2011-10-14T12:37:50-05:00 2011-02-28 KPMG LLP 345 Park Avenue New York NY 101540102 990 2010-03-01 060655139 SILVER HILL HOSPITAL INC SILV 2039661380 208 VALLEY RD NEW CANAAN CT 06840 SIGURD H ACKERMAN MD 2039661380 2011-10-12 true KPMG LLP 2127589700 2010 2016-03-07 17:11:31Z SIGURD H ACKERMAN MD 208 VALLEY RD NEW CANAAN CT 06840 36010512 false X WWW.SILVERHILLHOSPITAL.ORG X 1934 CT SEE SCHEDULE O 20 16 344 146 0 0 1526337 2294704 29593900 30344974 257551 553848 545712 -164578 31923500 33028948 0 0 18137315 18678432 0 433142 10480446 10466421 28617761 29144853 3305739 3884095 34720281 37981491 11410010 9962170 23310271 28019321 THE MISSION OF SILVER HILL HOSPITAL IS TO PROVIDE OUR PATIENTS WITH THE BEST AVAILABLE TREATMENT OF MENTAL ILLNESS AND ADDICTION; AND TO OFFER CONTINUING SUPPORT, COUNSELING AND EDUCATION TO OUR PATIENTS AND THEIR FAMILIES IN EVERY PHASE OF ILLNESS AND RECOVERY. false false 14856939 0 14117007 INPATIENT TREATMENT IS THE MOST INTENSIVE FORM OF CARE, INDICATED FOR A PHASE OF ILLNESS THAT REQUIRES A GREAT DEAL OF NURSING AND MEDICAL INTERVENTION, BECAUSE PATIENTS ARE USUALLY ACUTELY ILL DURING THIS PHASE OF CARE, OUR INPATIENT TREATMENT PLANS EMPHAZISE DIAGNOSTIC ASSESSMENT, SYMPTOM REDUCTION, AND STABILIZATION. 8446884 0 15209601 SILVER HILL HOSPITAL'S TRANSITIONAL LIVING PROGRAMS PROVIDE HIGHLY STRUCTURED INTENSIVE TREATMENT FOR PATIENTS WHO ARE READY FOR MORE PSYCHOLOGICAL AND BEHAVIORAL INTERVENTIONS. SET IN RESIDENTIAL, HOME-LIKE SETTINGS, THE TRANSITIONAL LIVING PROGRAMS HELP PATIENTS CONTINUE THEIR RECOVERY PROCESS UNTIL THEY ARE READY TO RETURN HOME FOR FURTHER COMMUNITY-BASED TREATMENTS, PATIENTS FOCUS ON DEVELOPING A PSYCHOLOGICAL UNDERSTANDING OF THEIR ILLNESS, OBTAINING INFORMATION ABOUT THEIR ILLNESS AND DEVELOPING NEW BEHAVIORAL SKILLS TO MANAGE THEIR RECOVERY PROCESS. 190547 0 1018366 INTENSIVE OUTPATIENT PROGRAMS (IOP) MEET FOR THREE HOURS/DAY, THREE DAYS/WEEK. SILVER HILL HOSPITAL PROVIDES A DIALECTICAL BEHAVIOR THERAPY IOP FOR PATIENTS EXPERIENCING DIFFICULTY REGULATING INTENSE EMOTIONS, IMPULSIVITY AND HARMFUL BEHAVIORS. THE WOMEN'S TRAUMA AND ADDICTION IOP IS FOR WOMEN WHO STRUGGLE WITH DRUGS AND ALCOHOL AND HAVE EXPERIENCED SOME FORM OF TRAUMA SUCH AS EARLY PHYSICAL OR SEXUAL ABUSE, EMOTIONAL ABUSE OR A TRAUMATIC EVENT THE DUAL DIAGNOSIS IOP PROVIDES SIMULTANEOUS TREATMENT FOR PATIENTS WITH A PSYCHIATRIC AND SUBSTANCE ABUSE DISORDER. 23494370 true true false false false false false false false true true false false false true true true false false false false false false false true false true false false false true false false false false false false false false true false false false false false false false false false true 129 0 344 true false false false false false true true false false false false X 20 16 false false false false false false false true true false false true true true true true true true true false CT NY X RUURD G LEEGSTRA CFO 