2012-08-15T12:45:35-05:00 2011-09-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 Indianapolis IN 46204 990 2010-10-01 060646917 THE STAMFORD HOSPITAL STAM 2032761000 30 Shelburne Rd PO Box 9317 Stamford CT 06904 KEVIN E GAGE 2012-08-14 3176817000 2010 2016-02-24 21:20:13Z Kevin Gage CFO 30 Shelburne Rd PO Box 9317 Stamford CT 06902 502869766 false X www.stamhealth.org X 1893 CT Our Mission: Together with our physicians we provide a broad range of high quality health and wellness services focused on the needs of our communities. 16 15 2958 604 6770901 4369698 4441131 5656742 446013568 485857948 1786211 1229027 1901820 2454910 454142730 495198627 2291321 0 0 0 208347845 221586026 0 0 2806595 219009654 236025215 429648820 457611241 24493910 37587386 425031425 475861907 315448765 340662907 109582660 135199000 Our Mission: Together with our physicians we provide a broad range of high quality health and wellness services focused on the needs of our communities. false false 396115902 2291321 481119938 In addition to a 305 Bed Hospital facility, The Stamford Hospital (TSH) operates a 225,000 square foot ambulatory Care center (Tully Center) also in Stamford, CT. Key operating statistics for the year ended 9/30/2011 include: Adult and pediatric inpatients cared for and discharged 14,940; Babies born 2,072; Total inpatient days of care provided 74,442. Patients seeking care in the Stamford Hospital emergency room: Admitted for Inpatient treatment 8,175; treated and released 40,316; treated at Tully Immediate Care Center 21,232. Surgeries performed at the Hospital and Tully Center: 11,727 (inpatient 2,392; outpatient 9,335). Radiation Therapy procedures performed: 13,162. 396115902 true true false true false false false false true true false false true true false false true false false false false false false true false true true false false true true false false false false false false false true false false true false false false true true true true false false true 351 0 true 2958 true true true true BD false false false true true false false true false X 16 15 false false false false false false false true true false false true true true true true true true true false CT X KEVIN GAGE CFO 2032761000 30 SHELBURNE RD Stamford CT 06902 X Mr Brian Grissler 37.5 X X 1829716 0 30336 Mr Douglas Milne III 2.0 X 0 0 0 Mr Edwin Ford 2.0 X 0 0 0 Dr Arthur Klein 2.0 X 0 0 0 Dr Charles Miner 2.0 X 0 0 0 Dr Neil Dreyer 2.0 X 0 0 0 Dr Dorothy A Levine 2.0 X 0 0 0 Mr Andrew Merrill 2.0 X 0 0 0 Mr Charles Krause III 2.0 X 0 0 0 Mr David R Nissen 2.0 X 0 0 0 Mr Elliot S Jaffe 2.0 X 0 0 0 Mr Ernest N Abate 2.0 X 0 0 0 Mr Jay Higham 2.0 X 0 0 0 Dr Allen Troy 2.0 X 0 0 0 Ms Amy C Downer 2.0 X 0 0 0 Ms Suzanne B Peters 2.0 X 0 0 0 Mr Darryl McCormick 37.5 X 461456 0 73495 Mr David Smith 37.5 X 639948 0 92577 Mrs Kathleen Silard 37.5 X 659720 0 100173 Mr Kevin Gage 37.5 X 649788 0 94596 Dr Sharon Kiely 37.5 X 610663 0 84305 Dr John Rodis 37.5 X 443589 0 130132 Dr Michael Coady 37.5 X 1095854 0 20438 Dr Lance Bruck 37.5 X 566685 0 42586 Dr Steven Horowitz 37.5 X 550210 0 42586 Dr Timothy Hall 37.5 X 801254 0 38969 Dr