2013-08-14T11:56:33-05:00 2012-09-30 990 2011-10-01 060653171 Hospital of Saint Raphael HOSP 2037893940 200 Orchard Street Suite 204 New Haven CT 06511 James R Rude 2037893575 2013-08-14 2011 2016-02-24 21:20:13Z X Jane Anne Lubin Szafransk 200 Orchard Street Suite 204 New Haven CT 06511 471827245 0 X N/A X 1907 CT Not for Profit Hospital X 15 12 4286 700 6131130 0 5555754 5487195 477956801 443953259 304901 293298 22106354 21174308 505923810 470908060 0 0 0 0 284957442 272875725 0 0 0 216793388 200064634 501750830 472940359 4172980 -2032299 277047305 160560508 323551576 149059341 -46504271 11501167 X The Hospital of Saint Raphael is a community teaching hospital and health care resource sponsored and guided by the values of the Sisters of Charity of Saint Elizabeth and of the Roman Catholic Church. The mission is to witness, share in, and promote excellence in the healing ministry of Jesus Christ. The Hospital is committed to preserving the dignity and well-being of each individual, and assuring that every person is treated according to the principles of charity and justice. The Hospital accepts the Gospel challenge that prompted their founders of the sponsoring congregation, Saint Vincent DePaul, Saint Elizabeth Ann Seton, and Mother Mary Xavier Mehegan by pledging every loving service in their power to reach out to those in need of services. 0 1 420696443 458996437 The Hospital of Saint Raphael provides services to the poor and the medically underserved, as well as providing benefits to the broader community. The Hospital also provides services to other needy populations that may not qualify as poor but need special services and support. These include the cost of health promotion, health screening and education of the general community. Total discharges for the year were 19,941, Emergency Room Visits 55,528, Patient days 102,666, Inpatient Surgical Procedures 5,367 and Ambulatory Surgery 8,811. 420696443 1 1 0 1 0 0 0 0 0 1 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 365 0 1 4286 1 1 1 1 BD 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Hospital of Saint Raphael Acctg Dep 2037893940 200 Orchard Street Suite 204 New Haven CT 06511 Vincent Calarco 3.30 X 0 0 0 M Joseph Canavan 5.00 X 0 0 0 James M Carolan 3.00 X 7327 0 0 Sister Teresa Confroy 8.00 X 0 0 0 Ralph DeNatale MD 5.00 X 126033 0 0 James Farmer MD 3.00 X 403872 0 0 Sister Mary Kathleen Flanagan 2.50 X 0 0 0 Paul Fortgang MD 2.00 X 0 0 0 Rev Bonita Grubbs 3.00 X 0 0 0 W Bruce Lundberg MD 4.00 X 276832 0 0 Michele Macauda 2.00 X 0 0 0 Linda Masci 3.00 X 0 0 0 Sister Mary Morley 8.50 X 0 0 0 Sister Rosemary Moynihan 6.00 X 0 0 0 Edward J Mullen 1.00 X 0 0 0 Christopher M O'Connor 40.00 X X 0 959577 392713 Most Reverend Peter Rosazza 1.50 X 0 0 0 Sister Maureen Shaughnessy 6.00 X 0 0 0 James P Torgerson 2.00 X 0 0 0 Kevin Twohig MD 3.00 X 0 0 0 Sister Margaret Welch 6.50 X 0 0 0 Janeanne Lubin-Szafranski 40.00 X X 0 406168 131241 Alan Kliger MD 40.00 X 0 609368 215761 Lawrence E McManus 40.00 X 0 704640 219781 James Rude 40.00 X 219080 0 62821 Joseph Bisson 40.00 X 0 244275 111940 Russ Braun MD 40.00 X 0 544457 78719 John Burke 40.00 X 0 317960 97862 Elizabeth Conrad 40.00 X 0 342760 116628 Thomas DonahueMD 40.00 X 0 465762 131788 Peter Duffy 40.00 X 0 265818 94172 John Fitzgerald 40.00 X 214839 0 51973 Sister Joan Granville 20.00 X 0 257685 71731 W Scott Helton MD 0.00 X 0 161091 3670 Gary J Kaml MD 40.00 X 430419 0 19583 Mary Kuncas 40.00 X 0 332835 100615 Marshal Mandelkern MD 40.00 X 0 347184 79764 Kim Samele 40.00 X 0 182908 43179 Howard Shaw MD 40.00 X 0 344738 57212 Lucinda VonBeren 40.00 X 0 301785 101675 Andre Ghantous MD 40.00 X 493397 0 18946 John Federico MD 40.00 X 533228 0 18325 Donald Kim MD 40.00 X 472379 0 18651 Ernest Moritz MD 40.00 X 362030 0 21130 Samuel Hahn MD 40.00 X 509333 0 18438 Benedict Fernando MD 0.00 X 73419 0 0 