2011-08-15T10:10:37-04:00 2010-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2009-10-01 060250773 THE WILLIAM W BACKUS HOSPITAL WILL 8608898331 326 WASHINGTON STREET NORWICH CT 06360 DANIEL E LOHR 2011-07-01 true Michael J Engle 8162216300 2009 2016-02-24 21:20:13Z DAVID WHITEHEAD 326 WASHINGTON STREET NORWICH CT 06360 300631393 false X WWW.BACKUSHOSPITAL.ORG X 1891 CT BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH-QUALITY HEALTHCARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT. 13 9 2116 464 2933580 537401 713612 1527754 259652271 270048715 -2455678 3471412 2668006 1774538 260578211 276822419 83063 81360 0 0 139676198 136363855 0 0 302487 110950609 124070814 250709870 260516029 9868341 16306390 312498408 335457576 199488251 176145231 113010157 159312345 SEE SCHEDULE O false false 204994874 81360 270016974 IN FISCAL YEAR 2010, BACKUS HOSPITAL HAD 11,210 ADMISSIONS, 65,561 EMERGENCY DEPARTMENT VISITS, AND 449,993 OUTPATIENT VISITS. THE HOSPITAL PERFORMED 954 BIRTHS AND 7,453 SAME DAY SURGICAL PROCEDURES. BACKUS PERFORMED 124,214 IMAGING EXAMS, 9,365 MRI EXAMINATIONS, 12,550 PSYCHIATRIC CLINICAL VISITS, AND 9,629 PSYCHIATRIC PARTIAL HOSPITAL VISITS. 204994874 true true false true false false false false true true true true false false false false false false true false true true true true true false false false false false false false false false true false false false false false true true true false true 171 0 true 2116 true true true false false false false true true false false false 13 9 true false false false true true true true true false false true true true true true true true true true false X X DANIEL E LOHR 8608898331 326 WASHINGTON STREET NORWICH CT 06360 DAVID WHITEHEAD 40.0 X X 444582 0 31487 PETER V DISCH 6.0 X X 0 0 0 ROBERT RAMSDELL 6.0 X X 0 0 0 JOSEPH FATONE 6.0 X X 0 0 0 ANTHONY JOYCE 6.0 X X 0 0 0 JOHN F BILDA 2.0 X 0 0 0 STEPHEN T BRIGGS MD 2.0 X 0 0 0 ELIZABETH CONWAY 2.0 X 0 0 0 BERT A COPPOTELLI MD 2.0 X 0 0 0 GRACE JONES PHD 2.0 X 0 0 0 DEBORAH MONAHAN 2.0 X 0 0 0 TODD POSTLER 2.0 X 0 0 0 PATRICIA STUART MD 2.0 X 0 0 0 DANIEL E LOHR 40.0 X 475709 0 45011 MARK SANTAMARIA 40.0 X 356517 0 36124 PETER SHEA 40.0 X 373516 0 41942 SERGIO CASILLAS MD 40.0 X 449616 0 1487 ROBERT SIDMAN MD 40.0 X 391426 0 44725 VICTOR ALEXANDER MD 40.0 X 355752 0 43612 JUAN ESCALON MD 40.0 X 333361 0 38188 DANIEL FAGNANT MD 40.0 X 321984 0 32624 THOMAS P PIPICELLI 0.0 X 780953 0 2215956 DAVID KALLA MD 24.0 X 146845 0 20385 4430261 0 2551541 122 true true false WELLSPRING PARTNERS CONSULTING 1800000 NAVIN HAFTY ASSOC INC CONSULTING 1334060 NORWICH ANESTHESIA ASSOCIATES MEDICAL SERVICES 1010404 DAVITA INC MEDICAL SERVICES 489183 NUANCE TRANSCRIPTION SERV PURCHASE SERVICE 474027 22 60555 1975 733844 731380 4279 1527754 Inpatient 900099 122215357 122215357 Outpatient 900099 101199201 101199201 Emergency Department 900099 43668836 43668836 Lab courier service 621500 2965321 2965321 270048715 2756478 2756478 0 0 1102133 1700268 -598135 -598135 -31741 -566394 22420233 35314 21588538 152075 831695 -116761 714934 714934 21600 60555 39669 -18069 -18069 0 454393 328424 125969 125969 Cafeteria 722320 1062901 1062901 Child care 624410 355497 355497 Purchase discounts 900099 351343 351343 495032 495032 2264773 276822419 267083394 2933580 5277691 71310 71310 10050 10050 0 0 2181240 754683 1426557 0 106997786 94808378 12080025 109383 8074896 7186657 879984 8255 11219641 9985480 1222691 11470 7890292 7022361 859865 8066 0 1680899 1680899 158816 155716 3100 45452 45452 0 100126 100126 24551685 11339853 