2012-08-10T09:44:40-05:00 2011-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2010-10-01 060250773 THE WILLIAM W BACKUS HOSPITAL WILL 8608898331 326 WASHINGTON STREET NORWICH CT 06360 DANIEL E LOHR 2012-08-15 Michael J Engle 8162216300 2010 2016-02-24 21:20:13Z DAVID WHITEHEAD 326 WASHINGTON STREET NORWICH CT 06360 354887874 false X WWW.BACKUSHOSPITAL.ORG X 1891 CT BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH-QUALITY HEALTHCARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT. 14 11 2064 442 2162036 41320 1527754 1296004 270048715 271933218 3471412 5938478 1774538 1609862 276822419 280777562 81360 692681 0 0 136363855 135892894 0 0 273836 124070814 113381675 260516029 249967250 16306390 30810312 335457576 358349465 176145231 195793905 159312345 162555560 X SEE SCHEDULE O false false 201048233 692681 272479814 IN 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. 201048233 true true false true false false false false true true false false false true true true true false false false false false false true false true true true true true true false false false false false false false false false true false false false false false true true true false false true 206 0 true 2064 true true true false false false false true true false false false false X 14 11 true false false false true true true true true false false true true true true true true true true true false X X DANIEL E LOHR 8608898331 326 WASHINGTON STREET NORWICH CT 06360 X DAVID WHITEHEAD 40.0 X X 533927 0 40155 PETER V DISCH 6.0 X X 0 0 0 ROBERT RAMSDELL 6.0 X X 0 0 0 JOSEPH FATONE 6.0 X X 0 0 0 ANTHONY JOYCE 6.0 X X 0 0 0 JOHN F BILDA 2.0 X 0 0 0 ELIZABETH CONWAY 2.0 X 0 0 0 BERT A COPPOTELLI MD 2.0 X 0 0 0 GRACE JONES PHD 2.0 X 0 0 0 PETER MANERI 2.0 X 0 0 0 DEBORAH MONAHAN 2.0 X 0 0 0 TODD POSTLER 2.0 X 0 0 0 LYNNE QUINTAL-HILL 2.0 X 0 0 0 MARK TRAMONTOZZI MD 2.0 X 0 0 0 DANIEL E LOHR 40.0 X 412881 0 34617 PETER SHEA 40.0 X 424113 0 32805 SERGIO CASILLAS MD 40.0 X 460101 0 13307 ROBERT SIDMAN MD 40.0 X 375275 0 33514 MARK TOUSIGNANT MD 40.0 X 317187 0 33514 JUAN ESCALON MD 40.0 X 313617 0 33514 NADER BAHADORY MD 40.0 X 306020 0 40693 THOMAS P PIPICELLI 0.0 X 692040 0 34228 MARK SANTAMARIA 0.0 X 206690 0 0 4041851 0 296347 111 true true false WELLSPRING PARTNERS CONSULTING 4250000 ALLIANCE HEALTHCARE SERVICES MEDICAL SERVICES 3016144 HURON CONSULTING GROUP CONSULTING 2930194 YALE NH HOSPITAL MEDICAL SERVICES 2094415 NORWICH ANESTHESIA ASSOC MEDICAL SERVICES 556404 32 68480 1200 578977 647347 2921 1296004 Inpatient 900099 125515508 125515508 Outpatient 900099 101175035 101175035 Emergency Department 900099 42902718 42902718 Lab courier service 621500 2339957 2339957 271933218 1854181 1854181 0 0 1216398 2208204 -991806 -991806 -181585 -810221 75408845 206186 70758675 772059 4650170 -565873 4084297 4084297 22900 68480 42116 -19216 -19216 0 457671 329258 128413 128413 Cafeteria 722320 1102720 1102720 Child care 624410 391976 391976 Purchase discounts 900099 269594 269594 728181 724517 3664 2492471 280777562 270317778 2162036 7001744 682681 682681 10000 10000 0 0 2370911 479197 1891714 0 107798945 93702462 14003552 92931 8743448 7606800 1136648 9094736 7912420 1182316 7884854 