2015-08-11T16:15:04-05:00 2014-09-30 350921680 CROWE HORWATH LLP 175 POWDER FOREST DRIVE SIMSBURY CT 06089 990 2013-10-01 060646559 BRISTOL HOSPITAL INC BRIS 8605853000 BREWSTER RD BRISTOL CT 06011 GEORGE W EIGHMY VP & CFO 8605853000 2015-08-11 1 KRISTIN ANDERSON P01231300 8606789200 2013 2016-02-25 16:41:14Z KURT BARWIS BREWSTER RD BRISTOL CT 06011 143559628 0 X WWW.BRISTOLHOSPITAL.ORG X 1920 CT TO ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. WE WILL PROVIDE SAFE, QUALITY CARE AND SERVICES TO OUR PATIENTS THROUGH OUR CONTINUUM OF SERVICES AND HEALTH PROMOTION. WE WILL COLLABORATE WITH HEALTH PROFESSIONAL AND OTHER ORGANIZATIONS AS ADVOCATES FOR OUR COMMUNITY. WE WILL PROVIDE THE OPPORTUNITY FOR GROWTH TO OUR MEDICAL STAFF AND EMPLOYEES IN AN ENVIRONMENT WHERE EACH INDIVIDUAL IS RESPECTED AND VALUED. 16 13 1389 245 416411 -309157 1114855 1386045 129286883 140125869 288256 771315 1225255 1276399 131915249 143559628 0 0 0 0 68831487 73574368 0 0 0 60872187 67654581 129703674 141228949 2211575 2330679 113932754 114337729 87460483 85910774 26472271 28426955 X BRISTOL HOSPITAL AND HEALTH CARE GROUP IS COMMITTED TO ENHANCING THE HEALTH AND WELL-BEING OF OUR COMMUNITY. WE WILL PROVIDE SAFE, QUALITY CARE AND SERVICES TO OUR PATIENTS THROUGH OUR CONTINUUM OF SERVICES AND HEALTH PROMOTION. WE WILL COLLABORATE WITH HEALTH PROFESSIONALS AND OTHER ORGANIZATIONS AS ADVOCATES FOR OUR COMMUNITY. WE WILL PROVIDE THE OPPORTUNITY FOR GROWTH TO OUR MEDICAL STAFF AND EMPLOYEES IN AN ENVIRONMENT WHERE EACH INDIVIDUAL IS RESPECTED AND VALUED. 0 0 116716054 140205427 AS 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 $4,530,623 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.BRISTOL HOSPITAL BACKGROUND: BRISTOL HOSPITAL, THE FLAGSHIP OF THE BRISTOL HOSPITAL AND HEALTH CARE GROUP, IS COMMITTED TO PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES THAT ARE PROGRESSIVE, COMPASSIONATE, COORDINATED, ACCESSIBLE, AFFORDABLE, HIGH QUALITY AND RESPONSIVE TO COMMUNITY NEEDS. THE HOSPITAL'S CENTRAL MISSION IS TO BE THE LEADING HEALTH CARE PROVIDER FOR THE PEOPLE WHO LIVE AND WORK IN THE GREATER BRISTOL AREA, A ROLE THAT IT HAS PLAYED FOR MANY GENERATIONS SINCE THE EARLY 1920S. BRISTOL HOSPITAL SERVES ALL PEOPLE WHO NEED CARE, REGARDLESS OF THEIR AGE, GENDER, SEXUAL ORIENTATION, RACE, RELIGION, NATURAL ORIGIN, PERSONAL LIMITATIONS, OR ABILITY TO PAY. IN ADDITION TO BEING THE LEADING HEALTH CARE PROVIDER, BRISTOL HOSPITAL IS ALSO ONE OF THE AREA'S LARGEST EMPLOYERS. THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF COMMUNITY AND CIVIC LEADERS, WORKING AND RETIRED LOCAL BUSINESS EXECUTIVES, AND PHYSICIANS WHO GUIDE THE OVERALL PHILOSOPHY AND DIRECTION OF THE ORGANIZATION TO MEET THE NEEDS OF THE LOCAL COMMUNITY.BRISTOL HOSPITAL VISION: BRISTOL HOSPITAL AND HEALTH CARE GROUP ASPIRES TO BE RECOGNIZED AS THE BEST COMMUNITY HEALTH CARE PROVIDER IN CONNECTICUT. WORKING WITH OUR PATIENTS, PHYSICIANS, EMPLOYEES, VOLUNTEERS AND COMMUNITY, BRISTOL HOSPITAL AND HEALTH CARE GROUP WILL UTILIZE OUR CORE VALUES TO ACHIEVE THE VISION WHICH: CREATES A CULTURE OF SAFETY, QUALITY AND SERVICE THAT IS EMBRACED AS AN INDIVIDUAL AND TEAM RESPONSIBILITY; ENSURES A USER-FRIENDLY CONTINUUM MODELED ON PROVIDING PATIENT-CENTERED CARE AND SERVICES; CONTINUALLY ASSESSES AND PROMOTES NEW SERVICES AND TECHNOLOGY; AND ERVES AS THE