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NORWALK HOSPITAL FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
NORWALK HOSPITAL FOUNDATION INC (EIN 22-2577707)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-15
IRS object ID
201222289349302662
Schema version
2010v3.7
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)
Timestamp2012-08-15T12:57:50-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

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 Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN222577707EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Norwalk Hospital FoundationBusinessNameLine1
FieldValueIRS element (for citing)
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
TitlePRESIDENT & CEOTitle
Date Signed2012-08-14DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone4048748300Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
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 Receipts12835540GrossReceipts
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
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6989124ContributionsGrantsPriorYear
Contributions Grants Current Year11484940ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year688861InvestmentIncomePriorYear
Investment Income Current Year367924InvestmentIncomeCurrentYear
Other Revenue Prior Year-132726OtherRevenuePriorYear
Other Revenue Current Year-190967OtherRevenueCurrentYear
Total Revenue Prior Year7545259TotalRevenuePriorYear
Total Revenue Current Year11661897TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year3088251GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2171214GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1411108SalariesEtcPriorYear
Salaries Etc Current Year1378054SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year60603TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY50357TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year954418TotalFundrsngExpCurrentYear
Other Expense Prior Year3669289OtherExpensePriorYear
Other Expenses Current Year567482OtherExpensesCurrentYear
Total Expenses Prior Year8229251TotalExpensesPriorYear
Total Expenses Current Year4167107TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-683992RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7494790RevenuesLessExpensesCY
Total Assets BOY29487813TotalAssetsBOY
Total Assets EOY37236896TotalAssetsEOY
Total Liabilities BOY459025TotalLiabilitiesBOY
Total Liabilities EOY597325TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY29028788NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY36639571NetAssetsOrFundBalancesEOY
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
Expense939335Expense
Grants0Grants
Revenue0Revenue
DescriptionPATIENT CARE & OTHER PROGRAMS: Foundation funds were used to support a variety of patient care programs including the mammogram screening program, integrative medicine programs, nursing documentation, patient education materials, art 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 Grace Cole Jones Gift shop manager.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense394416Expense
Grants323017Grants
Revenue0Revenue
DescriptionFACILITIES, EQUIPMENT & TECHNOLOGY: In 2011, Foundation funds supported the master facility plan including planning and design for the new ambulatory pavilion. Foundation funds supported the opening of the Pediatric Development Therapy Center, which provides comprehensive, advanced pediatric developmental assessment and therapy treatment services. In addition, funds were used to support the purchase of rehabilitation equipment, patient stretchers, ventilators, an ambulance, communications equipment, and upgrades to pediatric patient rooms and outpatient surgery waiting area.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense204256Expense
Grants65500Grants
Revenue0Revenue
DescriptionEDUCATION, TRAINING & RESEARCH: Norwalk Hospital Foundation supports a variety of learning opportunities for employees as well as scholarships for students both undergraduate and advanced degrees in nursing. Nineteen 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 to patients in the community. Foundation support enabled Norwalk Hospital's Whittingham Cancer Center to continue its robust clinical research trial program. In 2011, research trials were conducted in breast, colon, head and neck, lung and ovarian cancers, and hematology among others.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp1042576TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt1042576TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense2580583TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
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 EntityfalseTransactionRelatedEntity
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 RelationshiptrueFamilyOrBusinessRelationship
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 (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeFormerFormer
MARY G FRANCO
PRESIDENT50.0XX030356227657
FREDERICK R AFRAGOLA
TREASURER1.0XX000
ROBERT CIOFFI
VICE CHAIRMAN1.0XX000
HOWARD EISON MD
TRUSTEE1.0X000
JAMES F GUTHRIE MD
TRUSTEE1.0X000
DAVID M LEHN
CHAIRMAN2.0XX000
KATHLEEN MCSHANE
TRUSTEE1.0X000
ROBERT B OBERNIER
TRUSTEE1.0X000
LUNSFORD RICHARDSON JR
TRUSTEE1.0X000
CORNELIUS T RYAN
TRUSTEE1.0X000
AMY SCHAFRANN
SECRETARY2.0XX000
ERVIN R SHAMES
TRUSTEE2.0X000
LUISA URIARTE
TRUSTEE1.0X000
RICHARD ZELKOWITZ
TRUSTEE1.0X000
DIANE ALLISON ESQ
TRUSTEE1.0X000
DANIEL DEBARBA
TRUSTEE/HOSP CEO1.0X067078529920
LEONARD DINARDO
TRUSTEE1.0X000
JILL HANAU
TRUSTEE1.0X000
PHILIP MORRIS
TRUSTEE1.0X000
ALISON SCAVONE
TRUSTEE1.0X000
PETER THORNER
TRUSTEE1.0X000
CAROL ASNESS AS OF 01252011
TRUSTEE1.0X000
MARY GRACE GUDIS AS OF 01252011
TRUSTEE1.0X000
CHRISTIAN TREFTZ AS OF 01252011
TRUSTEE1.0X000
JOHN M WILSON MD UNTIL 12302010
TRUSTEE1.0X000
PATSY R BRESCIA UNTIL 12312010
TRUSTEE1.0X000
MARIANNE W CREW UNTIL 12302010
TRUSTEE1.0X000
SHEILA J KLEIN UNTIL 12302010
TRUSTEE1.0X000
FRANK N ZULLO ESQ
TRUSTEE (UNTIL 12/30/10)1.0X000
LISA FERRARO
DIRECTOR, FDN MAJOR GIFTS50.0018241613699X
GEOFFREY COLE
Former TRUSTEE/CEO (4/05/2010)1.00124805246796X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2404815TotalReportableCompFrmRltdOrgs
Total Other Compensation118072TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events888092FundraisingEvents
Related Organizations1042576RelatedOrganizations
All Other Contributions9554272AllOtherContributions
Noncash Contributions247497NoncashContributions
Total Contributions11484940TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column400454TotalRevenueColumn
Exclusion$400,454ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities865856Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities898386Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-32530Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-32530TotalRevenueColumn
Exclusion-$32,530ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events84290GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events888092CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses275257FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-190967TotalRevenueColumn
Exclusion-$190,967ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

