2016-08-11T07:58:02-05:00 2015-09-30 135565207 KPMG LLP ONE FINANCIAL PLAZA 755 MAIN STREET HARTFORD CT 06103 990 2014-10-01 222908698 BRIDGEPORT HOSPITAL FOUNDATIONINC BRID 2036886088 267 GRANT STREET BRIDGEPORT CT 06610 STEPHEN JAKAB PRESIDENT 2036886088 2016-08-02 0 MARY-EVELYN ANTONETTI P00431862 8602976085 2014 2016-12-15 16:53:06Z STEPHEN JAKAB 267 GRANT ST BRIDGEPORT CT 06610 57858117 0 X HTTP://FOUNDATION.BRIDGEPORTHOSPITAL.ORG/ X 1988 CT FUNDRAISING FOR BRIDGEPORT HOSPITAL. 11 9 0 0 0 0 7773362 9085513 0 0 761586 146636 -50262 225343 8484686 9457492 80518 97143 0 0 975480 2510384 0 0 1494126 860622 2047963 1916620 4655490 6568066 4802002 67842601 71975415 2030886 2708244 65811715 69267171 X TO SUPPORT BRIDGEPORT HOSPITAL BY, IN LARGE PART, FUNDRAISING, AND, FURTHER, TO FUND AND PROMOTE ACTIVITIES OF THE YALE NEW HAVEN HEALTH SYSTEM, THE INTEGRATED HEALTH CARE DELIVERY SYSTEM OF WHICH IT IS A PART. 0 0 806203 97143 0 SCHEDULE OTHE BRIDGEPORT HOSPITAL FOUNDATION ACHIEVED $9,492,531 IN TOTAL PHILANTHROPY IN THE FISCAL YEAR ENDING SEPTEMBER 30, 2015, THE MOST EVER GIVEN TO THE FOUNDATION IN A SINGLE FISCAL YEAR IN ITS 27 YEAR HISTORY. THE NORMA PFRIEM BREAST CENTER CONTINUES TO BE THE TOP DESIGNATION FOR DONORS WITH $2,697,560 IN TOTAL CONTRIBUTIONS. THE BREAST CENTER CELEBRATED ITS 15TH ANNIVERSARY WITH ANOTHER RECORD-SETTING ROSE OF HOPE LUNCHEON, ATTRACTING 542 ATTENDEES AND RAISING MORE THAN $391,000 AFTER EXPENSES FOR ITS PROGRAMS FOR UNDERSERVED WOMEN. THE FOUNDATION BECAME ONE OF THE CHARITABLE BENEFICIARIES OF THE FAIRFIELD COUNTY HUNT CLUB'S ANNUAL HORSE SHOW IN JUNE. THE 35TH ANNUAL KAULBACH MEMORIAL GOLF CLASSIC, ALSO TO BENEFIT CANCER SERVICES, NETTED MORE THAN $135,000 AND SIGNIFICANT GIFTS TOTALING OVER $2 MILLION WERE GIVEN BY INDIVIDUAL DONORS TO HELP BUILD A NEW HYBRID OPERATING ROOM. 806203 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 45 0 0 0 0 0 0 0 1 1 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X KEITH TANDLER 2036889642 789 HOWARD AVENUE NEW HAVEN CT 06519 RONALD DEFEO CHAIR/TRUSTEE 1.00 0.00 X X 0 0 0 MITCHELL DRIESMAN VICE CHAIR/TRUSTEE 1.00 0.00 X X 0 0 0 WILLIAM JENNINGS TRUSTEE 1.00 39.00 X 0 1228835 320176 ROBERT STANTON TREASURER/TRUSTEE 1.00 0.00 X X 0 0 0 CARLA KLEIN SECRETARY/TRUSTEE 1.00 0.00 X X 0 0 0 RAYMOND CONDON TRUSTEE 1.00 0.00 X 0 0 0 STEPHEN JAKAB PRESIDENT/TRUSTEE 1.00 39.00 X X 0 323764 40547 NEWMAN MARSILIUS III TRUSTEE 1.00 2.00 X 0 0 0 EMIL MESHBERG TRUSTEE 1.00 0.00 X 0 0 0 LESLEY O'CONNELL TRUSTEE 1.00 0.00 X 0 0 0 PATRICK SHAW TRUSTEE 1.00 0.00 X 0 0 0 MEREDITH REUBEN THRU 1014 CHAIR/TRUSTEE 1.00 0.00 X X 0 0 0 ROBERT TREFRY RET 910 FORMER OFFICER 0.00 