TY 2011 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
EXECUTIVE HEALTH RESOURCES	CONSULTING	799,847
ALLIANCE HEALTHCARE SERVICES	MEDICAL SERVICES	3,204,696
HURON CONSULTING GROUP	CONSULTING	3,308,146
YALE NH HOSPITAL	MEDICAL SERVICES	2,255,899
NAVIN HAFTY ASSOCIATES	CONSULTING	571,116
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 35

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	740,184	740,184
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	12,500	12,500
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	5,580,387	587,917	4,992,470
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	108,559,950	97,665,139	10,798,732	96,079
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	9,850,231	8,865,208	985,023
9	Other employee benefits .......	13,862,551	12,476,296	1,386,255
10	Payroll taxes ...........	8,295,378	7,465,840	829,538
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	2,167,582		2,167,582
c	Accounting ...........	415,616		415,616
d	Lobbying ...........	51,213		51,213
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	132,898		132,898
g	Other ..........	20,320,485	15,235,141	5,084,844	500
12	Advertising and promotion ....	188,256	166,829		21,427
13	Office expenses .......	6,060,614	4,152,449	1,905,902	2,263
14	Information technology ......	3,398,561	353,216	3,045,345
15	Royalties ..	0
16	Occupancy ...........	5,578,019	553,635	5,024,384
17	Travel ............	255,725	108,125	147,600
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	31,175	5,560	25,560	55
20	Interest ...........	3,008,114		3,008,114
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	16,954,609	8,344,451	8,610,158
23	Insurance ..............	1,720,586	1,295,901	424,685
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	MEDICAL SUPPLIES	34,428,304	34,428,304
b	BAD DEBT	7,950,269	7,949,694	575
c	MAINTENANCE/SERVICE CONTRACT	5,345,541	3,840,244	1,505,297
d	LAB EXPENSES	4,338,527	4,338,527
e
f	All other expenses	2,842,576	1,906,788	731,041	204,747
25	Total functional expenses. Add lines 1 through 24f	262,089,851	210,491,948	51,272,832	325,071
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	2,802,148	1	3,816,199
2	Savings and temporary cash investments .......	90,659,933	2	103,907,072
3	Pledges and grants receivable, net .........	101,211	3	31,723
4	Accounts receivable, net .........	32,373,122	4	32,015,340
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	100,023	7	74,517
8	Inventories for sale or use ..............	3,757,730	8	3,602,936
9	Prepaid expenses and deferred charges ............	4,493,355	9	5,066,915
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	240,354,654
b	Less: accumulated depreciation. .....	10b	149,000,168	89,983,664	10c	91,354,486
11	Investments—publicly traded securities ..........	133,516,829	11	147,043,829
12	Investments—other securities. See Part IV, line 11 ......	12,632	12	12,632
13	Investments—program-related. See Part IV, line 11 ..	0	13	0
14	Intangible assets .........	0	14	0
15	Other assets. See Part IV, line 11 ...........	548,818	15	6,358,852
16	Total assets. Add lines 1 through 15 (must equal line 34)...	358,349,465	16	393,284,501
	17	Accounts payable and accrued expenses .	22,318,404	17	23,583,670
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	61,230,000	20	59,265,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	1,183,176	23	1,126,557
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	111,062,325	25	111,113,753
26	Total liabilities. Add lines 17 through 25.....	195,793,905	26	195,088,980
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	153,706,889	27	187,548,862
28	Temporarily restricted net assets .....	1,399,547	28	2,890,743
29	Permanently restricted net assets .....	7,449,124	29	7,755,916
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	162,555,560	33	198,195,521
34	Total liabilities and net assets/fund balances .....	358,349,465	34	393,284,501

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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization THE WILLIAM W BACKUS HOSPITAL
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization THE WILLIAM W BACKUS HOSPITAL
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Yes

51,213

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

51,213

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back
1a	Beginning of year balance ....	5,396,859	5,320,786	4,841,631	3,871,631
b	Contributions ........		5,000	358,064	970,000
c	Net investment earnings, gains, and losses ...	5,226	76,505	505,259	142,089
d	Grants or scholarships .....		0	0	0
e	Other expenditures for facilities and programs ........		0	378,271	135,254
f	Administrative expenses ....	5,226	5,432	5,897	6,835
g	End of year balance ......	5,396,859	5,396,859	5,320,786	4,841,631

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	0	2,229,795		2,229,795
b	Buildings ................	10,381,267	46,448,280	33,861,382	22,968,165
c	Leasehold improvements ............		80,846,314	45,668,172	35,178,142
d	Equipment ................		98,659,140	69,428,410	29,230,730
e	Other .................		1,747,654		1,747,654
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					91,354,486

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
Tax exempt bond premium, net		667,276
Due to 3rd parties		18,193,420
Employee related obligations		75,571,071
Self-insured prof liability		9,685,357
Capital lease obligations		6,344,367
Other liabilities		652,262



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		111,113,753
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	293,330,163
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	262,089,851
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	31,240,312
4	Net unrealized gains (losses) on investments ..........................	4	10,067,106
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6	-365,321
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8	-5,302,136
9	Total adjustments (net). Add lines 4 through 8 .........................	9	4,399,649
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	35,639,961

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	305,112,306
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	10,067,106
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................			2e	10,067,106
3	Subtract line 2e from line 1.....................			3	295,045,200
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	365,321
b	Other (Describe in Part XIV.) ...........	4b	-2,080,358
c	Add lines 4a and 4b.......................			4c	-1,715,037
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	293,330,163

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	264,141,267
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d	2,205,365
e	Add lines 2a through 2d......................			2e	2,205,365
3	Subtract line 2e from line 1.....................			3	261,935,902
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b	153,949
c	Add lines 4a and 4b.......................			4c	153,949
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	262,089,851

