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WILLIAM W BACKUS HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
WILLIAM W BACKUS HOSPITAL (EIN 06-0250773)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-10
IRS object ID
201222239349300022
Schema version
2010v3.7
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)
Timestamp2012-08-10T09:44:40-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1
CityKansas CityCity
StateMOState
ZIP Code641062246ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN060250773EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE WILLIAM W BACKUS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWILLNameControl
Phone8608898331Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1326 WASHINGTON STREETAddressLine1
CityNORWICHCity
StateCTState
ZIP Code06360ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDANIEL E LOHRName
TitleCFOTitle
Date Signed2012-08-15DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameMichael J EngleName
Phone8162216300Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID WHITEHEADNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1326 WASHINGTON STREETAddressLine1
CityNORWICHCity
StateCTState
ZIP Code06360ZIPCode
FieldValueIRS element (for citing)
Gross Receipts354887874GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BACKUSHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1891YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionBACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH-QUALITY HEALTHCARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees2064TotalNbrEmployees
Total Nbr Volunteers442TotalNbrVolunteers
Total Gross UBI2162036TotalGrossUBI
Net Unrelated Business Txbl Income41320NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1527754ContributionsGrantsPriorYear
Contributions Grants Current Year1296004ContributionsGrantsCurrentYear
Program Service Revenue Prior Year270048715ProgramServiceRevenuePriorYear
Program Service Revenue CY271933218ProgramServiceRevenueCY
Investment Income Prior Year3471412InvestmentIncomePriorYear
Investment Income Current Year5938478InvestmentIncomeCurrentYear
Other Revenue Prior Year1774538OtherRevenuePriorYear
Other Revenue Current Year1609862OtherRevenueCurrentYear
Total Revenue Prior Year276822419TotalRevenuePriorYear
Total Revenue Current Year280777562TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year81360GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY692681GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year136363855SalariesEtcPriorYear
Salaries Etc Current Year135892894SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year273836TotalFundrsngExpCurrentYear
Other Expense Prior Year124070814OtherExpensePriorYear
Other Expenses Current Year113381675OtherExpensesCurrentYear
Total Expenses Prior Year260516029TotalExpensesPriorYear
Total Expenses Current Year249967250TotalExpensesCurrentYear
Revenues Less Expenses Prior Year16306390RevenuesLessExpensesPriorYear
Revenues Less Expenses CY30810312RevenuesLessExpensesCY
Total Assets BOY335457576TotalAssetsBOY
Total Assets EOY358349465TotalAssetsEOY
Total Liabilities BOY176145231TotalLiabilitiesBOY
Total Liabilities EOY195793905TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY159312345NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY162555560NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense201048233Expense
Grants692681Grants
Revenue272479814Revenue
DescriptionIN FISCAL YEAR 2011, BACKUS HOSPITAL HAD 11,050 ADMISSIONS, 63,198 EMERGENCY DEPARTMENT VISITS, AND 435,458 OUTPATIENT VISITS. THE HOSPITAL DELIVERED 948 BABIES AND 7,347 SAME DAY SURGICAL PROCEDURES. BACKUS PERFORMED 120,505 IMAGING EXAMS, 8,101 MRI EXAMINATIONS, 11,057 PSYCHIATRIC CLINICAL VISITS, AND 8,433 PSYCHIATRIC PARTIAL HOSPITAL VISITS.Description
Total Program Service Expense201048233TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096206NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees2064NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDANIEL E LOHRNamePerson
Telephone Number8608898331TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1326 WASHINGTON STREETAddressLine1
CityNORWICHCity
StateCTState
ZIP Code06360ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
DAVID WHITEHEAD
TRUSTEE/PRESIDENT/CEO40.0XX533927040155
PETER V DISCH
TRUSTEE/CHAIRMAN6.0XX000
ROBERT RAMSDELL
TRUSTEE/TREASURER6.0XX000
JOSEPH FATONE
TRUSTEE/SECRETARY6.0XX000
ANTHONY JOYCE
TRUSTEE/VICE CHAIRMAN6.0XX000
JOHN F BILDA
TRUSTEE2.0X000
ELIZABETH CONWAY
TRUSTEE2.0X000
BERT A COPPOTELLI MD
TRUSTEE2.0X000
GRACE JONES PHD
TRUSTEE2.0X000
PETER MANERI
TRUSTEE2.0X000
DEBORAH MONAHAN
TRUSTEE2.0X000
TODD POSTLER
TRUSTEE2.0X000
LYNNE QUINTAL-HILL
TRUSTEE2.0X000
MARK TRAMONTOZZI MD
TRUSTEE2.0X000
DANIEL E LOHR
SENIOR VP/CFO40.0X412881034617
PETER SHEA
SENIOR VP/MEDICAL DIRECTOR40.0424113032805X
SERGIO CASILLAS MD
PHYSICIAN40.0460101013307X
ROBERT SIDMAN MD
PHYSICIAN40.0375275033514X
MARK TOUSIGNANT MD
PHYSICIAN40.0317187033514X
JUAN ESCALON MD
PHYSICIAN40.0313617033514X
NADER BAHADORY MD
PHYSICIAN40.0306020040693X
THOMAS P PIPICELLI
FORMER PRESIDENT0.0692040034228X
MARK SANTAMARIA
FORMER SENIOR VP/COO0.020669000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4041851TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation296347TotalOtherCompensation
Number Individuals GT100 K111NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
WELLSPRING PARTNERS
CONSULTING4250000
ALLIANCE HEALTHCARE SERVICES
MEDICAL SERVICES3016144
HURON CONSULTING GROUP
CONSULTING2930194
YALE NH HOSPITAL
MEDICAL SERVICES2094415
NORWICH ANESTHESIA ASSOC
MEDICAL SERVICES556404
FieldValueIRS element (for citing)
Number Of Contractors GT100 K32NumberOfContractorsGT100K
Fundraising Events68480FundraisingEvents
Related Organizations1200RelatedOrganizations
Government Grants578977GovernmentGrants
All Other Contributions647347AllOtherContributions
Noncash Contributions2921NoncashContributions
Total Contributions1296004TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Inpatient900099125515508125515508
Outpatient900099101175035101175035
Emergency Department9000994290271842902718
Lab courier service62150023399572339957
FieldValueIRS element (for citing)
Total Program Service Revenue271933218TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1854181TotalRevenueColumn
Exclusion$1,854,181ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1216398Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2208204Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-991806Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-991806TotalRevenueColumn