RESPONSIBLE STEWARD AND ADVOCATE FOR THE HEALTH OF OUR COMMUNITY.BRISTOL HOSPITAL PATHWAYS COMMUNITY PROGRAMMING: THIS IS COMPRISED OF DOZENS OF LOW COST OR FREE CLASSES AND SEMINARS THAT ARE OFFERED THROUGH ITS PATHWAYS CATALOG. THE CATALOG ALSO IS MAILED TO HOUSEHOLDS IN TOWNS IN BRISTOL HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREAS. THE COMMUNITY PROGRAMMING OFFERED THROUGH THE PATHWAYS INCLUDE: WEIGHT LOSS SURGERY INFORMATION, MATERNITY, PARENTING EDUCATION, NUTRITION, CPR/EMT, STRESS RELIEF, REIKI, PERSONAL HEALTH AND DEVELOPMENT, SUPPORT GROUPS, THE DOCTOR IS IN - FREE HEALTH INFORMATION AND SEMINAR SERIES, HEALTH SCREENINGS, WEIGHT LOSS SUPPORT GROUP, CANCER CARE GROUPS, EVENING DIABETES SUPPORT GROUP, DAYTIME DIABETES SUPPORT GROUP, ALZHEIMER'S SUPPORT GROUP, OVEREATERS ANONYMOUS, AND EPILEPSY SUPPORT. "THE DOCTOR IS IN" FREE HEALTH INFORMATION AND SEMINAR SERIES INCLUDES FREE PRESENTATIONS BY THE PHYSICIANS OF THE BRISTOL HOSPITAL MULTI-SPECIALTY GROUP IN THE FOLLOWING DISCIPLINES: DEMENTIA, HEALTHY LIVING, FALL PREVENTION, POLY PHARMACY, JOINT HEALTH, THYROID HEALTH, SMOKING, COPD & ASTHMA, BREAST HEALTH, EXERCISE FOR THE ELDERLY, AND CARDIO AND SPORTS HEALTH.BRISTOL HOSPITAL COMMUNITY RELATIONS/BENEFIT ACTIVITIES: THE PARENT AND CHILD CENTER AT BRISTOL HOSPITAL: THE CENTER'S PRIMARY FOCUS IS ON PREVENTION OF CHILD ABUSE, NEGLECT AND FAMILY VIOLENCE BY PROVIDING SUPPORT SYSTEMS FOR FAMILIES INCLUDING: STRESS/ANGER MANAGEMENT, FAMILY FINANCES, CHILD DEVELOPMENT, COMMUNICATION SKILLS, EFFECTIVE DISCIPLINE, AND PLANNING/DECISION-MAKING SKILLS.BRISTOL HOSPITAL COMMUNITY CARE TEAM: THE OBJECTIVE OF THE BRISTOL HOSPITAL COMMUNITY CARE TEAM IS TO PROVIDE PATIENT-CENTERED CARE AND TO IMPROVE HEALTH OUTCOMES BY DEVELOPING AND IMPLEMENTING A SAFETY NET OF ALTERNATIVE SERVICES THROUGH MULTI-AGENCY INTERVENTION AND CARE PLANNING. THE TARGET POPULATION IS HIGH-RISK PATIENTS EXPERIENCING ACUTE AND CHRONIC MENTAL HEALTH ISSUES, SUBSTANCE ABUSE AND HIGH EMERGENCY DEPARTMENT UTILIZATION.NURSES IN THE COMMUNITY: THE BRISTOL HOSPITAL NURSE EXECUTIVE COUNCIL INITIATED NURSES IN THE COMMUNITY TO DISPLAY PROFESSIONALISM AND PROVIDE SERVICE TO THE COMMUNITY. THE PROGRAM INCLUDES COLLECTED FOOD GOODS AND CLOTHING FROM NUMEROUS DRIVES CONDUCTED AT THE HOSPITAL. THE NURSES ALSO TRAVEL TO THE SHELTER TO TAKE BLOOD PRESSURES AND ACCESS WOUNDS.HEALTH FAIRS: BRISTOL HOSPITAL PARTICIPATES IN NUMEROUS HEALTH FAIRS THROUGHOUT THE YEAR.ADOPT A FAMILY FOR THE HOLIDAYS: THE EMPLOYEES WITH AN OPPORTUNITY TO ADOPT A LOCAL FAMILY AND PURCHASE HOLIDAY GIFTS FOR THEM INCLUDING CLOTHES, BASIC NECESSITIES, TOYS, ETC. IN 2013, 87 CHILDREN WERE SERVED WHICH EQUATES TO 54 FAMILIES. WEST END EVENT: THE EVENT ATTRACTED AN ESTIMATED 10,000-PLUS PEOPLE. THE TEAM FROM THE BRISTOL HOSPITAL OBSTETRICS/GYNECOLOGY TEAM HANDED OUT EDUCATIONAL MATERIALS AND CONDUCTED FREE BLOOD PRESSURE CHECKS. TEXTING AND DRIVING EVENT: BRISTOL HOSPITAL'S LEARNING CENTER PRESENTED ITS ANNUAL COMBINATION MEDICAL CAREER FAIR AND DISTRACTING DRIVING AWARENESS EVENT ENTITLED "CONSEQUENCES OF DISTRACTED DRIVING." THE TWO-PART EVENT INCLUDES A CAREER FAIR FOR STUDENTS WHO MAY BE INTERESTED IN PURSUING A CAREER IN HEALTH CARE. TEDDY BEAR CLINIC: STAFF FROM BRISTOL HOSPITAL'S EMERGENCY CENTER TOOK PART IN A TEDDY BEAR CLINIC. THE TEAM EXAMINED DOZENS OF TEDDY BEARS