2012-08-09T06:32:46-05:00 2011-09-30 SASLOW LUFKIN & BUGGY LLP TEN TOWER LANE AVON CT 06001 990 2010-10-01 060646678 THE CHARLOTTE HUNGERFORD HOSPITAL CHAR 8604966728 540 LITCHFIELD STREET PO BOX 988 TORRINGTON CT 067900988 SUSAN M SCHAPP 8604966728 2012-08-01 1 BETH THURZ 8606789200 2010 2016-02-24 21:20:13Z SUSAN M SCHAPP 540 LITCHFIELD STREET PO BOX 988 TORRINGTON CT 067900988 123412885 0 X WWW.CHARLOTTESWEB.HUNGERFORD.ORG X 1917 CT TO PROVIDE QUALITY, COMPASSIONATE AND COST EFFECTIVE HEALTHCARE TO THE COMMUNITY OF NORTHWESTERN CONNECTICUT. 15 15 1091 170 1852626 -73576 3509677 3090679 105888350 111675220 2066888 1535589 607983 481119 112072898 116782607 12000 12000 0 0 65975270 69100340 0 0 408098 43904798 44844632 109892068 113956972 2180830 2825635 117822296 118964048 59139886 52846422 58682410 66117626 X THE CHARLOTTE HUNGERFORD HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY COEXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGAMS FOR THE ELDERLY, HANDICAPPED, THE MEDICALLY UNDERSERVED AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. 0 0 104362471 12000 110099324 DURING FY 2011 THE HOSPITAL CONTRIBUTED OVER 17,000 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTHCARE NEEDS OF THE COMMUNITY. THE VALUE OF THIS CONTRIBUTION IS APPROXIMATELY $141,000, WHICH IS GIVEN BACK TO THE COMMUNITY THOUGH LOWER COSTS IN BOTH PATIENT SERVICES AND OTHER "WELLNESS" PROGRAMS. IN ADDITION THE HOSPITAL GRANTED CHARITY CARE IN THE AMOUNT OF $1,726,098 DURING FISCAL YEAR 2011. THE CHARLOTTE HUNGERFORD HOSPITAL RENDERED THE FOLLOWING SERVICES DURING FY 2011:INPATIENT SERVICES:DISCHARGES 6,512PATIENT DAYS 27,425 SPECIAL SERVICES: OPERATING ROOM CASES 4,025 AMBULATORY SURGERY CASES 3,244 ENDOSCOPY CASES 951 AMBULATORY MEDICAL CASES 2,790 POST ANESTHESIA CARE UNIT CASES 2,503 DELIVERY ROOM DELIVERIES 367RESPIRATORY THERAPY TREATMENTS 39,353 PULMONARY REHAB TESTS 4,329PULMONARY FUNCTION LAB TESTS 1,745 CARDIO DIAGNOSTIC EXAMS 13,440EEG EXAMS 2,060PHYSICAL THERAPY TREATMENTS 27,403 CARDIAC REHAB TREATMENTS 3,381 SPEECH THERAPY TREATMENTS 568 OCCUPATIONAL THERAPY TREATMENTS 3,468 SLEEP STUDY TESTS 641 DIAGNOSTIC RADIOLOGY EXAMS 30,404 MAMMOGRAPHY EXAMS 9,595 NUCLEAR MEDICINE EXAMS 1,181 ULTRASOUND EXAMS 8,805 C.A.T. SCAN EXAMS 12,918 P.E.T. SCAN EXAMS 57 M.R.I. EXAMS 957 SPECIAL PROCEDURES (RADIOLOGY) EXAMS 1,259 RADIATION THERAPY TREATMENTS 8,175 LABORATORY TESTS 647,799 PSYCHIATRIC CLINIC VISITS 35,193 PHP-ADULT/ADOLESCENT VISITS 4,618 RENAL DIALYSIS VISITS 360 EMERGENCY DEPARTMENT VISITS 33,109 EMERGENCY DEPARTMENT PHYSICIAN VISITS 4,836 OUTPATIENT DIABETES PROGRAM VISITS 1,556 WALK IN CENTER