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BRISTOL HOSPITAL INCORPORATED: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
BRISTOL HOSPITAL INCORPORATED (EIN 06-0646559)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-13
IRS object ID
201312259349302321
Schema version
2011v1.5
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)
Timestamp2013-08-13T13:36:56-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN061533253EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SASLOW LUFKIN & BUGGY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1TEN TOWER LANEAddressLine1
CityAVONCity
StateCTState
ZIP Code06001ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN060646559EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1BRISTOL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBRISNameControl
Phone8605853000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1BREWSTER RDAddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06011ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGEORGE W EIGHMYName
TitleVP & CFOTitle
Phone8605853000Phone
Date Signed2013-08-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBETH THURZName
PTINP00346435PTIN
Phone8606789200Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKURT BARWISNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1BREWSTER RDAddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06011ZIPCode
FieldValueIRS element (for citing)
Gross Receipts148061522GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BRISTOLHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1920YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE QUALITY HEALTHCARE SERVICES TO THE COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees1399TotalNbrEmployees
Total Nbr Volunteers300TotalNbrVolunteers
Total Gross UBI981636TotalGrossUBI
Net Unrelated Business Txbl Income-576333NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1812490ContributionsGrantsPriorYear
Contributions Grants Current Year1338407ContributionsGrantsCurrentYear
Program Service Revenue Prior Year126737955ProgramServiceRevenuePriorYear
Program Service Revenue CY131079119ProgramServiceRevenueCY
Investment Income Prior Year516585InvestmentIncomePriorYear
Investment Income Current Year477499InvestmentIncomeCurrentYear
Other Revenue Prior Year5445575OtherRevenuePriorYear
Other Revenue Current Year3914160OtherRevenueCurrentYear
Total Revenue Prior Year134512605TotalRevenuePriorYear
Total Revenue Current Year136809185TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year64766097SalariesEtcPriorYear
Salaries Etc Current Year69542815SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year67128430OtherExpensePriorYear
Other Expenses Current Year64943488OtherExpensesCurrentYear
Total Expenses Prior Year131894527TotalExpensesPriorYear
Total Expenses Current Year134486303TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2618078RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2322882RevenuesLessExpensesCY
Total Assets BOY103125741TotalAssetsBOY
Total Assets EOY112654038TotalAssetsEOY
Total Liabilities BOY95110053TotalLiabilitiesBOY
Total Liabilities EOY102022703TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8015688NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10631335NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionBRISTOL HOSPITAL IS COMMITTED TO PROVIDING THE BEST PATIENT EXPERIENCE IN THE REGION. OUR 134-BED, FULL-SERVICE HEALTH CARE INSTITUTION PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT CARE FOR THE GREATER BRISTOL, CONNECTICUT AREA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense111143719Expense
Revenue133059206Revenue
DescriptionAS A SHORT-TERM ACUTE CARE COMMUNITY HOSPITAL, BRISTOL HOSPITAL PROVIDES A BROAD SPECTRUM OF HEALTHCARE SERVICES TO ANY INDIVIDUAL REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY. THE HOSPITAL PROVIDED $3,781,958 IN CHARITY CARE DURING THE OPERATING YEAR. THE HOSPITAL ALSO PROVIDES EDUCATION AND WELLNESS PROGRAMS TO THE COMMUNITY. THESE ACTIVITIES TYPICALLY REACH ABOUT 1,600 INDIVIDUALS PER QUARTER. THESE ACTIVITIES INCLUDE: WELLNESS CENTER - SPECIAL CENTER FOR EDUCATIONAL OUTREACH PROGRAMMING SERVING HUNDREDS OF INDIVIDUALS PER MONTH. - COMMUNITY HEALTH SCREENINGS - ONGOING FREE AND REDUCED PRICE SCREENINGS FOR MAMMOGRAMS, BLOOD PRESSURE, CHOLESTEROL, PROSTATE CANCER, SKIN CANCER AND A FLU CLINIC PROVIDING FREE FLU SHOTS IN THE FALL. - SPEAKERS BUREAU - A COMMUNITY SERVICE WHERE THE HOSPITAL PROVIDES SPEAKERS ON A VARIETY OF TOPICS TO SERVE THE COMMUNITY'S EDUCATIONAL NEEDS. - PERIODIC COMMUNITY SERVICE PROJECTS - THE HOSPITAL HAS SPONSORED TWO MAJOR OUTREACH EFFORTS, ONE TO PROMOTE EARLY DETECTION OF BREAST CANCER AND ONE TARGETED TO PREVENT COLON CANCER. BOTH PROGRAMS HAVE INCREASED THE COMMUNITY'S COMPLIANCE WITH THE RECOMMENDED CANCER SCREENINGS AND HAVE BEEN RECOGNIZED WITH STATE, REGIONAL AND NATIONAL AWARDS.Description
Total Program Service Expense111143719TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest1ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109691NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1399NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1GEORGE EIGHMYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8605853000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1BREWSTER ROADAddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06011ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (27 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
KENNETH BENOIT MD
DIRECTOR2.00X000
MARK BLUM
SECRETARY/TREASURER2.00X000X
BALA SHANMUGAM MD
DIRECTOR2.00X73132600774900
JOHN J LEONE JR
VICE CHAIRMAN2.00X000X
GLENN HEISER
DIRECTOR2.00X000
KURT BARWIS
PRESIDENT & CEO60.00X8073280121318X
JOHN LODOVICO JR
DIRECTOR2.00X000
MARIE O'BRIEN
CHAIRMAN2.00X000X
KENNETH RHEE MD
DIRECTOR40.00X8306800
RICK ABBOTT
DIRECTOR2.00X000
DOUGLAS DEVNEW
DIRECTOR2.00X000
KAREN GUADAGNINI MD
DIRECTOR2.00X162691064103280
MARY ANN CORDEAU PHD RN
DIRECTOR2.00X000
FAWAD KAZI MD
DIRECTOR2.00X000
THOMAS MONAHAN
DIRECTOR2.00X000
ELLEN SOLEK
DIRECTOR2.00X000
VALERIE VITALE MD
DIRECTOR2.00X000
GEORGE EIGHMY
VICE PRESIDENT OF FINANCE / CFO40.006813802543X
LEONARD BANCO MD
CHIEF MEDICAL OFFICER40.00348660025975X
JEANINE RECKDENWALD
VP, HUMAN RESOURCES AND SU40.00188090022996X
DAVE RACKLIFF
AVP INFORMATION TECHNOLOGY40.00160838024658X
SHEILA KEMPF PHD
SENIOR VP/PATIENT CARE SERVS/CHIEF NURSING OFFICER40.00251331028149X
KATHLEEN BUCKLEY