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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 Column11661897TotalRevenueColumn
Exclusion$176,957ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2105714Total
Program Services2105714ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total65500Total
Program Services65500ProgramServices

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)
Total491299Total
Management And General251935ManagementAndGeneral
Fundraising239364Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total611144Total
Management And General342144ManagementAndGeneral
Fundraising269000Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total207230Total
Management And General110798ManagementAndGeneral
Fundraising96432Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total68381Total
Management And General37722ManagementAndGeneral
Fundraising30659Fundraising

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)
Total50357Total
Fundraising50357Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total76849Total
Management And General6317ManagementAndGeneral
Fundraising70532Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total127654Total
Management And General8866ManagementAndGeneral
Fundraising118788Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total39816Total
Fundraising39816Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total43200Total
Management And General43200ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total4260Total
Management And General4193ManagementAndGeneral
Fundraising67Fundraising

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)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PATIENT CARE, OTHER PROGRAMS8635286352
DUES/ MEMBERSHIP67450658751575
DONOR RECOGNITION2220222202
All other expenses345391891315626

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total4167107Total
Program Services2257566ProgramServices
Management And General955123ManagementAndGeneral
Fundraising954418Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY392798BOY
EOY3004244EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY428540BOY
EOY1350050EOY
FieldValueIRS element (for citing)
Accounts ReceivableAccountsReceivable