13206462 5370 154483 113318 41165 38437945 37476425 956630 4890 2883395 445156 2438239 0 5293268 678507 4610362 4399 189952 85375 104412 165 0 49237 37797 11350 90 2933786 2933786 0 16651550 8014259 8637291 3163927 2443084 720843 LAB EXPENSES 4142880 4142880 FOOD/DIETARY 1151732 1044352 107380 MAINTENANCE/SERVICE CONTRACTS 4974557 3859576 1110659 4322 EDUCATION 419229 347946 71113 170 BAD DEBT 14409876 14409876 2678019 717551 1858826 101642 260516029 204994874 55218668 302487 1537978 4239212 56399972 68235460 0 185866 36111295 30758941 203437 153242 3292014 3844330 3925993 4267569 231891916 132769529 98131132 99122387 67243895 123615211 41160106 12632 270843 0 4221743 1022726 312498408 335457576 25902374 25301642 64950000 63125000 0 1236586 108635877 86482003 199488251 176145231 X 102700895 147735382 3447432 4101543 6861830 7475420 113010157 159312345 312498408 335457576 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 45452 true false false 45452 false 4841631 358064 505259 0 378271 5897 5320786 3871631 970000 142089 0 135254 6835 4841631 0.00000 1.00000 0.00000 false false 2229795 2229795 10381267 41471084 31068453 20783898 76545346 33327779 43217567 100633618 68373297 32260321 630806 630806 99122387 0 Tax exempt bond premium, net 757072 DUE TO 3RD PARTY REIMB AGENCIES 15381854 Employee related obligations 57973203 Self-insured prof liability 10514332 Capital lease obligations 1505864 Other liabilities 349678 86482003 276822419 260516029 16306390 3742481 -180767 26434084 29995798 46302188 281364313 3742481 39669 3782150 277582163 180767 -940511 -759744 276822419 262219045 1856698 1856698 260362347 153682 153682 260516029 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE MEANT TO PROVIDE LONG-TERM SUPPORT FOR CAPITAL AND OPERATING PROGRAMS FOR THE HOSPITAL IN ACCORDANCE WITH THE DONOR'S WISHES. UNCERTAIN TAX POSITIONS DISCLOSURE SCHEDULE D, PART X, LINE 2 ASC 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 financial statements is not significant. RECONCILIATION OF CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 K-1 GAIN AND INTEREST (2,316) TRANSFER TO AFFILIATES (73,056) MERGER OF PROPERTIES 1,402,938 INCREASE IN NET ASSETS HELD IN TRUST 134,435 CHANGE IN PENSION FUNDING 24,972,083 ------------ 26,434,084 RECONCILIATION OF REVENUE- OTHER ADJUSTMENTS SCHEDULE D, PART XII, LINE 2D GOLF TOURNAMENT EXPENSES 39,669 RECONCILIATION OF REVENUES- OTHER ADJUSTMENTS SCHEDULE D, PART XII, LINE 4B AUXILIARY INCOME 134,420 K-1 GAIN & INTEREST 2,316 LOSS ON FIXED ASSETS (116,761) RENTAL EXPENSE (1,700,268) TEMPORARILY RESTRICTED INCOME 739,782 ----------- (940,511) RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTS SCHEDULE D, PART XIII, LINE 2D RENTAL EXPENSE 1,700,268 GOLF TOURNAMENT EXPENSE 39,669 LOSS ON FIXED ASSETS 116,761 ----------- 1,856,698 RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTS SCHEDULE D, PART XIII, LINE 4B AUXILIARY EXPENSE 153,682 GOLF TOURNAMENT 82155 60555 21600 0 6857 15351 3411 0 14050 0 82155 60555 21600 0 6857 15351 3411 0 14050 39669 -18069 true true true X 250. true X true true false true true 2830076 279376 2550700 0.01040 41910575 24570741 17339834 0.07050 44740651 24850117 19890534 0.08090 42452 642190 11960 630230 0.00260 1058 193795 140 193655 0.00080 13512 16458860 12178716 4280144 0.01740 121 29967 0 29967 0.00010 46017 0 46017 0.00020 57143 17370829 12190816 5180013 0.02110 57143 62111480 37040933 25070547 0.10200 14538 0 14538 6099 0 6099 7588 0 7588 28225 0 28225 false 6451301 2193451 53432655 70236869 -16804214 X true true WILLIAM W BACKUS HOSPITAL