2038012230 208 VALLEY RD NEW CANAAN CT 06840 WARD F CLEARY 3.0 X 0 0 0 DEANN E MURPHY 3.0 X 0 0 0 STEVE STILLERMAN 1.0 X 0 0 0 CYNTHIA ZIEGLAR BRIGHTON 1.0 X 0 0 0 PATRICIA BURROWS LCSW 1.0 X 0 0 0 SPERRY A DECEW 1.0 X 0 0 0 JOHN L ENGELS JR 1.0 X 0 0 0 FREDERICK S FEINER MD 1.0 X 0 0 0 JUDITH FREEDMAN 1.0 X 0 0 0 RICHARD GANNON 1.0 X 0 0 0 J DAVID HADDOX DDS MD 1.0 X 0 0 0 THEODORE HERMAN 1.0 X 0 0 0 CLAUDETTE H KUNKES PHD 1.0 X 0 0 0 PAUL LAMBDIN 1.0 X 0 0 0 LANCE LUNBERG 1.0 X 0 0 0 PETER ORTHWEIN 1.0 X 0 0 0 SIGURD H ACKERMAN MD 40.0 X X 509228 0 22051 ELIZABETH E MOORE 40.0 X X 298321 0 16426 BARRY KERNER MD 40.0 X X 252184 0 27767 RUURD G LEEGSTRA 40.0 X X 210067 0 9764 ANRI KISSILENKO MD 40.0 X 191919 0 28173 ROCCO MAROTTA MD 40.0 X 186651 0 18216 MISSY FALLON 40.0 X 191968 0 4670 SANDRA GOMEZ-LUNA MD 40.0 X 191034 0 4653 AVE ALBRECHT MD 40.0 X 178212 0 13395 2209584 0 145115 22 false true false PAC GROUP LLC PO BOX 52 HARWINGTON CT 06791 GENERAL CONTRACTOR 1772467 UNIDINE CORPORATION ONE GATEWAY CENTER SUITE 751 NEWTON MA 02458 FOOD SERVICES 1269527 RICHARD TURLINGTON ARCHITECTS 244 MAPLE STREET NEW HAVEN CT 06511 ARCHITECT 481587 PHARMACY THERAPEUTICS CONSULTANTS 300 CHURCH ST WALLINGFORD CT 06492 PHARMACY MANAGEMENT 311787 MEDSPHERE SYSTEMS CORPORATION 1917 PALOMAR OAKS WAY SUITE 200 CARLSBAD CA 92008 IT CONSULTANT 304863 12 1310642 984062 330027 2294704 INPATIENT PROGRAM 623000 14117007 14117007 TRANSITIONAL LIVING PROGRAM 623000 15209601 15209601 NON RESIDENTIAL SERVICES 623000 1018366 1018366 30344974 426654 426654 0 0 0 13550 0 13550 13550 13550 2478083 2350889 127194 127194 127194 279303 1310642 630675 -351372 -351372 0 0 GIFT SHOP REVENUE 900099 38999 38999 OTHER 900099 74521 74521 ALL OTHER REVENUE 900099 59724 59724 173244 33028948 30905873 0 -171629 0 0 0 0 1309240 508601 734481 66158 0 13777685 12262443 1241587 273655 578831 504560 67928 6343 1988928 1668729 312576 7623 1023748 878534 130769 14445 0 238695 3000 235695 0 104124 0 104124 0 0 0 53988 0 53988 0 3762978 3207573 539815 15590 262895 246590 3825 12480 1023480 803504 205627 14349 136186 129740 6248 198 0 1324176 746941 572616 4619 87900 70047 15524 2329 0 126199 114470 10737 992 0 0 1207934 962016 244322 1596 608578 75038 533540 0 BAD DEBT 587384 587384 0 0 PHARMACY 326531 326531 0 0 OTHER EXPENSES 615373 398669 203939 12765 29144853 23494370 5217341 433142 1902 1901 5127803 5500191 138573 107421 2791269 2347022 60920 59279 470299 489261 34562540 15445535 16149146 19117005 9559025 10214113 421344 145298 34720281 37981491 1406315 1752443 8327680 6327680 1676015 1882047 11410010 9962170 X 22985863 26822128 111408 984193 213000 213000 23310271 28019321 34720281 37981491 X 3884095 824955 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 213000 4650 4650 213000 213000 5910 5910 213000 213000 5868 5868 213000 1.00000 false false 92996 92996 24257130 10839069 13418061 5466476 3770384 1696092 4745938 836082 3909856 19117005 