Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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 on 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|
| Software ID: | 23017437 |
| Software Version: | 2023v6.0 |
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 6 Classes of members or stockholders | STAMFORD HEALTH INC. (SHI), A TAX-EXEMPT ORGANIZATION, IS THE SOLE MEMBER OF THE STAMFORD HOSPITAL. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | STAMFORD HEALTH INC. (SHI), THE SOLE MEMBER OF THE STAMFORD HOSPITAL, HAS THE POWER, AS THE SOLE MEMBER: TO ELECT THE BOARD OF DIRECTORS OF THE STAMFORD HOSPITAL (THE "HOSPITAL") (EXCEPT FOR THE HOSPITAL PRESIDENT/CEO, WHO SERVES AS AN EX OFFICIO DIRECTOR) (SECTIONS V.2, VI.2), TO ELECT/REMOVE/REPLACE THE HOSPITAL'S OFFICERS OTHER THAN THE PRESIDENT/CEO (SECTIONS VII.1, VII.4-5), AND TO ADOPT/AMEND/RESTATE/REPEAL THE BYLAWS (ART. XII). SHI HAS CERTAIN STATUTORY APPROVAL RIGHTS AS THE SOLE MEMBER, SUCH AS THE RIGHT TO APPROVE MOST AMENDMENTS TO THE HOSPITAL'S CERTIFICATE AND THE HOSPITAL'S MERGER, DISSOLUTION, OR SALE OF ALL ASSETS LEAVING THE HOSPITAL WITH NO SIGNIFICANT CONTINUING ACTIVITY. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | SHI HAS CERTAIN STATUTORY APPROVAL RIGHTS AS THE SOLE MEMBER, SUCH AS THE RIGHT TO APPROVE MOST AMENDMENTS TO THE HOSPITAL'S CERTIFICATE AND THE HOSPITAL'S MERGER, DISSOLUTION, OR SALE OF ALL ASSETS LEAVING THE HOSPITAL WITH NO SIGNIFICANT CONTINUING ACTIVITY. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE STAMFORD HOSPITAL HAS A COMPREHENSIVE REVIEW PROCESS IN PLACE RELATING TO THE REVIEW OF FORM 990. PRIOR TO FINALIZATION OF THE FORM 990, MANAGEMENT PRESENTS THE DRAFT FORM 990 TO THE FULL BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION. THE HOSPITAL'S EXTERNAL TAX ACCOUNTANTS ATTEND THIS MEETING WITH MANAGEMENT TO ADDRESS ANY SPECIFIC CONCERNS OR QUESTIONS. THIS REVIEW PROCEDURE HELPS TO ASSURE SOUND REPORTING AND COMPLIANCE WITH TAX LAW. |
| Form 990, Part VI, Line 12c Conflict of interest policy | IT IS THE POLICY OF THE STAMFORD HOSPITAL TO PROHIBIT ITS EMPLOYEES AND OTHER ASSOCIATES FROM ENGAGING IN ANY ACTIVITY, PRACTICE, OR ACT WHICH CONFLICTS WITH, OR APPEARS TO CONFLICT WITH, THE INTERESTS OF THE STAMFORD HOSPITAL, OR ITS PATIENTS. EMPLOYEES ARE EXPECTED TO CONDUCT THE BUSINESS OF THE STAMFORD HOSPITAL TO THE BEST OF THEIR ABILITY AND FOR THE BENEFIT OF THE STAMFORD HOSPITAL AND ITS PATIENTS. THE POLICY ALSO REQUIRES BOARD MEMBERS, OFFICERS, SENIOR LEADERS, MEDICAL STAFF LEADERS, COMMITTEE MEMBERS AND OTHER INDIVIDUALS AS APPROPRIATE TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST THEY OR THEIR IMMEDIATE FAMILY MAY HAVE ON AN ANNUAL BASIS. SURVEYS ARE DISTRIBUTED ANNUALLY AND TIMELY RECEIPT IS MONITORED BY THE HOSPITAL'S COMPLIANCE DEPARTMENT. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | IT IS THE POLICY OF THE STAMFORD HOSPITAL TO PAY EMPLOYEES FAIR AND COMPETITIVE WAGES. THE HOSPITAL HAS ADOPTED A WAGE AND SALARY PROGRAM TO ENSURE THAT ALL EMPLOYEES ARE PAID IN RELATION TO THE VALUE OF THE WORK THEY PERFORM. THIS PROGRAM IS REVIEWED ANNUALLY. EXECUTIVE COMPENSATION IS SUBJECT TO A MORE COMPREHENSIVE REVIEW, INCLUDING AN ANNUAL BENCHMARKING ANALYSIS AND BOARD LEVEL APPROVAL PROCESS. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | IT IS THE POLICY OF THE STAMFORD HOSPITAL TO PAY EMPLOYEES FAIR AND COMPETITIVE WAGES. THE HOSPITAL HAS ADOPTED A WAGE AND SALARY PROGRAM TO ENSURE THAT ALL EMPLOYEES ARE PAID IN RELATION TO THE VALUE OF THE WORK THEY PERFORM. THIS PROGRAM IS REVIEWED ANNUALLY. EXECUTIVE COMPENSATION IS SUBJECT TO A MORE COMPREHENSIVE REVIEW, INCLUDING AN ANNUAL BENCHMARKING ANALYSIS AND BOARD LEVEL APPROVAL PROCESS. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE STAMFORD HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | Cafeteria, Coffee Shop - Total Revenue: 2476726, Related or Exempt Function Revenue: 2476726, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Clinical Trials - Total Revenue: 1052752, Related or Exempt Function Revenue: 794017, Unrelated Business Revenue: 258735, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Income on Corporate Investment - Total Revenue: 600000, Related or Exempt Function Revenue: 600000, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Gift Shop Revenue - Total Revenue: 282540, Related or Exempt Function Revenue: 282540, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Perpetual Trust Income - Total Revenue: 280303, Related or Exempt Function Revenue: 280303, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Miscellaneous Income - Total Revenue: 220476, Related or Exempt Function Revenue: 220476, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Contract Income Smg - Total Revenue: 199826, Related or Exempt Function Revenue: 199826, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Abstracts - Total Revenue: 80901, Related or Exempt Function Revenue: 80901, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Vending Machine Revenue - Total Revenue: 34203, Related or Exempt Function Revenue: 34203, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; EMR Income - Total Revenue: 29182, Related or Exempt Function Revenue: 29182, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Library Membership Fee Income - Total Revenue: 1715, Related or Exempt Function Revenue: 1715, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part IX, Line 11g Other Fees | PURCHASED SERVICES - Total Expense: 33258019, Program Service Expense: 17700604, Management and General Expenses: 15550902, Fundraising Expenses: 6513; INTERCOMPANY STAFFING FEES - Total Expense: 4011865, Program Service Expense: 3937476, Management and General Expenses: , Fundraising Expenses: 74389; PHYSICIAN FEES - Total Expense: 12591219, Program Service Expense: 12619334, Management and General Expenses: -28115, Fundraising Expenses: ; PURCHASED SERVICE HSS INVOICE - Total Expense: 10490482, Program Service Expense: 10490482, Management and General Expenses: , Fundraising Expenses: ; CONSULTING SERVICE - Total Expense: 5971871, Program Service Expense: 2915374, Management and General Expenses: 2938754, Fundraising Expenses: 117743; ARCHIVING EXPENSE - Total Expense: 8107, Program Service Expense: 8107, Management and General Expenses: , Fundraising Expenses: ; Foreign Recruitment - Total Expense: 304188, Program Service Expense: 304188, Management and General Expenses: , Fundraising Expenses: ; TEMP NURSING PERSONNEL - Total Expense: 3791492, Program Service Expense: 3361492, Management and General Expenses: 430000, Fundraising Expenses: ; COLLECTION FEES - Total Expense: 4404897, Program Service Expense: 382692, Management and General Expenses: 3965947, Fundraising Expenses: 56258; DATA PROCESSING FEES - Total Expense: 466397, Program Service Expense: 166892, Management and General Expenses: 299505, Fundraising Expenses: ; Temporary Employee Services - Total Expense: 8184268, Program Service Expense: 7145205, Management and General Expenses: 1039063, Fundraising Expenses: ; Intercompany Agreements Staffing Fee - Total Expense: 37638744, Program Service Expense: 37644717, Management and General Expenses: -5973, Fundraising Expenses: ; Hospital Practices SHMG BLT - Total Expense: 17940920, Program Service Expense: 18114400, Management and General Expenses: -173480, Fundraising Expenses: ; Purchased Service Exp Reimb - Total Expense: 8294631, Program Service Expense: -38274, Management and General Expenses: 8332905, Fundraising Expenses: ; Recruiting - Total Expense: 2494531, Program Service Expense: 2493234, Management and General Expenses: 1297, Fundraising Expenses: ; SHMG Year End Loss Transfer - Total Expense: 83677805, Program Service Expense: , Management and General Expenses: 83677805, Fundraising Expenses: ; Purchased Service - Total Expense: -25400, Program Service Expense: , Management and General Expenses: -25400, Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | PENSION ADJUSTMENTS OTHER THAN PENSION COST - 1397000; SHMG EQUITY TRANSFER - 4388097; PENSION COST - -3586798; HEALTHSTAR NET PROCEEDS - 1406750; OTHER - -4672; |
| Software ID: | 23017437 |
| Software Version: | 2023v6.0 |