326 WASHINGTON ST NORWICH CT 06360

X X X BACKUS OUTPATIENT CARE CENTER

111 SALEM TURNPIKE NORWICH CT 06360

OUTPATIENT SERVICES BACKUS OUTPATIENT CENTER

12/19 CASE STREET NORWICH CT 06360

LAB/X-RAY/ MAMMOGRAPHY COLCHESTER BACKUS HEALTH CENTER

163 BROADWAY COLCHESTER CT 06415

RADIOLOGY/LAB/ PRIMARY CARE MONTVILLE BACKUS HEALTH CENTER

80 NORWICH-NEW LONDON TPKE UNCASVILLE CT 06382

RADIOLOGY/LAB/ PRIMARY CARE JEWETT CITY PATIENT SERVICE CENTER

70 MAIN STREET JEWETT CITY CT 06351

LAB PLAINFIELD BACKUS PATIENT SERVICE CENTER

122 PLAINFIELD ROAD MOSSUP CT 06354

LAB/X-RAY/ PRIMARY CARE PAIN MANAGEMENT

112 LAFAYETTE STREET NORWICH CT 06360

PAIN MANAGEMENT INFECTIOUS DISEASE CLINIC

107 LAFAYETTE STREET NORWICH CT 06360

CLINIC MEDICAL OFFICE BUILDING

330 WASHINGTON STREET NORWICH CT 06360

LAB/RADIATION THERAPY LEDYARD BACKUS HEALTH CENTER

743 COLONEL LEDYARD HWY LEDYARD CT 06339

LAB/PRIMARY CARE THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $14,409,876. THE HOSPITAL PROVIDES SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE, SUCH SERVICES ARE NOT REPORTED AS NET REVENUE. THE HOSPITAL'S CHARITY CARE POLICY UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE. FOR PATIENTS WHO DO NOT APPLY OR DO NOT QUALIFY, THE UNCOLLECTED AMOUNTS ARE RECOGNIZED AS BAD DEBT EXPENSE. ESTIMATED COST OF BAD DEBT IS BASED ON THE RATIO OF COST TO CHARGES AS DETERMINED BY HOSPITAL SPECIFIC DATA. THE MEDICARE SHORTFALL WAS NOT INCLUDED IN THE COMMUNITY BENEFIT COST. THE COSTING METHODOLOGY CONSISTED OF INFORMATION FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM AS WELL AS COSTS FROM THE MEDICARE COST REPORT. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE. (A) IN ADDITION TO CONDUCTING ITS OWN RESEARCH, BACKUS HOSPITAL COLLABORATES WITH LOCAL AND REGIONAL HEALTH CARE ORGANIZATIONS TO DETERMINE THE NEED FOR HEALTH-RELATED PROGRAMS AND SERVICES. (B) THE HOSPITAL COMMISSIONED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY HOLLERAN, A PROFESSIONAL RESEARCH FIRM. THE ASSESSMENT CONSISTED OF 1,109 BRFSS TELEPHONE SURVEYS WHICH WERE CONDUCTED THROUGHOUT THE HOSPITAL'S SERVICE REGION (BOTH NEW LONDON AND WINDHAM COUNTIES). THE ASSESSMENT ALSO INCLUDED A DETAILED ANALYSIS OF SECONDARY DATA SOURCES, AS WELL AS TWO COMPREHENSIVE FOCUS GROUPS TO GAIN QUALITATIVE DATA ON IDENTIFIED PRIORITY HEALTH AREAS. THE NEEDS ASSESSMENT WAS PRESENTED AND DISTRIBUTED, AND CAN BE ACCESSED AT WWW.BACKUSHOSPITAL.ORG/HEALTHSURVEY SUBSEQUENTLY THE HOSPITAL HAS DEVELOPED A COMMUNITY NEEDS STRATEGIC PLAN WHICH IDENTIFIES AND OUTLINES TOP PRIORITY HEALTH NEEDS AS DETERMINED BY THE NEEDS ASSESSMENT. PRIORITY HEALTH AREAS INCLUDE OBESITY AND OVERWEIGHT, AUTISM, SMOKING, ALCOHOL AND SUBSTANCE ABUSE, MENTAL HEALTH, CHRONIC LOWER RESPIRATORY DISEASES, AND ACCESS TO HEALTHCARE. THIS PLAN WILL GUIDE THE HOSPITAL'S OUTREACH EFFORTS OVER THE NEXT THREE FISCAL YEARS, AT WHICH TIME A SECOND NEEDS ASSESSMENT WILL BE CONDUCTED TO MEASURE THE HOSPITAL'S PROGRESS. BASED ON THE HOLLERAN SURVEY, THE HOSPITAL PARTNERED WITH THE UNITED WAY OF SOUTHEASTERN CONNECTICUT TO CREATE THE NEW LONDON COUNTY FOOD POLICY COUNCIL, WHICH IS USING THE DATA TO ADDRESS OBESITY AND OTHER FOOD-RELATED ISSUES. (C) THE HOSPITAL INDENTIFIES HEALTH PROBLEMS IN THE COMMUNITY THROUGH INDICATORS AND MEASURES OF HEALTH RISK, DISEASE PREVALENCE, DISEASE MANAGEMENT AND OUTCOMES USING SOURCES SUCH AS BIRTH AND MORTALITY RECORDS, CENSUS DATA, HOSPITAL DISCHARGE RECORDS, CANCER REGISTERY DATA, BEHAVIORAL RISK FACTOR SURVEY DATA, AND OTHER DATASETS. (D) THE HOSPITAL PARTNERS WITH TWO REGIONAL FEDERALLY QUALIFIED HEALTH CENTERS-UNITED COMMUNITY AND FAMILY SERVICES, AND GENERATIONS HEALTHCARE. CASE MANAGERS FROM THE HOSPITAL MEET TO DETERMINE UNMET COMMUNITY NEEDS TO DEVELOP EDUCATIONAL, OUTREACH AND PREVENTATIVE HEALTH