Unrelated Business Revenue-181585UnrelatedBusinessRevenue
Exclusion-$810,221ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities75408845Securities
Other206186Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities70758675Securities
Other772059Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities4650170Securities
Other-565873Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column4084297TotalRevenueColumn
Exclusion$4,084,297ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events22900GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events68480CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses42116FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-19216TotalRevenueColumn
Exclusion-$19,216ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory457671GrossSalesOfInventory
Cost Of Goods Sold329258CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column128413TotalRevenueColumn
Exclusion$128,413ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Cafeteria7223201102720$1,102,720
Child care624410391976$391,976
Purchase discounts900099269594$269,594

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column728181TotalRevenueColumn
Related Or Exempt Function Income724517RelatedOrExemptFunctionIncome
Unrelated Business Revenue3664UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue2492471TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column280777562TotalRevenueColumn
Related Or Exempt Function Income270317778RelatedOrExemptFunctionIncome
Unrelated Business Revenue2162036UnrelatedBusinessRevenue
Exclusion$7,001,744ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total682681Total
Program Services682681ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total10000Total
Program Services10000ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2370911Total
Program Services479197ProgramServices
Management And General1891714ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total107798945Total
Program Services93702462ProgramServices
Management And General14003552ManagementAndGeneral
Fundraising92931Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total8743448Total
Program Services7606800ProgramServices
Management And General1136648ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total9094736Total
Program Services7912420ProgramServices
Management And General1182316ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total7884854Total
Program Services6859823ProgramServices
Management And General1025031ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total971044Total
Management And General971044ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total158170Total
Management And General158170ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total47410Total
Management And General47410ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total77835Total
Management And General77835ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total15966576Total
Program Services12697875ProgramServices
Management And General3268251ManagementAndGeneral
Fundraising450Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total194970Total
Program Services149411ProgramServices
Fundraising45559Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total38647753Total
Program Services37631879ProgramServices
Management And General1013284ManagementAndGeneral
Fundraising2590Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4480434Total
Program Services376363ProgramServices
Management And General4104071ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total5448973Total
Program Services586056ProgramServices
Management And General4862089ManagementAndGeneral
Fundraising828Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total253178Total
Program Services100629ProgramServices
Management And General152549ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total31343Total
Program Services2754ProgramServices
Management And General27967ManagementAndGeneral
Fundraising622Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total2951831Total
Management And General2951831ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total15861992Total
Program Services7768430ProgramServices
Management And General8093562ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1937247Total
Program Services1344246ProgramServices
Management And General593001ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Lab expenses43602644360264
Food/dietary1146564108581760747
Maintenance/service contracts509582139560931139568160
Education52771445572971985
Bad debt125229781249209030888

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2699578Total
Program Services787214ProgramServices
Management And General1781668ManagementAndGeneral
Fundraising130696Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total249967250Total
Program Services201048233ProgramServices
Management And General48645181ManagementAndGeneral
Fundraising273836Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4239212BOY
EOY2802148EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY68235460BOY
EOY90659933EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY185866BOY
EOY101211EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY30758941BOY
EOY32373122EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY153242BOY
EOY100023EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3844330BOY
EOY3757730EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4267569BOY
EOY4493355EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis230812071LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec140828407LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY99122387BOY
EOY89983664EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY123615211BOY
EOY133516829EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY12632BOY
EOY12632EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1022726BOY
EOY548818EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY335457576BOY
EOY358349465EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY25301642BOY
EOY22318404EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY63125000BOY
EOY61230000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1236586BOY
EOY1183176EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY86482003BOY
EOY111062325EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY176145231BOY
EOY195793905EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY147735382BOY
EOY153706889EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4101543BOY
