2014-08-14T15:17:47-05:00 2013-09-30 ERNST & YOUNG US LLP 1101 NEW YORK AVENUE NW WASHINGTON DC 20005 990 2012-10-01 222577707 Norwalk Hospital Foundation % TONI HORNE NORW 2038522000 34 Maple Street Suite Norwalk CT 06856 DANIEL DEBARBA 2014-08-08 2023277097 2012 2015-11-30 17:44:51Z DANIEL DEBARBA 34 Maple Street Norwalk CT 06856 8654164 false X www.norwalkhospital.org X 1985 CT THE NORWALK HOSPITAL FOUNDATION GENERATES PHILANTHROPY AND AWARENESS TO SUPPORT NORWALK HOSPITAL IN BEING A LEADER IN ADVANCED MEDICAL CARE IN THE REGION. 18 16 0 300 0 16594441 7297982 0 0 877132 953036 -214832 -422654 17256741 7828364 4728571 2630762 0 0 1589161 1425206 30481 25146 1049528 620517 11152301 6968730 15233415 10288011 -7405051 49929632 46650727 453281 1408044 49476351 45242683 X THE NORWALK HOSPITAL FOUNDATION GENERATES PHILANTHROPY AND AWARENESS TO SUPPORT NORWALK HOSPITAL IN BEING A LEADER IN ADVANCED MEDICAL CARE IN THE REGION. GIFTS TO NORWALK HOSPITAL FOUNDATION SUPPORT WORLD CLASS MEDICAL CARE TO MEET THE HIGHEST LEVEL PATIENT EXPECTATIONS INCLUDING THE FOLLOWING INITIATIVES: PROVIDING QUALITY COMPASSIONATE PATIENT-CENTERED CARE FOR ALL PATIENTS; BUILDING STATE-OF-THE-ART FACILITIES WITH INNOVATIVE NEW TECHNOLOGIES AND EQUIPMENT; DEVELOPING AND PROVIDING PROGRESSIVE EDUCATIONAL PROGRAMS TO ASSURE MEDICAL PERSONNEL ARE UP-TO-DATE ON THE MOST RECENT TREATMENTS AND QUALITY OF CARE; ATTRACTING AND RETAINING THE BEST, THE BRIGHTEST, AND THE MOST DEDICATED PHYSICIANS, NURSES AND OTHER MEDICAL STAFF; AND LEADING RELEVANT RESEARCH IN KEY AREAS IN MEDICINE AND SURGERY. false false 10627037 1220642 FACILITIES, EQUIPMENT & TECHNOLOGY: FOUNDATION FUNDS SUPPORTED RENOVATIONS IN SEVERAL AREAS OF THE HOSPITAL INCLUDING THE NEW AMBULATORY PAVILION, PEDIATRIC DEPARTMENT, MICROBIOLOGY, AND CP3. ADDITIONALLY, FUNDS WERE USED TO SUPPORT THE PURCHASE OF PINK AID VAN, IMMUNOASSAY OPEN PLATFORM ANALYZER, MOLECULAR DNA FILM ARRAY SYSTEM AND VIRAL RESPIRATORY PANEL TESTING, STERILIZE RD RAPID INFUSER, DA VINCI INSTRUMENTS AND SCOPES, IT SCANNING SYSTEM, GI MONITORS AND EMS STRYKER STRETCHERS. 1313956 671126 PATIENT CARE & OTHER PROGRAMS: FOUNDATION FUNDS WERE USED TO SUPPORT A VARIETY OF PATIENT CARE PROGRAMS INCLUDING THE PEDIATRIC DEVELOPMENT AND THERAPY PROGRAM, MAMMOGRAM SCREENING PROGRAM, LYMPHEDEMA SLEEVE PROGRAM, INTEGRATIVE MEDICINE PROGRAMS, PATIENT EDUCATION MATERIALS, ART AND MUSIC THERAPY, SPIRITUAL CARE, COMMUNITY CHILDHOOD OBESITY PROGRAM AND INDIVIDUAL AND GROUP THERAPY FOR CANCER PATIENTS. INTEREST FROM ENDOWMENTS AND OTHER RESTRICTED FUNDS SUPPORT SEVERAL KEY POSITIONS INCLUDING THE CHAIRS OF PEDIATRICS AND PSYCHIATRY, PEDIATRIC HOSPITALISTS, THE SMILOW FAMILY BREAST HEALTH DIRECTOR AND THE GRACE COLE JONES GIFT SHOP MANAGER. 