AND STUFFED ANIMALS AND EXPLAINED TO THEM WHAT HAPPENS DURING A VISIT TO A HOSPITAL EMERGENCY DEPARTMENT. BOYS AND GIRLS CLUB BIKE HELMET EVENT: TEAM MEMBERS FROM BRISTOL HOSPITAL'S EMERGENCY CENTER AND ITS PHYSICIANS GROUP, MEP HEALTH, STAFFED A BICYCLE SAFETY EVENT AT THE BRISTOL BOYS AND GIRLS CLUB AND FAMILY CENTER'S FAMILY FUN NIGHT. DOZENS OF DONATED BIKE HELMETS WERE PROPERLY FITTED FOR THE CHILDREN WHO ATTENDED THE EVENT. MEDICAL STAFF, THANKSGIVING FOOD DONATION: MORE THAN 100 MEMBERS OF THE BRISTOL HOSPITAL MEDICAL STAFF DONATED MORE THAN $9,700 TO HELP FAMILIES IN THROUGH BRISTOL HOSPITAL'S WOMEN'S, INFANTS AND CHILDREN'S PROGRAM. BECAUSE OF THE GENEROSITY, APPROXIMATELY 180 FAMILIES ENJOYED A HOLIDAY MEAL ON THANKSGIVING.EMERGENCY MEDICAL SERVICES DONATION: THE BRISTOL HOSPITAL EMS TEAM REGULARLY DONATES THEIR TIME AND AMBULANCES TO COMMUNITY EVENTS, FREE OF CHARGE. SOME OF THESE EVENTS INCLUDE HEALTH FAIRS, HIGH SCHOOL SPORTING EVENTS, FOOD DRIVES AND COMMUNITY EVENTS.NURSING STUDENTS: BRISTOL HOSPITAL OVERSEES NURSING STUDENTS AS PART OF THEIR FIELD TRAINING. OUR NURSES AND PA-CS ACT AS THEIR SUPERVISORS, PROVIDING EDUCATION, HANDS ON LEARNING AND AN OPEN FORUM FOR QUESTIONS. JOB SHADOWING: BRISTOL HOSPITAL PROVIDES JOB SHADOWING EXPERIENCES TO LOCAL HIGH SCHOOL STUDENTS. STUDENTS TYPICALLY SHADOW THE NURSING DEPARTMENT, PHYSICIAN ASSISTANTS OR PHYSICAL THERAPISTS. CLINICAL & NON-CLINICAL JOB FAIR: OUR EDUCATION DEPARTMENT HOSTS A CLINICAL AND NON-CLINICAL JOB FAIR DAY FOR HIGH SCHOOL STUDENTS TO COME INTO THE HOSPITAL AND VISIT DIFFERENT DEPARTMENTS TO LEARN MORE ABOUT HOW THE DEPARTMENTS RUN. IT PROVIDES AN OPPORTUNITY FOR STUDENTS TO LEARN ABOUT CLINICAL AND NON-CLINICAL CAREERS IN HEALTHCARE. TYPICALLY 50 STUDENTS ATTEND AND 15-20 DEPARTMENTS ARE REPRESENTED. BRISTOL COMMUNITY ORGANIZATION: BRISTOL HOSPITAL PARTICIPATES WITH THE BRISTOL COMMUNITY ORGANIZATION'S EMPLOYMENT OPPORTUNITIES FOR AT RISK YOUNG ADULTS. THE HOSPITAL EMPLOYS THE PARTICIPANTS FOR 30 HOURS PER WEEK, SIX TO EIGHT WEEKS A YEAR.EMS FOOD DRIVE: HOSPITAL EMPLOYEES PARTNERED WITH SPRINT TO COLLECT FOOD AND TOYS FOR LOCAL COMMUNITY ORGANIZATIONS. FOOD WAS DONATED TO ST. VINCENT DE PAUL'S IN BRISTOL AND TOYS WERE DONATED TO TOYS FOR TOTS. EXECUTIVE LEADERSHIP BOARD & COMMITTEE AFFILIATIONS: KURT A. BARWIS, FACHE, PRESIDENT AND CEO: DIRECTOR, QUALIDIGM - THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR THE STATE OF CONNECTICUT; DIRECTOR AND CO-CHAIR OF THE GOVERNMENTAL AFFAIRS COMMITTEE, BRISTOL CHAMBER OF COMMERCE; JEANINE F. RECKDENWALD, SPHR, VICE PRESIDENT, HUMAN RESOURCES AND SUPPORT SERVICES: BOARD, BRISTOL EDUCATION FOUNDATION 116716054 1 1 0 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 97 0 1 1389 1 1 1 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X GEORGE EIGHMY 8605853000 BREWSTER ROAD BRISTOL CT 06011 KENNETH BENOIT MD DIRECTOR 2.00 2.00 X 0 0 0 MARK BLUM SECRETARY/TREASURER 8.00 2.00 X X 0 0 0 BALA SHANMUGAM MD DIRECTOR 40.00 40.00 X 0 307603 0 JOHN J LEONE JR VICE CHAIRMAN 10.00 2.00 X X 0 0 0 GLENN HEISER DIRECTOR 2.00 2.00 X 0 0 0 KURT BARWIS PRESIDENT & CEO 60.00 2.00 X X 632799 0 185344 JOHN LODOVICO JR DIRECTOR 2.00 2.00 X 0 0 0 MARIE O'BRIEN CHAIRMAN 10.00 2.00 X X 0 0 0 DOUGLAS DEVNEW DIRECTOR 2.00 2.00 X 0 0 0 KAREN GUADAGNINI MD DIRECTOR 40.00 40.00 X 116509 94778 0 MARY ANN