Charles Hollander MD 0.00 X 0 209251 0 David W Benfer 0.00 X 0 193261 0 4122188 7191523 2278318 469 1 1 0 Cardinal Health 21377 Network Place Chicago IL 60673 Management 20450068 Rhode Island Blood Center PO Box 9399 Providence RI 02940 Medical 4283811 Morrison Management PO Box 102289 Atlanta GA 30368 Dietary 3728856 Yale University PO Box 208087 New Haven CT 06511 Medical 2485570 Saint Raphael MRI PO Box 9651 New Haven CT 06511 MRI Service 1729674 58 5487195 5487195 Net Patient Services 621500 443953259 440574125 3379134 443953259 312483 312483 900000 919185 -19185 -19185 -19185 Physician Premiums 524298 2232000 2232000 Yankee Alliance 561499 519996 519996 Auxiliary 453220 -65993 -65993 18488305 18488305 21174308 470908060 458996437 6131130 293298 5346102 1202206 4143896 212540205 190222234 22317971 5061321 4446633 614688 34270635 30108533 4162102 15657462 13755894 1901568 228721 200943 27778 600637 527691 72946 386134 339239 46895 2463 2164 299 28170961 24749652 3421309 961455 844688 116767 87596781 76958323 10638458 6307675 5541620 766055 11755712 10328004 1427708 690381 606536 83845 671841 590247 81594 2279689 2002825 276864 13175681 11575520 1600161 4471143 3928131 543012 Pharmacy 18591441 18591441 Bad debts - net 13531774 13531774 Malpractice Insurance 5592278 5592278 Red Cross charges 3586206 3586206 1463661 1463661 472940359 420696443 52243916 0 26894270 93375248 42793002 25007422 2253020 16289043 7423719 6898002 49580 0 91355080 43743670 556963 41651039 24189707 14035503 1092545 277047305 160560508 61485997 48321015 660619 261404960 100738326 323551576 149059341 X -77285560 -6517301 19690868 10301495 11090421 7716973 -46504271 11501167 277047305 160560508 X -2032299 60037737 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 109600 1 7012 0 1 2709 119321 0 Explanation of Lobbying Activities: Part II-B, Line 1: The majority of lobbying by Saint Raphael employees takes place at the state and federal levels. During fiscal 2012, state law required Saint Raphael to register as a state lobbyist as well (as its Chief Executive Officer, its Chief Financial Officer, the Executive Director of Saint Regis Health Center and its Director of Community and Government Relations). These four individuals met with elected officials, sent correspondence, and educated the Saint Raphael community about proposed legislation. Occasionally, other Saint Raphael employees may be asked to write to their legislators about proposed healthcare legislation. These combined efforts constitue Saint Raphael's direct lobbying efforts. Other lobbying activites include: dues paid to a national coalition to influence Medicare reimbursement; background and research work completed by Saint Raphael employees and a legal firm concerning a variety of federal issues; and a lobbying contract with a federal lobbying firm. The Hospital is also a member of several trade associations, and periodically participates in their lobbying efforts since a portion of the dues paid to these groups (American Hospital Association, Catholic Health Association, Association of American Medical Colleges, Premier, Connecticut Hospital Association, and Connecticut Catholic Hospital Council) may be used for lobbying efforts. 3446673 557390 4004063 3431456 15217 3446673 3122933 308523 3431456 3173968 -51035 3122933 1.00000 0 0 0 Cash 1125555 F Money Market Funds 9401688 F CD's and Other 13662464 F 24189707 Post retirement Medical Costs 1608486 Accrued Pension - Defined Benefit Plan 99128041 Self Insurance - Workers Compensation 1799 100738326 Footnote to financial statements that reports the organization's liability for uncertain tax positions under FIN 48: Based on status of tax matters as of September 30, 2011, there were no disclosures in the footnotes to the organization's financial statements related to uncertain tax positions under FIN 48. 