2011-08-17T11:38:44-05:00 2010-09-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2009-10-01 061137531 Danbury Office of Physician Services DANB 2037318707 95 Locust Avenue Danbury CT 06801 Doug Magazu 2011-08-17 3176817000 2009 2016-02-24 21:20:13Z Patrick Broderick 95 LOCUST AVENUE DANBURY CT 06810 131772400 false X N/A X 1985 CT OUR MISSION AT DOPS INCLUDES THE PROVISION OF HIGH QUALITY HEALTH CARE TO ALL PERSONS WHO COME TO OUR PHYSICIANS' OFFICES, TO DANBURY HOSPITAL AND TO WESTERN CONNECTICUT HEALTH NETWORK AFFILIATES. 8 0 779 0 31757 -61053 0 0 120933280 131101845 70363 17977 614981 304833 121618624 131424655 0 0 0 0 99149290 109233555 0 0 0 22393926 26993840 121543216 136227395 75408 -4802740 25498892 24242470 22028756 25575074 3470136 -1332604 OUR MISSION AT DOPS INCLUDES THE PROVISION OF HIGH QUALITY HEALTH CARE TO ALL PERSONS WHO COME TO OUR PHYSICIANS' OFFICES, TO DANBURY HOSPITAL AND TO WESTERN CONNECTICUT HEALTH NETWORK AFFILIATES. false false 48115199 33923387 Medicine Sub specialty is comprised of 73 full and part time physicians serving the greater Western Connecticut area and representing the following medicine subspecialties; Cardiology Gastroenteritis Pulmonary Physical Medicine Infectious Disease Oncology Rheumatically Hospitality services Nephridia The specialty offices are located in Danbury, Ridgepiece, New Milford and Southbury. 23618593 18238907 The Primary Care Division of DOPS has 35 full and part-time physicians located in several towns across Western Connecticut and Eastern New York providing medical services. Primary Care Offices are located in; Danbury, CT Brewster, NY Southbury, CT Brookfield, CT Ridgefield, CT New Milford, CT New Fairfield, CT 17923733 16970638 Anesthesiology is comprised of 46 full and part-time physicians as well as CRNA's. The department has two sites located in Danbury and Ridgefield providing medical services. 34965896 62241989 124623421 true false false true false false false false false true true false false false false false false false false false false false false true false false false false false false false false false false false false false true true false false true 215 0 true 779 true true true false false false false false false false false 8 0 false false false false true false false true true false false true true true true true true true true false X DOUGLAS MAGAZU 2037977218 95 LOCUST AVENUE DANBURY CT 06801 PATRICK BRODERICK 50.0 X X 486259 0 7331 MATTHEW MILLER 2.0 X 572408 0 31752 CHARLES HERRICK 50.0 X 428952 0 9749 PIERRE SALDINGER 50.0 X X 689212 0 8121 RAMON KRANWINKEL 50.0 X 649844 0 6821 MARTIN SERRINS 50.0 X X 675628 0 8238 PATRICIA TIETJEN 50.0 X 622226 0 1246 RAUL ARGUELLO 50.0 X 390598 0 5251 DOUG MAGAZU 50.0 X 242103 0 264 EDWARD KUSHMEREK 50.0 X 311770 0 3379 ALAN DIETZEK 50.0 X 1031260 0 8556 HAL WASSERMAN 50.0 X 765907 0 5056 Scott Estrabrook 50.0 X 717612 0 8241 CARY PASSIK 50.0 X 729387 0 7096 JOSEPH FIORITO 50.0 X 715546 0 3494 9028712 0 114595 228 false true false GE HEALTHCARE PO BOX 277475 ATLANTA GA 30384 HEALTHCARE BILLING 734315 MMRI PO BOX 2000 EAST SYRACUSE NY 13057 HEALTHCARE BILLING 1047066 WOMENS HEALTH SERVICES 90 LOCUST AVE DANBURY CT 06801 PHYSICIAN FEES 517333 CREDIT CENTER INC A/R COLLECTIONS 379001 ALLSCRIPTS 8529 SIX FORKS ROAD RLEIGH NC 27615 COMPUTER INTEGRATION 1461851 13 0 MEDICAL REVENUE 621110 131101845 131101845 131101845 17977 17977 0 0 340199 340199 0 0 0 39303 7546 31757 31757 REIMBURSE PROVIDER CONT 621610 190050 190050 MEDICAL RECORDS 900003 83026 83026 273076 131424655 131374921 31757 17977 0 0 0 0 8926780 8343209 583571 0 83226941 79254154 3972787 5036832 4716276 320556 7802360 6924570 877790 4240642 3974652 265990 0 183390 183390 100147 100147 0 0 0 6524694 2824578 3700116 108150 108150 2574342 2455819 118523 200003 179267 20736 0 4665464 4343687 321777 389621 356652 32969 0 0 55979 55979 0 880195 734746 145449 3289957 2932128 357829 BAD DEBT 5431473 