2016-08-13T08:00:47-05:00 2015-09-30 990 2014-10-01 222635676 HARTFORD HEALTHCARE SENIOR SERVICES INC HART 8606219559 45 MERIDEN AVENUE SOUTHINGTON CT 06489 Rita Parisi VP Post Acute Division 8606219559 2016-08-13 2014 2016-12-15 16:53:06Z Rita Parisi 45 Meriden Avenue Southington CT 06489 20431815 0 X WWW.SOUTHINGTONCARE.ORG X 1990 CT To provide sub-acute and long-term care to a senior population 3 0 366 56 0 0 71953 564257 17117615 19654568 140028 212990 1306802 0 18636398 20431815 0 0 0 0 13918334 14543148 0 0 101393 4574668 5401403 18493002 19944551 143396 487264 13763708 13183125 9802282 9000041 3961426 4183084 To provide sub-acute and long-term care to a senior population. 0 0 15187430 19654568 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. 15187430 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 1 0 0 1 36 0 1 366 1 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 1 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 Daniel Daigle Director (Thru June 2015) 1.00 2.00 X 0 0 0 John Manning Director (Thru June 2015) 1.00 2.00 X 0 0 0 John Mullett Director (Thru June 2015) 1.00 2.00 X 0 0 0 Susan Venberg Director (Thru June 2015) 1.00 2.00 X 0 0 0 John Dillaway Director (Thru June 2015) 1.00 2.00 X 0 0 0 Craig Bogdanski MD Director (Thru June 2015) 1.00 2.00 X 0 0 0 Phillip Davidson Director (Thru June 2015) 1.00 2.00 X 0 0 0 John Matulis Atty Director (Thru June 2015) 1.00 2.00 X 0 0 0 Carl Sokolowski Director (Thru June 2015) 1.00 2.00 X 0 0 0 Lucille Janatka Director (Thru June 2015) 1.00 59.00 X 0 3295845 107940 Joseph Crispino Director (Thru June 2015) 1.00 2.00 X 0 0 0 Barbara Mackay Director (Thru June 2015) 1.00 2.00 X 0 0 0 Harry Mazadoorian Director (Thru June 2015) 1.00 2.00 X 0 0 0 Dennis Stanek Director (Thru June 2015) 1.00 2.00 X 0 0 0 Audrey Zack Director (Thru June 2015) 1.00 2.00 X 0 0 0 Jeffrey Flaks Chair 1.00 59.00 X X 0 1120432 63630 Rocco Orlando MD Secretary 1.00 59.00 X X 0 796480 81208 Charles Johnson President (As of 07/2015) 1.00 59.00 X X 0 0 0 Carol Barno Director (Thru 6/2015)/ VP Finance 20.00 40.00 X 0 183069 15592 Rita Parisi VP Post Acute Division 1.00 59.00 X 0 401246 78236 Lisa Connolly VP, Operations 60.00 X 210236 0 23028 Heidi Gil Senior Director of Quality 60.00 X 200420 0 10926 William Kowalewski Executive Director 60.00 X 173562 0 10752 Perry Philips Executive Director 60.00 X 165795 0 10592 Audrey Vinci-McNamara Executive Director 60.00 X 158632 0 10467 Susan Vinal Administrator 60.00 X 133537 0 30781 Clarence Silvia Former President 0.00 X 0 1719601 50455 1042182 7516673 493607 9 1 1 0 Connecticut Computer Service Inc 101 East Summer Street Plantsville CT 06479 Computer Services 310991 HealthMEDX LLC 5100 N Towne Centre Drive Ozark MO 65721 Computer Software 290588 US Foods Inc PO Box 842700 Boston MA 02284 Food Service 256064 McKesson Medical-Surgical Minnesota Supp PO Box 630693 Cincinnati OH 45263 Medical Supplies 131588 4 551457 12800 564257 Net Patient Services 623000 19654568 19654568 19654568 51522 51522 161468 0 161468 161468 161468 20431815 19654568 0 212990 942035 942035 10818731 8553621 2184441 80669 287043 220438 64526 2079 1868609 1435017 420059 13533 626730 481303 140887 4540 2672 2672 94770 94770 179953 138740 41213 33181 14485 18696 577164 546012 30580 572 402319 402319 16014 16014 41243 25739 15504 68419 68419 1296734 972550 324184 470515 455312 15203 67091 67091 Medical Supplies 739278 739278 Nursing Home User Fee 724076 724076 Purchase Services 324026 249817 74209 Repairs & Maintenance 200457 29627 170830 163491 35907 127584 19944551 15187430 4655728 101393 0 3463916 3362593 0 0 0 2059674 1978464 0 0 32804 33567 99333 66313 6771821 1976019 4885938 4795802 0 0 2777673 5193 0 0 0 0 545693 2839870 13763708 13183125 2015175 1376022 19429 26014 7767678 7598005 9802282 9000041 X 3863102 3724506 93131 453385 5193 5193 3961426 4183084 13763708 13183125 X 487264 -268188 2582 X 0 1 X 1 0 X 79781 82548 65888 71953 564257 864427 16323647 16380730 16420877 17117615 19654568 85897437 16403428 16463278 16486765 17189568 20218825 86761864 0 0 0 86761864 33413 28620 24930 42482 51522 180967 33413 28620 24930 42482 51522 180967 825479 791043 1103003 1306802 4026327 17262320 17282941 17614698 18538852 