2012-08-15T12:57:50-05:00 2011-09-30 ERNST & YOUNG US LLP 55 IVAN ALLEN BLVD SUITE 1000 ATLANTA GA 30308 990 2010-10-01 061522078 Fairfield County Medical Services Inc FAIR 2038522000 24 Stevens Street Norwalk CT 06850 DANIEL DEBARBA 2012-08-14 4048748300 2010 2016-02-24 21:20:13Z Daniel Debarba 24 Stevens Street Norwalk CT 06850 14929787 false X WWW.NORWALKHEALTH.ORG X 1998 CT THE PHYSICIANS OF FAIRFIELD COUNTY MEDICAL SERVICES, INC. ASSIST NORWALK HOSPITAL ASSOCIATION IN CARRYING OUT THE HOSPITAL'S MISSION TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO ALL PATIENTS. 1 0 78 0 0 0 0 60379 14143989 14869408 0 0 0 0 14143989 14929787 0 0 0 0 12965427 14921745 0 0 0 4964196 5272291 17929623 20194036 -3785634 -5264249 1383858 1137485 1594317 1969928 -210459 -832443 X The physicians of Fairfield County Medical Services, Inc. assist Norwalk Hospital Association in carrying out the Hospital's mission to provide comprehensive health care services to all patients. false false 6585805 0 6362955 ADULT HOSPITALISTS: The Adult Hospitalists of Fairfield County Medical Services, Inc. provide primary healthcare services to the general public regardless of the patient's ability to pay. Services are provided at Norwalk Hospital. The physicians assist Norwalk Hospital Association in carrying out the Hospital's mission to provide comprehensive health care services to all patients. 3534963 2096549 CENTER FOR WOMENS' CARE: The Center for Women's Care provides obstetrics & gynecological healthcare services to the general public regardless of the patient's ability to pay. They have offices in Stamford, Wilton & at the medical suites at Norwalk Hospital. The physicians assist Norwalk Hospital Association in carrying out the Hospital's mission to provide comprehensive health care services to all patients. 2625497 1715430 GASTROENTEROLOGY ASSOCIATES: Gastroenterology Associates provides gastroenterology healthcare services to the general public regardless of the patient's ability to pay. The office is at Norwalk Hospital and the physicians assist Norwalk Hospital Association in carrying out the Hospital's mission to provide comprehensive health care services to all patients. 6158464 4694474 18904729 true true false true false false false false false false false false true false false false true false false false false false false false false false false false true false false false false false false false false false false false false false true true false false false true 0 0 78 true false false false false false false false false false false false false false X 1 0 true false false false false false false true true false false true true true true true false false true false X TONI HORNE 2038522071 24 STEVENS STREET NORWALK CT 06850 X Daniel DeBarba 2.0 X X 0 670785 29920 Richard Singer 50.0 X 370666 0 21745 Jason Orlinick 50.0 X 396769 0 34850 Stephen O'Mahony 50.0 X 359739 0 34185 William Hale 50.0 X 586337 0 43299 Dennis Meighan 50.0 X 580518 0 37808 Geoffrey Cole 0.0 X 0 1248052 46796 Kathleen Madden 0.0 X 168821 0 21211 2462850 1918837 269814 36 true true false Integrated Healthcare Services 300 Main St Suite 804 STANFORD CT 06901 OFFICE STAFFING 1587331 Ingenix Care Tracker PO Box 6300 PROVIDENCE RI 029406300 BILLING SERVICES 337082 Comforce Technical Services Inc PO Box 31001-0893 PASADENA CA 911100893 STAFFING 277733 Vantage Point LLC 9 Washington Avenue HAMDEN CT 06518 CONSULTING 126900 4 60379 60379 PATIENT SERVICE REVENUE 621110 14869408 14869408 14869408 0 0 0 0 0 0 0 0 14929787 14869408 0 0 0 0 0 0 0 0 11393685 10897383 496302 0 2696279 2695418 861 831781 795549 36232 0 33595 33595 0 0 0 0 2532723 1886651 646072 29696 27139 2557 353269 293380 59889 68996 57366 11630 0 823720 823720 27812 27812 0 0 0 0 115889 115889 1153656 1153656 PHARMACY 94927 94927 DUES & MEMBERSHIPS 27005 26366 639 OTHER SUPPLIES & EXPENSE 4708 4440 268 BOOKS & PERIODICALS 3124 1862 1262 HOUSEKEEPING SUPPLIES 1627 1627 1544 1544 20194036 18904729 1289307 0 10566 269271 474191 0 899101 868214 1383858 1137485 1594317 1969928 1594317 1969928 X -210459 -832443 -210459 -832443 1383858 1137485 X -5264249 4642265 X false true true X false X X X false false false NORWALK HOSPITAL ASSOCIATION 066068853 C true 0 1 0 Caring for patients in the community without regard for their ability to pay reduces the need for patients to come through our emergency department. