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Hospital of Saint Raphael: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
Hospital of Saint Raphael (EIN 06-0653171)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-15
IRS object ID
201212289349302591
Schema version
2010v3.4
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)
Timestamp2012-08-15T13:01:44-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN060653171EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Hospital of Saint RaphaelBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOSPNameControl
Phone2037893000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11450 Chapel StreetAddressLine1
CityNew HavenCity
StateCTState
ZIP Code06511ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJames R RudeName
TitleAssist Vice President FinanceTitle
Phone2037893575Phone
Date Signed2012-08-15DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonChristopher M O'ConnorNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11450 Chapel StreetAddressLine1
CityNew HavenCity
StateCTState
ZIP Code06511ZIPCode
FieldValueIRS element (for citing)
Gross Receipts507729136GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitesrhs.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1907YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionNot for Profit HospitalActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees4262TotalNbrEmployees
Total Nbr Volunteers700TotalNbrVolunteers
Total Gross UBI6944566TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3635690ContributionsGrantsPriorYear
Contributions Grants Current Year5555754ContributionsGrantsCurrentYear
Program Service Revenue Prior Year471037065ProgramServiceRevenuePriorYear
Program Service Revenue CY477956801ProgramServiceRevenueCY
Investment Income Prior Year233861InvestmentIncomePriorYear
Investment Income Current Year304901InvestmentIncomeCurrentYear
Other Revenue Prior Year20426376OtherRevenuePriorYear
Other Revenue Current Year22106354OtherRevenueCurrentYear
Total Revenue Prior Year495332992TotalRevenuePriorYear
Total Revenue Current Year505923810TotalRevenueCurrentYear
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 Year280314635SalariesEtcPriorYear
Salaries Etc Current Year284957442SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year215195197OtherExpensePriorYear
Other Expenses Current Year216793388OtherExpensesCurrentYear
Total Expenses Prior Year495509832TotalExpensesPriorYear
Total Expenses Current Year501750830TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-176840RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4172980RevenuesLessExpensesCY
Total Assets BOY283518684TotalAssetsBOY
Total Assets EOY277047305TotalAssetsEOY
Total Liabilities BOY291639962TotalLiabilitiesBOY
Total Liabilities EOY323551576TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-8121278NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-46504271NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense449230975Expense
Revenue493118589Revenue
DescriptionThe 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 23,120, Emergency Room Visits 58,448, Patient days 121,946, Inpatient Surgical Procedures 6,080 and Ambulatory Surgery 9,770.Description
Total Program Service Expense449230975TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
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 Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
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 Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096305NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees4262NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryBDNameOfForeignCountry
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 Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
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 Line1Hospital of Saint Raphael Acctg DepBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2037893505TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11450 Chapel StreetAddressLine1
CityNew HavenCity
StateCTState
ZIP Code06511ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (47 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Vincent Calarco
Volunteer3.30X000
M Joseph Canavan
Volunteer5.00X000
James M Carolan
Volunteer3.00X2444600
Sister Teresa Confroy
Volunteer8.00X000
Ralph DeNatale MD
Volunteer5.00X5082900
James Farmer MD
Volunteer3.00X26666700
Sister Mary Kathleen Flanagan
Volunteer2.50X000
Paul Fortgang MD
Volunteer2.00X000
Rev Bonita Grubbs
Volunteer3.00X000
WBruce Lundberg MD
Volunteer4.00X18750000
Michele Macauda
Volunteer2.00X000
Linda Masci
Volunteer3.00X000
Sister Mary Morley
Volunteer8.50X000
Sister Rosemary Moynihan
volunteer6.00X000
Edward J Mullen
Volunteer1.00X000
Christopher M O'Connor
Chief Executive Officer40.00X0616352290387X
Most Reverend Peter Rosazza
Volunteer1.50X000
Sister Maureen Shaughnessy
Volunteer6.00X000
James P Torgerson
Volunteer2.00X000
Kevin Twohig MD
Volunteer3.00X000
Sister Margaret Welch
Volunteer6.50X000
Alan Kliger MD
Chief Medical Officer40.000673486174437X
Lawrence E McManus
Chief Financial Officer40.000780054220217X
Joseph Bisson
VP, Planning Services40.000963816105X
Russ Braun MD
Chair/Emergency Med40.00020177815186X
John Burke
VP Information Services40.00024920137044X
Elizabeth Conrad
VP, Human Resources40.00028909080976X
Thomas DonahueMD
SEc Chief/Cardiology40.00443583023510X
Peter Duffy
VP, Facility Operations40.00024223264996X
John Fitzgerald
Asst Vice President40.00191291028146X
Sister Joan Granville
VP, Mission Services20.00023735645831X
W Scott Helton MD
Chair/Surgery40.000701271127151X
Mary Kuncas
VP Patient Care Service40.00030715967192X
Janeanne Lubin-Szafranski
VP, General Counsel40.00035219793626X
Marshal Mandelkern MD
Chair/Psychiatry40.00027315579936X
James Rude
Asst Vice President Finance40.00202812038096X
Lucinda VonBeren
VP, Corporate Affairs40.00022871868861X
Andre Ghantous MD
Director/Cardiology40.00531044023312X
John Federico MD
Section Chief/Thoracic40.00429383018191X
Donald Kim MD
Director/SICU40.00432807018510X
Ernest Moritz MD
Associate Chair General Med40.00372883020889X
Samuel Hahn MD
Sec Chief/Cardiology40.0030580909868X
David W Benfer
Former Chief Executive Off0.000184214812166X
Benedict Fernando MD
Former Volunteer0.008253300X
Charles Hollander MD
Former Chief Medical Officer0.00069617714984X
Ronald Thomas MD
Former Chair/Emergency Med40.0002904536906X
Keith Williams MD
Former Chair/OB GYN40.000886321888X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3521587TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs7980827TotalReportableCompFrmRltdOrgs
Total Other Compensation1580418TotalOtherCompensation
Number Individuals GT100 K409NumberIndividualsGT100K
Formers Listed1FormersListed
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
Cardinal Health
21377 Network PlaceChicagoIL60673Management20451204
Morrison Management
PO Box 102289AtlantaGA30368Dietary3533508
Yale University
PO Box 208087New HavenCT06511Medical1844051
Murphy Security Service LLC
PO Box 356New BritainCT06050Security1424783
Saint Raphael MRI
PO Box 9651New HavenCT06511MRI Service1251046
FieldValueIRS element (for citing)
Number Of Contractors GT100 K46NumberOfContractorsGT100K
All Other Contributions5555754AllOtherContributions
Total Contributions5555754TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNet Patient ServicesDescription
Business Code621500BusinessCode
Total Revenue Column477956801TotalRevenueColumn
Related Or Exempt Function Income474305925RelatedOrExemptFunctionIncome
Unrelated Business Revenue3650876UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Program Service Revenue477956801TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column310227TotalRevenueColumn
Exclusion$310,227ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1800000Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1805326Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-5326Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-5326TotalRevenueColumn
Exclusion-$5,326ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Physician Premiums52429823694702369470
Yankee Alliance561499924205924205
Auxiliary453220-5021-5021

