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NORWALK HOSPITAL FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
NORWALK HOSPITAL FOUNDATION INC (EIN 22-2577707)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-13
IRS object ID
201342259349303514
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-13T20:44:30-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line155 IVAN ALLEN BLVD SUITE 1000AddressLine1
CityATLANTACity
StateGAState
ZIP Code30308ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN222577707EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Norwalk Hospital FoundationBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% TONI HORNEInCareOfName
Name ControlNORWNameControl
Phone2038522000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line134 Maple StreetAddressLine1
CityNorwalkCity
StateCTState
ZIP Code06856ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDaniel DebarbaName
TitleCEOTitle
Date Signed2013-08-12DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone4048748300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMary G FrancoNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line134 Maple StreetAddressLine1
CityNorwalkCity
StateCTState
ZIP Code06856ZIPCode
FieldValueIRS element (for citing)
Gross Receipts18756304GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.norwalkhospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1985YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionTHE NORWALK HOSPITAL FOUNDATION GENERATES PHILANTHROPY AND AWARENESS TO SUPPORT NORWALK HOSPITAL IN BEING A LEADER IN ADVANCED MEDICAL CARE IN THE REGION.ActivityOrMissionDescription
Nbr Voting Members Governing Body24NbrVotingMembersGoverningBody
Nbr Independent Voting Members22NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers300TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year11484940ContributionsGrantsPriorYear
Contributions Grants Current Year16594441ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year367924InvestmentIncomePriorYear
Investment Income Current Year877132InvestmentIncomeCurrentYear
Other Revenue Prior Year-190967OtherRevenuePriorYear
Other Revenue Current Year-214832OtherRevenueCurrentYear
Total Revenue Prior Year11661897TotalRevenuePriorYear
Total Revenue Current Year17256741TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2171214GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY4728571GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1378054SalariesEtcPriorYear
Salaries Etc Current Year1589161SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year50357TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY30481TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1313467TotalFundrsngExpCurrentYear
Other Expense Prior Year567482OtherExpensePriorYear
Other Expenses Current Year620517OtherExpensesCurrentYear
Total Expenses Prior Year4167107TotalExpensesPriorYear
Total Expenses Current Year6968730TotalExpensesCurrentYear
Revenues Less Expenses Prior Year7494790RevenuesLessExpensesPriorYear
Revenues Less Expenses CY10288011RevenuesLessExpensesCY
Total Assets BOY37236896TotalAssetsBOY
Total Assets EOY49929632TotalAssetsEOY
Total Liabilities BOY597325TotalLiabilitiesBOY
Total Liabilities EOY453281TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY36639571NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY49476351NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense3146477Expense
DescriptionPATIENT 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense765005Expense
Grants737532Grants
DescriptionFACILITIES, EQUIPMENT & TECHNOLOGY: In 2012, Foundation funds supported renovations in several areas of the hospital including the pediatric department, the department of psychiatry, and the Smilow Family Breast Health Center. Additionally, funds were used to support the purchase of pathology equipment, rehabilitation equipment, a simulation baby, remote monitoring equipment, electronic medical record upgrades, ultrasound equipment and inventory control equipment.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense509005Expense
Grants60815Grants
DescriptionEDUCATION, 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. Forty-six 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 Hospitals Whittingham Cancer Center to continue its robust clinical research trial program. In 2012, research trials were conducted in breast, colon, esophageal, lung, ovarian, pancreatic and bladder cancers along with hematology trials.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp1182308TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt1182308TotalOfOtherProgramServiceGrnt