PROGRAMS TO MEET THESE NEEDS. (E) THE HOSPITAL CONDUCTS FOLLOW-UP SURVEYS WITH ALL PARTICIPANTS IN ITS FREE EDUCATIONAL PROGRAMS. THE SURVEYS ASSESS PARTICIPANTS SATISFACTION WITH THE PROGRAM, AND SOLICIT INFORMATION ABOUT OTHER NEEDS. (A) NOTIFICATION ABOUT CHARITABLE CARE AND ASSISTANCE PROGRAMS IS AVAILABLE AT ALL REGISTRATION AREAS, ON AND OFF THE MAIN HOSPITAL CAMPUS, IN WAITING AREAS, IN THE PATIENT HANDBOOK, ON OUR WEBSITE, AND ON PROMINENTLY PLACED SIGNS (IN ENGLISH AND SPANISH). ADDITIONALLY, CARE MANAGEMENT SOCIAL WORKERS MEET WITH PATIENTS, FAMILY, CLERGY AND OTHERS AS APPROPRIATE TO DISCUSS ASSISTANCE PROGRAMS AND SERVICES THAT MAY BE AVAILABLE. HERE IS THE INFORMATION FROM OUR WEBSITE: IF YOU DO NOT HAVE HEALTH INSURANCE AND ARE ELIGIBLE FOR A GOVERNMENT SPONSORED HEALTH PROGRAM, OUR ACCESS TO CARE STAFF AT BACKUS HOSPITAL IS AVAILABLE TO HELP YOU THROUGH THE APPLICATION PROCESS. IF YOU QUALIFY, PROGRAMS SUCH AS HUSKY, T-19, AND SAGA MAY HELP YOU WITH ACCESS TO HEALTHCARE AND OTHER VITAL SERVICES FOR YOURSELF AND YOUR FAMILY. IF YOU ARE UNINSURED, AND DO NOT QUALIFY FOR A GOVERNMENT SPONSORED INSURANCE PROGRAM YOU MAY BE ELIGIBLE FOR FREE OR DISCOUNTED SERVICES FROM BACKUS HOSPITAL DEPENDING ON YOUR INCOME LEVEL AND CIRCUMSTANCES. IN ADDITION, EXTENDED PAYMENT PLANS ARE AVAILABLE TO PATIENTS WHO QUALIFY FOR PAYMENT ASSISTANCE AND WHO ARE MAKING GOOD-FAITH EFFORTS TO PAY THEIR BILL. TO GET HELP ENROLLING IN A GOVERNMENT SPONSORED INSURANCE PROGRAM OR TO APPLY FOR CHARITABLE CARE FROM BACKUS HOSPITAL, PLEASE CALL OUR ADVOCATE FOR CHARITABLE CARE AT (860) 889-8331, EXT. 3831 OR CUSTOMER SERVICE AT (860) 823-6394. OUR STAFF WILL WORK WITH YOU TO COMPLETE AN APPLICATION WHICH MUST BE RETURNED WITH INCOME AND RESOURCES INFORMATION. WE LOOK FORWARD TO WORKING WITH YOU TO IMPROVE ACCESS TO CARE FOR YOU AND YOUR FAMILY. (B) THE HOSPITAL PROVIDES TWO ACCESS TO CARE SPECIALISTS (BOTH FIRST AND SECOND SHIFT) IN ITS EMERGENCY DEPARTMENT, WHO PROVIDES FREE INSURANCE ELIGIBILITY SCREENINGS TO UNINSURED CLIENTS SEEKING CARE. THE SPECIALIST WORKS WITH UNINSURED PATIENTS TO CONNECT THEM WITH A PRIMARY MEDICAL HOME, SO THEY CAN RECEIVE PREVENTATIVE CARE, RATHER THAN USING COSTLY EMERGENCY SERVICES FOR ILLNESSES THAT ARE NOT MEDICAL EMERGENCIES. SIGNIFICANT ONE-ON-ONE FOLLOW-UP IS PROVIDED THROUGH PHONE CALLS OR LETTERS TO MAKE APPOINTMENTS TO SCREEN PATIENTS AND HELP THEM FILL OUT APPLICATIONS FOR HUSKY OR STATE ADMINISTRATED GENERAL ASSISTANCE. THE WILLIAM W. BACKUS HOSPITAL IS LOCATED IN NORWICH, 45 MINUTES SOUTHEAST OF HARTFORD. IN THE PAST DECADE, THE REGION HAS UNDERGONE MAJOR ECONOMIC CHANGES, DUE TO THE OPERATION OF TWO NATIVE AMERICAN-OWNED CASINOS - BOTH AMONG THE LARGEST CASINOS IN THE WORLD. THESE GAMBLING AND ENTERTAINMENT VENUES BRING AN AVERAGE OF 40,000 VISITORS INTO THE REGION EACH DAY. THE CASINOS ARE THE LARGEST EMPLOYERS, AND ARE EXPERIENCING LAYOFFS AND CUTBACKS AS THE ECONOMY CONTINUES TO DECLINE. THE HOSPITAL'S PRIMARY SERVICE AREA HAS AN ESIMATED POPULATION OF ABOUT 118,000. THE SECONDARY SERVICE AREA CONSISTS OF LARGER COMMUNITIES, SUCH AS NEW LONDON AND GROTON, AND SMALLER LOWER-DENSITY RURAL COMMUNITIES. THE TOTAL POPULATION OF THE SECONDARY SERVICE AREA IS ABOUT 123,000. THE SERVICE AREAS CONTAIN MUNICIPALITIES IN NEW LONDON AND WINDHAM COUNTIES. THE FASTEST GROWING SEGMENT OF THE REGION'S POPULATION IS THE ELDERLY. FOR THE LAST DECENNIAL CENSUS, THE REGION'S ELDERLY POPULATION GREW AT 10 TIMES THE RATE OF GROWTH FOR THE TOTAL POPULATION. THE REGION'S LACK OF AFFORDABLE HOUSING BEGAN TO EMERGE AS A CRITICAL ISSUE EVEN BEFORE THE ECONOMIC DOWNTURN. HOMELESSNESS IS A GROWING CONCERN, AS THE NUMBER OF MORTGAGE FORECLOSURES GROW. UNEMPLOYEMENT IN THE REGIONAL LABOR MARKET (LATEST AVAILABILITY; MAY 2009) STANDS AT 11.7%, WELL ABOVE THE STATE