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
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 LOSS 892 TRANSFER TO AFFILIATES (1,248,123) INCREASE IN NET ASSETS HELD IN TRUST 306,792 CHANGE IN PENSION FUNDING (4,361,697) ------------ TOTAL $(5,302,136)
RECONCILIATION OF REVENUE- OTHER ADJUSTMENTS	SCHEDULE D, PART XII, LINE 2D
RECONCILIATION OF REVENUES- OTHER ADJUSTMENTS	SCHEDULE D, PART XII, LINE 4B	AUXILIARY INCOME 125,899 K-1 LOSS ( 892) LOSS ON FIXED ASSETS ( 29,536) RENTAL EXPENSE (2,126,333) TEMPORARILY RESTRICTED INCOME ( 49,496) ------------ TOTAL $(2,080,358)
RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTS	SCHEDULE D, PART XIII, LINE 2D	RENTAL EXPENSE 2,126,333 GOLF TOURNAMENT EXPENSE 49,496 LOSS ON FIXED ASSETS 29,536 ---------- TOTAL $2,205,365
RECONCILIATION OF EXPENSES- OTHER ADJUSTMENTS	SCHEDULE D, PART XIII, LINE 4B	AUXILIARY EXPENSE $ 153,949

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization
THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and e-mail solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.

(i) Name and address of individual or entity (fundraiser)	(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
	(ii) Activity	Yes	No	(iv) Gross receipts from activity		(vi) Amount paid to (or retained by) organization
Total .................

List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2011

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.

		(a) Event #1 GOLF TOURNAMENT (event type)	(b) Event #2 SEDER GOLF (event type)	(c) Other Events 0 (total number)	(d) Total Events (Add col. (a) through col. (c))
1	Gross receipts . . .	90,515	37,350	0	127,865
2	Less: Charitable contributions . . .	67,715	27,990	0	95,705
3	Gross income (line 1 minus line 2) . . .	22,800	9,360	0	32,160
4	Cash prizes . . .	0	0	0	0
5	Non-cash prizes . .	5,136	1,560	0	6,696
6	Rent/facility costs . .	20,118	4,680	0	24,798
7	Food and beverages . .	3,265	0	0	3,265
8	Entertainment . . .	0	0	0	0
9	Other direct expenses .	11,609	3,128	0	14,737
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........				49,496
11	Net income summary. Combine lines 3 and 10 in column (d)............				-17,336

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (Add col. (a) through col. (c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes
	No

	Yes
	No

	Yes
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," Explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," Explain:

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Schedule G (Form 990 or 990-EZ) 2011

Page 3

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Provide the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)

Identifier	ReturnReference	Explanation

Schedule G (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 250 %

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

If "Yes," did the organization make it available to the public? ...............

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..			3,313,006	1,038,468	2,274,538	0.900 %
b Medicaid (from Worksheet 3, column a) .....			55,952,799	39,553,595	16,399,204	6.450 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....			59,265,805	40,592,063	18,673,742	7.350 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	96	41,062	658,308	12,340	645,968	0.250 %
f Health professions education (from Worksheet 5) ..	17	4,531	275,274	2,250	273,024	0.110 %
g Subsidized health services (from Worksheet 6) ..		22,476	5,140,665		5,140,665	2.020 %
h Research (from Worksheet 7)	1		24,431		24,431	0.010 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	22	23	669,064		669,064	0.260 %
jTotal Other Benefits ...	136	68,092	6,767,742	14,590	6,753,152	2.650 %
kTotal. Add lines 7d and 7j. ..	136	68,092	66,033,547	40,606,653	25,426,894	10.000 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

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Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	8	69,051	69,051	0.030 %
4	Environmental improvements
5	Leadership development and training for community members	1	1,848	1,848
6	Coalition building	2	18,320	18,320	0.010 %
7	Community health improvement advocacy	1	510	510
8	Workforce development
9	Other	1	100	100
10	Total	13	89,829	89,829	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense........

3,308,653

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

3,143,316

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

62,914,770

Enter Medicare allowable costs of care relating to payments on line 5.....

90,995,950

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-28,081,180

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	WILLIAM W BACKUS HOSPITAL 326 WASHINGTON ST NORWICH,CT06360	X	X	X

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

WILLIAM W BACKUS HOSPITAL

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 250.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?11
Name and address		Type of Facility (describe)
1	BACKUS OUTPATIENT CARE CENTER 111 SALEM TURNPIKE NORWICH,CT06360	OUTPATIENT SERVICES
2	MEDICAL OFFICE BUILDING 330 WASHINGTON STREET NORWICH,CT06360	RADIATION THERAPY/LAB
3	COLCHESTER BACKUS HEALTH CENTER 163 BROADWAY COLCHESTER,CT06415	RADIOLOGY/LAB/PRIMARY CARE
4	MONTVILLE BACKUS HEALTH CARE 80 NORWICH/NEW LONDON TURNPIKE UNCASVILLE,CT06382	RADIOLOGY/LAB/PRIMARY CARE
5	PAIN MANAGEMENT 112 LAFAYETTE STREET NORWICH,CT06360	PAIN MANAGEMENT CLINIC
6	LEDYARD BACKUS HEALTH CENTER 743 COLONEL LEDYARD HWY LEDYARD,CT06339	LAB/PRIMARY CARE
7	JEWETT CITY PATIENT SERVICE CENTER 70 MAIN STREET JEWETT CITY,CT06351	LAB
8	INFECTIOUS DISEASE CLINIC 107 LAFAYETTE STREET NORWICH,CT06360	CLINIC
9	NORTH STONINGTON BACKUS HEALTH CENTER 82 NORWICH-WESTERLY ROAD NORTH STONINGTON,CT06359	PRIMARY CARE
10	NORWICHTOWN BACKUS PATIENT SERVICE CNTR 55 TOWN STREET NORWICH,CT06360	LAB
11	PLAINFIELD EMERGENCY CENTER 582 NORWICH ROAD PLAINFIELD,CT06374	LAB/RADIOLOGY/EMERGENCY SRVCS