1 1 1 X 250.000000000000 1 X 1 1 1 0 1 1 1108 787194 787194 0.00170 83080 68513648 53750182 14763466 0.03120 84188 69300842 53750182 15550660 0.03290 6 6447 219567 5522 214045 0.00050 4 1570 39424067 25715162 13708905 0.02900 2 9071 11905214 12033908 -128694 0.00000 1 0 2869 2869 0.00000 2 3571 144712 144712 0.00030 15 20659 51696429 37754592 13941837 0.02980 15 104847 120997271 91504774 29492497 0.06270 1 19337 19337 0.00000 1 628 1931 1931 0.00000 1 40 1334 1334 0.00000 1 9042 9042 0.00000 4 668 31644 31644 1 4755065 2848759 180638638 214072521 -33433883 X 1 1 1 CT CK Leasing LLC Cyberkife stereotactic radiosurgery system. 0.49090 0.13640 2 Health CT LLC Provides comprehensive health care through hospital provider network. 0.15800 3 Yankee Alliance LLC Hospital supply chain management. 0.11110 1 1 Hospital of Saint Raphael

1450 Chapel Street New Haven CT 06511

X X X X NA 1 1 1 250.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X X 1 X X X X 1 X X X X X X X X 1 X 0 0 Part II: The Hospital of Saint Raphael's community building activities include: the HOPE Program which provides basic job skills training to members of the community in order to assist them in finding employment and improving their overall quality of life; Disaster Preparedness - the Disaster Preparedness Committee works with local agencies (police, fire, etc.) to coordinate activities and prepare our staff in the event that a local disaster would occur; the maintenance of two Hospital parks and an "adopted" site within the neighborhood for community use; and periodic street patrols within the neighborhood promoting security and safety. Part III, Line 4: The Hospital is committed to the community by providing services to the poor and the medically underserved, as well as providing benefits to the broader community. Focused on providing nondiscriminatory treatment of all patients, the Hospital fosters universal access to emergency care regardless of ability to pay. The Hospital grants credit without collateral to its patients, most of who are local residents and are insured under third-party payer arrangements. Services provided to the poor and the medically underserved include services provided to persons who cannot afford healthcare due to lack of resources, lack of insurance, or both. The Hospital considers care provided for which no payment was received from the patient or their insurer as uncompensated care. Uncompensated care is composed of free care provided, charity care provided, and bad debt expense. The Hospital makes available free care and financial assistance programs for qualifying patients. In accordance with established policies, during the registration, billing, and collection processes, a patient's eligibility for free care and financial assistance is determined. For patients who were determined to have the ability to pay but did not, the Hospital provision for uncollectible accounts is bad debt expense. Part III, Line 8: The Medicare shortfall should be considered a part of the community benefit provided by the Hospital. Medicare patients who receive care at the Hospital are primarily local residents. They receive the same quality care as Medicaid and charity care patients.The costs reported on line 6 were estimated using a cost to charge ratio, which was derived by comparing total routine costs to total charges. Part III, Line 9b: Whenever it is determined that the patient qualifies for Charity Care, a Patient Accounts Representative will adjust the balance by the appropriate amount, and the residual balance (if any) will become the patient's responsibility. N/A Part V, Section B, Line 19d: A patient's annual family income must be greater than 250% and is less than or equal to 400% of the current year's Federal Poverty Guidelines in order to be eligible for partial financial assistance. Partial financial assistance means the patient will be charged only the