0 ACCRUED 401K EMPLOYER CONTRIBUTION 659951 ACCRUED SALARIES AND WAGES 591038 ACCRUED VACATION 340439 ACCRUED LEGAL 117811 EMPLOYEE FSA PAYABLE 55090 UNCLAIMED PROPERTY 61731 INT. PAYABLE ON THE LINE OF CREDIT 28171 ACCRUED FICA - EMPLOYER PORTION 27816 1882047 33028948 29144853 3884095 824958 824958 4709053 34011787 824958 214369 1039327 32972460 53988 2500 56488 33028948 29302734 214369 214369 29088365 53988 2500 56488 29144853 PART V, LINE 4 DONORS HAVE STIPULATED THAT ANY INCOME FROM THE ENDOWMENT FUNDS IS TO BE USED FOR ADOLESCENT AND CHEMICAL DEPENDENCY PROGRAMS. PART X, LINE 2 THE HOSPITAL IS QUALIFIED AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), AND AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. THE INTERNAL REVENUE SERVICE INFORMED THE HOSPITAL BY A LETTER DATED JUNE 23, 1997 THAT THE HOSPITAL'S OPERATIONS ARE DESIGNED IN ACCORDANCE WITH SUCH SECTION TO THE CODE. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED "UNRELATED BUSINESS INCOME" AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAN NOT. IT IS MANAGEMENT'S ESTIMATION THAT ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. PART XII AND XIII, LINE 2D THIS AMOUNT REPRESENTS $214,369 OF SPECIAL EVENT EXPENSES THAT ARE INCLUDED IN OPERATING EXPENSES IN THE STATEMENT OF OPERATIONS OF THE AUDITED FINANCIAL STATEMENTS, BUT NETTED AGAINST SPECIAL EVENT REVENUES FOR 990 PURPOSES AND INCLUDED IN PART VIII LINE 12 OF THE FORM 990. PART XII AND XIII, LINE 4B THIS AMOUNT REPRESENTS PROVISION FOR UNCOLLECTIBLE PLEDGES OF $2,500, WHICH IS NETTED AGAINST REVENUE IN THE STATEMENT OF OPERATIONS OF THE AUDITED FINANCIAL STATEMENTS BUT INCLUDED IN PART IX LINE 25 ON THE FORM 990. 2010 GALA 1589945 1310642 279303 0 0 0 131435 44582 454657 0 1589945 1310642 279303 0 0 0 131435 44582 454657 630674 -351371 true true true X 500. true X 800. false true false true true 389578 0 389578 0.01360 389578 0 389578 0.01360 23033 375 22658 0.00080 142536 0 142536 0.00500 14543331 14117007 426324 0.01490 16000 16000 0.00060 14724900 14117382 607518 0.02130 15114478 14117382 997096 0.03490 true 432476 82682 16019 66663 X true true 1 1 Silver Hill Hospital Inc

208 valley RD New Canaan CT 06840

X Silver Hill Hospital Inc 1 Part I, Line 3c: N/A Part I, line 6a: During FY 11, the Hospital filed a Community Benefit Report with the Connecticut Dept of Public Health for calendar years 2009 and 2010. Part I, line 7g: N/A Part I, line 7 column (f): Bad debt Expense included on Form 990, Part IX, Line 25, Column (A), but excluded for purposes of calculating financial assistance and certain other community benefits at cost: $587,384 Part I, line 7: A cost to charge ratio, derived from Worksheet 2: Ratio of Patient Care Cost to Charges, was used to determine charity care costs reported. All other expenses reported are actual costs. Part II: N/A Part III, line 4: Consistent with HFMA Statement 15, bad debt expense reported in the audited