2014-07-15T13:22:21-05:00 2013-09-30 061533253 SASLOW LUFKIN & BUGGY LLP 175 POWDER FOREST DRIVE SIMSBURY CT 06089 990 2012-10-01 060655138 WESTERN CONNECTICUT HOME CARE INC WEST 2037924120 4 LIBERTY STREET DANBURY CT 06810 MOREEN DONAHUE 2037924120 2014-06-27 1 RICHARD BUGGY P00512316 8606789200 2012 2015-11-30 17:44:51Z MOREEN DONAHUE 4 LIBERTY STREET DANBURY CT 06810 5517792 0 X WWW.DANBURYHOSPITAL.ORG X 1940 CT THE ORGANIZATION EXISTS TO ENHANCE THE HEALTH AND WELL BEING OF THE COMMUNITIES IT SERVES BY EMPLOYING THE MOST ADVANCED KNOWLEDGE ABOUT CAUSES AND PREVENTION OF DISEASE, ILLNESS MANAGEMENT AND HEALTH MAXIMIZATION. THE ORGANIZATION'S MISSION IS ACHIEVED THROUGH THE PROVISION OF HOME, COMMUNITY AND PUBLIC HEALTH BASED CARE, EDUCATION AND RESEARCH. 10 9 68 0 0 0 242522 298357 4443205 5279360 49859 35454 -19739 -122581 4715847 5490590 0 0 0 0 3351503 3335139 0 0 0 1567704 2087566 4919207 5422705 -203360 67885 2457182 2564415 712871 701369 1744311 1863046 X THE ORGANIZATION EXISTS TO ENHANCE THE HEALTH AND WELL BEING OF THE COMMUNITIES IT SERVES BY EMPLOYING THE MOST ADVANCED KNOWLEDGE ABOUT CAUSES AND PREVENTION OF DISEASE, ILLNESS MANAGEMENT AND HEALTH MAXIMIZATION. THE MISSION IS ACHIEVED THROUGH THE PROVISION OF HOME, COMMUNITY AND PUBLIC HEALTH BASED CARE, EDUCATION AND RESEARCH. 0 0 635199 488910 PUBLIC HEALTH NURSING IS A PROGRAM DESIGNED TO PROMOTE AND MAINTAIN COMMUNITY HEALTH THROUGH THE USE OF PUBLIC HEALTH NURSES. IMMUNIZATIONS, CLINICS AND OUTREACH PROGRAMS ARE PROVIDED TO THE COMMUNITY. 2849276 4667869 HOME HEALTH CARE IS A PROGRAM DESIGNED TO PROVIDE BASIC HEALTH SERVICE TO SELECTED PATIENTS WHO CAN BE CARED FOR AT HOME, THUS REDUCING THE EXPENSE ASSOCIATED WITH HOSPITALIZATION, AND ALLOWING PATIENTS TO BE TREATED IN THE COMFORT AND FAMILIARITY OF THEIR OWN HOMES. SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. 3484475 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 65 0 1 68 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CT X BRIAN CARNEY 2037924120 4 LIBERTY STREET DANBURY CT 06810 ERIC BERGSTRAESSER 1.00 X 0 0 0 MARY-PAT COTTRELL 1.00 X 0 0 0 ALEXANDER DELUCIA 1.00 X 0 0 0 MARY R GRIFFIN 1.00 X 0 0 0 SEBASTIAN C LISI 2.00 X X 0 0 0 MICHAEL MALONE 1.00 X 0 0 0 VINCENT MCRUIZ 2.00 X X 0 0 0 DR JOHN MURPHY 1.00 48.00 X X 0 1183850 52091 JAMES M POST 2.00 X X 0 0 0 RICHARD JABARA 1.00 3.00 X 0 0 0 MOREEN DONAHUE 1.00 40.00 X 0 376521 68362 BRIAN A CARNEY 40.00 X 133761 0 3662 BRIAN O'LOUGHLIN 40.00 X 127468 0 4585 261229 1560371 128700 2 0 1 0 SIMIONE HEALTHCARE CONSULTANTS 4130 WHITNEY AVENUE HAMDEN CT 06518 CONSULTING 166887 MANAGEMENT HEALTH SYSTEMS PO BOX 9386 COLUMBUS GA 31908 CONTRACTED PHYSICAL THERAPY 124891 2 18634 92029 187694 298357 MEDICARE/MEDICAID PAYM 621610 4304173 4304173 OTHER FEES 621610 943901 943901 SALE OF SERVICE 621610 31286 31286 5279360 21314 21314 41342 27202 14140 14140 14140 BAD DEBT 621610 -122581 -122581 -122581 5490590 5156779 0 35454 X 270633 270633 2370297 1842257 528040 59794 41264 18530 441806 304879 136927 192609 132912 59697 21927 21927 9611 9611 966133 560110 406023 12089 1409 10680 387674 102614 285060 19683 7381 12302 160943 62629 98314 104649 100629 4020 5413 5413 12836 12836 58217 58217 NURSING/FLU CLINIC SUPP 328391 328391 5422705 3484475 1938230 0 250 250 932485 796704 20712 27614 468617 646296 203485 130900 772993 710223 8447 62770 823186 899881 2457182 2564415 637565 565736 30298 21120 45008 114513 712871 701369 X 1636279 1735598 108032 127448 1744311 1863046 