Total Program Service Expense5602795TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingtrueProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10966NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members24NbrVotingGoverningBodyMembers
Number Independent Voting Members22NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCTStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTONI HORNENamePerson
Telephone Number2038522071TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line134 MAPLE STREETAddressLine1
CityNORWALKCity
StateCTState
ZIP Code06856ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeFormerFormer
MARY G FRANCO
PRESIDENT50.0XX034741350696
FREDERICK R AFRAGOLA
TREASURER1.0XX
ROBERT CIOFFI
VICE CHAIRMAN1.0XX
HOWARD EISON MD
TRUSTEE1.0X
DAVID M LEHN
CHAIRMAN2.0XX
KATHLEEN MCSHANE
TRUSTEE1.0X
ROBERT OBERNIER
TRUSTEE1.0X
CORNELIUS T RYAN
TRUSTEE1.0X
AMY SCHAFRANN
SECRETARY2.0XX
ERVIN R SHAMES
TRUSTEE1.0X
LUISA URIARTE
TRUSTEE1.0X
RICHARD ZELKOWITZ
TRUSTEE1.0X
DIANNE ALLISON ESQ
TRUSTEE1.0X
DANIEL DEBARBA
TRUSTEE/ HOSPITAL CEO1.0X078524029083
LEONARD DINARDO
TRUSTEE1.0X
PHILIP MORRIS
TRUSTEE1.0X
ALISON SCAVONE
TRUSTEE1.0X
CAROL ASNESS
TRUSTEE1.0X
MARY GRACE GUDIS
TRUSTEE1.0X
CHRISTIAN TREFTZ
TRUSTEE1.0X
AMY KATZ
TRUSTEE (AS OF 1/01/2012)1.0X
MICHAEL LUBLINSKY
TRUSTEE (AS OF 1/01/2012)1.0X
STEPHEN MICHAELSON
TRUSTEE (AS OF 1/01/2012)1.0X
DEVANG PATEL DPM
TRUSTEE (AS OF 1/01/2012)1.0X
PETER THORNER
TRUSTEE (UNTIL 12/31/2011)1.0X
JAMES F GUTHRIE MD
TRUSTEE (UNTIL 12/31/2011)1.0X
LUNSFORD RICHARDSON JR
TRUSTEE (UNTIL 12/31/2011)1.0X
JILL HANAU
TRUSTEE (UNTIL 12/31/2011)1.0X
LISA FERRARO
DIRECTOR, FDN MAJOR GIFTS50.0019598635157X
GEOFFREY COLE
Former TRUSTEE/CEo0.006304980X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1959137TotalReportableCompFrmRltdOrgs
Total Other Compensation114936TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonNONENamePerson
FieldValueIRS element (for citing)
Address Of ContractorAddressOfContractor
FieldValueIRS element (for citing)
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events970439FundraisingEvents
Related Organizations1182308RelatedOrganizations
All Other Contributions14441694AllOtherContributions
Noncash Contributions1182886NoncashContributions
Total Contributions16594441TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column879665TotalRevenueColumn
Exclusion$879,665ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1180353Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1182886Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-2533Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-2533TotalRevenueColumn
Exclusion-$2,533ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events101845GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events970439CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses316677FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-214832TotalRevenueColumn
Exclusion-$214,832ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column17256741TotalRevenueColumn
Exclusion$662,300ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total4667756Total
Program Services4667756ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total60815Total
Program Services60815ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total561206Total
Management And General238642ManagementAndGeneral
Fundraising322564Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total710123Total
Management And General351605ManagementAndGeneral
Fundraising358518Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total243773Total
Management And General111755ManagementAndGeneral
Fundraising132018Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total74059Total
Management And General35807ManagementAndGeneral
Fundraising38252Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total65160Total
Management And General65160ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total30481Total
Fundraising30481Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total100664Total
Management And General8128ManagementAndGeneral
Fundraising92536Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total3557Total
Fundraising3557Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total149769Total
Management And General3089ManagementAndGeneral
Fundraising146680Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total48545Total
Fundraising48545Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total43200Total
Management And General43200ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total15010Total
Management And General15010ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalFundraisingFundraisingManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
DONOR RECOGNITION5352453524
DUES/MEMBERSHIP3654436544
TEMP HELP-AGENCY1665716657
PATIENT CARE, OTHER PROGRAMS85928592