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column18817700TotalRevenueColumn
Related Or Exempt Function Income18817685RelatedOrExemptFunctionIncome
Unrelated Business Revenue15UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue22106354TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column505923810TotalRevenueColumn
Related Or Exempt Function Income493118589RelatedOrExemptFunctionIncome
Unrelated Business Revenue6944566UnrelatedBusinessRevenue
Exclusion$304,901ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3689665Total
Program Services3259307ProgramServices
Management And General430358ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total229482194Total
Program Services202715668ProgramServices
Management And General26766526ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3925256Total
Program Services3467419ProgramServices
Management And General457837ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total31486591Total
Program Services27814033ProgramServices
Management And General3672558ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total16373736Total
Program Services14463923ProgramServices
Management And General1909813ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total205829Total
Program Services181821ProgramServices
Management And General24008ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total764199Total
Program Services675064ProgramServices
Management And General89135ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total386086Total
Program Services341053ProgramServices
Management And General45033ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total63519Total
Program Services56110ProgramServices
Management And General7409ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total25562543Total
Program Services22580959ProgramServices
Management And General2981584ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total873567Total
Program Services771675ProgramServices
Management And General101892ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total96682847Total
Program Services85405877ProgramServices
Management And General11276970ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total5490464Total
Program Services4850063ProgramServices
Management And General640401ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total12827465Total
Program Services11331285ProgramServices
Management And General1496180ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total827313Total
Program Services730816ProgramServices
Management And General96497ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total604722Total
Program Services534188ProgramServices
Management And General70534ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2512441Total
Program Services2219393ProgramServices
Management And General293048ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total13478326Total
Program Services11906230ProgramServices
Management And General1572096ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total5041000Total
Program Services4453024ProgramServices
Management And General587976ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
Bad debts - net2284000022840000
Pharmacy1988514619885146
Red Cross charges40304984030498
Malpractice Insurance31149953114995
Laundry and Linen16024281602428

