2017-08-10T07:20:53-05:00 2016-09-30 440160260 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 64106 990 2015-10-01 222635676 HARTFORD HEALTHCARE SENIOR SERVICES INC HART 8606219559 45 MERIDEN AVENUE SOUTHINGTON CT 06489 Mark Keise VP Finance 8606219559 2017-08-10 0 Michael J Engle P00482834 8162216300 2015 2021-01-29 14:40:06Z Rita Parisi 45 Meriden Avenue Southington CT 06489 20793826 0 X www.hhcseniorservices.org X 1990 CT To provide sub-acute and long-term care services to a senior population. 3 0 374 58 0 0 564257 55000 19654568 20659273 212990 58653 0 20900 20431815 20793826 0 755 0 0 14543148 14387915 0 0 105243 5401403 6581175 19944551 20969845 487264 -176019 13183125 14335744 9000041 10136670 4183084 4199074 To provide and promote wellness and independence to ensure optimal quality of life for the people we serve. 0 0 16585436 755 20659273 Hartford HealthCare Senior Services, Inc. is a licensed, 130-bed skilled nursing home facility, which provides room and board, nursing and physical therapy services to its residents in the community served. 16585436 1 1 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 1 0 0 1 37 0 1 374 1 0 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 8606219559 45 Meriden Avenue Southington CT 06489 Jeffrey Flaks Chair 1.00 59.00 X X 0 1371766 113623 Charles Johnson President 1.00 59.00 X X 0 344245 59722 Rocco Orlando MD Treasurer 1.00 59.00 X X 0 898279 106883 Rita Parisi VP, Post Acute Division 10.00 50.00 X 0 436824 85790 Lisa Connolly VP, Operations 60.00 X 240158 0 38975 William Kowalewski Executive Director 60.00 X 171706 0 17405 Audrey Vinci-McNamara Executive Director 60.00 X 158446 0 16747 Perry Phillips Executive Director 60.00 X 155364 0 16638 Susan Vinal Executive Director 60.00 X 140553 0 38847 Sharon Robinson Managed Care Common Relations 60.00 X 123528 0 21991 Carol Barno Former Officer 0.00 X 0 134379 16380 989755 3185493 533001 11 1 1 0 Connecticut Computer Service Inc 101 East Summer Street Plantsville CT 06479 Computer Services 322645 US Foods Inc PO Box 842700 Boston MA 02284 Food Service 265820 Reliable Flooring Contractor LLC 102 Cherry Street East Hartford CT 06108 Contractor Services 180262 Omega Contractor LLC 1190 Woodtick Road Wolcott CT 06716 Contractor Services 174563 Painting & Wallcovering Serv 1486 Highland Avenue Suite 7B Cheshire CT 06410 Painting Services 150180 6 55000 55000 Net Patient Services 623000 20659273 20659273 20659273 31159 31159 20900 0 20900 20900 20900 27494 0 27494 27494 27494 20793826 20659273 0 79553 755 755 247016 247016 11260284 8902727 2273596 83961 244103 187461 54874 1768 1984974 1524381 446217 14376 651538 500355 146464 4719 6658 6658 2308 2308 9092 9092 168313 129766 38547 28632 12499 16133 422857 400034 22404 419 367857 367857 8924 8924 35689 22273 13416 81880 81880 1515776 1066698 449078 478440 462980 15460 80995 80995 Miscellaneous Expense 1082002 929469 152533 Medical Supplies 722565 722565 Nursing Home User Fee 720208 720208 Purchased Services 660237 509029 151208 188742 44499 144243 20969845 16585436 4279166 105243 3463916 4946078 1978464 1484333 33567 33567 66313 63363 7298048 2454459 4795802 4843589 5193 5193 2839870 2959621 13183125 14335744 1376022 1384039 26014 52680 7598005 8699951 9000041 10136670 X 3724506 3801907 453385 391974 5193 5193 4183084 4199074 13183125 14335744 -176019 192009 0 X 0 1 X 1 0 X 82548 65888 71953 564257 55000 839646 16380730 16420877 17117615 19654568 20659273 90233063 16463278 16486765 17189568 20218825 20714273 91072709 0 0 0 91072709 28620 24930 42482 51522 52059 199613 28620 24930 42482 51522 52059 199613 791043 1103003 1306802 3200848 17282941 17614698 18538852 20270347 20766332 94473170 0.96400 0.95380 0.00210 0.00200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2706052 298507 11363 2993196 2777673 -58670 12951 2706052 1719598 901214 166160 9299 2777673 1622060 99489 1951 1719598 0.90000 0.09000 0.01000 0 1 1 1176370 1176370 4550589 1630212 2920377 119019 119019 1201098 824247 376851 250972 250972 4843589 Intercompany Allocation - Bond Debt 2954542 Patient Refunds 5079 2959621 Program Related Liability 845957 Payable to HHC - Interco Bonds 7031284 Due To Affiliates 822710 8699951 X 0 0 0 1 0 0 0 0 0 1 0 Jeffrey Flaks Chair 0 813226 0 382765 0 175775 0 60445 0 53178 0 1485389 0 0 Charles Johnson President 0 280374 0 60000 0 3871 0 39482 0 20240 0 403967 0 0 Rocco Orlando MD Treasurer 0 566368 0 203507 0 128404 0 56425 0 50458 0 1005162 0 0 Rita Parisi VP, Post Acute Division 0 310114 0 84955 0 41755 0 52425 0 33365 0 522614 0 0 Lisa Connolly