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total79295Total
Management And General9160ManagementAndGeneral
Fundraising70135Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6968730Total
Program Services4737163ProgramServices
Management And General918100ManagementAndGeneral
Fundraising1313467Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3004244BOY
EOY6793363EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1350050BOY
EOY3712550EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY96063BOY
EOY51933EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis131033LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec131033LandBldgEquipmentAccumDeprec

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY27748248BOY
EOY31442627EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5038291BOY
EOY7929159EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY37236896BOY
EOY49929632EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7253BOY
EOY0EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY202725BOY
EOY262475EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY387347BOY
EOY190806EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY597325BOY
EOY453281EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY27200329BOY
EOY40030499EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY9439242BOY
EOY9445852EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY36639571BOY
EOY49476351EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37236896BOY
EOY49929632EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses10288011ReconcilationRevenueExpenses
Reconcilation Other Changes2548769ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7254995CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6145403CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6989124CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11484940CurrentTaxYearMinus1Year
Current Tax Year16359341CurrentTaxYear
Total48233803Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7254995CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6145403CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6989124CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11484940CurrentTaxYearMinus1Year
Current Tax Year16359341CurrentTaxYear
Total48233803Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total1041031AmountsSubstContributorsTotal
Public Support Total17047192772PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1069340CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years845570CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years622717CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year400454CurrentTaxYearMinus1Year
Current Tax Year879665CurrentTaxYear
Total3817746Total
FieldValueIRS element (for citing)
Total Support52051549TotalSupport
Gross Receipts From Admissions Etc755769GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.90665PublicSupportPertcentage170
Public Support Pertcent Prior Year0.76540PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance9439242BeginningOfYearBalance
Contributions6610Contributions
End Of Year Balance9445852EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance9428708BeginningOfYearBalance
Contributions10534Contributions
End Of Year Balance9439242EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance9343642BeginningOfYearBalance
Contributions85066Contributions
End Of Year Balance9428708EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance9338472BeginningOfYearBalance
Contributions5170Contributions
End Of Year Balance9343642EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis131033OtherCostOrOtherBasis
Depreciation131033Depreciation
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
PLEDGE RECEIVABLES NON-CURRENT7925050
LIFE INSURANCE4089
INTEREST RECEIVABLES20
FieldValueIRS element (for citing)
Total Book Value Other Assets7929159TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO AFFILIATESDescription
Amount$190,806Amount
FieldValueIRS element (for citing)
Total Of Amounts190806TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierUses of endowment fundsIdentifier
Return ReferenceSCHEDULE D, PART v, LINE 4ReturnReference
ExplanationNORWALK 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.Explanation

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
Email SolicitationsXEmailSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Solicitation Of Govt GrantsXSolicitationOfGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref FundraisingtrueAgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

FieldValueIRS element (for citing)
Name Of IndividualRUOTOLO ASSOCIATESNameOfIndividual
ActivityCAMPAIGN STUDYActivity
Fundraiser Control Of FundsfalseFundraiserControlOfFunds
Gross Receipts0GrossReceipts
Amount Retained By Contractor30481AmountRetainedByContractor
Net To Organization0NetToOrganization
FieldValueIRS element (for citing)
Total Gross Receipts0TotalGrossReceipts
Total Retained By Contractors30481TotalRetainedByContractors
Total Net To Organization0TotalNetToOrganization
Licensed StatesCTLicensedStates

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CANCER Ctr walkNameOfEvent1
Gross Receipts Event1328606GrossReceiptsEvent1
Charitable Contributions Event1328606CharitableContributionsEvent1
Rent Facility Costs Event11475RentFacilityCostsEvent1
Other Direct Expenses Event147441OtherDirectExpensesEvent1
Name Of Event2GALA 10/14/11NameOfEvent2
Gross Receipts Event2526425GrossReceiptsEvent2
Charitable Contributions Event2465825CharitableContributionsEvent2
Gross Revenue Event260600GrossRevenueEvent2
Rent Facility Costs Event2110052RentFacilityCostsEvent2
Food And Beverage Event254705FoodAndBeverageEvent2
Entertainment Event227773EntertainmentEvent2
Other Direct Expenses Event239383OtherDirectExpensesEvent2
Total Number Of Other Events3TotalNumberOfOtherEvents
Gross Receipts Other Events217253GrossReceiptsOtherEvents
Charitable Contrib Other Events176008CharitableContribOtherEvents
Gross Revenue Other Events41245GrossRevenueOtherEvents
Rent Facility Costs Other Events27194RentFacilityCostsOtherEvents
Other Direct Expenses Other Events8654OtherDirectExpensesOtherEvents
Gross Receipts Total1072284GrossReceiptsTotal
Charitable Contributions Total970439CharitableContributionsTotal
Gross Revenue Total Events101845GrossRevenueTotalEvents
Rent Facility Costs Total Events138721RentFacilityCostsTotalEvents
Food And Beverage Total Events54705FoodAndBeverageTotalEvents
Entertainment Total Events27773EntertainmentTotalEvents
Other Direct Expenses Total Events95478OtherDirectExpensesTotalEvents
Direct Expense Summary Events316677DirectExpenseSummaryEvents
Net Income Summary-214832NetIncomeSummary