Andrew Snyder 37.5 X 725174 0 66330 9034057 0 816523 421 false true false HEMATOLOGY ONCOLOGY PC 34 SHELBURNE RD STAMFORD CT 069023628 PHYSICIAN FEES 3913559 SPECIALIZED RECEIVABLES INC PO BOX 12414 NEWARK NJ 071013514 COLLECTIONS 1273448 MEDGUEST LTD PO BOX 102467 ATLANTA GA 30368 TRANSACTION SERVICES 1083758 PETRA CONSTRUCTION CORPORATION 98 REBESCHI DR NORTH HAVEN CT 06473 CONSTRUCTION 1619688 ASHFORTH PROPERTIES CONSTRUCTION 707 SUMMER ST STAMFORD CT 069011026 CIP VENDOR 1382727 54 1505857 629488 3521397 55726 5656742 PATIENT REVENUE 621400 334453063 334453063 PHYSICIAN BILLING 621110 12230008 12230008 WELLNESS AND TRAINING 621400 3204124 3204124 MEDICARE/MEDICAID PAYMENTS 621400 129270567 129270567 REF LAB INCOME 621500 6700186 6700186 485857948 1968058 1962176 5882 0 0 2689655 3943884 -1254229 -1254229 64833 -1319062 2611571 22500 3373102 0 -761531 22500 -739031 -739031 296778 1505857 354153 -57375 -57375 0 0 MEDICAL RESIDENT FICA REFUND 900099 1398832 1398832 MANAGEMENT FEES 722210 596521 596521 CAFETERIA AND COFFEE SHOP 532000 1451225 1451225 319936 319936 3766514 495198627 481119938 6770901 1651046 0 0 0 0 4045351 582313 3463038 0 168501388 149046217 18664967 790204 18882254 16374254 2421526 86474 18662910 16184044 2393396 85470 11494123 9967571 1473918 52634 950636 922447 28189 2189572 70129 2119443 387725 387725 106770 106770 0 2365030 2291321 73709 42056026 28909921 13067826 78279 3140992 2037813 67482 1035697 63839062 61317606 2399668 121788 5224064 -16278 5240342 0 17402149 15755773 1516469 129907 524520 278022 188931 57567 0 414692 269552 87573 57567 166352 166352 0 25944360 25136122 615662 192576 9870200 9870200 Provision for Bad Debts 47360053 47360053 Taxes 1781393 184071 1597322 SUBSCRIPTIONS, DUES & MEMBER 1755396 634285 1116151 4960 Recruiting 1392675 34897 1357778 Service Contracts 7705385 7677664 16 27705 1448163 1061553 300843 85767 457611241 396115902 58688744 2806595 4888803 151382 44415329 80541399 1046751 608061 50691447 58871844 4741479 5243405 4093933 3608897 555714444 313200599 239320942 242513845 19407006 15674580 19982207 18094444 36443528 50554050 425031425 475861907 59522392 71075513 379601 806805 133964425 129662012 562033 5380916 121020314 133737661 315448765 340662907 X 82054898 108503626 19494388 18662000 8033374 8033374 109582660 135199000 425031425 475861907 X 37587386 -11971046 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 106770 false false false 106770 false SCHEDULE C, SUPPLEMENTAL INFORMATION SCHEDULE C PART II-B, LINE F THE HOSPITAL CONTRACTS LOBBYING FIRMS WHO LOBBY LEGISLATIVE ACTION ON BEHALF OF THE HOSPITAL AND THE HEALTHCARE INDUSTRY. ADDITIONALLY, THE HOSPITAL PAYS DUES TO ORGANIZATIONS THAT USE A PORTION OF THE DUES FOR HEALTHCARE LOBBYING EXPENSES. 