VP STRATEGIC PLANNING AND BUSINESS40.0019932706440X
JOSEPH HART
CONTROLLER40.00177641016882X
PAUL SMITH
DIRECTOR OF ENGINEERING AND FACILITIES40.0015600000X
RUSSELL TUVERSON MD
OCCUPATIONAL HEALTH PHYSICIAN40.0015522607775X
BARBARA NAWROCKI
DIRECTOR OF CLINICAL OPERATIONS40.0015300000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2772229TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs366487TotalReportableCompFrmRltdOrgs
Total Other Compensation264916TotalOtherCompensation
Number Individuals GT100 K58NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MAYO COLLABORATIVE SERVICES INC
PO BOX 9146MINNEAPOLISMN55480LAB SERVICES911521
CROSS COUNTRY STAFFING
PO BOX 404674ATLANTAGA30384TEMP LABOR SERVICES637806
TOTAL LAUNDRY COLLABORATIVE LLC
114 WOODLAND STREETHARTFORDCT06105LAUNDRY SERVICES278919
KFORCE INC
PO BOX 277997ATLANTAGA30384TEMP LABOR SERVICES203243
ALLIANCE HEALTHCARE SERVICES
PO BOX 96485CHICAGOIL603966485PET/CT SCANS193250
FieldValueIRS element (for citing)
Number Of Contractors GT100 K19NumberOfContractorsGT100K
Related Organizations219460RelatedOrganizations
Government Grants1118947GovernmentGrants
Noncash Contributions21556NoncashContributions
Total Contributions1338407TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENU900099130360493129429200931293
OCCUPATIONAL HEALTH RE621990718626718626
FieldValueIRS element (for citing)
Total Program Service Revenue131079119TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column355214TotalRevenueColumn
Exclusion$355,214ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real337948Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real337948Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column337948TotalRevenueColumn
Exclusion$337,948ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities11374622Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities11252337Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities122285Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column122285TotalRevenueColumn
Exclusion$122,285ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
MISC. PROGRAM AND HEAL62199021860682186068
JOINT VENTURES90009977565572531250343
CAFETERIA722210406124$406,124

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column208365TotalRevenueColumn
Exclusion$208,365ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3576212TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column136809185TotalRevenueColumn
Related Or Exempt Function Income133059206RelatedOrExemptFunctionIncome
Unrelated Business Revenue981636UnrelatedBusinessRevenue
Exclusion$1,429,936ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2377048Total
Management And General2377048ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total52251262Total
Program Services44793228ProgramServices
Management And General7458034ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3885661Total
Program Services3108529ProgramServices
Management And General777132ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7028996Total
Program Services5623197ProgramServices
Management And General1405799ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3999848Total
Program Services3199878ProgramServices
Management And General799970ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total599068Total
Program Services26500ProgramServices
Management And General572568ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total145261Total
Management And General145261ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total73891Total
Management And General73891ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1681180Total
Program Services208263ProgramServices
Management And General1472917ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1046774Total
Program Services126646ProgramServices
Management And General920128ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total12783150Total
Program Services12309762ProgramServices
Management And General473388ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2487846Total
Program Services212330ProgramServices
Management And General2275516ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2546189Total
Program Services2164261ProgramServices
Management And General381928ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total241525Total
Program Services190230ProgramServices
Management And General51295ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1681654Total
Program Services1681654ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total6287299Total
Program Services5658569ProgramServices
Management And General628730ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1410661Total
Program Services1128529ProgramServices
Management And General282132ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SERVICES FEES122898461221558574261
DRUGS73507147350714
BAD DEBT64702926470292
REPAIR & MAINTENENCE17920841111496680588

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total6056054Total
Program Services3564056ProgramServices
Management And General2491998ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total134486303Total
Program Services111143719ProgramServices
Management And General23342584ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4272881BOY
EOY9376449EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY96343BOY
EOY96452EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY20427829BOY
EOY16562143EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1696559BOY
EOY1592222EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2119071BOY
EOY2242612EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis143218358LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec105453829LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY40030258BOY
EOY37764529EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY11618379BOY
EOY13893883EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY12513653BOY
EOY13377950EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY5034092BOY
EOY7642154EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5316676BOY
EOY10105644EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY103125741BOY
EOY112654038EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY29472454BOY
EOY29017801EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1186812BOY
EOY630235EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY24658242BOY
EOY24261420EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY305407BOY
EOY297961EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2351228BOY