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierFUNDRAISING EVENTS NET INCOMEIdentifier
Return ReferenceSCHEDULE G, PART II, LINE 11ReturnReference
ExplanationIn 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 10/14/2011 Other events Donations $ 328,606 $ 526,425 $ 217,253 Expenses $ (48,916) $(231,913) $ (35,848) --------------- --------------- --------------- Net Profit $ 279,690 $ 294,512 $ 181,405 Gala events have been traditionally held in the fall. All revenues and expenses related to the gala held on October 13, 2012 were recorded in the fiscal year ending 9/30/2013.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
NORWALK HOSPITAL ASSOCIATION
24 STEVENS STREETNORWALKCT06850066068853501 (C) (3)4520237TRANSFER OF CONT. & OPERATIONAL SUPPORT
NORWALK HOSPITAL PHYSICIANS & SURGEONS INC
24 STEVENS STREETNORWALKCT06850061522078501 (C) (3)147519OPERATIONAL SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSTUDENT SCHOLARSHIPSTypeOfGrant
Number Of Recipients46NumberOfRecipients
Amount Of Cash Grant60815AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierForm 990, Schedule I, Line 2Identifier
Return ReferenceDescription of Organization's Procedures for Monitoring the Use of GrantsReturnReference
ExplanationREQUEST 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARY G FRANCO
0247813080478019122031738018958039810900
DANIEL DEBARBA
04761340250000059106011025018058081432300
LISA FERRARO
01789910166280367018399016758023114300
GEOFFREY COLE
000006304980000063049800

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUPPLEMENTAL COMPENSATION INFORMATIONSCHEDULE J, PART I, LINE 3The 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, $630,498, HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B (iii).
Supplemental Compensation InformationSchedule J, part III, Line 4bNorwalk 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 2011 W-2.
supplemental compensationschedule J, part I, line 7BONUSES 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.

