2012-08-16T08:26:16-05:00 2011-09-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 Indianapolis IN 46204 990 2010-10-01 271648289 STAMFORD HEALTH INTEGRATED PRACTICES INC STAM 2032761000 30 Shelburne Road Stamford CT 069049317 Dr Lance Bruck 2012-08-15 3176817000 2010 2016-02-24 21:20:13Z Dr Lance Bruck 30 Shelburne Rd P O Box 9317 Stamford CT 06902 8834031 false X N/A X 2009 CT Supports the provision of physician services and other health practitioner services to residents of the communities served by Stamford Hospital and affiliated organizations. 6 0 192 0 0 0 0 0 0 8821031 0 0 0 13000 0 8834031 0 0 0 0 555743 10891941 0 0 0 412257 6300642 968000 17192583 -968000 -8358552 340438 6472566 135907 14563317 204531 -8090751 Support the Stamford Health System (SHS), Stamford Hospital and affiliated organizations by employing physicians and other health practitioners and providing and supporting the provision of physician services and other health practitioner services to residents of the communities served by SHS, the Hospital and their affiliates. false false 7683402 0 8834031 Stamford Health Integrated Practices Inc. (SHIP) provides a comprehensive array of management services in support of physician practices. 7683402 true false false false false false false false false true false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false true true true true false false true 54 0 true 192 true false false false false false false false false false false X 6 0 false false false false true true true true true false false true true true true true true true true false X KEVIN GAGE CFO 2032761000 30 SHELBURNE RD Stamford CT 06902 X Dr Angelo Mallozzi 2.0 X 480137 0 31570 Dr Kevin Miller 2.0 X 315869 0 19717 Dr Craig Tifford 2.0 X 705658 0 0 Dr Craig Olin 2.0 X 612566 0 27054 Dr Andrew Snyder 2.0 X 0 716174 66330 DR LANCE BRUCK 2.0 X 0 566685 42586 Dr Rodrigo Acosta 40.0 X 480111 0 31670 2594341 1282859 218927 32 false true false ADELMAN SHEFF AND SMITH LLC 180 ADMIRAL COCHRANE DR ANNAPOLIS MD 21401 LEGAL 113188 ASHFORTH PROPERTIES CONSTRUCTION 707 SUMMER ST STAMFORD CT 069011026 CIP VENDOR 482588 COASTAL CARE MEDICAL MANAGEMENT 10 DAVOL SQUARE SUITE 400 PROVIDENCE RI 02903 BILLING SERVICES 305707 SYED H REZA MD 345 MAIN AVE NORWALK CT 06851 PHYSICIAN FEES 176565 7 0 Medicare/Medicaid Payments 621400 889579 889579 Physician Billing 621110 7919726 7919726 Abstracts 621110 11726 11726 8821031 0 0 0 13000 0 13000 13000 13000 0 0 0 0 0 8834031 8821031 13000 0 0 0 0 2755792 612093 2143699 0 6708290 2143699 4564591 6464 6464 796296 780342 15954 625099 619853 5246 353533 299750 53783 230415 64 230351 12000 12000 0 0 0 2111353 381616 1729737 89877 270 89607 901574 745337 156237 0 0 976480 924595 51885 28172 15349 12823 0 0 0 0 1036637 684180 352457 372099 372099 All other expenses 188502 97691 90811 17192583 7683402 9509181 0 14763 1318489 0 2352053 0 55738 2060927 446999 325675 1613928 1132358 340438 6472566 115552 2274453 20355 12288864 135907 14563317 X 204531 -8090751 204531 -8090751 340438 6472566 X -8358552 63270 X false true true X false X 0 0 0 0 0 0 0 0 0 0 8834031 8834031 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8834031 8834031 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8834031 0 0 0 0 13000 13000 0 0 0 0 13000 13000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8847031 8847031 0.99853 0.00000 0.00147 0.00000 X 602664 0 602664 1275441 387004 888437 182822 59995 122827 1613928 DEPOSITS 13101 DUE FROM AFFILIATES 1119257 1132358 0 DUE TO AFFILIATES 12288864 12288864 X true true X X X X X X false false false false false false false false false Dr Angelo Mallozzi 363830 0 114982 0 1325 0 0 0 31570 0 511707 0 0 0 Dr Craig Olin 478792 0 133301 0 473 0 0 0 27054 0 639620 0 0 0 Dr Rodrigo Acosta 364420 0 114982 0 709 0 0 0 31670 0 511781 0 0 0 Dr Kevin Miller 285825 0 29613 0 431 0 0 0 19717 0 335586 0 0 0 Dr Craig Tifford 679408 0 26250 0 0 0 0 0 0 705658 0 0 0 Dr Andrew Snyder 0 323431 0 72231 0 320512 0 46106 0 20224 0 782504 0 0 DR LANCE BRUCK 0 493375 