Hospital of Saint Raphael: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- Hospital of Saint Raphael (EIN 06-0653171)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2014-12-22
- IRS object ID
- 201443569349300524
- Schema version
- 2013v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-12-22T12:19:28-06:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 060653171 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hospital of Saint Raphael | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HOSP | BusinessNameControlTxt |
| Phone | 2032223160 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | c/o Levett Rockwood PC PO Box 141 | AddressLine1 |
| City | Westport | City |
| State | CT | State |
| ZIP Code | 06880 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James R Rude | PersonNm |
| Person Title | Chief Financial Officer | PersonTitleTxt |
| Phone | 2037893575 | PhoneNum |
| Signature | 2014-12-22 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | Jane Anne Lubin Szafransk | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | c/o Levett Rockwood PC PO Box 141 | AddressLine1 |
| City | Westport | City |
| State | CT | State |
| ZIP Code | 06880 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $0 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1907 | FormationYr |
| Legal Domicile State | CT | LegalDomicileStateCd |
| Activity Or Mission | Not for Profit Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 103 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $0 | PYTotalRevenueAmt |
| CY Total Revenue | $0 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $0 | PYOtherExpensesAmt |
| CY Other Expenses | $0 | CYOtherExpensesAmt |
| PY Total Expenses | $0 | PYTotalExpensesAmt |
| CY Total Expenses | $0 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $0 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $0 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,200,829 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $22,545,821 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $655,008 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The Hospital of Saint Raphael was a community teaching hospital and health care resource sponsored and guided by the values of the Sisters of Charity of Saint Elizabeth and of the Roman Catholic Church. The mission was to witness, share in, and promote excellence in the healing ministry of Jesus Christ. The Hospital was committed to preserving the dignity and well-being of each individual, and assuring that every person is treated according to the principles of charity and justice. The Hospital accepted the Gospel challenge that prompted their founders of the sponsoring congregation, Saint Vincent DePaul, Saint Elizabeth Ann Seton, and Mother Mary Xavier Mehegan by pledging every loving service in their power to reach out to those in need of services. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Desc | As of September 12, 2012 active operations of the Hospital of Saint Raphael ceased and the company has been winding-up its business affairs. Effective September 24, 2014 the company merged into the Saint Raphael Healthcare System , Inc. (EIN: 06-1157542). | Desc |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | Yes (1) | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 71 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 103 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Levett Rockwood PC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2032223160 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 141 | AddressLine1 |
| City | Westport | City |
| State | CT | State |
| ZIP Code | 06880 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| M Joseph Canavan | ||||||||
| Volunteer | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Sister Teresa Confroy | ||||||||
| Volunteer | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| Sister Mary Morley | ||||||||
| Volunteer | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| Edward J Mullen | ||||||||
| Volunteer | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Most Reverend Peter Rosazza | ||||||||
| Volunteer | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Sister Maureen Shaughnessy | ||||||||
| Volunteer | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| Kevin Twohig MD | ||||||||
| Volunteer | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Sister Margaret Welch | ||||||||
| Volunteer | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| Janeanne Lubin-Szafranski | ||||||||
| Chief Executive Officer | 38.00 | Yes (X) | $0 | $436,408 | $19,581 | Yes (X) | ||
| James Rude | ||||||||
| Chief Financial Officer | 38.00 | $322,073 | $0 | $16,687 | Yes (X) | |||
| Katherine Buckley | ||||||||
| Director/Reimbursement | 40.00 | $211,923 | $0 | $7,238 | Yes (X) | |||
| Caren Genovese | ||||||||
| Director/Medical Affairs | 40.00 | $217,810 | $0 | $401 | Yes (X) | |||
| Victor Cimino | ||||||||
