROVIDE GUIDANCE TO THE TRUSTEE, OFFICER, OR KEY EMPLOYEE AND TO THE BOARD OF TRUSTEES AS TO THE APPRORIATE COURSE OF ACTION. WHEN DEEMED PRUDENT BY THE CHAIR OR THE PRESIDENT, THE CHAIR AND THE PRESIDENT SHALL SEEK THE ADVICE AND APPROVAL OF THE FULL BOARD OF TRUSTEES OR GOVERNANCE COMMITTEE IN DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS AND THAT THE TRUSTEE, OFFICER, OR KEY EMPLOYEE SERVES THE HOSPITAL'S BEST INTERESTS. IF, AFTER COMPLETING AND SIGNING THE ANNUAL DISCLOSURE STATEMENT, AN ACTUAL OR POTENTIAL CONFLICT ARISES, THE TRUSTEE, OFFICER, OR KEY EMPLOYEE WITH THE CONFLICT SHALL PROMPTLY NOTIFY THE COMPLIANCE OFFICER IN WRITING. TRUSTEES, OFFICERS, AND KEY EMPLOYEES WHO HAVE DECLARED OR HAVE BEEN DEEMED TO HAVE A CONFLICT OF INTEREST MUST REFRAIN FROM CONSIDERATION OF PROPOSED TRANSACTIONS OR ARRANGMENTS, UNLESS FOR SPECIAL REASON THE BOARD OF TRUSTEES REQUESTS INFORMATION OR INTERPRETATIONS. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B A PERFORMANCE REVIEW COMMITTEE CONSISTING OF INDEPENDENT BOARD MEMBERS REVIEWS THE PERFORMANCE OF THE SENIOR MANAGEMENT TEAM. COMPENSATION IS BASED ON THE RESULTS OF THESE REVIEWS. THE COMMITTEE ALSO TAKES INTO CONSIDERATION INFORMATION FROM COMPENSATION SURVEYS. JOINT VENTURES FORM 990, PART VI, SECTION B, LINE 16B ALL NEW VENTURES ARE REVIEWED BY OUTSIDE COUNSEL AND PRESENTED TO THE BOARD FOR REVIEW AND APPROVAL. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PLEASE CONTACT DANIEL E LOHR AT 326 WASHINGTON STREET, NORWICH, CT, 06360, ABOUT INSPECTING THE ORGANIZATION'S DOCUMENTS. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 K-1 GAIN 892 TRANSFER TO AFFILIATE (1,248,123) INCREASE IN ASSETS HELD IN TRUST 306,792 CHANGE IN PENSION FUNDING (4,361,697) UNREALIZED GAIN 10,067,106 INVESTMENT EXPENSES (365,321) ------------ TOTAL $ 4,399,649 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID WHITEHEAD TITLE:TRUSTEE/PRESIDENT/CEO HOURS:7 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT RAMSDELL TITLE:TRUSTEE/TREASURER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH FATONE TITLE:TRUSTEE/SECRETARY HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANTHONY JOYCE TITLE:TRUSTEE/VICE CHAIRMAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN F BILDA TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELIZABETH CONWAY TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BERT A COPPOTELLI, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PETER MANERI TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEBORAH MONAHAN TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LYNNE QUINTAL-HILL TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK TRAMONTOZZI, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHEN T BRIGGS, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PAUL MAXFIELD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONNA ROMITO, DO TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL E LOHR TITLE:SENIOR VP/CFO HOURS:9 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS P PIPICELLI TITLE:FORMER PRESIDENT HOURS:10 BACKUS HEALTH CARE INC 326 WASHINGTON ST NORWICH CT 06360 222481794 SUPPORT CT 501(C)(3) 11A BACKUS CORP true BACKUS CORPORATION 326 WASHINGTON ST NORWICH CT 06360 222757608 SUPPORT CT 501(C)(3) 11B NA false OMNI HOME HEALTH NORWICH CT 06360 NORWICH CT 06360 061458837 HOME HEALTH CARE CT NA WWB CORPORATION 326 WASHINGTON ST NORWICH CT 06360 061094836 HOLDING COMPANY CT NA C-CORP CONNCARE INC 326 WASHINGTON ST NORWICH CT 06360 061387598 HEALTH CARE SRVCS CT NA C CORP BACKUS MEDICAL CENTER CONDO ASSOC INC 330 WASHINGTON ST NORWICH CT 06360 061542647 CONDO ASSOCIATION CT NA C-CORP 0 0 0.65000 false true false false false false false false true false true false false true false true false false CONNCARE INC I 367717 COST OMNI HOME HEALTH K 125263 COST CONNCARE INC K 96142 COST CONNCARE INC P 3375000 COST WWB INC P 8017000 COST