BLOOD DRAWING VISITS 825 WALK IN CENTER VISITS 11,961 HOSPITALIST CONSULTS 18,756WINSTED HEALTH CENTER: CARDIAC REHAB TREATMENTS 1,441 DIAGNOSTIC RADIOLOGY EXAMS 4,090 LABORATORY TESTS 21,104 EMERGENCY DEPARTMENT VISITS 6,426 EMERGENCY DEPARTMENT PHYSICIAN VISITS 576 PULMONARY REHAB TESTS 2,095 104362471 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 201 0 1 1091 1 1 1 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X SUSAN M SCHAPP 8604966728 540 LITCHFIELD STREET TORRINGTON CT 06790 EDWARD ARUM 2.50 X 0 0 0 RICHARD DUTTON MD 1.00 X 0 0 0 GLADYS CERRUTO 1.00 X 0 0 0 DAVID J FRAUENHOFER 1.00 X X 0 0 0 JAMIE GREG 1.00 X 0 0 0 PAUL GROSSMAN 1.00 X 0 0 0 KENDRICK HOM MD 1.00 X 0 0 0 JOHN JANCO 2.50 X X 0 0 0 NANCY SULLIVAN HODKOSKI 1.00 X 0 0 0 JOHN LAVIERI 2.50 X X 0 0 0 DIANE LIBBY CPA 1.00 X 0 0 0 MARVIN MASKOVSKY 1.00 X 0 0 0 JAMES O'LEARY 1.00 X 0 0 0 CHARLES W RORABACK 1.00 X 0 0 0 ALFRED J FINN MD 1.00 X 0 0 0 DANIEL J MCINTYRE 60.00 X 361716 0 88408 SUSAN M SCHAPP 60.00 X 155580 0 35604 JOHN J CAPOBIANCO 60.00 X 196967 0 41939 MARK PRETE MD 60.00 X 317143 0 113323 RAYMOND J ELLIOTT 60.00 X 167462 0 53487 STEVEN SINGER MD 60.00 X 265613 0 63987 ELZBIETA LACH-PASKO MD 60.00 X 396162 0 56773 ROBERTA MELTZER MD 60.00 X 185417 0 59974 WILLIAM POLITO MD 60.00 X 248264 0 50606 ASHOK DUBEY MD 60.00 X 262659 0 27404 MUSTAFA UGURLU MD 60.00 X 307766 0 37229 TIMOTHY GOSTKOWSKI MD 60.00 X 432715 0 45147 RAHUL MAGAVI MD 60.00 X 219986 0 25472 3517450 0 699353 62 0 1 0 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINEAPOLIS MN 554809146 LABORATORY TESTS 1220602 PORTAL HEALTHCARE SOLUTIONS LLC 5885 TRINITY PARKWAY SUITE 210 CENTERVILLE VA 20120 TRANSCRIPTION SERVICES 440034 NWCT EMERGENCY SERVICES 80 S MAIN STREET WEST HARTFORD CT 06107 MEDICAL 433682 NEW MILFORD LAUNDRY 40 COMMONS COURT WATERBURY CT 06704 LAUNDRY/LINEN SERVICES 423332 O'BRIEN TANSKI & YOUNG LLP CITY PLACE II ASYLUM STREET HARTFORD CT 061033402 LEGAL 379161 27 40333 2179225 871121 3090679 NET PATIENT REVENUE 900099 96917507 96917507 LABORATORY SERVICES 621500 12662210 10792223 1869987 OTHER HOSPITAL SERVICE 900099 2095503 2095503 111675220 962023 962023 678361 384270 294091 294091 294091 6727788 6150851 3371 576937 -3371 573566 573566 84460 40333 26960 57500 57500 102657 64826 37831 37831 GAIN FROM EQUITY METHO 900001 109058 109058 MEDCONN 561499 -17361 -17361 91697 116782607 110099324 1852626 1739978 12000 12000 2366975 1775231 591744 50920700 47054740 3668749 197211 6298777 5771862 503604 23311 5924465 5428862 473677 21926 3589423 3289155 286984 13284 1489460 1364862 119086 5512 341697 313112 27320 1265 122256 112029 9775 452 