0.00 X 0 216182 0 0 1768781 360723 0 1 1 0 0 762473 441265 1758996 6122779 106342 9085513 313240 313240 47927601 48094205 -166604 -166604 -166604 242240 762473 306420 -64180 -64180 OTHER INCOME 900099 289523 289523 289523 9457492 0 0 371979 X 97143 97143 2072238 322341 1070663 679234 438146 68154 226377 143615 294952 45880 152393 96679 5834 908 3014 1912 21618 3363 11169 7086 923573 143663 477184 302726 116958 18193 60429 38336 262286 40799 135515 85972 9687 1507 5005 3175 257879 40114 133238 84527 16239 2526 8390 5323 DUES,FEES AND MEMBERSHI 61368 9546 31707 20115 ENTERTAINMENT 60217 9367 31112 19738 MISCELLANEOUS EXPENSES 17352 2699 8965 5688 4655490 806203 2355161 1494126 913458 865775 2739217 838612 1158491 865382 171472 127990 29690610 19310843 33039353 49836813 130000 130000 67842601 71975415 70211 95722 1960675 2612522 2030886 2708244 X 34453979 34763984 15023082 17035486 16334654 17467701 65811715 69267171 67842601 71975415 X 4802002 2077534 -3424081 X 0 1 X 1 1 1 X 7886587 8399311 7421332 7773362 9085513 40566105 7886587 8399311 7421332 7773362 9085513 40566105 11354467 29211638 1441126 563964 507534 494078 313240 3319942 289523 289523 44175570 0.66130 0.64890 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19237000 2287000 609000 -1129000 21004000 17733000 2178000 473000 -1147000 19237000 15098000 3319000 -35000 -649000 17733000 13858000 874000 418000 -52000 15098000 12034000 1805000 59000 -40000 13858000 0.83000 0.17000 0 0 0 ENDOWMENT POOL 49384833 F PERPETUAL TRUST 451980 F 49836813 DUE TO BRIDGEPORT HOSPITAL 2293230 P.V. OF FUTURE ANNUITY-IRELAND 12836 P.V. OF FUTURE ANNUITY-YURKSAITIS 133026 P.V. OF FUTURE ANNUITY-MACDONALD 156295 P.V. OF FUTURE ANNUITY-BODINE 10306 P.V. OF MINORITY INT- SPINELLI 6829 2612522 X PART V, LINE 4: THE ENDOWED FUNDS' INTENDED USE IS TO GENERATE INCOME TO SUPPORT BRIDGEPORT HOSPITAL PROGRAM SERVICE FUNCTIONS AND OTHER OPERATIONS IN ACCORDANCE WITH THE BRIDGEPORT HOSPITAL POOLED INVESTMENT POLICY. PART X, LINE 2: THE CONSOLIDATED FINANCIAL STATEMENTS OF BRIDGEPORT HOSPITAL AND SUBSIDIARIES INCLUDE THE FOOTNOTE AS FOLLOWS: THE HOSPITAL AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. PROPERTIES IS A TAX-EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(2) OF THE CODE AND ALSO IS NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED "UNRELATED BUSINESS INCOME AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. ROH LUNCH 531586 455096 76490 155794 KAULBACH 199117 122090 77027 56246 6 274010 185287 88723 94380 1004713 762473 242240 306420 306420 -64180 1 NURSING SCHOLARSHIP 106 97143 PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS: THE GRANT WRITER IN THE