EOY1957753EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY37135910BOY
EOY45857533EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY95110053BOY
EOY102022703EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY427122BOY
EOY-376115EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1021495BOY
EOY4079847EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY6567071BOY
EOY6927603EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8015688BOY
EOY10631335EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY103125741BOY
EOY112654038EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2322882ReconcilationRevenueExpenses
Reconcilation Other Changes292765ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$884DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$73,007OtherActivitiesAmount
Total Lobbying Expenditures IIB73891TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE HOSPITAL IS A MEMBER OF THE CONNECTICUT HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. $19,007 REPRESENTS THE PORTION OF THE DUES PAID TO THESE ASSOCIATIONS WHICH WERE USED FOR LOBBYING PURPOSES. THE HOSPITAL ENGAGED CAMILLIERE, CLOUD & KENNEDY, A CONNECTICUT LOBBYING AND BUSINESS DEVELOPMENT FIRM, FOR CONSULTING SERVICES IN THE AMOUNT OF $54,000.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance12736479BeginningOfYearBalance
Contributions2000000Contributions
Investment Earnings Or Losses4558973InvestmentEarningsOrLosses
Other Expenditures1625979OtherExpenditures
End Of Year Balance17669473EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance12881077BeginningOfYearBalance
Investment Earnings Or Losses40613InvestmentEarningsOrLosses
Other Expenditures185211OtherExpenditures
End Of Year Balance12736479EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance12016137BeginningOfYearBalance
Investment Earnings Or Losses1587194InvestmentEarningsOrLosses
Other Expenditures722254OtherExpenditures
End Of Year Balance12881077EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance13256619BeginningOfYearBalance
Contributions570728Contributions
Investment Earnings Or Losses-523731InvestmentEarningsOrLosses
Other Expenditures1287479OtherExpenditures
End Of Year Balance12016137EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.37700BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.39210PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.23090TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1506976OtherCostOrOtherBasis
Book Value1506976BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis57966190OtherCostOrOtherBasis
Depreciation38330377Depreciation
Book Value19635813BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1006331OtherCostOrOtherBasis
Depreciation696644Depreciation
Book Value309687BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis78595185OtherCostOrOtherBasis
Depreciation64298581Depreciation
Book Value14296604BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4143676OtherCostOrOtherBasis
Depreciation2128227Depreciation
Book Value2015449BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings37764529TotalOfBookValueLandBuildings

Other Securities OtherSecurities (5 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
FUNDS HELD FOR MALPRACTICE SELF-INSURANCE6914759F
ASSETS HELD IN TRUST BY OTHERS3103647F
FUNDS HELD UNDER BOND INDENTURE2506470F
DONOR RESTRICTED INVESTMENTS394142F
DEBT SERVICE FUND458932C
FieldValueIRS element (for citing)
Total Of Book Value Securities13377950TotalOfBookValueSecurities

Investments Program Related InvestmentsProgramRelated (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
INVESTMENTS IN JOINT VENTURES933589C
INTEREST IN NET ASSETS OF FOUNDATION6708565F
FieldValueIRS element (for citing)
Total Of Book Value Program Related7642154TotalOfBookValueProgramRelated

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
OTHER RECEIVABLES4999472
DUE FROM AFFILIATES3142097
ESTIMATED SETTLEMENTS WITH THIRD-PARTY PAYERS1964075
FieldValueIRS element (for citing)
Total Book Value Other Assets10105644TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
ACCRUED POSTRETIREMENT BENEFIT LIABILITY$7,151,257
LINE OF CREDIT$3,375,000
ASSET RETIREMENT OBLIGATIONS$2,116,281
ACCRUED PENSION LIABILITY$30,446,134
OTHER LIABILITIES$2,768,861
FieldValueIRS element (for citing)
Total Of Amounts45857533TotalOfAmounts
Total Revenue136809185TotalRevenue
Total Expenses134486303TotalExpenses
Excess Or Deficit For Year2322882ExcessOrDeficitForYear
Net Unrealized GL On Investments2626853NetUnrealizedGLOnInvestments
Other-$2,334,088OtherAmount
Total Adjustments292765TotalAdjustments
Excess Or Deficit Per FS2615647ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt136787629TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal136787629RevenueSubtotal
Other Revenues Not Included21556OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt21556RevenueNotRptdOnFinStmt
Total Revenue Per Form990136809185TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt134486303TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal134486303ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990134486303TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE HOSPITAL'S ENDOWMENT CONSISTS OF MULTIPLE FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES, SUCH AS CAPITAL EXPENDITURES, OPERATING EXPENSES, AND OTHER SPECIFIED DONOR AND BOARD RESTRICTED USES.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FASB ASC 740, "INCOME TAXES" WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. THE HOSPITAL MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS SEPTEMBER 30, 2012 AND 2011. IT IS THE HOSPITAL'S POLICY TO RECORD PENALTIES AND INTEREST ASSOCIATED WITH UNCERTAIN TAX PROVISIONS AS A COMPONENT OF OPERATING EXPENSES. AS OF SEPTEMBER 30, 2012 AND 2011, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE HOSPITAL'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XI, LINE 8 - OTHER ADJUSTMENTS:INCREASE IN PERMANENTLY RESTRICTED NET ASSETS 360,532. TRANSFER TO BRISTOL HOSPITAL MULTISPECIALTY GROUP -576,633. PENSION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS -6,181,908. CHANGES IN POSTRETIREMENT HEALTH & WELFARE BENEFITS -1,390,669. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 2,376,146. NONCASH VACCINE CONTRIBUTIONS -21,556. TRANSFER FROM BRISTOL HOSPITAL AND HEALTH CARE GROUP 1,100,000. TEMPORARILY RESTRICTED CONTRIBUTIONS 2,000,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -2,334,088.
