2022-08-11T10:19:20-05:00 2021-09-30 990 2020-10-01 061490803 THE ORCHARDS AT SOUTHINGTON ORCH 8606285656 34 HOBART STREET SOUTHINGTON CT 064893350 Mark Keise Authorized Signer 8606285656 2022-08-11 Mark Keise 999009999 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Eric Smullen 34 HOBART STREET SOUTHINGTON CT 064893350 5156441 0 X WWW.SOUTHINGTONORCHARDS.ORG X 1997 CT The mission of The Orchards at Southington is to promote a lifestyle in which our residents can age gracefully in a place while supporting independence. 4 0 74 4 0 0 896 1603 5449713 5154736 3299 102 0 0 5453908 5156441 0 0 0 0 2556773 2539915 0 0 0 2005762 2081041 4562535 4620956 891373 535485 11903320 12073077 9521958 9156230 2381362 2916847 The mission of The Orchards at Southington is to promote a lifestyle, which allows our residents to age in place while supporting independence. 0 0 3362978 5154736 The Orchards is a 90 apartment senior living community. The assisted living program is designed to promote the independence and dignity of seniors by providing assistance with activities of daily living. These actives includes: bathing, dressing, ambulating and medication reminders in a residential setting. Other services include weekly housekeeping, meals, health promotion, exercise programs, cultural, educational and social activities. 3362978 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 18 0 1 74 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X David Baranik 8606962546 181 Patricia M Genova Drive Newington CT 06111 Charles Johnson President (Thru July 2021) 1.00 59.00 X X 0 1637844 87365 Tracy Church Chair 2.00 58.00 X X 0 1152696 77527 Rocco Orlando MD Secretary 1.00 59.00 X X 0 1064133 102284 Gerald Boisvert President 1.00 59.00 X X 0 903361 79820 Rita Parisi SVP, Community Network 10.00 50.00 X X 0 568311 68279 David Baranik VP, Finance 10.00 50.00 X 0 375120 72404 Eric Smullen VP, HHC Community Network Ops 10.00 50.00 X 0 356991 70251 Laurie St John VP, Clinical Services 20.00 40.00 X 0 313027 55954 Lisa Connolly VP, Senior Services 20.00 40.00 X 0 310378 57863 LeaAnn Blanchard Exec Dir Assisted Living 60.00 0.00 X 110192 0 22762 Heather DePaolo VP, Human Resources 20.00 40.00 X 0 196858 25807 Sandra Ingriselli Dir Resident Care 60.00 0.00 X 104938 0 20225 215130 6878719 740541 2 0 1 0 Morrison Management Specialists Inc 400 Northridge Road Sandy Springs GA 30350 Food Services 373656 1 1603 1603 Resident Income 623000 5154736 5154736 5154736 102 102 5156441 5154736 0 102 1986081 1549773 436308 51043 39830 11213 360059 280960 79099 142732 109354 33378 294550 294550 6289 6289 113248 32595 80653 141312 90440 50872 468208 277462 190746 55 55 554 554 90280 53265 37015 162648 3253 159395 205809 100922 104887 21234 21234 Purchased Services 420723 370260 50463 Repairs and Maintenance 103649 102837 812 Medical Supplies 36063 36063 Dues, Subs and Licenses 16419 180 16239 4620956 3362978 1257978 0 2248846 2672349 17270 8950 51543 36843 5628866 1852090 3893456 3776776 5692205 5578159 11903320 12073077 350861 242148 18237 36462 9152860 8877620 9521958 9156230 X 2381362 2916847 2381362 2916847 11903320 12073077 535485 0 X 0 1 X 1 0 X 2228 1073 389 896 1603 6189 4857748 4989086 5414378 5450609 5154736 25866557 4859976 4990159 5414767 5451505 5156339 25872746 0 702484 604553 3543919 641844 700145 6192945 702484 604553 3543919 641844 700145 6192945 19679801 28425 3981 9017 3298 102 44823 15130 15130 43555 3981 9017 3298 102 59953 4903531 4994140 5423784 5454803 5156441 25932699 0.75890 0.77640 0.00230 0.00290 X 1000195 1000195 3974243 1339973 2634270 625612 512117 113495 28816 28816 3776776 Due from Affiliates 5558161 Bond Billing 14349 Patient Refunds 5649 5578159 Payable to HHC - Interco Bonds 8549260 Other Liabilities Program Related 328360 8877620 0 1 0 0 0 0 0 1 0 Charles Johnson President (Thru July 2021) 0 714190 0 391142 0 532512 0 19950 0 67415 0 1725209 0 377612 Tracy Church Chair 0 657676 0 376989 0 118031 0 19950 0 57577 0 1230223 0 0 Rocco Orlando MD Secretary 0 623780 0 284280 0 156073 0 37050 0 65234 0 1166417 0 0 Gerald Boisvert President 0 495980 0 327822 0 79559 0 19950 0 59870 0 983181 0 0 Rita Parisi SVP, Community Network 0 353037 0 156358 0 58916 0 34200 0 34079 0 636590 0 0 David Baranik VP, Finance 0 239762 0 131714 0 3644 0 19950 0 52454 0 447524 0 0 Eric Smullen VP, HHC Community Network Ops 0 259067 0 96149 0 1775 0 22800 0 47451 0 427242 0 0 Laurie St John VP, Clinical Services 0 227229 0 80643 0 5155 0 19950 0 36004 0 368981 0 0 Lisa Connolly VP, Senior