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total501750830Total
Program Services449230975ProgramServices
Management And General52519855ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY12582506BOY
EOY26894270EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY46474066BOY
EOY42793002EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2681453BOY
EOY2253020EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY7913605BOY
EOY7423719EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY9995656BOY
EOY6898002EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis443470672LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec352115592LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY94202092BOY
EOY91355080EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY39974541BOY
EOY43743670EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY45843443BOY
EOY41651039EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY23851322BOY
EOY14035503EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY283518684BOY
EOY277047305EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY56144302BOY
EOY61485997EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY1946643BOY
EOY660619EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY233549017BOY
EOY261404960EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY291639962BOY
EOY323551576EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-38810360BOY
EOY-77285560EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY17619759BOY
EOY19690868EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY13069323BOY
EOY11090421EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-8121278BOY
EOY-46504271EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY283518684BOY
EOY277047305EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4172980ReconcilationRevenueExpenses
Reconcilation Other Changes-42555973ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Organizations1GrantsOtherOrganizations
Grants Other Organizations$124,453GrantsOtherOrganizationsAmount
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$3,409DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$7,789OtherActivitiesAmount
Total Lobbying Expenditures IIB135651TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Other Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1i:ReturnReference
ExplanationThe majority of lobbying by Saint Raphael employees takes place at the state and federal levels. During fiscal 2011, 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.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3431456BeginningOfYearBalance
Investment Earnings Or Losses15217InvestmentEarningsOrLosses
End Of Year Balance3446673EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3122933BeginningOfYearBalance
Investment Earnings Or Losses308523InvestmentEarningsOrLosses
End Of Year Balance3431456EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3173968BeginningOfYearBalance
Investment Earnings Or Losses-51035InvestmentEarningsOrLosses
End Of Year Balance3122933EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis6064040OtherCostOrOtherBasis
Book Value6064040BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis181235016OtherCostOrOtherBasis
Depreciation123526222Depreciation
Book Value57708794BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis46060269OtherCostOrOtherBasis
Depreciation45179733Depreciation
Book Value880536BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis208109839OtherCostOrOtherBasis
Depreciation183409637Depreciation
Book Value24700202BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2001508OtherCostOrOtherBasis
Book Value2001508BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings91355080TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Cash7447151F
Money Market Funds10271872F
CD's and Other23932016F
FieldValueIRS element (for citing)
Total Of Book Value Securities41651039TotalOfBookValueSecurities

Other Assets OtherAssets (9 entries)

DescriptionDescriptionBook ValueBookValue
Due from Affiliates20500
Deferred financing costs1629100
Investment in Caritas4350000
Long Term Investments2204090
Cash Surrender Value of life insurance123876
Investment Cyberknife124509
Investment Yankee Alliance421111
SERP Deposit445910
Long Term Third Party Receivables4716407
FieldValueIRS element (for citing)
Total Book Value Other Assets14035503TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (9 entries)

