MOUNT SINAI REHABILITATION HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MOUNT SINAI REHABILITATION HOSPITAL INC (EIN 06-1422973)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-13
IRS object ID
201342259349300224
Schema version
2011v1.5
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

FieldValueIRS element (for citing)
Timestamp2013-08-13T08:35:54-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN111986323EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MARCUM LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1CITY PLACE II 185 ASYLUM STREETAddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN061422973EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MOUNT SINAI REHABILITATION HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMOUNNameControl
Phone8607143500Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1114 WOODLAND STREET NO 4312AddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06105ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID BITTNERName
TitleVICE PRESIDENT OF FINANCETitle
Phone8607143500Phone
Date Signed2013-08-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDOUGLAS FARRINGTONName
PTINP00370668PTIN
Phone8605498500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID BITTNERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1114 WOODLAND STREET NO 4312AddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06105ZIPCode
FieldValueIRS element (for citing)
Gross Receipts27213264GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.STFRANCISCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionREHABILITATION SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees247TotalNbrEmployees
Total Nbr Volunteers127TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1144550ContributionsGrantsPriorYear
Contributions Grants Current Year867442ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21692651ProgramServiceRevenuePriorYear
Program Service Revenue CY26134800ProgramServiceRevenueCY
Investment Income Prior Year211403InvestmentIncomePriorYear
Investment Income Current Year130602InvestmentIncomeCurrentYear
Other Revenue Prior Year59554OtherRevenuePriorYear
Other Revenue Current Year80420OtherRevenueCurrentYear
Total Revenue Prior Year23108158TotalRevenuePriorYear
Total Revenue Current Year27213264TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year17213488SalariesEtcPriorYear
Salaries Etc Current Year19967350SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3467576OtherExpensePriorYear
Other Expenses Current Year4286146OtherExpensesCurrentYear
Total Expenses Prior Year20681064TotalExpensesPriorYear
Total Expenses Current Year24253496TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2427094RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2959768RevenuesLessExpensesCY
Total Assets BOY21272992TotalAssetsBOY
Total Assets EOY24510746TotalAssetsEOY
Total Liabilities BOY1970633TotalLiabilitiesBOY
Total Liabilities EOY2248619TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY19302359NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY22262127NetAssetsOrFundBalancesEOY
Mission DescriptionTO OPERATE A REHABILITATION HOSPITAL IN HARTFORD, CONNECTICUT, AND PROVIDE INPATIENT AND OUTPATIENT REHABILITATION SERVICES TO PERSONS WHO ARE DISABLED WITH PHYSICAL OR MENTAL HANDICAP.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense23265518Expense
Revenue26211235Revenue
DescriptionTO PROVIDE COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL REHABILITATION SERVICES IN THE GREATER HARTFORD CONNECTICUT COMMUNITY AS PART OF THE SAINT FRANCIS CARE HEALTH SYSTEM.Description
Total Program Service Expense23265518TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10964NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees247NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Own WebsiteXOwnWebsite
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DONNA GILBERTBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8607149632TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1114 WOODLAND STREET SUITE 4312AddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06105ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
HOWARD W ORR JR
CHAIRMAN2.00XX000
CHRISTOPHER M DADLEZ
PRESIDENT & CEO2.00XX0135744448681
DELORES GRAHAM
VICE CHAIRMAN1.00XX000
P ANTHONY GIORGIO PHD
SECRETARY1.00XX000
EDWARD S JOHNSON DDS
DIRECTOR1.00X01774552926
JEANNINE MARA
TREASURER1.00XX000
ROLF KNOLL MD
DIRECTOR2.00X042848143508
JOHN SUISMAN
DIRECTOR1.00X134000
MICHAEL E CUMMINGS
DIRECTOR1.00X000
WENDY E ELBERTH
DIRECTOR2.00X000
ANDREW MANDELL
DIRECTOR1.00X000
BRAD DAVIS
DIRECTOR2.00X000
KATHLEEN M ROCHE MSRN
ASSISTANT SECRETARY2.00X062154230637
DIANNE M BERNIER
STAFF RN55.00140730018072X
ANNE-MARIE ALCIDE
STAFF RN55.00143660019924X
MAURA A MURRAY