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST	SCHEDULE H, PART I, LINE 7	FROM OCTOBER 2011 THROUGH SEPTEMBER OF 2012 THE WILLIAM W. BACKUS HOSPITAL SUPPORTED 146 PROGRAMS THAT SERVED 68,101 PEOPLE, TOTALING A COMMUNITY BENEFIT OF $6,859,351. PROGRAMS IMPROVED THE HEALTH AND WELLNESS OF THE COMMUNITY, ADDRESSING STRATEGIC COMMUNITY HEALTH PRIORITY AREAS. SUCH PRIORITY HEALTH AREAS INCLUDE REDUCING OBESITY, AUTISM, DRUG AND ALCOHOL USE, AND INCREASING ACCESS TO HEALTH CARE. PROGRAMS ALSO INCLUDED CLINICAL SERVICES PROVIDED BY THE HOSPITAL AT A FINANCIAL LOSS (SUBSIDIZED SERVICES). THESE SERVICES, IF DISCONTINUED, WOULD NOT BE AVAILABLE TO THE COMMUNITY OR WOULD FALL TO ANOTHER NOT-FOR-PROFIT OR GOVERNMENT AGENCY TO PROVIDE. HEALTH PROFESSIONAL EDUCATION WAS ALSO ENHANCED, THROUGH MENTORSHIPS, INTERNING OPPORTUNITIES, AND STUDENT ROTATIONS THROUGH THE FACILITY. THE HOSPITAL ALSO SUPPORTED COMMUNITY PARTNERSHIPS THROUGH CASH AND IN-KIND DONATIONS. SUCH SUPPORT INCLUDED ASSISTING A LOCAL FEDERALLY-QUALIFIED LOOK-ALIKE IN SUSTAINING A GYNECOLOGY SERVICES PROGRAM FOR UNDERSERVED AND UNINSURED WOMEN, AS WELL AS DONATING A BUILDING TO ESTABLISH A SATELLITE FQHC FACILITY TO PROVIDE PRIMARY CARE IN AN UNDERSERVED COMMUNITY. LASTLY, THE HOSPITAL COMMITTED RESOURCES TO FINDING "NOT-FOR-PROFIT" RESEARCH OPPORTUNITIES (IN OTHER WORDS, THOSE RESEARCH OPPORTUNITIES IN WHICH THE HOSPITAL HAS NO FINANCIAL INCENTIVE) TO HELP IMPROVE CLINICAL CARE AVAILABLE TO THE RESIDENTS OF EASTERN CONNECTICUT. SCHEDULE H, PART I, LINE 7 THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THE COLUMN IS $7,950,269. SCHEDULE H, PART I LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2.
COMMUNITY BUILDING ACTIVITIES	SCHEDULE H, PART II	Backus Hospital conducts and sponsors 10 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 HEALTH CARE COUNCIL OF EASTERN CONNECTICUT, THE FOUNDATION OF THREE RIVERS COMMUNITY COLLEGE (WHICH PROVIDEDS FUNDING FOR NURSING STUDENT EDUCATION AND EQUIPMENT), THE REGION'S NON-PROFIT HOSPICE ORGANIZATION, THE NORWHICH CHAMBER OF COMMERCE HEALTH CARE COMMITTEE, 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, family support and social service organizations, the regional Chamber of Commerce, numerous civic and governmental bodies, and various volunteer fire companies and ambulance services. 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.
BAD DEBT EXPENSE	SCHEDULE H, PART III, LINES 4, 8 AND 9B	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.
MEDICARE SHORTFALL	SCHEDULE H, PART III, LINE 8	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.
COLLECTION POLICY	SCHEDULE H, PART III, LINE 9B	IN THE SELF-PAY POLICY, SECTION II, B STATES THAT THE MEDICAL BUREAU OF ECONOMICS ("MBE") RECEIVES A WEEKLY LIST OF PATIENTS WHO WERE SENT FINANCIAL ASSISTANCE APPLICATIONS FROM BACKUS STAFF. THIS INFORMATION IS FROM THE PATIENT ACCOUNTS OR FINANCIAL COUNSELING DEPARTMENTS. MBE'S COLLECTION ACTIVITY ON THESE PATIENTS IS HALTED UNTIL IT HAS BEEN DETERMINED IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE HOSPTIAL'S POLICY, BY THE HOSPITAL FINANCIAL COUNSELING UNIT. COLLECTION ACTION IS ONLY RESUMED ONCE IT IS DETERMINED THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE.
AVAILABILITY OF FINANCIAL ASSISTANCE	SCHEDULE H, PART V, LINES 13G, 17E	THE WILLIAM W. BACKUS HOSPITAL PROVIDES FINANCIAL ASSISTANCE FOR CERTAIN QUALIFIED PATIENTS WHO ARE UNABLE TO PAY ALL OR PART OF THEIR BILL FOR INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES RENDERED AT THE HOSPITAL. IF YOU ARE COPING WITH A FINANCIAL HARDSHIP AND ARE FACING DEBTS OWED TO THE WILLIAM W. BACKUS HOSPITAL, FINANCIAL ASSISTANCE SUCH AS FREE CARE OR A SLIDING SCALE DISCOUNT MAY BE AVAILABE TO YOU. THE FINANCIAL COUNSELING PROCESS WILL INDICATE WHAT OPTIONS EXIST TO ASSIST YOU WITH YOUR OUTSTANDING BALANCE. FINANCIAL ASSISTANCE APPLIES TO BACKUS HOSPITAL BILLS ONLY. IT DOES NOT APPLY TO RADIOLOGISTS, PATHOLOGISTS, ANESTHESIOLOGISTS OR OTHER PROFESSIONAL SERVICES INVOLVED IN YOUR CARE THAT ARE BILLED SEPARATELY. TO APPLY PLEASE SUBMIT THE ATTACHED APPLICATION FOR FINANCIAL ASSISTANCE AND THE FOLLOWING VERIFICATIONS OF INCOME INFORMATION: - Most recent Federal tax return and W-2 - Most recent 3 payroll checks - Copies of unemployment checks - Copies of any pension, alimony, child support or other sources of income - Copies of Social Security earnings, if any - Any other pertinent information. Proof of income or earnings is required with application or the application will not be considered. Please allow 3 to 4 weeks for processing time; you will be notified by mail of the outcome of your application. If you have any questions please contact Customer Service: Monday thru Friday, 9:00 am to 4:00 pm (860) 823-6394 / Fax: (860) 892-6902. Further, as detailed in the Hospitals Bad Debt Write Off Policy, a series of statements, all indicating the availability of financial assistance (per the letter described previously) are sent out prior to collecting on the open account. The bad-debt collections and write off policy is described below: I Self Pay Accounts Collection Process (Accounts that do not qualify for MBE outsource) A Initial letter is sent 5 days after discharge. B Statement #1 is sent 30 days later. C Statement # 2 is sent 30 days later. D Precollect Letter is sent 15 days later (by Medconn). E Account will be written off to bad debt 45 days later. II Self Pay balances after insurance (Accounts that do not qualify for MBE outsource) A Statement # 1 is sent 15 day after account goes to self pay. B Statement # 2 is sent 30 days later. C Statement # 3 is sent 21 days later. D Precollect Letter is sent 21 days later. E Account will be written off to bad debt 45 days later. III All final billed accounts with self-pay balances only will be outsourced to Medical Bureau of Economics (MBE). (refer to Self Pay Collections policy) A Statement # 1 is sent at placement with MBE. (5 days after discharge) B Statement # 2 is sent 30 days later. C Statement # 3 is sent 30 days later. D Final Statement sent 15 days later. E Account closed and returned to WWBH for bad debt process 45 days later 1 Accounts with balances of $1000 or more. a. If time permits the staff will attempt to contact the patient to attempt to determine if they may qualify for free bed funds, charity