2457182 2564415 67885 50850 0 X X 0 1 X 1 0 X 107339 277761 316411 242522 298357 1242390 4829561 4760099 4096402 4443205 5279360 23408627 4936900 5037860 4412813 4685727 5577717 24651017 0 0 0 24651017 28828 25001 24190 17458 21314 116791 28828 25001 24190 17458 21314 116791 4965728 5062861 4437003 4703185 5599031 24767808 0.99530 0.99410 0.00470 0.00590 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3835 3835 0 769158 706388 62770 62770 FIXED INCOME SECURITIES 335636 F EQUITIES & OTHER 564245 F 899881 ESTIMATED THIRD-PARTY PAYOR RESERVE 114513 114513 X 5541440 50850 50850 5490590 0 5490590 5422705 0 5422705 0 5422705 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE COMPANY ACCCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FASB ASC 740, "INCOME TAXES" WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. UNDER FASB ASC 740, THE COMPANY MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE COMPANY DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2013 AND 2012. AS OF SEPTEMBER 30, 2013 AND 2012, THE COMPANY DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE COMPANY'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. X X 0 0 0 0 0 0 0 0 0 DR JOHN MURPHY 0 796683 0 380000 0 7167 0 12500 0 39591 0 1235941 0 0 MOREEN DONAHUE 0 286053 0 80000 0 10468 0 22040 0 46322 0 444883 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A MEMBERSHIP ORGANIZATION, WITH ITS SOLE MEMBER BEING WESTERN CONNECTICUT HEALTH NETWORK. FORM 990, PART VI, SECTION A, LINE 7A WESTERN CONNECTICUT HEALTH NETWORK MUST APPROVE THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD OF DIRECTORS ARE SUBJECT TO APPROVAL BY WESTERN CONNECTICUT HEALTH NETWORK, THE SOLE MEMBER OF WESTERN CONNECTICUT HOME CARE, INC. THESE DECISIONS INCLUDE: (1) WESTERN CONNECTICUT HOME CARE'S ANNUAL OPERATING AND CAPITAL BUDGET, (2) PROPOSED ANNUAL FUNDRAISING PROGRAMS, (3) PROPOSED SIGNIFICANT PROGRAMS AND EXPENDITURES, (4) PURCHASE OR SALE OF SIGNIFICANT CAPITAL OR OPERATING ASSETS, (5) ACQUISITION OF INDEBTEDNESS FOR BORROWED MONEY, (6) ELECTION OR REMOVAL OF A MEMBER OF THE BOARD OF DIRECTORS, (7) DEVELOPMENT, IMPLEMENTATION, REVIEW, AND MONITORING OF INVESTMENT POLICY, (8) SETTING THE MAXIMUM AND MINIMUM NUMBER OF THE BOARD OF DIRECTORS, (9) REPLACEMENT OF A DIRECTOR DUE TO DEATH, RESIGNATION, OR OTHERWISE, AND (10) ANY OTHER MATTERS ON WHICH MEMBERS ARE ENTITLED TO VOTE UNDER THE NONSTOCK CORPORATION ACT OF THE STATE OF CONNECTICUT. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S AUDIT FIRM PREPARES THE IRS FORM 990 FROM INFORMATION PROVIDED BY THE ORGANIZATION. A DRAFT COPY IS REVIEWED AND APPROVED BY MANAGEMENT. THE DRAFT IS THEN FORWARDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW AND INPUT, IF ANY. THE DRAFT IS THEN PRESENTED TO THE COMPLETE BOARD OF DIRECTORS FOR THEIR REVIEW AND INPUT, IF ANY. THE FINAL COPY IS THEN FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO READ THE CONFLICT OF INTEREST POLICY STATEMENT, DISCLOSE ANY CONFLICTS OF INTEREST, AND SIGN. FORM 990, PART VI, SECTION B, LINE 15 15A. COMPENSATION OF CEO: IN ORDER TO ACHIEVE ITS MISSION AND ITS OVERALL PERFORMANCE OBJECTIVES, WESTERN CONNECTICUT HEALTH NETWORK, INC. EMPLOYS A PERFORMANCE-BASED TOTAL COMPENSATION PROGRAM FOR ITS SENIOR EXECUTIVES THAT IS MARKET COMPETITIVE, COMPLIANT WITH REGULATORY GUIDELINES, AND REPRESENTATIVE OF BEST PRACTICES. ELIGIBLE EXECUTIVES ARE GENERALLY DIRECT REPORTS OF THE CEO ALONG WITH OTHER EXECUTIVES DESIGNATED BY THE CEO. TO MEET WESTERN