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BRISTOL HOSPITAL INCORPORATED: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
BRISTOL HOSPITAL INCORPORATED (EIN 06-0646559)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-11-01
IRS object ID
201103059349300430
Schema version
2009v1.7
Note
A later return for the same period supersedes this one.
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)
Timestamp2011-11-01T11:52:46-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SASLOW LUFKIN & BUGGY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1TEN TOWER LANEAddressLine1
CityAVONCity
StateCTState
ZIP Code06001ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN060646559EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Bristol Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBRISNameControl
Phone8605853000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1Brewster RdAddressLine1
CityBristolCity
StateCTState
ZIP Code06010ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGEORGE W EIGHMYName
TitleVP & CFOTitle
Phone8605853000Phone
Date Signed2011-10-21DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBeth ThurzName
Phone8606789200Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnXAmendedReturn
Name Of Principal Officer PersonKURT BARWISNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1Brewster RdAddressLine1
CityBristolCity
StateCTState
ZIP Code06010ZIPCode
FieldValueIRS element (for citing)
Gross Receipts133502724GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.BRISTOLHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1920YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE QUALITY HEALTHCARE SERVICES TO THE COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees1433TotalNbrEmployees
Total Nbr Volunteers385TotalNbrVolunteers
Total Gross UBI1381252TotalGrossUBI
Net Unrelated Business Txbl Income-348560NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1281575ContributionsGrantsPriorYear
Contributions Grants Current Year1947224ContributionsGrantsCurrentYear
Program Service Revenue Prior Year126270402ProgramServiceRevenuePriorYear
Program Service Revenue CY128738355ProgramServiceRevenueCY
Investment Income Prior Year330890InvestmentIncomePriorYear
Investment Income Current Year285251InvestmentIncomeCurrentYear
Other Revenue Prior Year2147930OtherRevenuePriorYear
Other Revenue Current Year2531894OtherRevenueCurrentYear
Total Revenue Prior Year130030797TotalRevenuePriorYear
Total Revenue Current Year133502724TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year67645918SalariesEtcPriorYear
Salaries Etc Current Year70523697SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year62011481OtherExpensePriorYear
Other Expenses Current Year60463936OtherExpensesCurrentYear
Total Expenses Prior Year129657399TotalExpensesPriorYear
Total Expenses Current Year130987633TotalExpensesCurrentYear
Revenues Less Expenses Prior Year373398RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2515091RevenuesLessExpensesCY
Total Assets BOY94428773TotalAssetsBOY
Total Assets EOY97645788TotalAssetsEOY
Total Liabilities BOY87189513TotalLiabilitiesBOY
Total Liabilities EOY89425255TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7239260NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8220533NetAssetsOrFundBalancesEOY
Mission DescriptionBRISTOL HOSPITAL IS COMMITTED TO PROVIDING THE BEST PATIENT EXPERIENCE IN THE REGION. OUR 134-BED, FULL-SERVICE HEALTH CARE INSTITUTION PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT CARE FOR THE GREATER BRISTOL, CONNECTICUT AREA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense112654790Expense
Revenue128836860Revenue
DescriptionAS A SHORT-TERM ACUTE CARE COMMUNITY HOSPITAL, BRISTOL HOSPITAL PROVIDES A BROAD SPECTRUM OF HEALTHCARE SERVICES TO ANY INDIVIDUAL REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY. THE HOSPITAL PROVIDED MORE THAN $259,000 IN CHARITY CARE DURING THE OPERATING YEAR. THE HOSPITAL ALSO PROVIDES EDUCATION AND WELLNESS PROGRAMS TO THE COMMUNITY. THESE ACTIVITIES TYPICALLY REACH ABOUT 1,600 INDIVIDUALS PER QUARTER. THESE ACTIVITIES INCLUDE: WELLNESS CENTER - SPECIAL CENTER FOR EDUCATIONAL OUTREACH PROGRAMMING SERVING HUNDREDS OF INDIVIDUALS PER MONTH. - COMMUNITY HEALTH SCREENINGS - ONGOING FREE AND REDUCED PRICE SCREENINGS FOR MAMMOGRAMS, BLOOD PRESSURE, CHOLESTEROL, PROSTATE CANCER, SKIN CANCER AND A FLU CLINIC PROVIDING FREE FLU SHOTS IN THE FALL. - SPEAKERS BUREAU - A COMMUNITY SERVICE WHERE THE HOSPITAL PROVIDES SPEAKERS ON A VARIETY OF TOPICS TO SERVE THE COMMUNITY'S EDUCATIONAL NEEDS. - PERIODIC COMMUNITY SERVICE PROJECTS - THE HOSPITAL HAS SPONSORED TWO MAJOR OUTREACH EFFORTS, ONE TO PROMOTE EARLY DETECTION OF BREAST CANCER AND ONE TARGETED TO PREVENT COLON CANCER. BOTH PROGRAMS HAVE INCREASED THE COMMUNITY'S COMPLIANCE WITH THE RECOMMENDED CANCER SCREENINGS AND HAVE BEEN RECOGNIZED WITH STATE, REGIONAL AND NATIONAL AWARDS.Description
Total Program Service Expense112654790TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109696NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1433NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JOSEPH HARTBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8605853000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1BREWSTER ROADAddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06010ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
KENNETH BENOIT MD
DIRECTOR2.00X000
NANCY BLANCHETTE