EXECUTIVE DIRECTOR SERVICE LINES55.00138369014631X
DONNA RICKETTS
NURSE MANAGER55.00126332019906X
JANETTE M GORDON
NURSE MANAGER55.0012442107092X
FieldValueIRS element (for citing)
Total Reportable Comp From Org674852TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2584922TotalReportableCompFrmRltdOrgs
Total Other Compensation205377TotalOtherCompensation
Number Individuals GT100 K16NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations571111RelatedOrganizations
All Other Contributions296331AllOtherContributions
Total Contributions867442TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT CARE SERVICESDescription
Business Code621400BusinessCode
Total Revenue Column26134800TotalRevenueColumn
Related Or Exempt Function Income26134800RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue26134800TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column130602TotalRevenueColumn
Exclusion$130,602ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real44438Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real44438Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column44438TotalRevenueColumn
Related Or Exempt Function Income44438RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
WELLNESS REVENUE9000993179131791
MISCELLANEOUS REVENUE9000992307$2,307
COFFEE SHOP REVENUE9000991678$1,678

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column206TotalRevenueColumn
Related Or Exempt Function Income206RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue35982TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column27213264TotalRevenueColumn
Related Or Exempt Function Income26211235RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$134,587ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total966Total
Program Services966ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total11633459Total
Program Services11228798ProgramServices
Management And General404661ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total680289Total
Program Services680289ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6573618Total
Program Services6573618ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1079018Total
Program Services1079018ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total19200Total
Management And General19200ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1753527Total
Program Services1720935ProgramServices
Management And General32592ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total62553Total
Program Services16551ProgramServices
Management And General46002ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total171156Total
Program Services143388ProgramServices
Management And General27768ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total300000Total
Management And General300000ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total395090Total
Program Services395090ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total108035Total
Program Services76900ProgramServices
Management And General31135ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total620695Total
Program Services620695ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total5831Total
Management And General5831ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
LICENSES & FEES31466928386630803
MEDICAL SUPPLIES182297182297
BAD DEBTS124596124596
REPAIRS & MAINTENANCE4760447604

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total180893Total
Program Services90907ProgramServices
Management And General89986ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total24253496Total
Program Services23265518ProgramServices
Management And General987978ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1143931BOY
EOY2358355EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5932971BOY
EOY12479232EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3400965BOY
EOY2625122EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY6460BOY
EOY25560EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis14831524LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8568511LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6077349BOY
EOY6263013EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY236429BOY
EOY193160EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4474887BOY
EOY566304EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY21272992BOY
EOY24510746EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1589781BOY
EOY1856330EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY380852BOY
EOY392289EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1970633BOY
EOY2248619EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY17040837BOY
EOY21194953EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2261522BOY
EOY1067174EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19302359BOY
