2013-08-14T08:16:44-05:00 2012-09-30 ERNST & YOUNG US LLP 55 IVAN ALLEN BLVD SUITE 1000 ATLANTA GA 30308 990 2011-10-01 222577711 Norwalk Health Services Corporation % Toni Horne NORW 2038522071 24 Stevens Street Norwalk CT 06850 Daniel Debaraba 2013-08-13 4048748300 2011 2016-02-25 16:41:14Z Daniel DeBarba 24 Stevens Street Norwalk CT 06850 1294891 false X WWW.NORWALKHOSPITAL.ORG X 1985 CT To support the mission of Norwalk Hospital Association by acting as the parent organization of Norwalk Hospital and affiliates. 19 18 0 19 272622 -719727 0 0 0 0 999208 1022269 745566 272622 1744774 1294891 0 0 0 0 0 0 0 0 0 362469 82469 362469 82469 1382305 1212422 28035863 35010845 628997 4603646 27406866 30407199 To support the mission of Norwalk Hospital Association by acting as the parent organization of Norwalk Hospital and affiliates. false false 82469 NORWALK HEALTH SERVICES CORPORATION IS THE PARENT COMPANY OF AND PROVIDES SUPPORT SERVICES FOR NORWALK HOSPITAL ASSOCIATION, NORWALK HEALTH CARE, INC., NORWALK HOSPITAL FOUNDATION AND NORWALK HOSPITAL PHYSICIANS AND SURGEONS, INC. 82469 true false false false false false false false false false true false false true true false false true false false true false false false false false false false false true false false false false false false false false false false false false false true true true false false true 0 0 0 true true true BD false false false false false false false false false X 19 18 true false false false false false false true true false false true true true true true false false false false X Toni Horne 2038522071 24 Stevens Street Norwalk CT 06850 X Ervin Shames 1.0 X Diane M Allison Esq 2.0 X X George P Bauer 1.0 X Andrew Whittingham 1.0 X X Joseph Mann 1.0 X X Fred Afragola 1.0 X Charles Augenbraun MD 0.0 X Barbara Butler 1.0 X Daniel DeBarba 1.0 X X 0 785240 29083 Victor Liss 1.0 X David Komansky 1.0 X David Lehn 1.0 X Gary Reiner 1.0 X Roland Stichweh 1.0 X William J Tammee 1.0 X Richard Zelkowitz 1.0 X Robert Ready 1.0 X Thomas Ayoub 1.0 X 85000 0 Maria Borges-Lopez 1.0 X Paul Gagne MD 1.0 X Mark Gudis 1.0 X Ed Kangas - ttee thru 123111 2.0 X X Ed Mahony 1.0 X Geoffrey Cole 0.0 X 0 630498 0 0 1500738 29083 0 true true false NONE 0 0 0 1022269 1022269 0 0 0 0 0 0 CAPTIVE INSURANCE INCOME 272622 272622 272622 1294891 272622 1022269 0 0 0 0 0 0 0 0 0 0 0 0 49500 49500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7469 7469 0 ESTIMATED INCOME TAX 25500 25500 82469 82469 0 0 96219 492280 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1299968 283222 1024215 1016746 20269811 21603382 0 0 0 0 0 0 6645618 11898437 28035863 35010845 357365 102102 0 0 0 0 0 0 0 0 0 0 0 0 0 0 271632 4501544 628997 4603646 X 21067108 23334555 6339758 7072644 0 0 27406866 30407199 28035863 35010845 X 1212422 1787911 X false true true X false X X X false false false NORWALK HOSPITAL ASSOCIATION 066068853 03 true 0 1 0 Monetary support is not required. NHSC supports NHA by serving as its parent organization and coordinating legal, accounting and other services across all Norwalk entities. 937642 937642 362326 283222 79104 1016746 EQUITY IN UNCONSOLIDATED SUB 324249 CHARITABLE REM AND LEAD TRUSTS 7072644 DUE FROM AFFILIATES 4501544 11898437 0 DUE TO AFFILIATES 4501544 4501544 FIN 48 FOOTNOTE SCHEDULE D, PART X, LINE 2 THERE WAS NO FIN 48/ASC 740 FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS. Central America and the Caribbean 1 0 Program Services Captive Insurance 15952745 1 0 1 0 15952745 15952745 false false true false false false TOTAL EXPENDITURE OF THE REGION SCHEDULE F, PART I, LINE 3, COLUMN (F) NORWALK HEALTH SERVICES CORPORATION (NHSC) MAINTAINS INSURANCE COVERAGE THROUGH MAPLE STREET INDEMNITY COMPANY, LTD (MSI), A RELATED ORGANIZATION BASED IN BERMUDA. MSI USES THE SERVICES OF A MANAGING AGENT IN BERMUDA TO MAINTAIN ALL FINANCIAL BOOKS AND RECORDS FOR MSI. INFORMATION IS REPORTED TO MSI IN ACCORDANCE WITH THE REQUIRMENTS OF THE BERMUDA MONETARY AUTHORITY. INFORMATION RECEIVED IS CONVERTED TO GAAP BASED FINANCIAL REPORTING AND INCLUDED IN THE CONSOLIDATED AUDIT OF NHSC. The total amount reported on schedule F, part I, line 3, column (f) is comprised of the following amounts: Premium Transfer amount per form 5471 $7,804,000 Book value of transfer $8,148,745 ----------- Schedule F, Part I, line 3, column (f) total $15,952,745 