EOY1399547EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY7475420BOY
EOY7449124EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY159312345BOY
EOY162555560EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY335457576BOY
EOY358349465EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses30810312ReconcilationRevenueExpenses
Reconcilation Other Changes-27567097ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

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)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$47,410GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB47410TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance5320786BeginningOfYearBalance
Contributions5000Contributions
Investment Earnings Or Losses76505InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses5432AdministrativeExpenses
End Of Year Balance5396859EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance4841631BeginningOfYearBalance
Contributions358064Contributions
Investment Earnings Or Losses505259InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures378271OtherExpenditures
Administrative Expenses5897AdministrativeExpenses
End Of Year Balance5320786EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3871631BeginningOfYearBalance
Contributions970000Contributions
Investment Earnings Or Losses142089InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures135254OtherExpenditures
Administrative Expenses6835AdministrativeExpenses
End Of Year Balance4841631EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2229795OtherCostOrOtherBasis
Book Value2229795BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis10381267InvestmentCostOrOtherBasis
Other Cost Or Other Basis40999717OtherCostOrOtherBasis
Depreciation32278800Depreciation
Book Value19102184BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis77656294OtherCostOrOtherBasis
Depreciation39062881Depreciation
Book Value38593413BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis98179225OtherCostOrOtherBasis
Depreciation69486726Depreciation
Book Value28692499BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1365773OtherCostOrOtherBasis
Book Value1365773BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings89983664TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
Tax exempt bond premium, net$711,971
DUE TO 3RD PARTY REIMB AGENCIES$23,845,704
Employee related obligations$73,827,779
Self-insured prof liability$10,853,762
Capital lease obligations$1,379,926
Other liabilities$443,183
FieldValueIRS element (for citing)
Total Of Amounts111062325TotalOfAmounts
Total Revenue280777562TotalRevenue
Total Expenses249967250TotalExpenses
Excess Or Deficit For Year30810312ExcessOrDeficitForYear
Net Unrealized GL On Investments-5813831NetUnrealizedGLOnInvestments
Investment Expenses-226561InvestmentExpenses
Other-$21,526,705OtherAmount
Total Adjustments-27567097TotalAdjustments
Excess Or Deficit Per FS3243215ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt283503815TotRevenueEtcAuditedFinclStmt
Other Revenues42116OtherRevenues
Revenue Not Rptd F99042116RevenueNotRptdF990
Revenue Subtotal283461699RevenueSubtotal
Investment Expenses Not Included226561InvestmentExpensesNotIncluded
Other Revenues Not Included-2910698OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-2684137RevenueNotRptdOnFinStmt
Total Revenue Per Form990280777562TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt258453439TotExpensesEtcAuditedFinclStmt
Losses Reported5813831LossesReported
Other Expenses Included2816193OtherExpensesIncluded
Expenses Not Rptd F9908630024ExpensesNotRptdF990
Expenses Subtotal249823415ExpensesSubtotal
Other Expenses Not Included143835OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt143835ExpensesNotRptdOnFinStmt
Total Expenses Per Form990249967250TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ENDOWMENT FUNDSSCHEDULE D, PART V, LINE 4THE PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE MEANT TO PROVIDE LONG-TERM SUPPORT FOR CAPITAL AND OPERATING PROGRAMS FOR THE HOSPITAL IN ACCORDANCE WITH THE DONOR'S WISHES.
UNCERTAIN TAX POSITIONS DISCLOSURESCHEDULE D, PART X, LINE 2ASC 740-10, Uncertain Tax Positions, prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. This interpretation also provides guidance on derecognition, classification, interest and penalties, accounting in interim periods, and disclosure requirements for uncertain tax positions. Management has evaluated the implications of ASC 740-10 and determined that its impact on the financial statements is not significant.
RECONCILIATION OF CHANGE IN NET ASSETSSCHEDULE D, PART XI, LINE 8K-1 GAIN AND INTEREST (2,641) TRANSFER TO AFFILIATES (245,005) DECREASE IN NET ASSETS HELD IN TRUST (102,368) CHANGE IN PENSION FUNDING (21,176,691) ------------ TOTAL $(21,526,705)
RECONCILIATION OF REVENUE- OTHER ADJUSTMENTSSCHEDULE D, PART XII, LINE 2DGOLF TOURNAMENT EXPENSES $42,116
RECONCILIATION OF REVENUES- OTHER ADJUSTMENTSSCHEDULE D, PART XII, LINE 4BAUXILIARY INCOME 136,034 K-1 GAIN AND INTEREST 2,641 LOSS ON FIXED ASSETS (565,873) RENTAL EXPENSE (2,208,204) TEMPORARILY RESTRICTED INCOME (275,296) ---------- TOTAL $(2,910,698)
RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTSSCHEDULE D, PART XIII, LINE 2DRENTAL EXPENSE 2,208,204 GOLF TOURNAMENT EXPENSE 42,116 LOSS ON FIXED ASSETS 565,873 ---------- TOTAL $2,816,193
RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTSSCHEDULE D, PART XIII, LINE 4BAUXILIARY EXPENSE 143,835

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event191380GrossReceiptsEvent1
Charitable Contributions Event168480CharitableContributionsEvent1
Gross Revenue Event122900GrossRevenueEvent1
Non Cash Prizes Event12613NonCashPrizesEvent1
Rent Facility Costs Event127709RentFacilityCostsEvent1
Food And Beverage Event13524FoodAndBeverageEvent1
Other Direct Expenses Event18270OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total91380GrossReceiptsTotal
Charitable Contributions Total68480CharitableContributionsTotal
Gross Revenue Total Events22900GrossRevenueTotalEvents
Non Cash Prizes Total Events2613NonCashPrizesTotalEvents
Rent Facility Costs Total Events27709RentFacilityCostsTotalEvents
Food And Beverage Total Events3524FoodAndBeverageTotalEvents
Other Direct Expenses Total Events8270OtherDirectExpensesTotalEvents
Direct Expense Summary Events42116DirectExpenseSummaryEvents
Net Income Summary-19216NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage250.FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent350XPcent350