CORDEAU PHD RN DIRECTOR 2.00 2.00 X 0 0 0 FAWAD KAZI MD DIRECTOR 2.00 2.00 X 0 0 0 THOMAS MONAHAN DIRECTOR 2.00 2.00 X 0 0 0 ELLEN SOLEK DIRECTOR 2.00 2.00 X 0 0 0 VALERIE VITALE MD DIRECTOR 2.00 2.00 X 0 0 0 SHARON ADLER DIRECTOR 2.00 2.00 X 0 0 0 GEORGE EIGHMY VICE PRESIDENT OF FINANCE/ 40.00 X 299022 0 19003 LEONARD BANCO MD CHIEF MEDICAL OFFICER 40.00 X 347072 0 20056 JEANINE RECKDENWALD VP, HUMAN RESOURCES AND SU 40.00 X 228570 0 21206 DAVE RACKLIFFE AVP INFORMATION TECHNOLOGY 40.00 X 176108 0 22064 SHEILA KEMPF PHD SENIOR VP/PATIENT CARE SER 40.00 X 285747 0 23500 EVA WICKWIRE AVP CHIEF DEVELOPMENT OFFI 40.00 2.00 X 169363 0 7211 PAUL SMITH DIRECTOR OF FACILITIES AND 40.00 X 154800 0 0 RUSSELL TUVERSON MD OCCUPATIONAL HEALTH PHYSIC 40.00 X 166790 0 3322 MARIA SIMMONE DIRECTOR OF REVENUE CYCLE 40.00 X 140093 0 10070 MARIE RIZZO DIRECTOR OF INPATIENT SERVICES 40.00 X 147000 0 0 DIANE BOUFFARD DIRECTOR OF QUALITY IMPROVEMENT 40.00 X 135655 0 701 2999528 402381 312477 48 0 1 0 MEP OF BRISTOL LLC PO BOX 742528 DALLAS TX 75374 MEDICAL SERVICES 1212894 MAYO COLLABORATIVE SERVICES INC 200 SW 1ST STREET ROCHESTER MN 55905 LAB SERVICES 1009037 IPC THE HOSPITALIST COMPANY INC PO BOX 844929 LOS ANGELES CA 90084 MEDICAL SERVICES 603162 TOTAL LAUNDRY COLLABORATIVE LLC 114 WOODLAND STREET HARTFORD CT 06105 LAUNDRY SERVICES 390335 NORRIS MCLAUGHLIN & MARCUS PA 515 WEST HAMILTON STREET ALLENTOWN PA 18101 LEGAL SERVICES 347875 28 1386045 17968 1386045 PATIENT SERVICE REVENUE 622110 137976406 137544914 431492 MISC. PROGRAM AND HEALTHCARE REVE 621990 1169250 1169250 OCCUPATIONAL HEALTH REVENUE 621990 980213 980213 140125869 364945 364945 385527 0 385527 385527 385527 406370 0 406370 406370 406370 JOINT VENTURES 900099 462385 477466 -15081 CAFETERIA 722210 428487 428487 890872 143559628 140171843 416411 1585329 3307131 3307131 54485029 44082440 10402589 2827972 2262378 565594 8763782 7011026 1752756 4190454 3352363 838091 552463 64963 487500 129000 129000 80471 80471 1842023 1829267 12756 13887716 13193330 694386 3151406 315141 2836265 3308985 2812637 496348 232569 171868 60701 1412468 1412468 6614415 6559821 54594 1762562 1410050 352512 MEDICAL SERVICES FEES A 18711596 18521571 190025 DRUGS 8878275 8872893 5382 REPAIR & MAINTENENCE 1723136 1723136 COLLECTION FEES 1241634 1241634 4125862 1879068 2246794 141228949 116716054 24512895 0 12810191 13617245 96526 96550 16887452 17715144 1445186 1413639 2321980 2215479 157393979 118322799 38760281 39071180 13766654 13501147 14260744 12924878 7150033 7430091 6433707 6352376 113932754 114337729 29340577 28975389 765934 524473 23842748 23404411 290136 281909 2828131 2575101 30392957 30149491 87460483 85910774 X 15896282 17633376 3555410 3708091 7020579 7085488 26472271 28426955 113932754 114337729 X 2330679 -664325 288331 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 2478 0 1 77993 80471 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE CONNECTICUT HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. $23,993 REPRESENTS THE PORTION OF THE DUES PAID TO THESE ASSOCIATIONS WHICH WERE USED FOR LOBBYING PURPOSES. THE HOSPITAL ENGAGED CAMILLIERE, CLOUD & KENNEDY, A CONNECTICUT LOBBYING AND BUSINESS DEVELOPMENT FIRM, FOR CONSULTING SERVICES IN THE AMOUNT OF $54,000. 