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 27005 27005 false LOBBYING ACTIVITIES FORM 990, SCHEDULE C, PART II-B, LINE 1i FAIRFIELD COUNTY MEDICAL SERVICES PAYS MEMBERSHIP DUES TO MEMBER ORGANIZATIONS WHICH ENGAGE IN LOBBYING ACTIVITIES. A PORTION OF THE DUES MAY BE ATTRIBUTABLE TO LOBBYING ACTIVITIES. OTHER RECEIVABLES 868214 868214 FIN 48 Footnote Schedule D, Part X, Line 2 The Organization's financial statements do not contain a footnote concerning uncertain tax positions. true true false false false false false true false Daniel DeBarba 0 416638 0 210000 0 44147 0 11025 0 18895 0 700705 0 0 Richard Singer 350233 0 20433 0 0 0 7350 0 14395 0 392411 0 0 0 Jason Orlinick 298294 0 42993 0 55482 0 15964 0 18886 0 431619 0 0 0 Stephen O'Mahony 250890 0 53875 0 54974 0 14886 0 19299 0 393924 0 0 0 William Hale 456350 0 48708 0 81279 0 28904 0 14395 0 629636 0 0 0 Dennis Meighan 466246 0 40172 0 74100 0 23413 0 14395 0 618326 0 0 0 Geoffrey Cole 0 202525 0 100247 0 945280 0 30767 0 16029 0 1294848 0 0 Kathleen Madden 121635 0 0 0 47186 0 8831 0 12380 0 190032 0 0 0 Supplemental Compensation Information Schedule J, Part I, Line 3 TAX GROSS-UP PAYMENTS ARE PROVIDED ON TAXABLE BENEFITS IN ACCORDANCE WITH THE NORWALK HOSPITAL ASSOCIATION'S SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, DESCRIBED BELOW IN RESPONSE TO LINE 4B. ADDITIONALLY, TAX GROSS UP PAYMENTS ARE PROVIDED FOR TAXABLE MOVING EXPENSES AND ON THE TAXATION OF THE FORMER CEO'S PERSONAL USE OF A HOSPITAL-OWNED AUTOMOBILE PRIOR TO HIS TERMINATION AS CEO(FOR CALENDAR YEAR 2010 ONLY). ALL TAX GROSS-UP PAYMENTS ARE TREATED AS TAXABLE COMPENSATION TO THE INDIVIDUALS RECEIVING SUCH PAYMENTS. Supplemental Compensation Information Schedule J, Part I, Line 4a Geoffrey Cole RECEIVED a SEVERANCE ARRANGEMENT FOR A SPECIFIED PERIOD OF TIME, BASED ON his COMPENSATION AT THE TIME OF TERMINATION. THE AMOUNT PAID, $862,249, has BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B(III). Supplemental Compensation Information Schedule J, Part I, Line 4B NORWALK HOSPITAL ASSOCIATION (NHA), A RELATED ORGANIZATION OF FAIRFIELD COUNTY MEDICAL SERVICES (FCMS), HAS ESTABLISHED THE NORWALK HOSPITAL SENIOR EXECUTIVE DEFERRED COMPENSATION PLAN, PRIMARILY FOR THE PURPOSE OF PROVIDING A PROGRAM OF DEFERRED COMPENSATION FOR DANIEL DERBARBA, PRESIDENT AND 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. Supplemental Compensation Information Schedule J, Part I, line 7 Bonuses are provided based on a goals system. Goals are established for eligible employees at the beginning of the fiscal year. Bonuses are paid in accordance with the overall financial performance of the hospital as well as the employee's success in meeting or exceeding those goals. Other Program Services Form 990, Part III, Line 4 Other Program Services Include: WESTPORT FAMILY HEALTH PEDIATRIC HOSPITALISTS & SPECIALISTS MIDWIVES & OBGYN COVERAGE ASSOC INTERNISTS OF DARIEN & WESTPORT NORWALK INTERNAL MEDICINE PULMONARY Serivces HEAD & NECK SURGICAL CARE PERINATOLOGY Services PROGRAM MANAGEMENT Compensation Form 990, Part V, Line 2 & Part IX, Lines 5-10 A PORTION OF THE COMPENSATION REPORTED IN PART IX OF THIS RETURN RESPRESENTS AN ALLOCATION OF SALARIES AND BENEFITS PAID BY NORWALK HOSPITAL