6859823 1025031 0 971044 971044 158170 158170 47410 47410 0 77835 77835 15966576 12697875 3268251 450 194970 149411 45559 38647753 37631879 1013284 2590 4480434 376363 4104071 0 5448973 586056 4862089 828 253178 100629 152549 0 31343 2754 27967 622 2951831 2951831 0 15861992 7768430 8093562 1937247 1344246 593001 Lab expenses 4360264 4360264 Food/dietary 1146564 1085817 60747 Maintenance/service contracts 5095821 3956093 1139568 160 Education 527714 455729 71985 Bad debt 12522978 12492090 30888 2699578 787214 1781668 130696 249967250 201048233 48645181 273836 4239212 2802148 68235460 90659933 185866 101211 30758941 32373122 153242 100023 3844330 3757730 4267569 4493355 230812071 140828407 99122387 89983664 123615211 133516829 12632 12632 1022726 548818 335457576 358349465 25301642 22318404 63125000 61230000 1236586 1183176 86482003 111062325 176145231 195793905 X 147735382 153706889 4101543 1399547 7475420 7449124 159312345 162555560 335457576 358349465 X 30810312 -27567097 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 47410 false false false 47410 false 5320786 5000 76505 0 0 5432 5396859 4841631 358064 505259 0 378271 5897 5320786 3871631 970000 142089 0 135254 6835 4841631 0.00000 1.00000 0.00000 false false 2229795 2229795 10381267 40999717 32278800 19102184 77656294 39062881 38593413 98179225 69486726 28692499 1365773 1365773 89983664 0 Tax exempt bond premium, net 711971 DUE TO 3RD PARTY REIMB AGENCIES 23845704 Employee related obligations 73827779 Self-insured prof liability 10853762 Capital lease obligations 1379926 Other liabilities 443183 111062325 280777562 249967250 30810312 -5813831 -226561 -21526705 -27567097 3243215 283503815 42116 42116 283461699 226561 -2910698 -2684137 280777562 258453439 5813831 2816193 8630024 249823415 143835 143835 249967250 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE 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 DISCLOSURE SCHEDULE D, PART X, LINE 2 ASC 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 ASSETS SCHEDULE D, PART XI, LINE 8 K-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 ADJUSTMENTS SCHEDULE D, PART XII, LINE 2D GOLF TOURNAMENT EXPENSES $42,116 RECONCILIATION OF REVENUES- OTHER ADJUSTMENTS SCHEDULE D, PART XII, LINE 4B AUXILIARY 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 ADJUSTMENTS SCHEDULE D, PART XIII, LINE 2D RENTAL EXPENSE 2,208,204 GOLF TOURNAMENT EXPENSE 42,116 LOSS ON FIXED ASSETS 565,873 ---------- TOTAL $2,816,193 RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTS SCHEDULE D, PART XIII, LINE 4B AUXILIARY EXPENSE 143,835 GOLF TOURNAMENT 91380 68480 22900 2613 27709 3524 8270 0 91380 68480 22900 2613 27709 3524 8270 42116 -19216 true true true X 250. true X true true false true true 2221554 481911 1739643 0.00700 46273759 31545137 14728376 0.05900 48495313 32027048 16468019 0.06600 40398 430740 9834 420906 0.00170 1775 240048 0 240048 0.00100 9379 12347573 8999744 3347829 0.01340 24279 0 24279 0.00010 650133 0 650133 0.00260 51552 13692773 9009578 4683195 0.01880 51552 62188086 41036626 21151214 0.08480 8618 8618 2645 2645 4377 4377 2622 2622 18262 18262 false 5225824 3832933 53932695 66548262 -12615567 X true true 1 1 WILLIAM W BACKUS HOSPITAL