BRIDGEPORT HOSPITAL FOUNDATION SUPPORTS CLINICAL AND PROGRAM STAFF GRANTEES IN COMPLYING WITH THE VARIOUS REQUIREMENTS ASSOCIATED WITH STATE, FEDERAL, AND PRIVATE GRANTS, INCLUDING THE FOLLOWING: -MAINTAINING FILES FOR EACH GRANT THAT CONTAIN THE GRANT APPLICATION AND PROGRAM GUIDANCE, THE NOTICE OF GRANT AWARD, ANY ASSOCIATED CONTRACTS OR MEMORANDA OF AGREEMENT/UNDERSTANDING, COPIES OF CHECKS, AND CORRESPONDENCE RELATED TO THE GRANT; -PREPARING PROGRAM AND FINANCIAL REPORTS IN COMPLIANCE WITH THE DEADLINES SPECIFIED; -MAINTAINING VARIOUS REGISTRATIONS REQUIRE BY STATE AND FEDERAL FUNDING SOURCES; -ASSISTING IN DRAWING DOWN FUNDS ACCESSED THROUGH ACH DEPOSITS. 0 1 0 0 0 0 0 0 0 WILLIAM JENNINGS TRUSTEE 0 851671 0 249084 0 128080 0 300736 0 19440 0 1549011 0 89545 STEPHEN JAKAB PRESIDENT/TRUSTEE 0 235608 0 69769 0 18387 0 23257 0 17290 0 364311 0 1892 ROBERT TREFRY RET 910 FORMER OFFICER 0 0 0 0 0 216182 0 0 0 0 0 216182 0 216182 PART I, LINE 3 INDIVIDUALS LISTED ON PART VII AS OFFICERS OF THE CORPORATION ARE EMPLOYEES OF A RELATED ORGANIZATION(S) AND COMPENSATED THROUGH THE RESPECTIVE RELATED ORGANIZATION(S). THE METHOD USED BY THE RELATED ORGANIZATION(S) FOR DETERMINING COMPENSATION FOR THESE INDIVIDUAL ARE: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE INDIVIDUAL LISTED BELOW IS A PARTICIPANT IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THE ACCRUAL IS INCLUDED IN THE AMOUNT REPORTED IN PART II, COLUMN C (DEFERRED COMPENSATION) AND REPRESENTS THE RELATED ENTITY'S AMOUNT CONSISTENT WITH THE COMPENSATION REPORTING PER IRS INSTRUCTIONS. SEVERANCE NONQUALIFIED EQUITY-BASED WILLIAM M. JENNINGS $0 $182,736 $0 ONE FORMER OFFICER, ROBERT TREFRY RECEIVED PAYMENT FROM THE NONQUALIFIED PLAN. THE AMOUNT IS INCLUDED IN SECTION II, COLUMN B (III). THE FOLLOWING PAYMENT WAS MADE DIRECTLY TO HIM FROM THE RABBI TRUST: ROBERT TREFRY $216,182 THE SUPPLEMENTAL RETIREMENT PLAN IS DESIGNED TO ENSURE THE PAYMENT OF A COMPETITIVE LEVEL OF RETIREMENT INCOME WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME IN ORDER TO ATTRACT AND RETAIN KEY MANAGEMENT EMPLOYEES SERVING AS CORPORATE OFFICERS. THE PLAN PROVIDES SUPPLEMENTAL RETIREMENT INCOME THROUGH AN UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION ARRANGEMENT UNDER SECTION 457(F) AND THROUGH A DEFERRED COMPENSATION PLAN UNDER SECTION 409A OF THE INTERNAL REVENUE CODE AND A MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES' PLAN UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). X 7 62204 STOCK EXCHANGE QUOTES X GIFTS/BAGS/FOOD 5 44138 COMPARABLE MARKET PR 0 0 0 0 FORM 990, PART VI PART I, LINE 4 & PART VI, LINE 1B NUMBER OF INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY THE ORGANIZATION SOUGHT TO CONFIRM THE INDEPENDENCE OF EACH VOTING MEMBER OF ITS GOVERNING BODY BY REQUESTING THAT EACH SUCH VOTING MEMBER RESPOND TO A QUESTIONNAIRE CONTAINING THE PERTINENT INSTRUCTIONS AND DEFINITIONS AND DESIGNED TO ELICIT THE INFORMATION NECESSARY TO DETERMINE INDEPENDENCE. BASED ON RESPONSES TO THE QUESTIONNAIRES RECEIVED BY THE ORGANIZATION AND ANNUAL CONFLICTS OF INTEREST DISCLOSURES, THE ORGANIZATION WAS ABLE TO CONFIRM THAT NINE (9) VOTING MEMBERS ARE INDEPENDENT. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: THE SOLE MEMBER OF BRIDGEPORT HOSPITAL FOUNDATION, INC. IS BRIDGEPORT HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A BRIDGEPORT HOSPITAL HAS THE RIGHT TO ELECT THE BOARD OF TRUSTEES OF THE FOUNDATION IN CONSULTATION WITH AND WITH THE CONSENT OF YALE-NEW HAVEN HEALTH SERVICES CORPORATION AND OFFICERS OF THE FOUNDATION ARE ELECTED BY THE FOUNDATION BOARD OR AS OTHERWISE SET FORTH IN ACCORDANCE WITH THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B SUBJECT TO THE APPROVAL OF YALE-NEW HAVEN HEALTH SERVICES CORPORATION (HSC), BRIDGEPORT HOSPITAL, AS THE SOLE MEMBER OF THE FOUNDATION, HAS THE AUTHORITY TO A. MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THIS CORPORATION OR ANY AFFILIATE AND THE CREATION OR ACQUISITION OF AN INTEREST IN ANY CORPORATE ENTITY, INCLUDING JOINT VENTURES; B. AMENDMENT OR RESTATEMENT OF THE MISSION, CERTIFICATE OF INCORPORATION OR THE BYLAWS OF THIS CORPORATION OR ANY AFFILIATE, OR ANY NEW OR REVISED "DOING BUSINESS AS" NAME; C. ADOPTION OF OPERATING AND CASH FLOW BUDGETS OF THE CORPORATION OR ANY AFFILIATE, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THIS CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION (PURSUANT TO THE AUTHORITY DELEGATED TO THIS CORPORATION BY THE MEMBER AND HSC TO ADOPT SUCH BUDGETS WITHIN PARAMETERS ESTABLISHED BY THE MEMBER AND HSC); D. ADOPTION OF CAPITAL BUDGETS AND CAPITAL ALLOCATIONS OF THIS CORPORATION OR ANY AFFILIATE (PURSUANT TO THE AUTHORITY DELEGATED TO THIS CORPORATION BY THE MEMBER AND HSC TO ADOPT SUCH BUDGETS WITHIN PARAMETERS ESTABLISHED BY THE MEMBER AND HSC); E. INCURRING AGGREGATE OPERATING OR CAPITAL EXPENDITURES ON AN ANNUAL BASIS THAT EXCEED OPERATING OR CAPITAL BUDGETS OF THE CORPORATION ADOPTED BY THE MEMBER AND HSC BY A SPECIFIED DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE MEMBER AND HSC; F. LONG-TERM OR MATERIAL AGREEMENTS INCLUDING, BUT NOT LIMITED TO, EQUITY FINANCINGS, CAPITALIZED LEASES, OPERATING LEASES AND INSTALLMENT CONTRACTS; AND PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE OR ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A