DescriptionDescriptionAmountAmount
Current Portion of Long Term Debt$67,058,020
Interest Payable$298,983
Post retirement Medical Costs$21,088,907
Accrued Pension - Defined Benefit Plan$121,576,582
Self Insurance - Workers Compensation$6,980,642
Outstanding Malpractice Losses Payable$16,804,013
Malpractice IBNR Costs$12,600,970
Third party payables$7,904,216
Other Long term liabilities$7,092,627
FieldValueIRS element (for citing)
Total Of Amounts261404960TotalOfAmounts
Total Revenue505923810TotalRevenue
Total Expenses501750830TotalExpenses
Excess Or Deficit For Year4172980ExcessOrDeficitForYear
Net Unrealized GL On Investments-906607NetUnrealizedGLOnInvestments
Other-$41,649,366OtherAmount
Total Adjustments-42555973TotalAdjustments
Excess Or Deficit Per FS-38382993ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt504909034TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments87810NetUnrealizedGainsInvestments
Revenue Not Rptd F99087810RevenueNotRptdF990
Revenue Subtotal504821224RevenueSubtotal
Investment Expenses Not Included63519InvestmentExpensesNotIncluded
Other Revenues Not Included1039067OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1102586RevenueNotRptdOnFinStmt
Total Revenue Per Form990505923810TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt502045661TotExpensesEtcAuditedFinclStmt
Other Expenses Included358350OtherExpensesIncluded
Expenses Not Rptd F990358350ExpensesNotRptdF990
Expenses Subtotal501687311ExpensesSubtotal
Investment Expenses Not Included263519InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt63519ExpensesNotRptdOnFinStmt
Total Expenses Per Form990501750830TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierExplanationExplanation
Part XI, Line 8 - Other Adjustments:Net equity transfers to affiliates -14148301. Contributions restricted to Special Purpose Fund 3806715. Losses on restricted Net Assets -142946. Net assets released from restriction -5555755. Change in interest in net assets of Saint Raphael Foundation, Inc. 1598921. Decrease in Minimum Pension Liability -27208000.
Part XII, Line 4b - Other Adjustments:Elimination/reclass Subsidiary activity 1039067.
Part XIII, Line 2d - Other Adjustments:Elimination/reclass Subsidiary activity 358350.
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.