| IT Project Manager | 40.00 | $216,758 | $0 | $17,595 | Yes (X) | |||
| Frank Jazab | ||||||||
| IT Project Manager | 40.00 | $185,603 | $0 | $7,238 | Yes (X) | |||
| Craig Fenn | ||||||||
| IT Systems Engineer | 40.00 | $179,550 | $0 | $7,271 | Yes (X) | |||
| Kim Samele | ||||||||
| Former VP Surgical Services | 0.00 | $0 | $243,853 | $7,500 | Yes (X) | |||
| Russ Braun MD | ||||||||
| Former Chair/Emergency Medicine | 0.00 | $0 | $191,909 | $8,627 | Yes (X) | |||
| John Burke | ||||||||
| Former VP Information Services | 0.00 | $0 | $265,221 | $0 | Yes (X) | |||
| Elizabeth Conrad | ||||||||
| Former VP Human Resources | 0.00 | $0 | $320,626 | $7,400 | Yes (X) | |||
| Peter Duffy | ||||||||
| Former VP Facility Operations | 0.00 | $0 | $208,968 | $0 | Yes (X) | |||
| John Fitzgerald | ||||||||
| Former Asst VP Finance | 0.00 | $301,756 | $0 | $7,219 | Yes (X) | |||
| Sister Joan Granville | ||||||||
| Former VP Mission Services | 0.00 | $0 | $177,594 | $6,267 | Yes (X) | |||
| Mary Kuncas | ||||||||
| Former VP Patient Care Services | 0.00 | $0 | $358,289 | $7,219 | Yes (X) | |||
| Susan Lipka | ||||||||
| Former Director/Decision Support | 40.00 | $176,659 | $0 | $12,756 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,812,132 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,202,868 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $132,999 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 16 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Towers Watson | |||||
| 263 Tresser Blvd | Stamford | CT | 06901 | Professional Services | $391,315 |
| Ernst & Young LLP | |||||
| 200 Plaza Drivw | Secaucus | NJ | 07094 | Professional Services | $388,407 |
| Leaders for Today LLC | |||||
| 50 Resnik Road Suite 103 | Plymouth | MA | 02360 | Professional Services | $280,003 |
| St Raphael Dialysis Center | |||||
| 137 Water Street | New Haven | CT | 06511 | Medical | $139,240 |
| Levett Rockwood PC | |||||
| 33 Riverside Avenue | Westport | CT | 06881 | Professional Services | $112,567 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,005,349 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,051 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,264,580 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $846,849 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,200,829 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,545,821 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,545,821 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$5,609,561 | BOYAmt |
| EOY | $0 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,833,380 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,431,189 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $655,008 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,200,829 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $0 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$655,008 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,026,567 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $17,473 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $4,044,040 | OtherExpendituresAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,004,063 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $22,504 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,026,567 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,446,673 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $557,390 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,004,063 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,431,456 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $15,217 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,446,673 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,122,933 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $308,523 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,431,456 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: | FormAndLineReferenceDesc |
| Explanation | The Attorney General of the State of Connecticut has reviewed all restrictions on temporarily and permanently restricted net assets, and a cy-pres action in Connecticut Superior Court has been completed for some of these restricted amounts. Upon merger of the company restricted net assets were transferred to Saint Raphael Healthcare System, Inc., with the majority of such assets ultimately transferred to Yale-New Haven Hospital by Saint Raphael Healthcare System, Inc. on October 21, 2014. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Janeanne Lubin-Szafranski | ||||||||||||||
| Chief Executive Officer | $0 | $427,893 | $0 | $0 | $0 | $8,515 | $0 | $0 | $0 | $19,581 | $0 | $455,989 | $0 | $0 |
| James Rude | ||||||||||||||
| Chief Financial Officer | $313,779 | $0 | $0 | $0 | $8,294 | $0 | $0 | $0 | $16,687 | $0 | $338,760 | $0 | $0 | $0 |
| Katherine Buckley | ||||||||||||||
| Director/Reimbursement | $138,767 | $0 | $0 | $0 | $73,156 | $0 | $0 | $0 | $7,238 | $0 | $219,161 | $0 | $0 | $0 |
| Caren Genovese | ||||||||||||||