AVERAGE OF 8.0%. THE REGION ALSO DISPLAYED A SUDDEN EROSION IN ITS HOUSING MARKET. HOME PRICES SANK 12.5% FROM MAY 2008 TO MAY 2009 (THE MOST RECENT DATA AVAILABLE), AND NEW HOUSING PERMITS PLUNGED BY ALMOST TWO-THIRDS - THE WORST RECORD ON BOTH SCORES OF ANY REGION IN THE STATE. SALES OF SINGLE-FAMILY HOMES FELL 18.5% FROM MAY 2008 TO MAY 2009. STATE. SALES OF SINGLE-FAMILY HOMES FELL 18.5% FROM MAY 2008 TO MAY 2009. BACKUS HOSPITAL CONDUCTS AND SPONSORS 9 SUPPORT GROUPS THAT PROVIDE ONGOING EDUCATION AND COUNSELING FOR A WIDE ARRAY OF HEALTH-RELATED ISSUES, FROM INFANT CHILD LOSS TO CANCER. HOSPITAL EMPLOYEES VOLUNTEER THEIR SERVICE ON DOZENS OF COMMUNITY NOT-FOR-PROFIT ORGANIZATIONS, MANY OF WHICH HAS HEALTHCARE AS A PRIMARY OR MAJOR FOCUS. EXAMPLES INCLUDE THE NEW LONDON COUNTY HEALTHCARE COLLABORATIVE, THE HEALTH CARE COUNCIL OF EASTERN CONNECTICUT, THE FOUNDATION OF THREE RIVERS COMMUNITY COLLEGE (WHICH PROVIDES FUNDING FOR NURSING STUDENT EDUCATION AND EQUIPMENT), THE REGION'S NON-PROFIT HOSPICE ORGANIZATION, UNITED WAY OF SOUTHEASTERN CONNECTICUT (WHICH PROVIDES FUNDING FOR MANY REGIONAL HUMAN SERVICES, INCLUDING THOSE THAT ARE HEALTH RELATED); AS WELL AS SERVICE AND BOARD MEMBERSHIPS ON THE REGION'S TWO FEDERALLY QUALIFIED HEALTH CENTERS. ADDITIONALLY, BACKUS PERSONNEL VOLUNTEER ON OTHER BOARDS AND ORGANIZATIONS THAT ADVANCE THE QUALITY OF LIFE AND ECONOMIC WELL-BEING OF THE REGION, INCLUDING THE LOCAL LIBRARY, THE REGIONAL CHAMBER OF COMMERCE, NUMEROUS CIVIC AND GOVERNMENTAL BODIES, AND VARIOUS VOLUNTEER FIRE COMPANIES AND AMBULANCE SERVICES. THE HOSPITAL REGULARLY HOSTS COMMUNITY FORUMS ON HEALTH-RELATED ISSUES, AND WAS A KEY COMMUNITY CONVENER FOR A MULTI-AGENCY EFFORT TO EQUIP ALL LOCAL SCHOOLS WITH AUTOMATED EXTERNAL DEFIBRILLATORS. THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT, AND ITS FINDINGS OF THE PREVELANCE OF OBESITY AS A HEALTH CONCERN, WAS THE CATALYST TO FORMING NEW LONDON COUNTY FOOD POLICY COUNCIL IN PARTNERSHIP WITH THE UNITED WAY. MEMBERS OF THE ADMINISTRATIVE STAFF ROUTINELY SUBMIT GOVERNMENT TESTIMONY ON BEHALF OF REGIONAL NOT-FOR-PROFIT HEALTH-RELATED ORGANIZATIONS, AND PROVIDE RESEARCH AND ADVOCACY FOR THE HEALTHCARE ACCESS. (A) THE HOSPITAL IS GOVERNED BY A VOLUNTEER COMMUNITY BOARD OF DIRECTORS/TRUSTEES. THESE INDIVIDUALS REPRESENT AN ARRAY OF PROFESSIONS AND BACKGROUNDS. (B) THE HOSPITAL HAS 110 CORPORATORS - VOLUNTEER MEMBERS CHOSEN FROM ALL THE COMMUNITIES IN OUR PRIMARY AND SECONDARY SERVICE AREAS. IN ADDITION TO THEIR OFFICIAL CAPACITY AS NOMINATORS OF BOARD MEMBERS, THE CORPORATORS SERVE AS THE HOSPITAL'S EYES AND EARS THROUGHOUT ITS SERVICE AREA. (C) THE HOSPITAL OWNS AND OPERATES A MOBILE HEALTH RESOURCE CENTER - A 40-FOOT VAN THAT TRAVELS TO VARIOUS LOCATIONS IN EASTERN CONNECTICUT OFFERING HEALTH EDUCATION, COUNSELING, AND SCREENINGS. THE VAN MAKES REGULARLY SCHEDULED STOPS AT SENIOR CITIZENS CENTERS, SOUP KITCHENS, ELDERLY HOUSING COMPLEXES AND HOMELESS SHELTERS. NOT-FOR-PROFIT GROUPS ARE ENCOURAGED TO REQUEST THE VAN AND ITS SERVICES AT THEIR FUNCTIONS OR OFFICES. (D) THE HOSPITAL PROVIDES INDIVIDUALS WHO DO NOT IDENTIFY AS HAVING A PRIMARY MEDICAL HOME WITH A FOLLOW UP VISIT POST DISCHARGE TO LINK THESE INDIVIDUALS WITH A PRIMARY CARE PHYSICIAN IN THE COMMUNITY. THIS IS FACILITATED THROUGH MY HEALTH DIRECT PROGRAM, A WEB-BASED TOOL THAT ALLOWS HOSPITAL STAFF TO ACCESS BLOCKED APPOINTMENTS FOR PHYSICIANS IN THE COMMUNITY. FROM 10/1/09 TO 9/30/10, THE HOSPITAL LINKED 398 INDIVIDUALS WITH PRIMARY CARE. (E)THE HOSPITAL PROVIDES FREE COMMUNITY CHOLESTEROL SCREENINGS, DIABETES EDUCATION, BACKPACK SAFETY, HIV EDUCATION/TESTING, BLOOD PRESSURE TESTS, SKIN CANCER SCREENINGS, NUTRITION EDUCATION AND MANY OTHER SERVICES. (F) THE HOPSITAL PROVIDES FREE WEBSITE ACCESS TO COMPLETE AND CURRENT MEDICAL INFORMATION TO