care or a payment contract. b. If the patient may qualify, and application is sent and the account is not sent to bad debt, pending a response within 14 days. If no response is received the account will be sent to bad debt in the next weekly processing cycle. C. THE ACCOUNT WILL BE PLACED ON "BAD DEBT HOLD". A NOTE IS PLACED ON THE ACCOUNT INDICATING THE APPLICATION FOR FREE BED AND CHARITY CARE. d. A reminder will be set up to review the account in 14 days. If the application is received the hold will be removed and the account will be processed according to the free Bed/charity care policy. If the patient does not qualify, the hold will be removed and the account will go to bad debt in the next weekly processing cycle. If the application is not received back in 14 days the hold will be removed and the account will go to bad debt in the next weekly processing cycle. e. If time permits the staff will attempt to process the accounts through Passport One/SSI to determine if Medicaid coverage has been established for the patient. If so, the account will be updated and Medicaid billed. updated and Medicaid billed.
COMMUNITY HEALTH NEEDS ASSESSMENT	SCHEDULE H, PART V, SECTION B	(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) In 2010, 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 has guided Hospital's outreach efforts for the last two fiscal years. A second needs assessment was undertaken in the fourth quarter of FY 2012 to measure the Hospital's progress, and augment existing research. Based on the Holleran survey, the Hospital partnered with 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, as well as Norwich Technical High School, to focus on adolescent health issues such as self-esteem, depression, and substance abuse. (c) The hospital identifies 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, Behavioral Risk Factor Survey data, Robert Wood Johnson County Health Rankings, and other datasets. Priority areas were ranked utilizing a methodology which determined the severity of the problem and the Hospital's ability to impact it. (d) The hospital partners with two regional Federally Qualified Health Centers ("FQHC") - United Community and Family Services, and Generations Healthcare. Managers from the hospital and FQHCs 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.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI, LINE 3	(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, 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. In addition to the complete Financial Assistance Policy and Application for Financial Assistance, here is the information included on the Hospitals website: Financial Assistance Backus Hospital provides financial assistance programs for certain qualified patients who are unable to pay all or part of their bill for inpatient, outpatient and emergency services rendered at the Hospital. If you are coping with a financial hardship, and are facing debts owed to Backus Hospital, financial assistance may be available to you. Income Verification Backus requests income information from the applicant. Verification of reported income should be included within the application package. Appropriate verification sources include: - Most recent Federal tax return and W-2 - Most recent 3 payroll checks - Copies of unemployment checks - Copies of any pension, alimony, child support or other sources of income - Copies of Social Security earnings, if any - Any other pertinent information If the applicant has no income a statement detailing the current method of support will be accepted. Proof of income or earnings is required with application or the application will not be considered. Financial Assistance Options The level of financial assistance that you may be eligible to receive will be based upon the criteria defined in the Financial Assistance Policy. The William W. Backus Hospital considers Financial Assistance awards on a case-by-case basis. Please contact us if you have questions regarding eligibility. Financially Indigent Financially Indigent is defined as an individual whose total gross annual income is less than or equal to 250% of the Federal Poverty Guidelines (FPG). Patients at or below 250% FPG are eligible for a 100% discount off of their outstanding balances. Individuals above 250% up to 400% FPG are eligible for a discount based on their total gross annual income. Medically Indigent Backus Hospital considers an individual to be Medically Indigent if their total annual gross income is above 400% FPG and their outstanding medical obligations are greater than 50% of their total annual gross income. These individuals may be eligible for a discount separate from traditional financial assistance. Please refer to the Financial Assistance Policy for details regarding eligibility and the discount schedule. MEDICALLY INDIGENT IS DEFINED BY THE IRS AS: 'Persons whom the organization has determined are unable to pay some or all of their medical bills because their medical bills exceed a certain percentage of their family or household income or assets (for example, due to catastrophic costs or conditions), even though they have income or assets that otherwise exceed the generally applicable eligibility requirements for free or discounted care under the organizations financial assistance policy.' Backus Hospital treats each application individually. If you have any questions about your specific situation, please contact our customer service representatives at 860-889-8331, ext. 2917, Monday through Friday from 7:30 am to 4 pm. Financial Assistance Letter The William W. Backus Hospital provides financial assistance for certain qualified patients who are unable to pay all or part of their bill for inpatient, outpatient and emergency services rendered at the hospital. If you are coping with a financial hardship and are facing debts owed to The William W. Backus Hospital, financial assistance such as free care or a sliding scale discount may be available to you. The financial counseling process will indicate what options exist to assist you with your outstanding balance. Financial assistance applies to Backus Hospital bills only. It does not apply to Radiologists, Pathologists, Anesthesiologists or other professional services involved in your care that are billed separately. Frequently