27527319 3087737 -56132 3863702 26695222 28198000 2154945 874515 3700141 27527319 29311544 2687150 -864244 2936450 28198000 0.30090 0.69910 false false 42662000 42662000 175779044 86576450 89202594 6702752 3187238 3515514 303362668 220765167 82597501 27207980 2671744 24536236 242513845 Miscellaneous Receivable 6336582 Donor Restricted Funds 18642243 Inv in Healthstar 11898063 Due from Affliates 11607661 Debt Issuance Costs 2020479 Deposits 49023 50554050 0 Charitable Gift Annuity Payable 152481 Est Third Party Settlements 11284381 Pension Liability 88274020 Due to Affiliates 23955423 Est for Professional Liability 10071356 133737661 WALK, RUN, RIDE 832167 696267 135900 18836 25743 DREAM BALL 725348 675040 50308 5310 205128 2 245120 134550 110570 7366 41000 50770 1802635 1505857 296778 31512 246128 76513 354153 -57375 true true X true X true X true true true false true false 11496 8176032 5577589 2598443 0.00630 54450460 28079037 26371423 0.06430 2291321 0 2291321 0.00560 11496 64917813 33656626 31261187 0.07620 14671 4582406 22347 4560059 0.01110 14671 4582406 22347 4560059 0.01110 26167 69500219 33678973 35821246 0.08730 false 14160656 248111 77092637 104341539 -27248902 X true true 1 1 The Stamford Hospital

30 Shelburne Rd Stamford CT 06902

X X X X The Stamford Hospital 1 SCHEDULE H SUPPLEMENTAL INFORMATION PART I, LINE 6A A COMMUNITY BENEFIT REPORT IS PREPARED FOR THE PREPARED FOR THE STATE OF CONNECTICUT; HOWEVER, THAT REPORT IS NOT MADE AVAILABLE TO THE PUBLIC. PART III, LINE 4 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8 TO THE EXTENT THERE IS A MEDICARE "SHORTFALL", THE HOSPITAL HAS PROVIDED SERVICES AND IS REIMBURSED LESS THAN THE COST OF THOSE SERVICES. THIS TRANSFER OF VALUE BENEFITS THE PATIENT AND THE COMMUNITY. THE COSTING METHODOLOGY USED FOLLOWS THE METHODOLOGY OF THE MEDICARE COST REPORT. PART III, LINE 9B ALL COLLECTION EFFORTS CEASE AT ANY POINT IN THE PROCESS IF THE PATIENT APPLIES FOR FREE BED FUNDS OR FINANCIAL ASSISTANCE. NEEDS ASSESSMENT THE STAMFORD HOSPITAL ("SH" OR "HOSPITAL") PARTNERS WITH A NUMBER OF NONPROFIT HEALTH AND SOCIAL SERVICES ORGANIZATIONS THAT SEEK TO BENEFIT THE COMMUNITY AND IMPROVE THE HEALTH AND WELL-BEING OF THEIR CLIENTS. IN ADDITION, TOGETHER WITH OUR PHYSICIANS, THE HOSPITAL WORKS CLOSELY WITH THE STAMFORD DEPARTMENT OF HEALTH AND SOCIAL SERVICES ("STAMFORD HEALTH DEPT.") TO IDENTIFY NEEDS AND DEVELOP PROGRAMS, PROVIDE SCREENINGS, AND PROMOTE DISSEMINATION OF HEALTH INFORMATION. WITH THE STAMFORD HEALTH DEPARTMENT, SH SPONSORED A JOINT CITY OF STAMFORD ("STAMFORD")-WIDE FLU CAMPAIGN, TO REDUCE THE NUMBER OF HOSPITALIZATIONS AND EMERGENCY DEPARTMENT VISITS. THE CAMPAIGN INCLUDED: A JOINT SENIOR HEALTH FAIR/COMMUNITY PROJECTS; A COMMON ELECTRONIC DATABASE; SHARED VACCINE SUPPLIES AND REDISTRIBUTION TO LOCAL PROVIDERS; FLU HOTLINE; ARRANGEMENTS FOR VACCINATION OF HOMEBOUND INDIVIDUALS; AND VACCINATION CLINICS AT THE STAMFORD HEALTH DEPT. AND HOSPITAL STAFFED WITH VOLUNTEERS AND CROSS-OVER STAFFING. IN FY11, THE HOSPITAL'S OUTPATIENT COMPONENT OF THIS EFFORT TOTALED 10,786 VACCINATIONS. SH COLLABORATES WITH THE STAMFORD HEALTH DEPARTMENT'S HIV PREVENTION PROGRAM AND STAMFORD CARES, A PROGRAM OF FAMILY CENTERS THAT PROVIDES HIV MEDICAL CASE MANAGEMENT. ALSO, THIS COLLABORATION INCLUDES PARTICIPATION IN COMMUNITY HEALTH FAIRS AND EDUCATIONAL OUTREACH EFFORTS; PROVIDES HIV UPDATES FOR AIDS SERVICE PROVIDERS IN THE COMMUNITY; PERFORMS CLIENT HOME VISITS; AND CONDUCTS MONTHLY HIV POSITIVE WOMEN'S SUPPORT GROUP. SH PARTNERS WITH