2013-08-13T08:35:54-05:00 2012-09-30 111986323 MARCUM LLP CITY PLACE II 185 ASYLUM STREET HARTFORD CT 06103 990 2011-10-01 061450168 SAINT FRANCIS MEDICAL GROUP INC SAIN 8607149632 114 WOODLAND STREET NO 4312 HARTFORD CT 06105 DAVID BITTNER 8607144603 2013-08-06 1 DOUGLAS FARRINGTON P00370668 8605498500 2011 2016-02-25 16:41:14Z DAVID BITTNER 114 WOODLAND STREET NO 4312 HARTFORD CT 06105 65686118 0 X WWW.STFRANCISCARE.ORG X 1995 CT MEDICAL AND EDUCATIONAL PROGRAMS 13 0 301 0 0 0 0 0 57104185 62514698 244 0 3229282 3171420 60333711 65686118 0 0 0 0 49897706 56740165 0 0 0 12210093 13350040 62107799 70090205 -1774088 -4404087 4829159 5453522 7354541 12382991 -2525382 -6929469 TO ENGAGE IN THE TEACHING AND EDUCATION OF MEDICAL STUDENTS, RESIDENTS AND FELLOWS, TO PERFORM MEDICAL AND RELATED RESEARCH ACTIVITIES, AND TO RENDER PROFESSIONAL MEDICAL SERVICES TO PERSONS IN NEED OF SUCH SERVICES. 0 0 66691950 65686118 EMPLOYS PHYSICIANS AND PHYSICIAN ASSISTANTS WHO PROVIDE MEDICAL SERVICES IN THE GREATER HARTFORD CONNECTICUT COMMUNITY AND CONDUCTS TEACHING AND EDUCATION PROGRAMS FOR MEDICAL STUDENTS AND RESIDENTS IN SUPPORT OF THE SAINT FRANCIS CARE HEALTH SYSTEM. 66691950 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 45 0 1 301 1 0 0 0 0 0 0 0 0 0 0 X 13 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X X X DONNA GILBERT 8607149632 114 WOODLAND STREET HARTFORD CT 06105 X ROLF KNOLL MD 55.00 X X 428481 0 43508 JOHN RODIS MD 55.00 X X 383302 0 7238 JOHN N GIAMALIS 2.00 X X 0 533020 30228 DANIEL DIVER MD 55.00 X X 615345 0 30380 BERNARD CLARK III MD 55.00 X 314879 0 32830 HEMA DESILVA MD 55.00 X 216713 0 24108 ROBERT J KRUG MD 55.00 X 357564 0 30792 PAUL F MITCHELL DMD 55.00 X 263770 68750 32601 KATHLEEN M ROCHE MSRN 2.00 X 0 621542 30637 JONATHON SPORN MD 55.00 X 402315 0 19083 THOMAS TERENZI DOEDD 55.00 X 221602 0 19677 JOSE ARIAS-CAMISON MD 55.00 X 265249 0 28326 LAURIE LOIACONO MD 55.00 X 318985 0 25834 WALTER TRYMBULAK MD 55.00 X 213373 0 25268 RAUL MENDELOVICI 55.00 X 588799 0 30252 ANDREW P MACKENZIE MD 55.00 X 509506 0 5581 IOANNIS RAFTOPOULOS MD 55.00 X 490644 0 25424 ERIC A SILVERSTEIN 55.00 X 738820 0 16544 WILLIAM T MARSHALL DO 55.00 X 575587 0 26132 HOWARD SHAW 0.00 X 96842 0 80 JEFFREY STEINBERG 0.00 X 439451 0 0 7441227 1223312 484523 157 1 1 0 DELPHI HEALTHCARE PARTNERS INC PO BOX 634850 CINCINNATI OH 45263 PHYSICIAN SERVICES 1887590 HEALY MACINSKI RAO WADE & GORDON 1000 ASYLUM AVENUE STE 4304 HARTFORD CT 06105 PHYSICIAN SERVICES 263466 SAPPINGTONFREUNDPRAKASH PC 1000 ASYLUM AVENUE STE 3211 HARTFORD CT 06105 PHYSICIAN SERVICES 233479 VISTA STAFFING SOLUTIONS PO BOX 50834 LOS ANGELES CA 90074 PHYSICIAN SERVICES 226042 CENTRAL CT CARDIOLOGY LLC 19 WOODLAND STREET HARTFORD CT 06105 PHYSICIAN SERVICES 205950 8 PATIENT SERVICE REVENU 621400 31313283 31313283 PHYSICIAN LEASE REVENU 531190 17714740 17714740 TEACHING REVENUE 900099 6360440 6360440 ADMINISTRATION REVENUE 900099 4035939 