EOY22262127EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21272992BOY
EOY24510746EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2959768ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10360565OtherCostOrOtherBasis
Depreciation5885043Depreciation
Book Value4475522BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis844332OtherCostOrOtherBasis
Depreciation155418Depreciation
Book Value688914BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2356255OtherCostOrOtherBasis
Depreciation1551995Depreciation
Book Value804260BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1270372OtherCostOrOtherBasis
Depreciation976055Depreciation
Book Value294317BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6263013TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO THIRD PARTIES REIMBURSEMENT AGENCIESDescription
Amount$392,289Amount
FieldValueIRS element (for citing)
Total Of Amounts392289TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense84604TotalCommunityBenefitExpense
Net Community Benefit Expense84604NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense873693TotalCommunityBenefitExpense
Net Community Benefit Expense873693NetCommunityBenefitExpense
Percent Of Total Expense0.03600PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense958297TotalCommunityBenefitExpense
Net Community Benefit Expense958297NetCommunityBenefitExpense
Percent Of Total Expense0.03950PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense127280TotalCommunityBenefitExpense
Net Community Benefit Expense127280NetCommunityBenefitExpense
Percent Of Total Expense0.00520PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense78899TotalCommunityBenefitExpense
Net Community Benefit Expense78899NetCommunityBenefitExpense
Percent Of Total Expense0.00330PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense39525TotalCommunityBenefitExpense
Net Community Benefit Expense39525NetCommunityBenefitExpense
Percent Of Total Expense0.00160PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense245704TotalCommunityBenefitExpense
Net Community Benefit Expense245704NetCommunityBenefitExpense
Percent Of Total Expense0.01010PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1204001TotalCommunityBenefitExpense
Net Community Benefit Expense1204001NetCommunityBenefitExpense
Percent Of Total Expense0.04960PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense25289TotalCommunityBuildingExpense
Net Community Building Expense25289NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense25289TotalCommunityBuildingExpense
Net Community Building Expense25289NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$49,398BadDebtExpenseAmount
Amount Reimbursed By Medicare6702226AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare6206310CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall495916MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MOUNT SINAI REHABILITATION HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1490 BLUE HILLS AVENUEAddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06112ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MOUNT SINAI REHABILITATION HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent250.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Uninsured DiscountXUninsuredDiscount
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy0NondiscrimEmergencyCarePolicy
No Emergency CareXNoEmergencyCare
Medicare RateXMedicareRate
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: N/APART I, LINE 4: MOUNT SINAI REHABILITATION HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE OF CONNECTICUT, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES. IN ADDITION, ALL SELF-PAY PATIENTS RECEIVE A 45% DISCOUNT FROM CHARGES WHICH IS NOT INCLUDED IN NET PATIENT SERVICE REVENUE FOR FINANCIAL REPORTING PURPOSES.
PART I, LINE 6A: MOUNT SINAI REHABILITATION HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT JOINTLY WITH SAINT FRANCIS HOSPITAL & MEDICAL CENTER, A RELATED ENTITY. THIS REPORT IS AVAILABLE ON THE SAINT FRANCIS HOSPITAL WEBSITE.
PART I, LINE 7: MOUNT SINAI REHABILITATION HOSPITAL USES A COST ACCOUNTING SYSTEM WITHIN THE DECISION SUPPORT SYSTEM PRODUCT. IT IS A FULLY ABSORBED COSTING SYSTEM USING REMAPS OF EXPENSE AND REVENUES WHERE NEEDED. INDIRECT, OR OVERHEAD, COSTS ARE ALLOCATED USING STATISTICS IN ORDER TO ALLOCATE THE COSTS TO THE REVENUE PRODUCING DEPARTMENTS. THE METHOD OF ALLOCATING DOLLARS TO THE CHARGE ITEMS IS CURRENTLY PRIMARILY BASED ON A RCC METHOD USING OUR CHARGE ITEM PRICE AS THE DRIVER. WE HAVE INTERSPERSED SOME NATIONAL RVU'S FROM THE CMS FEE SCHEDULE TO MANY DEPARTMENTS AS WELL AS USING COSTS TO HELP ALLOCATE OUR PHARMACY AND SUPPLY EXPENSES. ALL CHARGE ITEMS OBTAIN A COST AND ALL PATIENT SEGMENTS ARE FULLY COSTED.