17542462 262137 175259 17629340 18397107 2199827 3054472 17542462 13347087 2000000 4675975 1625979 18397083 13491685 40613 185211 13347087 12626745 1587194 722254 13491685 0.38780 0.40190 0.21030 0 0 1595276 1595276 63875563 42608073 21267490 1006331 803980 202351 86560455 72724866 13835589 4356354 2185880 2170474 39071180 FUNDS HELD FOR MALPRACTICE SELF-INSURANCE 5597992 F ASSETS HELD IN TRUST BY OTHERS 3285532 F FUNDS HELD UNDER BOND INDENTURE 2506471 F DONOR RESTRICTED INVESTMENTS 1140058 F DEBT SERVICE FUND 394825 C 12924878 INVESTMENTS IN JOINT VENTURES 764613 C INTEREST IN NET ASSETS OF FOUNDATION 6665478 F 7430091 OTHER RECEIVABLES 2785093 DUE FROM AFFILIATES 2986089 ESTIMATED SETTLEMENTS WITH THIRD-PARTY PAYERS 581194 6352376 ACCRUED POSTRETIREMENT BENEFIT LIABILITY 170972 LINE OF CREDIT 2900000 ASSET RETIREMENT OBLIGATIONS 604800 ACCRUED PENSION LIABILITY 23468844 OTHER LIABILITIES 3004875 30149491 X 143541659 0 143541659 17968 17968 143559627 141228949 0 141228949 0 141228949 PART V, LINE 4: 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, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FASB 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 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 SEPTEMBER 30, 2013 AND 2012. IT IS THE HOSPITAL'S POLICY TO RECORD PENALTIES AND INTEREST ASSOCIATED WITH UNCERTAIN TAX PROVISIONS AS A COMPONENT OF OPERATING EXPENSES. AS OF SEPTEMBER 30, 2013 AND 2012, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE HOSPITAL'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 4B - OTHER ADJUSTMENTS: NONCASH VACCINE CONTRIBUTIONS 17,968. 1 1 1 X 250.000000000000 1 X 800.000000000000 1 1 1 0 0 5196795 2889355 2307440 0.01630 28038541 19708135 8330406 0.05900 33235336 22597490 10637846 0.07530 1538116 1538116 0.01090 6150000 6150000 0.04350 7688116 7688116 0.05440 40923452 22597490 18325962 0.12970 1 4007799 1001950 51942733 64641370 -12698637 X 1 1 1 1 BRISTOL HOSPITAL INC BREWSTER ROAD BRISTOL CT 06010 41 X X X X BRISTOL HOSPITAL INC 1 1 X X X X X X X X 12 1 0 1 X WWW.BRISTOLHOSPITAL.ORG X X X X X X X X X 0 0 1 1 250.000000000000 1 800.000000000000 1 X X X X 1 1 X X X X X 1 X X X 1 X X X X X X X 1 X 0 0 BRISTOL HOSPITAL, INC. PART V, SECTION B, LINE 3: COMMUNITY ENGAGEMENT AND FEEDBACK WERE AN INTEGRAL PART OF THE CHNA PROCESS. BRISTOL HOSPITAL SOUGHT COMMUNITY INPUT THROUGH THE INCLUSION OF COMMUNITY LEADERS IN THE PRIORITIZATION AND IMPLEMENTATION PLANNING PROCESS. PUBLIC HEALTH AND HEALTH CARE PROFESSIONALS SHARED KNOWLEDGE AND EXPERTISE ABOUT HEALTH ISSUES, AND LEADERS AND REPRESENTATIVES OF NON-PROFIT AND COMMUNITY-BASED ORGANIZATIONS PROVIDED INSIGHT ON THE COMMUNITY, INCLUDING THE MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. FOR A COMPLETE LIST OF PARTICIPANTS, PLEASE SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT - FINAL SUMMARY REPORT, AVAILABLE ON THE BRISTOL HOSPITAL WEBSITE. BRISTOL HOSPITAL, INC. PART V, SECTION B, LINE 11: THERE IS AN APPROVED SLIDING SCALE FOR DISCOUNTS BASED ON INCOME LEVELS AND FAMILY SIZE. BRISTOL HOSPITAL, INC. PART V, SECTION B, LINE 12I: BRISTOL HOSPITAL RECOGNIZES THAT THE BURDEN OF HEALTH CARE COSTS ON INDIVIDUALS IS A NATIONAL CRISIS. DECADES OF HOSPITAL PRICING, DISTORTED BY THE UNIQUE BILLING REQUIREMENTS IMPOSED BY PRIVATE AND GOVERNMENTAL PAYERS AND REGULATIONS, HAS RESULTED IN A CHARGE STRUCTURE WHICH UNFAIRLY BURDENS THE INDIVIDUALS AND FAMILIES WITHOUT OR WITH LIMITED INSURANCE. BRISTOL