Asked Questions 1. DOES THE HOSPITAL HAVE A FINANCIAL ASSISTANCE POLICY? The William W. Backus Hospital does have a written financial assistance policy that defines the discount structure and programs available to qualifying patients. The William W. Backus Hospital bases all financial assistance on the most current Federal Poverty Guidelines (FPG), which are based on the gross income and household size. Backus grants 100% charity care to those applicants whose gross household income is at or below 250% FPG. A sliding discount is available to those patients who have gross income up to 400% FPG. Currently, the Federal government defines 100% of poverty as an individual earning a gross income of $10,890 per year. The William W. Backus Hospital Financial Assistance Policy grants 100% Charity Care to a family of one earning up to $21,780 per year, or 250% FPG. Income thresholds increase relative to household size. A discount is available for applicants earning up to 400% FPG. 2. WHAT SERVICES DOES THE FINANCIAL ASSISTANCE POLICY COVER? The William W. Backus Hospitals Financial Assistance Policy covers services rendered at the William W. Backus Hospital, including inpatient, emergency, and outpatient procedures. Financial assistance may not be granted for some procedures, such as elective procedures or some special situations, such as that of an individual who is eligible for insurance but has refused to apply or funds are available through another source for payment (i.e. settlements, State Funded programs). Financial assistance applies to Backus Hospital bills only. It does not apply to Radiologists, Pathologists, Anesthesiologists or other professional services involved in your care that are billed separately. 3. DOES THE HOSPITAL PROVIDE PERSONNEL TO HELP WITH APPLICATIONS AND TO ANSWER QUESTIONS? The William W. Backus Hospital employs Financial Counselors to help patients apply for Financial Assistance, Medicaid, and other State health programs. The Hospital also has resources to help with applications for State Nutritional Assistance Programs (SNAP) and pharmacy assistance programs. Financial Counselors can help to determine appropriate referrals to these resources. The William W. Backus Hospital provides language translation via Cyracom and MARTTI Language Lines. 4. DOES THE HOSPITAL COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THE COMMUNITY? The William W. Backus Hospital believes it is important to communicate the availability of financial assistance to the communities it serves. Therefore, a notice of the availability of financial assistance is included with the paper bill sent to the patients home, is posted in all main registration areas, is available on the Hospitals website, and upon request of Hospital staff or representatives. 5. DOES THE HOSPITAL EVER DENY CARE BASED ON INABILITY TO PAY? The William W. Backus Hospital will never delay or deny emergency care or necessary services due to an inability to pay. 6. DOES THE HOSPITAL HAVE A PROGRAM FOR PATIENTS WHO DONT QUALIFY FOR TRADITIONAL FINANCIAL ASSISTANCE BUT INCUR CATASTROPHIC MEDICAL DEBTS? The Hospital has a written policy that covers Catastrophic Financial Assistance for the Medically Indigent. The policy is included in the financial assistance policy, is available on the website, and upon request. (b) The hospital provides two Access to Care Specialists (both first and second shift) in its Emergency Departments and two health centers, who provides free insurance eligibility screenings to uninsured clients seeking care. The Specialists work 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 Charter Oak applications. 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 Charter Oak applications.
COMMUNITY INFORMATION	SCHEDULE H, PART VI, LINE 4	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 bringing 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 hospitals primary service area has an estimated 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 regions population is the elderly. For the last decennial census, the regions elderly population grew at 10 times the rate of growth for the total population. The regions 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. Further, the 2012 Robert Wood Johnson County Health Rankings reported that in New London and Windham Counties between 12-15% of children are living in poverty, and 31-32% are living in single parent households. Unemployment in the regional labor market (per the 2012 Robert Wood Johnson County Health Ranking) stands at 8.7-10.3% in New London and Windham Counties, hovering around state average of 9.1%, and well above the national average of 5.4%.
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI, LINE 5	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 MEMEBERS 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 hospitals 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 from to become link these individuals with a primary care physician in the community. This is facilitated through the My Health Direct program, a web-based tool that allows hospital staff to access blocked appointments for physicians in the community. From 10/1/11 to 9/30/12 the Hospital linked 582 individuals with primary care. e) The hospital provides free community prostate screenings, diabetes education, backpack safety, HIV education/testing, blood pressure tests, skin cancer screenings, nutrition education and many others services. f) The hospital provides a comprehensive medical library, which is open to all staff. The library has subscriptions to hundreds of major scientific and clinical journals, as well as an on-staff librarian to help with specific research requests. g) The hospital provides free website access to complete and current medical information to answer 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. h) 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. i) The hospital offers free wireless internet (wi-fi) use throughout the campus, and provides free computer use to visitors. j) 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. 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.
STATE FILING OF COMMUNITY BENEFIT REPORT	SCHEDULE H, PART VI, LINE 7	THE HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE CONNECTICUT OFFICE OF THE HEALTH ADVOCATE ("OHA").