ASSOCIATION. FAIRFIELD COUNTY MEDICAL SERVICES, INC. REIMBURSES NORWALK HOSPITAL ASSOCIATION FOR THESE EXPENSES. Description of Relationships FORM 990, PART VI, LINE 2 CERTAIN BOARD MEMBERS OF FAIRFIELD COUNTY MEDICAL SERVICES SERVE ON THE BOARDS OF SWC CORPORATION, AND MAPLE STREET INDEMNITY COMPANY LTD. Describe the Process used by Management &/or Governing Body to Review 990 FORM 990, PART VI, LINE 11B FAIRFIELD COUNTY MEDICAL SERVICES' (FCMS) FORM 990 IS PREPARED WITH THE ASSISTANCE OF ERNST & YOUNG LLP AND REVIEWED BY FCMS' INTERNAL MANAGEMENT. FOLLOWING THAT REVIEW, FCMS' INTERNAL MANAGEMENT PRESENTS THE FORM 990 TO THE AUDIT COMMITTEE FOR REVIEW AND COMMENT. THE COMPLETED FORM 990 IS PROVIDED, via email, TO ALL MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO THE FORM BEING FILED WITH THE IRS. Description of Process to Monitor Transactions for Conflicts of Interest Form 990, Part VI, Question 12c MONITORING 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 Fairfield County Medical Services, Inc. IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, Fairfield County Medical Services, Inc. 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 Fairfield County Medical Services, Inc. CAN OBTAIN, WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, THE GOVERNING BOARD OR COMMITTEE SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. RESTRICTIONS PLACED ON CONFLICTED PERSONS IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. Document Retention & Destruction Policy FORM 990, PART VI, LINE 14 FAIRFIELD COUNTY MEDICAL SERVICES IS IN THE PROCESS OF DRAFTING A FORMAL WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. Offices & Positions for Which Process was Used, & Year Process was Begun Form 990, Part VI, LINE 15B FAIRFIELD COUNTY MEDICAL SERVICES (FCMS) DOES NOT RETAIN ANY COMPENSATED EXECUTIVE DIRECTORS, OFFICERS, OR TOP MANAGEMENT OFFICIALS. THE OFFICERS RECEIVING COMPENSATION ARE COMPENSATED BY NORWALK HOSPITAL ASSOCIATION (NHA), A RELATED ORGANIZATION OF FCMS. THEREFORE, THEIR COMPENSATION AND BENEFITS ARE DETERMINED BY NHA. THE KEY EMPLOYEE'S SALARY IS NOT SUBJECT TO THE COMPENSATION COMMITTEE REVIEW. THE RESPECTIVE VICE PRESIDENT ASSESSES PERFORMANCE AND DETERMINES 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. GOVERNING DOCUMENTS FORM 990, PART VI, LINE 19 FAIRFIELD COUNTY MEDICAL SERVICES, INC. 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. Hours devoted to a RELATED ORGANIZATION FORM 990, PART VII THE INDIVIDUAL LISTED BELOW WORKED THE FOLLOWING HOURS PER WEEK FOR A RELATED ORGANIZATION DURING THE FISCAL YEAR: DANIEL DEBARBA - 56 HOURS/WEEK Other Changes in Net Assets or Fund Balances Form 990, Part XI, Line 5 The amount on part XI, line 5, $4,642,265, represents Transfers from Norwalk Hospital Association (Parent) to FCMS. Norwalk Hospital Association 24 Stevens Street Norwalk CT 06850 066068853 Heatlh Svcs CT 501(c)(3) 3 NHSC Norwalk Health Care DBA Honey Hill Rehab 34 Midrocks Drive Norwalk CT 06851 222577722 Nursing/Rehab CT 501(c)(3) 9 NHSC Norwalk Health Services Corp Inc 24 Stevens Street Norwalk CT 06850 222577711 Support Svcs CT 501(c)(3) 11B NA Norwalk Hospital Foundation 34 Maple Street Norwalk CT 06850 222577707 Fundraising CT 501(c)(3) 7 NHSC Advanced Center for Rehab Medicine 24 Stevens Street Norwalk CT 06850 061304799 Inactive CT 501(C)(3) 11B NHSC Maple Street Indemnity Company Ltd 40 Church St PO Box HM 2062 Hamilton HM HX BD 980549862 Captive Insurance BD NHSC C-Corp SWC Corporation 24 Stevens Street Norwalk CT 06850 222577718 Pharmacy CT NHSC C-Corp false false true false false false false false false true true false false false true true false false NORWALK HOSPITAL FOUNDATION C 60379 NORWALK HOSPITAL ASSOCIATION J 133194 NORWALK HOSPITAL ASSOCIATION K 4229918 NORWALK HOSPITAL ASSOCIATION O 9581910