2018-08-13T10:00:08-05:00 2017-09-30 990 2016-10-01 061490803 THE ORCHARDS AT SOUTHINGTON ORCH 8606285656 34 HOBART STREET SOUTHINGTON CT 064893350 David Baranik VP Finance 8606285656 2018-08-13 2016 2022-09-23 18:48:47Z Rita Parisi 34 Hobart Street Southington CT 06489 4903531 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. 3 0 78 9 15130 0 2057 2228 5011042 4857748 963 28425 13160 15130 5027222 4903531 0 0 0 0 2375212 2234663 0 0 0 1986713 2152431 4361925 4387094 665297 516437 9372480 9677163 9895802 9684048 -523322 -6885 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 3715761 4857748 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. 3715761 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 11 0 1 78 1 1 1 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Paula DePinto 8606285656 80 Meriden Avenue Southington CT 064893350 Charles Johnson President 1.00 59.00 X X 0 868701 137241 Rocco Orlando MD Secretary 1.00 59.00 X X 0 936263 74228 Tracy Church Chair 1.00 59.00 X X 0 898904 51653 Rita Parisi SVP, Community Network 10.00 50.00 X 0 464411 71938 David Baranik VP, Finance 10.00 50.00 X 0 38001 4522 0 3206280 339582 0 0 1 0 Morrison Community Living PO Box 102289 Atlanta GA 303682289 Dietary Services 252944 1 2228 2228 Resident Income 623990 4857748 4857748 4857748 28425 28425 Food Service/Catering 722320 15130 15130 15130 4903531 4857748 15130 28425 1741433 1432729 308704 37863 27824 10039 338106 248460 89646 117261 86170 31091 6389 6389 54396 54396 445967 445967 350 350 2324 1859 465 170661 170661 494219 370664 123555 235391 235391 29515 29515 Purchased Services 507220 405776 101444 Repairs and Maintenance 181164 181164 Medical Supplies 18170 18170 Dues, Subs and Licenses 6665 6665 4387094 3715761 671333 0 4860302 628268 4883025 206561 86577 70604 52946 5259832 1330203 4146029 3929629 88984 96718 9372480 9677163 379376 386956 9516426 9297092 9895802 9684048 X -538926 -24602 15604 17717 -523322 -6885 9372480 9677163 516437 0 X 0 1 X 1 0 X 7421 2685 3990 2057 2228 18381 4622713 4881806 4992450 5011042 4857748 24365759 4630134 4884491 4996440 5013099 4859976 24384140 0 539468 451554 436722 203872 702484 2334100 539468 451554 436722 203872 702484 2334100 22050040 1016 1018 1022 963 28425 32444 13160 15130 28290 1016 1018 1022 14123 43555 60734 18268 21960 40228 4649418 4907469 4997462 5027222 4903531 24485102 0.90050 0.91200 0.00250 0.00080 X 1372787 1372787 3224320 865119 2359201 662725 465084 197641 3929629 Security Deposits 348186 Payable to HHC - Interco Bonds 8948906 9297092 X 1 1 0 1 0 0 0 0 0 1 0 Charles Johnson President 0 596488 0 258353 0 13860 0 101698 0 35543 0 1005942 0 0 Rocco Orlando MD Secretary 0 557951 0 210173 0 168139 0 34450 0 39778 0 1010491 0 0 Tracy Church Chair 0 423528 0 174765 0 300611 0 18550 0 33103 0 950557 0 189038 Rita Parisi SVP, Community Network 0 305901 0 99794 0 58716 0 44161 0 27777 0 536349 0 0 Part I, Line 1b Tax indemnification and gross-up payments to individuals for benefits were included as taxable income on their 2016 Form W-2. 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, Integrated Healthcare Strategies, a division of Gallagher Benefit Services, Inc., 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 CEO, President, Executive Vice President, Senior Vice President and Vice President levels that are reported by The Orchards at Southington 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 change 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. 2016 SERP Accruals were made on behalf of the following individuals: Charles Johnson $83,148 Rocco Orlando $72,449 Tracy Church $272,183 2016 SERP Payout was made on behalf of the following individual: Tracy Church $130,674* Rocco Orlando $33,648* *For these individuals, vesting occurred, causing taxable income. A 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 three 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. It was then forwarded to the organization's Vice President of Finance for review. 