2015-08-13T06:40:27-05:00 2014-09-30 111986323 MARCUM LLP CITY PLACE II 185 ASYLUM STREET HARTFORD CT 06103 990 2013-10-01 061450168 SAINT FRANCIS MEDICAL GROUP INC SAIN 8607149632 114 WOODLAND STREET HARTFORD CT 06105 DAVID BITTNER SENIOR VICE PRESIDENT & CFO 8607144603 2015-08-10 1 DOUGLAS FARRINGTON P00370668 8607600600 2013 2016-02-25 16:41:14Z DAVID BITTNER 114 WOODLAND STREET HARTFORD CT 06105 80109023 0 X WWW.STFRANCISCARE.ORG X 1995 CT MEDICAL AND EDUCATIONAL PROGRAMS 15 1 455 0 0 0 0 0 69085815 75699162 0 0 3528975 4409861 72614790 80109023 0 0 0 0 67256389 80498307 0 0 0 15319778 19511895 82576167 100010202 -9961377 -19901179 9411939 11496643 9211288 21197171 200651 -9700528 TO ENGAGE IN THE TEACHING AND EDUCATION OF MEDICAL STUDENTS, RESIDENTS AND FELLOWS, TO PERFORM MEDICAL AND RELATED RESEARCH ACTIVITIES, AND TO RENDER PROFESSIONAL MEDICAL SERVICES TO PERSONS IN NEED OF SUCH SERVICES. 0 0 92910781 80048260 EMPLOYS PHYSICIANS AND PHYSICIAN ASSISTANTS WHO PROVIDE MEDICAL SERVICES IN THE GREATER HARTFORD CONNECTICUT COMMUNITY AND CONDUCTS TEACHING AND EDUCATION PROGRAMS FOR MEDICAL STUDENTS AND RESIDENTS IN SUPPORT OF THE SAINT FRANCIS CARE HEALTH SYSTEM. 92910781 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 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 1 0 0 0 1 54 0 1 455 1 0 0 0 0 0 0 0 0 0 0 X 15 1 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X X DONNA GILBERT 8607149632 114 WOODLAND ST MS 5-103-58 HARTFORD CT 06105 ROLF KNOLL MD CHAIRMAN 55.00 2.00 X X 162942 0 4124 JOHN RODIS MD VICE PRESIDENT 55.00 2.00 X X 773627 0 34542 JOHN N GIAMALIS TREASURER 2.00 61.00 X X 0 693200 23634 DANIEL DIVER MD SECRETARY 55.00 2.00 X X 638062 0 41897 BERNARD CLARK III MD PRESIDENT 55.00 3.00 X X 368676 0 43784 ROBERT J KRUG MD DIRECTOR 55.00 3.00 X 376021 0 38613 PAUL F MITCHELL DMD DIRECTOR 55.00 2.00 X 263173 0 43232 JONATHON SPORN MD DIRECTOR 55.00 2.00 X 442463 0 23025 THOMAS TERENZI DOEDD DIRECTOR 55.00 2.00 X 226280 0 20848 JOSE ARIAS-CAMISON MD DIRECTOR 55.00 0.00 X 307971 0 32430 WALTER TRYMBULAK MD DIRECTOR 55.00 2.00 X 217159 0 25996 DAVID BITTNER TREASURER 2.00 63.00 X X 0 345714 16058 ROBERT ELLIS DIRECTOR 2.00 4.00 X 0 0 0 SCOTT ELLNER DO DIRECTOR 55.00 2.00 X 426370 0 27919 THEODORE HARTENSTEIN MD DIRECTOR 55.00 1.00 X 333215 0 14611 SURENDRA KHERAMD DIRECTOR 55.00 2.00 X 451352 0 31159 STEVEN RUBY MD DIRECTOR 1.00 58.00 X 0 690480 18179 JENNIFER SCHNEIDER DIRECTOR 2.00 59.00 X 0 221960 33853 ADAM SILVERMAN MD DIRECTOR 55.00 3.00 X 329305 0 27369 KARIANNE SILVERMAN MD DIRECTOR 55.00 1.00 X 211486 0 7686 STEVEN WOLF MD DIRECTOR 1.00 55.00 X 0 441504 30713 RAUL MENDELOVICI SECTION CHIEF 55.00 0.00 X 595278 0 35836 DAVID SPIRO MD STAFF PHYSICIAN 55.00 0.00 X 645398 0 28573 IOANNIS RAFTOPOULOS MD MEDICAL DIRECTOR 