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
THE WILLIAM W BACKUS HOSPITAL

Employer identification number
06-0250773

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) HOSPICE OF SE CONNECTICUT	22-2667260	501(C)(3)	8,500				SPONSORSHIP
(2) AMERICAN HEART ASSOC	13-5613797	501(C)(3)	7,500				SPONSORSHIP
(3) UNITED COMMUNITY & FAMILY SERVICES	06-0653142	501(C)(3)	200,000				WOMEN'S HEALTH
(4) CHAMBER OF COMMERCE	06-0475490	501(C)(6)	6,500				SPONSORSHIP
(5) THREE RIVERS COLLEGE	23-7303151	501(C)(3)	16,000				SPONSORSHIP
(6) BROADWAY KIDS			5,100				SPONSORSHIP
(7) UNITED COMMUNITY & FAMILY SERVICES	06-0653142	501(C)(3)		410,000	APPRAISAL	BUILDING	PRIMARY CARE

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant
(1) SCHOLARSHIPS	5	12,500

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
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 SPONSORSHIPS, ARE TYPICALLY ATTENDED BY HOSPITAL EMPLOYEES. FIVE SCHOLARSHIPS IN THE AMOUNT OF $2,500 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.

Schedule I (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) DAVID WHITEHEAD	(i) (ii)	740,686 0	0 0	21,535 0	20,580 0	23,272 0	806,073 0
(2) DANIEL E LOHR	(i) (ii)	491,649	0	23,079	20,580	16,882	552,190
(3) PETER SHEA	(i) (ii)	491,146	0	1,651	13,230	23,503	529,530
(4) SERGIO CASILLAS MD	(i) (ii)	378,355	118,000	0	13,230	1,057	510,642
(5) ROBERT SIDMAN MD	(i) (ii)	296,400	96,525	16,500	13,230	23,272	445,927
(6) MARK TOUSIGNANT MD	(i) (ii)	265,264	70,000	0	13,230	23,503	371,997
(7) JUAN ESCALON MD	(i) (ii)	341,282	0	4,889	13,230	23,503	382,904
(8) THOMAS P PIPICELLI	(i) (ii)	608,153	0	3,169,625	20,580	16,882	3,815,240	2,782,763
(9) WILLIAM HORGAN MD	(i) (ii)	252,291	58,890	11,400	9,632	23,503	355,716

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
GROSS-UP PAYMENTS	SCHEDULE J, PART I, LINE 1A	THE FORMER PRESIDENT RECEIVED GROSS-UP PAYMENTS ON SELECTED EXPENSES. THEY WERE PROPERLY INCLUDED IN HIS W-2 WAGES.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN	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.
NON-FIXED PAYMENTS	SCHEDULE J, PART I, LINE 7	BASE COMPENSATION FOR EXECUTIVES IS APPROVED BASED ON THE CRITERIA LISTED IN PART I, LINE 3, HOWEVER A PORTION OF THAT IS HELD BACK AND SUBSEQUENTLY DISTRIBUTED BASED ON EVALUATION OF THE INDIVIDUALS PERFORMANCE AND ACCOMPLISHMENT OF THE GOALS SET AT THE BEGINNING OF THE YEAR BY AN INDEPENDENT COMPENSATION COMMITTEE. PHYSICIAN BONUSES ARE BASED ON MEETING PREESTABLISHED GOALS.
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.
ADDITIONAL INFORMATION	SCHEDULE J, PART II, LINE 10	THOMAS PIPICELLI'S COMPENSATION INCLUDES AMOUNTS ESTABLISHED AND PAID PURSUANT TO AN EMPLOYMENT AGREEMENT DATED DECEMBER 15, 2008, UNDER WHICH EMPLOYEE'S EMPLOYMENT WOULD TERMINATE ON DECEMBER 31, 2011. THE AMOUNT OF COMPENSATION RECOGNIZED THE EMPLOYEE'S DECADES-LONG SERVICE TO THE ORGANIZATION AS PRESIDENT AND CEO, AND HIS SERVICES IN TRANSITIONING TO THE ORGANIZATION'S CURRENT MANAGEMENT TEAM.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
THE WILLIAM W BACKUS HOSPITAL

Employer identification number
06-0250773

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	STATE OF CT HEALTH & EDUCATIONAL FACILITIES	06-0806186	20774LSV3	08-10-2005	28,992,719	SEE SCHEDULE K, PART V		X		X		X
B	STATE OF CT HEALTH & EDUCATIONAL FACILITIES	06-0806186	20774UC86	07-02-2008	30,168,922	SEE SCHEDULE K, PART V		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . .	3,535,000		2,850,000
2 Amount of bonds legally defeased . . . . . . . . . .	0		0
3 Total proceeds of issue . . . . . . . . . . . . .	28,992,719		30,168,922
4 Gross proceeds in reserve funds . . . . . . . .	755,086		0
5 Capitalized interest from proceeds . . . . . . . . . .	0		0
6 Proceeds in refunding escrows . . . . . . . . . . .	16,750,062		30,100,000
7 Issuance costs from proceeds . . . . . . . . . . .	369,723		68,922
8 Credit enhancement from proceeds . . . . . . . . . .	583,673		0
9 Working capital expenditures from proceeds . . . . . . .	0		0
10 Capital expenditures from proceeds . . . . . . . . . .	10,514,252		0
11 Other spent proceeds . . . . . . . . . . .	19,923		0
12 Other unspent proceeds . . . . . . . . . . .	0		0
13 Year of substantial completion . . . . . . . . . . .	2008		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . .		X	X
15 Were the bonds issued as part of an advance refunding issue? . . . .	X			X
16 Has the final allocation of proceeds been made? . . . . . .	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . .	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2011

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .		X		X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .		X		X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0.00000%		0.00000%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	0.00000%		0.00000%		%		%
6 Total of lines 4 and 5 . . .. . . . . . . . .	0.00000%		0.00000%		%		%
7 Does the bond issue meet the private security or payment test? . . .	X		X
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X	X
2 Is the bond issue a variable rate issue?		X	X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X
b Name of provider . . . . . . . .	0		UBS AG
c Term of hedge . . . . . . . .	29.9		29.9
d Was the hedge superintegrated? . . . .		X		X
e Was a hedge terminated? . . . . .		X		X
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .		X		X
b Name of provider . . . . . .	0		0
c Term of GIC . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .		X		X
6 Did the bond issue qualify for an exception to rebate? .		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X