PART I, LINE 7G: N/A
PART II: MOUNT SINAI REHABILITATION HOSPITAL IS INVOLVED IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES WHICH ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS. SOME ARE SPECIFIC TO THE COMMUNITY SERVED AND OTHERS ARE MORE GLOBAL IN APPROACH, SUCH AS ADVOCACY WORK AND BOARD MEMBERSHIP IN LOCAL ORGANIZATIONS THAT PROVIDE CRITICAL SERVICES TO THOSE IN NEED. LEADERSHIP DEVELOPMENTON A REGULAR BASIS, GRAND ROUNDS ARE OFFERED TO NURSING STAFF WITHIN THE HARTFORD COMMUNITY TO EDUCATE THEM ABOUT REHABILITATION TREATMENT AND ENCOURAGE CONNECTIONS FOR PATIENTS TO THE SPECIALIZED SERVICES AVAILABLE.COMMUNITY ACTIVITIES SUCH AS STUDENT TRAINING, PARTICIPATION IN RESEARCH PROJECTS, AND EDUCATIONAL SESSION ARE ENCOURAGED. COALITION BUILDINGADAPTIVE ROWING PROGRAM INCLUDES COLLABORATION WITH A VARIETY OF AGENCIES INCLUDING RIVERFRONT RECAPTURE, JAYCEES FOUNDATION AND THE CHRISTOPHER REEVES FOUNDATION. STAFF PLAY A ROLE IN DEVELOPING COALITIONS TO PROVIDE UNIQUE SERVICES TO THE DISABLED POPULATION.EXECUTIVE STAFF AT MOUNT SINAI REHABILITATION HOSPITAL ARE EXPECTED TO PARTICIPATE IN COMMUNITY IMPROVEMENT ACTIVITIES SUCH AS SERVING ON BOARDS, ASSISTING SMALL NON-PROFITS WITH FUNDRAISING ACTIVITIES, PROVIDING EXPERTISE AND IN-KIND SUPPORT AND PROVIDING MEETING SPACE FREE OF CHARGE. IN THE AREA OF WORKFORCE DEVELOPMENT MOUNT SINAI REHABILITATION HOSPITAL OFFERS TRAINING OF NURSING STAFF IN THE AREA OF REHABILITATION. INTERNSHIP OPPORTUNITIES FOR COLLEGE STUDENTS AS WELL AS HIGH SCHOOL STUDENTS DURING THE SUMMER MONTHS TO EXPOSE THEM TO CAREERS IN REHABILITATION ARE ON-GOING. MASTERS AND PHD LEVEL STUDENTS ARE ALSO RECRUITED TO PARTICIPATE IN A VARIETY OF PROJECTS SO THAT THEY BETTER UNDERSTAND THE OPPORTUNITIES AVAILABLE IN THE WORKPLACE. ADVOCACY FOR HEALTH IMPROVEMENTSADVOCACY WORK AT MOUNT SINAI REHABILITATION HOSPITAL IS DONE BY THOSE WITH HIGH LEVEL EXPERTISE IN AN AREA OF HEALTH CARE TO WHICH THEY CAN SPEAK WITH BOTH KNOWLEDGE AND CONVICTION. SOME EXAMPLES OF STAFF WHO HAVE BEEN ENGAGED IN ADVOCACY WORK IN THE PAST INCLUDE:DR. WADE IS A BOARD MEMBER OF THE CT MS SOCIETY AND ALSO SERVES AS A DIPLOMAT FOR THE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY. DR. LO CONDUCTS A NUMBER OF RESEARCH PROJECTS FOCUSED ON IMPROVEMENT OF SERVICES TO MS PATIENTS INCLUDING A COOPERATIVE STUDY WITH VA HOSPITALS, BRAIN INJURY REHABILITATION, THE USE OF ROBOTICS FOR REHABILITATION AND EPIDEMIOLOGICAL STUDIES OF MS PATIENTS.THOMAS ROMANS SERVES AS LEADER IN THE NATIONAL ALLIANCE ON MENTAL ILLNESS.
PART III, LINE 4: MOUNT SINAI REHABILITATION HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE OF CONNECTICUT, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES. IN ADDITION, ALL SELF-PAY PATIENTS RECEIVE A 45% DISCOUNT FROM CHARGES WHICH IS NOT INCLUDED IN NET PATIENT SERVICE REVENUE FOR FINANCIAL REPORTING PURPOSES.
PART III, LINE 8: N/A FOR SHORTFALL REPORTED IN LINE 7.MEDICARE ALLOWABLE COSTS OF CARE ON LINE 6 WERE DETERMINED FROM THE MEDICARE COST REPORTS.