cost of services rather than the hospital's published charges. Part VI, Line 2: The Hospital of Saint Raphael community benefit programs have been designed to meet the long standing needs of individuals living in our services area. The Hospital utilizes data from local, regional, state, and federal resources to develop and expand our community benefit program. Examples of these informational sources include Connecticut Department of Public Health - 2009 Connecticut Health Disparities Report, CDC Behavioral Risk Factors Surveillance System, DATA Haven of South Central CT - Community Data Well Being Indicators, and the Community Alliance for Research and Engagement at the School of Public Health- Yale University /2009 CARE Neighborhood Health Survey Results. Part VI, Line 3: The Hospital of Saint Raphael is committed to providing quality healthcare that is affordable and accessible to all, regardless of their ability to pay. To ensure that cost will not be a barrier to our community, we provide financial assistance coordinators who work closely with our patients to apply for eligible financial assistance programs, including assistance from our charitable resources. In addition there are brochures and signage in two languages indicating that financial assistance is available to qualified patients and their families. Part VI, Line 4: The Hospital of Saint Raphael is a 511-bed community teaching hospital located in New Haven. The Hospital of Saint Raphael's Service Area consists of the 22 towns which surround New Haven. The Service Area has a population of approximately 863,000. Average household income for the entire service area in 2012 was determined to be approximately $63,000. The City of New Haven demographics include a population of approximately 131,000 in 49,000 households. Average household income approximates $39,000 and per capita income approximates $23,000. Part VI, Line 5: In addition to the community building activities identified in Part VI, line 5 and the quantified free or discounted health services identified in Part I, Charity Care and Certain Other Community Benefits at Cost, the Hospital of Saint Raphael provides the following community benefits: Community Health Improvement Services - provides free and discounted services, such as screenings, lectures, health fairs, support groups, consultations, and referrals to outside agencies, aimed toward improving the health of the community; Health Professions Education - in addition to our medical interns and residents program, we provide a training site for high school and college students who are interested in pursing other degrees within the medical industry; and Financial and In-Kind Contributions - we financially support other community organizations through sponsorships and in-kind donations via time spent by staff volunteering in the community. Part VI, Line 6: Saint Raphael Healthcare System affiliated organizations include Saint Regis Nursing Home, Inc., d/b/a The Sister Anne Virginie Grimes Health Center and DePaul Health Services Corporation, both of which operate healthcare organizations that complement the care given at the Hospital of Saint Raphael. Our healthcare providing organizations are supported through the fund raising efforts of The Saint Raphael Foundation, Inc., the One for All Fund, and the Saint Raphael Auxiliary. These affiliated organizations share the Hospital's mission to witness, share in, and promote excellence in the healing ministry of Jesus Christ. The Saint Raphael Healthcare System and its affiliates are committed to preserving the dignity and well-being of each individual, and assuring that every person is treated according to the principles of charity and justice. Reports Filed With States Part VI, Line 7 CT X X X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 James Farmer MD 0 0 0 0 403872 0 0 0 0 0 403872 0 0 0 