true true false false false false false false false Daniel DeBarba 0 476134 0 250000 0 59106 0 11025 0 18058 0 814323 0 0 Geoffrey Cole 0 0 0 0 0 630498 0 0 0 0 0 630498 0 0 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, $630,498, HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B (III). SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 4B NORWALK HOSPITAL ASSOCIATION( NHA), A RELATED ORGANIZATION OF NORWALK HEALTH SERVICES CORPORATION (NHSC), HAS ESTABLISHED THE NORWALK HOSPITAL SENIOR DEFERRED COMPENSATION PLAN, PRIMARILY FOR THE PURPOSE OF PROVIDING A PROGRAM OF DEFERRED COMPENSATION FOR DANIEL DEBARBA, PRESIDENT AND CEO OF NHA AND NHSC. AMOUNTS PROMISED UNDER THE PLAN ARE BASED ON TARGETED RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PLAN IS SUBJECT TO VESTING. NO AMOUNTS WERE VESTED OR REPORTED AS TAXABLE INCOME ON MR. DEBARBA'S 2011 W2. DESCRIPTION OF RELATIONSHIPS FORM 990, PART VI, LINE 2 CERTAIN MEMBERS OF THE BOARD OF TRUSTEES OF NORWALK HEALTH SERVICES CORPORATION ALSO SERVE AS BOARD MEMBERS OF SWC CORPORATION AND MAPLE STREET INDEMNITY COMPANY LTD. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B NORWALK HEALTH SERVICES CORPORATION (NHSC) FORM 990 IS PREPARED WITH THE ASSISTANCE OF ERNST AND YOUNG LLP AND REVIEWED BY NHSC'S INTERNAL MANAGEMENT. FOLLOWING THAT REVIEW, NHSC'S INTERNAL MANAGEMENT PRESENT THE FORM 990 TO THE AUDIT COMMITTEE FOR REVIEW AND COMMENT. THE COMPLETED 990 IS PROVIDED, via email, TO ALL MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO THE FORM BEING FILED WITH THE IRS. 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. WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY FORM 990, PART VI, LINE 14 NORWALK HEALTH SERVICES CORPORATION IS IN THE PROCESS OF DRAFTING A FORMAL WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINE 15A NORWALK HEALTH SERVICES CORPORATION (NHSC) DOES NOT RETAIN ANY COMPENSATED EMPLOYEES. THE OFFICERS AND TRUSTEES RECEIVING COMPENSATION ARE EMPLOYEES AND INDEPENDENT CONTRACTORS OF NORWALK HOSPITAL ASSOCIATION (NHA), A RELATED ORGANIZATION OF NHSC. THEREFORE, THEIR COMPENSATION AND BENEFITS ARE DETERMINED BY NHA. 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. HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII THE INDIVIDUALS LISTED BELOW WORKED THE FOLLOWING HOURS PER WEEK FOR A RELATED ORGANIZATION DURING THE FISCAL YEAR: DANIEL DEBARBA - 55 HOURS/WEEK ERVIN SHAMES - 4 HOURS/WEEK DIANE M. ALLISON, ESQ. - 6 HOURS/WEEK GEORGE P. BAUER - 3 HOURS/WEEK ANDREW WHITTINGHAM - 3 HOURS/WEEK JOSEPH MANN - 2 HOURS/WEEK FRED AFRAGOLA - 4 HOURS/WEEK BARBARA BUTLER - 4 HOURS/WEEK VICTOR LISS - 6 HOURS/WEEK DAVID KOMANSKY - 2 HOURS/WEEK DAVID LEHN - 4 HOURS/WEEK GARY REINER - 3 HOURS/WEEK ROLAND STICHWEH - 2 HOURS/WEEK WILLIAM J. TAMMEE - 3 HOURS/WEEK RICHARD ZELKOWITZ - 3 HOURS/WEEK ROBERT READY - 4 HOURS/WEEK THOMAS AYOUB - 18 HOURS/WEEK MARIA BORGES-LOPEZ - 2 HOURS/WEEK PAUL GAGNE, MD - 2 HOURS/WEEK MARK GUDIS - 2 HOURS/WEEK ED KANGAS - 3 HOURS/WEEK ED MAHONY - 5 HOURS/WEEK OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 NET UNREALIZED Gains on investments 2,458,590 Increase IN ASSETS HELD IN TRUST 732,886 MSI-MD INCOME (272,622) Net asset transfer to NHC (1,130,943) Transfer from NHA 4,501,544 Transfer to NHPS (4,501,544) ------------ LINE 5 - CHANGES IN NET ASSETS 1,787,911 compensation committee SCHEDULE J, PART I, LINE 3 THE COMPENSATION COMMITTEE IS FROM NORWALK HEALTH SERVICES CORPORATION (NHSC) AS PER THE NHSC BYLAWS. Norwalk Hospital Association 24 Stevens Street Norwalk CT 06850 066068853 Health SVCS CT 501(C)(3) 3 NHSC true Norwalk Hospital Foundation Inc 24 Stevens Street Norwalk CT 06850 222577707 Fundraising CT 501(C)(3) 7 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 24 STEVENS STREET NORWALK CT 06850 222577722 inactive CT 501(C)(3) 9 NHSC true 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 St PO Box HM 2062 Hamilton HM HX BD 980549862 CAPTIVE INSURANCE BD C-Corp 8181522 53751406 1.00000 SWC Corporation 24 Stevens Street Norwalk CT 06850 222577718 Pharmacy Svcs CT C-Corp 11660696 1022063 1.00000 false false false false false false false false false false false false false false true false true true NORWALK HOSPITAL ASSOCIATION Q 319630 COST NORWALK HOSPITAL ASSOCIATION R 4501544 COST NORWALK HOSPITAL PHYSICIANS & SURGEONS Q 4501544 COST