815401 110810 EDUCATION, TRAINING & RESEARCH: NORWALK HOSPITAL FOUNDATION SUPPORTS A VARIETY OF LEARNING OPPORTUNITIES FOR EMPLOYEES AS WELL AS SCHOLARSHIPS FOR STUDENTS PURSUING BOTH UNDERGRADUATE AND ADVANCED DEGREES IN NURSING. SEVENTY EIGHT SCHOLARSHIPS WERE AWARDED TO STUDENTS ENROLLED IN NURSING PROGRAMS AT LOCAL COLLEGES AND UNIVERSITIES. FUNDS WERE ALSO USED TO SUPPORT CONTINUING EDUCATION AND TRAINING FOR MEDICAL RESIDENTS, SPIRITUAL CARE PROVIDERS, LABOR AND DELIVERY NURSES, PULMONARY AND CRITICAL CARE NURSES, AND RESPIRATORY THERAPISTS AMONG OTHERS. IN ADDITION, FOUNDATION FUNDS SUPPORTED MEDICAL GRAND ROUNDS LECTURES, LIBRARY SERVICES, AND PRINTED EDUCATIONAL MATERIALS. AS A COMMUNITY TEACHING HOSPITAL, RESEARCH IS A KEY ELEMENT IN ATTRACTING NEW RESIDENTS, FELLOWS AND PHYSICIANS AS WELL AS TO CONTINUOUS IMPROVEMENTS IN MEDICAL CARE AND SERVICES FOR PATIENTS IN THE COMMUNITY. FOUNDATION SUPPORT ENABLED NORWALK HOSPITAL'S WHITTINGHAM CANCER CENTER TO CONTINUE ITS ROBUST CLINICAL RESEARCH TRIAL PROGRAM. IN FISCAL YEAR 2013, RESEARCH TRIALS WERE CONDUCTED IN BREAST, COLON, ESOPHAGEAL, LUNG, OVARIAN, PANCREATIC AND BLADDER CANCERS ALONG WITH HEMATOLOGY TRIALS. 628184 628184 13384579 true true false false false false false false false true true false false true true false false true false false false false false true true false false true true true false false false false false false false false true false false false false true true true false false true X 6 0 true 0 false false false false false false false false false false X 18 16 false false false false true true false true true false false false true true true true true false false false CT X TONI HORNE 2038522071 34 MAPLE STREET NORWALK CT 06856 X MARY G FRANCO 50.0 X X 353672 0 60221 FREDERICK R AFRAGOLA 1.0 4.0 X ROBERT CIOFFI 1.0 X X HOWARD EISON MD 2.0 3.0 X X DAVID M LEHN 2.0 3.0 X KATHLEEN MCSHANE 1.0 X ROBERT OBERNIER 1.0 X CORNELIUS T RYAN 1.0 X AMY SCHAFRANN 2.0 3.0 X ERVIN R SHAMES 1.0 3.0 X LUISA URIARTE 1.0 X RICHARD ZELKOWITZ 1.0 X DIANNE ALLISON ESQ 1.0 7.0 X DANIEL DEBARBA 1.0 55.0 X 935506 31978 LEONARD DINARDO 1.0 X PHILIP MORRIS 1.0 X ALISON SCAVONE 2.0 X X CAROL ASNESS 2.0 X X MARY GRACE GUDIS 1.0 X CHRISTIAN TREFTZ 1.0 X AMY KATZ 1.0 X MICHAEL LUBLINSKY 1.0 X STEPHEN MICHAELSON 1.0 X DEVANG PATEL DPM 1.0 X LISA FERRARO UNTIL 71913 50.0 X 206481 0 43717 GEOFFREY COLE X 218249 560153 1153755 135916 2 true true false NONE 0 1645616 628184 5024182 209266 7297982 0 953923 953923 0 0 0 0 0 208379 209266 -887 -887 -887 193880 1645616 616534 -422654 -422654 0 0 0 7828364 530382 2519952 2519952 110810 110810 0 0 543045 208048 334997 0 597120 309366 287754 0 216778 96494 120284 68263 32860 35403 0 0 65160 65160 0 25146 25146 0 53253 16108 37145 0 138571 4325 134247 38041 38041 0 43200 43200 7556 7556 0 0 0 0 0 0 FACILITIES, EQUIPMENT & TECHNO 10627037 10627037 PATIENT CARE, OTHER PROGRAMS 126780 126780 DONOR RECOGNITION 28931 28931 All other expenses 23772 16192 7580 15233415 13384579 799309 1049528 6793363 5987072 0 0 3712550 3074574 0 0 0 0 0 0 0 0 0 0 51933 0 131033 131033 31442627 32968495 0 0 0 0 0 0 7929159 4620586 49929632 46650727 0 20124 0 0 262475 