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
EOY96063EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis131033LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec131033LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY0BOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY27891739BOY
EOY27748248EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY774736BOY
EOY5038291EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY29487813BOY
EOY37236896EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY477BOY
EOY7253EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY163025BOY
EOY202725EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY295523BOY
EOY387347EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY459025BOY
EOY597325EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY19600080BOY
EOY27200329EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY9428708BOY
EOY9439242EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY29028788BOY
EOY36639571EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY29487813BOY
EOY37236896EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7494790ReconcilationRevenueExpenses
Reconcilation Other Changes115993ReconcilationOtherChanges
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 Years3558867CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7254995CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6145403CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6989124CurrentTaxYearMinus1Year
Current Tax Year11484940CurrentTaxYear
Total35433329Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3558867CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7254995CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6145403CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6989124CurrentTaxYearMinus1Year
Current Tax Year11484940CurrentTaxYear
Total35433329Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total5103652AmountsSubstContributorsTotal
Public Support Total17030329677PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1254003CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1069340CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years845570CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year622717CurrentTaxYearMinus1Year
Current Tax Year400454CurrentTaxYear
Total4192084Total
FieldValueIRS element (for citing)
Total Support39625413TotalSupport
Gross Receipts From Admissions Etc653924GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.76541PublicSupportPertcentage170
Public Support Pertcent Prior Year0.61611PublicSupportPertcentPriorYear
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 Balance9428708BeginningOfYearBalance
Contributions10534Contributions
End Of Year Balance9439242EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
Book Value0BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis131033OtherCostOrOtherBasis
Depreciation131033Depreciation
Book Value0BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
PLEDGE RECEIVABLES NON-CURRENT5034080
LIFE INSURANCE4089
INTEREST RECEIVABLES122
FieldValueIRS element (for citing)
Total Book Value Other Assets5038291TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO AFFILIATESDescription
Amount$387,347Amount
FieldValueIRS element (for citing)
Total Of Amounts387347TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
USES OF ENDOWMENT FUNDSSCHEDULE D, Part V, Line 4Norwalk Hospital Foundation's Endowed Funds are used to support the general capital and operating expenses of Norwalk Hospital, scholarships and personnel.
FIN 48 FOOTNOTESCHEDULE D, Part X, Line 2The organization's financial statements do not contain a footnote concerning uncertain tax positions under Fin 48.

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 ASSOCIATES INCNameOfIndividual

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1Horizon Square 29 BroadwayAddressLine1
CityCresskillCity
StateNJState
ZIP Code07626ZIPCode
FieldValueIRS element (for citing)
ActivityCAMPAIGN STUDYActivity
Fundraiser Control Of FundsfalseFundraiserControlOfFunds
Gross Receipts0GrossReceipts
Amount Retained By Contractor50357AmountRetainedByContractor
Net To Organization0NetToOrganization
FieldValueIRS element (for citing)
Total Gross Receipts0TotalGrossReceipts
Total Retained By Contractors50357TotalRetainedByContractors
Total Net To Organization0TotalNetToOrganization
Licensed StatesCTLicensedStates

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GALA 10.15.2010NameOfEvent1
Gross Receipts Event1395090GrossReceiptsEvent1
Charitable Contributions Event1344240CharitableContributionsEvent1
Gross Revenue Event150850GrossRevenueEvent1
Rent Facility Costs Event1119819RentFacilityCostsEvent1
Food And Beverage Event142870FoodAndBeverageEvent1
Entertainment Event128380EntertainmentEvent1
Other Direct Expenses Event117124OtherDirectExpensesEvent1
Name Of Event2CANCER CTR WALKNameOfEvent2
Gross Receipts Event2384677GrossReceiptsEvent2
Charitable Contributions Event2384677CharitableContributionsEvent2
Rent Facility Costs Event21625RentFacilityCostsEvent2
Other Direct Expenses Event230764OtherDirectExpensesEvent2
Total Number Of Other Events5TotalNumberOfOtherEvents
Gross Receipts Other Events192615GrossReceiptsOtherEvents
Charitable Contrib Other Events159175CharitableContribOtherEvents
Gross Revenue Other Events33440GrossRevenueOtherEvents
Rent Facility Costs Other Events30925RentFacilityCostsOtherEvents
Other Direct Expenses Other Events3750OtherDirectExpensesOtherEvents
Gross Receipts Total972382GrossReceiptsTotal
Charitable Contributions Total888092CharitableContributionsTotal
Gross Revenue Total Events84290GrossRevenueTotalEvents
Rent Facility Costs Total Events152369RentFacilityCostsTotalEvents
Food And Beverage Total Events42870FoodAndBeverageTotalEvents
Entertainment Total Events28380EntertainmentTotalEvents
Other Direct Expenses Total Events51638OtherDirectExpensesTotalEvents
Direct Expense Summary Events275257DirectExpenseSummaryEvents
Net Income Summary-190967NetIncomeSummary