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 Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served1565PersonsServed
Total Community Benefit Expense2006450TotalCommunityBenefitExpense
Direct Offsetting Revenue1402572DirectOffsettingRevenue
Net Community Benefit Expense603878NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served85385PersonsServed
Total Community Benefit Expense72434875TotalCommunityBenefitExpense
Direct Offsetting Revenue58344655DirectOffsettingRevenue
Net Community Benefit Expense14090220NetCommunityBenefitExpense
Percent Of Total Expense0.02810PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served86950PersonsServed
Total Community Benefit Expense74441325TotalCommunityBenefitExpense
Direct Offsetting Revenue59747227DirectOffsettingRevenue
Net Community Benefit Expense14694098NetCommunityBenefitExpense
Percent Of Total Expense0.02930PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served12041PersonsServed
Total Community Benefit Expense444390TotalCommunityBenefitExpense
Direct Offsetting Revenue6935DirectOffsettingRevenue
Net Community Benefit Expense437455NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served2623PersonsServed
Total Community Benefit Expense40080098TotalCommunityBenefitExpense
Direct Offsetting Revenue28057139DirectOffsettingRevenue
Net Community Benefit Expense12022959NetCommunityBenefitExpense
Percent Of Total Expense0.02400PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served9090PersonsServed
Total Community Benefit Expense11741693TotalCommunityBenefitExpense
Direct Offsetting Revenue12691382DirectOffsettingRevenue
Net Community Benefit Expense-949689NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served382PersonsServed
Total Community Benefit Expense78541TotalCommunityBenefitExpense
Net Community Benefit Expense78541NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served3163PersonsServed
Total Community Benefit Expense651386TotalCommunityBenefitExpense
Net Community Benefit Expense651386NetCommunityBenefitExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs14NumberOfActivitiesOrPrograms
Persons Served27299PersonsServed
Total Community Benefit Expense52996108TotalCommunityBenefitExpense
Direct Offsetting Revenue40755456DirectOffsettingRevenue
Net Community Benefit Expense12240652NetCommunityBenefitExpense
Percent Of Total Expense0.02640PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs14NumberOfActivitiesOrPrograms
Persons Served114249PersonsServed
Total Community Benefit Expense127437433TotalCommunityBenefitExpense
Direct Offsetting Revenue100502683DirectOffsettingRevenue
Net Community Benefit Expense26934750NetCommunityBenefitExpense
Percent Of Total Expense0.05570PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense20956TotalCommunityBuildingExpense
Net Community Building Expense20956NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense6691TotalCommunityBuildingExpense
Net Community Building Expense6691NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served1773PersonsServed
Total Community Building Expense40196TotalCommunityBuildingExpense
Net Community Building Expense40196NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense21347TotalCommunityBuildingExpense
Net Community Building Expense21347NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served20PersonsServed
Total Community Building Expense876TotalCommunityBuildingExpense
Net Community Building Expense876NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense15367TotalCommunityBuildingExpense
Net Community Building Expense15367NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served3500PersonsServed
Total Community Building Expense9187TotalCommunityBuildingExpense
Net Community Building Expense9187NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served204PersonsServed
Total Community Building Expense144118TotalCommunityBuildingExpense
Net Community Building Expense144118NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served5497PersonsServed
Total Community Building Expense258738TotalCommunityBuildingExpense
Net Community Building Expense258738NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$7,923,196BadDebtExpenseAmount
Amount Attributable To5070845AmountAttributableTo
Amount Reimbursed By Medicare197520043AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare232518456CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-34998413MedicareSurplusOrShortfall

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 (3 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 CT CK Leasing LLC
Cyberkife stereotactic radiosurgery system.0.490900.13640
2 Health CT LLC
Provides comprehensive health care through hospital provider network.0.15800
3 Yankee Alliance LLC
Hospital supply chain management.0.11110
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 Line1Hospital of Saint RaphaelBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11450 Chapel StreetAddressLine1
CityNew HavenCity
StateCTState
ZIP Code06511ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
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 car 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 patients 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 patients responsibility.
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 700,000. Average household income for the entire service area in 2011 was determined to be approximately $82,000. The City of New Haven demographics include a population of approximately 129,000 in 48,000 households. Average household income approximates $39,000 and per capita income approximates $22,000.
Part VI, Line 6: 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 7: 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 Hospitals 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.
CTReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
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 Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (27 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
James Farmer MD
000026666700000266667000
WBruce Lundberg MD
000018750000000187500000
Christopher M O'Connor
0595606000207460271979018408090673900
Alan Kliger MD
0448456039571018545901593020151350847923039571
Lawrence E McManus
0436158015000001938960201703018514010002710150000
Russ Braun MD
020092900084900015186021696400
John Burke
02253700002383103500202042028624500
Elizabeth Conrad
02340820217600332480635700174060370066021760
Thomas DonahueMD
442889000694019790215310467093000
Peter Duffy
01930550191190300580479440170520307228019119
John Fitzgerald
1886740150001117021000071460219437015000
Sister Joan Granville
0166756016414054186039162066690283187016414
W Scott Helton MD
0491718047700016185301075750195760828422047700
Mary Kuncas
0238011023365045783058528086640374351023365
Janeanne Lubin-Szafranski
02648450237910635610760760175500445823023791
Marshal Mandelkern MD
0253484015231044400619310180050353091015231
James Rude
192223010000058902258101551502409080100000
Lucinda VonBeren
01872540156480258160544560144050297579015648
Andre Ghantous MD
4556240750000420019790213330554356000
John Federico MD
4028270261420414019790162120447574000
Donald Kim MD
3378120946750320019790165310451317000
Ernest Moritz MD
3686510220002032019790189100393772000
Samuel Hahn MD
30569800011100098680315677000
David W Benfer
06789130001163235000121660185431401160639
Benedict Fernando MD
0000825330000082533000
Charles Hollander MD
0413769015000001324080001498407111610150000
Ronald Thomas MD
0129023035321012610901979049270297359035321