20270347 90969158 0.95380 0.94370 0.00200 0.00190 X 810000 810000 2953166 831192 2121974 1440480 305506 1134974 1242061 692652 549409 326114 146669 179445 4795802 Intercompany Allocation - Bond Debt 2786561 Due From/To Affliliates 53309 2839870 Program Related Liability 566721 Payable to HHC - Interco Bonds 7031284 7598005 0 1 0 0 0 0 0 1 0 Lucille Janatka Director (Thru June 2015) 0 560112 0 128700 0 2607033 0 20800 0 87140 0 3403785 0 2575769 Jeffrey Flaks Chair 0 704959 0 270040 0 145433 0 20800 0 42830 0 1184062 0 0 Rocco Orlando MD Secretary 0 547918 0 101743 0 146819 0 37700 0 43508 0 877688 0 0 Carol Barno Director (Thru 6/2015)/ VP Finance 0 162071 0 20800 0 198 0 0 0 15592 0 198661 0 0 Rita Parisi VP Post Acute Division 0 294087 0 69978 0 37181 0 37700 0 40536 0 479482 0 0 Lisa Connolly VP, Operations 185358 0 24500 0 378 0 0 0 23028 0 233264 0 0 0 Heidi Gil Senior Director of Quality 179693 0 14500 0 6227 0 0 0 10926 0 211346 0 0 0 William Kowalewski Executive Director 157772 0 15000 0 790 0 0 0 10752 0 184314 0 0 0 Perry Philips Executive Director 143542 0 22000 0 253 0 0 0 10592 0 176387 0 0 0 Audrey Vinci-McNamara Executive Director 138444 0 19500 0 688 0 0 0 10467 0 169099 0 0 0 Susan Vinal Administrator 126394 0 7000 0 143 0 4144 0 26637 0 164318 0 0 0 Clarence Silvia Former President 0 171983 0 25901 0 1521717 0 49890 0 565 0 1770056 0 197657 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 2014 Severance payout was made to the following individual: Mr. Clarence Silvia $1,213,838 Hartford HealthCare Corporation, a related organization, maintains a 457(f) plan. 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. 2014 SERP Accrual was made on behalf of the following individual: Mr. Clarence Silvia $28,226 2014 Serp Payments were made to the following individuals: Ms. Lucille Janatka $2,575,769 Mr. Clarence Silvia $197,657 Mr. Jeffrey Flaks $97,014* Dr. Rocco Orlando $63,924* Ms. Rita Parisi $34,592* *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 an At Risk Plan that encourages and rewards achievements of significant functional goals for management that contribute to 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 4 The Corporation amended its Certificate of Incorporation during fiscal year 2015. The Amended and Restated Certificate includes the following substantive amendments: The board duties were revised to focus on quality, and the size of the board was reduced. The indemnification provisions were changed consistent with Connecticut law. The Organization's governing documents are available upon request. 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 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, Audit & Privacy (OCAP). Employee disclosures are reviewed by OCAP 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, 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: - 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 Committee based on comparative market information and organizational performance - All changes are reviewed and approved by the Executive Compensation Committee The CEO compensation determination process 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. Form 990, Part XI, line 9: Capital Contribution -4,593. Temp Restricted Net Assets - Used for Capital 7,176. Rounding -1. 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 Central CT Health Alliance 100 Grand Street New Britain CT 06050 222785033 Support & Management Svcs. to THOCC and Affiliates - Shell CT 501(c)(3) 11(b) 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) 1 Eva Stearns Faulkner Foundation 435 Lewis Avenue Meriden CT 06451 066065398 Supporting Organization CT 501(c)(3) 3 MidState Medical Center 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) 11(c) N/A 0 HHC PhysiciansCare Inc 80 Seymour Street Hartford CT 06102 454456939 Practice Medicine and Provide Health Care Services to the Public 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 To Manage and Coordinate Care for Medicare Beneficiares CT 501(c)(3) 7 Hartford HealthCare Corporation 1 Hartford HealthCare Corp Group (VEBA) 777 Main Street Hartford CT 06102 266671355 To provide medical benefits to employees. 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