HOSPITAL WISHES TO CORRECT THIS UNFAIRNESS BY ENSURING THAT ALL UNINSURED PATIENTS' CHARGES ARE LIMITED AND CAPPED AT MEDICARE PAYMENT LEVELS. THIS DISCOUNTED LEVEL IS DEFINED AS THE RATIO OF MEDICARE CHARGE TO PAYMENTS AND IS LISTED ON THE MOST RECENT OHCA FILING. THE MOST CURRENT DISCOUNT IS 71%. WHEN A PATIENT HAS NO INSURANCE, THEIR BILL WILL BE IMMEDIATELY REDUCED BY THAT PERCENTAGE DISCOUNT, USING THE CHARITY CARE UNINSURED ALLOWANCE CODE. PATIENTS WHO HAVE BALANCES DUE AFTER INSURANCE AND REQUIRE FINANCIAL ASSISTANCE IN PAYING THOSE BILLS, WILL BE ENTITLED TO A CHARITY CARE PATIENT ASSISTANCE DISCOUNT BASED ON THEIR INCOME AND FAMILY SIZE, USING THE APPROVED SLIDING FINANCIAL ASSISTANCE SCALE. THE STATE OF CONNECTICUT HAS SET RECOMMENDED LEVELS OF CHARITY CARE DISCOUNTS WHICH STIPULATES THAT FOR FAMILIES AT OR BELOW 200% OF FEDERAL POVERTY LEVELS SHOULD BE DISCOUNTED TO COST, AND THAT FOR FAMILIES BETWEEN 200 AND 400% SHOULD BE DISCOUNTED TO THE COMMERCIAL AND/OR MEDICARE RATE. THE BRISTOL HOSPITAL SLIDING SCALE HAS GREATER DISCOUNTS APPLIED AT LOWER LEVELS OF THE FEDERAL POVERTY INCOME LEVELS. 12 BRISTOL BEHAVIORAL HEALTH SERVICES 10 N MAIN STREET SUITE 210 BRISTOL CT 06010 BEHAVIORAL HEALTH BRISTOL HOSPITAL CENTER FOR DIABETES 102 NORTH STREET BRISTOL CT 06010 DIABETES MEDICAL CARE AND EDUCATION BRISTOL HOSPITAL COUNSELING CENTER 440-C NORTH MAIN STREET BRISTOL CT 06010 THERAPY AND COUNSELING BRISTOL HOSPITAL WELLNESS CENTER 842 CLARK AVENUE BRISTOL CT 06010 MEDICAL AND FITNESS SERVICES BRISTOL RADIOLOGY CENTER 25 COLLINS ROAD BRISTOL CT 06010 MAMMOGRAPHY AND MRI MED HELP 539 FARMINGTON AVENUE BRISTOL CT 06010 URGENT CARE MEDWORKS LLC 375 CEDAR STREET NEWINGTON CT 06111 OCCUPATIONAL HEALTH SERVICES PARENT & CHILD CENTER - BRISTOL HOSPITA 9 PROSPECT STREET BRISTOL CT 06010 CHILDREN AND FAMILY SERVICES REHAB DYNAMICS 975 FARMINGTON AVENUE BRISTOL CT 06010 PHYSICAL THERAPY AND SPORTS MEDICINE BRISTOL HOSPITAL LABORATORY 641 FARMINGTON AVENUE BRISTOL CT 06010 LABORATORY SERVICES BRISTOL HOSPITAL LABORATORY 27 MAIN STREET TERRYVILLE CT 06786 LABORATORY SERVICES BRISTOL HOSPITAL WIC PROGRAM 450 MAIN STREET NEW BRITAIN CT 06051 NUTRITION FOR WOMEN AND CHILDREN PART I, LINE 3C: THERE IS AN APPROVED SLIDING SCALE FOR DISCOUNTS BASED ON INCOME LEVELS AND FAMILY SIZE. PART III, LINE 4: USE OF ESTIMATES - THE PREPARATION OF FINANCIAL STATEMENTS IN CONFORMITY WITH GAAP REQUIRES MANAGEMENT TO MAKE ESTIMATES AND ASSUMPTIONS THAT IMPACT THE REPORTED AMOUNTS OF ASSETS AND LIABILITIES AND DISCLOSURE OF CONTINGENT ASSETS AND LIABILITIES AT THE DATE OF THE FINANCIAL STATEMENTS. ESTIMATES ALSO IMPACT THE REPORTED AMOUNTS OF REVENUES AND EXPENSES DURING THE REPORTING PERIOD. ACTUAL RESULTS COULD DIFFER FROM THOSE ESTIMATES. THE HOSPITAL'S SIGNIFICANT ESTIMATES RELATE TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ALLOWANCES ON PATIENT ACCOUNTS RECEIVABLE, VALUATION OF INVESTMENTS, ESTIMATED SETTLEMENTS DUE TO THIRD-PARTY PAYERS, RESERVES FOR SELF-INSURANCE LIABILITIES AND THE PENSION AND OTHER POSTRETIREMENT EMPLOYEE BENEFIT PLAN LIABILITY ASSUMPTIONS. PART 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. 