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2221554TotalCommunityBenefitExpense
Direct Offsetting Revenue481911DirectOffsettingRevenue
Net Community Benefit Expense1739643NetCommunityBenefitExpense
Percent Of Total Expense0.00700PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense46273759TotalCommunityBenefitExpense
Direct Offsetting Revenue31545137DirectOffsettingRevenue
Net Community Benefit Expense14728376NetCommunityBenefitExpense
Percent Of Total Expense0.05900PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense48495313TotalCommunityBenefitExpense
Direct Offsetting Revenue32027048DirectOffsettingRevenue
Net Community Benefit Expense16468019NetCommunityBenefitExpense
Percent Of Total Expense0.06600PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served40398PersonsServed
Total Community Benefit Expense430740TotalCommunityBenefitExpense
Direct Offsetting Revenue9834DirectOffsettingRevenue
Net Community Benefit Expense420906NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served1775PersonsServed
Total Community Benefit Expense240048TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense240048NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Persons Served9379PersonsServed
Total Community Benefit Expense12347573TotalCommunityBenefitExpense
Direct Offsetting Revenue8999744DirectOffsettingRevenue
Net Community Benefit Expense3347829NetCommunityBenefitExpense
Percent Of Total Expense0.01340PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense24279TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense24279NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense650133TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense650133NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served51552PersonsServed
Total Community Benefit Expense13692773TotalCommunityBenefitExpense
Direct Offsetting Revenue9009578DirectOffsettingRevenue
Net Community Benefit Expense4683195NetCommunityBenefitExpense
Percent Of Total Expense0.01880PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served51552PersonsServed
Total Community Benefit Expense62188086TotalCommunityBenefitExpense
Direct Offsetting Revenue41036626DirectOffsettingRevenue
Net Community Benefit Expense21151214NetCommunityBenefitExpense
Percent Of Total Expense0.08480PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense8618TotalCommunityBuildingExpense
Net Community Building Expense8618NetCommunityBuildingExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense2645TotalCommunityBuildingExpense
Net Community Building Expense2645NetCommunityBuildingExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense4377TotalCommunityBuildingExpense
Net Community Building Expense4377NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense2622TotalCommunityBuildingExpense
Net Community Building Expense2622NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense18262TotalCommunityBuildingExpense
Net Community Building Expense18262NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$5,225,824BadDebtExpenseAmount
Amount Attributable To3832933AmountAttributableTo
Amount Reimbursed By Medicare53932695AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare66548262CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-12615567MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
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 Line1WILLIAM W BACKUS HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1326 WASHINGTON STAddressLine1
CityNORWICHCity
StateCTState
ZIP Code06360ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1WILLIAM W BACKUS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities10NumberOfOtherFacilities

Other Facilities OtherFacilities (10 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
BACKUS OP CARE CENTER
111 SALEM TURNPIKENORWICHCT06360OUTPATIENT SERVICES
MEDICAL OFFICE BUILDING
330 WASHINGTON STREETNORWICHCT06360RADIATION THERAPY/LAB
BACKUS OUTPATIENT CENTER
12/19 CASE STREETNORWICHCT06360XRAY/MAMMOGRAPHY/LAB
COLCHESTER BACKUS HC
163 BROADWAYCOLCHESTERCT06415RAIOLOGY/LAB/PRIMARY CARE
MONTVILLE BACKUS HC
80 NORWICH/NL TURNPIKEUNCASVILLECT06382RADIOLOGY/LAB/PRIMARY CARE
PAIN MANAGEMENT
112 LAFAYETTE STREETNORWICHCT06360PAIN MANAGEMENT
BACKUS PATIENT SERVICE CENTER
122 PLAINFIELD ROADMOOSUPCT06354XRAY/LAB/PRIMARY CARE
LEDYARD BACKUS HC
743 COLONEL LEDYARD HWYLEDYARDCT06339LAB/PRIMARY CARE
JEWETT CITY PATIENT SERVICE CTR
70 MAIN STREETJEWETT CITYCT06351LAB
INFECTIOUS DISEASE CLINIC
107 LAFAYETTE STREETNORWICHCT06360CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
SCHEDULE H, PART I, LINE 7, COLUMN FTHE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THE COLUMN IS $12,522,978.
SCHEDULE H, PART I, LINE 7THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2.
SCHEDULE H, PART I, LINE 7GPHYSICIAN CLINIC COST $ 877,678SCHEDULE H, PART II
COMMUNITY BUILDING ACTIVITIESBackus Hospital conducts and sponsors 11 support groups that provide ongoing education and counseling for a wide array of health-related issues, from infant child loss to cancer. Hospital employees volunteer their service on dozens of community not-for-profit organizations, many of which has healthcare as a primary or major focus. Examples include the New London County Healthcare Collaborative, the Health Care Council of Eastern Connecticut, the Foundation of Three Rivers Community College (which provides funding for nursing student education and equipment), the region's non-profit Hospice organization, United Way of Southeastern Connecticut (which provides funding for many regional human services, including those that are health-related); as well as service and board memberships on the region's two Federally Qualified Health Centers. Additionally, Backus personnel volunteer on other boards and organizations that advance the quality of life and economic well-being of the region, including the local library, family support and social service organizations, the regional Chamber of Commerce, numerous civic and governmental bodies, and various volunteer fire companies and ambulance services. Members of the administrative staff routinely submit government testimony on behalf of regional not-for-profit health-related organizations, and provide research and advocacy for the healthcare access.SCHEDULE H, PART II
