Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 7,886,587 | 8,399,311 | 7,421,332 | 7,773,362 | 9,085,513 | 40,566,105 |
| 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 | 7,886,587 | 8,399,311 | 7,421,332 | 7,773,362 | 9,085,513 | 40,566,105 |
| 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).. | 11,354,467 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 29,211,638 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 7,886,587 | 8,399,311 | 7,421,332 | 7,773,362 | 9,085,513 | 40,566,105 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,441,126 | 563,964 | 507,534 | 494,078 | 313,240 | 3,319,942 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | 289,523 | 289,523 | ||||
| 11 | Total support Add lines 7 through 10. | 44,175,570 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI | PART I, LINE 4 & PART VI, LINE 1B NUMBER OF INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY THE ORGANIZATION SOUGHT TO CONFIRM THE INDEPENDENCE OF EACH VOTING MEMBER OF ITS GOVERNING BODY BY REQUESTING THAT EACH SUCH VOTING MEMBER RESPOND TO A QUESTIONNAIRE CONTAINING THE PERTINENT INSTRUCTIONS AND DEFINITIONS AND DESIGNED TO ELICIT THE INFORMATION NECESSARY TO DETERMINE INDEPENDENCE. BASED ON RESPONSES TO THE QUESTIONNAIRES RECEIVED BY THE ORGANIZATION AND ANNUAL CONFLICTS OF INTEREST DISCLOSURES, THE ORGANIZATION WAS ABLE TO CONFIRM THAT NINE (9) VOTING MEMBERS ARE INDEPENDENT. |
| FORM 990, PART VI, SECTION A, LINE 6 | CLASSES OF MEMBERS OR STOCKHOLDERS: THE SOLE MEMBER OF BRIDGEPORT HOSPITAL FOUNDATION, INC. IS BRIDGEPORT HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | BRIDGEPORT HOSPITAL HAS THE RIGHT TO ELECT THE BOARD OF TRUSTEES OF THE FOUNDATION IN CONSULTATION WITH AND WITH THE CONSENT OF YALE-NEW HAVEN HEALTH SERVICES CORPORATION AND OFFICERS OF THE FOUNDATION ARE ELECTED BY THE FOUNDATION BOARD OR AS OTHERWISE SET FORTH IN ACCORDANCE WITH THE BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 7B | SUBJECT TO THE APPROVAL OF YALE-NEW HAVEN HEALTH SERVICES CORPORATION (HSC), BRIDGEPORT HOSPITAL, AS THE SOLE MEMBER OF THE FOUNDATION, HAS THE AUTHORITY TO A. MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THIS CORPORATION OR ANY AFFILIATE AND THE CREATION OR ACQUISITION OF AN INTEREST IN ANY CORPORATE ENTITY, INCLUDING JOINT VENTURES; B. AMENDMENT OR RESTATEMENT OF THE MISSION, CERTIFICATE OF INCORPORATION OR THE BYLAWS OF THIS CORPORATION OR ANY AFFILIATE, OR ANY NEW OR REVISED "DOING BUSINESS AS" NAME; C. ADOPTION OF OPERATING AND CASH FLOW BUDGETS OF THE CORPORATION OR ANY AFFILIATE, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THIS CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION (PURSUANT TO THE AUTHORITY DELEGATED TO THIS CORPORATION BY THE MEMBER AND HSC TO ADOPT SUCH BUDGETS WITHIN PARAMETERS ESTABLISHED BY THE MEMBER AND HSC); D. ADOPTION OF CAPITAL BUDGETS AND CAPITAL ALLOCATIONS OF THIS CORPORATION OR ANY AFFILIATE (PURSUANT TO THE AUTHORITY DELEGATED TO THIS CORPORATION BY THE MEMBER AND HSC TO ADOPT SUCH BUDGETS WITHIN PARAMETERS ESTABLISHED BY THE MEMBER AND HSC); E. INCURRING AGGREGATE OPERATING OR CAPITAL EXPENDITURES ON AN ANNUAL BASIS THAT EXCEED OPERATING OR CAPITAL BUDGETS OF THE CORPORATION ADOPTED BY THE MEMBER AND HSC BY A SPECIFIED DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE MEMBER AND HSC; F. LONG-TERM