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 by the VP of Finance 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 Executive Compliance Steering Committee ("ECSC") (the Committee) which includes representation from the Medical Staff, the Legal Department, Human Services, Supply Chain Management and Compliance. The Committee assesses and may recommend the conflicting interest either be (a) eliminated for continued relationship with HHC/ Hartford HealthCare Senior Services, Inc., 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, Integrated Healthcare Strategies, a division of Gallagher Benefit Services, Inc., 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 Corporation 326 Washington Street Norwich CT 06360 222757608 Supporting Organization CT 501(c)(3) 12(b) Hartford HealthCare Corporation 1 The William W Backus Hospital 326 Washington Street Norwich CT 06360 060250773 Hospital CT 501(c)(3) 3 Hartford HealthCare Corporation 1 Backus HealthCare Inc 326 Washington Street Norwich CT 06360 222481794 Supporting Organization CT 501(c)(3) 12(a) Hartford HealthCare Corporation 1 Caring for Colleagues Employee Crisis Fund 100 Grand Street New Britain CT 06052 264469178 Employee Fund CT 501(c)(3) 7 Hartford HealthCare Corporation 1 Connecticut Health Systems Inc 80 Seymour Street Hartford CT 06102 222779421 Coordination of Health Care Delivery CT 501(c)(3) 12(c) N/A 1 Hartford HealthCare At Home Inc 1290 Silas Deane Hwy Suite 4B Wethersfield CT 06109 060646938 Home Healthcare CT 501(c)(3) 7 Hartford HealthCare Corporation 1 Hartford HealthCare Corporation One State Street Suite 19 Hartford CT 06103 222672834 Support and Management Services to Hartford Hospital and Affiliates CT 501(c)(3) 12(c) N/A 0 Hartford HealthCare Medical Group Inc 1290 Silas Deane Hwy 2nd Floor Wethersfield CT 06109 454456939 Medical Services CT 501(c)(3) 9 Hartford HealthCare Corporation 1 Hartford HealthCare Accountable Care Org Inc 1290 Silas Deane Hwy 2nd Floor Wethersfield CT 06109 460886367 Government Contracts CT 501(c)(3) 7 HHC PhysiciansCare Inc 1 Hartford Hospital 80 Seymour Street Hartford CT 06102 060646668 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 Hartford Hospital Auxiliary co Hartford Hospital 80 Seymour Street Hartford CT 06115 066040747 Fundraising CT 501(c)(3) 12(c) Hartford Hospital 1 The Hospital of Central CT and Bradley Memorial 100 Grand Street New Britain CT 06050 060646768 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 MidState Medical Center 435 Lewis Avenue Meriden CT 06451 060646715 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 MidState Medical Center Auxiliary 435 Lewis Avenue Meriden CT 06451 066063082 Fundraising CT 501(c)(3) 12(a) MidState Medical Center 1 Mulberry Gardens of Southington LLC 58 Mulberry Street Plantsville CT 06479 820586577 Assisted Living & Adult Day Care Facility CT 501(c)(3) 10 Hartford HealthCare Senior Services Inc 1 Natchaug Hospital Inc 189 Storrs Road Mansfield CT 06226 060966963 Behavioral Health CT 501(c)(3) 3 Hartford HealthCare Corporation 1 Hartford HealthCare Senior Services Inc 45 Meriden Avenue Southington CT 06489 222635676 Sub-Acute & Long Term Healthcare CT 501(c)(3) 10 Hartford HealthCare Corporation 1 Rushford Center Inc 883 Paddock Avenue Meriden CT 06450 060932875 Substance Abuse Healthcare Services CT 501(c)(3) 7 Hartford HealthCare Corporation 1 Rushford Foundation Inc 883 Paddock Avenue Meriden CT 06450 061432692 Supporting Organization CT 501(c)(3) 12(a) Rushford Center Inc 1 Hartford HealthCare Independence at Home Inc 1290 Silas Deane Hwy Suite 4B Wethersfield CT 06226 061161422 Home Healthcare CT 501(c)(3) 10 Hartford HealthCare At Home Inc 1 Windham Community Memorial Hospital 112 Mansfield Avenue