FAIR MARKET VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE MEMBER AND HSC, WHICH SHALL NOT BE LESS THAN 10% OF THE TOTAL ANNUAL CAPITAL BUDGET OF THIS CORPORATION; G. APPROVAL OF ANY NEW RELATIONSHIPS OR AGREEMENTS FOR UNDERGRADUATE OR GRADUATE MEDICAL EDUCATION PROGRAMS OR ANY MATERIAL AMENDMENTS TO OR TERMINATIONS OF EXISTING AGREEMENTS FOR UNDERGRADUATE OR GRADUATE MEDICAL EDUCATION PROGRAMS; H. CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL OR SUBSTANTIALLY ALL OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THIS CORPORATION OR ANY AFFILIATE; I. APPROVAL OF MAJOR NEW PROGRAMS AND CLINICAL SERVICES OF THIS CORPORATION OR ANY AFFILIATE OR DISCONTINUATION OR CONSOLIDATION OF ANY SUCH PROGRAM. THE MEMBER AND HSC SHALL FROM TIME TO TIME DEFINE THE TERM "MAJOR" IN THIS CONTEXT; J. APPROVAL OF STRATEGIC PLANS OF THIS CORPORATION OR ANY AFFILIATE; AND K. ADOPTION OF SAFETY AND QUALITY ASSURANCE POLICIES NOT IN CONFORMITY WITH POLICIES ESTABLISHED BY THE MEMBER AND HSC. OTHER MAJOR ACTIVITIES: A. IN ADDITION, THE MEMBER AND HSC SHALL HAVE THE AUTHORITY, EXCEPT AS OTHERWISE PROVIDED BY THE MEMBER AND HSC AND AFTER CONSULTATION WITH THIS CORPORATION, TO REQUIRE THE PRIOR REVIEW AND APPROVAL OF THOSE ACTIVITIES OF THIS CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY THAT THE MEMBER AND HSC DETERMINE TO BE "MAJOR ACTIVITIES." B. "MAJOR ACTIVITIES" SHALL BE THOSE WHICH THE MEMBER AND HSC BY A VOTE OF NOT LESS THAN TWO-THIRDS (2/3) OF HSC'S BOARD OF TRUSTEES HAS DECLARED MAJOR, BY WRITTEN NOTICE TO THIS CORPORATION, DELIVERED PERSONALLY OR TRANSMITTED BY REGISTERED OR CERTIFIED MAIL RETURN RECEIPT REQUESTED. SUCH NOTICE SHALL SPECIFICALLY IDENTIFY THE MATTER OR MATTERS REQUIRING APPROVAL OF THE MEMBER AND HSC, AND SHALL REFER TO THIS BYLAW PROVISION GRANTING SUCH APPROVAL RIGHTS TO THE MEMBER AND HSC. NOTICES RECEIVED PURSUANT TO THIS SECTION SHALL BE RECORDED IN THE MINUTES OF THIS CORPORATION AND SHALL BE FILED WITH THE MINUTES OF THIS CORPORATION. NOTHING IN THESE BYLAWS SHALL BE CONSTRUED IN A MANNER THAT IS INCONSISTENT WITH THE AUTHORITIES WITH RESPECT TO THE CORPORATION THAT ARE RESERVED OR RETAINED BY THE MEMBER AND HSC PURSUANT TO THESE BYLAWS AND THE BYLAWS OF THE MEMBER AND/OR HSC, AS APPLICABLE. FURTHER, YALE-NEW HAVEN HEALTH SERVICES CORPORATION HAS THE SOLE AUTHORITY WITH RESPECT TO CERTAIN ACTION, INCLUDING, BUT NOT LIMITED TO THE ISSUANCE AND INCURRENCE OF INDEBTEDNESS: A. ADOPTION OF TARGETS FOR THE ANNUAL OPERATING AND CASH FLOW BUDGETS OF THIS CORPORATION AND ITS AFFILIATES, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THIS CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; B. ADOPTION