PART III, LINE 9B: SEE PART III, LINE 4
DESCRIPTION: MOUNT SINAI REHABILITATION HOSPITAL IS CONNECTICUT'S ONLY FREESTANDING ACUTE CARE REHABILITATION HOSPITAL. IT WAS FOUNDED IN 1923 AND MERGED WITH SAINT FRANCIS HOSPITAL AND MEDICAL CENTER IN 1995. THE MOUNT SINAI REHABILITATION HOSPITAL HAS 60 LICENSED BEDS AND PROVIDES SPECIALIZED SERVICES FOR REHABILITATION IN BOTH THE INPATIENT AND OUTPATIENT SETTING. ADDITIONALLY, THE HOSPITAL PROVIDES A COMPREHENSIVE SET OF SERVICES FOR THOSE WHO SUFFER WITH MULTIPLE SCLEROSIS AT THE MANDELL CENTER. MOUNT SINAI REHABILITATION HOSPITAL SHARES RESOURCES WITH SAINT FRANCIS HOSPITAL AND MEDICAL CENTER IN A VARIETY OF AREAS INCLUDING THE DEPARTMENTS OF: HUMAN RESOURCES, FINANCE, ACCOUNTING, ADMINISTRATION, ENGINEERING AND PURCHASING. SUPPLEMENTAL INFORMATION ABOUT COMMUNITY BENEFITS REPORTED ON THE SCHEDULE H FOR SAINT FRANCIS HOSPITAL INCLUDES ACTIVITIES FROM THESE SHARED DEPARTMENTS.
PART VI, LINE 2: MOUNT SINAI REHABILITATION HOSPITAL PARTICIPATED IN A COMMUNITY HEALTH ASSESSMENT WITH THE THREE OTHER HOSPITALS LOCATED IN HARTFORD, SAINT FRANCIS HOSPITAL AND MEDICAL CENTER, CONNECTICUT CHILDREN'S MEDICAL CENTER, AND HARTFORD HOSPITAL AND THE CITY OF HARTFORD HEALTH AND HUMAN SERVICES DEPARTMENT TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. MEETINGS OF THE "COMMUNITY NEEDS ASSESSMENT WORKGROUP" TOOK PLACE OVER A 6 MONTH PERIOD EVERY TWO WEEKS TO DISCUSS THE DESIGN AND IMPLEMENTATION OF THE NEEDS ASSESSMENT. AN INVENTORY OF LOCAL RESOURCES WAS CONDUCTED TO DETERMINE HOW BEST UTILIZE RESOURCES AT THE LOCAL COLLEGES AND UNIVERSITIES, LOCAL COMMUNITY ORGANIZATION, CITY GOVERNMENT AND THE HOSPITALS THEMSELVES. AN OUTSIDE CONSULTANT WAS ENGAGED TO COMPLETE THE NEEDS ASSESSMENT ONCE THE WORK PLAN WAS AGREED UPON. THE ASSESSMENT METHODOLOGY INCLUDED A NUMBER OF DATA GATHERING PROCESSES: REVIEW OF THE AVAILABLE SECONDARY DATA, INCLUSION OF DATA FROM A LOCAL HEALTH EQUITY INDEX AND TELEPHONE INTERVIEWS OF LOCAL KEY INFORMANTS. SECONDARY DATA PROFILE FINDINGS:HARTFORD IS A VERY DIVERSE (42% HISPANIC AND 37% AFRICAN AMERICAN), YOUNG (49% BETWEEN THE AGES OF 15-45), POOR (32% OF ALL PEOPLE BELOW THE POVERTY LEVEL) AND UNDER EDUCATED (32% OF 25 YEAR OLDS DID NOT GRADUATE FROM HIGH SCHOOL) CITY. THE UNEMPLOYMENT RATE IS 18% AND SAFETY IS A MAJOR CONCERN FOR RESIDENTS WITH RATES OF LARCENY, DRUG ABUSE, ASSAULT AND MURDER ALL HIGHER THAN STATE LEVELS. HEALTH ISSUES OF THE CITIES RESIDENTS INCLUDE HIGH RATES OF DIABETES, OBESITY, ASTHMA, DRUG ABUSE AND MENTAL ILLNESS. RATES OF HEART DISEASE AND CANCER ARE ON AVERAGE LOWER THAN THE REST OF THE STATE WHICH IS LIKELY DUE TO THE AGE OF THE CITY'S RESIDENTS. KEY INFORMANT INTERVIEW FINDINGS:RESULTS FROM THE KEY INFORMANT INTERVIEWS SERVED TO CLARIFY THE ISSUES THAT THOSE WORKING IN THE COMMUNITY SEE AS KEY COMMUNITY NEEDS. INTERESTINGLY, THE INFORMATION ON THE MOST IMPORTANT HEALTH ISSUES WAS RIGHT ON TARGET WITH DIABETES, OBESITY, MENTAL ILLNESS AND DRUG ABUSE ALL INCLUDED IN THE TOP 5 KEY HEALTH ISSUES. ADDITIONALLY, KEY INFORMANTS FELT THAT NEIGHBORHOOD SAFETY WAS A MAJOR CONCERN AS IS THE QUALITY OF HOUSING AND THE LIMITED NUMBER OF JOB OPPORTUNITIES.