VP, Operations 189281 0 50240 0 637 0 8563 0 30412 0 279133 0 0 0 William Kowalewski Executive Director 157921 0 12455 0 1330 0 5982 0 11423 0 189111 0 0 0 Audrey Vinci-McNamara Executive Director 138576 0 18826 0 1044 0 5530 0 11217 0 175193 0 0 0 Perry Phillips Executive Director 143993 0 10882 0 489 0 5442 0 11196 0 172002 0 0 0 Susan Vinal Executive Director 124896 0 15509 0 148 0 5137 0 33710 0 179400 0 0 0 Carol Barno Former Officer 0 134132 0 0 0 247 0 242 0 16138 0 150759 0 0 Part I, Line 1b Tax indemnification and gross-up payments to individuals for benefits were included as taxable income on their 2015 Form W-2. Part I, Line 3 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of Hartford HealthCare Senior Services, Inc., 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 President, Executive Vice President, Senior Vice President and Vice President levels that are reported by Hartford HealthCare Senior Services, Inc. on 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 or upon reaching age 65. 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. 2015 SERP Accruals made on behalf of the following individuals: Jeffrey Flaks $21,245 Charles Johnson $27,692 Jeffrey Flaks $106,225* Rocco Orlando $68,545* Rita Parisi $35,383* *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 stayed in the SERP acccount. Part I, Line 7 Hartford HealthCare Corporation, a related organization, has a Compensation At Risk Plan that provides at-risk award opportunities to motivate eligible executives to put forth maximum effort to accomplish specified annual goals. The payment of an award to any senior executive is contingent on the System achieving pre-established performance goals and maintaining financial stability, participants achieving pre-established performance goals, and on approval of the Executive Compensation Committee of the Board of Directors. 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 Hartford HealthCare Senior Services, Inc. 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 transactions such as mergers, acquisitions, dissolutions, etc. Form 990, Part VI, Section B, line 11 The Form 990 was prepared by Hartford HealthCare's Tax Department. It was then reviewed by an independent accounting firm. It was then forwarded to the organization's top management including the VP of Post Acute Division 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 Post Acute Division and then filed with the IRS. Form 990, Part VI, Section B, line 12c Hartford HealthCare Senior Services Inc. 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 Committee) which includes representation from the Medical Staff, the Legal Department, Human Resources, Supply Chain Management and Compliance. The Committee assesses and may recommend the conflicting interest either be (a) eliminated for a 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 Hartford HealthCare Senior Services, Inc., 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 Hartford HealthCare Senior Health Services, Inc., 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 an independent third party compensation consulting firm and is then reviewed by the committee; - Recommendations are made based on the 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 company's Form 990, Form 1023 and its attachments are available upon request. Form 990, Part VI, Section C, line 19 The company'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) 11(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) 11(a) Hartford HealthCare Corporation 1 Bradley Health Services Inc 100 Grand Street New Britain CT 06050 061367014 Healthcare Services CT 501(c)(3) 9 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) 11(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 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Hartford HealthCare Corporation 1 Rushford Foundation Inc 883 Paddock Avenue Meriden CT 06450 061432692 Supporting Organization CT 501(c)(3) 11(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) 9 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) 11(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) 11(a) Windham Community Memorial Hospital 1 Hartford HealthCare Endowment LLC 80 Seymour Street Hartford CT 06102 454181103 Endowment Management CT 501(c)(3) 11(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 HealthCare Endowment LLC 80 Seymour Street Hartford CT 06102 454181103 Endowment Management CT N/A Investment 0 0 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 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