OPTIMUMS HEALTH CENTER (FORMERLY BRIDGEPORT COMMUNITY HEALTH CENTER), A FEDERALLY QUALIFIED HEALTH CARE CENTER, TO CREATE AN INTEGRATED PRIMARY CARE DELIVERY NETWORK FOR THE MEDICALLY UNDERSERVED COMMUNITIES IN STAMFORD. THE HOSPITAL PROVIDED SUPPLEMENTAL SUPPORT TO OPTIMUMS OF $2,291,321 IN FY11 TO ENSURE ITS CONTINUED VIABILITY. THE HOSPITAL COLLABORATES WITH THE FAIRFIELD COUNTY CHAPTER OF THE LINKS, INC. ("LINKS"), WHICH IS PART OF AN INTERNATIONAL VOLUNTEER SERVICE ORGANIZATION OF OVER TEN THOUSAND (10,000) AFRICAN -AMERICAN WOMEN COMMITTED TO ENHANCING THE QUALITY OF LIFE IN THEIR COMMUNITIES. THIS LOCAL PARTNERSHIP IDENTIFIES THE MOST EFFECTIVE WAYS TO DEVELOP AND IMPLEMENT INITIATIVES AIMED AT RAISING AWARENESS ABOUT THE UNIQUE HEALTH CONCERNS THAT DISPROPORTIONATELY AFFECT AFRICAN- AMERICANS AND INDIVIDUALS OF COLOR. COMMUNITY INPUT TO PREVENT CHILDHOOD OBESITY IS PROVIDED THROUGH A STAMFORD CITY-WIDE TASK FORCE LEAD BY SH. THIS EFFORT FOCUSES ON PREVENTION, ADVOCACY, TREATMENT, AND RESEARCH, AND IS A CITY-WIDE COLLABORATION THAT NOW INCLUDES STAMFORD PUBLIC SCHOOLS, THE STAMFORD HEALTH DEPARTMENT, EARLY CHILDHOOD EDUCATORS, AND COMMUNITY PEDIATRICIANS AND FAMILY MEDICINE PRACTITIONERS. SH'S KIDS' FANS (KIDS' FITNESS AND NUTRITION SERVICES) PROGRAM, PROMOTING PHYSICAL ACTIVITY AND HEALTH CONSCIOUS NUTRITION, IS A CORNERSTONE OF THIS CHILDHOOD OBESITY INITIATIVE. KIDS' FANS RECEIVED THE 2010 CONNECTICUT'S HOSPITAL COMMUNITY SERVICE AWARD. SPONSORED BY THE CONNECTICUT HOSPITAL ASSOCIATION AND THE CONNECTICUT DEPARTMENT OF PUBLIC HEALTH, THE AWARD RECOGNIZED A HOSPITAL IN THE STATE THAT MADE AN OUTSTANDING CONTRIBUTION TO ITS COMMUNITY, PARTICULARLY FOR A PROGRAM OR SERVICE TARGETED TOWARD A PARTICULAR SEGMENT OF ITS COMMUNITY. SH WAS HONORED FOR TACKLING THE SERIOUS ISSUE OF CHILDHOOD OBESITY IN SOUTHWESTERN CT. ANOTHER INITIATIVE REPRESENTATIVE OF THE COLLABORATIVE EFFORTS OF SH AND COMMUNITY ORGANIZATIONS IS "PAINT THE TOWN PINK," A COMMUNITY-WIDE BREAST CANCER AWARENESS PROGRAM. "PAINT THE TOWN PINK" HOLDS A MONTH-LONG SERIES OF EVENTS IN OCTOBER OF EACH YEAR. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE STAMFORD HOSPITAL USES SEVERAL VENUES TO NOTIFY OUR PATIENTS OF THE AVAILABLE FINANCIAL OPTIONS. 1) SIGNS AND OR BROCHURES ARE DISPLAYED IN ENGLISH AND SPANISH IN THE FOLLOWING AREAS: * EMERGENCY ROOM WAITING ROOMS AND REGISTRATION WORKSTATIONS * IMMEDIATE CARE CENTER WAITING ROOM * PATIENT REGISTRATION AREAS ON THE MAIN CAMPUS AND TULLY CAMPUS * CASHIER'S OFFICE, OFFICES OF THE FINANCIAL COUNSELORS, RECEPTION AREA OF THE PATIENT BUSINESS SERVICES DEPARTMENT * ANCILLARY DEPARTMENTS * BROCHURES ARE ALSO AVAILABLE IN CREOLE AND POLISH 2) THE HOSPITAL'S BILLING STATEMENTS INCLUDE AN INFORMATIONAL PAGE THAT IS PRINTED ON THE REVERSE SIDE OF THE STATEMENT OUTLINING THE FINANCIAL OPTIONS. 3) THE "ARE YOU UNINSURED NOTICE" IN ENGLISH AND SPANISH IS ATTACHED TO THE TRUE SELF PAY STATEMENTS. 