5000 0 0 0 0 0 0 0 0 0 0 190806 1382920 453281 1408044 X 0 0 40030499 35787831 9445852 9454852 49476351 45242683 49929632 46650727 X -7405051 3171382 X false true X true false X 6145403 6989124 11484940 16359441 7297982 48276890 0 0 6145403 6989124 11484940 16359441 7297982 48276890 5094721 43182169 845570 622717 400454 879665 953923 3702329 0 0 51979219 493365 0.83076 0.90670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9445852 9000 9454852 9439242 6610 9445852 9428708 10534 9439242 9343642 85066 9428708 9338472 5170 9343642 1.00000 false false 131033 131033 PLEDGE RECEIVABLES NON- CURREN 4616492 LIFE INSURANCE 4089 INTEREST RECEIVABLES 5 4620586 0 DUE TO AFFILIATES 1382920 1382920 X USES OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 NORWALK HOSPITAL FOUNDATION'S ENDOWED FUNDS ARE USED TO SUPPORT THE GENERAL CAPITAL AND OPERATING EXPENSES OF NORWALK HOSPITAL, SCHOLARSHIPS AND PERSONNEL. FIN 48 FOOTNOTE SCHEDULE D, PART X, LINE 2 THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE CONCERNING TAX POSITIONS UNDER FIN 48. X X X X X X true RUOTOLO ASSOCIATES CAMPAIGN STUDY false 25146 25146 CT CANCER CTR WALK 282927 282927 2175 42647 GALA 1380834 1238334 142500 299845 128333 34268 78885 4 175735 124355 51380 30381 1839496 1645616 193880 302020 128333 34268 151913 616534 -422654 FUNDRAISING EVENTS NET INCOME SCHEDULE G, PART II, LINE 11 IN SCHEDULE G, PART II, CONTRIBUTIONS ARE SUBTRACTED AND REFLECTED IN REVENUE. IF CONTRIBUTIONS ARE ADDED BACK, THE RESULTS ARE THE FOLLOWING Cancer Ctr Walk Gala Other events Donations $ 282,927 $ 1,238,334 $ 124,355 Expenses $ (44,822) $ ( 541,331) $ ( 30,381) ------------ ---------- ------------ Net Profit $ 238,105 $ 697,003 $ 93,974 GALA EVENTS WERE HELD ON 10/13/2012 AND ON 09/28/2013. ALL REVENUES AND EXPENSES RELATED TO BOTH GALA EVENTS WERE RECORDED IN FISCAL YEAR ENDING 9/30/2013. true NORWALK HOSPITAL ASSOCIATION 24 STEVENS STREET NORWALK CT 06850 066068853 501(c)(3) 2129761 TRANSFER OF CONT. & OPERATIONAL SUPPORT NORWALK HOSPITAL PHYSICIANS & SURGEONS INC 24 STEVENS STREET NORWALK CT 06850 061522078 501(c)(3) 390191 OPERATIONAL SUPPORT 2 0 STUDENT SCHOLARSHIPS 78 110810 Form 990, Schedule I, LINE 2 Description of Organization's Procedures for Monitoring the Use of Grants REQUEST FOR FUNDS TO BE TRANSFERRED FOR THE BENEFIT OF NORWALK HOSPITAL ARE PROCESSED IN THREE CATEGORIES. 1. A NORWALK HOSPITAL CAPITAL BUDGET COMMITTEE OVERSEES CAPITAL PROJECT DEVELOPMENT AND EXECUTION AT THE HOSPITAL. THE NORWALK HOSPITAL FOUNDATION PRESIDENT AND/OR DIRECTOR IS A MEMBER OF THE COMMITTEE. THE FOUNDATION DIRECTOR & PRESIDENT REVIEW ALL CAPITAL REQUESTS FOR FUNDING, LOOKING AT REQUESTS THAT ALIGN WITH DONOR INTENT IN THE VARIOUS RESTRICTED FUNDS. WHEN A MATCH IS IDENTIFIED, SPECIFIC NORWALK HOSPITAL FOUNDATION FUNDS ARE EARMARKED FOR SPECIFIC NORWALK HOSPITAL PROJECTS. ALL REQUESTS ARE DOCUMENTED ON-LINE AND MUST BE SIGNED OFF BY DEPARTMENT CHAIRS AND/OR VICE PRESIDENTS DEPENDING UPON THE LEVEL OF THE REQUEST. 