Services 0 229715 0 77786 0 2877 0 19950 0 37913 0 368241 0 0 Heather DePaolo VP, Human Resources 0 178218 0 18408 0 232 0 13764 0 12043 0 222665 0 0 Part I, Line 3 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of The Orchards at Southington, hires an outside consultant, Human Resources and Compensation Consulting Practice of Gallagher to determine best practices in governing executive compensation. Please refer to compensation narrative reported on Schedule O. Part I, Line 4b Hartford Healthcare Corporation, a related organization, maintains a 457(f) Supplemental Executive Retirement Plan (SERP). Participants include certain officers and key employees at the President & CEO, Executive Vice President and Senior Vice President levels that are reported by Mulberry Gardens of Southington, LLC, on its Form 990, Part VII. Contributions are made by Hartford HealthCare Corporation to the plan based on a percentage of the participant's compensation. Participants vest in the plan at the earlier of reaching age 55 and having 5 years of service, death, disability, involuntary separation without reasonable cause, upon reaching age 65 or the occurence of a chane in control. Each participant ceases to be eligible for further contributions by Hartford Healthcare Corporation on the date of the participant's separation from service. Participants receive a one-time lump sum payment of the accumulated amount during the 30-day period following the participant's separation from service. 2020 SERP Payouts were made on behalf of the following individuals: Charles Johnson $226,543* Tracy Church $41,543* Rocco Orlando $24,724* Rita Parisi $13,615* Gerald Boisvert $19,737* *For these individuals, vesting occurred, causing taxable income. This portion of the vested amount was used to pay the associated tax liability. The remaining balance was deposited into the employee SERP account. Part I, Line 7 Hartford HealthCare Corporation, a related organization, has a Compensation At Risk Plan that encourages and rewards achievements of significant functional goals. These goals contribute to the organization's strategic and financial direction. The plan utilizes market practice alignment to ensure competitive recruitment and retention. Awards are based on CEO and/or Hartford HealthCare Corporation's Compensation Committee discretionary assessment of overall organization performance and individual contribution to results. Form 990, Part VI, Section A, line 1 The organization is governed by a management Board comprised of four employed individuals. These individuals are compensated for their services by Hartford HealthCare Corporation (HHC). HHC is the parent of an integrated healthcare delivery system which includes multiple tax-exempt hospitals that have community boards. Form 990, Part VI, Section A, line 6 The Orchards at Southington is organized as a non-stock not for profit entity. Hartford HealthCare Corporation is the sole member. Form 990, Part VI, Section A, line 7a The sole member of the organization has the authority to approve/remove members of the governing body. Form 990, Part VI, Section A, line 7b The sole member of the organization has the right to review, approve, disapprove, and deny significant transactons such as mergers, acquisitions, dissolutions, etc. Form 990, Part VI, Section B, line 11b The Form 990 was prepared by Hartford HealthCare's Tax Department. The final Form was provided to the entire Board prior to submission to the Internal Revenue Services (IRS). Once the entire review process was completed, the Form was signed and then filed with the IRS. Form 990, Part VI, Section B, line 12c The Orchards at Southington's Board has adopted the policy of the member, Hartford HealthCare Corporation (HHC). HHC's Conflict of Interest Policy (Policy) requires all covered individuals, including board members and officers, to provide a disclosure of relationships that create or have the appearance of creating a conflict of interest or commitment. The Policy requires updates if changes in circumstances arise during the year that either (a) create a new potential conflict of interest or commitment or (b) change or eliminate a conflict of interest or commitment previously disclosed. Conflict of interest disclosure statements are maintained by the HHC Office of Compliance and Integrity (OCI). Employee disclosures are reviewed by OCI in collaboration with the Covered Individuals' supervisor when deemed appropriate, to determine if there is a potential conflict. Oversight