CHAIRMAN OF THE BOARD2.00X000X
MARK BLUM
SECRETARY/TREASURER2.00X000X
BALA SHANMUGAM MD
DIRECTOR2.00X01828288243
JACKIE BRACCO
DIRECTOR2.00X000
LESLIE KISH MD
DIRECTOR2.00X000
MORRIS LAVIERO
DIRECTOR2.00X000
JOHN J LEONE JR
DIRECTOR2.00X000
GLENN HEISER
DIRECTOR2.00X000
DANIEL S SACCU
DIRECTOR2.00X000
VALERIE VITALE MD
DIRECTOR2.00X000
KURT BARWIS
PRESIDENT & CEO60.00X3769010102053X
STEWART BOBER MD
DIRECTOR2.00X1054200
JOHN LODOVICO JR
DIRECTOR2.00X000
MARIE O'BRIEN
VICE CHAIRMAN2.00X000X
PETER VALERIO
DIRECTOR2.00X000
KENNETH RHEE MD
DIRECTOR2.00X000
DAVID DOBRZANSKI
MEDICAL DIRECTOR40.00389516014982X
LEONARD BANCO MD
SR. V.P. CHIEF MEDICAL OFFICER40.00281331021228X
ROBERT ROSE
V.P. PATIENT CARE SERVICES40.00169722021251X
RUSSELL TUVERSON
PHYSICIAN32.0016196005478X
MARC EDELMAN
V.P. OPERATIONS40.00161421017089X
PETER FREYTAG
FORMER V.P. CFO40.00271004021321X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1822397TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs182828TotalReportableCompFrmRltdOrgs
Total Other Compensation211645TotalOtherCompensation
Number Individuals GT100 K23NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ALLIANCE HEALTHCARE SERVICES
PO BOX 96485CHICAGOIL603966485PET/CT SCANS1617819
HOSPITAL INTERNISTS OF BRISTOL LLC
3 MICHELLE LANEMYSTICCT06355MEDICAL SERVICES630000
FRIAR ASSOCIATES INC
281 FARMINGTON AVEFARMINGTONCT06032DESIGN SERVICES270835
DIALYSIS CTR OF NEWINGTON
C/O DSD - NE REGIONAL OFFICEBOSTONMA022413696MEDICAL SERVICES254458
MARTIN LAVIERO CONTRACTOR
PO BOX 1659BRISTOLCT060111659CONTRACTOR SERVICES207613
FieldValueIRS element (for citing)
Number Of Contractors GT100 K21NumberOfContractorsGT100K
Related Organizations720254RelatedOrganizations
Government Grants1226970GovernmentGrants
Noncash Contributions9020NoncashContributions
Total Contributions1947224TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENU5413801280188961267415341277362
OCCUPATIONAL HEALTH RE621990719459719459
FieldValueIRS element (for citing)
Total Program Service Revenue128738355TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column285251TotalRevenueColumn
Exclusion$285,251ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real339339Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real339339Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column339339TotalRevenueColumn
Exclusion$339,339ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
MISC. PROGRAM AND HEAL621990894888894888
JOINT VENTURES900099584869480979103890
CAFETERIA722210419108$419,108

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column293690TotalRevenueColumn
Exclusion$293,690ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue2192555TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column133502724TotalRevenueColumn
Related Or Exempt Function Income128836860RelatedOrExemptFunctionIncome
Unrelated Business Revenue1381252UnrelatedBusinessRevenue
Exclusion$1,337,388ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1437611Total
Management And General1437611ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total53914329Total
Program Services46366323ProgramServices
Management And General7548006ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2905052Total
Program Services2324042ProgramServices
Management And General581010ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total8100751Total
Program Services6480601ProgramServices
Management And General1620150ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4165954Total
Program Services3332763ProgramServices
Management And General833191ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total492340Total
Management And General492340ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total84996Total
Management And General84996ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total9423269Total
Program Services7778061ProgramServices
Management And General1645208ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total728157Total
Program Services47330ProgramServices
Management And General680827ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total17690737Total
Program Services15921663ProgramServices
Management And General1769074ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2114173Total
Program Services2114173ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3434609Total
Program Services2953764ProgramServices
Management And General480845ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total262248Total
Program Services222360ProgramServices
Management And General39888ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1688566Total
Program Services1688566ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5241260Total
Program Services4193008ProgramServices
Management And General1048252ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2127714Total
Program Services2064918ProgramServices
Management And General62796ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT1094434810944348
REPAIR AND MAINTENANCE16983431698343
MEDICAL SERVICES FEES16859931685993
COLLECTION FEES10918251091825
EQUIPMENT RENTAL603845603194651

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1151513Total
Program Services1143515ProgramServices
Management And General7998ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total130987633Total
Program Services112654790ProgramServices
Management And General18332843ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6746197BOY
EOY8286702EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY96062BOY