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aTaxable housing and automobile allowances are provided to Christopher M. O'Connor ( Saint Raphael Healthcare System Inc. Chief Executive Officer) 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 Financial Officer) under the terms of the individual's employment arrangement. In addition, reimbursements (non-taxable) are made for the business use of a social club. Taxable housing and automobile allowances are provided to John Burke (Saint Raphael Healthcare System, Inc. Chief Information Officer) under the terms of the individual's employment arrangement. A taxable automobile allowance is provided to Saint Raphael Healthcare System, Inc.'s Vice Presidents under the terms of their employment arrangements. Certain payments to David W. Benfer (former Saint Raphael Healthcare System, Inc. Chief Executive Officer) are for gross-up payments (taxable) under the terms of the individual's employment arrangement.
Part I, Line 4bThe chief executive officer, chief financial officer, chief medical officer and key employees at the vice presidential/ clinical chairperson level are eligible to participate in a supplemental non-qualified retirement plan. During calendar year 2010 provision was made for participation in another such plan; these amounts are reported as a component of the value reported in Schedule J Part II Column (C) Deferred Compensation for the following individuals- Alan Kliger, MD ($27,323), Lawrence E. McManus ($26,138), Elizabeth Conrad ($8,210), Peter Duffy ($7,214), Sister Joan Granville ($6,193), W. Scott Helton ($30,596), Mary Kuncas ($11,461), Janeanne Lubin-Szafranski ($12,567), Marshal Mandelkern MD ($8,277), Lucinda VonBeren ($5,904).
Part I, Line 7The chief executive officer, chief financial officer, chief medical officer and key employees at the vice presidential/ clinical chairperson level are eligible to earn incentive compensation based upon the achievement of Board of Trustees' approved metrics. During calendar year 2010 payments were made for incentives related to fiscal year ended September 30, 2009 and are reported in Schedule J Part II Column (Bii) "Bonus and Incentive Compensation". During fiscal year 2010 provision was made for incentives related to fiscal year ended September 30, 2010; 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 ($270,000), Alan Kliger MD ($130,000), Lawrence E. McManus ($175,000), John Burke ($35,002), Elizabeth Conrad ($53,550), Peter Duffy ($39,139), John Fitzgerald ($21,000), Sister Joan Granville ($31,700), Scott Helton MD ($75,000), Mary Kuncas ($45,123), Janeanne Lubin-Szafranski ($61,530), Marshal Mandelkern ($51,675), James Rude ($21,000), Lucinda VonBeren ($47,250). Certain Hospital of Saint Raphael physician caregivers are elibigle to earn incentive compensation based upon the achievement of approved productivity metrics. During calendar year 2010 payments were made for such incentives as reported in Schedule J Part II Column (B) (ii) "Bonus and Incentive Compensation" for the persons and amounts identified.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
State of Connecticut Health and Educational Faciliaites Authority
06080618620774LY252004-12-1627599152See Schedule O below.000
State of Connecticut Health and Educational Faciliaites Authority
06080618620774LY332004-12-1625366864See Schedule O below.000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
27599152151550819053821011
253668644653301011