PART XII, LINE 4B - OTHER ADJUSTMENTS:NONCASH VACCINE CONTRIBUTIONS 21,556.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage250.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4132987TotalCommunityBenefitExpense
Direct Offsetting Revenue2719308DirectOffsettingRevenue
Net Community Benefit Expense1413679NetCommunityBenefitExpense
Percent Of Total Expense0.01050PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense24401608TotalCommunityBenefitExpense
Direct Offsetting Revenue16662718DirectOffsettingRevenue
Net Community Benefit Expense7738890NetCommunityBenefitExpense
Percent Of Total Expense0.05750PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense28534595TotalCommunityBenefitExpense
Direct Offsetting Revenue19382026DirectOffsettingRevenue
Net Community Benefit Expense9152569NetCommunityBenefitExpense
Percent Of Total Expense0.06800PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense147790TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense147790NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense147790TotalCommunityBenefitExpense
Net Community Benefit Expense147790NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense28682385TotalCommunityBenefitExpense
Direct Offsetting Revenue19382026DirectOffsettingRevenue
Net Community Benefit Expense9300359NetCommunityBenefitExpense
Percent Of Total Expense0.06910PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,042,723BadDebtExpenseAmount
Amount Attributable To510681AmountAttributableTo
Amount Reimbursed By Medicare49410291AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare54068747CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-4658456MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (7 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 BRISTOL MSO LLC
RADIOLOGY SERVICES0.500000.000000.00000
2 MEDWORKS LLC
REHAB & OCCUPATIONAL HEALTH0.500000.000000.00000
3 CT OCCUPATIONAL MEDICAL PARTNERS
OCCUPATIONAL HEALTH0.330000.000000.00000
4 MEDCONN COLLECTION AGENCY
COLLECTION SERVICES0.250000.000000.00000
5 TOTAL LAUNDRY COLLABORATIVE LLC
LAUNDRY SERVICES0.141100.000000.00000
6 CENTRAL CT ENDOSCOPY CENTER
MEDICAL SERVICES0.065000.000000.00000
7 HEALTH CT LLC
MEDICAL SERVICES0.054000.000000.00000
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1BRISTOL HOSPITAL INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1BREWSTER ROADAddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06010ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
Er OtherXErOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1BRISTOL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent250.000000000000FPGFreePercent
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Insurance StatusXInsuranceStatus
Other FactorsXOtherFactors
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities11NumberOfOtherFacilities

Other Facilities OtherFacilities (11 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
BRISTOL BEHAVIORAL HEALTH SERVICES
10 N MAIN STREET SUITE 210BRISTOLCT06010BEHAVIORAL HEALTH
BRISTOL HOSPITAL CENTER FOR DIABETES
102 NORTH STREETBRISTOLCT06010DIABETES MEDICAL CARE AND EDUCATION
BRISTOL HOSPITAL COUNSELING CENTER
440-C NORTH MAIN STREETBRISTOLCT06010THERAPY AND COUNSELING
BRISTOL HOSPITAL WELLNESS CENTER
842 CLARK AVENUEBRISTOLCT06010MEDICAL AND FITNESS SERVICES
BRISTOL RADIOLOGY CENTER
25 COLLINS ROADBRISTOLCT06010MAMMOGRAPHY AND MRI
MED HELP
539 FARMINGTON AVENUEBRISTOLCT06010URGENT CARE
MEDWORKS LLC
375 CEDAR STREETNEWINGTONCT06111OCCUPATIONAL HEALTH SERVICES
PARENT & CHILD CENTER - BRISTOL HOSPITA
9 PROSPECT STREETBRISTOLCT06010CHILDREN AND FAMILY SERVICES
REHAB DYNAMICS
975 FARMINGTON AVENUEBRISTOLCT06010PHYSICAL THERAPY AND SPORTS MEDICINE
BRISTOL HOSPITAL LABORATORY
641 FARMINGTON AVENUEBRISTOLCT06010LABORATORY SERVICES
BRISTOL HOSPITAL LABORATORY
27 MAIN STREETTERRYVILLECT06786LABORATORY SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: THERE IS AN APPROVED SLIDING SCALE FOR DISCOUNTS BASED ON INCOME LEVELS AND FAMILY SIZE.
PART III, LINE 4: USE OF ESTIMATES - THE PREPARATION OF FINANCIAL STATEMENTS IN CONFORMITY WITH GAAP REQUIRES MANAGEMENT TO MAKE ESTIMATES AND ASSUMPTIONS THAT IMPACT THE REPORTED AMOUNTS OF ASSETS AND LIABILITIES AND DISCLOSURE OF CONTINGENT ASSETS AND LIABILITIES AT THE DATE OF THE FINANCIAL STATEMENTS. ESTIMATES ALSO IMPACT THE REPORTED AMOUNTS OF REVENUES AND EXPENSES DURING THE REPORTING PERIOD. ACTUAL RESULTS COULD DIFFER FROM THOSE ESTIMATES. THE HOSPITAL'S SIGNIFICANT ESTIMATES RELATE TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ALLOWANCES ON PATIENT ACCOUNTS RECEIVABLE, VALUATION OF INVESTMENTS, ESTIMATED SETTLEMENTS DUE TO THIRD-PARTY PAYERS, RESERVES FOR SELF-INSURANCE LIABILITIES AND THE PENSION AND OTHER POSTRETIREMENT EMPLOYEE BENEFIT PLAN LIABILITY ASSUMPTIONS.THE METHODOLOGY USED IN DETERMINING THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY ASSUMES, BASED ON PAST EXPERIENCE AND PATIENT DEMOGRAPHICS, THAT 25% OF BAD DEBT ACCOUNTS ARE FROM INDIVIDUALS THAT WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE OR MEDICAID, HAD THEY FOLLOWED THROUGH PROPERLY WITH THE APPLICATION PROCESS. THIS AMOUNT SHOULD BE INCLUDED AS COMMUNITY BENEFIT.
PART III, LINE 8: THE CALCULATED MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE IT REPRESENTS UNREIMBURSED COSTS FOR PATIENT SERVICES. THESE UNREIMBURSED COSTS ARE BRISTOL HOSPITAL EXPENSES THAT ULTIMATELY BENEFIT THE COMMUNITY BRISTOL HOSPITAL SERVICES.