EOY96165EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY16448223BOY
EOY15483112EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1641730BOY
EOY1439654EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2819609BOY
EOY2581093EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis130519447LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec93518978LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY35160154BOY
EOY37000469EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY10754969BOY
EOY12001102EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY13299723BOY
EOY12654647EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY5393223BOY
EOY5465804EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2068883BOY
EOY2637040EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY94428773BOY
EOY97645788EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY22029417BOY
EOY23412362EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY647673BOY
EOY607691EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY25486746BOY
EOY25042967EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY319228BOY
EOY312490EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2471657BOY
EOY2749252EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY36234792BOY
EOY37300493EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY87189513BOY
EOY89425255EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-255398BOY
EOY755592EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY939739BOY
EOY800850EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY6554919BOY
EOY6664091EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7239260BOY
EOY8220533EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY94428773BOY
EOY97645788EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$39,000DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$13,350OtherActivitiesAmount
Total Lobbying Expenditures IIB52350TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationTHE HOSPITAL IS A MEMBER OF THE CONNECTICUT HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THE ASSOCIATIONS MAY BE USED FOR LOBBYING PURPOSES.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance12016137BeginningOfYearBalance
Investment Earnings Or Losses1587194InvestmentEarningsOrLosses
Other Expenditures722254OtherExpenditures
End Of Year Balance12881077EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance13256619BeginningOfYearBalance
Contributions570728Contributions
Investment Earnings Or Losses-523731InvestmentEarningsOrLosses
Other Expenditures1287479OtherExpenditures
End Of Year Balance12016137EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.42050BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.51730PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.06220TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1581762OtherCostOrOtherBasis
Book Value1581762BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis56257285OtherCostOrOtherBasis
Depreciation34587039Depreciation
Book Value21670246BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2307017OtherCostOrOtherBasis
Depreciation2027877Depreciation
Book Value279140BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis67716900OtherCostOrOtherBasis
Depreciation56904062Depreciation
Book Value10812838BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2656483OtherCostOrOtherBasis
Book Value2656483BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings37000469TotalOfBookValueLandBuildings

Other Securities OtherSecurities (5 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
FUNDS HELD FOR MALPRACTICE SELF-INSURANCE6461527F
ASSETS HELD IN TRUST BY OTHERS2840135F
FUNDS HELD UNDER BOND INDENTURE2506470F
DONOR RESTRICTED INVESTMENTS394142F
DEBT SERVICE FUND452373C
FieldValueIRS element (for citing)
Total Of Book Value Securities12654647TotalOfBookValueSecurities

Investments Program Related InvestmentsProgramRelated (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
INVESTMENTS IN JOINT VENTURES1264054C
INTEREST IN NET ASSETS OF FOUNDATION4201750F
FieldValueIRS element (for citing)
Total Of Book Value Program Related5465804TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ACCRUED POSTRETIREMENT BENEFIT LIABILITY$6,148,004
LINE OF CREDIT$3,771,110
ASSET RETIREMENT OBLIGATIONS$2,026,281
ACCRUED PENSION LIABILITY$25,355,098
FieldValueIRS element (for citing)
Total Of Amounts37300493TotalOfAmounts
Total Revenue133502724TotalRevenue
Total Expenses130987633TotalExpenses
Excess Or Deficit For Year2515091ExcessOrDeficitForYear
Net Unrealized GL On Investments1426300NetUnrealizedGLOnInvestments
Other-$2,960,118OtherAmount
Total Adjustments-1533818TotalAdjustments
Excess Or Deficit Per FS981273ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt132773450TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal132773450RevenueSubtotal
Other Revenues Not Included729274OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt729274RevenueNotRptdOnFinStmt
Total Revenue Per Form990133502724TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt130987633TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal130987633ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990130987633TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:THE HOSPITAL'S ENDOWMENT CONSISTS OF MULTIPLE FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES, SUCH AS CAPITAL EXPENDITURES, OPERATING EXPENSES, AND OTHER SPECIFIED DONOR AND BOARD RESTRICTED USES.