review of employee disclosures is provided by the HHC Conflict of Interest Committee. The Conflict of Interest Committee assesses and may recommend the conflicting interest either be (a) eliminated for continued relationship with HHC/HHC Affiliate, or, (b) managed through a management plan. Oversight review of physician disclosures is provided by the HHC Physician Conflict Resolution Committee. The Physician Conflict Resolution Committee assesses and may recommend the conflicting interest either be (a) eliminated for continued relationship with HHC/HHC Affiliate, or, (b) managed through a management plan. Board member disclosures are reported to the HHC Nominating and Governance Committee for determinations of conflicts and the management of them, where applicable. Form 990, Part VI, Section B, line 15 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of The Orchards of Southington, hires an outside consultant, Human Resources and Compensation Consulting Practice of Gallagher to determine best practices in governing executive compensation. The following steps were taken: -The use of an Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of The Orchards of Southington, established and regularly reviews Executive Compensation Philosophy; -The Committee regularly reviews scope and depth of positions taking into account complexity and the financial impact and accountability of all "disqualified persons; -National peer groups are selected for comparative purposes based on organizational size, operating revenue, geography and other relevant factors; -Analysis of current total compensation versus market is performed by independent third party compensation consulting firm and is then reviewed by the committee; -Recommendations are made based on market data analysis to ensure appropriate competitive positioning within parameters of compensation philosophy; -The CEO compensation is reviewed by the Committee and is based on comparative market information and organizational performance; -All changes are reviewed and approved by the Executive Compensation Committee; The compensation determination process for the CEO is reviewed on an annual basis. All other executive compensation is regularly reviewed for scope and depth of positions taking into account complexity and the financial impact and accountability. Form 990, Part VI, Section C, line 18 The Organization's Form 990, 990T and Form 1023 and its attachments are available upon request. Form 990, Part VI, Section C, line 19 The Organization's Financial Statements, Governing Documents and the Conflict of Interest Policy are available for inspection upon request at the Organization's address. Backus HealthCare Inc 326 Washington Street Norwich CT 06360 222481794 Supporting Organization CT 501(c)(3) 12 (a) Hartford HealthCare Corporation 1 Connecticut Health System Inc 80 Seymour Street Hartford CT 06102 222779421 Coordination of Health Care Delivery CT 501(c)(3) 12 (c) Hartford HealthCare Corporation 1 Hartford HealthCare ACO Inc 1290 Silas Deane Hwy 2nd Floor Wethersfield CT 06109 460886367 Government Contracts CT 501(c)(3) 7 Hartford HealthCare Medical Group Inc 1 Hartford HealthCare at Home Inc 1290 Silas Deane Hwy Suite 4B Wethersfield CT 06109 060646938 Home Healthcare CT 501(c)(3) 10 Hartford HealthCare Corporation 1 Hartford HealthCare Corporation One State Street Suite 19 Hartford CT 06102 222672834 Support & Management Svcs. 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Windham Community Memorial Hospital 1 Advanced Medical Imaging of NW CT LLC 57 Commercial Blvd Torrington CT 06790 061594854 Magnetic Resonance Imaging CT N/A 0 0 Ambulance Service of Manchester LLC PO Box 300 Manchester CT 06450 061557358 Ambulatory Service CT N/A 0 0 Central Connecticut Endoscopy Center 440 New Britain Avenue Plainville CT 06062 141855010 Endoscopy Svcs CT N/A 0 0 Connecticut Imaging Partners LLC c/o Jefferson Radiology 1500 Concor Sunrise FL 33323 134298940 Imaging Services CT N/A 0 0 Connecticut Orthopaedic Surgery Center LLC 205 Sub Way Milford CT 06461 134298940 Surgery Svcs CT N/A 0 0 Connecticut Proton Therapy Center LLC 789 Howard Ave Suite CB 230 New Haven CT 06519 Proton Therapy Services CT N/A 0 0 Constitution Surgery Center East LLC 174 Cross Road Waterford CT 06385 061574704 Surgery Svcs CT N/A 0 0 CT GI Endoscopy Center LLC ( Bloomfield) 4 Northwestern Drive Bloomfield CT 06002 061573358 GI Services CT N/A 0 0 Glastonbury Endoscopy Center LLC 300 Western 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