ANSWER THEIR CLINICAL QUESTIONS, THROUGH UPTODATE.COM, A PEER-REVIEWED ONLINE MEDICAL REFERENCE. UPTODATE COVERS MORE THAN 7,400 TOPICS IN 13 MEDICAL SPECIALTIES AND INCLUDES MORE THAN 76,000 PAGES OF TEXT, GRAPHICS, LINKS TO MEDLINE ABSTRACTS, MORE THAN 254,000 REFERENCES, AND A DRUG DATABASE. (G) THE HOSPITAL PROVIDES FREE MEDICATION CARDS TO HELP PATIENTS KEEP TRACK OF THEIR CURRENT MEDICATIONS, AND ITS PHARMACISTS OFFER FREE REGULAR MEDICATION REVIEWS TO CHECK FOR POSSIBLE INTERACTIONS AND EXPIRED MEDICATIONS. (H) THE HOSPITAL OFFERS FREE WIRELESS INTERENT (WI-FI) USE THROUGHOUT THE CAMPUS, AND PROVIDES FREE COMPUTER USE TO VISITORS. (I) THE HOSPITAL PUBLISHES A MONTHLY CONSUMER HEALTH MAGAZINE. THE PUBLICATION CONTAINS INFORMATION ABOUT HEALTH ISSUES AND TRENDS, A CALENDAR OF FREE HEALTHCARE EDUCATION AND SCREENINGS, AND CONTACT INFORMATION FOR HEALTHCARE PROVIDERS. 44,000 COPIES ARE DISTRIBUTED MONTHLY. true HOSPICE OF SE CONNECTICUT 222667260 501( C)(3) 8500 CORPORATE BENEFACTOR CHAMBER OF COMMERCE OF SE CT 060475490 501( C)(6) 5405 SPONSORSHIP COMMUNITY FOUNDATION OF THE TRICOUNTY AREA 222897455 501( C)(3) 10000 DEFRIBULATORS AMERICAN HEART ASSOC 135613797 501( C)(3) 15000 SPONSORSHIP 3 1 SCHOLARSHIPS 3 10050 Procedures for Monitoring the use of grant funds in the U.S. Schedule I, Part I, Line 2. DONATIONS MADE FOR LOCAL EVENTS, SUCH AS THE RELAY FOR LIFE AND HEALTH FAIRS, ARE TYPICALLY ATTENDED BY HOSPITAL EMPLOYEES. THREE SCHOLARSHIPS IN THE AMOUNT OF $3,350 EACH ARE AWARDED TO STUDENTS WHO WILL ATTEND SCHOOL EITHER FOR NURSING OR IN THE MEDICAL FIELD. THE APPLICANTS ARE REVIEWED BY THE SCHOLARSHIP COMMITTEE OF THE AUXILIARY AND WINNERS ARE CHOSEN BASED ON ACADEMICS AS WELL AS COMMUNITY SERVICE. X false true X X X X false true false false false false false true false DAVID WHITEHEAD 375897 0 60000 0 8685 0 10234 0 21253 0 476069 0 0 0 DANIEL E LOHR 332246 0 120000 0 23463 0 29715 0 15296 0 520720 0 0 0 THOMAS P PIPICELLI 744737 0 0 0 36216 0 2200661 0 15295 0 2996909 0 0 0 MARK SANTAMARIA 304261 0 45000 0 7256 0 14871 0 21253 0 392641 0 0 0 PETER SHEA 344723 0 25000 0 3793 0 20689 0 21253 0 415458 0 0 0 DAVID KALLA MD 146486 0 0 0 359 0 0 0 20385 0 167230 0 0 0 SERGIO CASILLAS MD 449616 0 0 0 0 0 0 0 1487 0 451103 0 0 0 ROBERT SIDMAN MD 298320 0 93106 0 0 0 23392 0 21333 0 436151 0 0 0 VICTOR ALEXANDER MD 288091 0 67661 0 0 0 22309 0 21303 0 399364 0 0 0 JUAN ESCALON MD 333361 0 0 0 0 0 16500 0 21688 0 371549 0 0 0 DANIEL FAGNANT MD 253908 0 68076 0 0 0 11464 0 21160 0 354608 0 0 0 GROSS-UP PAYMENTS SCHEDULE J, PART I, LINE 1A THE FORMER PRESIDENT RECEIVED GROSS-UP PAYMENTS ON SELECTED EXPENSES PROPERLY INCLUDED IN HIS W-2 WAGES. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS SCHEDULE J, PART I, LINE 4B DAVID WHITEHEAD, DANIEL E LOHR AND PETER SHEA PARTICIPATE IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, HOWEVER THERE WERE NO ACCRUALS OR CONTRIBUTIONS THAT WERE MADE TO THE PLAN DURING THE REPORTING PERIOD. THOMAS P PIPICELLI $2,160,980 NON-FIXED PAYMENTS SCHEDULE J, PART 1, LINE 7 BONUSES ARE BASED ON THE EVALUATION OF AN INDIVIDUAL'S PERFORMANCE AND ACCOMPLISHMENT OF GOALS SET AT THE BEGINNING OF THE YEAR BY AN INDEPENDENT COMPENSATION COMMITTEE. RETIREMENT AND OTHER DEFERRED COMPENSATION EXPLANATION SCHEDULE J, PART II, COLUMN C COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS GENERALLY REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS PAID TO THE INDIVIDUAL. AS A RESULT OF THE REPORTING REQUIREMENT, AN ORGANIZATION COULD BE REQUIRED TO REPORT THE SAME COMPENSATION ON FORM 990 IN TWO DIFFERENT YEARS. STATE OF CT HEALTH & EDUCATIONAL FACILITIES 060806186 20774LSV3 2005-08-10 28992719 SEE SCHEDULE O false false STATE OF CT HEALTH & EDUCATIONAL FACILITIES 060806186 20774UC86 2008-07-02 30168922 SEE SCHEDULE O false false 