financial statements represents the amount that the payer is expected to pay. For 990 reporting purposes, Bad debt cost was calculated based on the patient cost to charge ratio applied to the bad debt expense reported in the audited financial statements. Footnote - "The collections of receivables from third-party payors and patients is the Hospital's primary source of cash for operations and is critical to its operating performance. The primary collection risks relate to uninsured patient accounts and patient accounts for which the primary insurance payor has paid, but patient responsibility amounts (deductibles and copayments) remain outstanding. Patient receivables, where a third-party payor is responsible for paying the amount, are carried at a net amount determined by the original charge for the service provided, less an estimate made for contractual adjustments to third-party payors. Patient receivables due directly from the patients are carried at the original charge for the service provided less amounts covered by the third-party payors and less an estimated allowance for uncollectible receivables. Management estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each payor type. Recoveries of receivables previously written off are recorded as a reduction of the provision for uncollectible accounts when received. The past due status of receivables is determined on a case-by-case basis depending on the responsible payor. Interest is generally not charged on the past due accounts. Part III, line 8: Amounts reported in Part III (b) represent Outpatient medicare, as inpatient medicare revenue and expenses are included in subsidized care (part 1, line 7 (g)). Revenue received from medicare was taken from worksheet e, part b line 17.01 of the fy 2011 medicare cost report; the allowable cost amount was taken from worksheet e, part b line 1.01 of the fy 2011 medicare cost report. Part III, line 9b: The collection policy states: "this policy is applicable to all patients receiving services at silver hill hospital (SHH) who are considered self-pay (as defined in this policy) and are judged to be able to pay; that is, this policy applies to those who are not eligible for financial assistance program (see policy on free care program)." Part V, Section B: N/A for 501(c)(3) organizations with tax years beginning before March 23, 2010. shh's tax year is March 1, 2010 - February 28, 2011. X X X X X false false false false false false false true false SIGURD H ACKERMAN MD 429228 0 80000 0 0 0 0 0 22051 0 531279 0 0 0 ELIZABETH E MOORE 258321 0 40000 0 0 0 0 0 16426 0 314747 0 0 0 BARRY KERNER MD 222184 0 30000 0 0 0 0 0 27767 0 279951 0 0 0 RUURD G LEEGSTRA 175067 0 35000 0 0 0 0 0 9764 0 219831 0 0 0 ANRI KISSILENKO MD 191919 0 0 0 0 0 0 0 28173 0 220092 0 0 0 ROCCO MAROTTA MD 186651 0 0 0 0 0 0 0 18216 0 204867 0 0 0 MISSY FALLON 191968 0 0 0 0 0 0 0 4670 0 196638 0 0 0 SANDRA GOMEZ-LUNA MD 191034 0 