| Director/Medical Affairs | $152,896 | $0 | $0 | $0 | $64,914 | $0 | $0 | $0 | $401 | $0 | $218,211 | $0 | $0 | $0 |
| Victor Cimino | ||||||||||||||
| IT Project Manager | $134,067 | $0 | $0 | $0 | $82,691 | $0 | $0 | $0 | $17,595 | $0 | $234,353 | $0 | $0 | $0 |
| Frank Jazab | ||||||||||||||
| IT Project Manager | $126,296 | $0 | $0 | $0 | $59,307 | $0 | $0 | $0 | $7,238 | $0 | $192,841 | $0 | $0 | $0 |
| Craig Fenn | ||||||||||||||
| IT Systems Engineer | $122,482 | $0 | $0 | $0 | $57,068 | $0 | $0 | $0 | $7,271 | $0 | $186,821 | $0 | $0 | $0 |
| Kim Samele | ||||||||||||||
| Former VP Surgical Services | $0 | $243,853 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,500 | $0 | $251,353 | $0 | $0 |
| Russ Braun MD | ||||||||||||||
| Former Chair/Emergency Medicine | $0 | $191,909 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,627 | $0 | $200,536 | $0 | $0 |
| John Burke | ||||||||||||||
| Former VP Information Services | $0 | $265,221 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $265,221 | $0 | $0 |
| Elizabeth Conrad | ||||||||||||||
| Former VP Human Resources | $0 | $320,626 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,400 | $0 | $328,026 | $0 | $0 |
| Peter Duffy | ||||||||||||||
| Former VP Facility Operations | $0 | $208,920 | $0 | $0 | $0 | $48 | $0 | $0 | $0 | $0 | $0 | $208,968 | $0 | $0 |
| John Fitzgerald | ||||||||||||||
| Former Asst VP Finance | $221,671 | $0 | $0 | $0 | $80,085 | $0 | $0 | $0 | $7,219 | $0 | $308,975 | $0 | $0 | $0 |
| Sister Joan Granville | ||||||||||||||
| Former VP Mission Services | $0 | $177,594 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,267 | $0 | $183,861 | $0 | $0 |
| Mary Kuncas | ||||||||||||||
| Former VP Patient Care Services | $0 | $255,120 | $0 | $0 | $0 | $103,169 | $0 | $0 | $0 | $7,219 | $0 | $365,508 | $0 | $0 |
| Susan Lipka | ||||||||||||||
| Former Director/Decision Support | $123,993 | $0 | $0 | $0 | $52,666 | $0 | $0 | $0 | $12,756 | $0 | $189,415 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | |
| Part I, Line 4a | Certain Saint Raphael executives are eligible to receive severance payments upon termination of employment in certain circumstances. During calendar year 2013 severance payments made are reported as a component of the value reported in Schedule J Part II Column B (i) "Base Compensation" for the following individuals - Russ Braun, MD ($191,909), John Burke ($265,221), Elizabeth Conrad ($320,626), Peter Duffy ($208,920), John Fitzgerald ($221,671), Sister Joan Granville ($177,594), Mary Kuncas ($206,336), Kim Samele ($243,853), Katherine Buckley ($38,878), Caren Genovese ($4,138), Victor Cimino ($3,698), Frank Jazab ($3,444), Craig Fenn ($3,380). |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | Cash | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2014-09-24 | DistributionDt |
| Fair Market Value Of Asset | $4,703,275 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | Book Value | MethodOfFMVDeterminationTxt |
| EIN | 061157542 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Saint Raphael Healthcare System Inc | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Orchard Street Suite 204 | AddressLine1 |
| City | New Haven | City |
| State | CT | State |
| ZIP Code | 06511 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(c)(3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | Yes (1) | DirectorOfSuccessorInd |
| Employee Of Successor | 0 | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | 0 | BondsOutstandingInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 2e: | Person(s) Involved: M. Joseph CanavanSister Teresa ConfroyJaneanne Lubin-SzafranskiSister Mary MorleyEdward J. MullenMost Reverend Peter RosazzaSister Maureen ShaughnessyKevin Twohig, MDSister Margaret WelchJames Rude |
| Part I, Line 2e: | Explanation of Involvement: All trustees and officers of the organization, listed above, were also trustees and/or officers of the Saint Raphael Healthcare System, Inc. (the transferee organization) for the fiscal year ended September 30, 2014. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 3 | The Hospital of Saint Raphael provided services to the poor and the medically underserved, as well as provided benefits to the broader community. The Hospital also provided services to other needy populations that may not qualify as poor but needed special services and support. Effective as of 12:01am September 12, 2012 the majority of the assets and the operations of the Hospital of Saint Raphael were sold to Yale-New Haven Hospital (a 966 bed not for profit hospital located in New Haven, Connecticut) and its parent company (Yale-New Haven Health Services Corporation), and active operations ceased. The company remained in existence to wind-up corporate affairs, which included the collection of outstanding accounts receivable, payment of outstanding accounts payable and accrued expenses and the disposition of temporarily and permanently restricted net assets. Effective September 24, 2014 the company merged into the Saint Raphael Healthcare System, Inc., (EIN: 06-1157542). |
