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CHARLOTTE HUNGERFORD HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
CHARLOTTE HUNGERFORD HOSPITAL (EIN 06-0646678)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-08
IRS object ID
201112209349300911
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-08T10:58:03-05:00Timestamp
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)
EIN060646678EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE CHARLOTTE HUNGERFORD HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHARNameControl
Phone8604966728Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1540 LITCHFIELD STREET PO BOX 988AddressLine1
CityTORRINGTONCity
StateCTState
ZIP Code067900988ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSusan M SchappName
TitleASSISTANT VP FINANCETitle
Phone8604966728Phone
Date Signed2011-08-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBeth ThurzName
Phone8606789200Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSusan M SchappNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1540 LITCHFIELD STREET PO BOX 988AddressLine1
CityTORRINGTONCity
StateCTState
ZIP Code067900988ZIPCode
FieldValueIRS element (for citing)
Gross Receipts113824222GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.CHARLOTTESWEB.HUNGERFORD.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1917YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE QUALITY, COMPASSIONATE AND COST EFFECTIVE HEALTHCARE TO THE COMMUNITY OF NORTHWESTERN CONNECTICUT.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees1053TotalNbrEmployees
Total Nbr Volunteers170TotalNbrVolunteers
Total Gross UBI2115129TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3782338ContributionsGrantsPriorYear
Contributions Grants Current Year3509677ContributionsGrantsCurrentYear
Program Service Revenue Prior Year100568164ProgramServiceRevenuePriorYear
Program Service Revenue CY105888350ProgramServiceRevenueCY
Investment Income Prior Year-174726InvestmentIncomePriorYear
Investment Income Current Year2066888InvestmentIncomeCurrentYear
Other Revenue Prior Year202657OtherRevenuePriorYear
Other Revenue Current Year607983OtherRevenueCurrentYear
Total Revenue Prior Year104378433TotalRevenuePriorYear
Total Revenue Current Year112072898TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year16000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY12000GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year62125908SalariesEtcPriorYear
Salaries Etc Current Year65975270SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year447846TotalFundrsngExpCurrentYear
Other Expense Prior Year41435164OtherExpensePriorYear
Other Expenses Current Year43904798OtherExpensesCurrentYear
Total Expenses Prior Year103577072TotalExpensesPriorYear
Total Expenses Current Year109892068TotalExpensesCurrentYear
Revenues Less Expenses Prior Year801361RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2180830RevenuesLessExpensesCY
Total Assets BOY114560220TotalAssetsBOY
Total Assets EOY117822296TotalAssetsEOY
Total Liabilities BOY54204378TotalLiabilitiesBOY
Total Liabilities EOY59139886TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY60355842NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY58682410NetAssetsOrFundBalancesEOY
Mission DescriptionTHE CHARLOTTE HUNGERFORD HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY COEXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGAMS FOR THE ELDERLY, HANDICAPPED, THE MEDICALLY UNDERSERVED AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense82646261Expense
Grants12000Grants
Revenue104179591Revenue
DescriptionDURING FY 2010 THE HOSPITAL CONTRIBUTED OVER 21,000 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTHCARE NEEDS OF THE COMMUNITY. THE VALUE OF THIS CONTRIBUTION IS APPROXIMATELY $168,000, WHICH IS GIVEN BACK TO THE COMMUNITY THOUGH LOWER COSTS IN BOTH PATIENT SERVICES AND OTHER "WELLNESS" PROGRAMS. IN ADDITION THE HOSPITAL GRANTED CHARITY CARE IN THE AMOUNT OF $1,421,695 DURING FISCAL YEAR 2010. THE CHARLOTTE HUNGERFORD HOSPITAL RENDERED THE FOLLOWING SERVICES DURING FY 2010:INPATIENT SERVICES:DISCHARGES 6,438PATIENT DAYS 27,979 SPECIAL SERVICES: OPERATING ROOM CASES 4,031 AMBULATORY SURGERY CASES 3,357 ENDOSCOPY CASES 1,026 AMBULATORY MEDICAL CASES 2,791 POST ANESTHESIA CARE UNIT CASES 2,589 DELIVERY ROOM DELIVERIES 412RESPIRATORY THERAPY TREATMENTS 35,061 PULMONARY REHAB TESTS 5,801PULMONARY FUNCTION LAB TESTS 1,680 CARDIO DIAGNOSTIC EXAMS 12,800EEG EXAMS 1,643PHYSICAL THERAPY TREATMENTS 23,149 CARDIAC REHAB TREATMENTS 3,704 SPEECH THERAPY TREATMENTS 672 OCCUPATIONAL THERAPY TREATMENTS 1,418 SLEEP STUDY TESTS 585 DIAGNOSTIC RADIOLOGY EXAMS 29,415 MAMMOGRAPHY EXAMS 9,366 NUCLEAR MEDICINE EXAMS 1,304 ULTRASOUND EXAMS 8,515 C.A.T. SCAN EXAMS 12,786 P.E.T. SCAN EXAMS 60 M.R.I. EXAMS 850 SPECIAL PROCEDURES (RADIOLOGY) EXAMS 1,281 RADIATION THERAPY TREATMENTS 8,683 LABORATORY TESTS 673,270 PSYCHIATRIC CLINIC VISITS 34,512 PHP-ADULT/ADOLESCENT VISITS 4,282 RENAL DIALYSIS VISITS 509 EMERGENCY DEPARTMENT VISITS 31,939 EMERGENCY DEPARTMENT PHYSICIAN VISITS 4,348 OUTPATIENT DIABETES PROGRAM VISITS 1,579 WALK IN CENTER BLOOD DRAWING VISITS 1,964 WALK IN CENTER VISITS 11,519 HOSPITALIST CONSULTS 9,525WINSTED HEALTH CENTER: CARDIAC REHAB TREATMENTS 1,521 DIAGNOSTIC RADIOLOGY EXAMS 4,762 LABORATORY TESTS 22,047 EMERGENCY DEPARTMENT VISITS 6,654 EMERGENCY DEPARTMENT PHYSICIAN VISITS 614 PULMONARY REHAB TESTS 2,376Description
Total Program Service Expense82646261TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities1PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096186NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1053NumberOfEmployees
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 Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
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
States Where Copy Of Return Is FiledCTStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SUSAN M SCHAPPBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8604966728TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1540 LITCHFIELD STREETAddressLine1
CityTORRINGTONCity
StateCTState
ZIP Code06790ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
EDWARD ARUM
GOVERNOR2.50X000
RICHARD DUTTON MD
GOVERNOR1.00X000
GLADYS CERRUTO
GOVERNOR1.00X000
DAVID J FRAUENHOFER
SECRETARY1.00X000X
JAMIE GREGG
GOVERNOR1.00X000
PAUL GROSSMAN
GOVERNOR1.00X000
KENDRICK HOM MD
GOVERNOR1.00X000
JOHN JANCO
VICE CHAIRMAN1.00X000X
NANCY SULLIVAN HODKOSKI
GOVERNOR1.00X000
JOHN LAVIERI
CHAIRMAN2.50X000X
DIANE LIBBY CPA
GOVERNOR1.00X000
MARVIN MASKOVSKY
GOVERNOR1.00X000
JAMES O'LEARY
GOVERNOR1.00X000
CHARLES W RORABACK
GOVERNOR1.00X000
ALFRED J FINN MD
GOVERNOR1.00X000
DANIEL J MCINTYRE
CEO/PRESIDENT60.00388725075240X
GARY J DEPAUL
VP FINANCE/ TREASURER60.00282305091815X
JOHN J CAPOBIANCO
VP ADMINISTRATION60.00214507033737X
MARK PRETE MD
VP MEDICAL AFFAIRS60.00331731061309X
RAYMOND J ELLIOTT
VICE PRESIDENT HUMAN RESOU60.00181398036858X
STEVEN SINGER MD
PHYSICIAN60.00290910055344X
ELZBIETA LACH-PASKO MD
PHYSICIAN60.00390719059395X
roberta meltzer md
PHYSICIAN60.00184858045637X
SUSAN SCHAPP
ASSISTANT VP FINANCE60.00150218035722X
MARIA BAIULESCU MD
PHYSICIAN60.00196507029436X
KAREN O'FLYNN MD
PHYSICIAN60.00181202032842X
STACY TAYLOR MD
PHYSICIAN60.00192806034997X
ASMA QAMAR
PHYSICIAN60.00189665028234X
RAHUL MAGAVI MD
PHYSICIAN60.00224919030822X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3400470TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation651388TotalOtherCompensation
Number Individuals GT100 K55NumberIndividualsGT100K
Formers Listed0FormersListed
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
mayo collaborative services
po box 9146mineapolisMN554809146labORATORY TESTS1302761
NWCT EMERGENCY SERVICES
80 S MAIN STREETWEST HARTFORDCT06107MEDICAL524946
PORTAL HEALTHCARE SOLUTIONS LLC
5885 TRINITY PARKWAY SUITE 210CENTERVILLEVA20120TRANSCRIPTION SERVICES405848
NEW MILFORD LAUNDRY
40 COMMONS COURTWATERBURYCT06704LAUNDRY/LINEN SERVICES405782
TORRINGTON RADIOLOGIST PC
57 COMMERCIAL BLVDTORRINGTONCT06790MEDICAL389664
FieldValueIRS element (for citing)
Number Of Contractors GT100 K26NumberOfContractorsGT100K
Fundraising Events22160FundraisingEvents
Government Grants2348497GovernmentGrants
All Other Contributions1139020AllOtherContributions
Total Contributions3509677TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT REVENUE9000999129292291292922
LABORATORY SERVICES62150012895994109110331984961
OTHER HOSPITAL SERVICE90009921300652130065
SURGICAL ASSOC OF LITC621110-430631-430631
FieldValueIRS element (for citing)
Total Program Service Revenue105888350TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1409742TotalRevenueColumn
Exclusion$1,409,742ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real717405Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real441203Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real276202Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column276202TotalRevenueColumn
Related Or Exempt Function Income276202RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1880894Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1137861Securities
Other85887Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities743033Securities
Other-85887Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column657146TotalRevenueColumn
Exclusion$657,146ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events75640GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events22160CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses29087FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column46553TotalRevenueColumn
Exclusion$46,553ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory93009GrossSalesOfInventory
Cost Of Goods Sold57286CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column35723TotalRevenueColumn
Exclusion$35,723ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
MEDCONN561499129912129912
GAIN FROM EQUITY METHO900001119337$119,337
CT HOSPITAL LAB NETWOR621500256256
FieldValueIRS element (for citing)
Total Other Revenue249505TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column112072898TotalRevenueColumn
Related Or Exempt Function Income104179591RelatedOrExemptFunctionIncome
Unrelated Business Revenue2115129UnrelatedBusinessRevenue
Exclusion$2,268,501ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total12000Total
Program Services12000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2510765Total
Program Services1883074ProgramServices
Management And General627691ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total47820509Total
Program Services35679264ProgramServices
Management And General11929112ManagementAndGeneral
Fundraising212133Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6039532Total
Program Services4507316ProgramServices
Management And General1506761ManagementAndGeneral
Fundraising25455Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6071267Total
Program Services4530999ProgramServices
Management And General1514679ManagementAndGeneral
Fundraising25589Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3533197Total
Program Services2636833ProgramServices
Management And General881473ManagementAndGeneral
Fundraising14891Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1499116Total
Program Services1118794ProgramServices
Management And General374004ManagementAndGeneral
Fundraising6318Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total276581Total
Program Services206413ProgramServices
Management And General69002ManagementAndGeneral
Fundraising1166Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total119165Total
Program Services88933ProgramServices
Management And General29730ManagementAndGeneral
Fundraising502Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total9716409Total
Program Services7251377ProgramServices
Management And General2424080ManagementAndGeneral
Fundraising40952Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total661548Total
Program Services493715ProgramServices
Management And General165045ManagementAndGeneral
Fundraising2788Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total374566Total
Program Services279539ProgramServices
Management And General93448ManagementAndGeneral
Fundraising1579Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1191966Total
Program Services889567ProgramServices
Management And General297375ManagementAndGeneral
Fundraising5024Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2232949Total
Program Services1666455ProgramServices
Management And General557083ManagementAndGeneral
Fundraising9411Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total179610Total
Program Services134043ProgramServices
Management And General44810ManagementAndGeneral
Fundraising757Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total374299Total
Program Services279340ProgramServices
Management And General93381ManagementAndGeneral
Fundraising1578Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total6177041Total
Program Services4609939ProgramServices
Management And General1541067ManagementAndGeneral
Fundraising26035Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total1867148Total
Program Services1393456ProgramServices
Management And General465822ManagementAndGeneral
Fundraising7870Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
SUPPLIES1561152411650914389481265798
PROVISION FOR BAD DEBT24136492413649
PHYSICIAN FEES1154344865758288586
HOSPITAL AUXILIARY EXPE5488354883

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total109892068Total
Program Services82646261ProgramServices
Management And General26797961ManagementAndGeneral
Fundraising447846Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4295BOY
EOY4615EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4167900BOY
EOY5577511EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY280200BOY
EOY282069EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY9892274BOY
EOY9573985EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1838456BOY
EOY1902704EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1162270BOY
EOY1678690EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis138148361LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec96586131LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY45555251BOY
EOY41562230EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY49551991BOY
EOY54362578EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2107583BOY
EOY2877914EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY114560220BOY
EOY117822296EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY8429178BOY
EOY7460667EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY4555000BOY
EOY3475000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4218334BOY
EOY3880641EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY37001866BOY
EOY44323578EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY54204378BOY
EOY59139886EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY41852805BOY
EOY39309707EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2944647BOY
EOY3000453EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY15558390BOY
EOY16372250EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY60355842BOY
EOY58682410EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY114560220BOY
EOY117822296EOY
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

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart I-A, Line 1:Identifier
Return ReferenceOrganizations Direct and Indirect Political Campaign Activities:ReturnReference
ExplanationTHE HOSPITAL PAID DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION. SOME PORTION OF THESE DUES MAY HAVE BEEN USED FOR LOBBYING EXPENSES ON BEHALF OF ITS' MEMBERS.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance45533758BeginningOfYearBalance
Contributions690138Contributions
Investment Earnings Or Losses3824302InvestmentEarningsOrLosses
Other Expenditures774452OtherExpenditures
End Of Year Balance49273746EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance47240328BeginningOfYearBalance
Contributions1043719Contributions
Investment Earnings Or Losses-1532480InvestmentEarningsOrLosses
Other Expenditures1217809OtherExpenditures
End Of Year Balance45533758EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.60720BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.33230PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.06050TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis155467OtherCostOrOtherBasis
Book Value155467BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis75462132OtherCostOrOtherBasis
Depreciation45067826Depreciation
Book Value30394306BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis57056080OtherCostOrOtherBasis
Depreciation47428989Depreciation
Book Value9627091BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5474682OtherCostOrOtherBasis
Depreciation4089316Depreciation
Book Value1385366BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings41562230TotalOfBookValueLandBuildings

Other Securities OtherSecurities (5 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
INVESTMENTS HELD IN TRUST FOR ESTIMATED SELF-INSURANCE LIABILITIES4042373F
UNDER BOND INDENTURE AGREEMENT-HELD BY OTHERS277118F
BENEFICIAL INTEREST IN ASSETS HELD IN TRUST BY OTHERS12619869F
LONG-TERM INVESTMENTS30690384F
DONOR RESTRICTED ASSETS6732834F
FieldValueIRS element (for citing)
Total Of Book Value Securities54362578TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
CAPITAL LEASE OBLIGATIONS$21,204
ESTIMATED AMOUNTS DUE TO THIRD PARTY REIMBURSEMENT AGENCIES$2,034,000
OTHER CURRENT LIABILITIES$5,718,436
ESTIMATED SELF-INSURANCE LIABILITIES$2,554,405
ACCRUED PENSION LIABILITY$33,995,533
FieldValueIRS element (for citing)
Total Of Amounts44323578TotalOfAmounts
Total Revenue112072898TotalRevenue
Total Expenses109892068TotalExpenses
Excess Or Deficit For Year2180830ExcessOrDeficitForYear
Net Unrealized GL On Investments2027450NetUnrealizedGLOnInvestments
Other-$5,881,712OtherAmount
Total Adjustments-3854262TotalAdjustments
Excess Or Deficit Per FS-1673432ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt114100348TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments2027450NetUnrealizedGainsInvestments
Revenue Not Rptd F9902027450RevenueNotRptdF990
Revenue Subtotal112072898RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990112072898TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt109892068TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal109892068ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990109892068TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:THE ENDOWMENT FUNDS WILL BE USED PRIMARILY FOR CAPITAL PURCHASES, INDIGENT CARE AND OTHER USES AS APPROVED BY THE BOARD IN ACCORDANCE WITH DONOR RESTRICTIONS.
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" WHICH PROVIDE A NEW FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR CONSOLIDATED FINANCIAL STATEMENTS. 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:PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS: -5216819. NET ASSETS RELEASED FROM RESTRICTIONS: -774452. RECLASSIFICATION OF TEMPORARY RESTRICTED NET ASSETS: 109559.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event175640GrossReceiptsEvent1
Gross Revenue Event175640GrossRevenueEvent1
Cash Prizes Event13795CashPrizesEvent1
Rent Facility Costs Event122455RentFacilityCostsEvent1
Other Direct Expenses Event12837OtherDirectExpensesEvent1
Name Of Event2FASHION SHOWNameOfEvent2
Gross Receipts Event29330GrossReceiptsEvent2
Charitable Contributions Event29330CharitableContributionsEvent2
Total Number Of Other Events6TotalNumberOfOtherEvents
Gross Receipts Other Events12830GrossReceiptsOtherEvents
Charitable Contrib Other Events12830CharitableContribOtherEvents
Gross Receipts Total97800GrossReceiptsTotal
Charitable Contributions Total22160CharitableContributionsTotal
Gross Revenue Total Events75640GrossRevenueTotalEvents
Cash Prizes Total Events3795CashPrizesTotalEvents
Rent Facility Costs Total Events22455RentFacilityCostsTotalEvents
Other Direct Expenses Total Events2837OtherDirectExpensesTotalEvents
Direct Expense Summary Events29087DirectExpenseSummaryEvents
Net Income Summary46553NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served1372PersonsServed
Total Community Benefit Expense784776TotalCommunityBenefitExpense
Direct Offsetting Revenue23828DirectOffsettingRevenue
Net Community Benefit Expense760948NetCommunityBenefitExpense
Percent Of Total Expense0.00690PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served33148PersonsServed
Total Community Benefit Expense15271377TotalCommunityBenefitExpense
Direct Offsetting Revenue14008178DirectOffsettingRevenue
Net Community Benefit Expense1263199NetCommunityBenefitExpense
Percent Of Total Expense0.01150PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Persons Served8039PersonsServed
Total Community Benefit Expense4233350TotalCommunityBenefitExpense
Direct Offsetting Revenue2779329DirectOffsettingRevenue
Net Community Benefit Expense1454021NetCommunityBenefitExpense
Percent Of Total Expense0.01320PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served42559PersonsServed
Total Community Benefit Expense20289503TotalCommunityBenefitExpense
Direct Offsetting Revenue16811335DirectOffsettingRevenue
Net Community Benefit Expense3478168NetCommunityBenefitExpense
Percent Of Total Expense0.03160PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs93NumberOfActivitiesOrPrograms
Persons Served3574PersonsServed
Total Community Benefit Expense109654TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense109654NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served12PersonsServed
Total Community Benefit Expense12000TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense12000NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense16215934TotalCommunityBenefitExpense
Direct Offsetting Revenue15659217DirectOffsettingRevenue
Net Community Benefit Expense556717NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs93NumberOfActivitiesOrPrograms
Persons Served3586PersonsServed
Total Community Benefit Expense16337588TotalCommunityBenefitExpense
Direct Offsetting Revenue15659217DirectOffsettingRevenue
Net Community Benefit Expense678371NetCommunityBenefitExpense
Percent Of Total Expense0.00620PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs93NumberOfActivitiesOrPrograms
Persons Served46145PersonsServed
Total Community Benefit Expense36627091TotalCommunityBenefitExpense
Direct Offsetting Revenue32470552DirectOffsettingRevenue
Net Community Benefit Expense4156539NetCommunityBenefitExpense
Percent Of Total Expense0.03780PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,413,649BadDebtExpenseAmount
Amount Reimbursed By Medicare38976426AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare39192673CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-216247MedicareSurplusOrShortfall

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 (6 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
ADVANCED MEDICAL IMAGING OF NORTHWEST CT LLC
IMAGING CENTER0.500000.000000.50000
MEDCONN COLLECTION AGENCY LLC
PATIENT COLLECTION AGENCY0.200000.000000.00000
SURGICAL ASSOCIATES OF LITCHFIELD COUNTY LLC
SURGICAL SERVICES1.000000.000000.00000
UROLOGY CENTER OF NW CT
UROLOGY CENTER0.625000.000000.37500
LITCHFIELD COUNTY HEALTHCARE SERVICE CORP
PHYSICIANS PRACTICE1.000000.000000.00000
NORTHWESTERN CT DIALYSIS LLC (DISSOLVED 32410)
RENTAL REAL ESTATE0.500000.000000.00000

Form990 Schedule H Part V Form990ScheduleHPartV (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursEr OtherErOther
CHARLOTTE HUNGERFORD HOSPITAL
540 LITCHFIELD STRRETTORRINGTONCT06790XXXX
HUNGERFORD EMERGENCY MEDICAL CENTER
115 SPENCER STREETWINSTEDCT06098X

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaPart I, Line 3c: Care will be provided free for those uninsured who qualify as uninsured and verification has determined that their annual income is less than 200% of the Federal Income Poverty Level. Care will be provided at Hospital cost, as established by the Office of Health Care Access (OCHA), for those uninsured patients who request assistance and verification has determined that their annual income is between 200% and 250% of the FPL. Care will be discounted by 30% for those unisured patients who request assistance and verification has determined that their annual income is between 250% and 400% of the FPL. The hospital will also consider the total medical expenses faced by a family and the family's ability to pay for those expenses, and will consider offering greater assistance when possible to those families facing castastrophic medical expenses.IncomeBasedCriteria
Costing Method UsedPart I, Line 7: A cost to charge ratio based on charity care charges and expenses.CostingMethodUsed
Bad Debt FootnotePart III, Line 4: The rationale for reporting bad debt expense directly from the trial balance is that accounts have already been discounted prior to being classified as a bad debt expense.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: The reported amounts for Medicare revenue received and Medicare costs are derived directly from the Medicare cost report.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: The hospital attempts to have individuals fill out all paper work required for charity care. If the person is not capable of doing this or is known to be unable to do this (such as a known homeless person), then the financial assistance committee will adjust the account to charity care and it will not be reported as bad debt. If an account has been reported as bad debt and information comes forth indicating an inability to pay, then the account would be removed from bad debt and moved to charity care.DebtCollectionPolicy
Needs AssessmentPart VI, Line 2: The hospital offers free health screenings, free health education and lectures at various community events including fairs, expos, private companies, public municipalities, and public gatherings. This helps the community assess their medical needs. In addition to the above items, the hospital distributes free medical summary cards which allow patients to track their medications.NeedsAssessment
Patient Education AssistancePart VI, Line 3: The hospital counsels all self pay patients either by meeting with a financial counselor or if he or she is an inpatient, meeting with a social worker. All statements received by patients include financial counseling information. Signs are posted throughout the hospital including in the emergency room which state the charity care policies and financial assistance information.PatientEducationAssistance
Community InformationPart VI, Line 4: The Charlotte Hungerford Hospital is a 109 bed, general acute care hospital located in Torrington, Connecticut, serving a twelve town primary service area comprised of approximately 100,000 persons.CommunityInformation
Other InformationPart VI, Line 6: All board of directors members reside in the community served by the Charlotte Hungerford Hospital and are not employees of the hospital nor are they independent contractors doing business with the hospital. The hospital extends medical staff privileges to all qualified physicians who apply for such privileges. The hospital establishes an annual capital budget to add or replace patient care equipment and facilities. Medical education is provided to physicians through conferences on a monthly basis.OtherInformation
Reports Filed With StatesCTReportsFiledWithStates

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantHEALTHCARE SCHOLARSHIPSTypeOfGrant
Number Of Recipients12NumberOfRecipients
Amount Of Cash Grant12000AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierOther Information:Identifier
Return ReferencePart IV:ReturnReference
ExplanationTHE CHARLOTTE HUNGERFORD HOSPITAL AUXILIARY AWARDS SCHOLARSHIPS IN THE AMOUNT OF $1,000 EACH TO STUDENTS PURSUING HEALTHCARE EDUCATIONS. THE STUDENTS MUST LIVE IN THE AREA SERVED BY THE HOSPITAL. THEY MUST ALSO PROVIDE EVIDENCE OF HAVING BEEN ACCEPTED INTO A COLLEGE PROGRAM OR THEIR CURRENT GRADES IN COLLEGE. RECIPIENTS OF THE SCHOLARSHIPS MUST SUBMIT LETTERS OF RECOMMENDATION FROM THEIR TEACHERS AND ALSO FROM NON-FAMILY PERSONS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
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 (14 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
DANIEL J MCINTYRE
38872500000290930461470463965000
GARY J DEPAUL
28230500000583020335130374120000
JOHN J CAPOBIANCO
2145070000082720254650248244000
MARK PRETE MD
33173100000219280393810393040000
RAYMOND J ELLIOTT
18139800000153240215340218256000
STEVEN SINGER MD
29091000000208090345350346254000
ELZBIETA LACH-PASKO MD
39071900000130120463830450114000
roberta meltzer md
18485800000236920219450230495000
SUSAN SCHAPP
15021800000178890178330185940000
MARIA BAIULESCU MD
1965070000061080233280225943000
KAREN O'FLYNN MD
18120200000113310215110214044000
STACY TAYLOR MD
19280600000121080228890227803000
ASMA QAMAR
1896650000057180225160217899000
RAHUL MAGAVI MD
2249190000041210267010255741000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section B, line 11A COPY OF FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS BEFORE IT IS FILED WITH THE IRS. THIS ENABLES THE BOARD TO ASK QUESTIONS, AND TO APPROVE THE DISCLOSURES MADE IN THE RETURN.
Form 990, Part VI, Section B, line 12cTHE HOSPITAL DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY TO ITS BOARD OF DIRECTORS, ALL MANAGEMENT PERSONNEL, AND PURCHASING AGENTS.
Form 990, Part VI, Section B, line 15Compensation for senior staff is determined using the following steps: - A market survey based on CT Hospital Association is used as a starting point. - Adjustments are then made based on the candidate's current salary and prior experience. - The compensation figure is then presented to the board of directors for approval.
Form 990, Part VI, Section C, line 19THE HOSPITAL MAKES ITS GOVERNING POLICIES AVAILABLE TO THE PUBLIC UPON REQUEST. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO THE BOARD OF DIRECTORS, ALL MANAGEMENT PERSONNEL, AND THE PURCHASING AGENTS FOR THE HOSPITAL. AN ANNUAL REPORT OF THE OPERATIONS OF THE HOSPITAL INCLUDING FINANCIAL INFORMATION IS PUBLISHED EACH YEAR AND IS AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 2C:THE HOSPITAL'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THESE FUNCTIONS AND PROCESSES HAVE NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SURGICAL ASSOCIATES OF LITCHFIELD COUNTY LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1538 LITCHFIELD STREET SUITE 201AddressLine1
CityTORRINGTONCity
StateCTState
ZIP Code06790ZIPCode
FieldValueIRS element (for citing)
EIN200796298EIN
Primary ActivitiesSURGICAL SERVICESPrimaryActivities
Legal Domicile StateCTLegalDomicileState
Total Income-430631TotalIncome
EOY Assets0EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1THE CHARLOTTE HUNGERFORD HOSPITALBusinessNameLine1

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
ADVANCED MEDICAL IMAGING OF NW CT LLC
57 COMMERCIAL BLVDTORRINGTONCT06790061594854MAGNETIC RESONANCE IMAGINGCTN/ARELATED67168528717100
UROLOGY CENTER OF NW CT LLC
538 LITCHFIELD STREETTORRINGTONCT06790582674029EQUIPMENT RENTALCTN/ARELATED347254778200
NORTHWESTERN CONNECTICUT DIALYSIS LLC
540 LITCHFIELD STREETTORRINGTONCT06790061491220RENTAL REAL ESTATECTN/ARELATED-281900

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1LITCHFIELD COUNTY HEALTHCARE SERVICE CORPORATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1540 LITCHFIELD STREETAddressLine1
CityTORRINGTONCity
StateCTState
ZIP Code06790ZIPCode
FieldValueIRS element (for citing)
EIN061227655EIN
Primary ActivityMANAGEMENT SERVICESPrimaryActivity
Legal Domicile StateCTLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1THE CHARLOTTE HUNGERFORD HOSPTIALBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of EOY Assets505ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
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 Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1ADVANCED MEDICAL IMAGING OF NW CT LLCBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeRTransactionType
Amount Involved661000AmountInvolved