Part X:Description of Uncertain Tax Positions Under FIN 48:THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FASB ASC 740 "INCOME TAXES" (FASB ASC 740), WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS WITHIN THE FINANCIAL STATEMENTS. WITH THESE CHANGES, THE HOSPITAL MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2010 AND 2009. AS OF SEPTEMBER 30, 2010 AND 2009, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS.
Part XI, Line 8 - Other Adjustments:INCREASE IN PERMANENTLY RESTRICTED NET ASSETS: 109172. TRANSFER TO CCMM: -665510. ADJUSTMENT FOR MINIMUM PENSION LIABILITY: -1945671. CHANGES IN JOINT VENTURES: -69493. changes in postretirement health & welfare benefits: -546188. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION: 886846. NONCASH VACCINE CONTRIBUTIONS: -9020. CONTRIBUTION FROM BRISTOL HOSPITAL DEVELOPMENT FUND: -720254.
Part XII, Line 4b - Other Adjustments:NONCASH VACCINE CONTRIBUTIONS: 9020. CONTRIBUTION FROM BRISTOL HOSPITAL DEVELOPMENT FUND: 720254.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense92500TotalCommunityBenefitExpense
Net Community Benefit Expense92500NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense10257000TotalCommunityBenefitExpense
Direct Offsetting Revenue7972000DirectOffsettingRevenue
Net Community Benefit Expense2285000NetCommunityBenefitExpense
Percent Of Total Expense0.01900PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense9359000TotalCommunityBenefitExpense
Direct Offsetting Revenue7198000DirectOffsettingRevenue
Net Community Benefit Expense2161000NetCommunityBenefitExpense
Percent Of Total Expense0.01800PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense19708500TotalCommunityBenefitExpense
Direct Offsetting Revenue15170000DirectOffsettingRevenue
Net Community Benefit Expense4538500NetCommunityBenefitExpense
Percent Of Total Expense0.03780PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense115452TotalCommunityBenefitExpense
Direct Offsetting Revenue1830DirectOffsettingRevenue
Net Community Benefit Expense113622NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense2046TotalCommunityBenefitExpense
Net Community Benefit Expense2046NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense117498TotalCommunityBenefitExpense
Direct Offsetting Revenue1830DirectOffsettingRevenue
Net Community Benefit Expense115668NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense19825998TotalCommunityBenefitExpense
Direct Offsetting Revenue15171830DirectOffsettingRevenue
Net Community Benefit Expense4654168NetCommunityBenefitExpense
Percent Of Total Expense0.03870PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$3,907,143BadDebtExpenseAmount
Amount Attributable To976786AmountAttributableTo
Amount Reimbursed By Medicare49152860AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare57846655CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-8693795MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (8 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
BRISTOL MSO LLC
RADIOLOGY SERVICES0.50000
MEDWORKS LLC
REHAB & OCCUPATIONAL HEALTH0.500000.000000.00000
CT OCCUPATIONAL MEDICAL PARTNERS
OCCUPATIONAL HEALTH0.33000
MEDCONN COLLECTION AGENCY
COLLECTION SERVICES0.200000.000000.00000
COLLABORATIVE LABRATORY SERVICES
LABORATORY SERVICES0.20000
TOTAL LAUNDRY COLLABORATIVE LLC
LAUNDRY SERVICES0.09000
CENTRAL CT ENDOSCOPY CENTER
MEDICAL SERVICES0.06500
HEALTH CT LLC
HEALTH CARE0.045000.000000.00000

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1BRISTOL HOSPITAL INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1BREWSTER ROADAddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06010ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
Er OtherXErOther

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Shortfall As Community BenefitPart III, Line 8: The calculated Medicare shortfall should be considered community benefit because it represents unreimbursed costs for patient services. These unreimbursed costs are Bristol Hospital expenses that ultimately benefit the community Bristol Hospital services.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: Part III, Line 9b- It is the policy of Bristol Hospital to provide every patient from the community we serve with medically necessary health services regardless of their ability to pay. The policy sets specific guidlines for the collection of patient payments and establishes a hierarchy for payment methods that are both friendly to the patient and beneficial to the hospital. Patients who are unable to pay their liability are referred to a financial counselor who will assess the patient's eligibility for charity care or alternative funding sources. Funding Sources include Charity Care, Outside Financing, Hospital Payment Plans, Federal, State and Local programs and the Hospital Financial Assistance Program.DebtCollectionPolicy