55.00 0.00 X 590171 0 26785 ERIC A SILVERSTEIN STAFF PHYSICIAN 55.00 0.00 X 777908 0 14634 WILLIAM T MARSHALL DO DIRECTOR OF TRAUMA 55.00 0.00 X 760015 0 27133 KATHLEEN M ROCHE MSRN FORMER DIRECTOR 0.00 0.00 X 0 640052 10215 8896872 3032910 682848 203 1 1 0 DHP MANAGEMENT SERVICES INC PO BOX 634850 CINCINNATI OH 45263 PHYSICIAN SERVICES 1885234 MED3000 PO BOX 1236 BUTLER PA 16003 BILLING AND REVENUE MANAGEMENT 1482286 COMPHEALTH PO BOX 972651 DALLAS TX 75397 PHYSICIAN SERVICES 587623 VISTA STAFFING SOLUTIONS FILE 50834 LOS ANGELES CA 90074 PHYSICIAN SERVICES 441125 J MORRISSEY & CO 289 BROAD STREET WINDSOR CT 06095 TEMPORARY EMPLOYMENT SERVICES 387568 10 PATIENT SERVICE REVENUE 621110 40763510 40763510 PHYSICIAN LEASE REVENUE 900099 21070610 21070610 TEACHING REVENUE 900099 5982386 5982386 ADMINISTRATION REVENUE 900099 4098395 4098395 CONTRACT REVENUE 900099 3233244 3233244 551017 551017 75699162 59516 0 59516 59516 59516 WPA SUBSIDY 900099 4074996 4074996 MEANINGFUL USE 900099 254332 254332 OTHER REVENUE 900099 21017 21017 4350345 80109023 80049507 0 59516 5907019 5611668 295351 62291472 60070909 2220563 1891339 1824007 67332 7058678 6195017 863661 3349799 3230546 119253 41789 14246 27543 56888 56888 7794442 6575230 1219212 5191 5191 1385228 572926 812302 10940 558 10382 1998645 1702651 295994 592532 581433 11099 89 89 226355 157868 68487 BAD DEBT EXPENSE 2324573 2324573 LICENSES & FEES 1354567 1297679 56888 MEDICAL SUPPLIES 1202116 1202055 61 RECRUITMENT EXPENSES 339611 9497 330114 2178929 1534727 644202 100010202 92910781 7099421 0 717039 2757934 6455906 6847441 0 42823 1618036 512111 753072 1105925 1485922 742520 9411939 11496643 9211288 11583409 0 9613762 9211288 21197171 X 200651 -9700528 200651 -9700528 9411939 11496643 X -19901179 10000000 X X 0 1 X 1 0 X 186193 62916 123277 1431843 449195 982648 1105925 DEFERRED COMP TRUST 742520 742520 DUE TO/FROM AFFILIATES 9613762 9613762 1 0 0 0 0 0 0 0 0 ROLF KNOLL MD CHAIRMAN 162942 0 0 0 0 0 0 0 4124 0 167066 0 0 0 JOHN RODIS MD VICE PRESIDENT 698627 0 75000 0 0 0 15000 0 19542 0 808169 0 0 0 JOHN N GIAMALIS TREASURER 0 564200 0 129000 0 0 0 0 0 23634 0 716834 0 0 DANIEL DIVER MD SECRETARY 638062 0 0 0 0 0 19291 0 22606 0 679959 0 0 0 BERNARD CLARK III MD PRESIDENT 358676 0 10000 0 0 0 23162 0 20622 0 412460 0 0 0 ROBERT J KRUG MD DIRECTOR 376021 0 0 0 0 0 18188 0 20425 0 414634 0 0 0 PAUL F MITCHELL DMD DIRECTOR 263173 0 0 0 0 0 24614 0 18618 0 306405 0 0 0 JONATHON SPORN MD DIRECTOR 442463 0 0 0 0 0 18585 0 4440 0 465488 0 0 0 THOMAS TERENZI DOEDD DIRECTOR 226280 0 0 0 0 0 14320 0 6528 0 247128 0 0 0 JOSE ARIAS-CAMISON MD DIRECTOR 307971 0 0 0 0 0 16978 0 15452 0 340401 0 0 0 WALTER TRYMBULAK MD DIRECTOR 217159 0 0 0 0 0 12423 0 13573 0 243155 0 0 0 DAVID BITTNER TREASURER 0 240714 0 105000 0 0 