9622651 8817682 769357 35612 599251 549121 47912 2218 392716 359864 31399 1453 1392657 1276156 111347 5154 2184180 2001466 174631 8083 164123 150394 13122 607 308286 282497 24648 1141 6178081 5661263 493954 22864 2375290 2176588 189911 8791 SUPPLIES 16000092 14661628 1279250 59214 PROVISION FOR BAD DEBT 2129955 2129955 PHYSICIAN FEES 1479732 1109799 369933 HOSPITAL AUXILIARY EXPE 64205 64205 113956972 104362471 9186403 408098 4615 35278 5577511 8542940 282069 169438 9573985 11144539 1902704 2009008 1678690 1051648 142473071 102496652 41562230 39976419 54362578 51701434 2877914 4333344 117822296 118964048 7460667 8948843 128582 3475000 2355000 3880641 3610528 44323578 37803469 59139886 52846422 X 39309707 47173941 3000453 2830655 16372250 16113030 58682410 66117626 117822296 118964048 X 2825635 4609581 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL PAID DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION. SOME PORTION OF THESE DUES MAY HAVE BEEN USED FOR LOBBYING EXPENSES ON BEHALF OF ITS' MEMBERS. 49273746 186977 -2264127 266780 46929816 45533758 690138 3824302 774452 49273746 47240328 1043719 -1532480 1217809 45533758 0.59680 0.34330 0.05990 0 0 155467 155467 77970871 47969112 30001759 58753563 50349826 8403737 5593170 4177714 1415456 39976419 INVESTMENTS HELD IN TRUST FOR ESTIMATED SELF-INSURANCE LIABILITIES 3726581 F UNDER BOND INDENTURE AGREEMENT-HELD BY OTHERS 288839 F BENEFICIAL INTEREST IN ASSETS HELD IN TRUST BY OTHERS 12360649 F LONG-TERM INVESTMENTS 28762329 F DONOR RESTRICTED ASSETS 6563036 F 51701434 ESTIMATED AMOUNTS DUE TO THIRD PARTY REIMBURSEMENT AGENCIES 1693818 MISCELLANEOUS CURRENT LIABILITIES 91711 ESTIMATED SELF-INSURANCE LIABILITIES 2631693 ACCRUED PENSION LIABILITY 26422971 PENSION CONTRIBUTION - CURRENT PORTION 6963276 37803469 116782607 113956972 2825635 -2203969 6813550 4609581 7435216 116540216 0 116540216 242391 242391 116782607 113880767 0 113880767 76205 76205 113956972 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS WILL BE USED PRIMARILY FOR CAPITAL PURCHASES, INDIGENT CARE AND OTHER USES AS APPROVED BY THE BOARD IN ACCORDANCE WITH DONOR RESTRICTIONS. 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 OF SEPTEMBER 30, 2011 AND 2010. AS OF SEPTEMBER 30, 2011 AND 2010, 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. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS 6,880,330. NET ASSETS RELEASED FROM RESTRICTIONS -266,780. NET ASSETS RELEASED FOR PROPERTY, PLANT & EQUIPMENT 200,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: TEMPORARY RESTRICTED ACTIVITY 175,236. AUXILIARY REVENUE 67,155. PART XIII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 76,205. 