MOUNT SINAI REHABILITATION HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MOUNT SINAI REHABILITATION HOSPITAL INC (EIN 06-1422973)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-08
IRS object ID
201222219349300022
Schema version
2010v3.4
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)
Timestamp2012-08-08T09:16:45-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-10-01TaxPeriodBeginDate

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)
NameJOHN N GIAMALISName
TitleSENIOR VP & CFOTitle
Phone8607143500Phone
Date Signed2012-08-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDOUGLAS FARRINGTONName
Phone8605498500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN N GIAMALISNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1114 WOODLAND STREET NO 4312AddressLine1
CityHARTFORDCity
StateCTState
ZIP Code06105ZIPCode
FieldValueIRS element (for citing)
Gross Receipts23108158GrossReceipts
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 Employees223TotalNbrEmployees
Total Nbr Volunteers52TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year705148ContributionsGrantsPriorYear
Contributions Grants Current Year1144550ContributionsGrantsCurrentYear
Program Service Revenue Prior Year16459401ProgramServiceRevenuePriorYear
Program Service Revenue CY21692651ProgramServiceRevenueCY
Investment Income Prior Year172612InvestmentIncomePriorYear
Investment Income Current Year211403InvestmentIncomeCurrentYear
Other Revenue Prior Year54723OtherRevenuePriorYear
Other Revenue Current Year59554OtherRevenueCurrentYear
Total Revenue Prior Year17391884TotalRevenuePriorYear
Total Revenue Current Year23108158TotalRevenueCurrentYear
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 Year13470874SalariesEtcPriorYear
Salaries Etc Current Year17213488SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2980627OtherExpensePriorYear
Other Expenses Current Year3467576OtherExpensesCurrentYear
Total Expenses Prior Year16451501TotalExpensesPriorYear
Total Expenses Current Year20681064TotalExpensesCurrentYear
Revenues Less Expenses Prior Year940383RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2427094RevenuesLessExpensesCY
Total Assets BOY18411350TotalAssetsBOY
Total Assets EOY21272992TotalAssetsEOY
Total Liabilities BOY1536085TotalLiabilitiesBOY
Total Liabilities EOY1970633TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY16875265NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY19302359NetAssetsOrFundBalancesEOY
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
Expense20595940Expense
Revenue21745077Revenue
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 Expense20595940TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
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 Rltnshp1OfficerEntityWithBsnssRltnshp
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 With10965NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees223NumberOfEmployees
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 (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
HOWARD W ORR
CHAIRMAN2.00XX000
CHRISTOPHER M DADLEZ
PRESIDENT & CEO2.00XX0129839853864
DELORES GRAHAM
VICE CHAIRMAN2.00XX000
P ANTHONY GIORGIO PHD
SECRETARY2.00XX000
EDWARD S JOHNSON DDS
DIRECTOR2.00X030357220621
JEANNINE MARA
TREASURER2.00XX000
ROLF KNOLL MD
DIRECTOR2.00X041810443319
JOHN SUISMAN
DIRECTOR2.00X164400
MICHAEL E CUMMINGS
DIRECTOR2.00X000
WENDY E ELBERTH
DIRECTOR2.00X000
ANDREW MANDELL
DIRECTOR2.00X000
BRAD DAVIS
DIRECTOR2.00X000
DONALD STRACESKI
ASSISTANT TREASURER2.00X031660042208
KATHLEEN M ROCHE
ASSISTANT SECRETARY2.00X061787939747
DIANNE M BERNIER
STAFF RN55.00142711015738X
ANNE-MARIE ALCIDE
STAFF RN55.00124093018328X
MAURA A MURRAY
EXECUTIVE DIR SERVICE LINES55.00125282012777X
DONNA RICKETTS
NURSE MANAGER55.00113545018130X
BEVERLY A JONES
NURSE MANAGER55.0011192409523X
FieldValueIRS element (for citing)
Total Reportable Comp From Org619199TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2954553TotalReportableCompFrmRltdOrgs
Total Other Compensation274255TotalOtherCompensation
Number Individuals GT100 K13NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations1007901RelatedOrganizations
All Other Contributions136649AllOtherContributions
Total Contributions1144550TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT CARE SERVICESDescription
Business Code621400BusinessCode
Total Revenue Column21692651TotalRevenueColumn
Related Or Exempt Function Income21692651RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue21692651TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column211403TotalRevenueColumn
Exclusion$211,403ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real28555Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real28555Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column28555TotalRevenueColumn
Related Or Exempt Function Income28555RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
WELLNESS REVENUE9000992381523815
MISCELLANEOUS REVENUE9000994611$4,611
COFFEE SHOP REVENUE9000992517$2,517