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. PART VI, LINE 2: HOSPITAL'S ASSESSMENT OF THE HEALTH CARE NEEDS OF THE COMMUNITY IS A DYNAMIC PROCESS THAT INVOLVES ALL LEVELS OF HOSPITAL ADMINISTRATION, STAFF, THE BOARD OF DIRECTORS, AND MEDICAL STAFF. VARIOUS COMMITTEES AND GROUPS AT THE HOSPITAL MEET PERIODICALLY TO DISCUSS THE NEEDS OF THE COMMUNITY, AS WELL AS THE RESOURCES AND SERVICES AVAILABLE AT THE HOSPITAL AND OTHER AGENCIES IN THE AREA. THE HOSPITAL IS REPRESENTED AT VARIOUS COMMUNITY ORGANIZATIONS AND GROUPS INVOLVED WITH ASSESSMENT OF COMMUNITY NEEDS. HOSPITAL RESOURCES ARE FREQUENTLY CALLED UPON TO PARTICIPATE IN PROGRAMS AND PROJECTS TO ADDRESS THOSE NEEDS. PART 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) TO ENSURE THAT ALL ASPECTS OF ASSISTANCE ARE PROVIDED FOR EACH PATIENT. THE FINANCIAL ASSISTANCE DEPARTMENT ALSO DISCUSSES GOVERNMENT BENEFITS 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 UNINSURED INCLUDING FREE BLOOD PRESSURE CLINCS, SKIN CANCER SCREENING CLINICS AND SMINARS TO PROVIDE PATIENTS ACCESS TO AS MUCH FREE HEALTH INFORMATION AS POSSIBLE. PART 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 IMPATIENT 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. 62,000. 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 U.S.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 THE FOLLOWING DATA POINTS WERE PROVIDED: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%BURLINGTON: MEDIAN HOUSEHOLD INCOME: $116,419 FAMILIES BELOW POVERTY LEVEL- 1.2% INDIVIDUALS BELOW POVERTY LEVEL- 1.9% RACE: WHITE- 98%, BLACK OR AFRICAN AMERICAN- 0.2%,AMERICAN INDIAN OR ALASKA NATIVE- 0.1%, ASIAN- 1.2%PLAINVILLE: MEDIAN HOUSEHOLD INCOME: $62,440 FAMILIES BELOW POVERTY LEVEL- 4.1% INDIVIDUALS BELOW POVERTY LEVEL- 5.0% RACE: WHITE- 93.1%, BLACK OR AFRICAN AMERICAN- 2.5%, AMERICAN INDIAN OR ALASKA NATIVE- 0.3%, ASIAN- 1.3%, OTHER RACE- 0.6% PLYMOUTH: MEDIAN HOUSEHOLD INCOME: $70,132 FAMILIES BELOW POVERTY LEVEL- 2.9% INDIVIDUALS BELOW POVERTY LEVEL- 5.6% RACE: WHITE- 96.7%, BLACK OR AFRICAN AMERICAN- 0.5%, AMERICAN INDIAN OR ALASKA NATIVE- 0.3%, ASIAN- 0.6%, OTHER RACE- 0.7% 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. PART 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.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. PART VI, LINE 7, REPORTS FILED WITH STATES CT X X 1 0 X X X X X 0 1 0 0 0 1 1 0 1 1 BALA SHANMUGAM MD DIRECTOR 0 304603 0 3000 0 0 0 0 0 0 0 307603 0 0 KURT BARWIS PRESIDENT & CEO 474407 0 150000 0 8392 0 166725 0 18619 0 818143 0 0 0 KAREN GUADAGNINI MD DIRECTOR 116509 89490 0 5288 0 0 0 0 0 0 116509 94778 0 0 GEORGE EIGHMY VICE PRESIDENT OF FINANCE/ 255066 0 43956 0 0 0 503 0 18500 0 318025 0 0 0 LEONARD BANCO MD CHIEF MEDICAL OFFICER 293370 0 53702 0 0 0 5100 0 14956 0 367128 0 0 0 JEANINE RECKDENWALD VP, HUMAN RESOURCES AND SU 195725 0 32845 0 0 0 2706 0 18500 0 249776 0 0 0 DAVE RACKLIFFE AVP INFORMATION TECHNOLOGY 158096 0 18012 0 0 0 3217 0 18847 0 198172 0 0 0 SHEILA KEMPF PHD SENIOR VP/PATIENT CARE SER 244399 0 41348 0 0 0 5000 0 18500 0 309247 0 0 0 EVA WICKWIRE AVP CHIEF DEVELOPMENT OFFI 144471 0 24892 0 0 0 0 0 7211 0 176574 0 0 0 PAUL SMITH DIRECTOR OF FACILITIES AND 143100 0 0 0 11700 0 0 0 0 0 154800 0 0 0 RUSSELL TUVERSON MD OCCUPATIONAL HEALTH PHYSIC 166790 0 0 0 0 0 3322 0 0 0 170112 0 0 0 MARIA SIMMONE DIRECTOR OF REVENUE CYCLE 133343 0 6750 0 0 0 2700 0 7370 0 150163 0 0 0 PART I, LINE 1A THE HOSPITAL PAID $6,615 IN GOLF CLUB MEMBERSHIP FEES FOR THE HOSPITAL'S PRESIDENT, AS THE CLUB DID NOT HAVE A CORPORATE