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CARDIOVASCULAR PHYSICIANS PRACTICE PART I, LINE 3C: CARE WILL BE PROVIDED FREE FOR THOSE UNINSURED WHO QUALIFY AS UNINSURED AND VERIFICATION HAS DETERMINED THAT THEIR ANNUAL INCOME IS LESS THAN 200% OF THE FEDERAL INCOME POVERTY LEVEL. CARE WILL BE PROVIDED AT HOSPITAL COST, AS ESTABLISHED BY THE OFFICE OF HEALTH CARE ACCESS (OCHA), FOR THOSE UNINSURED PATIENTS WHO REQUEST ASSISTANCE AND VERIFICATION HAS DETERMINED THAT THEIR ANNUAL INCOME IS BETWEEN 200% AND 250% OF THE FPL. CARE WILL BE DISCOUNTED BY 30% FOR THOSE UNISURED PATIENTS WHO REQUEST ASSISTANCE AND VERIFICATION HAS DETERMINED THAT THEIR ANNUAL INCOME IS BETWEEN 250% AND 400% OF THE FPL. THE HOSPITAL WILL ALSO CONSIDER THE TOTAL MEDICAL EXPENSES FACED BY THE FAMILY AND THE FAMILY'S ABILITY TO PAY FOR THOSE EXPENSES, AND WILL CONSIDER OFFERING GREATER ASSISTANCE WHEN POSSIBLE TO THOSE FAMILIES FACING CATASTROPHIC MEDICAL EXPENSES. PART I, LINE 7: A COST TO CHARGE RATIO BASED ON CHARITY CARE CHARGES AND EXPENSES. PART III, LINE 4: THE RATIONALE FOR REPORTING BAD DEBT EXPENSE DIRECTLY FROM THE TRIAL BALANCE IS THAT ACCOUNTS HAVE ALREADY BEEN DISCOUNTED PRIOR TO BEING CLASSIFIED AS A BAD DEBT EXPENSE. PART III, LINE 8: THE REPORTED AMOUNTS FOR MEDICARE REVENUE RECEIVED AND MEDICARE COSTS ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. PART III, LINE 9B: THE HOSPITAL ATTEMPTS TO HAVE INDIVIDUALS FILL OUT ALL PAPER WORK REQUIRED FOR CHARITY CARE. IF THE PERSON IS NOT CAPABLE OF DOING THIS OR IS KNOWN TO BE UNABLE TO DO THIS (SUCH AS A KNOWN HOMELESS PERSON), THEN THE FINANCIAL ASSISTANCE COMMITTEE WILL ADJUST THE ACCOUNT TO CHARITY CARE AND IT WILL NOT BE REPORTED AS BAD DEBT. IF AN ACCOUNT HAS BEEN REPORTED AS BAD DEBT AND INFORMATION COMES FORTH INDICATING AN INABILITY TO PAY, THEN THE ACCOUNT WOULD BE REMOVED FROM BAD DEBT AND MOVED TO CHARITY CARE. CHARLOTTE HUNGERFORD HOSPITAL PART V, SECTION B, LINE 3: A CONSULTANT WAS ENGAGED TO CONDUCT A COMMUNITY PERCEPTION SURVEY. IN ADDITION TO THIS THE MEDICAL STAFF, BOARD OF DIRECTORS, AND EMPLOYEES WERE SURVEYED FOR THEIR INPUT INTO THE PROCESS. HUNGERFORD EMERGENCY MEDICAL CENTER PART V, SECTION B, LINE 3: A CONSULTANT WAS ENGAGED TO CONDUCT A COMMUNITY PERCEPTION SURVEY. IN ADDITION TO THIS THE MEDICAL STAFF, BOARD OF DIRECTORS, AND EMPLOYEES WERE SURVEYED FOR THEIR INPUT INTO THE PROCESS. CHARLOTTE HUNGERFORD HOSPITAL PART V, SECTION B, LINE 5C: IN ADDITION TO THE GENERAL PUBLIC, THE NEEDS ASSESSMENT IS MADE AVAILABLE TO THE MEDICAL STAFF, BOARD OF DIRECTORS, AND EMPLOYEES. HUNGERFORD EMERGENCY MEDICAL CENTER