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierFUNDRAISING EVENTS NET INCOMEIdentifier
Return ReferenceSCHEDULE G, PART II, LINE 11ReturnReference
ExplanationTHE NET INCOME RESULTS IN SCHEDULE II are adjusted for charitable contributions. When charitable contributions are considered in the total amount the organization raised for the event, the net results are calculated as donations less expenses. Cancer Ctr Walk Other Events (5) Donations $ 384,677 $ 192,615 Expenses $ (32,675) $ (34,675) ---------- ---------- Net Profit $ 352,288 $ 157,940 Gala events have been traditionally held in the fall. All revenues and expenses related to the Gala held on October 15, 2010 were recorded in Fiscal Year ending 9/30/2011. Gala 10/15/2010 Donations $ 395,090 Expenses $(208,193) --------- Net Profit $ 186,897Explanation

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)2045335TRANSFER OF CONTRIBUTIONS & OPERATIONS SUPPORT SCHOLARSHIPS
Fairfield County Medical Services Inc
24 Stevens StNorwalkCT06850061522078501(c)(3)60379OPERATIONAL 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 Recipients19NumberOfRecipients
Amount Of Cash Grant65500AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierDescription of Organization's Procedures for Monitoring the Use of GrantsIdentifier
Return ReferenceSchedule I, PART I, LINE 2ReturnReference
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. Applications are distributed throughout Norwalk Hospital as well as to the financial aid offices and nursing departments at local colleges and universities and guidance offices at local high schools. The scholarship application is also available electronically on the Norwalk Hospital Foundation website. Completed scholarship applications are due to the Foundation office by the end of May. The scholarship applications are reviewed by a scholarship committee, which is comprised of one nursing director, one nurse manager, legal counsel, a human resources representative, a Foundation board member, the Foundation's director of development and the 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 educational institution with half the scholarship applied to the student's account in the fall and the other half applied for 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
023436303925702994202465703000033121900
DANIEL DEBARBA
04166380210000044147011025018895070070500
GEOFFREY COLE
0202525010024709452800307670160290129484800
LISA FERRARO
017456007500035601369900019611500

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Supplemental Compensation InformationSCHEDULE J, PART I, line 4aGeoffrey Cole RECEIVED part of a two year severance arrangement based upon his COMPENSATION AT THE TIME OF TERMINATION. THE AMOUNT PAID during the year, $862,249, has BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B(III).
Supplemental Compensation InformationSCHEDULE J, PART IIINorwalk 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 2010 W-2.