| Form 990, Part VI, Section A, line 6 | Hospital of Saint Raphael is a membership corporation and the sole Member of the Hospital was the Saint Raphael Healthcare System, Inc. |
| Form 990, Part VI, Section A, line 7a | Saint Raphael Healthcare System, Inc. was the sole Member of the Hospital of Saint Raphael. |
| Form 990, Part VI, Section A, line 7b | The following rights and powers were reserved to the Membership of the Hospital's sole Member: >To acquire, alienate or convey the real property or endowment funds of the Hospital having a value of $3,000,000 or more, or to place a mortgage on such property or funds in the amount of $3,000,000 or more. >To dispose of all or substantially all of the physical assets of the Hospital and to approve the merger or consolidation of the Hospital. >To borrow money and issue evidences of indebtedness in connection with the activities of the Hospital in the amount $3,000,000 or more, if such borrowings are to secured by mortgage, pledge or other lien on the Hospital's real property or endowment funds. >To organize or direct the organization of any corporation or other entity in which the Hospital will be a member or shareholder or have an equity interest greater than $1,000,000. >To dispose of stock or other equity interest of a corporation or other entity controlled by the Hospital. >To elect the Trustees of the Hospital who do not serve in an ex officio capacity. >To fill any vacancy occurring on the Board of Trustees, other than ex officio positions. >To amend the Certificate of Incorporation and Bylaws of the Hospital. >To appoint or remove the President of the Hospital. >To exercise any right specifically reserved to them in the certificate of incorporation of a subsidiary corporation controlled by the Hospital. |
| Form 990, Part VI, Section B, line 11 | The governing body reviewed key elements of the 990 prior to submission. |
| Form 990, Part VI, Section B, line 12c | Officers, trustees and key employees are required to complete the conflict of interest questionaire on an annual basis. Results of the questionaire are reviewed annually by the executive committee. |
| Form 990, Part VI, Section B, line 15 | Compensation of the organization's chief executive officer and chief financial officer are determined by the Compensation Committee of the Board of Trustees (utilizing an independent compensation consultant in conjunction with a compensation survey of the relevant marketplace). The Compensation Committee maintains minutes of its meetings. The Chief Executive Officer and the Chief Financial Officer are employed with a written employment contract. |
| Form 990, Part VI, Section C, line 19 | The organization made its governing documents and conflict of interest policy available to the public upon request. |
| Form 990, Part VII, Section A, Line 1A | Hours reported for volunteer trustees are the estimated hours per week that the volunteer trustees contribute to this and all other related exempt organizations, not necessarily equally but in the proportion required, for which they receive no compensation. Related exempt organizations included Saint Raphael Healthcare System, Inc. (06-1157542), and Hospital of Saint Raphael (06-0653171). |
| Form 990, Part XI, line 9: | Excess of revenues over expenses in Liquidation 3624913. Investment gains on restricted Net Assets 111895. Net unrealized gains on investments 15981. Net assets released from restrictions -34790. Net assets released from restrictions adjustment 317955. Net equity transfer from Saint Raphael Foundation, Inc. 12313. Net equity transfer to Saint Raphael Healthcare System, Inc. -4703275. |
| Form 990, Part XI, Line 9, Changes in Net Assets | The Attorney General of the State of Connecticut has reviewed all restrictions on temporarily and permanently restricted net assets, and a cy-pres action in Connecticut Superior Court has been completed for some of these restricted amounts. Upon merger of the company restricted net assets were transferred to Saint Raphael Healthcare System, Inc., with the majority of such assets ultimately transferred to Yale-New Haven Hospital by Saint Raphael Healthcare System, Inc. on October 21, 2014. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| Saint Raphael Healthcare System Inc | ||||||||||
| 200 Orchard Street Suite 204 | New Haven | CT | 06511 | 061157542 | Tax exempt holding company | CT | 501 (c) 3 | 11a | 0 | |
| Saint Raphael Foundation Inc | ||||||||||
| 200 Orchard Street Suite 204 | New Haven | CT | 06511 | 510140710 | Fundraising Foundation | CT | 501 (c) 3 | 11a | 0 | Saint Raphael Healthcare System Inc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Saint Raphael Healthcare System Inc | ||
| B | $4,703,275 | Cash Value |
| Saint Raphael Foundation Inc | ||
| C | $12,313 | Cash Value |
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