Willimantic CT 06226 060646966 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 Windham Hospital Foundation Inc 112 Mansfield Avenue Willimantic CT 06226 562546632 Supporting Organization CT 501(c)(3) 12(a) Windham Community Memorial Hospital 1 Windham Community Memorial Hospital Women's Auxiliary Inc 112 Mansfield Avenue Willimantic CT 06226 060677728 Fundraising CT 501(c)(3) 12(a) Windham Community Memorial Hospital 1 Hartford HealthCare Endowment LLC 80 Seymour Street Hartford CT 06103 454181103 Investment Management CT 501(c)(3) 12(a) Hartford HealthCare Corporation 1 Ambulance Service of Manchester LLC PO Box 300 Manchester CT 06450 061557358 Ambulatory Services CT N/A Connecticut Imaging Partners LLC 111 Founders Plaza East Hartford CT 06108 134298940 Imaging Services CT N/A Glastonbury Endoscopy Center LLC 300 Western Boulevard Glastonbury CT 06033 261721234 Endoscopy Services CT N/A Glastonbury Surgery Center LLC 195 Eastern Boulevard Glastonbury CT 06033 262600828 Surgery Services CT N/A Hartford-Middlesex Clinical System LLC 80 Seymour Street Hartford CT 06110 061543605 Affiliate Support Services CT N/A HHC Southington Surgery Center LLC 100 Avon Meadow Lane Avon CT 06001 465500829 Surgery Services CT N/A Med East Assoc LLC 1703 West Main Street Willimantic CT 06226 061469575 Outpatient Care Clinic CT N/A New Britain MRI Limited Partnership 100 Grand Street New Britain CT 06050 061271349 Magnetic Resonance Imaging CT N/A Omni Home Health Services E CT LLC 12 Case Street - 317 Norwich CT 06360 061458837 Backus Home Health Care CT N/A Constitution Surgery Center East LLC 174 Cross Road Waterford CT 06385 061574704 Surgery Services CT N/A CT GI Endoscopy Center LLC 4 Northwestern Drive Bloomfield CT 06002 061573358 GI Services CT N/A HHC Hartford Surgery Center LLC 100 Avon Meadow Lane Avon CT 06001 812637261 Surgery Services CT N/A HHC Urgent Care Go Health LLC 2711 Centerville Road Suite 400 Willmington DE 19808 815112698 Urgent Care Services DE N/A Wallingford Endoscopy Center LLC 85 Seymour Street Suite 1000 Hartford CT 06106 824601730 Endoscopy Services CT N/A Aetna Ambulance Service Inc PO Box 1150 Manchester CT 06045 060795431 Ambulance Services CT N/A C 1 Backus Medical Center Condo Assoc Inc 330 Washington Street Norwich CT 06360 061542647 Condo Assocation CT N/A C 1 CenConn Services Inc 100 Grand Street New Britain CT 06050 222836001 Holding Company CT N/A C 1 Hartford HealthCare Indemnity Services Ltd FB Perry Bld 40 Church St Hamilton BD Captive Insurance BD N/A C 1 ConnCare Inc 326 Washington Street Norwich CT 06360 061387598 Health Care Services CT N/A C 1 HHMOB Corporation 80 Seymour Street Hartford CT 06102 061140244 Real Estate & Parking CT N/A C 1 Hartford Physician Services PC 80 Seymour Street Hartford CT 06102 061254082 Medical Services CT N/A C 1 Meriden Imaging Center 101 North Plains Industrial Road Meriden CT 06429 061541468 Imaging CT N/A S 1 Midstate Medical Group PC 435 Lewis Avenue Meriden CT 06450 204327968 Medical Services CT N/A C 1 Hartford Physician Hospital Organization Inc 80 Seymour Street Hartford CT 06102 222785918 Physician & Hospital Support CT N/A C 1 Metro Wheelchair Service Inc PO Box 300 Manchester CT 06045 060878432 Wheelchair Services CT N/A C 1 Windham Health Services Inc 112 Mansfield Avenue Willimantic CT 06226 061461101 Home Healthcare CT N/A C 1 Windham Family Medical Services PC 112 Mansfield Avenue Willimantic CT 06226 061491649 Medical Services CT N/A C 1 Windham Physician Hospital Organization 112 Mansfield Avenue Willimantic CT 06226 061441614 Medical Services CT N/A C 1 WWB Corporation 326 Washington Street Norwich CT 06360 061094836 Holding Company CT N/A C 1 Windham Professional Office Condominium Association Inc 1120 Mansfield Avenue Willimantic CT 06226 061090041 Condo Assocation CT N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0