MEMBERSHIP CATEGORY. THE HOSPITAL PAID $11,700 HOUSING ALLOWANCE FOR PAUL SMITH, DIRECTOR OF FACILITIES AND ENGINEERING. PART I, LINE 4B KURT BARWIS, PRESIDENT, PARTICIPATES IN THE HOSPITAL'S 457(F) DEFINED CONTRIBUTION PLAN. PART I, LINE 5 THE COMPENSATION OF THE HOSPITAL'S PRESIDENT, CFO, AND KEY EMPLOYEES IS BASED IN PART ON THE NET EARNINGS OF THE HOSPITAL. PART I, LINE 6 THE COMPENSATION OF THE HOSPITAL'S PRESIDENT, CFO, AND KEY EMPLOYEES IS BASED IN PART ON THE NET EARNINGS OF THE HOSPITAL. PART I, LINE 8 AMOUNTS WERE PAID TO KURT BARWIS PURSUANT TO A CONTRACT THAT WAS SUBJECT TO THE INITIAL CONTRACT EXCEPTION DESCRIBED IN REGS. SECTION 53.4958-4(A)(3). THE ORGANIZATION FOLLOWED THE REBUTTABLE PRESUMPTION PROCEDURE DESCRIBED IN REGS. SECTION 53.4958-6(C). MORRIS LAVIERO FORMER DIRECTOR PURCHASE BUILDING X 350000 281909 0 1 1 281909 FORM 990, PART VI, SECTION B, LINE 11 A COMPLETED 990 IS PROVIDED TO EACH BOARD MEMBER BEFORE IT 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. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, 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 15 THE EXECUTIVE COMPENSATION COMMITTEE IS AUTHORIZED UNDER THE BRISTOL HOSPITAL AND HEALTH CARE GROUP BYLAWS AND IS RESPONSIBLE FOR (1) DETERMINING THE OVERALL TOTAL COMPENSATION STRATEGY FOR ALL CORPORATE OFFICERS, (2) APPROVING ALL COMPENSATION AND BENEFITS DECISIONS FOR CORPORATE OFFICERS, AND (3) REPORTING SUCH ACTIONS TO THE FULL BRISTOL HOSPITAL AND HEALTH CARE GROUP BOARD ON AN ANNUAL BASIS. IN ADDITION, THE EXECUTIVE COMPENSATION COMMITTEE EXPRESSLY DETERMINES THE REASONABLENESS OF TOTAL COMPENSATION AND BENEFITS FOR ALL CORPORATE OFFICERS AND ASSURES THAT ALL OFFICER COMPENSATION DECISIONS ARE MADE AFTER THOROUGH CONSIDERATION OF AND COMPARISON TO THE MARKET PRACTICES OF OTHER SIMILARLY SITUATED NOT-FOR-PROFIT HEALTHCARE EXECUTIVES IN COMPARABLE ORGANIZATIONS. THE EXECUTIVE COMPENSATION COMMITTEE CONSISTS OF BOARD MEMBERS WHO DO NOT HAVE MATERIAL FINANCIAL INTERESTS THAT COULD BE AFFECTED BY THE OFFICER COMPENSATION DECISIONS MADE BY THE COMMITTEE. THE COMPARABILITY DATA USED TO ASSIST THE EXECUTIVE COMPENSATION COMMITTEE IN ITS COMPENSATION DELIBERATIONS ARE COMPILED BY AN INDEPENDENT, NATIONAL COMPENSATION CONSULTING FIRM THAT IS RETAINED BY AND REPORTS DIRECTLY TO THE EXECUTIVE COMPENSATION COMMITTEE. THE DATA COLLECTED BY THE CONSULTANT CONSISTS OF MARKET INFORMATION FOR EXECUTIVES IN FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS. THE DELIBERATIONS AND DECISIONS OF THE EXECUTIVE COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED, REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE AND PROVIDED TO THE BOARD ON AN ANNUAL BASIS. THE LAST COMPENSATION REVIEW FOR THE CEO, OTHER OFFICERS AND KEY EMPLOYEES OCCURRED IN DECEMBER 11,2013. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: INCREASE IN PERMANENTLY RESTRICTED NET ASSETS 64,909. TRANSFER TO BRISTOL HOSPITAL MULTISPECIALTY GROUP 470,637. PENSION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS -6,242,251. CHANGES IN POSTRETIREMENT HEALTH & WELFARE BENEFITS 5,307,399. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 660,794. NONCASH VACCINE CONTRIBUTIONS -17,968. OTHER TRANSFERS 21,206. CONTRIBUTIONS 23,605. 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. 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