W Bruce Lundberg MD 0 0 0 0 276832 0 0 0 0 0 276832 0 0 0 Christopher M O'Connor 0 661339 0 270000 0 28238 0 370442 0 22271 0 1352290 0 270000 Janeanne Lubin-Szafranski 0 298893 0 61530 0 45745 0 111662 0 19579 0 537409 0 61530 Alan Kliger MD 0 461763 0 130000 0 17605 0 199305 0 16456 0 825129 0 130000 Lawrence E McManus 0 458902 0 175000 0 70738 0 199305 0 20476 0 924421 0 175000 James Rude 198320 0 20157 0 603 0 45354 0 17467 0 281901 0 20157 0 Joseph Bisson 0 242761 0 0 0 1514 0 91464 0 20476 0 356215 0 0 Russ Braun MD 0 387440 0 0 0 157017 0 58765 0 19954 0 623176 0 0 John Burke 0 256540 0 35002 0 26418 0 95275 0 2587 0 415822 0 35002 Elizabeth Conrad 0 258051 0 53550 0 31159 0 97180 0 19448 0 459388 0 53550 Thomas DonahueMD 0 462902 0 0 0 2860 0 106313 0 25475 0 597550 0 0 Peter Duffy 0 198729 0 39139 0 27950 0 75049 0 19123 0 359990 0 39139 John Fitzgerald 194152 0 19570 0 1117 0 44033 0 7940 0 266812 0 19570 0 Sister Joan Granville 0 171631 0 31700 0 54354 0 64431 0 7300 0 329416 0 31700 W Scott Helton MD 0 55970 0 75000 0 30121 0 0 0 3670 0 164761 0 75000 Gary J Kaml MD 430239 0 0 0 180 0 0 0 19583 0 450002 0 0 0 Mary Kuncas 0 245453 0 45124 0 42258 0 91716 0 8899 0 433450 0 45124 Marshal Mandelkern MD 0 263422 0 51675 0 32087 0 60255 0 19509 0 426948 0 51675 Kim Samele 0 182589 0 0 0 319 0 34279 0 8900 0 226087 0 0 Howard Shaw MD 0 342509 0 0 0 2229 0 54506 0 2706 0 401950 0 0 Lucinda VonBeren 0 228250 0 47250 0 26285 0 85748 0 15927 0 403460 0 47250 Andre Ghantous MD 492977 0 0 0 420 0 0 0 18946 0 512343 0 0 0 John Federico MD 439366 0 93448 0 414 0 0 0 18325 0 551553 0 0 0 Donald Kim MD 348154 0 123905 0 320 0 0 0 18651 0 491030 0 0 0 Ernest Moritz MD 352892 0 7700 0 1438 0 0 0 21130 0 383160 0 0 0 Samuel Hahn MD 506753 0 2400 0 180 0 0 0 18438 0 527771 0 0 0 Benedict Fernando MD 0 0 0 0 73419 0 0 0 0 0 73419 0 0 0 Charles Hollander MD 0 204976 0 0 0 4275 0 0 0 0 0 209251 0 0 David W Benfer 0 47306 0 0 0 145955 0 0 0 0 0 193261 0 0 Part I, Line 1a Taxable housing and automobile allowances are provided to Christopher M. O'Connor (Saint Raphael Healthcare System, Inc. Chief Executive Officer through 9/11/12) under the terms of the individual's employment contract. Taxable housing and automobile allowances are provided to Lawrence E. McManus (Saint Raphael Healthcare System, Inc. Chief Operating Officer and Chief Financial Officer through 4/4/12) under the terms of the individual's employment contract. In addition, reimbursements (non-taxable) are made for the business use of a social club. Taxable automobile allowance is provided to Janeanne Lubin-Szafranski (Saint Raphael Healthcare System, Inc. Chief Executive Officer effective 9/12/12) under the terms of the individual's employment contract. Taxable housing and automobile allowances are provided to John Burke (Saint Raphael's Chief Information Officer through 9/11/12) under the terms of the individual's employment contract. Taxable automobile allowances are provided to other vice-president level executives under the terms of the individual's employment contract. Part I, Line 4b Certain Saint Raphael executives were eligible to participate in a supplemental non-qualified retirement plan through a date in calendar year 2010. During calendar year 2011 no provision was made for participation in such plan. Vested amounts are reported as a component of the value reported in Schedule J Part II Column B (iii) "Other Reportable Compensation" for the following individuals- Lawrence E. McManus ($41,578), Alan Kliger, MD ($8), Janeanne Lubin-Szafranski ($34,659), Elizabeth Conrad ($22,644), Peter Duffy ($19,895), Sister Joan Granville ($42,390), Mary Kuncas ($31,608), Marshall Mandelkern, MD ($25,241), Lucinda VonBeren ($16,283). Part I, Line 7 Certain Saint Raphael executives are eligible to earn incentive compensation based upon the achievement of Board of