OR MATERIAL AGREEMENTS INCLUDING, BUT NOT LIMITED TO, EQUITY FINANCINGS, CAPITALIZED LEASES, OPERATING LEASES AND INSTALLMENT CONTRACTS; AND PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE OR ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A FAIR MARKET VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE MEMBER AND HSC, WHICH SHALL NOT BE LESS THAN 10% OF THE TOTAL ANNUAL CAPITAL BUDGET OF THIS CORPORATION; G. APPROVAL OF ANY NEW RELATIONSHIPS OR AGREEMENTS FOR UNDERGRADUATE OR GRADUATE MEDICAL EDUCATION PROGRAMS OR ANY MATERIAL AMENDMENTS TO OR TERMINATIONS OF EXISTING AGREEMENTS FOR UNDERGRADUATE OR GRADUATE MEDICAL EDUCATION PROGRAMS; H. CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL OR SUBSTANTIALLY ALL OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THIS CORPORATION OR ANY AFFILIATE; I. APPROVAL OF MAJOR NEW PROGRAMS AND CLINICAL SERVICES OF THIS CORPORATION OR ANY AFFILIATE OR DISCONTINUATION OR CONSOLIDATION OF ANY SUCH PROGRAM. THE MEMBER AND HSC SHALL FROM TIME TO TIME DEFINE THE TERM "MAJOR" IN THIS CONTEXT; J. APPROVAL OF STRATEGIC PLANS OF THIS CORPORATION OR ANY AFFILIATE; AND K. ADOPTION OF SAFETY AND QUALITY ASSURANCE POLICIES NOT IN CONFORMITY WITH POLICIES ESTABLISHED BY THE MEMBER AND HSC. OTHER MAJOR ACTIVITIES: A. IN ADDITION, THE MEMBER AND HSC SHALL HAVE THE AUTHORITY, EXCEPT AS OTHERWISE PROVIDED BY THE MEMBER AND HSC AND AFTER CONSULTATION WITH THIS CORPORATION, TO REQUIRE THE PRIOR REVIEW AND APPROVAL OF THOSE ACTIVITIES OF THIS CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY THAT THE MEMBER AND HSC DETERMINE TO BE "MAJOR ACTIVITIES." B. "MAJOR ACTIVITIES" SHALL BE THOSE WHICH THE MEMBER AND HSC BY A VOTE OF NOT LESS THAN TWO-THIRDS (2/3) OF HSC'S BOARD OF TRUSTEES HAS DECLARED MAJOR, BY WRITTEN NOTICE TO THIS CORPORATION, DELIVERED PERSONALLY OR TRANSMITTED BY REGISTERED OR CERTIFIED MAIL RETURN RECEIPT REQUESTED. SUCH NOTICE SHALL SPECIFICALLY IDENTIFY THE MATTER OR MATTERS REQUIRING APPROVAL OF THE MEMBER AND HSC, AND SHALL REFER TO THIS BYLAW PROVISION GRANTING SUCH APPROVAL RIGHTS TO THE MEMBER AND HSC. NOTICES RECEIVED PURSUANT TO THIS SECTION SHALL BE RECORDED IN THE MINUTES OF THIS CORPORATION AND SHALL BE FILED WITH THE MINUTES OF THIS CORPORATION. NOTHING IN THESE BYLAWS SHALL BE CONSTRUED IN A MANNER THAT IS INCONSISTENT WITH THE AUTHORITIES WITH RESPECT TO THE CORPORATION THAT ARE RESERVED OR RETAINED BY THE MEMBER AND HSC PURSUANT TO THESE BYLAWS AND THE BYLAWS OF THE MEMBER AND/OR HSC, AS APPLICABLE. FURTHER, YALE-NEW HAVEN HEALTH SERVICES CORPORATION HAS THE SOLE AUTHORITY WITH RESPECT TO CERTAIN ACTION, INCLUDING, BUT NOT LIMITED TO THE ISSUANCE AND INCURRENCE OF INDEBTEDNESS: A. ADOPTION OF TARGETS FOR THE ANNUAL OPERATING AND CASH FLOW BUDGETS OF THIS CORPORATION AND ITS AFFILIATES, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THIS CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; B. ADOPTION OF TARGETS FOR THE ANNUAL CAPITAL BUDGETS AND CAPITAL ALLOCATIONS OF THIS CORPORATION AND ANY AFFILIATE; C. ADOPTION OF ANNUAL OPERATING, CASH FLOW AND ANNUAL CAPITAL BUDGETS FOR THE CORPORATION AND ANY AFFILIATE WITHIN THE TARGETS ESTABLISHED BY HSC IN THE EVENT OF ANY FAILURE OF THE CORPORATION TO DO SO; D. ISSUANCE AND INCURRENCE OF INDEBTEDNESS ON BEHALF OF THIS CORPORATION; E. MANAGEMENT AND CONTROL