28992719 775086 16750062 369723 10514252 2008 false true true true 30168922 0 30100000 68922 0 2008 true false true true false false false false true 0.00000 0.00000 0.00000 true false false false false true 0.00000 0.00000 0.00000 true false false false false false true true true UBS AG 29.9 false false false SEE SCHEDULE O ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 & PART III, LINE 1 THE WILLIAM W. BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH QUALITY HEALTH CARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT. THE HOSPITAL IS COMMITTED TO BEING RESPONSIVE AND ACCOUNTABLE TO THOSE FOR WHOSE BENEFIT IT EXISTS, AND TO IMPROVING THE HEALTH OF ITS COMMUNITIES. BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 DAVID WHITEHEAD, DANIEL E LOHR, PETER V DISCH AND PETER SHEA HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVE AS AN OFFICER OR DIRECTOR FOR CONNCARE, INC. OR WWB CORPORATION, WHICH ARE RELATED FOR PROFIT COMPANIES. MEMBERS FORM 990, PART VI, SECTION A, LINE 6 BACKUS CORPORATION, A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF THE WILLIAM W. BACKUS HOSPITAL. MEMBERS WHO MAY ELECT THE GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A BACKUS CORPORATION, BEING THE SOLE MEMBER OF THE WILLIAM W. BACKUS HOSPITAL, HAS THE RIGHT TO ELECT ALL THE BOARD OF TRUSTEES. DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PART VI, SECTION A, LINE 7B THE ADMINISTRATIVE POWERS OF THE HOSPITAL SHALL BE VESTED IN THE BOARD OF TRUSTEES WHO SHALL HAVE CHARGE, CONTROL AND MANAGEMENT OF THE PROPERTY, AFFAIRS AND FUNDS OF THE HOSPITAL, SHALL BE RESPONSIBLE FOR THE DELIVERY AND MAINTENANCE OF QUALITY PATIENT CARE, THE PROMOTION OF QUALITY IMPROVEMENT, OVERSIGHT OF RISK MANAGEMENT ACTIVITIES, AND WHICH SHALL HAVE THE POWER AND AUTHORITY TO DO AND PERFOM ALL ACTS AND FUNCTIONS NOT INCONSISTENT WITH THE BYLAWS. THE BOARD OF TRUSTEES SHALL MAKE ALL POLICIES AND RULES THAT GOVERN THE HOSPITAL AND SHALL PROVIDE FOR THE ABILITY OF HOSPITAL LEADERSHIP TO ESTABLISH AND IMPLEMENT POLICIES AND TO PROVIDE NECESSARY RESOURCES. 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11A THE 990 IS PREPARED BY THE ACCOUNTING STAFF AND THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN REVIEWED BY THE CFO AND ANY QUESTIONS OR CONCERNS THE CFO MAY HAVE ARE ADDRESSED. THE FINANCE COMMITTEE OF THE BOARD WILL THEN REVIEW THE 990 AND ANY QUESTIONS OR CONCERNS THE FINANCE COMMITTEE HAVE ARE ADDRESSED. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C ALL TRUSTEES, OFFICERS, AND KEY EMPLOYEES OF THE HOSPITAL SHALL COMPLETE AND SIGN A DISCLOSURE STATEMENT. THE STATEMENT WILL INCLUDE AN ITEMIZATION AND DESCRIPTION OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND ALL MATERIAL FACTS RELATED THERETO FOR SUCH TRUSTEE, OFFICER, OR KEY EMPLOYEE BY VIRTUE OF HIS OR HER ACTIVITIES OR THE ACTIVITIES OF RELATED PERSONS. TRUSTEES, OFFICERS, AND KEY EMPLOYEES ARE URGED TO BE INCLUSIVE IN THIS DISCLOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST IS ESSENTIAL TO ENSURING DISCUSSION OF CONFLICT. DISCLOSURE STATEMENTS SHALL BE RETURNED TO THE CORPORATE COMPLIANCE OFFICER. ALL DISCLOSURES MADE WILL BE REVIEWED BY THE COMPLIANCE OFFICER, UNDER THE DIRECTION OF THE CHAIR AND THE PRESIDENT, WHO SHALL EXERCISE GOOD FAITH JUDGEMENT AS TO WHETHER A CONFLICT EXISTS. THE CHAIR AND THE PRESIDENT SHALL BE RESPONSIBLE FOR MONITORING TRANSACTIONS OR ARRANGMENTS IN WHICH A TRUSTEE, OFFICER, OR KEY EMPLOYEE MAY HAVE A CONFLICT OF INTEREST AND FOR ASSURING THAT THE TRUSTEE, OFFICER, OR KEY EMPLOYEE SERVES THE HOSPITAL'S BEST INTERESTS. THE COMPLIANCE OFFICER, THE CHAIR AND/OR PRESIDENT MAY CONSULT WITH ANY TRUSTEE, OFFICER, OR KEY EMPLOYEE AND OBTAIN INFORMATION NECESSARY FOR AN ORDINARILY PRUDENT PERSON TO MAKE A JUDGMENT AS TO WHETHER A CONFLICT EXISTS AND