2. PATIENT CARE AND OTHER OPERATIONAL AND EDUCATIONAL PROGRAMS ARE SUPPORTED AS PART OF THE HOSPITAL'S ANNUAL BUDGETING PROCESS. DEPARTMENT LEADERS MEET WITH FOUNDATION STAFF TO REVIEW BUDGETS TO DETERMINE IF THERE ARE ANY NORWALK HOSPITAL FOUNDATION FUNDS THAT CAN BE UTILIZED TO SUPPORT NORWALK HOSPITAL DEPARTMENT BUDGETS. IF RESTRICTED FUNDS WITH THE CORRECT DONOR INTENT ARE IDENTIFIED, FUNDS, MAY BE UTILIZED TO SUPPORT DEPARTMENT BUDGETS. ALSO, FROM TIME TO TIME, A SPECIAL REQUEST MAY COME FROM A DEPARTMENT TO FUND A TRAINING PROGRAM, RESOURCES, SUPPLIES, OR OTHER NEED TO IMPROVE OPERATIONS OR PERFORMANCE. AGAIN, THESE REQUESTS ARE EVALUATED AGAINST FOUNDATION FUNDS TO DETERMINE IF THERE IS A MATCH BETWEEN DONOR INTENT OF THE FOUNDATION FUND AND THE NEED REQUESTED FOR THE HOSPITAL. ALL REQUESTS ARE DOCUMENTED ON A FOUNDATION FUNDS REQUEST FORM AND MUST BE SIGNED OFF BY DEPARTMENT CHAIRS AND/OR VICE PRESIDENTS DEPENDING UPON THE LEVEL OF THE REQUEST. 3. SCHOLARSHIPS- AN ANNUAL CYCLE TO DETERMINE AWARDS IS FOLLOWED. NORWALK HOSPITAL FOUNDATION SCHOLARSHIP COMMITTEE UTILIZES AN APPLICATION FORM LISTING ALL OF THE SCHOLARSHIPS AVAILABLE FROM THE FOUNDATION. SCHOLARSHIPS ARE PROMOTED ON ELECTRONIC DISPLAYS THROUGHOUT NORWALK HOSPITAL. THE APPLICATION IS AVAILABLE ELECTRONICALLY ON THE NORWALK HOSPITAL FOUNDATION WEBSITE AND NORWALK HOSPITAL EMPLOYEE INTRANET. COMPLETED SCHOLASHIP APPLICATIONS ARE REVIEWED BY THE SCHOLARSHIP COMMITTEE, WHICH IS COMPRISED OF ONE NURSING DIRECTOR, ONE NURSING MANAGER, LEGAL COUNSEL, A HUMAN RESOURCES DEPARTMENT REPRESENTATIVE, THE FOUNDATION'S DIRECTOR OF DEVELOPMENT AND FUNDS MANAGER. APPLICATIONS ARE RATED ON ACADEMIC SUCCESS, FINANCIAL NEED, AND ESSAY COMPONENTS. THE SCHOLARSHIP COMMITTEE MEETS IN JUNE TO DISCUSS APPLICATION EVALUATIONS AND DETERMINE SCHOLARSHIP AWARDS. SCHOLARSHIPS ARE PAID DIRECTLY TO THE FINANCIAL INSTITUTION, WITH HALF THE SCHOLARSHIP AWARD APPLIED TO THE STUDENT'S ACCOUNT IN THE FALL AND THE OTHER HALF APPLIED TOWARDS THE SPRING SEMESTER. true true false false false false false false false MARY G FRANCO 256684 0 77366 19622 0 38293 21928 413893 0 DANIEL DEBARBA 562950 325000 47556 11250 20728 967484 GEOFFREY COLE 218249 218249 LISA FERRARO UNTIL 71913 185930 0 19975 576 0 24289 19428 250198 0 Supplemental Compensation Information Schedule J, Part I, Line 3 THE COMPENSATION COMMITTEE IS FROM NORWALK HOSPITAL ASSOCIATION (NHA). Supplemental Compensation Information Schedule J, Part I, Line 4a GEOFFREY COLE RECEIVED PART OF A TWO YEAR SEVERANCE ARRANGEMENT BASED UPON HIS COMPENSATION AT THE TIME OF TERMINATION. THE AMOUNT PAID DURING THE YEAR, $218,429, HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B (III). Supplemental Compensation Information Schedule J, Part I, Line 7 BONUSES ARE PROVIDED BASED ON A GOALS SYSTEM. GOALS ARE ESTABLISHED FOR ELIGIBLE EMPLOYEES AT THE BEGINNING OF THE FISCAL YEAR. BONUSES ARE PAID IN ACCORDANCE WITH