4) STAFFING: * STAMFORD HOSPITAL HAS A FULL-TIME DSS ST OF CT OUTREACH WORKER ON THE HOSPITAL CAMPUS. * SOCIAL SERVICES DEPARTMENT * CASE MANAGEMENT DEPARTMENT * PATIENT REGISTRATION HAS ONE FULL TIME FINANCIAL COUNSELOR * PATIENT BUSINESS SERVICES HAS ONE BILINGUAL PATIENT ASSISTANCE CO-COORDINATOR AND TWO FULL TIME BILINGUAL FINANCIAL COUNSELORS. THE DSS OUTREACH WORKER AND A SH FINANCIAL COUNSELOR HOLD EDUCATIONAL AND COUNSELING SESSIONS IN THE OPTIMUMS CLINICS AND STAMFORD HOSPITAL ONCE PER WEEK. HAND-OUTS ARE PROVIDED TO PATIENTS BY THE FINANCIAL COUNSELORS AT THE HOSPITAL AND THE COMMUNITY HEALTH CENTERS. PATIENTS ARE SCREENED FOR FEDERAL OR STATE PROGRAMS, AND THE HOSPITALS FINANCIAL ASSISTANCE PROGRAM (FAP) BY THE SOCIAL WORKERS, PATIENT ASSISTANCE CO-COORDINATOR, FINANCIAL ASSISTANCE COUNSELORS, AND THE DSS LIAISON. 5) NOTIFICATIONS: PATIENTS RECEIVE APPROVAL OR DENIAL LETTERS AND, IF ELIGIBLE, FINANCIAL ASSISTANCE PROGRAM IDENTIFICATION CARDS. COMMUNITY INFORMATION SH PROVIDES A BROAD RANGE OF COMMUNITY OUTREACH AND EDUCATIONAL SERVICES TO RESIDENTS OF PREDOMINANTLY ITS PRIMARY SERVICE AREA (PSA) AND SECONDARY SERVICE AREA (SSA) THAT INCLUDE 12 COMMUNITIES IN SOUTHERN FAIRFIELD COUNTY, CT. THE HOSPITAL'S SERVICE AREA WAS DEVELOPED THROUGH THE STRATEGIC PLANNING PROCESS AND IS DEFINED IN STAMFORD HEALTH SYSTEM, INC.'S STRATEGIC PLAN. THE HOSPITAL'S COMBINED PSA AND SSA INCLUDE AN ESTIMATED 135,511 HOUSEHOLDS WITH A TOTAL POPULATION OF 361,418 RESIDENTS. THE PSA INCLUDES THE COMMUNITIES OF STAMFORD, DARIEN, AND ROWAYTON, WITH AN ESTIMATED 54,392 HOUSEHOLDS AND A TOTAL POPULATION OF 143,122. STAMFORD COMPRISES AN ESTIMATED 46,195 HOUSEHOLDS WITH A TOTAL POPULATION OF 119,294. THE SSA INCLUDES THE COMMUNITIES OF GREENWICH, COS COB, RIVERSIDE, OLD GREENWICH, NEW CANAAN, NORWALK, WESTPORT, WESTON, AND WILTON, WITH AN ESTIMATED 81,119 HOUSEHOLDS AND A TOTAL POPULATION OF 218,296. FOR THE PSA, 24% OF THE POPULATION IS ESTIMATED TO BE LESS THAN 18 YEARS OF AGE; 34.7% IS 18-44; 27.8% IS 45-64; AND 13.5% IS 65 YEARS OF AGE AND OLDER. THE SSA HAS A SLIGHTLY OLDER AGE DISTRIBUTION WITH AN ESTIMATED 25.7% OF ITS POPULATION LESS THAN 18 YEARS OF AGE; 29.2% IS 18-44; 30.7% IS 45-64; AND 14.4% 65 YE STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI CT, X X true true X X X X X true true false false false false false false false Mr Brian Grissler 935335 0 338223 0 556157 0 0 0 30336 0 1860052 0 0 0 Mr Darryl McCormick 347816 0 100193 0 13447 0 65307 0 8188 0 534951 0 0 0 Mr David Smith 397837 0 110201 0 131910 0 59741 0 32836 0 732525 0 0 0 Mrs Kathleen Silard 485287 0 138500 0 35933 0 67337 0 32836 0 759893 0 0 0 Mr Kevin Gage 477405 0 132241 0 40142 0 70042 0 24554 0 744384 0 0 0 Dr Sharon Kiely 463012 0 119301 0 28350 0 51469 0 32836 0 694968 0 0 0 Dr Michael Coady 720192 0 285879 0 89783 0 12250 0 8188 0 1116292 0 0 0 Dr Lance Bruck 493375 0 60000 0 13310 0 12250 0 30336 0 609271 0 0 0 Dr Steven Horowitz 541684 0 0 0 8525 0 12250 0 30336 0 592796 0 0 0 Dr Timothy Hall 296562 0 35000 0 469692 0 9800 0 29170 0 840224 0 0 0 Dr John Rodis 301098 0 0 0 142491 0 115012 0 15120 0 573721 0 0 0 Dr Andrew Snyder 332431 0 72231 0 320512 0 46106 0 20224 0 791504 0 0 0 SCHEDULE J, SUPPLEMENTAL INFORMATION STAMFORD HOSPITAL PROVIDED BENEFITS, SUCH AS TAX INDEMNIFICATION GROSS-UP PAYMENTS AND HOUSING/RESIDENCE