0 60000 0 13310 0 12250 0 30336 0 609271 0 0 Supplemental Compensation Information SCHEDULE J, PART 1A Tax indemnification and gross-up payments and are given to certain employees. All benefits are treated as taxable compensation as required. Bonus are calculated and paid based on a percentage of revenue as defined by a contractual agreement. FORM 990, SUPPLEMENTAL INFORMATION FORM 990, PART VI, QUESTION 6 THE STAMFORD HEALTH INTEGRATED PRACTICES, INC. ("SHIP") IS A CONNECTICUT NONSTOCK CORPORATION. SHIP HAS TWO CLASSES OF MEMBERS. CLASS A MEMBERS ARE THE PHYSICIANS EMPLOYED BY SHIP. THE CLASS B MEMBER IS THE STAMFORD HOSPITAL. FORM 990, PART VI, QUESTION 7A THE BOARD OF DIRECTORS SHALL TOTAL SIX MEMBERS. THE INITIAL BOARD WAS SELECTED BY THE INCORPORATOR, AND THEREAFTER THE BOARD WILL BE ELECTED AS FOLLOWS: (A) EIGHT MEMBERS OF THE BOARD OF DIRECTORS SHALL BE ELECTED BY THE CLASS A MEMBERS, SUBJECT TO THE APPROVAL OF THE CLASS B MEMBER, AND (B) ONE MEMBER OF THE BOARD OF DIRECTORS SHALL BE APPOINTED BY THE CLASS B MEMBER. FORM 990, PART VI, QUESTION 7B ALL POWERS OF SHIP SHALL BE EXERCISED BY AND UNDER THE AUTHORITY OF THE BOARD OF DIRECTORS, EXCEPT THAT THE CLASS B MEMBER SHALL HAVE THE SOLE AUTHORITY TO AMEND THE BYLAWS OF SHIP AND SELECT THE AUDITORS OF SHIP. FORM 990, PART VI, QUESTION 11 THE STAMFORD HEALTH INTEGRATED PRACTICES, INC. (SHIP) HAS A COMPREHENSIVE REVIEW PROCESS IN PLACE RELATING TO THE REVIEW OF FORM 990. PRIOR TO FINALIZATION OF THE 990, MANAGEMENT PROVIDES THE DRAFT FORM 990 TO THE BOARD OF DIRECTORS. THE HOSPITAL'S EXTERNAL TAX ACCOUNTANTS ADDRESS ANY SPECIFIC CONCERNS OR QUESTIONS WITH MANAGEMENT AND THE BOARD. THIS REVIEW PROCEDURE HELPS TO ASSURE SOUND REPORTING AND COMPLIANCE WITH TAX LAW. FORM 990, PART VI, QUESTION 12 SHIP AS A WHOLLY OWNED SUBSIDIARY OF STAMFORD HOSPITAL FOLLOWS THE HOSPITAL'S CONFLICT OF INTEREST POLICY. IT IS THE POLICY 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 ORGANIZATION. EMPLOYEES ARE EXPECTED TO CONDUCT THE BUSINESS OF THE SHIP TO THE BEST OF THEIR ABILITY AND FOR THE BENEFIT OF THE SHIP AND IT'S 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. FORM 990, PART VI, QUESTIONS 15A & 15B IT IS THE POLICY OF THE SHIP TO PAY EMPLOYEES FAIR AND COMPETITIVE WAGES. SHIP 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. FORM 990, PART VI, QUESTION 19 SHIP MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 5 RECONCILIATION OF NET ASSETS EQUITY TRANSFER FROM STAMFORD HEALTH SYSTEM - $63,270 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr. Kevin Miller TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr. Craig Tifford TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr. Andrew Snyder TITLE:President & CEO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DR. LANCE BRUCK TITLE:SECRETARY HOURS:38 Fairfield County OBGYN Assoc PO Box 11580 Trumbull CT 06111 830352099 Obstetrl care CT 0 0 SHIP 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 Cont Care Retirement Comm of Gr Stamford 30 Shelburne Rd Stamford CT 06904 061402215 Retiremt Ctr CT 501(c)(3) 9 SHS The Stamford Hospital 30 Shelburne Rd Stamford CT 06904 060646917 Hospital CT 501(c)(3) 3 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 Premier Medical Group 230 Weschester Ave Harrison NY 10604 263467761 ORTHO/REHAB CARE NY SHS C 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 Self-Insurance BD TSH 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 false false true false false false false false false true false false false true true false true true Fairfield County OBGYN Assoc C 110335 FAIRFIELD COUNTY PRIMARY CARE C 1139333 FAIRFIELD COUNTY PRIMARY CARE C 950000 Fairfield County Surgical Specialists C 123828 PREMIER MEDICAL GROUP C 71137 PREMIER MEDICAL GROUP O 375366 PREMIER MEDICAL GROUP Q 3044059 PREMIER MEDICAL GROUP R 1745000 STAMFORD HEALTH SYSTEM C 1519051 STAMFORD HEALTH SYSTEM J 141285 STAMFORD HEALTH SYSTEM R 2131900 STAMFORD HOSPITAL C 1167796 STAMFORD HOSPITAL N 353532 STAMFORD OBGYN ASSOCIATES H 212100