THE OVERALL FINANCIAL PERFORMANCE OF THE HOSPITAL AS WELL AS THE EMPLOYEE'S SUCCESS IN MEETING OR EXCEEDING THOSE GOALS. ELIGIBLE EMPLOYEES INCLUDE PRESIDENT, VICE PRESIDENTS, CHAIRMAN, EXECUTIVE DIRECTORS, AND DIRECTORS. THERE IS A RATING SYSTEM REGARDING THE GOALS - MEETING GOALS BY A CERTAIN DATE OR THRESHOLD - THERE IS THEN A MATHEMATICAL CALCULATION THAT DETERMINES THE DOLLAR AMOUNTS. Supplemental Compensation Information Schedule J, Part III, Line 4b Norwalk Hospital Association (NHA), a related organization of Norwalk Hospital Foundation (NHF), has established the Norwalk Hospital Senior Executive Deferred Compensation Plan, primarily for the purpose of providing a program of deferred compensation for Daniel DeBarba, a trustee of NHF and President & CEO of NHA. Amounts promised under the plan are based on a targeted retirement benefit. The payment of benefits under the plan is subject to vesting. No amounts were vested or reported as taxable income on Mr. DeBarba's 2012 W-2. X 11 209266 COST/SELLING PRICE false true false NUMBER OF CONTRIBUTIONS SCHEDULE M, PART I, LINE 9, COLUMN B NORWALK HOSPITAL FOUNDATION IS REPORTING ELEVEN (11) DONORS WHO CONTRIBUTED STOCK. REVENUES LESS EXPENSES FORM 990 PART 1, LINE 19 REVENUE LESS EXPENSES REFLECTS TRANSFERS OF ACCUMULATED FUNDS FROM THE NORWALK HOSPITAL FOUNDATION TO THE NORWALK HOSPITAL TOTALING $14,077,972. FISCAL YEAR 2013 CONTRIBUTIONS AND OPERATIONAL EXPENSES FOR THE FOUNDATION WERE AS FOLLOWS: REVENUE: 7,200,000 EXPENSES: 2,400,000 REVENUE LESS EXPENSES: 4,800,000 DESCRIPTION OF OTHER PROGRAM SERVICES Form 990, Part III, Line 4d TRANSFER RESTRICTED FUNDS TO NORWALK HOSPITAL ASSOCIATION. COMPENSATION FORM 990, PART V, LINE 2A, PART VII; PART IX, LINES 5-10 NORWALK HOSPITAL FOUNDATION DOES NOT HAVE ANY DIRECT EMPLOYEES. NORWALK HOSPITAL IS THE DESIGNATED COMMON PAYMASTER FOR THE INDIVIDUALS REPORTED IN FORM 990, PART VII AND SCHEDULE J. COMPENSATION REPORTED IN PART IX OF THIS RETURN REPRESENTS ALLOCATION OF SALARIES AND BENEFITS PAID BY NORWALK HOSPITAL ASSOCIATION. NORWALK HOSPITAL FOUNDATION REIMBURSES NORWALK HOSPITAL ASSOCIATION FOR THESE EXPENSES. DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS Form 990, Part VI, Question 6 & 7 NORWALK HEALTH SERVICES CORPORATION, INC. IS THE SOLE MEMBER OF NORWALK HOSPITAL FOUNDATION AND APPOINTS NORWALK HOSPITAL FOUNDATION'S BOARD OF DIRECTORS. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990 PART VI, LINE 11B NORWALK HOSPITAL FOUNDATION'S FORM 990 IS PREPARED WITH THE ASSISTANCE OF ERNST & YOUNG AND REVIEWED BY NHF'S INTERNAL MANAGEMENT. FOLLOWING THAT REVIEW, NORWALK HOSPITAL FOUNDATION'S INTERNAL MANAGEMENT PRESENTS THE FORM 990 TO THE AUDIT COMMITTEE FOR REVIEW AND COMMENT. THE COMPLETED FORM 990 EXCLUDING THE SCHEDULE OF CONTRIBUTIONS, SCHEDULE B, IS PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO THE FORM BEING FILED WITH THE IRS. MANAGEMENT HAS DECIDED NOT TO DISTRIBUTE SCHEDULE B TO THE BOARD DUE TO THE SENSITIVITY TO DONOR IDENTITY AND CONTRIBUTIONS. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990 PART VI, LINE 12C MONITORING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY PROVIDES THAT ANNUALLY, EACH PERSON COVERED BY THE POLICY, INCLUDING BOARD MEMBERS, AND KEY MANAGEMENT PERSONNEL, INCLUDING THE CEO, VICE PRESIDENTS, CHAIRMEN, EXECUTIVE DIRECTORS, NORWALK HOSPITAL PHYSICIANS & SURGEONS, INC. AND ANY OTHER HOSPITAL EMPLOYED PHYSICIANS, DIRECTORS, AND ANY OTHER PERSONNEL WITH FINANCIAL DECISION MAKING AUTHORITY AS DESIGNATED BY THE CEO, SENIOR VICE PRESIDENT, VICE PRESIDENTS OR DEPARTMENT CHAIRMEN SHALL SIGN A STATEMENT AFFIRMING THAT SUCH PERSON RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, READ AND UNDERSTANDS THE POLICY AND AGREES TO COMPLY WITH THE POLICY. ADDITIONALLY, THE SIGNED STATEMENT AFFIRMS THAT THE PERSON UNDERSTANDS NORWALK HEALTH SERVICES CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, NORWALK HEALTH SERVICES CORPORATION MUST ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. ENFORCEMENT FAILURE TO COMPLY WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY SHALL CONSTITUTE GROUNDS FOR REMOVAL OF A PERSON COVERED BY THE POLICY AS A BOARD MEMBER OR BOARD COMMITTEE MEMBER, AND, IN THE CASE OF KEY MANAGEMENT PERSONNEL, TERMINATION OF EMPLOYMENT. WHO IS COVERED? THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS EACH PERSON COVERED BY THE POLICY, INCLUDING BOARD MEMBERS, AND KEY MANAGEMENT PERSONNEL, INCLUDING THE CEO, VICE PRESIDENTS, CHAIRMEN, EXECUTIVE DIRECTORS, NHP&S AND ANY OTHER HOSPITAL EMPLOYED PHYSICIANS, DIRECTORS, AND ANY OTHER PERSONNEL WITH FINANCIAL DECISION MAKING AUTHORITY AS DESIGNATED BY THE CEO, SENIOR VICE PRESIDENT, VICE PRESIDENTS OR DEPARTMENT LEVEL OF DETERMINATION AND REVIEW OF CONFLICTS IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER PRESENTATION OF A POTENTIAL TRANSACTION OR ARRANGEMENT IS MADE BY AN INTERESTED PERSON, THE REMAINING DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE IF NORWALK HEALTH SERVICES CORPORATION CAN OBTAIN, WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, THE GOVERNING BOARD OR COMMITTEE SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. RESTRICTIONS PLACED ON CONFLICTED PERSONS IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. DOCUMENT RETENTION & DESTRUCTION POLICY FORM 990 PART VI, LINE 14 EFFECTIVE 1/1/2014, WESTERN CONNECTICUT HEALTH NETWORK (WCHN) BECAME THE SOLE CORPORATE MEMBER OF NORWALK HEALTH SERVICES CORPORATION AND A CORPORATE AFFILIATION WAS COMPLETED. NORWALK HEALTH SERVICES CORPORATION AND ALL SUBSIDIARIES ARE NOW COVERED UNDER THE POLICIES OF WCHN AND AS SUCH, THE RECORD RETENTION POLICY APPLIES TO NHSC AS OF 1/1/2014. OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN FORM 990 PART VI, LINE 15A NORWALK HOSPITAL FOUNDATION DOES NOT COMPENSATE ANY OFFICERS OR KEY EMPLOYEES. THE OFFICERS AND KEY EMPLOYEES RECEIVING COMPENSATION ARE COMPENSATED BY NORWALK