2014-12-22T12:19:28-06:00 2014-09-30 990 2013-10-01 060653171 Hospital of Saint Raphael HOSP 2032223160 c/o Levett Rockwood PC PO Box 141 Westport CT 06880 James R Rude Chief Financial Officer 2037893575 2014-12-22 2013 2015-11-30 17:44:51Z X X Jane Anne Lubin Szafransk c/o Levett Rockwood PC PO Box 141 Westport CT 06880 0 0 X N/A X 1907 CT Not for Profit Hospital 9 8 103 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23200829 0 22545821 0 655008 0 X 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. 0 1 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). 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 71 0 1 103 1 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Levett Rockwood PC 2032223160 PO Box 141 Westport CT 06880 X M Joseph Canavan Volunteer 1.00 X 0 0 0 Sister Teresa Confroy Volunteer 2.00 X 0 0 0 Sister Mary Morley Volunteer 3.00 X 0 0 0 Edward J Mullen Volunteer 1.00 X 0 0 0 Most Reverend Peter Rosazza Volunteer 1.00 X 0 0 0 Sister Maureen Shaughnessy Volunteer 2.00 X 0 0 0 Kevin Twohig MD Volunteer 1.00 X 0 0 0 Sister Margaret Welch Volunteer 2.00 X 0 0 0 Janeanne Lubin-Szafranski Chief Executive Officer 38.00 X X 0 436408 19581 James Rude Chief Financial Officer 38.00 X 322073 0 16687 Katherine Buckley Director/Reimbursement 40.00 X 211923 0 7238 Caren Genovese Director/Medical Affairs 40.00 X 217810 0 401 Victor Cimino IT Project Manager 40.00 X 216758 0 17595 Frank Jazab IT Project Manager 40.00 X 185603 0 7238 Craig Fenn IT Systems Engineer 40.00 X 179550 0 7271 Kim Samele Former VP Surgical Services 0.00 X 0 243853 7500 Russ Braun MD Former Chair/Emergency Medicine 0.00 X 0 191909 8627 John Burke Former VP Information Services 0.00 X 0 265221 0 Elizabeth Conrad Former VP Human Resources 0.00 X 0 320626 7400 Peter Duffy Former VP Facility Operations 0.00 X 0 208968 0 John Fitzgerald Former Asst VP Finance 0.00 X 301756 0 7219 Sister Joan Granville Former VP Mission Services 0.00 X 0 177594 6267 Mary Kuncas Former VP Patient Care Services 0.00 X 0 358289 7219 Susan Lipka Former Director/Decision Support 40.00 X 176659 0 12756 1812132 2202868 132999 16 1 1 0 Towers Watson 263 Tresser Blvd Stamford CT 06901 Professional Services 391315 Ernst & Young LLP 200 Plaza Drivw Secaucus NJ 07094 Professional Services 388407 Leaders for Today LLC 50 Resnik Road Suite 103 Plymouth MA 02360 Professional Services 280003 St Raphael Dialysis Center 137 Water Street New Haven CT 06511 Medical 139240 Levett Rockwood PC 33 Riverside Avenue Westport CT 06881 Professional Services 112567 5 0 0 0 0 0 0 0 0 0 16005349 0 0 0 0 0 84051 0 0 0 0 0 6264580 0 0 0 846849 0 23200829 0 22545821 0 22545821 0 X -5609561 0 4833380 0 1431189 0 655008 0 23200829 0 X 0 -655008 X 0 0 0 X 4026567 17473 4044040 4004063 22504 4026567 3446673 557390 4004063 3431456 15217 3446673 3122933 308523 3431456 0 0 0 Part V, Line 4: 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. X X X X X 1 0 0 0 0 0 0 0 0 Janeanne Lubin-Szafranski Chief Executive Officer 0 427893 0 0 0 8515 0 0 0 19581 0 455989 0 0 James Rude Chief Financial Officer 313779 0 0 0 8294 0 0 0 16687 0 338760 0 0 0 Katherine Buckley Director/Reimbursement 138767 0 0 0 73156 0 0 0 7238 0 219161 0 0 0 Caren Genovese Director/Medical Affairs 152896 0 0 0 64914 0 0 0 401 0 218211 0 0 0 Victor Cimino IT Project Manager 134067 0 0 0 82691 0 0 0 17595 0 234353 0 0 0 Frank Jazab IT Project Manager 126296 0 0 0 59307 0 0 0 7238 0 192841 0 0 0 Craig Fenn IT Systems Engineer 122482 0 0 0 57068 0 0 0 7271 0 186821 0 0 0 Kim Samele Former VP Surgical Services 0 243853 0 0 0 0 0 0 0 7500 0 251353 0 0 Russ Braun MD Former Chair/Emergency Medicine 0 191909 0 0 0 0 0 0 0 8627 0 200536 0 0 John Burke Former VP Information Services 0 265221 0 0 0 0 0 0 0 0 0 265221 0 0 Elizabeth Conrad Former VP Human Resources 0 320626 0 0 0 0 0 0 0 7400 0 328026 0 0 Peter Duffy Former VP Facility Operations 0 208920 0 0 0 48 0 0 0 0 0 208968 0 0 John Fitzgerald Former Asst VP Finance 221671 0 0 0 80085 0 0 0 7219 0 308975 0 0 0 Sister Joan Granville Former VP Mission Services 0 177594 0 0 0 0 0 0 0 6267 0 183861 0 0 Mary Kuncas Former VP Patient Care Services 0 255120 0 0 0 103169 0 0 0 7219 0 365508 0 0 Susan Lipka Former Director/Decision Support 123993 0 0 0 52666 0 0 0 12756 0 189415 0 0 0 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). Cash 2014-09-24 4703275 Book Value 061157542 Saint Raphael Healthcare System Inc 200 Orchard Street Suite 204 New Haven CT 06511 501(c)(3) 1 0 0 0 1 1 1 1 0 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. 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. 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 Saint Raphael Healthcare System Inc 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Saint Raphael Healthcare System Inc B 4703275 Cash Value Saint Raphael Foundation Inc C 12313 Cash Value