Schedule K (Form 990) 2011

Page 3

Part V

Procedures To Undertake Corrective Action

Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . . YesNo

Part VI

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) SEE SCHEDULE L PART V

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
BUSINESS TRANSACTION INVOLVING INTERESTED PERSONS	SCHEDULE L, PART IV	(B) DAVID WHITEHEAD, DANIEL E LOHR, AND PETER SHEA ARE OFFICERS, TRUSTEES, DIRECTORS AND/OR KEY EMPLOYEES OF THE WILLIAM W. BACKUS HOSPITAL(WWBH) AND CONNCARE, INC.(CI) (C)/(D)$3,375,000 REIMBURSEMENTS PAID BY CI TO WWBH $ 96,142 PERFORMANCE OF SERVICES BY WWHBH FOR CI $ 367,717 LEASED PROPERTY (E) NO (B) DAVID WHITEHEAD AND DANIEL LOHR ARE OFFICERS OF THE WILLIAM W BACKUS HOSPITAL AND WWB, INC. (C)/(D)$8,017,000 REIMBURSEMENTS PAID BY WWB TO WWBH (E) NO (B) DAVID WHITEHEAD AND DANIEL LOHR ARE OFFICERS OF THE WILLIAM W BACKUS HOSPITAL AND OMNI HOME HEALTH. (C)/(D)$120,000 ACCOUNTING AND MANAGEMENT FEES PAID BY OMNI TO WWBH $ 5,263 PERFORMANCE OF SERVICES BY WWBH FOR OMNI

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Identifier	Return Reference	Explanation
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.
INDEPENDENT VOTING MEMBERS	FORM 990, PART VI, SECTION A, LINE 1B	THE TAXPAYER IS REPORTING SEVERAL MEMBERS OF THE BOARD OF DIRECTORS AS NOT BEING INDEPENDENT, EVEN THOUGH THEY DO NOT MEET ANY OF THE DEFINITIONS FROM THE 990 INSTRUCTIONS FOR DETERMINING INDEPENDENT DIRECTORS. HOWEVER, THEY DO HAVE PRIVILEGES AT THE HOSPITAL WHICH IS WHY THE HOSPITAL CONSIDERS THEM NOT INDEPENDENT. BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 DAVID WHITEHEAD AND DANIEL E LOHR HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVE AS AN OFFICER OR DIRECTOR FOR CONNCARE, INC., WWB CORPORATION, AND BACKUS HOME HEALTH 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 11B	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.
OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, LINE 5	K-1 GAIN 892 TRANSFER TO AFFILIATE (1,248,123) INCREASE IN ASSETS HELD IN TRUST 306,792 CHANGE IN PENSION FUNDING (4,361,697) UNREALIZED GAIN 10,067,106 INVESTMENT EXPENSES (365,321) ------------ TOTAL $ 4,399,649
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:DAVID WHITEHEAD TITLE:TRUSTEE/PRESIDENT/CEO HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:ROBERT RAMSDELL TITLE:TRUSTEE/TREASURER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:JOSEPH FATONE TITLE:TRUSTEE/SECRETARY HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:ANTHONY JOYCE TITLE:TRUSTEE/VICE CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:JOHN F BILDA TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:ELIZABETH CONWAY TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:BERT A COPPOTELLI, MD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:PETER MANERI TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:DEBORAH MONAHAN TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:LYNNE QUINTAL-HILL TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:MARK TRAMONTOZZI, MD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:STEPHEN T BRIGGS, MD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:PAUL MAXFIELD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:DONNA ROMITO, DO TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:DANIEL E LOHR TITLE:SENIOR VP/CFO HOURS:9
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:THOMAS P PIPICELLI TITLE:FORMER PRESIDENT HOURS:10

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

THE WILLIAM W BACKUS HOSPITAL

Employer identification number

06-0250773

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) BACKUS HEALTH CARE INC 326 WASHINGTON ST NORWICH,CT06360 22-2481794	SUPPORT	CT	501(C)(3)	11A	BACKUS CORP	Yes
(2) BACKUS CORPORATION 326 WASHINGTON ST NORWICH,CT06360 22-2757608	SUPPORT	CT	501(C)(3)	11B	NA		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) OMNI HOME HEALTH NORWICH CT 06360 NORWICH,CT06360 06-1458837	HOME HEALTH CARE	CT	NA

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) WWB CORPORATION 326 WASHINGTON ST NORWICH,CT06360 06-1094836	HOLDING COMPANY	CT	NA	C-CORP
(2) CONNCARE INC 326 WASHINGTON ST NORWICH,CT06360 06-1387598	HEALTH CARE SRVCS	CT	NA	C CORP
(3) BACKUS MEDICAL CENTER CONDO ASSOC INC 330 WASHINGTON ST NORWICH,CT06360 06-1542647	CONDO ASSOCIATION	CT	NA	C-CORP	0	0	65.000 %

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) CONNCARE INC	I	367,717	COST
(2) OMNI HOME HEALTH	K	125,263	COST
(3) CONNCARE INC	K	96,142	COST
(4) CONNCARE INC	P	3,375,000	COST
(5) WWB INC	P	8,017,000	COST
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH-QUALITY HEALTHCARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	9
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	2,063
6	Total number of volunteers (estimate if necessary) ....	6	484
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	2,161,879
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	69,663

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,296,004	1,179,014
9	Program service revenue (Part VIII, line 2g) .........	271,933,218	285,997,171
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,938,478	4,525,194
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,609,862	1,628,784
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	280,777,562	293,330,163
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	692,681	752,684
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	135,892,894	146,148,497
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 325,071
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	113,381,675	115,188,670
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	249,967,250	262,089,851
19	Revenue less expenses. Subtract line 18 from line 12.......	30,810,312	31,240,312
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	358,349,465	393,284,501
21	Total liabilities (Part X, line 26).............	195,793,905	195,088,980
22	Net assets or fund balances. Subtract line 21 from line 20.....	162,555,560	198,195,521