HOSPITAL ASSOCIATION (NHA). THEREFORE, THEIR COMPENSATION & BENEFITS ARE DETERMINED BY NHA. AN OUTSIDE CONSULTING FIRM CONDUCTS AN EXECUTIVE COMPENSATION ANALYSIS UTILIZING THIRD-PARTY, BLINDED SURVEY DATA SOURCES. THE CONSULTANT THEN PRESENTS FINDINGS TO THE COMPENSATION COMMITTEE OF THE BOARD, WHO DECIDES WHAT ACTION TO TAKE, IF ANY, FOR EACH EXECUTIVE. THIS PROCEDURE ONLY APPLIES TO THE PRESIDENT, VICE PRESIDENTS, AND CERTAIN KEY EMPLOYEES. FOR THOSE KEY EMPLOYEES WHOSE SALARIES ARE NOT SUBJECT TO THE COMPENSATION COMMITTEE REVIEW, THEIR RESPECTIVE VICE PRESIDENTS ASSESS THEIR PERFORMANCE AND DETERMINE SALARY INCREASES BASED ON THE GUIDELINES ESTABLISHED BY THE ANNUAL REVIEW PROGRAM AND FINAL REVIEW RATINGS. COMPENSATION DECISIONS ALSO EMPLOY EXTERNAL MARKET SURVEY DATA AND INTERNAL ANALYSIS BASED ON NORWALK HOSPITAL ASSOCIATION'S SALARY RANGES. THIS PROCESS IS UNDERTAKEN EACH YEAR. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990 PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. PAYMASTER FORM 990 PART VII, LINES 5-10 NORWALK HOSPITAL ASSOCIATION WAS GRANTED AUTHORIZATION TO ACT AS PAY AGENT ON BEHALF OF NORWALK HEALTH FOUNDATION, FEDERAL I.D. # 22-2577707. REVENUE DIFFERENCE TO AUDITED FINANCIAL STATEMENTS FORM 990 PART VIII, LINE 12, COLUMN A TOTAL REVENUE PER 990 $7,828,364 TOTAL REVENUE PER AUDITED FINANCIAL STATEMENTS $8,444,898 DIFFERENCE $(616,534) RECONCILING ITEMS: EVENTS - DIRECT EXPENSES $616,534 OTHER CHANGES IN NET ASSETS FORM 990 PART XI, LINE 9 TRANSFER NHF BALANCE OF OPERATIONS FROM NHA $ 1,155,442 UNREALIZED GAIN/ LOSS ON INVESTMENTS $ 2,644,124 TRANSFER UNRESTRICTED DONATIONS TO NHA $ (628,184) CHANGES IN NET ASSETS OR FUND BALANCES $ 3,171,382 Norwalk Hospital Association 24 Stevens Street Norwalk CT 06850 066068853 Health Svcs CT 501(c)(3) 3 NHSC true Norwalk Hospital Physicians & Surgeons 24 Stevens Street Norwalk CT 06850 061522078 Phys Practice CT 501(c)(3) 11B NHSC true Norwalk Health Care Inc DBA Honey Hill 34 Midrocks Drive Norwalk CT 06850 222577722 inactive CT 501(c)(3) 9 NHSC true Norwalk Health Services Corp 24 Stevens Street Norwalk CT 06850 222577711 Support Svc CT 501(c)(3) 11B NA false Advanced Center for Rehab Medicine 24 Stevens Street Norwalk CT 06850 061304799 Inactive CT 501(c)(3) 11B NHSC true Maple Street Indemnity Company Ltd 40 Church Street PO Box HM 02062 Hamilton HM HX BD 980549862 Captive Insurance BD NHSC C-Corp SWC Corporation 24 Stevens Street Norwalk CT 06850 222577718 Pharmacy CT NHSC C-Corp false true true false false false false false false false true false true false false true false true true NORWALK HOSPITAL ASSOCIATION B 2129761 COST NORWALK HOSPITAL ASSOCIATION C 628184 COST NORWALK HOSPITAL ASSOCIATION M 65160 COST NORWALK HOSPITAL ASSOCIATION P 1498950 COST NORWALK HOSPITAL ASSOCIATION R 11483036 COST NORWALK HOSPITAL ASSOCIATION S 1155442 COST NORWALK HOSPITAL PHYSICIAN & SURGEONS B 390191 COST NORWALK HOSPITAL PHYSICIAN & SURGEONS R 269391 COST