OF TARGETS FOR THE ANNUAL CAPITAL BUDGETS AND CAPITAL ALLOCATIONS OF THIS CORPORATION AND ANY AFFILIATE; C. ADOPTION OF ANNUAL OPERATING, CASH FLOW AND ANNUAL CAPITAL BUDGETS FOR THE CORPORATION AND ANY AFFILIATE WITHIN THE TARGETS ESTABLISHED BY HSC IN THE EVENT OF ANY FAILURE OF THE CORPORATION TO DO SO; D. ISSUANCE AND INCURRENCE OF INDEBTEDNESS ON BEHALF OF THIS CORPORATION; E. MANAGEMENT AND CONTROL OF THE LIQUID ASSETS OF THIS CORPORATION, INCLUDING THE AUTHORITY TO CAUSE SUCH ASSETS TO BE FUNDED TO HSC OR AS OTHERWISE DIRECTED BY HSC; AND F. APPOINTMENT OF THE INDEPENDENT AUDITOR FOR THIS CORPORATION AND EACH AFFILIATE AND THE MANAGEMENT OF THE AUDIT PROCESS AND COMPLIANCE PROCESS AND PROCEDURES FOR THIS CORPORATION AND EACH AFFILIATE; AND G. APPOINTMENT OF THE PRESIDENT CONSISTENT WITH SECTIONS 4.3(A). FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 TAX RETURN AND ATTACHED SCHEDULES WERE PREPARED BY EMPLOYEES OF THE SYSTEM TAX DEPARTMENT. THE RETURN IS INITIALLY REVIEWED BY THE EXECUTIVE DIRECTOR/DIRECTOR OF FINANCE. SUBSEQUENTLY IT IS SENT TO KPMG LLP FOR THEIR INITIAL REVIEW. AFTER ALL COMMENTS FROM THE ABOVE GROUP ARE CLEARED, THE RETURN IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER OF THE ENTITY AND A FINAL VERSION OF THE RETURN IS SENT BACK TO KPMG LLP FOR FINAL REVIEW. PRIOR TO FILING, THE ORGANIZATION MADE AVAILABLE A COMPLETE COPY OF THE RETURN TO THE BOARD OF TRUSTEES VIA A WEB PORTAL. FORM 990, PART VI, SECTION B, LINE 12C THE BRIDGEPORT HOSPITAL FOUNDATION, INC IS COVERED UNDER THE YALE-NEW HAVEN HEALTH SYSTEM CONFLICT OF INTEREST POLICY. THE YALE NEW HAVEN HEALTH SYSTEM CONFLICT OF INTEREST POLICY (CC:R-7) AND INDIVIDUAL ANNUAL DISCLOSURE FORM APPLIES TO A POOL OF EMPLOYEES, BOARD MEMBERS AND NON-BOARD MEMBERS SERVING ON BOARD COMMITTEES. THESE "COVERED INDIVIDUALS" ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT, UPON BEGINNING EMPLOYMENT OR OTHERWISE BECOMING A COVERED INDIVIDUAL AND ANNUALLY THEREAFTER. COVERED INDIVIDUALS ARE ALSO REQUIRED TO IMMEDIATELY REPORT MATERIAL CHANGES TO THEIR MOST RECENTLY COMPLETED DISCLOSURE STATEMENT. THESE DISCLOSURE STATEMENTS AND REPORTS ARE REVIEWED BY THE OFFICE OF PRIVACY AND CORPORATE COMPLIANCE AND/OR THE LEGAL AND RISK SERVICES DEPARTMENT TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF A POTENTIAL CONFLICT ARISES, THE PRESIDENT AND CEO WOULD CONSULT WITH THE BOARD CHAIRPERSON AND THE LEGAL AND RISK SERVICES DEPARTMENT AND TAKE ANY ACTIONS THAT SHE DEEMS REQUIRED OR APPROPRIATE TO MANAGE OR RESOLVE A POTENTIAL CONFLICT OF INTEREST. FOR EXAMPLE, A VOTING BOARD OR COMMITTEE MEMBER WOULD BE REQUIRED TO RECUSE HIMSELF OR HERSELF FROM VOTING ON MATTERS RELATED TO THE POTENTIAL CONFLICT AND THE POTENTIAL CONFLICT WOULD BE DISCLOSED TO OTHER VOTING MEMBERS. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF FORM 990, FORM 1023 (IF AVAILABLE) AND AUDITED FINANCIAL STATEMENTS ARE MAINTAINED IN THE SYSTEM TAX DEPARTMENT. OTHER CORPORATE GOVERNING DOCUMENTS ARE MAINTAINED BY THE LEGAL AND RISK SERVICES DEPARTMENT. THE CONFLICT OF INTEREST POLICY, WHISTLEBLOWER POLICY, AND DOCUMENT RETENTION POLICY ARE AVAILABLE TO ALL EMPLOYEES ON THE CORPORATE INTERNAL WEBSITE. COPIES OF ALL DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OUTSIDE CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 6,995. MANAGEMENT AND GENERAL EXPENSES 23,235. FUNDRAISING EXPENSES 14,740. TOTAL EXPENSES 44,970. CONSULTING FEES: PROGRAM SERVICE EXPENSES 136,668. MANAGEMENT AND GENERAL EXPENSES 453,949. FUNDRAISING EXPENSES 287,986. TOTAL EXPENSES 878,603. FORM 990, PART XI, LINE 9: TRANSFER TO BRIDGEPORT HOSPITAL -3,336,624. WRITE OFF UNCOLLECTIBLE PLEDGES -87,457. GREENWICH HOSPITAL 5 PERRYRIDGE ROAD GREENWICH CT 06830 060646659 HEALTHCARE SERVICES CT 501C3 LINE 3 GREENWICH HEALTH CARE SERVICES INC 1 GREENWICH HEALTH CARE SERVICES INC 5 PERRYRIDGE ROAD GREENWICH CT 06830 222593399 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II YALE NEW HAVEN HEALTH SERVICES CORP 0 THE GREENWICH HOSPITAL ENDOWMENT FUND INC 5 PERRYRIDGE ROAD GREENWICH CT 06830 061526642 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II GREENWICH HEALTH CARE SERVICES INC 1 SOUTHERN CONNECTICUT HEALTH SYSTEM PROPERTIES INC 267 GRANT STREET BRIDGEPORT CT 06610 061297708 TITLE HOLDING CT 501C2 BRIDGEPORT HOSPITAL 1 BRIDGEPORT HOSPITAL AUXILIARY INC 267 GRANT STREET BRIDGEPORT CT 06610 066042500 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11A, I BRIDGEPORT HOSPITAL 1 NORTHEAST MEDICAL GROUP INC 99 HAWLEY LANE STRATFORD CT 06614 061330992 HEALTHCARE SERVICES CT 501C3 LINE 9 YALE NEW HAVEN HEALTH SERVICES CORP 1 NORTHEAST MEDICAL GROUP PLLC 99 HAWLEY LANE STRATFORD CT 06614 352380180 HEALTHCARE SERVICES CT 501C3 LINE 11A, I NORTHEAST MEDICAL GROUP INC 1 YALE-NEW HAVEN HOSPITAL 20 YORK STREET NEW HAVEN CT 06504 060646652 HEALTHCARE SERVICES CT 501C3 LINE 3 YALE NEW HAVEN HEALTH SERVICES CORP 1 YALE-NEW HAVEN CARE CONTINUUM CORP 789 HOWARD AVE NEW HAVEN CT 06519 455235566 NURSING HOME CT 501C3 LINE 3 YALE-NEW HAVEN HOSPITAL 1 CARITAS INSURANCE - TERMINATED 121514 40 MAIN STREET BURLINGTON VT 05401 030322238 INSURANCE VT 501C3 LINE 11A, I YALE NEW HAVEN HOSPITAL 1 YALE NEW HAVEN HEALTH SERVICES CORP 789 HOWARD AVE NEW HAVEN CT 06519 222529464 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11A, I