Needs AssessmentPart VI, Line 2: Hospital assessment of the health care needs of the community it serves is a dynamic process that involves all levels of hospital administration, staff, the Board of Directors (BOD), and Medical staff. Various committees and groups at the hospital meet periodically to discuss the needs of the community we serve as well as the resources and services available at the hospital and other agencies in the area. The Hospital is represented at community level organizations and groups that are also involved with assessment of the community needs. Hospital resources are frequently called upon to participate in programs and projects put together to address those needs.NeedsAssessment
Patient Education AssistancePart VI, Line 3: At Bristol Hospital, patients are notified of their ability to discuss financial assistance options including charity care in all of their billing statements. The hospital encourages patients to find out their eligibility for assistance and provides financial counselors to assist patients in applying for charity care.Patients can contact the Financial Assistance department within the hospital at 860-585-3878. This support also includes a representative through the State of Connecticut (representative paid by Bristol Hospital) so we ensure that all aspects of assistance are provided for each patient.The Financial Assistance department also discusses government benefits with patients that they may be eligible for.Contact information for our Financial Counselor is also included on the hospital website for patients to reference. The hospital also offers many free programs for the uninsured including free blood pressure clinics, skin cancer screening clinics and seminars to provide patients access to as much free health information as possible.PatientEducationAssistance
Community InformationPart VI, Line 4: Bristol Hospital is committed to providing the best patient experience in the region. Our 134-bed, full-service health care institution provides comprehensive inpatient and outpatient care for the greater Bristol, Connecticut area.Bristol is a suburban city located in Hartford County, Connecticut, United States 20 miles southwest of Hartford. Bristol has a total area of 26.8 square miles and a population of approx 62K. In Bristol, 84.2% of the people speak English and 4.8% of people speak Spanish. In Bristol, 54.6% of people are married and 92.2% of residents were born in the US.Community Information:The primary service area (PSA) for our hospital includes:Bristol (zip code 06010,06011)- 2011 census 62,078Burlington (zip code 06013)- 2011 census- 10,011Plainville (zip code 06062)- 2011 census 17,767Plymouth (zip code 06781,06782,06786)- 2011 census 12,605The total population from the 2011 census for our PSA is- 102,461In 2009, the latest date data became available and the following data points were provided for Bristol:Median Household Income: $57,781Families below poverty level- 5.6%Individuals below poverty level- 7.7%Race: White- 87.6%, Black or African American- 3.6%, American Indian or Alaska Native- 0.3%, Asian- 1.8%, Other Race- 3.9%The secondary service area (SSA) for our hospital includes:Farmington (zip code 06085,06087)- 2011 census 6,058Southington (zip code 06489)- 2011 census 33,560Wolcott (zip code 06716)- 2011 census 17,458Thomaston (zip code 06787)- 2011 census 8,512Harwinton (zip code 06791)- 2011 census 5,938The total population from the 2011 census for our SSA is- 71,526Both the PSA (Primary Service Area) and SSA (Secondary Service Area) are primarily suburban and rural areas but also include some urban areas as well. Some of the major health problems prevalent in our PSA are associated with Behavioral Health, Chemical Dependency, Obesity, and Pulmonary Disease.CommunityInformation