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column56TotalRevenueColumn
Related Or Exempt Function Income56RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue30999TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column23108158TotalRevenueColumn
Related Or Exempt Function Income21745077RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$218,531ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total189Total
Program Services189ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10664853Total
Program Services10664853ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total658564Total
Program Services658564ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4939588Total
Program Services4939588ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total950294Total
Program Services950294ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total20050Total
Management And General20050ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1350455Total
Program Services1350455ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total56132Total
Program Services56132ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total357557Total
Program Services343493ProgramServices
Management And General14064ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total410565Total
Program Services410565ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total133932Total
Program Services87962ProgramServices
Management And General45970ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total573320Total
Program Services573320ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total5040Total
Management And General5040ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
BAD DEBTS355538355538
LICENSES & FEES4501545015
DUES & SUBSCRIPTIONS3499534995
REPAIRS & MAINTENANCE3491234912
TRAINING & DEVELOPMENT2890728907

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total61158Total
Program Services61158ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total20681064Total
Program Services20595940ProgramServices
Management And General85124ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1240998BOY
EOY1143931EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6519568BOY
EOY5932971EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3292109BOY
EOY3400965EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY9210BOY
EOY6460EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis14025165LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7947816LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4746411BOY
EOY6077349EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY186689BOY
EOY236429EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2416365BOY
EOY4474887EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY18411350BOY
EOY21272992EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1264233BOY
EOY1589781EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY271852BOY
EOY380852EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1536085BOY
EOY1970633EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY15809467BOY
EOY17040837EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1065798BOY
EOY2261522EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16875265BOY
EOY19302359EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18411350BOY
EOY21272992EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2427094ReconcilationRevenueExpenses
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 Basis8503982OtherCostOrOtherBasis
Depreciation5510790Depreciation
Book Value2993192BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis488581OtherCostOrOtherBasis
Depreciation117681Depreciation
Book Value370900BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2267378OtherCostOrOtherBasis
Depreciation1394788Depreciation
Book Value872590BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2765224OtherCostOrOtherBasis
Depreciation924557Depreciation
Book Value1840667BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6077349TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM AFFILIATES4473607
EMPLOYEE LOANS1280
FieldValueIRS element (for citing)
Total Book Value Other Assets4474887TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO THIRD PARTIES REIMBURSEMENT AGENCIESDescription
Amount$380,852Amount
FieldValueIRS element (for citing)
Total Of Amounts380852TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationASC 740-10, UNCERTAIN TAX POSITIONS, PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THIS INTERPRETATION ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, AND DISCLOSURE REQUIREMENTS FOR UNCERTAIN TAX POSITIONS. MANAGEMENT HAS EVALUATED THE IMPLICATIONS OF ASC 740-10 AND DETERMINED THAT ITS IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS IS NOT SIGNIFICANT.Explanation

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)
Persons Served56PersonsServed
Total Community Benefit Expense87594TotalCommunityBenefitExpense
Net Community Benefit Expense87594NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served1568PersonsServed
Total Community Benefit Expense1064467TotalCommunityBenefitExpense
Net Community Benefit Expense1064467NetCommunityBenefitExpense
Percent Of Total Expense0.05150PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served1624PersonsServed
Total Community Benefit Expense1152061TotalCommunityBenefitExpense
Net Community Benefit Expense1152061NetCommunityBenefitExpense
Percent Of Total Expense0.05570PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served2275PersonsServed
Total Community Benefit Expense80829TotalCommunityBenefitExpense
Net Community Benefit Expense80829NetCommunityBenefitExpense
Percent Of Total Expense0.00390PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served31PersonsServed
Total Community Benefit Expense8331TotalCommunityBenefitExpense
Net Community Benefit Expense8331NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Benefit Expense248196TotalCommunityBenefitExpense
Net Community Benefit Expense248196NetCommunityBenefitExpense
Percent Of Total Expense0.01200PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served2306PersonsServed
Total Community Benefit Expense337356TotalCommunityBenefitExpense
Net Community Benefit Expense337356NetCommunityBenefitExpense
Percent Of Total Expense0.01630PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served3930PersonsServed
Total Community Benefit Expense1489417TotalCommunityBenefitExpense
Net Community Benefit Expense1489417NetCommunityBenefitExpense
Percent Of Total Expense0.07200PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Building Expense1650TotalCommunityBuildingExpense
Net Community Building Expense1650NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense1650TotalCommunityBuildingExpense
Net Community Building Expense1650NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$145,882BadDebtExpenseAmount
Amount Reimbursed By Medicare6616356AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5638149CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall978207MedicareSurplusOrShortfall

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 Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