N/A 0 PERRYRIDGE CORPORATION 5 PERRYRIDGE ROAD GREENWICH CT 06830 061207316 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II GREENWICH HEALTH CARE SERVICES INC 1 BRIDGEPORT HOSPITAL 267 GRANT STREET BRIDGEPORT CT 06610 060646554 HEALTHCARE SERVICES CT 501C3 LINE 3 YALE NEW HAVEN HEALTH SERVICES CORP 0 BRIDGEPORT HOSPITAL FRIENDS OF PEDIATRICS INC 120 COLUMBINE DRIVE TRUMBULL CT 06611 066048427 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11A, I YALE-NEW HAVEN HOSPITAL 1 SARAH BEARDSLEY FBO BRIDGEPORT HOSPITAL 10 S DEARBORN IL1-0117 CHICAGO IL 60603 066021966 SYSTEM SUPPORT SERVICES IL 4947(A)(1) PF N/A 1 SHORELINE SURGERY CENTER LLC 60 TEMPLE STREET NEW HAVEN CT 06510 900110459 HEALTHCARE CT N/A SSC II LLC 111 GOOSE LANE GUILFORD CT 06437 261709382 HEALTHCARE CT N/A ORTHOPAEDIC & NEUROSURGERY CENTER 55 HOLLY HILL LANE GREENWICH CT 06830 273477197 HEALTHCARE CT N/A TOTAL HEALTH CONNECTICUT LLC 789 HOWARD AVENUE NEW HAVEN CT 06519 474070024 HEALTHCARE CT N/A YNHHS-MSO INC 789 HOWARD AVE NEW HAVEN CT 06519 061467717 MANAGEMENT SERVICES CT N/A C 1 YALE NEW HAVEN AMBULATORY SERVICES 40 TEMPLE STREET NEW HAVEN CT 06510 061398526 HEALTHCARE SERVICES CT N/A C 1 MEDICAL CENTER REALTY INC 50 YORK STREET NEW HAVEN CT 06511 061110858 RENTAL SERVICES CT N/A C 1 GREENWICH HEALTH SERVICES INC - TERMINATED 6302015 5 PERRYRIDGE ROAD GREENWICH CT 06830 061233643 HEALTHCARE SERVICES CT N/A C 1 GREENWICH FERTILITY & IVF PC 5 PERRYRIDGE ROAD GREENWICH CT 06830 300145464 HEALTHCARE SERVICES CT N/A C 1 YORK ENTERPRISES INC 50 YORK STREET NEW HAVEN CT 06511 061110937 TITLE HOLDING CT N/A C 1 YNHH-PHYSICIANS CORP 789 HOWARD AVE NEW HAVEN CT 06519 061202305 ADMINISTRATIVE SERVICES CT N/A C 1 MEDICAL CENTER PHARMACY INC 50 YORK STREET NEW HAVEN CT 06511 061087673 PHARMACY CT N/A C 1 GREENWICH OCCUPATIONAL HEALTH SERVICES OF NEW YORK PC 5 PERRYRIDGE ROAD GREENWICH CT 06830 061540101 HEALTHCARE SERVICES NY N/A C 1 LUKAN INDEMNITY COMPANY - TERMINATED 3312015 58 PAR-LA-VALLIS RD HAMILTON BD 981072793 INSURANCE BD N/A C 1 GREENWICH OCCUPATIONAL HEALTH SERVICES OF NEW JERSEY 5 PERRYRIDGE ROAD GREENWICH CT 06830 453833883 HEALTHCARE SERVICES NJ N/A C 1 PRIMARYNET OF CONNECTICUT INC 789 HOWARD AVE NEW HAVEN CT 06519 061463534 MANAGEMENT SERVICES CT N/A C 1 CENTURY FINANCIAL SERVICES INC 23 MAIDEN LANE NORTH HAVEN CT 06473 061110797 DEBT COLLECTION SERVICES CT N/A C 1 CENTURY MANAGEMENT SERVICES INC 23 MAIDEN LANE NORTH HAVEN CT 06473 061303173 RECEIVABLE MANAGEMENT SERVICES CT N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 BRIDGEPORT HOSPITAL P 3128621 TRANSACTION REVIEW BRIDGEPORT HOSPITAL M 3941042 TRANSACTION REVIEW