PART III, LINE 9B: IT IS THE POLICY OF BRISTOL HOSPITAL TO PROVIDE EVERY PATIENT FROM THE COMMUNITY WE SERVE WITH MEDICALLY NECESSARY HEALTH SERVICES REGARDLESS OF THEIR ABILITY TO PAY. THE POLICY SETS SPECIFIC GUIDLINES FOR THE COLLECTION OF PATIENT PAYMENTS AND ESTABLISHES A HIERARCHY FOR PAYMENT METHODS THAT ARE BOTH FRIENDLY TO THE PATIENT AND BENEFICIAL TO THE HOSPITAL. PATIENTS WHO ARE UNABLE TO PAY THEIR LIABILITY ARE REFERRED TO A FINANCIAL COUNSELOR WHO WILL ASSESS THE PATIENT'S ELIGIBILITY FOR CHARITY CARE OR ALTERNATIVE FUNDING SOURCES. FUNDING SOURCES INCLUDE CHARITY CARE, OUTSIDE FINANCING, HOSPITAL PAYMENT PLANS, FEDERAL, STATE AND LOCAL PROGRAMS AND THE HOSPITAL FINANCIAL ASSISTANCE PROGRAM.
PART V, SECTION B, LINE 10: THERE IS AN APPROVED SLIDING SCALE FOR DISCOUNTS BASED ON INCOME LEVELS AND FAMILY SIZE AS FURTHER DETAILED IN PART V QUESTION 11H.BRISTOL HOSPITAL, INC.
PART V, SECTION B, LINE 11H: BRISTOL HOSPITAL RECOGNIZES THAT THE BURDEN OF HEALTH CARE COSTS ON INDIVIDUALS IS A NATIONAL CRISIS. DECADES OF HOSPITAL PRICING, DISTORTED BY THE UNIQUE BILLING REQUIREMENTS IMPOSED BY PRIVATE AND GOVERNMENTAL PAYERS AND REGULATIONS, HAS RESULTED IN A CHARGE STRUCTURE WHICH UNFAIRLY BURDENS THE INDIVIDUALS AND FAMILIES WITHOUT OR WITH LIMITED INSURANCE. BRISTOL HOSPITAL WISHES TO CORRECT THIS UNFAIRNESS BY ENSURING THAT ALL UNINSURED PATIENTS' CHARGES ARE LIMITED AND CAPPED AT MEDICARE PAYMENT LEVELS. THIS DISCOUNTED LEVEL IS DEFINED AS THE RATIO OF MEDICARE CHARGE TO PAYMENTS AND IS LISTED ON THE MOST RECENT OHCA FILING. THE MOST CURRENT DISCOUNT IS 71%. WHEN A PATIENT HAS NO INSURANCE, THEIR BILL WILL BE IMMEDIATELY REDUCED BY THAT PERCENTAGE DISCOUNT, USING THE CHARITY CARE UNINSURED ALLOWANCE CODE. PATIENTS WHO HAVE BALANCES DUE AFTER INSURANCE AND REQUIRE FINANCIAL ASSISTANCE IN PAYING THOSE BILLS, WILL BE ENTITLED TO A CHARITY CARE PATIENT ASSISTANCE DISCOUNT BASED ON THEIR INCOME AND FAMILY SIZE, USING THE APPROVED SLIDING FINANCIAL ASSISTANCE SCALE. THE STATE OF CONNECTICUT HAS SET RECOMMENDED LEVELS OF CHARITY CARE DISCOUNTS WHICH STIPULATES THAT FOR FAMILIES AT OR BELOW 200% OF FEDERAL POVERTY LEVELS SHOULD BE DISCOUNTED TO COST, AND THAT FOR FAMILIES BETWEEN 200 AND 400% SHOULD BE DISCOUNTED TO THE COMMERCIAL AND/OR MEDICARE RATE. THE BRISTOL HOSPITAL SLIDING SCALE HAS GREATER DISCOUNTS APPLIED AT LOWER LEVELS OF THE FEDERAL POVERTY INCOME LEVELS.BRISTOL HOSPITAL, INC.
PART VI, LINE 2: HOSPITAL ASSESSMENT OF THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES IS A DYNAMIC PROCESS THAT INVOLVES ALL LEVELS OF HOSPITAL ADMINISTRATION, STAFF, THE BOARD OF DIRECTORS (BOD), AND MEDICAL STAFF. VARIOUS COMMITTEES AND GROUPS AT THE HOSPITAL MEET PERIODICALLY TO DISCUSS THE NEEDS OF THE COMMUNITY WE SERVE AS WELL AS THE RESOURCES AND SERVICES AVAILABLE AT THE HOSPITAL AND OTHER AGENCIES IN THE AREA. THE HOSPITAL IS REPRESENTED AT COMMUNITY LEVEL ORGANIZATIONS AND GROUPS THAT ARE ALSO INVOLVED WITH ASSESSMENT OF THE COMMUNITY NEEDS. HOSPITAL RESOURCES ARE FREQUENTLY CALLED UPON TO PARTICIPATE IN PROGRAMS AND PROJECTS PUT TOGETHER TO ADDRESS THOSE NEEDS.
PART VI, LINE 3: AT BRISTOL HOSPITAL, PATIENTS ARE NOTIFIED OF THEIR ABILITY TO DISCUSS FINANCIAL ASSISTANCE OPTIONS INCLUDING CHARITY CARE IN ALL OF THEIR BILLING STATEMENTS. THE HOSPITAL ENCOURAGES PATIENTS TO FIND OUT THEIR ELIGIBILITY FOR ASSISTANCE AND PROVIDES FINANCIAL COUNSELORS TO ASSIST PATIENTS IN APPLYING FOR CHARITY CARE.PATIENTS CAN CONTACT THE FINANCIAL ASSISTANCE DEPARTMENT WITHIN THE HOSPITAL AT 860-585-3878. THIS SUPPORT ALSO INCLUDES A REPRESENTATIVE THROUGH THE STATE OF CONNECTICUT (REPRESENTATIVE PAID BY BRISTOL HOSPITAL) SO WE ENSURE THAT ALL ASPECTS OF ASSISTANCE ARE PROVIDED FOR EACH PATIENT.THE FINANCIAL ASSISTANCE DEPARTMENT ALSO DISCUSSES GOVERNMENT BENEFITS WITH PATIENTS THAT THEY MAY BE ELIGIBLE FOR.CONTACT INFORMATION FOR OUR FINANCIAL COUNSELOR IS ALSO INCLUDED ON THE HOSPITAL WEBSITE FOR PATIENTS TO REFERENCE. THE HOSPITAL ALSO OFFERS MANY FREE PROGRAMS FOR THE UNINSURED INCLUDING FREE BLOOD PRESSURE CLINICS, SKIN CANCER SCREENING CLINICS AND SEMINARS TO PROVIDE PATIENTS ACCESS TO AS MUCH FREE HEALTH INFORMATION AS POSSIBLE.