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
010000
010000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 6Hospital 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 7aSaint Raphael Healthcare System, Inc. is the sole Member of the Hospital of Saint Raphael.
Form 990, Part VI, Section A, line 7bThe 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 11The governing body reviewed key elements of the 990 prior to submission.
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 12c
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 B, line 15
The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Net unrealized losses on investments: -906607. Net equity transfers to affiliates -14148301. Contributions restricted to Special Purpose Fund 3806715. Losses on restricted Net Assets -142946. Net assets released from restriction -5555755. Change in interest in net assets of Saint Raphael Foundation, Inc. 1598921. Decrease in Minimum Pension Liability -27208000. Total to Form 990, Part XI, Line 5: -42555973.Form 990, Part XI, line 5:
Purpose Series LRefinance State of Connecticut Health and Educational Facilities Authority, Hospital of Saint Raphael Issue Series D and E (dated 4/1/1991), Series G (dated 1/1/1992) and Series F (dated 11/1/1993).Schedule K Part 1 Column F
PUrpose Series MRefinance State of Connecticut Health and Educational Facilities Authority, Hospital of Saint Raphael Issue Series J and K (dated 1/8/1998) and fund a portion of the construction and renovation costs of a facilities upgrade at Saint Regis Health Center, Inc.Schedule K Part 1 Column F
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 De Natale MD reflect payments made to Connecticut Vascular Center ($15,000) and the individual physician ($35,829) 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 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. The Medical Staff President's responsibilities include participation as a Hospital Trustee.Form 990, Part VII, Line 1a, Column F

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Lukan Indemnity Co LtdBusinessNameLine1

Address Foreign AddressForeign

FieldValueIRS element (for citing)
Address Line1FB Perry Building 40 Church StreetAddressLine1
CityHamiltonCity
Province Or StateHamiltonProvinceOrState
CountryBDCountry
FieldValueIRS element (for citing)
EIN060653171EIN
Primary ActivitiesDirect and reinsurance malpracticePrimaryActivities
Legal Domicile Foreign CountryBDLegalDomicileForeignCountry
Total Income4133294TotalIncome
EOY Assets34714015EOYAssets

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Saint Raphael Healthcare System Inc
659 George StreetNew HavenCT06511061157542Tax exempt holding companyCT501 (c) 311a0
Caritas Insurance Company LTD
30 Main Street Suite 330BurlingtonVT05401030322238InsuranceVT501 (c) 311a0Hospital of Saint Raphael
Saint Raphael Foundation Inc
1450 Chapel StreetNew HavenCT06511510140710Fundraising FoundationCT501 (c) 311a0Saint Raphael Healthcare System Inc
Saint Regis Health Center Inc
1354 Chapel StreetNew HavenCT06511061217867Skilled Nursing FacilityCT501 (c) 330Saint Raphael Healthcare System Inc
DePaul Health Services Corp
659 George StreetNew HavenCT06511061157544Tax exempt holding companyCT501 (c) 311a0Saint Raphael Healthcare System Inc
Hospital of Saint Raphael One for All Fund
1450 Chapel StreetNew HavenCT06511222505062Fundraising OrganizationCT501 (c) 311a0Hospital of Saint Raphael
VNA Services Inc
1100 Sherman AvenueHamdenCT06518060646709Provision of healthcare services to patients in their homesCT501 (c) 390DePaul Health Services Corporation
Saint Raphael Healthcare System Affiliated Physicians Inc
1450 Chapel StreetNew HavenCT06511800522532Medical FoundationCT501 (c) 311a0Saint Raphael Healthcare System Inc
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
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 Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (12 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Saint Raphael Healthcare System Inc
L2680260Cost Basis
Saint Raphael Healthcare System Inc
I24996FMV of Services
Saint Raphael Healthcare System Inc
C1025000Cash Value
Saint Raphael Healthcare System Inc
B16667969Cash Value
Caritas Insurance Company LTD
L1440000FMV of Services
Saint Raphael Foundation Inc
C230044Cash Value
Saint Regis Health Center Inc
I30036FMV of Services
Saint Regis Health Center Inc
K720865FMV of Services
Saint Regis Health Center Inc
J18024FMV of Services
Saint Regis Health Center Inc
B142445Cost Basis
VNA Services Inc
R488629FMV of Property
Saint Raphael Healthcare System Affiliated Physicians Inc
K2434190FMV of Services