0 0 0 16058 0 361772 0 0 SCOTT ELLNER DO DIRECTOR 426370 0 0 0 0 0 13250 0 14669 0 454289 0 0 0 THEODORE HARTENSTEIN MD DIRECTOR 333215 0 0 0 0 0 11550 0 3061 0 347826 0 0 0 SURENDRA KHERAMD DIRECTOR 451352 0 0 0 0 0 13583 0 17576 0 482511 0 0 0 STEVEN RUBY MD DIRECTOR 0 636792 0 53688 0 0 0 5000 0 13179 0 708659 0 0 JENNIFER SCHNEIDER DIRECTOR 0 185960 0 36000 0 0 0 14368 0 19485 0 255813 0 0 ADAM SILVERMAN MD DIRECTOR 294305 0 35000 0 0 0 13496 0 13873 0 356674 0 0 0 KARIANNE SILVERMAN MD DIRECTOR 211486 0 0 0 0 0 6197 0 1489 0 219172 0 0 0 STEVEN WOLF MD DIRECTOR 0 441504 0 0 0 0 0 15935 0 14778 0 472217 0 0 RAUL MENDELOVICI SECTION CHIEF 595278 0 0 0 0 0 21728 0 14108 0 631114 0 0 0 DAVID SPIRO MD STAFF PHYSICIAN 645398 0 0 0 0 0 15000 0 13573 0 673971 0 0 0 IOANNIS RAFTOPOULOS MD MEDICAL DIRECTOR 590171 0 0 0 0 0 13250 0 13535 0 616956 0 0 0 ERIC A SILVERSTEIN STAFF PHYSICIAN 777908 0 0 0 0 0 12733 0 1901 0 792542 0 0 0 WILLIAM T MARSHALL DO DIRECTOR OF TRAUMA 760015 0 0 0 0 0 13500 0 13633 0 787148 0 0 0 KATHLEEN M ROCHE MSRN FORMER DIRECTOR 0 431719 0 0 0 208333 0 0 0 10215 0 650267 0 0 PART I, LINE 3 SAINT FRANCIS MEDICAL GROUP RELIED ON SAINT FRANCIS HOSPITAL TO ESTABLISH THE COMPENSATION OF ITS CEO USING THE FOLLOWING: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A KATHLEEN M. ROCHE RECEIVED A SEVERANCE BENEFIT OF $208,333. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION MADE A CHANGE RELATED TO BOARD OF DIRECTOR REQUIREMENTS. FORM 990, PART VI, SECTION B, LINE 11 THE SAINT FRANCIS HOSPITAL & MEDICAL CENTER AUDIT AND CORPORATE COMPLIANCE COMMITTEE HAS RESPONSIBILITY FOR REVIEWING THE FORM 990 AND REPORTS BACK TO THE FULL BOARD REGARDING THEIR REVIEW OF THE FORM 990. THE FORM 990 IS AVAILABLE ON THE BOARD'S INTERNAL SECURE WEB PORTAL. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY INCLUDES AN OBLIGATION OF EACH BOARD MEMBER TO ANNUALLY DISCLOSE ALL MATERIAL FACTS AND RELATIONSHIPS AND REFRAIN FROM VOTING ON ANY MATTER WHEN THERE IS A CONFLICT OF INTEREST. THE GOVERNANCE AND NOMINATIONS COMMITTEE REVIEWS THE RESULTS OF THESE SUBMISSIONS ANNUALLY FOR COMPLIANCE WITH GOVERNANCE POLICIES. FORM 990, PART VI, SECTION B, LINE 15 REFER TO PART III OF SCHEDULE J FOR PROCESS. FORM 990, PART VI, SECTION C, LINE 19 A LINK ON THE SAINT FRANCIS WEBSITE HAS BEEN ESTABLISHED FOR INDIVIDUALS TO REQUEST GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990 AND FINANCIAL STATEMENTS. FORM 990, PART XI, LINE 9: TRANSFER TO/FROM PARENT 10,000,000. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS HAS DELEGATED ITS OVERSIGHT RESPONSIBILITY OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS TO SAINT FRANCIS HOSPITAL AND MEDICAL CENTER AUDIT & CORPORATE COMPLIANCE COMMITTEE. 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