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 210,491,948 including grants of $ 752,684 ) (Revenue $ 287,011,997 )
	IN FISCAL YEAR 2011, BACKUS HOSPITAL HAD 10,974 ADMISSIONS, 68,102 EMERGENCY DEPARTMENT VISITS, AND 440,605 OUTPATIENT VISITS. THE HOSPITAL DELIVERED 919 BABIES AND 6,968 SAME DAY SURGICAL PROCEDURES. BACKUS PERFORMED 122,132 OUTPATIENT IMAGING EXAMS, 7,707 MRI EXAMINATIONS, 9,443 PSYCHIATRIC CLINICAL VISITS, AND 7,914 PSYCHIATRIC PARTIAL HOSPITAL VISITS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 210,491,948

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) DAVID WHITEHEAD TRUSTEE/PRESIDENT/CEO	40.0	X	X			762,221	0	43,852
(2) ROBERT RAMSDELL TRUSTEE/TREASURER	6.0	X	X
(3) JOSEPH FATONE TRUSTEE/SECRETARY	6.0	X	X
(4) ANTHONY JOYCE TRUSTEE/VICE CHAIRMAN	6.0	X	X
(5) JOHN F BILDA TRUSTEE	2.0	X
(6) ELIZABETH CONWAY TRUSTEE	2.0	X
(7) BERT A COPPOTELLI MD TRUSTEE	2.0	X
(8) PETER MANERI TRUSTEE	2.0	X
(9) DEBORAH MONAHAN TRUSTEE	2.0	X
(10) LYNNE QUINTAL-HILL TRUSTEE	2.0	X
(11) MARK TRAMONTOZZI MD TRUSTEE	12.25	X				53,700		0
(12) STEPHEN T BRIGGS MD TRUSTEE	2.0	X
(13) PAUL MAXFIELD TRUSTEE	2.0	X
(14) DONNA ROMITO DO TRUSTEE	2.0	X
(15) DANIEL E LOHR SENIOR VP/CFO	40.0		X			514,728		37,462
(16) PETER SHEA SENIOR VP/MEDICAL DIRECTOR	40.0			X		492,797		36,733
(17) SERGIO CASILLAS MD PHYSICIAN	40.0				X	496,355		14,287

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) ROBERT SIDMAN MD PHYSICIAN	40.0	X		409,425	36,502
(19) MARK TOUSIGNANT MD PHYSICIAN	40.0	X		335,264	36,733
(20) JUAN ESCALON MD PHYSICIAN	40.0	X		346,171	36,733
(21) WILLIAM HORGAN MD PHYSICIAN	40.0	X		322,581	33,135
(22) THOMAS P PIPICELLI FORMER PRESIDENT	0.0		X	3,777,778	37,462

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	7,511,020	0	312,899

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c		95,705
d	Related organizations...1d		3,225
e	Government grants (contributions)1e		614,920

f	All other contributions, gifts, grants, and similar amounts not included above1f		465,164
g	Noncash contributions included in lines 1a-1f:$ 3,179
h	Total. Add lines 1a-1f.......			1,179,014
			Business Code
2a	Inpatient		900,099	126,151,493	126,151,493
b	Outpatient		900,099	108,882,771	108,882,771
c	Emergency Department		900,099	45,998,119	45,998,119
d	Lab courier service		621,500	2,187,372		2,187,372
e	E.H.R. REVENUE		722,320	2,777,416	2,777,416
f	All other program service revenue .
g	Total. Add lines 2a–2f........			285,997,171
3	Investment income (including dividends, interest
	and other similar amounts).....			3,731,395			3,731,395
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	1,025,860
b	Less: rental expenses	2,126,333
c	Rental income or (loss)	-1,100,473
d	Net rental income or (loss).......			-1,100,473		-50,079	-1,050,394
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	19,678,400	184,772
b	Less: cost or other basis and sales expenses	18,855,065	214,308
c	Gain or (loss)	823,335	-29,536
d	Net gain or (loss)..........			793,799			793,799
8a	Gross income from fundraising events (not including $ 95,705 of contributions reported on line 1c). See Part IV, line 18 ...
	a		32,160
b	Less: direct expenses ...b		49,496
c	Net income or (loss) from fundraising events..			-17,336			-17,336
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a		469,919
b	Less: cost of goods sold ..b		353,302
c	Net income or (loss) from sales of inventory..			116,617			116,617
Miscellaneous Revenue			Business Code
11a	Cafeteria		624,410	1,166,526			1,166,526
b	Child care		900,099	398,545			398,545
c	OTHER MISC REVENUE		900,099	1,064,905	1,040,319	24,586
d	All other revenue ....
e	Total. Add lines 11a–11d ......			2,629,976
12	Total revenue. See Instructions....			293,330,163	284,850,118	2,161,879	5,139,152


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			2,802,148	1	3,816,199
2	Savings and temporary cash investments .......			90,659,933	2	103,907,072
3	Pledges and grants receivable, net .........			101,211	3	31,723
4	Accounts receivable, net .........			32,373,122	4	32,015,340
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			100,023	7	74,517
8	Inventories for sale or use ..............			3,757,730	8	3,602,936
9	Prepaid expenses and deferred charges ............			4,493,355	9	5,066,915
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	240,354,654
b	Less: accumulated depreciation. .....	10b	149,000,168	89,983,664	10c	91,354,486
11	Investments—publicly traded securities ..........			133,516,829	11	147,043,829
12	Investments—other securities. See Part IV, line 11 ......			12,632	12	12,632
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			548,818	15	6,358,852
16	Total assets. Add lines 1 through 15 (must equal line 34)...			358,349,465	16	393,284,501
17	Accounts payable and accrued expenses .			22,318,404	17	23,583,670
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			61,230,000	20	59,265,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			1,183,176	23	1,126,557
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			111,062,325	25	111,113,753
26	Total liabilities. Add lines 17 through 25.....			195,793,905	26	195,088,980
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			153,706,889	27	187,548,862
28	Temporarily restricted net assets .....			1,399,547	28	2,890,743
29	Permanently restricted net assets .....			7,449,124	29	7,755,916
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			162,555,560	33	198,195,521
34	Total liabilities and net assets/fund balances .....			358,349,465	34	393,284,501