PART VI, LINE 4: BRISTOL HOSPITAL IS COMMITTED TO PROVIDING THE BEST PATIENT EXPERIENCE IN THE REGION. OUR 134-BED, FULL-SERVICE HEALTH CARE INSTITUTION PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT CARE FOR THE GREATER BRISTOL, CONNECTICUT AREA.BRISTOL IS A SUBURBAN CITY LOCATED IN HARTFORD COUNTY, CONNECTICUT, UNITED STATES 20 MILES SOUTHWEST OF HARTFORD. BRISTOL HAS A TOTAL AREA OF 26.8 SQUARE MILES AND A POPULATION OF APPROX 62K. IN BRISTOL, 84.2% OF THE PEOPLE SPEAK ENGLISH AND 4.8% OF PEOPLE SPEAK SPANISH. IN BRISTOL, 54.6% OF PEOPLE ARE MARRIED AND 92.2% OF RESIDENTS WERE BORN IN THE US.COMMUNITY INFORMATION:THE PRIMARY SERVICE AREA (PSA) FOR OUR HOSPITAL INCLUDES:BRISTOL (ZIP CODE 06010,06011)- 2011 CENSUS 62,078BURLINGTON (ZIP CODE 06013)- 2011 CENSUS- 10,011PLAINVILLE (ZIP CODE 06062)- 2011 CENSUS 17,767PLYMOUTH (ZIP CODE 06781,06782,06786)- 2011 CENSUS 12,605THE TOTAL POPULATION FROM THE 2011 CENSUS FOR OUR PSA IS- 102,461IN 2010, THE LATEST DATE DATA BECAME AVAILABLE AND THE FOLLOWING DATA POINTS WERE PROVIDED FOR THE FOLLOWING COMMUNITIES: BRISTOL:MEDIAN HOUSEHOLD INCOME: $57,781FAMILIES BELOW POVERTY LEVEL- 5.6%INDIVIDUALS BELOW POVERTY LEVEL- 7.7%RACE: WHITE- 87.6%, BLACK OR AFRICAN AMERICAN- 3.6%, AMERICAN INDIAN OR ALASKA NATIVE- 0.3%, ASIAN- 1.8%, OTHER RACE- 3.9%BURLINGTON: MEDIAN HOUSEHOLD INCOME: $116,419 FAMILIES BELOW POVERTY LEVEL- 1.2% INDIVIDUALS BELOW POVERTY LEVEL- 1.9% RACE: WHITE- 98%, BLACK OR AFRICAN AMERICAN- 0.2%,AMERICAN INDIAN OR ALASKA NATIVE- 0.1%, ASIAN- 1.2%PLAINVILLE: MEDIAN HOUSEHOLD INCOME: $62,440 FAMILIES BELOW POVERTY LEVEL- 4.1% INDIVIDUALS BELOW POVERTY LEVEL- 5.0% RACE: WHITE- 93.1%, BLACK OR AFRICAN AMERICAN- 2.5%, AMERICAN INDIAN OR ALASKA NATIVE- 0.3%, ASIAN- 1.3%, OTHER RACE- 0.6% PLYMOUTH: MEDIAN HOUSEHOLD INCOME: $70,132 FAMILIES BELOW POVERTY LEVEL- 2.9% INDIVIDUALS BELOW POVERTY LEVEL- 5.6% RACE: WHITE- 96.7%, BLACK OR AFRICAN AMERICAN- 0.5%, AMERICAN INDIAN OR ALASKA NATIVE- 0.3%, ASIAN- 0.6%, OTHER RACE- 0.7% THE SECONDARY SERVICE AREA (SSA) FOR OUR HOSPITAL INCLUDES:FARMINGTON (ZIP CODE 06085,06087)- 2011 CENSUS 6,058SOUTHINGTON (ZIP CODE 06489)- 2011 CENSUS 33,560WOLCOTT (ZIP CODE 06716)- 2011 CENSUS 17,458THOMASTON (ZIP CODE 06787)- 2011 CENSUS 8,512HARWINTON (ZIP CODE 06791)- 2011 CENSUS 5,938THE TOTAL POPULATION FROM THE 2011 CENSUS FOR OUR SSA IS- 71,526BOTH THE PSA (PRIMARY SERVICE AREA) AND SSA (SECONDARY SERVICE AREA) ARE PRIMARILY SUBURBAN AND RURAL AREAS BUT ALSO INCLUDE SOME URBAN AREAS AS WELL. SOME OF THE MAJOR HEALTH PROBLEMS PREVALENT IN OUR PSA ARE ASSOCIATED WITH BEHAVIORAL HEALTH, CHEMICAL DEPENDENCY, OBESITY, AND PULMONARY DISEASE.