Trustee's- approved metrics. During calendar year 2011 payments were made for incentives related to fiscal year ended September 30, 2010 and are reported in Schedule J Part II Column B (ii) "Bonus and Incentive Compensation". During fiscal year 2011 provision was made for incentives related to the fiscal year ended September 30, 2011; such provision is reported in Schedule J as a component of Part II Column C "Deferred Compensation" for the following individuals- Christopher M. O'Connor ($370,442), Lawrence E. McManus ($199,305), Alan Kliger, MD ($199,305), Janeanne Lubin-Szafranski ($111,662), James Rude ($45,354), Joseph Bisson ($91,464), Russ Braun, MD ($58,765), John Burke ($95,275), Elizabeth Conrad ($97,180), Thomas Donohue, MD ($106,313), Peter Duffy ($75,049), John Fitzgerald ($44,033), Sister Joan Granville ($64,431), Mary Kuncas ($91,716), Marshall Mandelkern, MD ($60,255), Kim Samele ($34,279), Howard Shaw, MD ($54,508), Lucinda VonBeren ($85,748). Certain Hospital of Saint Raphael physician caregivers are eligible to earn incentive compensation based upon the achievement of approved productivity metrics. During calendar year 2011 payments were made for such incentives as reported in Schedule J Part II Column B (ii) "Bonus and Incentive Compensation" for the physician caregivers and amounts identified. Cash 2012-09-12 3400000 Net Book Value as of 09/11/12 060646652 Yale-New Haven Hospital 20 York Street New Haven CT 06504 501(3)c Inventory 2012-09-12 7426862 Net Book Value as of 09/11/12 060646652 Yale-New Haven Hospital 20 York Street New Haven CT 06504 501(3)c Land 2012-09-12 985500 Net Book Value as of 09/11/12 060646652 Yale-New Haven Hospital 20 York Street New Haven CT 06504 501(3)c Property, Plant and Equipment 2012-09-12 85287614 Net Book Value as of 09/11/12 060646652 Yale-New Haven Hospital 20 York Street New Haven CT 06504 501(3)c Investment - Cyberknife Partnership 2012-09-12 226821 Net Book Value as of 09/11/12 060646652 Yale-New Haven Hospital 20 York Street New Haven CT 06504 501(3)c Lukan Indemnity Co. Assets 2012-09-12 33787352 Net Book Value as of 09/11/12 060646652 Yale-New Haven Hospital 20 York Street New Haven CT 06504 501(3)c Net Due From Third Parties 2012-09-12 2360882 Net Book Value as of 09/11/12 060646652 Yale-New Haven Hospital 20 York Street New Haven CT 06504 501(3)c 1 1 0 1 Part II, Line 2e: Part 1 Line 2a. Vincent Calarco, Linda Masci, Sister Rosemary Moynihan and James Torgerson (Saint Raphael Healthcare System, Inc. trustees through September 11, 2012) have become trustees of the transferee organization as of September 12, 2012.Part I Line 2b. Christopher M. O'Connor, Alan Kliger MD, Thomas Donohue MD, Marshall Mandelkern MD, Howard Shaw MD, Lucinda VonBeren, Andre Ghantous MD, John Federico MD, Donald Kim MD, Ernest Moritz MD, and Samuel Hahn MD became employees of the transferee organization as of September 12, 2012.Part I Line 2d. Christopher M. O'Connor, Lawrence E. McManus, Janeanne Lubin-Szafranski, Joe Bisson, John Burke, Elizabeth Conrad, Peter Duffy, Sister Joan Granville, Mary Kuncas, Kim Samele, Lucinda VonBeren, John Fitzgerald and James Rude received Board of Trustee's approved retention payments for continuous employment through September 11, 2012 from Saint Raphael's. Changes in Program Services Form 990, Part III, line 3 Effective as of 12:01am September 12, 2012, the majority of the assets and the operations of the Hospital of Saint Raphael were sold to Yale-New Haven Hospital (a 966-bed not-for-profit hospital located in New Haven, Connecticut) and its parent company (Yale-New Haven Health Services Corporation), and active operations ceased. The company remains in existence to wind-up corporate affairs, which includes the collection of outstanding accounts receivable and the payment of outstanding accounts payable & accrued expenses as of September 30, 2012. Wind-up