OF THE LIQUID ASSETS OF THIS CORPORATION, INCLUDING THE AUTHORITY TO CAUSE SUCH ASSETS TO BE FUNDED TO HSC OR AS OTHERWISE DIRECTED BY HSC; AND F. APPOINTMENT OF THE INDEPENDENT AUDITOR FOR THIS CORPORATION AND EACH AFFILIATE AND THE MANAGEMENT OF THE AUDIT PROCESS AND COMPLIANCE PROCESS AND PROCEDURES FOR THIS CORPORATION AND EACH AFFILIATE; AND G. APPOINTMENT OF THE PRESIDENT CONSISTENT WITH SECTIONS 4.3(A). |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 TAX RETURN AND ATTACHED SCHEDULES WERE PREPARED BY EMPLOYEES OF THE SYSTEM TAX DEPARTMENT. THE RETURN IS INITIALLY REVIEWED BY THE EXECUTIVE DIRECTOR/DIRECTOR OF FINANCE. SUBSEQUENTLY IT IS SENT TO KPMG LLP FOR THEIR INITIAL REVIEW. AFTER ALL COMMENTS FROM THE ABOVE GROUP ARE CLEARED, THE RETURN IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER OF THE ENTITY AND A FINAL VERSION OF THE RETURN IS SENT BACK TO KPMG LLP FOR FINAL REVIEW. PRIOR TO FILING, THE ORGANIZATION MADE AVAILABLE A COMPLETE COPY OF THE RETURN TO THE BOARD OF TRUSTEES VIA A WEB PORTAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BRIDGEPORT HOSPITAL FOUNDATION, INC IS COVERED UNDER THE YALE-NEW HAVEN HEALTH SYSTEM CONFLICT OF INTEREST POLICY. THE YALE NEW HAVEN HEALTH SYSTEM CONFLICT OF INTEREST POLICY (CC:R-7) AND INDIVIDUAL ANNUAL DISCLOSURE FORM APPLIES TO A POOL OF EMPLOYEES, BOARD MEMBERS AND NON-BOARD MEMBERS SERVING ON BOARD COMMITTEES. THESE "COVERED INDIVIDUALS" ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT, UPON BEGINNING EMPLOYMENT OR OTHERWISE BECOMING A COVERED INDIVIDUAL AND ANNUALLY THEREAFTER. COVERED INDIVIDUALS ARE ALSO REQUIRED TO IMMEDIATELY REPORT MATERIAL CHANGES TO THEIR MOST RECENTLY COMPLETED DISCLOSURE STATEMENT. THESE DISCLOSURE STATEMENTS AND REPORTS ARE REVIEWED BY THE OFFICE OF PRIVACY AND CORPORATE COMPLIANCE AND/OR THE LEGAL AND RISK SERVICES DEPARTMENT TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF A POTENTIAL CONFLICT ARISES, THE PRESIDENT AND CEO WOULD CONSULT WITH THE BOARD CHAIRPERSON AND THE LEGAL AND RISK SERVICES DEPARTMENT AND TAKE ANY ACTIONS THAT SHE DEEMS REQUIRED OR APPROPRIATE TO MANAGE OR RESOLVE A POTENTIAL CONFLICT OF INTEREST. FOR EXAMPLE, A VOTING BOARD OR COMMITTEE MEMBER WOULD BE REQUIRED TO RECUSE HIMSELF OR HERSELF FROM VOTING ON MATTERS RELATED TO THE POTENTIAL CONFLICT AND THE POTENTIAL CONFLICT WOULD BE DISCLOSED TO OTHER VOTING MEMBERS. |
| FORM 990, PART VI, SECTION C, LINE 19 | COPIES OF FORM 990, FORM 1023 (IF AVAILABLE) AND AUDITED FINANCIAL STATEMENTS ARE MAINTAINED IN THE SYSTEM TAX DEPARTMENT. OTHER CORPORATE GOVERNING DOCUMENTS ARE MAINTAINED BY THE LEGAL AND RISK SERVICES DEPARTMENT. THE CONFLICT OF INTEREST POLICY, WHISTLEBLOWER POLICY, AND DOCUMENT RETENTION POLICY ARE AVAILABLE TO ALL EMPLOYEES ON THE CORPORATE INTERNAL WEBSITE. COPIES OF ALL DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OUTSIDE CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 6,995. MANAGEMENT AND GENERAL EXPENSES 23,235. FUNDRAISING EXPENSES 14,740. TOTAL EXPENSES 44,970. CONSULTING FEES: PROGRAM SERVICE EXPENSES 136,668. MANAGEMENT AND GENERAL EXPENSES 453,949. FUNDRAISING EXPENSES 287,986. TOTAL EXPENSES 878,603. |
| FORM 990, PART XI, LINE 9: | TRANSFER TO BRIDGEPORT HOSPITAL -3,336,624. WRITE OFF UNCOLLECTIBLE PLEDGES -87,457. |
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