Community Building ActivitiesPart VI, Line 5: Bristol Hospital takes great pride in serving the community. As part of its mission, Bristol Hospital incorporates a broad array of community outreach and wellness activities, delivering educational material and counseling, offering free or low cost health screenings and hosting patient and family support groups. We understand the importance and value of emphasizing good health, fitness, safety and the promotion of early detection of illness or disease. Therefore, all of our outreach efforts reflect our strong desire to improve the quality of life for all who live and work in the communities we serve. Bristol Hospital provides financial support and access to appropriate clinical care for several life-saving initiatives, including the Bristol Community Breast Health Project and the Colon Cancer Awareness Project of Greater Bristol, which allow us to offer free breast, and colorectal cancer screenings to those who, due to insurance or income factors, might not otherwise have access to these valuable diagnostic screening services. The Eye Care Project of Greater Bristol provides vital access to services for those suffering from vision impairment.CommunityBuildingActivities
Other InformationPart VI, Line 6: At Bristol Hospital we understand the importance of our role as an exempt healthcare provider to the community we service. Our leadership team is committed to providing outstanding patient care and promoting the health of the community. Bristol Hospital attempts to promote our free and non-revenue generating programs in a variety of ways. Three times a year, the hospital mails a "Pathways to Your Health" catalog. The catalog contains a listing of programs available to the Greater Bristol community. This catalog is mailed to over 60,000 residents and provides information on free health screenings, support groups, health education, wellness programs, etc. The catalog is also included on our hospital website to provide increased access to patients. The Pathways catalog is delivered and displayed in each department within the hospital and is free for all patients to take. Programs are also listed on our website under an "events" section where patients can register for free, directly online. We also promote our programs monthly in the Bristol Press, Bristol Observer, Hartford Courant and Plymouth Connection. We subscribe to an "on-hold" system for our phones which allows us to record messages for patients when they call the hospital. Many of these messages are about free programs and services, health education facts and services to the community.OtherInformation
Reports Filed With StatesCTReportsFiledWithStates

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required0SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 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
BALA SHANMUGAM MD
018282800000824300019107100
KURT BARWIS
37690100000836850183680478954000
DAVID DOBRZANSKI
389516000007350076320404498000
LEONARD BANCO MD
2813310000073500138780302559000
ROBERT ROSE
1697220000038740173770190973000
RUSSELL TUVERSON
16196000000455109270167438000
MARC EDELMAN
1614210000000170890178510000
PETER FREYTAG
2710040000073500139710292325000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aThe Hospital paid $3,661 in golf club membership fees for its President during fiscal 2010.
Part I, Line 4b:Kurt Barwis, President, participates in the Hospital's 457(F) Defined Contribution Plan.

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonMORRIS LAVIERONamePerson
Purpose Of LoanPURCHASE BUILDINGPurposeOfLoan
Loan To OrganizationXLoanToOrganization
Original Principal$350,000OriginalPrincipalAmount
Balance Due312490BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due312490TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section B, line 11THE ORIGINAL 990 AS FILED WITH THE IRS WAS NOT PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING, ALTHOUGH PART VI, SECTION B, LINE 11 WAS ANSWERED YES. THE FORM 990 WAS REVIEWED INTERNALLY BY MEMBERS OF THE FINANCE DEPARTMENT AND MANAGMENT. THIS AMENDED RETURN WILL BE PRESENTED TO THE BOARD FOR THEIR REVIEW AND COMMENTS PRIOR TO FILING.
Form 990, Part VI, Section B, line 12cANNUALLY, ALL APPLICABLE PARTIES ARE REQUIRED TO RECEIVE AND SIGN A STATEMENT ACKNOWLEDGING THAT THEY HAVE READ, UNDERSTOOD AND AGREE TO COMPLY WITH THE CONFLICT OF INTEREST POLICY.
Form 990, Part VI, Section B, line 15COMPENSATION OF OFFICERS AND KEY EMPLOYEES IS DETERMINED VIA COMBINED USE OF COMPARISON STUDIES AND EXPERIENCE LEVELS AND IS SUBJECT TO BOARD APPROVAL.
Form 990, Part VI, Section C, line 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 2C:THE HOSPITAL'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESSES OF OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR.
AMENDED RETURN EXPLANATION AND CHANGES:This return is being amended to properly include additional information and to make changes to incorrectly reported information for the Forms, Schedules and Parts indicated below: Form 990, Part II, Signer of return changed to George W. Eighmy, VP & CFO Form 990, Part IV, Question 4: Answer changed to yes Form 990, Part VII, Line 1a, Column (F): Kurt Barwis amount increased by $76,335 to include additional deferred compensation Form 990, Schedule C, Parts II-B and Part IV completed Form 990, Schedule O: Description of 990 review process changed Form 990 Schedule H, Part I, Line 7: changes made to table amounts Form 990, Schedule H, Part II, Lines 5-10: Amounts moved to table in Part I Line 7 Form 990, Schedule J, Part I, Line 1a: Health or social club dues box checked and description added to Part III Form 990, Schedule J, Part I, Line 1b: Answered yes Form 990, Schedule J, Part I, Line 3: Additional boxes checked for Compensation committee, Independent compensation consultant, written employment contract Form 990, Schedule J, Part I, Line 4b: Answer changed to yes and description added to Part III Form 990, Schedule J, Part II, Column (c): Kurt Barwis amount increased by $76,335 to include additional deferred compensation

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HG PROPERTY HOLDINGS LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line141 BREWSTER RDAddressLine1
CityBRISTOLCity
StateCTState
ZIP Code06010ZIPCode
FieldValueIRS element (for citing)
EIN272548373EIN
Primary ActivitiesREAL ESTATEPrimaryActivities
Legal Domicile StateCTLegalDomicileState
Total Income9000TotalIncome
EOY Assets289725EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BRISTOL HOSPITAL INCBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
BRISTOL HOSPITAL AND HEALTH CARE GROUP INC
BREWSTER ROADBRISTOLCT06010222577726HEALTHCARE PARENT COMPANYCT501 (C) (3)11B, TYPE II
BRISTOL HOSPITAL DEVELOPMENT FOUNDATION INC
BREWSTER ROADBRISTOLCT06010222577740FUNDRAISINGCT501 (C) (3)7BRISTOL HOSPITAL AND HEALTH CARE GROUP INC
BRISTOL HEALTH CARE INC
400 NORTH MAIN STREETBRISTOLCT06010222577731NURSING HOMECT501 (C) (3)9BRISTOL HOSPITAL AND HEALTH CARE GROUP INC

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStatePredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
MEDWORKS LLC
375 EAST CEDAR STREETNEWINGTONCT06111061490483REHAB & OCCUPATIONAL HEALTHCTRELATED68496297100
BRISTOL MSO LLC
25 COLLINS ROADBRISTOLCT06010061506024RADIOLOGY SERVICESCTRELATED203883101302400

Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
BRISTOL HOSPITAL EMS LLC
PO BOX 977BRISTOLCT06011061547648EMERGENCY MEDICAL SERVICESCTBRISTOL HEALTH SERVICES INCC
BRISTOL HEALTH SERVICES INC
PO BOX 977BRISTOLCT06011203919173HOLDING COMPANYCTBRISTOL HOSPITAL AND HEALTH CARE GROUP INCC
CENTRAL CONNECTICUT MEDICAL MANAGEMENT INC
200 MAIN STREETBRISTOLCT06011222577728MANAGEMENT SERVICESCTBRISTOL HEALTH SERVICES INCC
GREATER BRISTOL PRIMARY CARE GROUP PC
200 MAIN STREETBRISTOLCT06011061466555PRIMARY CARE SERVICESCTC
BRISTOL PSYCHIATRIC SERVICES PC
200 MAIN STREETBRISTOLCT06011061511379PSYCHIATRIC SERVICESCTC
MED-HELP PC
200 MAIN STREETBRISTOLCT06011061484522URGENT CARE CENTERCTC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (9 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
BRISTOL HOSPITAL EMS LLC
N98802
BRISTOL HOSPITAL DEVELOPMENT FOUNDATION INC
N254453
BRISTOL HOSPITAL DEVELOPMENT FOUNDATION INC
R1203458
BRISTOL HOSPITAL EMS LLC
R134525
BRISTOL HEALTH CARE INC
N265351
BRISTOL HEALTH CARE INC
R1050506
BRISTOL HOSPITAL DEVELOPMENT FOUNDATION INC
C720254
BRISTOL HOSPITAL EMS LLC
I51736
CENTRAL CONNECTICUT MEDICAL MANAGEMENT INC
B665510