PART VI, LINE 3: PATIENTS' ABILITY TO PAY FOR HEALTH CARE IS ASSESSED DURING THE INTAKE PROCESS. IF IT BECOMES CLEAR THAT THE PATIENT DOES NOT HAVE COVERAGE OR HAS MINIMAL COVERAGE THEY ARE REFERRED TO A FINANCIAL COUNSELOR WHO REVIEWS THEIR CURRENT INCOME TO DETERMINE ELIGIBILITY FOR EITHER STATE ASSISTANCE OR HELP FROM MOUNT SINAI CHARITY CARE DOLLARS. IN AREAS OF THE HOSPITAL WHERE NEW PATIENTS ARRIVE: THE REHABILITATION CLINIC, THE MANDELL CENTER, AND THE ADMISSIONS AREA, SIGNAGE IS POSTED ABOUT THE FINANCIAL ASSISTANCE AVAILABLE TO ALL PATIENTS WHO QUALIFY. THIS INFORMATION OUTLINES, IN BOTH ENGLISH AND SPANISH, THE AVAILABILITY OF FINANCIAL COUNSELING AND ASSISTANCE FOR MEDICAL BILLS. ADDITIONALLY, A "PATIENT AND FAMILY INFORMATION NOTEBOOK" WHICH INCLUDES A CHAPTER ON THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR PATIENTS WHO EITHER DO NOT HAVE COVERAGE OR ARE NOT COVERED FULLY BY THEIR HEALTH INSURANCE IS LOCATED IN EACH PATIENT ROOM. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS ALSO INCLUDED IN DISCHARGE MATERIALS. MOUNT SINAI REHABILITATION HOSPITAL DOES NOT TURN PATIENTS AWAY DUE TO THEIR INABILITY TO PAY. FINALLY, PATIENTS WHO HAVE NOT BEEN FORTHCOMING IN THEIR NEED FOR FINANCIAL ASSISTANCE PRIOR TO THE DELIVERY OF HEALTH CARE SERVICES ARE PROVIDED WITH INFORMATION ABOUT OUR CHARITY CARE POLICY WHEN THEY RECEIVE A BILL FOR THE SERVICES RENDERED. THEY ARE ENCOURAGED TO TALK TO A FINANCIAL COUNSELOR TO DISCUSS A PAYMENT PLAN AND TO DETERMINE IF THEY ARE ELIGIBLE FOR STATE ASSISTANCE OR IF A PORTION OF THEIR BILL CAN BE "WRITTEN OFF" TO CHARITY CARE.
