2011-08-12T15:43:03-05:00 2010-09-30 PricewaterhouseCoopers LLP 125 High Street Boston MA 02110 990 2009-10-01 061522078 FAIRFIELD COUNTY MEDICAL SERVICES INC FAIR 2038522000 24 STEVENS STREET NORWALK CT 06850 DANIEL DEBARBA 2035823273 2011-08-12 6175305000 2011-08-11 2009 2016-02-24 21:20:13Z DANIEL DEBARBA 24 stevens street norwalk CT 06850 14143989 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 79 0 0 0 0 0 13237881 14143989 0 0 0 0 13237881 14143989 0 0 0 0 11233190 12965427 0 0 0 5221479 4964196 16454669 17929623 -3216788 -3785634 1933880 1383858 9265011 1594317 -7331131 -210459 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 17236679 14143989 FAIRFIELD COUNTY MEDICAL SERVICES, INC. PROVIDES PRIMARY AND SPECIALTY HEALTHCARE SERVICES TO THE GENERAL PUBLIC REGARDLESS OF THE PATIENT'S ABILITY TO PAY. SERVICES INCLUDE OBSTETRICS AND GYNECOLOGY, INTERNAL MEDICINE, GASTROENTEROLOGY AND SERVICES BY HOSPITALISTS. THE PHYSICIANS ASSIST NORWALK HOSPITAL ASSOCIATION IN CARRYING OUT THE HOSPITAL'S MISSION TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO ALL PATIENTS. 17236679 true false false true false false false false false true 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 true 0 0 79 true false false false false false false false false false 1 0 true false false false false false false true true false false true true true true true false true false X TONI HORNE 2038522071 24 STEVENS STREET NORWALK CT 06850 GEOFFREY COLE 2.0 X X 0 884538 52704 DANIEL DEBARBA 2.0 X X 0 559945 26675 KATHLEEN MADDEN 40.0 X 168550 0 23746 SUJATA PENDYALA 40.0 X 274334 0 21756 ELISABETH ARONOW 40.0 X 281109 0 33465 JASON ORLINICK 40.0 X 326208 0 34390 RICHARD SINGER 40.0 X 341472 0 20578 STEPHEN O'MAHONY 40.0 X 306679 0 34963 1698352 1444483 248277 40 false true false INTEGRATED HEALTHCARE SERVICES 300 MAIN STREET SUITE 804 STAMFORD CT 06901 OFFICE STAFFING 1660772 INGENIX CARE TRACKER PO BOX 6300 PROVIDENCE RI 02940 PHYSICIAN BILLING 240596 2 0 0 PATIENT SERVICE REVENUE 621110 14143989 14143989 14143989 0 0 0 0 0 0 0 0 14143989 14143989 0 0 0 0 0 0 202484 202484 0 9815508 9513923 301585 0 0 2183749 2116653 67096 0 763686 740222 23464 0 0 0 0 0 0 0 2416946 2174150 242796 0 2140 2140 397651 342546 55105 0 35526 34611 915 0 0 833004 833004 0 0 25171 25171 0 0 0 0 0 0 115078 115078 0 1010945 1010945 0 PHARMACY 73701 73701 0 0 DUES & MEMBERSHIPS 28344 27869 475 0 OTHER SUPPLIES & EXPENSE 19707 19707 0 0 UNIFORMS 2786 2786 0 0 PERIODICALS 2396 888 1508 0 801 801 0 17929623 17236679 692944 0 201192 10566 618982 474191 1113706 899101 1933880 1383858 1617421 1594317 7647590 0 9265011 1594317 X -7331131 -210459 -7331131 -210459 1933880 1383858 X false true true X X X X false false false NORWALK HOSPITAL ASSOCIATION 066068853 03 true true 0 1 0 false false false false false false false false true 28344 28344 false 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 899101 899101 0 0 false true false false false false false true false GEOFFREY COLE 0 601346 0 270000 0 13192 0 33354 0 19350 0 937242 0 0 DANIEL DEBARBA 0 358704 0 183200 0 18041 0 11025 0 15650 0 586620 0 0 KATHLEEN MADDEN 153606 0 14629 0 315 0 9009 0 14737 0 192296 0 0 0 SUJATA PENDYALA 213320 0 60333 0 681 0 7621 0 14135 0 296090 0 0 0 ELISABETH ARONOW 274194 0 0 0 6915 0 19465 0 14000 0 314574 0 0 0 JASON ORLINICK 261989 0 39808 0 24411 0 17285 0 17105 0 360598 0 0 0 RICHARD SINGER 289789 0 51683 0 0 0 7350 0 13228 0 362050 0 0 0 STEPHEN O'MAHONY 241961 0 32940 0 31778 0 15601 0 19362 0 341642 0 0 0 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 GEOFFREY COLE, PRESIDENT OF FCMS AND PRESIDENT & CEO OF NHA UP TO 4/10/2010 AND DANIEL DERBARBA, PRESIDENT AND CEO OF NHA AS OF 4/12/2010. 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. COLE'S OR MR. DEBARBA'S 2009 W-2. 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. 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. 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. FORM 990, PART VI, SECTION A, LINE 11A FAIRFIELD COUNTY MEDICAL SERVICES' (FCMS) FORM 990 IS PREPARED WITH THE ASSISTANCE OF PRICEWATERHOUSECOOPERS 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 TO ALL MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO THE FORM BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, TRUSTEES, KEY EMPLOYEES, AND MANAGERS ARE SURVEYED ANNUALLY REGARDING INTERESTS THAT PRESENT POTENTIAL CONFLICTS. RESPONSES ARE SCREENED FOR POTENTIAL CONFLICTS, INDIVIDUALS ARE INTERVIEWED AS NECESSARY, AND SURVEY RESULTS ARE SHARED WITH THE CEO. INDIVIDUALS ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICTS AT ANY MEETING OR DURING ANY DISCUSSION WHICH MAY BE AFFECTED BY THE POTENTIAL CONFLICT, AND THE INDIVIDUAL IS REQUIRED TO RECUSE HIMSELF/HERSELF ACCORDINGLY. FORM 990, PART VI, SECTION B, LINE 14 FAIRFIELD COUNTY MEDICAL SERVICES IS IN THE PROCESS OF DRAFTING A FORMAL WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. FORM 990, PART VI, SECTION B, LINE 15 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. FORM 990, PART VI, SECTION C, 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. FORM 990, PART VII, SECTION A THE INDIVIDUALS LISTED BELOW WORKED THE FOLLOWING HOURS PER WEEK FOR A RELATED ORGANIZATION DURING THE FISCAL YEAR: GEOFFREY COLE - 45 HOURS/WEEK DANIEL DEBARBA - 46 HOURS/WEEK NORWALK HOSPITAL ASSOCIATION 24 STEVENS STREET NORWALK CT 06850 066068853 HEALTH SVCS CT 501(C)(3) 3 NHSC NORWALK HEALTH CARE INC DBA HONEY HILL 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-II 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-II NHSC MAPLE STREET INDEMNITY COMPANY LTD 980549862 CAPTIVE INSUR BD NHSC C-CORP 0 0 0.00000 SWC CORPORATION 24 STEVENS STREET NORWALK CT 06850 222577718 PHARMACY CT NHSC C-CORP 0 0 0.00000 false false true false false false false false false true true false false false true true false false NORWALK HOSPITAL FOUNDATION C 150000 NORWALK HOSPITAL ASSOCIATION J 113104 NORWALK HOSPITAL ASSOCIATION K 3497109 NORWALK HOSPITAL ASSOCIATION O 8010837 NORWALK HOSPITAL ASSOCIATION P 72055