PART V, SECTION B, LINE 5C: IN ADDITION TO THE GENERAL PUBLIC, THE NEEDS ASSESSMENT IS MADE AVAILABLE TO THE MEDICAL STAFF, BOARD OF DIRECTORS, AND EMPLOYEES. CHARLOTTE HUNGERFORD HOSPITAL PART V, SECTION B, LINE 7: NOT ALL NEEDS HAVE BEEN ADDRESSED SINCE THE ASSESSMENT WAS IN YEAR ONE OF A FIVE YEAR PLAN WITH A CONTINUED EFFORT TO REFINE ASSESSMENTS. HUNGERFORD EMERGENCY MEDICAL CENTER PART V, SECTION B, LINE 7: NOT ALL NEEDS HAVE BEEN ADDRESSED SINCE THE ASSESSMENT WAS IN YEAR ONE OF A FIVE YEAR PLAN WITH A CONTINUED EFFORT TO REFINE ASSESSMENTS. CHARLOTTE HUNGERFORD HOSPITAL PART V, SECTION B, LINE 19D: CONNECTICUT STATE LAW (LOONEY BILL) REQUIRES THE HOSPITAL TO ADJUST THE PATIENTS BALANCE EQUAL TO THE COST OF PROVIDING THE CARE. HUNGERFORD EMERGENCY MEDICAL CENTER PART V, SECTION B, LINE 19D: CONNECTICUT STATE LAW (LOONEY BILL) REQUIRES THE HOSPITAL TO ADJUST THE PATIENTS BALANCE EQUAL TO THE COST OF PROVIDING THE CARE. PART VI, LINE 2: THE HOSPITAL OFFERS FREE HEALTH SCREENINGS, FREE HEALTH EDUCATION AND LECTURES AT VARIOUS COMMUNITY EVENTS INCLUDING FAIRS, EXPOS, PRIVATE COMPANIES, PUBLIC MUNICIPALITIES, AND PUBLIC GATHERINGS. THIS HELPS THE COMMUNITY ASSESS THEIR MEDICAL NEEDS. IN ADDITION TO THE ABOVE ITEMS, THE HOSPITAL DISTRIBUTES FREE MEDICAL SUMMARY CARDS WHICH ALLOW PATIENTS TO TRACK THEIR MEDICATIONS. PART VI, LINE 3: THE HOSPITAL COUNSELS ALL SELF PAY PATIENTS EITHER BY MEETING WITH A FINANCIAL COUNSELOR OR IF HE OR SHE IS AN INPATIENT, MEETING WITH A SOCIAL WORKER. ALL STATEMENTS RECEIVED BY PATIENTS INCLUDE FINANCIAL COUNSELING INFORMATION. SIGNS ARE POSTED THROUGHOUT THE HOSPITAL INCLUDING IN THE EMERGENCY ROOM WHICH STATE THE CHARITY CARE POLICIES AND FINANCIAL ASSISTANCE INFORMATION. PART VI, LINE 4: THE CHARLOTTE HUNGERFORD HOSPITAL IS A 109 BED, GENERAL ACUTE CARE HOSPITAL LOCATED IN TORRINGTON, CONNECTICUT, SERVING A TWELVE TOWN PRIMARY SERVICE AREA COMPRISED OF APPROXIMATELY 100,000 PERSONS. PART VI, LINE 6: ALL BOARD OF DIRECTORS MEMBERS RESIDE IN THE COMMUNITY SERVED BY THE CHARLOTTE HUNGERFORD HOSPITAL AND ARE NOT EMPLOYEES OF THE HOSPITAL NOR ARE THEY INDEPENDENT CONTRACTORS DOING BUSINESS WITH THE HOSPITAL. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS WHO APPLY FOR SUCH PRIVILEGES. THE HOSPITAL ESTABLISHES AN ANNUAL CAPITAL BUDGET TO ADD OR REPLACE PATIENT CARE EQUIPMENT AND FACILITIES. MEDICAL EDUCATION IS PROVIDED TO PHYSICIANS THROUGH CONFERENCES ON A MONTHLY BASIS. REPORTS FILED WITH STATES PART VI, LINE 7 CT 1 HEALTHCARE SCHOLARSHIPS 12 12000 OTHER INFORMATION: PART IV: THE CHARLOTTE HUNGERFORD HOSPITAL AUXILIARY AWARDS SCHOLARSHIPS IN THE AMOUNT OF $1,000 