BAD DEBT EXPENSETHE HOSPITAL PROVIDES SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE, SUCH SERVICES ARE NOT REPORTED AS NET REVENUE. THE HOSPITAL'S CHARITY CARE POLICY UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE. FOR PATIENTS WHO DO NOT APPLY OR DO NOT QUALIFY, THE UNCOLLECTED AMOUNTS ARE RECOGNIZED AS BAD DEBT EXPENSE. ESTIMATED COST OF BAD DEBT IS BASED ON THE RATIO OF COST TO CHARGES AS DETERMINED BY HOSPITAL SPECIFIC DATA.SCHEDULE H, PART III, LINE 4
MEDICARE SHORTFALLTHE MEDICARE SHORTFALL WAS NOT INCLUDED IN THE COMMUNITY BENEFIT COST. THE COSTING METHODOLOGY CONSISTED OF INFORMATION FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM AS WELL AS COSTS FROM THE MEDICARE COST REPORT.SCHEDULE H, PART III, LINE 8
COLLECTION POLICYTHE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE.SCHEDULE H, PART III, LINE 9B
NEEDS ASSESSMENT(a) In addition to conducting its own research, Backus Hospital collaborates with local and regional health care organizations to determine the need for health-related programs and services. (b) In 2010, the Hospital commissioned a comprehensive community health needs assessment conducted by Holleran, a professional research firm. The assessment consisted of 1,109 BRFSS telephone surveys which were conducted throughout the Hospital's service region (both New London and Windham Counties). The assessment also included a detailed analysis of secondary data sources, as well as two comprehensive focus groups to gain qualitative data on identified priority health areas. The needs assessment was presented and distributed, and can be accessed at www.backushospital.org/healthsurvey. Subsequently the Hospital has developed a Community Needs Strategic Plan which identifies and outlines top priority health needs as determined by the needs assessment. Priority health areas include obesity and overweight, autism, smoking, alcohol and substance abuse, mental health, chronic lower respiratory diseases, and access to healthcare. This plan has guided Hospital's outreach efforts for the last two fiscal years. A second needs assessment is planned to measure the Hospital's progress. Based on the Holleran survey, the Hospital partnered with United Way of Southeastern Connecticut to create the New London County Food Policy Council, which is using the data to address obesity and other food-related issues, as well as Norwich Technical High School, to focus on adolescent health issues such as self-esteem, depression, and substance abuse. (c) The hospital identifies health problems in the community through indicators and measures of health risk, disease prevalence, disease management and outcomes using sources such as birth and mortality records, census data, Behavioral Risk Factor Survey data, Robert Wood Johnson County Health Rankings, and other datasets. (d) The hospital partners with two regional Federally Qualified Health Centers (FQHC)- United Community and Family Services, and Generations Healthcare. Managers from the hospital and FQHCs meet to determine unmet community needs to develop educational, outreach and preventative health programs to meet these needs. (e) The hospital conducts follow-up surveys with all participants in its free educational programs. The surveys assess participants' satisfaction with the program, and solicit information about other needs.SCHEDULE H, PART VI, LINE 2
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE(a) Notification about charitable care and assistance programs is available at all registration areas, on and off the main hospital campus, in waiting areas, in the patient handbook, on our website, on prominently placed signs (in English and Spanish). Additionally, Care Management Social Workers meet with patients, family, clergy and others as appropriate to discuss assistance programs and services that may be available. Here is the information from our website: If you do not have health insurance and are eligible for a government sponsored health program, our Access to Care staff at Backus Hospital is available to help you through the application process. If you qualify, programs such as HUSKY, T-19, and SAGA may help you with access to healthcare and other vital services for yourself and your family. If you are uninsured, and do not qualify for a government sponsored insurance program you may be eligible for free or discounted services from Backus Hospital depending on your income level and circumstances. In addition, extended payment plans are available to patients who qualify for payment assistance and who are making good-faith efforts to pay their bill. To get help enrolling in a government sponsored insurance program or to apply for charitable care from Backus Hospital, please call our Advocate for Charitable Care at (860) 889-8331, ext. 3831 or Customer Service at (860) 823-6394. Our staff will work with you to complete an application which must be returned with income and resources information. We look forward to working with you to improve access to care for you and your family. (b) The hospital provides two Access to Care Specialists (both first and second shift) in its Emergency Department, who provides free insurance eligibility screenings to uninsured clients seeking care. The Specialist works with uninsured patients to connect them with a primary medical home, so they can receive preventative care, rather than using costly emergency services for illnesses that are not medical emergencies. Significant one-on-one follow-up is provided through phone calls or letters to make appointments to screen patients and help them fill out applications for HUSKY or Charter Oak applications.SCHEDULE H, PART VI, LINE 3
COMMUNITY INFORMATIONThe William W. Backus Hospital is located in Norwich, 45 minutes southeast of Hartford. In the past decade, the region has undergone major economic changes, due to the operation of two Native American-owned casinos - both among the largest casinos in the world. These gambling and entertainment venues bring bringing an average of 40,000 visitors into the region each day. The casinos are the largest employers, and are experiencing layoffs and cutbacks as the economy continues to decline. The hospital's primary service area has an estimated population of about 118,000. The secondary service area consists of larger communities, such as New London and Groton, and smaller lower-density rural communities. The total population of the secondary service area is about 123,000. The service areas contain municipalities in New London and Windham Counties. The fastest growing segment of the region's population is the elderly. For the last decennial census, the region's elderly population grew at 10 times the rate of growth for the total population. The region's lack of affordable housing began to emerge as a critical issue even before the economic downturn. Homelessness is a growing concern, as the number of mortgage foreclosures grow. Further, the 2012 Robert Wood Johnson County Health Rankings reported that in New London and Windham Counties between 12-15% of children are living in poverty, and 31-32% are living in single parent households. Unemployment in the regional labor market (per the 2012 Robert Wood Johnson County Health Ranking) stands at 8.7-10.3% in New London and Windham Counties, hovering around state average of 9.1%, and well above the national average of 5.4%.SCHEDULE H, PART VI, LINE 4