PART VI, LINE 5: BRISTOL HOSPITAL TAKES GREAT PRIDE IN SERVING THE COMMUNITY. AS PART OF ITS MISSION, BRISTOL HOSPITAL INCORPORATES A BROAD ARRAY OF COMMUNITY OUTREACH AND WELLNESS ACTIVITIES, DELIVERING EDUCATIONAL MATERIAL AND COUNSELING, OFFERING FREE OR LOW COST HEALTH SCREENINGS AND HOSTING PATIENT AND FAMILY SUPPORT GROUPS. WE UNDERSTAND THE IMPORTANCE AND VALUE OF EMPHASIZING GOOD HEALTH, FITNESS, SAFETY AND THE PROMOTION OF EARLY DETECTION OF ILLNESS OR DISEASE. THEREFORE, ALL OF OUR OUTREACH EFFORTS REFLECT OUR STRONG DESIRE TO IMPROVE THE QUALITY OF LIFE FOR ALL WHO LIVE AND WORK IN THE COMMUNITIES WE SERVE. BRISTOL HOSPITAL PROVIDES FINANCIAL SUPPORT AND ACCESS TO APPROPRIATE CLINICAL CARE FOR SEVERAL LIFE-SAVING INITIATIVES, INCLUDING THE BRISTOL COMMUNITY BREAST HEALTH PROJECT AND THE COLON CANCER AWARENESS PROJECT OF GREATER BRISTOL, WHICH ALLOW US TO OFFER FREE BREAST, AND COLORECTAL CANCER SCREENINGS TO THOSE WHO, DUE TO INSURANCE OR INCOME FACTORS, MIGHT NOT OTHERWISE HAVE ACCESS TO THESE VALUABLE DIAGNOSTIC SCREENING SERVICES. THE EYE CARE PROJECT OF GREATER BRISTOL PROVIDES VITAL ACCESS TO SERVICES FOR THOSE SUFFERING FROM VISION IMPAIRMENT.AT BRISTOL HOSPITAL WE UNDERSTAND THE IMPORTANCE OF OUR ROLE AS AN EXEMPT HEALTHCARE PROVIDER TO THE COMMUNITY WE SERVICE. OUR LEADERSHIP TEAM IS COMMITTED TO PROVIDING OUTSTANDING PATIENT CARE AND PROMOTING THE HEALTH OF THE COMMUNITY. BRISTOL HOSPITAL ATTEMPTS TO PROMOTE OUR FREE AND NON-REVENUE GENERATING PROGRAMS IN A VARIETY OF WAYS. THREE TIMES A YEAR, THE HOSPITAL MAILS A "PATHWAYS TO YOUR HEALTH" CATALOG. THE CATALOG CONTAINS A LISTING OF PROGRAMS AVAILABLE TO THE GREATER BRISTOL COMMUNITY. THIS CATALOG IS MAILED TO OVER 60,000 RESIDENTS AND PROVIDES INFORMATION ON FREE HEALTH SCREENINGS, SUPPORT GROUPS, HEALTH EDUCATION, WELLNESS PROGRAMS, ETC. THE CATALOG IS ALSO INCLUDED ON OUR HOSPITAL WEBSITE TO PROVIDE INCREASED ACCESS TO PATIENTS. THE PATHWAYS CATALOG IS DELIVERED AND DISPLAYED IN EACH DEPARTMENT WITHIN THE HOSPITAL AND IS FREE FOR ALL PATIENTS TO TAKE. PROGRAMS ARE ALSO LISTED ON OUR WEBSITE UNDER AN "EVENTS" SECTION WHERE PATIENTS CAN REGISTER FOR FREE, DIRECTLY ONLINE. WE ALSO PROMOTE OUR PROGRAMS MONTHLY IN THE BRISTOL PRESS, BRISTOL OBSERVER, HARTFORD COURANT AND PLYMOUTH CONNECTION. WE SUBSCRIBE TO AN "ON-HOLD" SYSTEM FOR OUR PHONES WHICH ALLOWS US TO RECORD MESSAGES FOR PATIENTS WHEN THEY CALL THE HOSPITAL. MANY OF THESE MESSAGES ARE ABOUT FREE PROGRAMS AND SERVICES, HEALTH EDUCATION FACTS AND SERVICES TO THE COMMUNITY.
PART VI, LINE 6: N/A
CTREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required0SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BALA SHANMUGAM MD
026007700731300490000731326497700
KURT BARWIS
44152909346902723300104419016899092864602717580
LEONARD BANCO MD
308318040342000122500137250374635000
JEANINE RECKDENWALD
16316302492700060970168990211086000
DAVE RACKLIFF
14434101649700074310172270185496000
SHEILA KEMPF PHD
219055032276000112500168990279480000
KATHLEEN BUCKLEY
199327000000064400205767000
JOSEPH HART
1640830135580008367085150194523000
PAUL SMITH
156000000000000156000000
RUSSELL TUVERSON MD
155226000007775000163001000
BARBARA NAWROCKI
153000000000000153000000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ATHE HOSPITAL PAID $6,305 IN GOLF CLUB MEMBERSHIP FEES FOR ITS PRESIDENT DURING THE CALENDAR YEAR 2011.
PART I, LINE 4BKURT BARWIS, PRESIDENT, PARTICIPATES IN THE HOSPITAL'S 457(F) DEFINED CONTRIBUTION PLAN.
PART I, LINE 6THE COMPENSATION OF THE HOSPITAL'S PRESIDENT, KURT BARWIS, IS BASED IN PART ON THE NET EARNINGS OF THE HOSPITAL.