5431473 WORKING CAPITAL 816876 816876 MEMBERSHIP DUES 482427 436115 46312 MAINTENANCE CONTRACTS 239753 239753 OTHER EXPENSES 234729 47109 187620 816640 448228 368412 136227395 124623421 11603974 0 5051 5257 7305171 3583516 8675380 10614681 231144 186591 87789 119335 12739409 6484980 4473053 6254429 254041 191177 4467263 3287484 25498892 24242470 7791892 8836272 268657 763426 1020470 917010 12947737 15058366 22028756 25575074 X 1000 1000 3469136 -1333604 3470136 -1332604 25498892 24242470 X true true true X false X 25176 143640 160329 329145 98711602 109544284 116231509 121548488 131374921 577410804 98736778 109687924 116391838 121548488 131374921 577739949 0 0 0 0 0 0 577739949 401622 429692 488325 457479 358176 2135294 401622 429692 488325 457479 358176 2135294 99138400 110117616 116880163 122005967 131733097 579875243 0.99632 0.99630 0.00368 0.00370 X false false false false true 7392 false false false false false 7392 false false PART II-B, LINE 1I- OTHER ACTIVITIES DESCRIPTION THE DOLLARS RELATED TO LOBBYING ACTIVITIES REPRESENTS APPROXIMATELY 1.5% OF THE TOTAL MEMBERSHIP DUE EXPENDITURES. ALL LOBBYING DOLLARS ARE A PORTION OF MEMBERSHIP DUES PAID. 280724 224305 56419 7571888 4108941 3462947 4886797 2151734 2735063 6254429 457B ASSET 2202830 CASH VALUE LIFE INSURANCE 1008912 DANBURY HOSPITAL RECEIVABLE -1538 DHCC RECEIVABLE 6911 NEW MILFORD RECEIVABLE 13500 RESEARCH RECEIVABLE 8150 SOUTHBURY RENT RECEIVABLE 48719 3287484 0 I/C DANBURY HOSPITAL 15058363 ROUNDING 3 15058366 131424655 136227395 -4802740 -4802740 131764854 340199 340199 131424655 131424655 136567594 340199 340199 136227395 136227395 PART X- FIN 48 FOOTNOTE There was no change since FIN 48 was adopted in a previous year, therefore there is no FIN 48 footnote in the audited financial statements. PART XII, LINE 2D reclass of rental expenses netted with revenue - 340,199 PART XIII, LINE 2D reclass of rental expenses netted with revenue - 340,199 X true true false true false false false false true true false PATRICK BRODERICK 335374 0 126044 0 24841 0 0 0 7331 0 493590 0 0 0 MATTHEW MILLER 422350 0 125000 0 25058 0 10200 0 21552 0 604160 0 0 0 DOUG MAGAZU 185673 0 40015 0 16415 0 0 0 264 0 242367 0 0 0 CHARLES HERRICK 315869 0 95000 0 18083 0 0 0 9749 0 438701 0 0 0 PIERRE SALDINGER 546635 0 140000 0 2577 0 0 0 8121 0 697333 0 0 0 RAMON KRANWINKEL 459576 0 120000 0 70268 0 0 0 6821 0 656665 0 0 0 MARTIN SERRINS 497086 0 150000 0 28542 0 0 0 8238 0 683866 0 0 0 PATRICIA TIETJEN 471266 0 125000 0 25960 0 0 0 1246 0 623472 0 0 0 RAUL ARGUELLO 283831 0 90000 0 16767 0 0 0 5251 0 395849 0 0 0 ALAN DIETZEK 709102 0 277676 0 44482 0 0 0 8556 0 1039816 0 0 0 EDWARD KUSHMEREK 236732 0 50000 0 25038 0 0 0 3379 0 315149 0 0 0 HAL WASSERMAN 623525 0 115076 0 27306 0 0 0 5056 0 770963 0 0 0 Scott Estrabrook 393892 0 305111 0 18609 0 0 0 8241 0 725853 0 0 0 CARY PASSIK 579203 0 107000 0 43184 0 0 0 7096 0 736483 0 0 0 JOSEPH FIORITO 433784 0 256570 0 25192 0 0 0 3494 0 719040 0 0 0 PART I, LINE 1A RELEVANT INFORMATION REGARDING COMPENSATION BENEFITS The following individuals 2009 W-2 wages reflected tax gross up amounts related to prior year SERP payouts and was governed by its own agreement: Matthew A. Miller, MD $186,758 PART I, LINE 3 ESTABLISHMENT OF COMPENSATION The organization relied on a related organization, Western Connecticut Healthcare, Inc. which used the following methods to establish top management's compensation: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, approval by board or compensation committee. With regard to how the organization determines compensation for its CFO and Executive Director; the job description and compensation parameters are reviewed by the Health System's Human Resource department as well as a third party consultant. The findings are presented to the DOPS Board of Directors and the Health Systems Governance Committee for review and approval. PART I, LINE 4B Supplemental non-qualified