PROMOTION OF COMMUNITY HEALTHa) The hospital is governed by a volunteer community Board of Directors/Trustees. These individuals represent an array of professions and backgrounds. b) The hospital has 110 Corporators - volunteer members chosen from all the communities in our primary and secondary service areas. In addition to their official capacity as nominators of Board members, the Corporators serve as the hospital's eyes and ears throughout its service area. c) The hospital owns and operates a Mobile Health Resource Center - a 40-foot van that travels to various locations in eastern Connecticut offering health education, counseling, and screenings. The van makes regularly scheduled stops at senior citizens centers, soup kitchens, elderly housing complexes and homeless shelters. Not-for-profit groups are encouraged to request the van and its services at their functions or offices. d) The hospital provides individuals who do not identify as having a primary medical home with a follow up visit post discharge from to become link these individuals with a primary care physician in the community. This is facilitated through the My Health Direct program, a web-based tool that allows hospital staff to access blocked appointments for physicians in the community. From 10/1/10 to 9/30/11 the Hospital linked 582 individuals with primary care. e) The hospital provides free community prostate screenings, diabetes education, backpack safety, HIV education/testing, blood pressure tests, skin cancer screenings, nutrition education and many others services. f) The hospital provides a comprehensive medical library, which is open to all staff. The library has subscriptions to hundreds of major scientific and clinical journals, as well as an on-staff librarian to help with specific research requests. g) The hospital provides free website access to complete and current medical information to answer clinical questions, through UpToDate.com, a peer-reviewed online medical reference. UpToDate covers more than 7,400 topics in 13 medical specialties and includes more than 76,000 pages of text, graphics, links to Medline abstracts, more than 254,000 references, and a drug database. h) The hospital provides free medication cards to help patients keep track of their current medications, and its pharmacists offer free regular medication reviews to check for possible interactions and expired medications. i) The hospital offers free wireless internet (wi-fi) use throughout the campus, and provides free computer use to visitors. j) The hospital publishes a monthly consumer health magazine. The publication contains information about health issues and trends, a calendar of free healthcare education and screenings, and contact information for healthcare providers. 44,000 copies are distributed monthly.SCHEDULE H, PART VI, LINE 5

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (5 entries)

EIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
HOSPICE OF SE CONNECTICUT
222667260501(C)(3)8500CORPORATE BENEFACTOR
UNITED WAY OF SE CT
060771393501(C)(3)17000CORPORATE BENEFACTOR
PLAINFIELD REC DEPT
066002062PLAINFIELD10000PRESIDENTS AWARD
AMERICAN HEART ASSOC
135613797501(C)(3)25000SPONSORSHIP
UNITED COMMUNITY & FAMILY SERVICES
060653142501(C)(3)559990WOMEN'S HEALTH
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants5TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients4NumberOfRecipients
Amount Of Cash Grant10000AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedures for Monitoring the use of grant funds in the U.S.Identifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationDONATIONS MADE FOR LOCAL EVENTS, SUCH AS THE RELAY FOR LIFE AND HEALTH FAIRS, ARE TYPICALLY ATTENDED BY HOSPITAL EMPLOYEES. FOUR SCHOLARSHIPS IN THE AMOUNT OF $2,500 EACH ARE AWARDED TO STUDENTS WHO WILL ATTEND SCHOOL EITHER FOR NURSING OR IN THE MEDICAL FIELD. THE APPLICANTS ARE REVIEWED BY THE SCHOLARSHIP COMMITTEE OF THE AUXILIARY AND WINNERS ARE CHOSEN BASED ON ACADEMICS AS WELL AS COMMUNITY SERVICE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E ExpensesfalseWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 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
DAVID WHITEHEAD
44611308740004140196000205550574082000
DANIEL E LOHR
3362480548000218330196000150170447498000
MARK SANTAMARIA
15056502500003112500000206690000
PETER SHEA
361520054800077930122500205550456918000
SERGIO CASILLAS MD
344101011600000012250010570473408000
ROBERT SIDMAN MD
2584560963440204750122500212640408789000
MARK TOUSIGNANT MD
249187000680000122500212640350701000
JUAN ESCALON MD
297117000165000122500212640347131000
NADER BAHADORY MD
226076077919020250196000210930346713000
THOMAS P PIPICELLI
609268000827720196000146280726268000

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
GROSS-UP PAYMENTSSCHEDULE J, PART I, LINE 1ATHE FORMER PRESIDENT RECEIVED GROSS-UP PAYMENTS ON SELECTED EXPENSES PROPERLY INCLUDED IN HIS W-2 WAGES.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANSCHEDULE J, PART I, LINE 4BDAVID WHITEHEAD, DANIEL E LOHR AND PETER SHEA PARTICIPATE IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, HOWEVER THERE WERE NO ACCRUALS OR CONTRIBUTIONS THAT WERE MADE TO THE PLAN DURING THE REPORTING PERIOD.
NON-FIXED PAYMENTSSCHEDULE J, PART I, LINE 7BONUSES ARE BASED ON THE EVALUATION OF AN INDIVIDUAL'S PERFORMANCE AND ACCOMPLISHMENT OF GOALS SET AT THE BEGINNING OF THE YEAR BY AN INDEPENDENT COMPENSATION COMMITTEE.
RETIREMENT AND OTHER DEFERRED COMPENSATION EXPLANATIONSCHEDULE J, PART II, COLUMN CCOMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS GENERALLY REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS PAID TO THE INDIVIDUAL. AS A RESULT OF THE REPORTING REQUIREMENT, AN ORGANIZATION COULD BE REQUIRED TO REPORT THE SAME COMPENSATION ON FORM 990 IN TWO DIFFERENT YEARS.