EACH TRUSTEE, OFFICER, AND KEY EMPLOYEE SHALL COOPERATE WITH SUCH REQUESTS. THE COMPLIANCE OFFICER, THE CHAIR, AND/OR THE PRESIDENT SHALL PROVIDE GUIDANCE TO THE TRUSTEE, OFFICER, OR KEY EMPLOYEE AND TO THE BOARD OF TRUSTEES AS TO THE APPRORIATE COURSE OF ACTION. WHEN DEEMED PRUDENT BY THE CHAIR OR THE PRESIDENT, THE CHAIR AND THE PRESIDENT SHALL SEEK THE ADVICE AND APPROVAL OF THE FULL BOARD OF TRUSTEES OR GOVERNANCE COMMITTEE IN DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS AND THAT THE TRUSTEE, OFFICER, OR KEY EMPLOYEE SERVES THE HOSPITAL'S BEST INTERESTS. IF, AFTER COMPLETING AND SIGNING THE ANNUAL DISCLOSURE STATEMENT, AN ACTUAL OR POTENTIAL CONFLICT ARISES, THE TRUSTEE, OFFICER, OR KEY EMPLOYEE WITH THE CONFLICT SHALL PROMPTLY NOTIFY THE COMPLIANCE OFFICER IN WRITING. TRUSTEES, OFFICERS, AND KEY EMPLOYEES WHO HAVE DECLARED OR HAVE BEEN DEEMED TO HAVE A CONFLICT OF INTEREST MUST REFRAIN FROM CONSIDERATION OF PROPOSED TRANSACTIONS OR ARRANGMENTS, UNLESS FOR SPECIAL REASON THE BOARD OF TRUSTEES REQUESTS INFORMATION OR INTERPRETATIONS. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B A PERFORMANCE REVIEW COMMITTEE CONSISTING OF INDEPENDENT BOARD MEMBERS REVIEWS THE PERFORMANCE OF THE SENIOR MANAGEMENT TEAM. COMPENSATION IS BASED ON THE RESULTS OF THESE REVIEWS. THE COMMITTEE ALSO TAKES INTO CONSIDERATION INFORMATION FROM COMPENSATION SURVEYS. JOINT VENTURES FORM 990, PART VI, SECTION B, LINE 16B ALL NEW VENTURES ARE REVIEWED BY OUTSIDE COUNSEL AND PRESENTED TO THE BOARD FOR REVIEW AND APPROVAL. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PLEASE CONTACT DANIEL E LOHR AT 326 WASHINGTON STREET, NORWICH, CT, 06360, ABOUT INSPECTING THE ORGANIZATION'S DOCUMENTS. AVERAGE HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, LINE 1A AVG HOURS WORKED FOR RELATED ORGANIZATIONS ---------------------- DAVID WHITEHEAD 14 DANIEL E LOHR 18 PETER V DISCH 1.25 ROBERT RAMSDELL 1 JOSEPH FATONE 1 ANTHONY JOYCE 1 JOHN F BILDA 1 STEPHEN T BRIGGS, MD 1 ELIZABETH CONWAY 1 BERT A COPPOTELLI, MD 1 GRACE JONES, PHD 1 DEBORAH MONAHAN 1 TODD POSTLER 1 PATRICIA STUART, MD 1 PETER SHEA .25 THOMAS P PIPICELLI 10 TAX-EXEMPT BONDS SCHEDULE K, PART I A-(F)- ADVANCE REFUND SERIES D/ FINANCE A PORTION OF THE COST OF THE PROJECT. B-(F)- CONSTRUCTION, RENNOVATION, AND IMPROVEMENTS TO THE FACILITY PURSUANT TO THE FACILITY MASTER PLAN BUSINESS TRANSACTION INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV TRANSACTION 1 (A) CONNCARE, INC. (B) DAVID WHITEHEAD, DANIEL E LOHR, PETER V DISCH AND PETER SHEA ARE OFFICERS, TRUSTEES, DIRECTORS AND/OR KEY EMPLOYEES OF THE WILLIAM W. BACKUS HOSPITAL(WWBH) AND CONNCARE, INC. (CI) (C)/(D) $4,327,890 REIMBURSEMENTS PAID BY CI TO WWBH $ 133,914 PERFORMANCE OF SERVICES BY WWBH FOR CI $ 214,184 LEASE FACILITIES AND EQUIPMENT TO CI BY WWBH $ 71,348 TRANSFER OF ASSETS TO CI FROM WWBH (E) NO BACKUS FOUNDATION INC 326 WASHINGTON ST NORWICH CT 06360 222481795 FUNDRAISING CT 501( C)(3) 7 NA BACKUS HEALTHCARE INC 326 WASHINGTON ST NORWICH CT 06360 222481794 SUPPORT CT 501( C)(3) PF NA BACKUS PROPERTIES INC 326 WASHINGTON ST NORWICH CT 06360 222767730 TITLE HOLDING CT 501( C)(2) NA BACKUS CORPORATION 326 WASHINGTON ST NORWICH CT 06360 222757608 SUPPORT CT 501( C)(3) 11b N/A OMNI HOME HEALTH SERVICES OF EASTERN CT NORWICH CT 06360 NORWICH CT 06360 061458837 HOME HEALTH CARE CT NA N/A 0 0 0 WWB CORPORATION 326 WASHINGTON ST NORWICH CT 06360 061094838 HOLDING COMPANY CT NA C CORP 0 0 0.00000 CONNCARE INC 326 WASHINGTON ST NORWICH CT 06360 061387598 HEALTH CARE SRVCS CT NA C CORP 0 0 0.00000 BACKUS MEDICAL CENTER CONDO ASSOC INC 330 WASHINGTON ST NORWICH CT 06360 061542647 CONDO ASSOCIATION CT NA C CORP 0 0 0.69000 false true false false false false false true true false true true false true false true false true BACKUS PROPERTIES INC R 1402938