activities for Hospital of Saint Raphael also include the disposition of temporarily and permanently restricted net assets pending transfer as of September 30, 2012. The Attorney General of the State of Connecticut must review all restrictions on these net assets, with a cy-pres action in Connecticut Superior Court probable for some of these restricted amounts. While the expectation is that these funds will ultimately transition to Yale-New Haven Hospital, it is possible that some of these funds could be directed to another charity. Form 990, Part VI, Section A, line 6 Hospital of Saint Raphael is a membership corporation and the sole Member of the Hospital is the Saint Raphael Healthcare System, Inc. Form 990, Part VI, Section A, line 7a Saint Raphael Healthcare System, Inc. is the sole Member of the Hospital of Saint Raphael. Form 990, Part VI, Section A, line 7b The following rights and powers are reserved to the Membership of the Hospital's sole Member: >To acquire, alienate or convey the real property or endowment funds of the Hospital having a value of $3,000,000 or more, or to place a mortgage on such property or funds in the amount of $3,000,000 or more. >To dispose of all or substantially all of the physical assets of the Hospital and to approve the merger or consolidation of the Hospital. >To borrow money and issue evidences of indebtedness in connection with the activities of the Hospital in the amount $3,000,000 or more, if such borrowings are to secured by mortgage, pledge or other lien on the Hospital's real property or endowment funds. >To organize or direct the organization of any corporation or other entity in which the Hospital will be a member or shareholder or have an equity interest greater than $1,000,000. >To dispose of stock or other equity interest of a corporation or other entity controlled by the Hospital. >To elect the Trustees of the Hospital who do not serve in an ex officio capacity. >To fill any vacancy occurring on the Board of Trustees, other than ex officio positions. >To amend the Certificate of Incorporation and Bylaws of the Hospital. >To appoint or remove the President of the Hospital. >To exercise any right specifically reserved to them in the certificate of incorporation of a subsidiary corporation controlled by the Hospital. Form 990, Part VI, Section B, line 11 The governing body reviewed key elements of the 990 prior to submission. Form 990, Part VI, Section B, line 12c Officers, trustees and key employees are required to complete the conflict of interest questionaire on an annual basis. Results of the questionaire are reviewed annually by the audit committee. Form 990, Part VI, Section B, line 15 Compensation of the organization's chief executive officer is determined by the Compensation Committee of the Board of Trustees (utilizing an independent compensation consultant in conjunction with a compensation survey of the relevant marketplace). The Compensation Committee maintains minutes of its meetings. The Chief Executive Officer is employed with a written employment contract. Compensation of the organization's other officers and most of its key employees are also determined by the Compensation Committee of the Board of Trustees (utilizing an independent compensation consultant in conjunction with a compensation survey of the relevant marketplace). The Compensation Committee maintains minutes of its meetings. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 695617. Net equity transfers to affiliates 5487848. Contributions restricted to Special Purpose Fund 3433484. Gains on restricted Net Assets 484659. Net assets released from restriction -5728047. Change in interest in net assets of Saint Raphael Foundation, Inc. -9254665. Decrease in Minimum Pension Liability 45266000. Debt Defeasance -6878725. Transfer of Caritas investment 4683496. Gain on affiliation transaction 21848070. Total to Form 990, Part XI, Line 5: 60037737. Form 990, Part VII, Line 1a, Column E Amounts reported for James Carolan reflect payments made to Withers Bergman, LLC in the normal and recurring course of Hospital of Saint Raphael business and are not related to the volunteer services provided by the trustee to the organization. Amounts reported for Ralph DeNatale, MD reflect payments made to Connecticut Vascular Center ($35,200) and the individual physician ($90,833). Certain of the amounts reported for the individual physician reflect payments made as a stipend for his role as President of the Hospital of Saint Raphael Medical Staff (responsibilities include participation as a Hospital trustee). Other payments made in the normal and recurring course of Hospital of Saint Raphael business. Amounts reported for James Farmer, MD reflect payments made to Anesthesia Associates in the normal and recurring course of Hospital of Saint Raphael business and are not related to the volunteer services provided by the trustee to the organization. Amounts reported for W. Bruce Lundberg, MD reflect payments made to Medical Oncology and Hematology in the normal and recurring course of Hospital of Saint Raphael business and are not related to the volunteer services provided by the trustee to the organization. Amounts reported for Benedict Fernando, MD include payments made to West Haven Medical Group as a stipend for his role as President of the Hospital of Saint Raphael Medical Staff (responsibilities include participation as a Hospital trustee). Other payments made in the normal and recurring course of Hospital of Saint Raphael business. Lukan Indemnity Co Ltd FB Perry Building 40 Church Street Hamilton Hamilton BD 060653171 Direct and reinsurance malpractice BD 3454859 0 Saint Raphael Healthcare System Inc 200 Orchard Street Suite 204 New Haven CT 06511 061157542 Tax exempt holding company CT 501 (c) 3 11a 0 Caritas Insurance Company LTD 30 Main Street Suite 330 Burlington VT 05401 030322238 Insurance VT 501 (c) 3 11a Hospital of Saint Raphael 0 Saint Raphael Foundation Inc 200 Orchard Street Suite 204 New Haven CT 06511 510140710 Fundraising Foundation CT 501 (c) 3 11a Saint Raphael Healthcare System Inc 0 Saint Regis Health Center Inc 200 Orchard Street Suite 204 New Haven CT 06511 061217867 Skilled Nursing Facility CT 501 (c) 3 3 Saint Raphael Healthcare System Inc 0 DePaul Health Services Corp 200 Orchard Street Suite 204 New Haven CT 06511 061157544 Tax exempt holding company CT 501 (c) 3 11a Saint Raphael Healthcare System Inc 0 Hospital of Saint Raphael One for All Fund 200 Orchard Street Suite 204 New Haven CT 06511 222505062 Fundraising Organization CT 501 (c) 3 11a Hospital of Saint Raphael 0 VNA Services Inc 200 Orchard Street Suite 204 New Haven CT 06511 060646709 Provision of healthcare services to patients in their homes CT 501 (c) 3 9 DePaul Health Services Corporation 0 Saint Raphael Healthcare System Affiliated Physicians Inc 200 Orchard Street Suite 204 New Haven CT 06511 800522532 Medical Foundation CT 501 (c) 3 11a Saint Raphael Healthcare System Inc 0 0 1 1 0 0 0 0 0 1 1 1 1 0 0 0 0 0 1 Saint Raphael Healthcare System Inc L 2203409 Cost Basis Saint Raphael Healthcare System Inc I 23702 FMV of Services Saint Raphael Healthcare System Inc C 1385000 Cash Value Saint Raphael Healthcare System Inc B 2748515 Cash Value Caritas Insurance Company LTD L 1422131 FMV of Services Saint Raphael Foundation Inc C 7810332 Cash Value Saint Regis Health Center Inc I 28402 FMV of Services Saint Regis Health Center Inc K 1421988 FMV of Services Saint Regis Health Center Inc J 17041 FMV of Services Saint Regis Health Center Inc B 240847 Cost Basis VNA Services Inc R 654665 FMV of Property Saint Raphael Healthcare System Affiliated Physicians Inc K 8108908 FMV of Services Caritas Insurance Company LTD C 1500000 Cash Value