326 WASHINGTON ST NORWICH CT 06360

X X X WILLIAM W BACKUS HOSPITAL 1 10 BACKUS OP CARE CENTER

111 SALEM TURNPIKE NORWICH CT 06360

OUTPATIENT SERVICES MEDICAL OFFICE BUILDING

330 WASHINGTON STREET NORWICH CT 06360

RADIATION THERAPY/LAB BACKUS OUTPATIENT CENTER

12/19 CASE STREET NORWICH CT 06360

XRAY/MAMMOGRAPHY/LAB COLCHESTER BACKUS HC

163 BROADWAY COLCHESTER CT 06415

RAIOLOGY/LAB/PRIMARY CARE MONTVILLE BACKUS HC

80 NORWICH/NL TURNPIKE UNCASVILLE CT 06382

RADIOLOGY/LAB/PRIMARY CARE PAIN MANAGEMENT

112 LAFAYETTE STREET NORWICH CT 06360

PAIN MANAGEMENT BACKUS PATIENT SERVICE CENTER

122 PLAINFIELD ROAD MOOSUP CT 06354

XRAY/LAB/PRIMARY CARE LEDYARD BACKUS HC

743 COLONEL LEDYARD HWY LEDYARD CT 06339

LAB/PRIMARY CARE JEWETT CITY PATIENT SERVICE CTR

70 MAIN STREET JEWETT CITY CT 06351

LAB INFECTIOUS DISEASE CLINIC

107 LAFAYETTE STREET NORWICH CT 06360

CLINIC SCHEDULE H, PART I, LINE 7, COLUMN F THE 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 7 THE 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 7G SCHEDULE H, PART II PHYSICIAN CLINIC COST $ 877,678 COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II Backus 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. BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 THE 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. MEDICARE SHORTFALL SCHEDULE H, PART III, LINE 8 THE 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. COLLECTION POLICY SCHEDULE H, PART III, LINE 9B THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 (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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 (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. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 The 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%. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 a) 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. true HOSPICE OF SE CONNECTICUT 222667260 501(C)(3) 8500 CORPORATE BENEFACTOR UNITED WAY OF SE CT 060771393 501(C)(3) 17000 CORPORATE BENEFACTOR PLAINFIELD REC DEPT 066002062 PLAINFIELD 10000 PRESIDENTS AWARD AMERICAN HEART ASSOC 135613797 501(C)(3) 25000 SPONSORSHIP UNITED COMMUNITY & FAMILY SERVICES 060653142 501(C)(3) 559990 WOMEN'S HEALTH 5 0 SCHOLARSHIPS 4 10000 Procedures for Monitoring the use of grant funds in the U.S. SCHEDULE I, PART I, LINE 2 DONATIONS 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. X false true X X X X X false true false false false false false true false DAVID WHITEHEAD 446113 0 87400 0 414 0 19600 0 20555 0 574082 0 0 0 DANIEL E LOHR 336248 0 54800 0 21833 0 19600 0 15017 0 447498 0 0 0 MARK SANTAMARIA 150565 0 25000 0 31125 0 0 0 0 0 206690 0 0 0 PETER SHEA 361520 0 54800 0 7793 0 12250 0 20555 0 456918 0 0 0 SERGIO CASILLAS MD 344101 0 116000 0 0 0 12250 0 1057 0 473408 0 0 0 ROBERT SIDMAN MD 258456 0 96344 0 20475 0 12250 0 21264 0 408789 0 0 0 MARK TOUSIGNANT MD 249187 0 0 0 68000 0 12250 0 21264 0 350701 0 0 0 JUAN ESCALON MD 297117 0 0 0 16500 0 12250 0 21264 0 347131 0 0 0 NADER BAHADORY MD 226076 0 77919 0 2025 0 19600 0 21093 0 346713 0 0 0 THOMAS P PIPICELLI 609268 0 0 0 82772 0 19600 0 14628 0 726268 0 0 0 GROSS-UP PAYMENTS SCHEDULE J, PART I, LINE 1A THE FORMER PRESIDENT RECEIVED GROSS-UP PAYMENTS ON SELECTED EXPENSES PROPERLY INCLUDED IN HIS W-2 WAGES. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B DAVID 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 PAYMENTS SCHEDULE J, PART I, LINE 7 BONUSES 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 EXPLANATION SCHEDULE J, PART II, COLUMN C COMPENSATION 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 INFORMATION SCHEDULE J, PART II, LINE 10 THOMAS 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. STATE OF CT HEALTH & EDUCATIONAL FACILITIES 060806186 20774LSV3 2005-08-10 28992719 SEE SCHEDULE K, PART V false false false STATE OF CT HEALTH & ENDUCATIONAL FACILITIES 060806186 20774UC86 2008-07-02 30168922 