ADDITIONAL INFORMATIONSCHEDULE J, PART II, LINE 10THOMAS PIPICELLI'S COMPENSATION INCLUDES AMOUNTS ESTABLISHED AND PAID PURSUANT TO EMPLOYMENT AGREEMENT DATED DECEMBER 15, 2008, UNDER WHICH EMPLOYEE'S EMPLOYMENT WOULD TERMINATE ON DECEMBER 31, 2011. THE AMOUNT OF COMPENSATION RECOGNIZED THE EMPLOYEE'S DECADES-LONG SERVICE TO THE ORGANIZATION AS PRESIDENT AND CEO, AND HIS SERVICES IN TRANSITIONING TO THE ORGANIZATION'S CURRENT MANAGEMENT TEAM.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
STATE OF CT HEALTH & EDUCATIONAL FACILITIES
06080618620774LSV32005-08-1028992719SEE SCHEDULE K, PART Vfalsefalsefalse
STATE OF CT HEALTH & ENDUCATIONAL FACILITIES
06080618620774UC862008-07-0230168922SEE SCHEDULE K, PART Vfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
2885000289927197550861675006236972358367310514252199232008falsetruetruetrue
210000030168922030100000689220002008truefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsetrue0.000000.000000.00000true
falsefalsefalsefalsetrue0.000000.000000.00000true

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGIC
(no name)
falsefalsefalsefalsefalse
UBS AG
truetruetruefalsefalse29.9falsefalsefalse

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
IdentifierTAX-EXEMPT BONDSIdentifier
Return ReferenceSCHEDULE K, PART IReturnReference
ExplanationA-(F)- ADVANCE REFUND SERIES D/ FINANCE FACILITY MASTER PLAN B-(F)- CONSTRUCTION, RENOVATIONS, AND IMPROVEMENTS TO THE FACILITY PURSUANT TO THE FACILITY MASTER PLANExplanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonSEE SCHEDULE L PART VNamePerson

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierBUSINESS TRANSACTION INVOLVING INTERESTED PERSONSIdentifier
Return ReferenceSCHEDULE L, PART IVReturnReference
Explanation(A) CONNCARE, INC. (B) DAVID WHITEHEAD, DANIEL E LOHR, PETER V DISCH AND PETER SHEA ARE OFFICERS, TRUSTEES, DIRECTORS AND/OR KEY EMPLOYEES OF THE WILLIAM W. BACKUS HOSPITAL(WWBH) AND CONNCARE, INC.(CI) (C)/(D) $3,687,182 REIMBURSEMENTS PAID BY CI TO WWBH $373,523 LEASE FACILITIES AND EQUIPMENT TO CI BY WWBH $109,258 PERFORMANCE OF SERVICES BY WWBH FOR CI (E) NOExplanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (27 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART I, LINE 1 & PART III, LINE 1THE WILLIAM W. BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH QUALITY HEALTH CARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT. THE HOSPITAL IS COMMITTED TO BEING RESPONSIVE AND ACCOUNTABLE TO THOSE FOR WHOSE BENEFIT IT EXISTS, AND TO IMPROVING THE HEALTH OF ITS COMMUNITIES.
BUSINESS RELATIONSHIPSFORM 990, PART VI, SECTION A, LINE 2DAVID WHITEHEAD, DANIEL E LOHR, PETER V DISCH AND PETER SHEA HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVE AS AN OFFICER OR DIRECTOR FOR CONNCARE, INC. OR WWB CORPORATION, WHICH ARE RELATED FOR PROFIT COMPANIES.
MEMBERSFORM 990, PART VI, SECTION A, LINE 6BACKUS CORPORATION, A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF THE WILLIAM W. BACKUS HOSPITAL.
MEMBERS WHO MAY ELECT THE GOVERNING BODYFORM 990, PART VI, SECTION A, LINE 7ABACKUS CORPORATION, BEING THE SOLE MEMBER OF THE WILLIAM W. BACKUS HOSPITAL, HAS THE RIGHT TO ELECT ALL THE BOARD OF TRUSTEES.
DECISIONS SUBJECT TO APPROVAL OF MEMBERSFORM 990, PART VI, SECTION A, LINE 7BTHE ADMINISTRATIVE POWERS OF THE HOSPITAL SHALL BE VESTED IN THE BOARD OF TRUSTEES WHO SHALL HAVE CHARGE, CONTROL AND MANAGEMENT OF THE PROPERTY, AFFAIRS AND FUNDS OF THE HOSPITAL, SHALL BE RESPONSIBLE FOR THE DELIVERY AND MAINTENANCE OF QUALITY PATIENT CARE, THE PROMOTION OF QUALITY IMPROVEMENT, OVERSIGHT OF RISK MANAGEMENT ACTIVITIES, AND WHICH SHALL HAVE THE POWER AND AUTHORITY TO DO AND PERFOM ALL ACTS AND FUNCTIONS NOT INCONSISTENT WITH THE BYLAWS. THE BOARD OF TRUSTEES SHALL MAKE ALL POLICIES AND RULES THAT GOVERN THE HOSPITAL AND SHALL PROVIDE FOR THE ABILITY OF HOSPITAL LEADERSHIP TO ESTABLISH AND IMPLEMENT POLICIES AND TO PROVIDE NECESSARY RESOURCES.
990 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BTHE 990 IS PREPARED BY THE ACCOUNTING STAFF AND THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN REVIEWED BY THE CFO AND ANY QUESTIONS OR CONCERNS THE CFO MAY HAVE ARE ADDRESSED. THE FINANCE COMMITTEE OF THE BOARD WILL THEN REVIEW THE 990 AND ANY QUESTIONS OR CONCERNS THE FINANCE COMMITTEE HAVE ARE ADDRESSED. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CALL TRUSTEES, OFFICERS, AND KEY EMPLOYEES OF THE HOSPITAL SHALL COMPLETE AND SIGN A DISCLOSURE STATEMENT. THE STATEMENT WILL INCLUDE AN ITEMIZATION AND DESCRIPTION OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND ALL MATERIAL FACTS RELATED THERETO FOR SUCH TRUSTEE, OFFICER, OR KEY EMPLOYEE BY VIRTUE OF HIS OR HER ACTIVITIES OR THE ACTIVITIES OF RELATED PERSONS. TRUSTEES, OFFICERS, AND KEY EMPLOYEES ARE URGED TO BE INCLUSIVE IN THIS DISCLOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST IS ESSENTIAL TO ENSURING DISCUSSION OF CONFLICT. DISCLOSURE STATEMENTS SHALL BE RETURNED TO THE CORPORATE COMPLIANCE OFFICER. ALL DISCLOSURES MADE WILL BE REVIEWED BY THE COMPLIANCE OFFICER, UNDER THE DIRECTION OF THE CHAIR AND THE PRESIDENT, WHO SHALL EXERCISE GOOD FAITH