retirement plan The following individuals 2009 W-2 wages reflected tax gross up amounts related to prior year SERP payouts and was governed by its own agreement: Matthew A. Miller, MD $186,758 PART I, LINE 6B Compensation Contingent On Net Earnings Or Related Organization Summary of Executive Incentive Plan (Excerpts From) The Plan will be administered subject to the Board policy on Executive Compensation by the Committee on Governance serving as the Executive Compensation Committee (the Committee) of the Board of Directors of Danbury Health Systems. The Committee may in its sole discretion interpret the Plan, prescribe any rules and regulations necessary or appropriate for administration of the Plan, and make such other determinations and take such action as it deems necessary or advisable. The Plan year will begin October 1, 2009, and end September 30, 2010. The measurement period for award purposes will be the same. Eligibility to participate in the Plan will be limited to those who are in positions in which their decisions, actions and counsel significantly affect the operations of Danbury Health System and its subsidiaries, as determined by the Committee and with input provided by Senior management. Prior to the start of each Plan year, or as soon as practicable thereafter, the Committee, with input provided by senior management, will determine which eligible individuals will participate in the Plan with respect to such Plan year. In determining which eligible individuals will participate, the Committee will take into account the extent to which eligible individuals are in positions in which their decisions, actions and counsel significantly affect the overall performance of Danbury Health System and its affiliates. To be considered for participation, an individual must be in an incentive eligible position for no less than 6 months of the respective Plan year. Incentive awards will be prorated as appropriate to reflect partial Plan year participation. Eligible individuals must be employed by Danbury Health Systems at the time of executive incentive award distribution. The Committee will establish the target award opportunity (expressed as a percentage of base salary) for each participant in the Plan. The target award is the amount paid to participants for actual performance that meets expectations. To recognize a range of performance above and below the "target" level, participants may earn one-half to one and one-half times the target award opportunities based on actual performance. A threshold of performance must be achieved in order for participants to earn awards. Prior to the beginning of each Plan year, or as soon thereafter as practicable, weightings for the nature of each participant's stated goals and responsibilities (i.e., organizational, functional/individual, etc.). Prior to the beginning of each Plan year, or as soon thereafter as practicable, performance measures and performance levels will be established for each participant in the Plan. Incentive awards will be modified or eliminated if at the level of performance specified in the circuit breaker is not achieved. If EBITDA is less than basic, could result in as much as 50% reduction in overall award. If EBITDA is less than 8%, full elimination of incentive award. Notwithstanding any other provision of the Plan, incentive awards can be affected by an individual modifier (based on individual executive performance) at the level specified. PART I, LINE 7 NON-FIXED PAYMENTS NOT LISTED FOR NON-BOARD MEMBERS, THE INCENTIVE COMPENSATION (IC) IS MADE UP OF BOTH FIXED AND NON-FIXED PAYMENTS. IC IS BASED ON RVU PRODUCTION, FIXED PAYMENTS, AS WELL AS A 20% WITHHOLD, NON-FIXED. FORM 990, PART I, LINE 3 There are no independent trustees due to compensation paid to trustees for their services as physicians rather than for their board service. However, the organization is part of an integrated healthcare delivery system of