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications
Clothing And Household GoodsClothingAndHouseholdGoods
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions11NumberOfContributions
Noncash Contribs Rptd F9901182886NoncashContribsRptdF990
Method Of Determining RevenuesCOST/SELLING PRICEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory
Drugs And Medical SuppliesDrugsAndMedicalSupplies
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierNUMBER OF CONTRIBUTIONSIdentifier
Return ReferenceSCHEDULE M, PART I, LINE 9, COLUMN BReturnReference
ExplanationNORWALK HOSPITAL FOUNDATION IS REPORTING ELEVEN (11) DONORS WHO CONTRIBUTED STOCK.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FORM 990 PART 1, LINE 19REVENUES LESS EXPENSESRevenue less expenses reflects transfers of accumulated funds from the Norwalk Hospital Foundation to the Norwalk Hospital totaling $6,078,949. Fiscal Year 2012 contributions and operational expenses for the Foundation were as follows: REVENUE: 16,074,000 EXPENSES: 2,389,000 REVENUE LESS EXPENSES: 13,685,000
DESCRIPTION OF OTHER PROGRAM SERVICESFORM 990, PART III, LINE 4DTRANSFER RESTRICTED FUNDS TO NORWALK HOSPITAL ASSOCIATION.
COMPENSATIONFORM 990, PART V, LINE 2A; PART VII; PART IX, Lines 5-10NORWALK HOSPITAL FOUNDATION DOES NOT HAVE ANY DIRECT EMPLOYEES. NORWALK HOSPITAL Association 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 an ALLOCATION OF SALARIES AND BENEFITS PAID BY NORWALK HOSPITAL ASSOCIATION. NORWALK HOSPITAL FOUNDATION REIMBURSES NORWALK HOSPITAL ASSOCIATION FOR THESE EXPENSES.
DESCRIPTION OF CLASSES OR MEMBERS OF STOCKHOLDERSFORM 990, PART VI, LINES 6 AND 7NORWALK 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 990FORM 990, PART VI, LINE 11BNORWALK 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 INTERESTFORM 990, PART VI, LINE 12CMONITORING 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 HOSPITAL FOUNDATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, NORWALK HOSPITAL FOUNDATION 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 HOSPITAL FOUNDATION 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 POLICYFORM 990, PART VI, LINE 14NORWALK HOSPITAL FOUNDATION IS IN THE PROCESS OF DRAFTING A FORMAL WRITTEN DOCUMENT RETENTION & DESTRUCTION POLICY.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUNFORM 990, PART VI, LINE 15ANORWALK 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 PUBLICFORM 990, PART VI, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
HOURS DEVOTED TO A RELATED ORGANIZATIONFORM 990, PART VIITHE INDIVIDUALS LISTED BELOW WORKED THE FOLLOWING HOURS PER WEEK FOR A RELATED ORGANIZATION DURING THE FISCAL YEAR: FREDERICK R. AFRAGOLA - 4 HOURS/WEEK DAVID M. LEHN - 3 HOURS/WEEK ERVIN R. SHAMES - 4 HOURS/WEEK RICHARD ZELKOWITZ - 3 HOURS/WEEK DIANNE ALLISON, ESQ. - 7 HOURS/WEEK DANIEL DEBARBA - 55 HOURS/WEEK
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5TRANSFER NHF BALANCE OF OPERATIONS FROM NHA $ 889,780 UNREALIZED GAIN/ LOSS ON INVESTMENTS $ 2,841,296 TRANSFER UNRESTRICTED DONATIONS TO NHA $ (1,182,307) __________ CHANGES IN NET ASSETS OR FUND BALANCES $2,548,769

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Norwalk Hospital Association
24 Stevens StreetNorwalkCT06850066068853Health SvcsCT501(c)(3)3NHSCtrue
Norwalk Hospital Physicians & Surgeons
24 Stevens StreetNorwalkCT06850061522078Phys PracticeCT501(c)(3)11BNHSCtrue
Norwalk Health Care Inc DBA Honey Hill
34 Midrocks DriveNorwalkCT06850222577722inactiveCT501(c)(3)9NHSCtrue
Norwalk Health Services Corp
24 Stevens StreetNorwalkCT06850222577711Support SvcCT501(c)(3)11BNAfalse
Advanced Center for Rehab Medicine
24 Stevens StreetNorwalkCT06850061304799InactiveCT501(c)(3)11BNHSCtrue

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryEINEINPrimary ActivityPrimaryActivityLegal Domicile Foreign CountryLegalDomicileForeignCountryBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeLegal Domicile StateLegalDomicileState
Maple Street Indemnity Company Ltd
40 Church Street PO Box HM 2062Hamilton HMHXBD980549862Captive InsuranceBDNHSCC-Corp
SWC Corporation
222577718PharmacyNHSCC-Corp24 Stevens StreetNorwalkCT06850CT
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
NORWALK HOSPITAL ASSOCIATION
B4520237COST
NORWALK HOSPITAL ASSOCIATION
C1182308COST
NORWALK HOSPITAL ASSOCIATION
L65160COST
NORWALK HOSPITAL ASSOCIATION
O1691552COST
NORWALK HOSPITAL ASSOCIATION
Q5125000COST
NORWALK HOSPITAL ASSOCIATION
R889780COST
NORWALK HOSPITAL PHYSICIANS & SURGEONS INC
B147519COST