EACH TO STUDENTS PURSUING HEALTHCARE EDUCATIONS. THE STUDENTS MUST LIVE IN THE AREA SERVED BY THE HOSPITAL. THEY MUST ALSO PROVIDE EVIDENCE OF HAVING BEEN ACCEPTED INTO A COLLEGE PROGRAM OR THEIR CURRENT GRADES IN COLLEGE. RECIPIENTS OF THE SCHOLARSHIPS MUST SUBMIT LETTERS OF RECOMMENDATION FROM THEIR TEACHERS AND ALSO FROM NON-FAMILY PERSONS. X X X 0 0 0 0 0 0 0 0 0 DANIEL J MCINTYRE 361716 0 0 0 0 0 50669 0 37739 0 450124 0 0 0 SUSAN M SCHAPP 155580 0 0 0 0 0 19372 0 16232 0 191184 0 0 0 JOHN J CAPOBIANCO 196967 0 0 0 0 0 21389 0 20550 0 238906 0 0 0 MARK PRETE MD 317143 0 0 0 0 0 80234 0 33089 0 430466 0 0 0 RAYMOND J ELLIOTT 167462 0 0 0 0 0 36015 0 17472 0 220949 0 0 0 STEVEN SINGER MD 265613 0 0 0 0 0 36275 0 27712 0 329600 0 0 0 ELZBIETA LACH-PASKO MD 396162 0 0 0 0 0 15440 0 41333 0 452935 0 0 0 ROBERTA MELTZER MD 185417 0 0 0 0 0 40629 0 19345 0 245391 0 0 0 WILLIAM POLITO MD 248264 0 0 0 0 0 24704 0 25902 0 298870 0 0 0 ASHOK DUBEY MD 262659 0 0 0 0 0 0 0 27404 0 290063 0 0 0 MUSTAFA UGURLU MD 307766 0 0 0 0 0 5119 0 32110 0 344995 0 0 0 TIMOTHY GOSTKOWSKI MD 432715 0 0 0 0 0 0 0 45147 0 477862 0 0 0 RAHUL MAGAVI MD 219986 0 0 0 0 0 2520 0 22952 0 245458 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS BEFORE IT IS FILED WITH THE IRS. THIS ENABLES THE BOARD TO ASK QUESTIONS, AND TO APPROVE THE DISCLOSURES MADE IN THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY TO ITS BOARD OF DIRECTORS, ALL MANAGEMENT PERSONNEL, AND PURCHASING AGENTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR SENIOR STAFF IS DETERMINED USING THE FOLLOWING STEPS: - A MARKET SURVEY BASED ON CT HOSPITAL ASSOCIATION IS USED AS A STARTING POINT. - ADJUSTMENTS ARE THEN MADE BASED ON THE CANDIDATE'S CURRENT SALARY AND PRIOR EXPERIENCE. - THE COMPENSATION FIGURE IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING POLICIES AVAILABLE TO THE PUBLIC UPON REQUEST. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO THE BOARD OF DIRECTORS, ALL MANAGEMENT PERSONNEL, AND THE PURCHASING AGENTS FOR THE HOSPITAL. AN ANNUAL REPORT OF THE OPERATIONS OF THE HOSPITAL INCLUDING FINANCIAL INFORMATION IS PUBLISHED EACH YEAR AND IS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,203,969. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS 6,880,330. NET ASSETS RELEASED FROM RESTRICTIONS -266,780. NET ASSETS RELEASED FOR PROPERTY, PLANT & EQUIPMENT 200,000. TOTAL TO FORM 990, PART XI, LINE 5: 4,609,581. FORM 990, PART XI, LINE 2C: THE HOSPITAL'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THESE FUNCTIONS AND PROCESSES HAVE NOT CHANGED FROM THE PRIOR YEAR. 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