0 0 0 0 0 0 4653 0 195687 0 0 0 AVE ALBRECHT MD 178212 0 0 0 0 0 0 0 13395 0 191607 0 0 0 Part I, Line 7 THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER AND PHYSICIAN-IN-CHIEF ARE ELIGIBLE FOR INCENTIVE COMPENSATION BASED ON THE ACHIEVEMENT OF PERFORMANCE GOALS ESTABLISHED AND APPROVED BY THE BOARD OF DIRECTORS. IN CALENDAR YEAR 2010, THE AFOREMENTIONED INDIVIDUALS RECEIVED COMPENSATION FOR ACHIEVEMENT OF INCENTIVE GOALS RELATED TO THE FISCAL YEAR ENDING FEBRUARY 28, 2010. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(II). X 4 45159 STOCK MARKET VALUE X AUCTION ITEMS 3 230000 MARKET VALUE X GIFT BAGS FOR GALA 4 44868 MARKET VALUE OF ITEM X GALA FLORALS & LINEN 1 10000 MARKET VALUE 0 false true true PART I, COLUMN (B) THE HOSPITAL IS REPORTING THE NUMBER OF NON CASH CONTRIBUTION MADE DURING THE FISCAL YEAR. PART I, LINE 32 A DONATIONS OF PUBLICLY TRADED SECURITIES WERE SOLD THROUGH A BROKER. PART I, LINE 1 MISSION STATEMENT THE MISSION OF SILVER HILL HOSPITAL IS TO PROVIDE OUR PATIENTS WITH THE BEST AVAILABLE TREATMENT OF MENTAL ILLNESS AND ADDICTION; AND TO OFFER CONTINUING SUPPORT, COUNSELING AND EDUCATION TO OUR PATIENTS AND THEIR FAMILIES IN EVERY PHASE OF ILLNESS AND RECOVERY. PART VI, SECTION B LINE 11B, 12C, 15 AND 19 LINE 11B - THE FORM 990 OF THE ORGANIZATION IS PREPARED BY THE FINANCE DEPARTMENT OF SILVER HILL HOSPITAL BASED ON THE BOOKS AND RECORDS OF THE ORGANIZATION. THE DRAFT RETURN AND ALL SUPPORTING DOCUMENTATION ARE PROVIDED TO THE ORGANIZATION'S INDEPENDENT ACCOUNTANTS FOR REVIEW AND FINAL PREPARATION OF THE RETURN. THE FINAL VERSION OF THE FORM 990 IS THEN REVIEWED BY THE DIRECTOR OF ACCOUNTING, CFO, COO AND PRESIDENT, AND MEDICAL DIRECTOR. THE FINAL VERSION OF THE FORM 990 IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY FOR THEIR REVIEW AND COMMENTS BEFORE FILING THE FORM WITH THE INTERNAL REVENUE SERVICE. LINE 12C - THE HOSPITAL REQUIRES THE BOARD OF DIRECTORS AND OFFICERS TO COMPLETE A NOTIFICATION OF COMPLIANCE QUESTIONNAIRE AT THE END OF EACH YEAR. THE FINANCE DEPARTMENT REVIEWS THE QUESTIONNAIRES FOR DETERMINATION OF POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICTS ARE MADE KNOWN TO THE BOARD FOR RESOLUTION. LINE 15 - EACH YEAR, OR WHEN OTHERWISE REQUIRED, THE BOARD OF DIRECTORS APPOINTS A COMPENSATION SUB-COMMITTEE OF INDEPENDENT DIRECTORS TO REVIEW THE COMPENSATION OF THE PRESIDENT AND MEDICAL DIRECTOR COO, CFO AND KEY EMPLOYEES. THE SUB-COMMITTEE REVIEWS FORM 990'S OF SIMILAR ORGANIZATIONS AS WELL AS COMPENSATION SURVEYS AND STUDIES PERFORMED BY AN INDEPENDENT CONSULTANT, AND MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. ANY DELIBERATIONS AND DECISIONS OF THE COMPENSATION SUB-COMMITTEE ARE DOCUMENTED IN THE MINUTES OF THE ANNUAL BOARD OF DIRECTORS MEETING. LINE 19 - THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. PART XI, LINE 5 OTHER CHANGES IN NET ASSEST OR FUND BALANCES UNREALIZED GAIN ON INVESTMENTS - 824,955.