SEE SCHEDULE K, PART V false false false 2885000 28992719 755086 16750062 369723 583673 10514252 19923 2008 false true true true 2100000 30168922 0 30100000 68922 0 0 0 2008 true false true true false false false false true 0.00000 0.00000 0.00000 true false false false false true 0.00000 0.00000 0.00000 true false false false false false true true true UBS AG 29.9 false false false false false TAX-EXEMPT BONDS SCHEDULE K, PART I A-(F)- ADVANCE REFUND SERIES D/ FINANCE FACILITY MASTER PLAN B-(F)- CONSTRUCTION, RENOVATIONS, AND IMPROVEMENTS TO THE FACILITY PURSUANT TO THE FACILITY MASTER PLAN SEE SCHEDULE L PART V BUSINESS TRANSACTION INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV (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) NO ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 & PART III, LINE 1 THE 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 RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 DAVID 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. MEMBERS FORM 990, PART VI, SECTION A, LINE 6 BACKUS 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 BODY FORM 990, PART VI, SECTION A, LINE 7A BACKUS 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 MEMBERS FORM 990, PART VI, SECTION A, LINE 7B THE 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 PROCESS FORM 990, PART VI, SECTION B, LINE 11B THE 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 POLICY FORM 990, PART VI, SECTION B, LINE 12C ALL 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 REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B A 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 VENTURES FORM 990, PART VI, SECTION B, LINE 16B ALL NEW VENTURES ARE REVIEWED BY OUTSIDE COUNSEL AND PRESENTED TO THE BOARD FOR REVIEW AND APPROVAL. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE 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 ASSETS FORM 990, PART XI, LINE 5 K-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 ORGANIZATION FORM 990 PART VII NAME:DAVID WHITEHEAD TITLE:TRUSTEE/PRESIDENT/CEO HOURS:7 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PETER V DISCH TITLE:TRUSTEE/CHAIRMAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT RAMSDELL TITLE:TRUSTEE/TREASURER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH FATONE TITLE:TRUSTEE/SECRETARY HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANTHONY JOYCE TITLE:TRUSTEE/VICE CHAIRMAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN F BILDA TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELIZABETH CONWAY TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BERT A COPPOTELLI, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GRACE JONES PHD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PETER MANERI TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEBORAH MONAHAN TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TODD POSTLER TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LYNNE QUINTAL-HILL TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK TRAMONTOZZI, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL E LOHR TITLE:SENIOR VP/CFO HOURS:9 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS P PIPICELLI TITLE:FORMER PRESIDENT HOURS:10 BACKUS HEALTH CARE INC 326 WASHINGTON ST NORWICH CT 06360 222481794 SUPPORT CT 501(C)(3) 11A BACKUS CORP BACKUS CORPORATION 326 WASHINGTON ST NORWICH CT 06360 222757608 SUPPORT CT 501(C)(3) 11B NA OMNI HOME HEALTH SERVICES NORWICH CT 06360 NORWICH CT 06360 061458837 HOME HEALTH CARE CT NA RELATED 0 0 false 0 false 0.00000 WWB CORPORATION 326 WASHINGTON ST NORWICH CT 06360 061094836 HOLDING COMPANY CT NA C-CORP 0 0 0.00000 CONNCARE INC 326 WASHINGTON ST NORWICH CT 06360 061387598 HEALTH CARE SRVCS CT NA C CORP 0 0 0.00000 BACKUS MEDICAL CENTER CONDO ASSOC INC 330 WASHINGTON ST NORWICH CT 06360 061542647 CONDO ASSOCIATION CT NA C-CORP 0 0 0.69000 false true false false false false false false true false true true false true false true false false