ALLOWANCE TO CERTAIN EMPLOYEES. ALL BENEFITS WERE TREATED AS TAXABLE COMPENSATION WHEN REQUIRED. SCHEDULE J, PART I, LINE 4A TIMOTHY HALL - FORMER CHAIR, DEPARTMENT OF SURGERY RECEIVED $308,784 SEVERANCE. SEE SCHEDULE O 060806186 20774U3P8 2010-05-27 133992115 See Schedule O false false false 0 0 133995069 0 0 0 2057323 0 0 24835260 105745505 1356981 true false false true false false false false true 0.00000 0.00000 0.00000 true false false false false false false false false SHR 1 LLC Business Relationship 459473 Please see Sch L, PART V false SCHEDULE L SUPPLEMENTAL INFORMATION SCHEDULE L, PART IV, COLUMN D SHR1, LLC LEASES SPACE TO THE HOSPITAL. DOUGLAS MILNE, DIRECTOR IS A 50% OWNER OF SHR1, LLC. X 9 55726 cost/selling price false true false Form 990, Supplemental Information PART VI, QUESTION 11 THE STAMFORD HOSPITAL HAS A COMPREHENSIVE REVIEW PROCESS IN PLACE RELATING TO THE REVIEW OF FORM 990. PRIOR TO FINALIZATION OF THE 990, MANAGEMENT PRESENTS THE DRAFT BOARD OF DIRECTORS FOR FINAL REVIEW AND DISCUSSION. THE HOSPITAL'S EXTERNAL TAX ACCOUNTANTS ATTEND THIS MEETING WITH MANAGEMENT TO ADDRESS ANY SPECIFIC CONCERNS OR QUESTIONS. THIS REVIEW PROCEDURE HELPS TO ASSURE SOUND REPORTING AND COMPLIANCE WITH TAX LAW. PART VI, QUESTION 12C IT IS THE POLICY OF STAMFORD HOSPITAL TO PROHIBIT ITS EMPLOYEES AND OTHER ASSOCIATES FROM ENGAGING IN ANY ACTIVITY, PRACTICE, OR ACT WHICH CONFLICTS WITH, OR APPEARS TO CONFLICT WITH, THE INTERESTS OF THE HOSPITAL, OR ITS PATIENTS. EMPLOYEES ARE EXPECTED TO CONDUCT THE BUSINESS OF THE HOSPITAL TO THE BEST OF THEIR ABILITY AND FOR THE BENEFIT OF THE HOSPITAL AND ITS PATIENTS. THE POLICY ALSO REQUIRES BOARD MEMBERS, OFFICERS, SENIOR LEADERS, MEDICAL STAFF LEADERS, COMMITTEE MEMBERS AND OTHER INDIVIDUALS AS APPROPRIATE TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST THEY OR THEIR IMMEDIATE FAMILY MAY HAVE ON AN ANNUAL BASIS. SURVEYS ARE DISTRIBUTED ANNUALLY AND TIMELY RECEIPT IS MONITORED BY THE HOSPITAL'S COMPLIANCE DEPARTMENT. PART VI, QUESTION 15A AND 15B IT IS THE POLICY OF THE STAMFORD HOSPITAL TO PAY EMPLOYEES FAIR AND COMPETITIVE WAGES. THE HOSPITAL HAS ADOPTED A WAGE AND SALARY PROGRAM TO ENSURE THAT ALL EMPLOYEES ARE PAID IN RELATION TO THE VALUE OF THE WORK THEY PERFORM. THIS PROGRAM IS REVIEWED ANNUALLY. EXECUTIVE COMPENSATION IS SUBJECT TO A MORE COMPREHENSIVE REVIEW, INCLUDING AN ANNUAL BENCHMARKING ANALYSIS AND BOARD-LEVEL APPROVAL PROCESS. FORM 990, PART VI, QUESTION 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST PART XI, LINE 5 RECONCILIATION OF NET ASSETS PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST - (13,080,163) EQUITY TRANSFER FROM SHS - 1,340,000 OTHER - (230,883) TOTAL - (11,971,046) SCHEDULE K SUPPLEMENTAL INFORMATION SCHEDULE K, PART I, LINE A (A) ISSUER NAME: STATE OF CONNECTICUT HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (D) BONDS WERE ISSUED 5/27/10 TO 1) REFUND THE 11/13/96, 03/24/99, 6/03/08 AND 05/28/09 BOND ISSUES; 2) FINANCE ROUTINE RENOVATIONS AND OTHER CAPITAL EXPENDITURES; AND 3) FINANCE DEVELOPMENT AND CONSTRUCTION OF NEW FACILITY. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Brian Grissler TITLE:President and CEO HOURS:7 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Douglas Milne, III TITLE:Chairman HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Edwin Ford TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr. Arthur Klein TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr. Charles Miner TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr. Neil Dreyer TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Andrew Merrill TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Charles Krause, III TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Elliot S. Jaffe TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Ernest N. Abate TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Jay Higham TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ms. Suzanne B. Peters TITLE:Director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Darryl McCormick TITLE:Assistant Secretary HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. David Smith TITLE:Assistant Secretary HOURS:7 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mrs. Kathleen Silard TITLE:Assistant Secretary HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mr. Kevin Gage TITLE:Treasurer HOURS:7 36 Grove Street New Canaan LLC 30 Shelburne Rd Stamford CT 06904 274941529 MED RENTALS CT 341275 0 TSH 24 Grove Street New Canaan LLC 30 Shelburne Rd Stamford CT 06904 274941167 MED RENTALS CT 28159 0 TSH Stamford Health System 30 Shelburne Rd Stamford CT 06904 222476636 Hosp Parent CT 501(c)(3) 11, TYPE I NA The Stamford Hospital Foundation 30 Shelburne Rd Stamford CT 06904 222478748 Fundraising CT 501(c)(3) 9 SHS Stamford Health Intergrated Practices 30 Shelburne Rd Stamford CT 06904 271648289 Medical Svcs CT 501(c)(3) 9 TSH Cont Care Retirement Comm of Gr Stamford 30 Shelburne Rd Stamford CT 06904 061402215 Retiremt Ctr CT 501(c)(3) 9 SHS Miller Hall Medical Suites 166 W Broad Street Stamford CT 06904 061619978 PROF OFFICE BLDG CT SHS C corp 0 0 0.00000 Stamford ObGyn Associates 30 Shelburne Rd Stamford CT 06904 061330879 Obstetrical Care CT SHS C corp 0 0 0.00000 Fairfield County Surgical Specialists 30 Shelburne Rd Stamford CT 06904 205234062 Surgical Services CT SHS C corp 0 0 0.00000 Premier Medical Group 230 Weschester Ave Harrison NY 10604 263467761 ORTHO/REHAB CARE NY SHIP S corp 0 0 0.00000 Fairfield County Primary Care 30 Shelburne Rd Stamford CT 06904 262903051 PRIM URGENT CARE CT SHS C corp 0 0 0.00000 Healthstar Indemnity Co Limited FB PERRY BUILDING 40 CHURCH ST HAMILTON BERMUDA BD Self-Insurance BD TSH C corp 3552000 57453000 1.00000 true false true false false false false false true false false false false true true true true true Fairfield County Surgical Specialist a 39061 Fairfield County Surgical Specialist P 577908 Fairfield County Surgical Specialist C 277850 Healthstar O 10012500 Healthstar P 437829 Premier Medical Group H 200000 Premier Medical Group p 309907 Stamford Health Integrated Services B 1167796 Stamford Health Integrated Services H 196457 Stamford Health Integrated Services p 971339 Stamford Health System J 448595 Stamford Health System q 5630000