4035939 CONTRACT REVENUE 900099 2431391 2431391 658905 658905 62514698 11113 0 11113 11113 11113 WPA SUBSIDY 900099 3075000 3075000 OTHER REVENUE 900099 85307 85307 3160307 65686118 65686118 0 0 4273745 3997235 276510 44115202 43593534 521668 1673384 1663449 9935 4344745 4189675 155070 2333089 2318465 14624 48019 48019 44140 44140 6355133 4668763 1686370 2330 2330 492943 365614 127329 922724 857531 65193 437965 6101 431864 58819 41286 17533 LICENSES & FEES 1975420 1975420 BAD DEBT EXPENSE 1843439 1843439 MEDICAL SUPPLIES 565448 565448 RECRUITMENT EXPENSES 307211 307211 296449 296449 70090205 66691950 3398255 0 1175353 939124 3275060 3884450 136667 12694 685568 332634 189802 352934 52277 264320 4829159 5453522 7285761 8566440 68780 0 0 3816551 7354541 12382991 X -2525382 -6929469 -2525382 -6929469 4829159 5453522 -4404087 0 X X 0 1 1 X 0 X 42775 36253 6522 642793 296381 346412 352934 DUE TO AFFILIATES 3816551 3816551 X 1 1 0 0 0 0 0 0 0 0 0 ROLF KNOLL MD 359809 0 68672 0 0 0 17484 0 26024 0 471989 0 0 0 JOHN RODIS MD 383302 0 0 0 0 0 0 0 7238 0 390540 0 0 0 JOHN N GIAMALIS 0 533020 0 0 0 0 0 334 0 29894 0 563248 0 0 DANIEL DIVER MD 565345 0 50000 0 0 0 17150 0 13230 0 645725 0 0 0 BERNARD CLARK III MD 314879 0 0 0 0 0 19600 0 13230 0 347709 0 0 0 HEMA DESILVA MD 216713 0 0 0 0 0 17199 0 6909 0 240821 0 0 0 ROBERT J KRUG MD 357564 0 0 0 0 0 15100 0 15692 0 388356 0 0 0 PAUL F MITCHELL DMD 263770 68750 0 0 0 0 19600 0 13001 0 296371 68750 0 0 KATHLEEN M ROCHE MSRN 0 451542 0 170000 0 0 0 15034 0 15603 0 652179 0 0 JONATHON SPORN MD 402315 0 0 0 0 0 14700 0 4383 0 421398 0 0 0 THOMAS TERENZI DOEDD 221602 0 0 0 0 0 13341 0 6336 0 241279 0 0 0 JOSE ARIAS-CAMISON MD 265249 0 0 0 0 0 13326 0 15000 0 293575 0 0 0 LAURIE LOIACONO MD 318985 0 0 0 0 0 11930 0 13904 0 344819 0 0 0 WALTER TRYMBULAK MD 213373 0 0 0 0 0 12098 0 13170 0 238641 0 0 0 RAUL MENDELOVICI 588799 0 0 0 0 0 17150 0 13102 0 619051 0 0 0 ANDREW P MACKENZIE MD 509506 0 0 0 0 0 4817 0 764 0 515087 0 0 0 IOANNIS RAFTOPOULOS MD 490644 0 0 0 0 0 10400 0 15024 0 516068 0 0 0 ERIC A SILVERSTEIN 738820 0 0 0 0 0 14700 0 1844 0 755364 0 0 0 WILLIAM T MARSHALL DO 575587 0 0 0 0 0 12962 0 13170 0 601719 0 0 0 HOWARD SHAW 96842 0 0 0 0 0 0 0 80 0 96922 0 0 0 JEFFREY STEINBERG 439451 0 0 0 0 0 0 0 0 0 439451 0 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: SAINT FRANCIS MEDICAL GROUP RELIED ON SAINT FRANCIS HOSPITAL TO ESTABLISH THE COMPENSATION OF ITS CEO USING THE FOLLOWING: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION B, LINE 11 THE SAINT FRANCIS HOSPITAL & MEDICAL CENTER AUDIT AND CORPORATE COMPLIANCE COMMITTEE HAS RESPONSIBILITY FOR REVIEWING THE FORM 990 AND REPORTS BACK TO THE FULL BOARD REGARDING THEIR REVIEW OF THE FORM 990. THE FORM 990 IS AVAILABLE ON THE BOARD'S INTERNAL SECURE WEB PORTAL. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY INCLUDES AN OBLIGATION OF EACH BOARD MEMBER TO ANNUALLY DISCLOSE ALL MATERIAL FACTS AND RELATIONSHIPS AND REFRAIN FROM VOTING ON ANY MATTER WHEN THERE IS A CONFLICT OF INTEREST. THE GOVERNANCE AND NOMINATIONS COMMITTEE REVIEWS THE RESULTS OF THESE SUBMISSIONS ANNUALLY FOR COMPLIANCE WITH GOVERNANCE POLICIES. FORM 990, PART VI, SECTION B, LINE 15 REFER TO PART III OF SCHEDULE J FOR PROCESS. FORM 990, PART VI, SECTION C, LINE 19 A LINK ON THE SAINT FRANCIS WEBSITE HAS BEEN ESTABLISHED FOR INDIVIDUALS TO REQUEST GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990 AND FINANCIAL STATEMENTS. FORM 990, PART VII, SECTION A: AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: BERNARD CLARK III, M.D. - 2 HOURS DANIEL DIVER, M.D. - 2 HOURS HEMA DESILVA, M.D.- 2 HOURS JOHN GIAMALIS - 64 HOURS JONATHON SPORN, M.D. - 2 HOURS KATHLEEN ROCHE, M.S.R.N. - 59 HOURS PAUL F. MITCHELL, D.M.D. - 4 HOURS ROBERT J. KRUG, M.D. - 3 HOURS ROLF KNOLL, M.D. - 6 HOURS THOMAS TERENZI, D.O., ED.D. - 2 HOURS WALTER TRYMBULAK, M.D. - 2 HOURS FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS HAS DELEGATED ITS OVERSIGHT RESPONSIBILITY OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS TO SAINT FRANCIS HOSPITAL AND MEDICAL CENTER AUDIT & CORPORATE COMPLIANCE COMMITTEE. ASYLUM HILL FAMILY MEDICAL CENTER 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH SERVICES CT 501(C)(3) LINE 3 SAINT FRANCIS CARE 0 ONE THOUSAND CORPORATION 1000 ASYLUM STREET HARTFORD CT 06105 060922325 PROPERTY MANAGEMENT CT 501(C)(2) ST FRANCIS HOSPITAL & MEDICAL CENTER 0 SAINT FRANCIS CARE INC 114 WOODLAND STREET HARTFORD CT 06105 061491191 SUPPORTS HEALTH CARE ORGANIZATIONS CT 501(C)(3) LINE 11A, I N/A 0 SAINT FRANCIS HOSPITAL & MEDICAL CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 060646813 HOSPITAL CT 501(C)(3) LINE 3 SAINT FRANCIS CARE 0 SAINT FRANCIS FOUNDATION INC 114 WOODLAND STREET HARTFORD CT 06105 061008255 FUNDRAISING CT 501(C)(3) LINE 11A, I SAINT FRANCIS CARE 0 THE CAMILLUS CORPORATION 1000 ASYLUM STREET HARTFORD CT 06105 061051261 SUPPORTS HEALTH CARE ORGANIZATIONS CT 501(C)(3) LINE 11A, I SAINT FRANCIS CARE 0 MT SINAI REHABILITATION HOSPITAL INC 114 WOODLAND STREET HARTFORD CT 06105 061422973 HOSPITAL CT 501(C)(3) LINE 3 SAINT FRANCIS CARE 0 SAINT FRANCIS EMERGENCY MEDICAL GROUP INC 114 WOODLAND STREET HARTFORD CT 06105 451994612 HEALTH SERVICES CT 501(C)(3) LINE 3 SAINT FRANCIS MEDICAL GROUP INC 0 TOTAL LAUNDRY COLLABORATIVE 114 WOODLAND STREET HARTFORD CT 06105 208335788 LAUNDRY SERVICES CT N/A MEDWORKS LLC 375 EAST CEDAR STREET NEWINGTON CT 06111 061490483 REHABILITATION SERVICES CT N/A SAINT FRANCIS CARE MEDICAL GROUP PC 114 WOODLAND STREET HARTFORD CT 06105 061432373 HEALTH SERVICES CT N/A C SAINT FRANCIS BEHAVIORAL HEALTH GROUP 114 WOODLAND STREET HARTFORD CT 06105 061384686 BEHAVIOR HEALTH SERVICES CT N/A C SAINT FRANCIS HEALTH CARE PARTNERS 95 WOODLAND ST FOURTH FLOOR HARTFORD CT 06105 061391257 MGMT AND ADMIN SERVICES CT N/A C 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0