PART VI, LINE 4: MOUNT SINAI REHABILITATION HOSPITAL SERVES PATIENTS FROM ALL OVER CONNECTICUT, AND ON OCCASION NATIONALLY DUE TO THE STRONG REPUTATION OF THE REHABILITATION PROGRAM AND THE MULTIPLE SCLEROSIS MANDELL CENTER. THE MAJORITY OF PATIENTS, HOWEVER, COME FROM HARTFORD COUNTY, WHICH INCLUDES THE STATE CAPITAL, HARTFORD, AND THIRTY-FIVE SURROUNDING URBAN AND SUBURBAN COMMUNITIES. HARTFORD IS THE CAPITAL OF THE STATE OF CONNECTICUT AND THE SEVENTH LARGEST CITY IN NEW ENGLAND. IT IS ONE OF THE OLDEST CITIES IN THE COUNTRY AND AT ONE POINT WAS ONE OF THE WEALTHIEST. THE POPULATION IN HARTFORD IS 125,000 WITH A PROPORTIONALLY YOUNGER AGE DISTRIBUTION THAT THE US OVERALL. THIS IMPACTS NUMEROUS ASPECTS OF HEALTH INCLUDING RATES OF SOME TYPES OF CANCER, VIOLENCE AND LEVELS OF UNINTENDED INJURY. OVER 70% OF CHILDREN IN THE HARTFORD PUBLIC SCHOOLS RECEIVED FREE OR REDUCED PRICE LUNCH. THE RATE OF INFANTS BORN LOW-BIRTH WEIGHT (LESS THAN 2500 G) IS 9.4%, WELL OVER THE NATIONAL AVERAGE OF 6.8%. HARTFORD IS AN URBAN COMMUNITY, THE MAJORITY OF HARTFORD RESIDENTS ARE MINORITIES WITH 42% LATINO, 37% AFRICAN AMERICAN, 17% WHITE AND 4% OTHER RACES. ACUTE REHABILITATION SERVICE ARE AVAILABLE IN HARTFORD AT NURSING HOME FACILITIES BUT MOUNT SINAI IS THE ONLY LICENSED REHABILITATION HOSPITAL IN THE AREA.
PART VI, LINE 5: MOUNT SINAI REHABILITATION HOSPITAL IS INVOLVED IN A VARIETY OF INITIATIVES THAT FOCUS ON THE IMPROVING THE HEALTH OF THE COMMUNITY OVERALL. COLLABORATIVE EFFORTS WITH A VARIETY OF LOCAL COMMUNITY FOUNDATIONS AND NON-PROFIT ORGANIZATIONS ARE NUMEROUS. THE MOUNT SINAI REHABILITATION - ROWING DISABLED PERSONS INCLUDING VETERANS IS VERY WELL KNOWN IN THE HARTFORD REGION AND HAS ENABLED NUMEROUS PATIENTS TO REGAIN PHYSICAL AND SOCIAL CONFIDENCE. NUMEROUS RESOURCES ARE DONATED BY THE HOSPITAL AND PARTNERING ORGANIZATIONS INCLUDING RIVERFRONT RECAPTURE, THE JAYCEES FOUNDATION, THE CHRISTOPHER REEVES FOUNDATION AND OTHERS. THE GOLFERS IN MOTION PROGRAM IS DESIGNED TO RE-INTRODUCE GOLF INTO THE LIVES OF THOSE WHO HAVE SUFFERED AN INJURY OR ILLNESS RESULTING IN DISABILITY. THE PROGRAM HAD DEVELOPED ADAPTIVE EQUIPMENT AND SPECIALIZED REHABILITATION SERVICES TO ENABLE GOLFERS TO RETURN TO THE COURSE AND BEGIN TO NORMALIZE THEIR LIVES.A PROGRAM FOR SUPPORTING CAREGIVERS IS NOW IN PLACE THAT PROVIDES TRAINING AND SUPPORT TO FAMILY MEMBERS WHO ARE TAKING CARE OF THOSE WITH CHRONIC ILLNESS; DEMENTIA OR OTHER LONG TERM HEALTH CHALLENGES.
PART VI, LINE 6: THE ORGANIZATION IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM.PART VI, LINE 7: COMMUNITY BENEFITS ARE REPORTED TO THE STATE'S OFFICE OF THE HEALTH CARE ADVOCATE IN CONNECTICUT. A COMMUNITY BENEFIT REPORT IS PUBLISHED AND WIDELY DISTRIBUTED IN THE LOCAL COMMUNITY AND IT IS POSTED ON THE WEBSITE FOR FULL VIEWING.
CTREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
CHRISTOPHER M DADLEZ
08574440500000000150340336470140612500
EDWARD S JOHNSON DDS
000001774550002926018038100
ROLF KNOLL MD
035980906867200017484026024047198900
KATHLEEN M ROCHE MSRN
0451542017000000015034015603065217900
DIANNE M BERNIER
1407300000068820111900158802000
ANNE-MARIE ALCIDE
1436600000064170135070163584000
MAURA A MURRAY
138369000007629070020153000000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINES 4A-BReturnReference
ExplanationEDWARD JOHNSON RECEIVED A SEVERANCE AMOUNT OF $177,455. CHRISTOPHER DADLEZ PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR. PART I, LINE 3: MOUNT SINAI REHABILITATION HOSPITAL 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 COMMITTEEExplanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15REFER TO PART III OF SCHEDULE J FOR PROCESS.
FORM 990, PART VI, SECTION C, LINE 19A 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 VII, SECTION A:AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: CHRISTOPHER M DADLEZ - 64 HOURS HOWARD W. ORR, JR. - 1 HOUR JOHN SUISMAN - 2 HOURS KATHLEEN M.ROCHE, M.S.R.N. - 59 HOURS P ANTHONY GIORGIO, PHD - 2 HOURS ROLF KNOLL, M.D. - 59 HOURS
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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
ASYLUM HILL FAMILY MEDICAL CENTER
114 WOODLAND STREETHARTFORDCT06105061450170HEALTH SERVICESCT501(C)(3)LINE 3SAINT FRANCIS CARE0
ONE THOUSAND CORPORATION
1000 ASYLUM STREETHARTFORDCT06105060922325PROPERTY MANAGEMENTCT501(C)(2)ST FRANCIS HOSPITAL & MEDICAL CENTER0
SAINT FRANCIS CARE INC
114 WOODLAND STREETHARTFORDCT06105061491191SUPPORTS HEALTH CARE ORGANIZATIONSCT501(C)(3)LINE 11A, I0N/A
SAINT FRANCIS FOUNDATION INC
114 WOODLAND STREETHARTFORDCT06105061008255FUNDRAISINGCT501(C)(3)LINE 11A, ISAINT FRANCIS CARE0
THE CAMILLUS CORPORATION
1000 ASYLUM STREETHARTFORDCT06105061051261SUPPORTS HEALTH CARE ORGANIZATIONSCT501(C)(3)LINE 11A, ISAINT FRANCIS CARE0
SAINT FRANCIS MEDICAL GROUP INC
114 WOODLAND STREETHARTFORDCT06105061450168HEALTH SERVICESCT501(C)(3)LINE 3SAINT FRANCIS CARE0
SAINT FRANCIS HOSPITAL & MEDICAL CENTER INC
114 WOODLAND STREETHARTFORDCT06105060646813HOSPITALCT501(C)(3)LINE 3SAINT FRANCIS CARE0
SAINT FRANCIS EMERGENCY MEDICAL GROUP INC
114 WOODLAND STREETHARTFORDCT06105451994612HEALTH SERVICESCT501(C)(3)LINE 3SAINT FRANCIS MEDICAL GROUP INC0

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
TOTAL LAUNDRY COLLABORATIVE
114 WOODLAND STREETHARTFORDCT06105208335788LAUNDRY SERVICESCTN/A
MEDWORKS LLC
375 EAST CEDAR STREETNEWINGTONCT06111061490483REHABILITATION SERVICESCTN/A
SFH-FF
1000 ASYLUM AVEHARTFORDCT06105061422973FITNESS MGMTCTN/ARELATED16289920949300

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
SAINT FRANCIS CARE MEDICAL GROUP PC
114 WOODLAND STREETHARTFORDCT06105061432373HEALTH SERVICESCTN/AC
SAINT FRANCIS BEHAVIORAL HEALTH GROUP
114 WOODLAND STREETHARTFORDCT06105061384686BEHAVIOR HEALTH SERVICESCTN/AC
SAINT FRANCIS HEALTH CARE PARTNERS
95 WOODLAND ST FOURTH FLOORHARTFORDCT06105061391257MGMT AND ADMIN SERVICESCTN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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