entities which have community boards. FORM 990, PART III, LINE 4D Other Program Services These programs include inpatient and outpatient Psychiatry, Surgical services, Emergency Room, inpatient and outpatient Pediatrics and Pathology. FORM 990, PART VI, LINE 6 Explanation of Classes of Members or Shareholder Danbury Office of Physician Services is a stock corporation with stock issued to its physician membership. FORM 990, PART VI, LINE 11 FORM 990 REVIEW PROCESS All Federal and State returns are reviewed by the Chief Financial Officer and Executive Director and are presented to the Board of Directors before they are filed. In addition, DOPS uses an outside accounting firm to perform a review on all returns. FORM 990, PART VI, LINE 12C Explanation of Monitoring and Enforcement of Conflicts The Organization regularly and consistently monitors and enforces compliance with the conflict of interest policy by requiring all physicians and Management to sign a conflict of interest disclosure. The documents are then reviewed by the Compliance Committee. If the Board or committee has reasonable cause to believe that a Representative has failed to disclose a personal or outside interest that could constitute a conflict of interest, it shall inform the Representative of the basis for that belief and give the Representative an opportunity to explain the alleged failure to disclose. If, after hearing the response of the Representative and making such further investigation as may be warranted in the circumstances, the Board or committee determines that the Representative has in fact failed to disclose a personal or outside interest that could constitute a conflict of interest, the Board shall take appropriate disciplinary and corrective action. Disciplinary action may result in termination of employment or the refusal of DOPS to defend the employee with a matter that was not disclosed but otherwise may have been eligible to be defended by DOPS. FORM 990, PART VI, LINE 15A & 15B Compensation Review & Approval Process for Officers & Key Employees Compensation for the Executive Director and CFO positions, Edward Kusmerek and Douglas Magazu, respectively, are reviewed and based on outside market data from a third party vendor. The review was last performed in 2009 while searching for a candidate to fill the Executive Director position. Compensation is further reviewed by the Human Resources Department and the DOPS Board of Directors. FORM 990, PART VI, LINE 19 Other Organization Documents Publicly Available The Organization makes its governing document, conflict of interest policy and financial statements available to the public upon request by contacting the Administrative Office. FORM 990, PART VII HOURS EXPLANATION Matthew A. Miller, MD is paid by Danbury Office of Physician Services for the services he provides to a related organization DANBURY HOSPITAL 24 HOSPITAL AVE DANBURY CT 06801 060646597 HEALTHCARE CT 501(C)3 3 NA WESTERN CONNECTICUT HEALTHCARE INC 95 LOCUST AVENUE DANBURY CT 06810 222594977 PROGRAM DEVEL CT 501(C)3 11 TYPE 2 NA DANBURY HEALTH CARE AFFILIATES 95 LOCUST AVE DANBURY CT 06801 222594968 OUTPATIENT CT 501(C)3 9 NA DANBURY HOSPITAL DEVELOPMENT FUND 24 Hospital Ave DANBURY CT 06801 237425557 SOLICITING CT 501(C)3 7 NA DANBURY VISITING NURSE ASSOC INC 4 Liberty Street DANBURY CT 06810 060655138 HOME HLTHCRE CT 501(C)3 9 NA REGIONAL HOSPICE OF WESTERN CONNECTICUT 405 MAIN STREET DANBURY CT 06810 061178847 PATIENT CARE CT 501(C)3 7 NA NEW MILFORD HOSPITAL 21 ELM STREET DANBURY CT 06776 060669121 ACUTE CARE CT 501(C)3 3 NA MEDICAL SERVICES OF DANBURY 24 HOSPITAL AVE DANBURY CT 06811 061635945 HEALTHCARE CT NA C CORP 0 0 1.00000 false false false false false false false false false true true true false true true false false true DANBURY HOSPITAL j 129996 DANBURY HOSPITAL l 647501 DANBURY HOSPITAL k 34585236 DANBURY HOSPITAL n 895145 DANBURY HOSPITAL o 5590539 DANBURY HOSPITAL r 38803717