JUDGEMENT AS TO WHETHER A CONFLICT EXISTS. THE CHAIR AND THE PRESIDENT SHALL BE RESPONSIBLE FOR MONITORING TRANSACTIONS OR ARRANGMENTS IN WHICH A TRUSTEE, OFFICER, OR KEY EMPLOYEE MAY HAVE A CONFLICT OF INTEREST AND FOR ASSURING THAT THE TRUSTEE, OFFICER, OR KEY EMPLOYEE SERVES THE HOSPITAL'S BEST INTERESTS. THE COMPLIANCE OFFICER, THE CHAIR AND/OR PRESIDENT MAY CONSULT WITH ANY TRUSTEE, OFFICER, OR KEY EMPLOYEE AND OBTAIN INFORMATION NECESSARY FOR AN ORDINARILY PRUDENT PERSON TO MAKE A JUDGMENT AS TO WHETHER A CONFLICT EXISTS AND EACH TRUSTEE, OFFICER, AND KEY EMPLOYEE SHALL COOPERATE WITH SUCH REQUESTS. THE COMPLIANCE OFFICER, THE CHAIR, AND/OR THE PRESIDENT SHALL PROVIDE GUIDANCE TO THE TRUSTEE, OFFICER, OR KEY EMPLOYEE AND TO THE BOARD OF TRUSTEES AS TO THE APPRORIATE COURSE OF ACTION. WHEN DEEMED PRUDENT BY THE CHAIR OR THE PRESIDENT, THE CHAIR AND THE PRESIDENT SHALL SEEK THE ADVICE AND APPROVAL OF THE FULL BOARD OF TRUSTEES OR GOVERNANCE COMMITTEE IN DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS AND THAT THE TRUSTEE, OFFICER, OR KEY EMPLOYEE SERVES THE HOSPITAL'S BEST INTERESTS. IF, AFTER COMPLETING AND SIGNING THE ANNUAL DISCLOSURE STATEMENT, AN ACTUAL OR POTENTIAL CONFLICT ARISES, THE TRUSTEE, OFFICER, OR KEY EMPLOYEE WITH THE CONFLICT SHALL PROMPTLY NOTIFY THE COMPLIANCE OFFICER IN WRITING. TRUSTEES, OFFICERS, AND KEY EMPLOYEES WHO HAVE DECLARED OR HAVE BEEN DEEMED TO HAVE A CONFLICT OF INTEREST MUST REFRAIN FROM CONSIDERATION OF PROPOSED TRANSACTIONS OR ARRANGMENTS, UNLESS FOR SPECIAL REASON THE BOARD OF TRUSTEES REQUESTS INFORMATION OR INTERPRETATIONS.
COMPENSATION REVIEWFORM 990, PART VI, SECTION B, LINES 15A & BA PERFORMANCE REVIEW COMMITTEE CONSISTING OF INDEPENDENT BOARD MEMBERS REVIEWS THE PERFORMANCE OF THE SENIOR MANAGEMENT TEAM. COMPENSATION IS BASED ON THE RESULTS OF THESE REVIEWS AND THE INDEPENDENT COMPENSATION CONSULTANT. THE COMMITTEE ALSO TAKES INTO CONSIDERATION INFORMATION FROM COMPENSATION SURVEYS.
JOINT VENTURESFORM 990, PART VI, SECTION B, LINE 16BALL NEW VENTURES ARE REVIEWED BY OUTSIDE COUNSEL AND PRESENTED TO THE BOARD FOR REVIEW AND APPROVAL.
AVAILABILITY OF DOCUMENTSFORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PLEASE CONTACT DANIEL E LOHR AT 326 WASHINGTON STREET, NORWICH, CT, 06360, ABOUT INSPECTING THE ORGANIZATION'S DOCUMENTS.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5K-1 GAIN AND INTEREST (2,641) TRANSFER TO AFFILIATE (245,005) DECREASE IN ASSETS HELD IN TRUST (102,368) CHANGE IN PENSION FUNDING (21,176,691) UNREALIZED LOSS (5,813,831) INVESTMENT EXPENSES (226,561) ------------ TOTAL $(27,567,097)
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:DAVID WHITEHEAD TITLE:TRUSTEE/PRESIDENT/CEO HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:PETER V DISCH TITLE:TRUSTEE/CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROBERT RAMSDELL TITLE:TRUSTEE/TREASURER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JOSEPH FATONE TITLE:TRUSTEE/SECRETARY HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ANTHONY JOYCE TITLE:TRUSTEE/VICE CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JOHN F BILDA TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ELIZABETH CONWAY TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:BERT A COPPOTELLI, MD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:GRACE JONES PHD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:PETER MANERI TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:DEBORAH MONAHAN TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:TODD POSTLER TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:LYNNE QUINTAL-HILL TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:MARK TRAMONTOZZI, MD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:DANIEL E LOHR TITLE:SENIOR VP/CFO HOURS:9
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:THOMAS P PIPICELLI TITLE:FORMER PRESIDENT HOURS:10

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
BACKUS HEALTH CARE INC
326 WASHINGTON STNORWICHCT06360222481794SUPPORTCT501(C)(3)11ABACKUS CORP
BACKUS CORPORATION
326 WASHINGTON STNORWICHCT06360222757608SUPPORTCT501(C)(3)11BNA

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1OMNI HOME HEALTH SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1NORWICH CT 06360AddressLine1
CityNORWICHCity
StateCTState
ZIP Code06360ZIPCode
FieldValueIRS element (for citing)
EIN061458837EIN
Primary ActivityHOME HEALTH CAREPrimaryActivity
Legal Domicile StateCTLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeType
Share Of Total Income0ShareOfTotalIncome
Share Of EOY Assets0ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
Code V$0CodeVAmount
General Or Managing PartnerfalseGeneralOrManagingPartner
Percentage Ownership0.00000PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
WWB CORPORATION
326 WASHINGTON STNORWICHCT06360061094836HOLDING COMPANYCTNAC-CORP000.00000
CONNCARE INC
326 WASHINGTON STNORWICHCT06360061387598HEALTH CARE SRVCSCTNAC CORP000.00000
BACKUS MEDICAL CENTER CONDO ASSOC INC
330 WASHINGTON STNORWICHCT06360061542647CONDO ASSOCIATIONCTNAC-CORP000.69000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg