2023-08-15T15:08:39-05:00 2022-09-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2021-10-01 222577731 BRISTOL HEALTH CARE INC BRIS 8605843400 400 NORTH MAIN STREET BRISTOL CT 06010 KURT BARWIS PRESIDENT, CEO & CFO 8605843400 2023-08-15 1 KURT BARWIS XXX-XX-XXXX KERRI N BOGDA CPA P00760402 7177404863 2023-08-14 X 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KURT BARWIS 400 NORTH MAIN STREET BRISTOL CT 06010 13945008 0 X WWW.BRISTOLHOSPITAL.ORG X 1984 CT SHORT/LONG TERM REHAB & SKILLED NURSING CARE TO ENHANCE QUALITY OF LIFE AND PHYSICAL FUNCTIONING. 17 13 243 21 0 0 75432 87948 13155821 13840640 22958 548 34973 15872 13289184 13945008 0 0 0 0 8213610 10231119 0 0 0 5256077 7772098 13469687 18003217 -180503 -4058209 7125805 5197182 3401018 5531014 3724787 -333832 TO PROVIDE QUALITY AND COMPREHENSIVE HEALTH CARE ACCORDING TO RESIDENT NEEDS, INCLUDING SHORT-TERM REHABILITATIVE CARE, SKILLED NURSING CARE, AND LONG-TERM CARE, WHILE BEING ATTENTIVE TO QUALITY OF LIFE AND PRESERVATION OF INDIVIDUAL DIGNITY IN A HOME-LIKE SETTING. 0 0 15058708 0 13840640 NURSING HOME AND LONG-TERM CARE FACILITY PROVIDING HEALTH CARE AND COMMUNITY HEALTH EDUCATION FOR THE ELDERLY AND OTHERS. 15058708 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 28 0 243 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X TIMOTHY AJAYI 8605853000 41 BREWSTER ROAD BRISTOL CT 06010 BRADFORD MEACHAM DIRECTOR 2.00 6.00 X 0 0 0 GLENN HEISER DIRECTOR 2.00 6.00 X 0 0 0 JARRE BETTS DIRECTOR 2.00 6.00 X 0 0 0 JEFFREY KAYE MD MEDICAL STAFF REPRESENTATIVE 2.00 6.00 X 0 0 0 JENNIFER MCCALLISTER MD MEDICAL STAFF REPRESENTATIVE 2.00 40.00 X 0 416917 1462 JOHN LODOVICO JR CHAIRMAN OF THE BOARD 2.00 10.00 X X 0 0 0 JOSEPH LOCKWOOD DIRECTOR 2.00 6.00 X 0 0 0 KURT BARWIS PRESIDENT, CEO & CFO 2.00 38.00 X X 0 961118 161004 LEXIE MANGUM SECRETARY/TREASURER 2.00 6.00 X X 0 0 0 LISA CASEY DIRECTOR 2.00 6.00 X 0 0 0 LOUIS AULETTA VICE CHAIRMAN 2.00 6.00 X X 0 0 0 MICHAEL HEIMBACH DIRECTOR 2.00 6.00 X 0 0 0 SHARON ADLER MD MEDICAL STAFF REP.(UNTIL JAN. 2022) 2.00 6.00 X 0 38000 0 WILLIAM HAMZY DIRECTOR (UNTIL OCT. 2021) 2.00 6.00 X 0 0 0 YONG-SUNG CHYUN MD DIRECTOR 2.00 6.00 X 0 0 0 IRENE BASSOCK DIRECTOR 2.00 6.00 X 0 0 0 KATARZYNA LESSARD DIRECTOR 2.00 6.00 X 0 0 0 MICHELE NORMANDIN MD MEDICAL STAFF REPRESENTATIVE 2.00 6.00 X 0 394453 148 RUPALINI RAWAL-DHINGRA MD MEDICAL STAFF REPRESENTATIVE 2.00 46.00 X 0 344178 148 ASHLEY JESSICA SOYKA ADMINISTRATOR 40.00 0.00 X 129778 0 21878 GORDON AVERY NURSING SUPERVISOR 40.00 0.00 X 125454 0 12000 MARSHA TUPAS NURSING SUPERVISOR 40.00 0.00 X 100827 0 11315 MIRZETA ADILI RN NURSING POOL 40.00 0.00 X 105537 0 2095 461596 2154666 210050 4 0 1 0 SYMBRIA REHAB 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 PHYSICAL THERAPY SERVICES 733836 UNITEX TEXTILE RENTAL SERVICE 401 SOUTH MACQUESTEN PKWY MT VERNON NY 105501700 LAUNDRY SERVICES 150598 2 87948 87948 PATIENT SERVICE REVENUE 623110 13840640 13840640 13840640 548 548 MISCELLANEOUS 900099 13196 13196 CAFE MEALS 722210 2676 2676 15872 13945008 13840640 0 16420 X 6919552 6782368 137184 71297 67019 4278 2307492 2169042 138450 932778 876811 55967 24771 24771 3434507 1319062 2115445 142718 56180 86538 96988 4695 92293 517291 376755 140536 2071 1947 124 446 326 120 146135 146135 BAD DEBT EXPENSE 2220830 2220830 MEDICAL SUPPLIES 757927 757927 FOOD & NUTRITION 425746 425746 DUES AND SUBSCRIPTIONS 2668 2668 18003217 15058708 2944509 0 10323 0 68845 0 4002435 3205819 68137 63348 49240 49481 13040190 11870194 1101270 1169996 19264 18854 1806291 689684 7125805 5197182 2037558 2376239 400410 292826 963050 2861949 3401018 5531014 X 3705523 -352686 19264 18854 3724787 -333832 7125805 5197182 X -4058209 -410 X 0 1 X 1 0 X 18665 852541 75432 87948 1034586 12809330 13492587 13262452 13155821 13840640 66560830 12827995 13492587 14114993 13231253 13928588 67595416 0 0 0 67595416 52339 71365 22958 548 147210 52339 71365 22958 548 147210 4817 51732 29460 34973 15872 136854 12885151 13615684 14144453 13289184 13945008 67879480 0.99580 0.99580 0.00220 0.00220 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: EMPLOYEE MEALS AND VENDING - 2017 AMOUNT: $ 4,817. 2018 AMOUNT: $ 1,148. 2019 AMOUNT: $ 1,250. 2020 AMOUNT: $ 400. CAFE MEALS - 2018 AMOUNT: $ 4,620. 2019 AMOUNT: $ 3,716. 2020 AMOUNT: $ 1,677. 2021 AMOUNT: $ 2,676. MISCELLANEOUS INCOME - 2018 AMOUNT: $ 334. 2019 AMOUNT: $ 6,741. 2020 AMOUNT: $ 32,710. 2021 AMOUNT: $ 13,196. MEDICAL RECORD FEES - 2018 AMOUNT: $ 566. 2019 AMOUNT: $ 50. PURCHASE DISCOUNTS - 2018 AMOUNT: $ 8. 2019 AMOUNT: $ 62. 2020 AMOUNT: $ 186. INCENTIVE PAYMENTS - 2018 AMOUNT: $ 45,056. 2019 AMOUNT: $ 6,880. UHC DIVIDEND - 2019 AMOUNT: $ 9,360. THERAPY SCREENING - 2019 AMOUNT: $ 1,401. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 343035 343035 10673811 10196098 477713 2003048 1674096 328952 20296 20296 1169996 DUE FROM AFFILIATES 689684 689684 DUE TO AFFLIATES 2009297 INSURANCE CLAIM PAYABLE 68600 WORKERS COMPENSATION PAYABLE 784052 2861949 X 11723768 -2221240 -2221240 13945008 0 13945008 15782387 0 15782387 2220830 2220830 18003217 PART X, LINE 2: THE COMPANY ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. THE COMPANY 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 COMPANY DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2022 AND 2021. IT IS THE COMPANY'S POLICY TO RECORD PENALTIES AND INTEREST ASSOCIATED WITH UNCERTAIN TAX PROVISIONS AS A COMPONENT OF OPERATING EXPENSES. AS OF SEPTEMBER 30, 2022 AND 2021, THE COMPANY DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE COMPANY'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE COMPANY DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN EQUITY INTEREST IN THE NET ASSETS OF THE FOUNDATION -410. BAD DEBT EXPENSE -2,220,830. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,220,830. 0 1 0 0 0 0 0 0 0 KURT BARWIS PRESIDENT, CEO & CFO 0 618324 0 94080 0 248714 0 141000 0 20004 0 1122122 0 248714 JENNIFER MCCALLISTER MD MEDICAL STAFF REPRESENTATIVE 0 395992 0 20925 0 0 0 0 0 1462 0 418379 0 0 MICHELE NORMANDIN MD MEDICAL STAFF REPRESENTATIVE 0 311953 0 82500 0 0 0 0 0 148 0 394601 0 0 RUPALINI RAWAL-DHINGRA MD MEDICAL STAFF REPRESENTATIVE 0 322475 0 21703 0 0 0 0 0 148 0 344326 0 0 ASHLEY JESSICA SOYKA ADMINISTRATOR 125038 0 4740 0 0 0 2699 0 19179 0 151656 0 0 0 PART I, LINE 3 KURT BARWIS, THE ORGANIZATION'S PRESIDENT, CEO AND CFO, IS PAID BY A RELATED ORGANIZATION, BRISTOL HOSPITAL, INC., WHICH USED A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH HIS COMPENSATION. PART I, LINE 4B KURT BARWIS, THE ORGANIZATION'S PRESIDENT, CEO AND CFO, PARTICIPATES IN THE HOSPITAL'S 457(F) DEFINED CONTRIBUTION PLAN. $141,000 WAS DEFERRED DURING CALENDAR YEAR 2021, AND IS INCLUDED IN SCHEDULE J, COLUMN C. $248,714 FROM PRIOR YEAR DEFERRED CONTRIBUTIONS VESTED AND IS INCLUDED IN TAXABLE COMPENSATION AS OTHER REPORTABLE COMPENSATION. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPRISED OF THE PRESIDENT OF THE MEDICAL STAFF OF THE HOSPITAL AND ADDITIONAL MEMBERS, ALL OF WHOM ARE ON THE GOVERNING BODY. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ANY BUSINESS OF THE CORPORATION REQUIRING ACTION DURING THE INTERIM BETWEEN REGULAR MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES OR EXPRESS WISHES OF THE BOARD AND FURTHER PROVIDED THAT THE EXECUTIVE COMMITTEE SHALL REPORT ALL MATTERS ON WHICH IT ACTS TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE MEMBER, WHICH IS BRISTOL HOSPITAL AND HEALTH CARE GROUP. THERE ARE NO CLASSES OF MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF THE CORPORATION AND HAS ALL OF THE OTHER RIGHTS, POWERS AND PRIVILEGES ACCORDED TO MEMBERS OF A NONSTOCK NONPROFIT CORPORATION UNDER CONNECTICUT LAW. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO SUCH OTHER RIGHTS, POWERS AND PRIVILEGES UNDER CONNECTICUT LAW, THE SOLE MEMBER HAS THE FOLLOWING RIGHTS, POWERS AND PRIVILEGES: (A) TO ACCEPT, AMEND OR REJECT, AFTER APPROVAL BY THE BOARD OF DIRECTORS, THE ANNUAL BUSINESS PLAN AND OPERATING AND CAPITAL BUDGETS OF THE CORPORATION. (B) TO APPROVE ANY PROGRAMS AND EXPENDITURES REQUIRING CERTIFICATE OF NEED APPROVAL BY APPROPRIATE GOVERNMENTAL BODIES AND PLANS THAT MATERIALLY AFFECT THE GROWTH AND DEVELOPMENT OF THE CORPORATION. (C) TO APPROVE SIGNIFICANT AFFILIATION AGREEMENTS BETWEEN THE CORPORATION AND OTHER INSTITUTIONS, SIGNIFICANT FUND RAISING PROGRAMS PROPOSED TO BE CONDUCTED BY THE CORPORATION, THE SALE OR DISPOSITION OF ANY ASSETS OF THE CORPORATION NOT IN THE ORDINARY COURSE OF BUSINESS, AND THE INCURRENCE OF ANY INDEBTEDNESS FOR BORROWED MONEY NOT IN ACCORDANCE WITH AN APPROVED OPERATING OR CAPITAL BUDGET. (D) TO REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS AT ANY TIME, REGARDLESS OF THE TERM FOR WHICH SUCH DIRECTOR MAY HAVE BEEN ELECTED. (E) TO VOTE UPON ALL MATTERS ON WHICH MEMBERS ARE ENTITLED TO VOTE UNDER THE ACT. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETED 990 IS PROVIDED TO EACH BOARD MEMBER BEFORE THE RETURN IS FILED. THIS PROVIDES AN OPPORTUNITY FOR MEMBERS TO ASK QUESTIONS AND FOLLOW UP WITH THE FINANCE TEAM REGARDING ANY ISSUES OR CONCERNS. THE 990 IS ALSO REVIEWED INTERNALLY BY MEMBERS OF THE FINANCE AND MANAGEMENT TEAMS PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THE PARENT ORGANIZATION, BRISTOL HOSPITAL AND HEALTH CARE GROUP, HAS THREE CONFLICT OF INTEREST POLICIES-ONE FOR THE BOARD OF DIRECTORS AND COMMITTEE MEMBERS, ONE FOR NON-MEDICAL STAFF EMPLOYEES, AND ONE FOR MEDICAL STAFF MEMBERS. BOARD OF DIRECTORS AND COMMITTEE MEMBERS EACH OF THE ABOVE LISTED PERSONS RECEIVES, READS AND SIGNS A STATEMENT ONCE ANNUALLY AGREEING TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. IF ANY ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES, THE PERSON SHALL MAKE FULL DISCLOSURE OF SUCH ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST, WITHIN FIFTEEN (15) DAYS OF THE TIME THAT SUCH CONFLICT IS DISCOVERED, OR AT LEAST ONCE ANNUALLY AT THE COMMENCEMENT OF EACH CALENDAR YEAR, WITH REGULAR WRITTEN UPDATES TO ACCORD WITH ANY CHANGE IN CIRCUMSTANCES. THE GOVERNANCE COMMITTEE REVIEWS ALL SUCH DISCLOSURES TO DETERMINE WHETHER AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST EXISTS. DECISIONS PERTAINING TO ACTUAL, APPARENT OR POTENTIAL CONFLICTS OF INTEREST SHALL BE MADE BY THE GOVERNANCE COMMITTEE. THE CORPORATE COMPLIANCE OFFICER (CCO) SHALL BE AVAILABLE TO THE GOVERNANCE COMMITTEE UPON REQUEST. IN THE EVENT THAT IT DETERMINES THAT AN APPARENT OR POTENTIAL CONFLICT OF INTEREST EXITS, THE GOVERNANCE COMMITTEE SHALL INSTITUTE A REASONABLE COMPLIANCE MANAGEMENT PLAN INCLUDING PERIODIC REVIEWS OF RELATIONSHIPS OR ACTIVITIES OF ANY PERSON OR RELATIVE. ANY CHANGES OR MODIFICATIONS IN SUCH RELATIONSHIPS OR ACTIVITIES SHALL BE PERIODICALLY REVIEWED AND EVALUATED BY THE GOVERNANCE COMMITTEE. NON-MEDICAL STAFF EMPLOYEES SAME PROCESS AS OUTLINED ABOVE WITH ONE EXCEPTION: THE OVERSIGHT, REVIEW AND DETERMINATIONS OF DISCLOSURES ARE MADE BY THE CCO. THE BRISTOL HEALTH EXECUTIVE LEADERSHIP GROUP (ELG) SHALL BE AVAILABLE TO THE CCO UPON REQUEST. MEDICAL STAFF MEMBERS MEDICAL STAFF MEMBERS COMPLETE CONFLICT OF INTEREST DISCLOSURE STATEMENTS DURING THE INITIAL CREDENTIALING PROCESS AND SUBSEQUENTLY EVERY TWO YEARS DURING THE RECREDENTIALING PROCESS. ANY NEW RELATIONSHIPS THAT ARISE IN THE INTERIM DEEMED TO BE A POTENTIAL CONFLICT MUST BE DISCLOSED IN A TIMELY MANNER. DISCLOSURES ARE REVIEWED AND DETERMINATIONS ARE MADE BY THE EXECUTIVE COMMITTEE OF THE MEDICAL STAFF (ECMS). THE CCO IS A MEMBER OF THIS COMMITTEE. IN THE EVENT THAT THE ECMS DETERMINES THAT AN APPARENT OR POTENTIAL CONFLICT OF INTEREST EXISTS, A REASONABLE COMPLIANCE MANAGEMENT PLAN INCLUDING PERIODIC REVIEWS OF RELATIONSHIPS OR ACTIVITIES OF ANY PERSON OR RELATIVE WILL BE INSTITUTED. ANY CHANGES OR MODIFICATIONS IN SUCH RELATIONSHIPS OR ACTIVITIES SHALL BE PERIODICALLY REVIEWED AND EVALUATED BY THE ECMS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 92,707. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,707. PHYSICAL THERAPY FEES: PROGRAM SERVICE EXPENSES 1,098,227. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,098,227. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 159,458. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 159,458. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 61,377. MANAGEMENT AND GENERAL EXPENSES 1,240. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,617. SHARED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,021,498. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,021,498. FORM 990, PART XI, LINE 9: CHANGE IN EQUITY INTEREST IN THE NET ASSETS OF THE FOUNDATION -410. BRISTOL HOSPITAL INC 41 BREWSTER ROAD BRISTOL CT 06010 060646559 SHORT-TERM ACUTE CARE COMMUNITY HOSPITAL CT 501(C)(3) LINE 3 BRISTOL HOSPITAL AND HEALTH CARE GROUP 0 BRISTOL HOSPITAL AND HEALTH CARE GROUP INC 41 BREWSTER ROAD BRISTOL CT 06010 222577726 HEALTHCARE PARENT COMPANY CT 501(C)(3) LINE 12B, II N/A 0 BRISTOL HOSPITAL DEVELOPMENT FOUNDATION INC 41 BREWSTER ROAD BRISTOL CT 06010 222577740 FUNDRAISING CT 501(C)(3) LINE 7 BRISTOL HOSPITAL AND HEALTH CARE GROUP 0 BRISTOL HOSPITAL MULTISPECIALTY GROUP INC 41 BREWSTER ROAD BRISTOL CT 06010 061466555 HEALTHCARE SERVICES CT 501(C)(3) LINE 10 BRISTOL HOSPITAL AND HEALTH CARE GROUP 0 BRISTOL HOME CARE AND HOSPICE AGENCY INC 41 BREWSTER ROAD BRISTOL CT 06010 821663577 HOME CARE AND HOSPICE CT 501(C)(3) LINE 10 BRISTOL HOSPITAL AND HEALTH CARE GROUP 0 BRISTOL HOSPITAL EMS LLC 41 BREWSTER ROAD BRISTOL CT 06010 061547648 EMERGENCY MEDICAL SERVICES CT N/A C 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0