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 Contributions16NumberOfContributions
Noncash Contribs Rptd F990247497NoncashContribsRptdF990
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 UsedtrueThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NUMBER OF CONTRIBUTIONSSCHEDULE M, PART I, LINE 9, COLUMN BNorwalk Hospital Foundation is reporting sixteen (16) donors who contributed stock.
HIRING THIRD PARTIES TO SOLICIT, PROCESS OR SELL NONCASH CONTRIBUTIONSSCHEDULE M, PART I, Line 32BNorwalk Hospital Foundation uses a third party to sell non-cash contributions of stock.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (17 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Revenue less ExpensesREVENUE LESS EXPENSES REFLECTS TRANSFERS OF ACCUMULATED FUNDS FROM THE NORWALK HOSPITAL FOUNDATION TO THE NORWALK HOSPITAL TOTALING $2,957,515. FISCAL YEAR 2011 CONTRIBUTIONS AND OPERATIONAL EXPENSES FOR THE FOUNDATION WERE AS FOLLOWS: REVENUE $ 10,894,000 EXPENSES $ 2,083,000 ____________ REVENUE LESS EXPENSES $ 8,811,000
Description of Other Program ServicesTRANSFER UNRESTRICTED FUNDS TO NORWALK HOSPITAL ASSOCIATION.FORM 990, PART III, LINE 4D
COMPENSATIONNORWALK 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.FORM 990, PART V, LINE 2A; PART VII; PART IX
DESCRIPTION OF RELATIONSHIPSFRANK ZULLO, ESQ. AND DIANE ALLISON, ESQ. HAVE A BUSINESS RELATIONSHIP.FORM 990, PART VI, LINE 2
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERSNORWALK HEALTH SERVICES CORPORATION, INC. IS THE SOLE MEMBER OF NORWALK HOSPITAL FOUNDATION AND APPOINTS NORWALK HOSPITAL FOUNDATION'S BOARD OF DIRECTORS.FORM 990, PART VI, LINE 6 & 7
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990NORWALK 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.FORM 990, PART VI, QUESTION 11B
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTERESTMONITORING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY PROVIDES THAT ANNUALLY, EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS 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 THE FOUNDATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, THE 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 DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS. 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 THE 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.FORM 990, PART VI, LINE 12C
Document Retention & Destruction PolicyNorwalk Hospital Foundation is in the process of drafting a formal written document retention & destruction policy.Form 990, Part VI, Line 14
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUNNORWALK 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 NHAForm 990, Part VI, Question 15A
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen PublicNORWALK HOSPITAL FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS AVAILABLE THROUGH NORWALK HEALTH SERVICES CORPORATION UPON REQUEST. Other Changes in Net Assets or Fund Balances Form 990, Part XI, Line 5 Transfer NHF Balance of Operations From NHA $ 765,289 Unrealized Gain/ Loss on Investments $(326,279) Transfer to NHA & FCMS $(323,017) __________ Changes in Net Assets or Fund Balances $ 115,993Form 990, Part VI, Question 19
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:FREDERICK R. AFRAGOLA TITLE:TREASURER HOURS:4FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:DAVID M. LEHN TITLE:CHAIRMAN HOURS:3FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:ERVIN R. SHAMES TITLE:TRUSTEE HOURS:5FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:RICHARD ZELKOWITZ TITLE:TRUSTEE HOURS:3FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:DIANE ALLISON, ESQ. TITLE:TRUSTEE HOURS:7FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:DANIEL DEBARBA TITLE:TRUSTEE/HOSP CEO HOURS:57FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:FRANK N. ZULLO, ESQ. TITLE:TRUSTEE (UNTIL 12/30/10) HOURS:1FORM 990 PART VII

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/BusinessNameLine1
Norwalk Hospital Association
24 Stevens StreetNorwalkCT06850066068853Health SvcsCT501(c)(3)3NHSC
Fairfield County Medical Services Inc
24 Stevens StreetNorwalkCT06850061522078Phys PracticeCT501(c)(3)11BNHA
Norwalk Health Care Inc DBA Honey Hill
34 Midrocks DriveNorwalkCT06851222577722Nursing/RehabCT501(c)(3)9NHSC
Norwalk Health Services Corp
24 Stevens StreetNorwalkCT06850222577711Support SvcCT501(c)(3)11BNA
Advanced Center for Rehab Medicine
24 Stevens StreetNorwalkCT06850061304799InactiveCT501(c)(3)11BNHSC

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 InsurBDNHSCC-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 OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Norwalk Hospital Association
b2045335
Norwalk Hospital Association
c1042576
Norwalk Hospital Association
o1459740
Norwalk Hospital Association
q2050000
Norwalk Hospital Association
r765289
Norwalk Hospital Association
l65160
Fairfield County Medical Services Inc
b60379