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonMORRIS LAVIERONamePerson
Purpose Of LoanPURCHASE BUILDINGPurposeOfLoan
Loan To OrganizationXLoanToOrganization
Original Principal$350,000OriginalPrincipalAmount
Balance Due297961BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due297961TotalBalanceDue

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99021556NoncashContribsRptdF990
Method Of Determining RevenuesREPORT FROM DHHSMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11A COMPLETED 990 IS PROVIDED TO EACH BOARD MEMBER. THIS PROVIDES AN OPPORTUNITY FOR MEMBERS TO ASK QUESTIONS AND FOLLOW UP WITH THE FINANCE TEAM REGARDING ANY ISSUES OR CONCERNS. THE 990 IS ALSO REVIEWED INTERNALLY BY MEMBERS OF THE FINANCE AND MANAGEMENT TEAMS.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY, ALL APPLICABLE PARTIES ARE REQUIRED TO RECEIVE AND SIGN A STATEMENT ACKNOWLEDGING THAT THEY HAVE READ, UNDERSTOOD AND AGREE TO COMPLY WITH THE CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15THE EXECUTIVE COMPENSATION COMMITTEE IS AUTHORIZED UNDER THE BRISTOL HOSPITAL AND HEALTH CARE GROUP BYLAWS AND IS RESPONSIBLE FOR (1) DETERMINING THE OVERALL TOTAL COMPENSATION STRATEGY FOR ALL CORPORATE OFFICERS, (2) APPROVING ALL COMPENSATION AND BENEFITS DECISIONS FOR CORPORATE OFFICERS, AND (3) REPORTING SUCH ACTIONS TO THE FULL BRISTOL HOSPITAL AND HEALTH CARE GROUP BOARD ON AN ANNUAL BASIS. IN ADDITION, THE EXECUTIVE COMPENSATION COMMITTEE EXPRESSLY DETERMINES THE REASONABLENESS OF TOTAL COMPENSATION AND BENEFITS FOR ALL CORPORATE OFFICERS AND ASSURES THAT ALL OFFICER COMPENSATION DECISIONS ARE MADE AFTER THOROUGH CONSIDERATION OF AND COMPARISON TO THE MARKET PRACTICES OF OTHER SIMILARLY SITUATED NOT-FOR-PROFIT HEALTHCARE EXECUTIVES IN COMPARABLE ORGANIZATIONS. THE EXECUTIVE COMPENSATION COMMITTEE CONSISTS OF BOARD MEMBERS WHO DO NOT HAVE MATERIAL FINANCIAL INTERESTS THAT COULD BE AFFECTED BY THE OFFICER COMPENSATION DECISIONS MADE BY THE COMMITTEE. THE COMPARABILITY DATA USED TO ASSIST THE EXECUTIVE COMPENSATION COMMITTEE IN ITS COMPENSATION DELIBERATIONS ARE COMPILED BY AN INDEPENDENT, NATIONAL COMPENSATION CONSULTING FIRM THAT IS RETAINED BY AND REPORTS DIRECTLY TO THE EXECUTIVE COMPENSATION COMMITTEE. THE DATA COLLECTED BY THE CONSULTANT CONSISTS OF MARKET INFORMATION FOR EXECUTIVES IN FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS. THE DELIBERATIONS AND DECISIONS OF THE EXECUTIVE COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED, REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE AND PROVIDED TO THE BOARD ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 2,626,853. INCREASE IN PERMANENTLY RESTRICTED NET ASSETS 360,532. TRANSFER TO BRISTOL HOSPITAL MULTISPECIALTY GROUP -576,633. PENSION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS -6,181,908. CHANGES IN POSTRETIREMENT HEALTH & WELFARE BENEFITS -1,390,669. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 2,376,146. NONCASH VACCINE CONTRIBUTIONS -21,556. TRANSFER FROM BRISTOL HOSPITAL AND HEALTH CARE GROUP 1,100,000. TEMPORARILY RESTRICTED CONTRIBUTIONS 2,000,000. TOTAL TO FORM 990, PART XI, LINE 5: 292,765.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2C:THE HOSPITAL'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESSES OF OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HG PROPERTY HOLDINGS LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line141 BREWSTER RDAddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06010ZIPCode
FieldValueIRS element (for citing)
EIN272548373EIN
Primary ActivitiesREAL ESTATEPrimaryActivities
Legal Domicile StateCTLegalDomicileState
Total Income5028TotalIncome
EOY Assets269368EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BRISTOL HOSPITAL INCBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
BRISTOL HOSPITAL AND HEALTH CARE GROUP INC
BREWSTER ROADBRISTOLCT06010222577726HEALTHCARE PARENT COMPANYCT501 (C) (3)11B, TYPE II0
BRISTOL HOSPITAL DEVELOPMENT FOUNDATION INC
BREWSTER ROADBRISTOLCT06010222577740FUNDRAISINGCT501 (C) (3)70BRISTOL HOSPITAL AND HEALTH CARE GROUP INC
BRISTOL HEALTH CARE INC
400 NORTH MAIN STREETBRISTOLCT06010222577731NURSING HOMECT501 (C) (3)90BRISTOL HOSPITAL AND HEALTH CARE GROUP INC
BRISTOL HOSPITAL MULTISPECIALTY GROUP INC
BREWSTER ROADBRISTOLCT06010061466555HEALTHCARE SERVICESCT501 (C) (3)90BRISTOL HOSPITAL AND HEALTH CARE GROUP INC

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStatePredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
MEDWORKS LLC
375 EAST CEDAR STREETNEWINGTONCT06111061490483REHAB & OCCUPATIONAL HEALTHCTRELATED-3824672941000.50000
BRISTOL MSO LLC
25 COLLINS ROADBRISTOLCT06010061506024RADIOLOGY SERVICESCTRELATED443365678758000.50000

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1BRISTOL HOSPITAL EMS LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 977AddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06011ZIPCode
FieldValueIRS element (for citing)
EIN061547648EIN
Primary ActivityEMERGENCY MEDICAL SERVICESPrimaryActivity
Legal Domicile StateCTLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BRISTOL HOSPITAL & HEALTH CARE GROUPBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
BRISTOL HOSPITAL EMS LLC
P464760COST
BRISTOL HOSPITAL EMS LLC
N118052COST
BRISTOL HEALTH CARE
P891824COST
BRISTOL HEALTH CARE
N361394COST
BRISTOL HOSPITAL DEVELOPMENT FOUNDATION
N352680COST
BRISTOL HOSPTIAL EMS LLC
R1100000COST
BRISTOL HOSPITAL MULTISPECIALTY GROUP
Q4713007COST
BRISTOL HOSPITAL DEVELOPMENT FOUNDATION
C219460COST