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 35% 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.
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 35% 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. ANALYSIS OF SECONDARY DATA AND KEY INFORMANT DATA HIGHLIGHTS THE NEED FOR DIRECT COMMUNITY MEMBER INPUT INTO CLARIFYING NEEDS. FOCUS GROUPS HAVE BEEN PLANNED FOR JULY 2012 WHICH WILL RECRUIT COMMUNITY MEMBERS TO DISCUSS THEIR IMPRESSIONS OF THE HEALTH CARE SYSTEM IN HARTFORD AND THE NEEDS THAT ARE NOT CURRENTLY BEING ADDRESSED.
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 6: 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 MT. 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.
PART VI, LINE 7: 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 (6 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
07983980500000000147000391640135226200
EDWARD S JOHNSON DDS
02685720350000001432206299032419300
ROLF KNOLL MD
034943206867200014700028619046142300
DONALD STRACESKI
027160004500000015893026315035880800
KATHLEEN M ROCHE
0447879017000000014700025047065762600
DIANNE M BERNIER
1427110000047420109960158449000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINES 4A-BReturnReference
ExplanationEDWARD JOHNSON RECEIVED A SEVERANCE AMOUNT OF $303,627. 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 L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonP ANTHONY GIORGIONamePerson
FieldValueIRS element (for citing)
RelationshipDIRECTORRelationship
Amount Of Transaction0AmountOfTransaction
Description Of TransactionP. ANTHONY GIORGIO IS A DIRECTOR OF CONNECTICUT BANK & TRUST. MT. SINAI REHABILITATION HOSPITAL MAINTAINS A BANKING RELATIONSIP WITH CONNECTICUT BANK & TRUST. ONE THOUSAND CORPORATION, A RELATED ENTITY, LEASES SPACE TO A CBT BRANCH LOCATION.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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.
THE 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 12C
REFER TO PART III OF SCHEDULE J FOR PROCESS.FORM 990, PART VI, SECTION B, LINE 15
A 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 VI, SECTION C, LINE 19
AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: CHRISTOPHER M DADLEZ - 65 HRS. DONALD STRACESKI - 57 HRS. EDWARD S. JOHNSON, DDS - 57 HRS. HOWARD W. ORR, JR. - 2 HRS. JOHN SUISMAN - 2 HRS. KATHLEEN ROCHE, M.S.R.N. - 57 HRS P ANTHONY GIORGIO, PHD - 4 HRS. ROLF KNOLL, M.D. - 57 HRS.FORM 990, PART VII, SECTION A:
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.FORM 990, PART XI, LINE 2C:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 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 STREETHARTFORDCT06105061450170EDUCATES STUDENTS, PERFORMS RESEARCH & PROVIDES SERVICES TO THE COMMUNITYCT501(C)(3)3SAINT FRANCIS CARE0
ONE THOUSAND CORPORATION
1000 ASYLUM STREETHARTFORDCT06105060922325MANAGEMENTCT501(C)(2)ST FRANCIS HOSPITAL & MEDICAL CENTER0
SAINT FRANCIS CARE INC
114 WOODLAND STREETHARTFORDCT06105061491191SUPPORTS HEALTH CARE ORGANIZATIONSCT501(C)(3)11 TYPE 10N/A
SAINT FRANCIS FOUNDATION INC
114 WOODLAND STREETHARTFORDCT06105061008255FUNDRAISINGCT501(C)(3)11 TYPE 1SAINT FRANCIS CARE0
THE CAMILLUS CORPORATION
1000 ASYLUM STREETHARTFORDCT06105061051261SUPPORTS HEALTH CARE ORGANIZATIONSCT501(C)(3)11 TYPE 1SAINT FRANCIS CARE0
SAINT FRANCIS MEDICAL GROUP INC
114 WOODLAND STREETHARTFORDCT06105061450168HEALTH SERVICESCT501(C)(3)3SAINT FRANCIS CARE0
SAINT FRANCIS HOSPITAL & MEDICAL CENTER INC
114 WOODLAND STREETHARTFORDCT06105060646813HOSPITALCT501(C)(3)3SAINT FRANCIS CARE0

Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
COLLABORATIVE LABORATORY SERVICES
114 WOODLAND STREETHARTFORDCT06105061520109LAB SERVICESCTN/A
TOTAL LAUNDRY COLLABORATIVE
114 WOODLAND STREETHARTFORDCT06105208335788LAUNDRY SERVICESCTN/A
MEDWORKS LLC
375 EAST CEDAR STREETNEWINGTONCT06111061490483REHABILITATION SERVICESCTN/A
SFH-FF
1000 ASYLUM AVEHARTFORDCT06105061422973FITNESS MGMTCTN/ARELATED00

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 Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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