CONNECTICUT HEALTH NETWORK INC.'S TOTAL COMPENSATION OBJECTIVES FOR EXECUTIVES, THE FOLLOWING SURVEY SOURCES ARE USED FOR COMPARISON PURPOSES: - BLEND OF NATIONAL CONFIDENTIAL SOURCE, IHS, AND HAY GROUP POINTS HEALTHCARE DATA (WHERE DATA AVAILABLE), PLUS 15% GEOGRAPHICAL DIFFERENTIAL. TITLE MATCH DATA CUTS SELECTED BASED ON REVENUE SIZE. - FOR PHYSICIAN EXECUTIVES, SURVEYS COVERING PHYSICIAN COMPENSATION IN ACCREDITED MEDICAL SCHOOLS (AAMC) ARE USED IN COMBINATION WITH PROPRIETARY SURVEYS COMPILED BY NATIONALLY KNOWN CONSULTING FIRM, SULLIVAN COTTER AND THE MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA). WESTERN CONNECTICUT HEALTH NETWORK, INC. TARGETS CASH COMPENSATION AT MARKET COMPETITIVE LEVELS. BASE SALARY PLUS SHORT-TERM (ANNUAL) INCENTIVE AWARDS (TOTAL CASH) APPROXIMATE MARKET COMPETITIVE LEVELS FOR TOTAL CASH COMPENSATION. EXECUTIVE PERFORMANCE IS EXPECTED TO MEET OR EXCEED PREDETERMINED OPERATIONAL AND FINANCIAL METRICS. OTHER FACTORS, SUCH AS COMPETITIVE MARKET FORCES, JOB PERFORMANCE, UNIQUE QUALIFICATIONS, AND/OR INDIVIDUAL JOB RESPONSIBILITIES ARE ALSO CONSIDERED IN WESTERN CONNECTICUT HEALTH NETWORK, INC.'S EXECUTIVE COMPENSATION DECISIONS. ROLES OF THE COMMITTEE ON GOVERNANCE AND KEY EXECUTIVES IN THE EXECUTIVE COMPENSATION PROCESS: - THE COMMITTEE ON GOVERNANCE IN CONSULTATION WITH THE CEO AND THE SVP HR SELECTS THE OUTSIDE COMPENSATION CONSULTANTS. THE CURRENT CONSULTANT IS THE HAY GROUP, WHOSE PURPOSE IS TO PROVIDE A VALID INDEPENDENT ASSESSMENT OF THE RELEVANT MARKET RATES AND PAY PRACTICES FOR HEALTHCARE EXECUTIVES, PHYSICIAN EXECUTIVES AND FOR PHYSICIANS IN GENERAL. - THE COMPENSATION CONSULTING FIRM COMPILES APPROPRIATE MARKET DATA, JOB EVALUATION AND RANKING INFORMATION FOR ALL EXECUTIVES AND PHYSICIANS OF THE ORGANIZATION, EXCLUDING THE CEO, AND WILL SUPPLY THIS MATERIAL TO THE CEO AND SVP HR FOR REVIEW AND AGREEMENT. ONCE THE REPORT IS FINAL, IT WILL BE SUPPLIED TO THE COMMITTEE ON GOVERNANCE FOR THEIR CONSIDERATION AND ACCEPTANCE. - THE COMMITTEE ON GOVERNANCE DETERMINES THE CEO'S SALARY BASED ON OVERALL PERFORMANCE AND MARKET DATA SUPPLIED BY THE OUTSIDE MARKET CONSULTANT. THE LAST EXECUTIVE COMPENSATION EVALUATION BY AN OUTSIDE CONSULTANT WAS DONE IN DECEMBER, 2013. 15B. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES: COMPENSATION REVIEW AND APPROVAL PROCESS IS IDENTICAL TO THE PROCESS FOR THE CEO AND EXECUTIVES NOTED IN 15A ABOVE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. INFORMATION IS MAINTAINED BY THE MANAGEMENT OF THE ORGANIZATION. OTHER FEES FORM 990, PART IX, LINE 11G OTHER SERVICE FEES: PROGRAM SERVICE EXPENSES 560,110. MANAGEMENT AND GENERAL EXPENSES 406,023. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 966,133. FORM 990, PART XI, LINE 2C: THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS, AND SELECTION OF AN INDEPENDENT ACCOUNTANT, HAS NOT CHANGED FROM THE PRIOR YEAR. THE TAXPAYER'S FORM 5471 FILING REQUIREMENTS HAVE BEEN OR WILL BE SATISFIED BY DANBURY HOSPITAL, 24 HOSPITAL AVENUE, DANBURY, CONNECTICUT, 06810, EIN: 06-0646597, THE MAJORITY SHAREHOLDER OF WESTERN CONNECTICUT HEALTHCARE INSURANCE CO., LTD. DANBURY HOSPITAL HAS FILED OR WILL FILE THE FORM 5471 AND THE APPLICABLE SCHEDULES WITH THE IRS SERVICE CENTER, PHILADELPHIA, PA. WESTERN CONNECTICUT HEALTH NETWORK 95 LOCUST AVENUE DANBURY CT 06810 222594977 PROGRAM DEVELOPMENT CT 501(C)(3) LINE 11B, II N/A 0 DANBURY HOSPITAL 24 HOSPITAL AVENUE DANBURY CT 06810 060646597 PROVIDER MEDICAL CARE AND DIAGNOSIS CT 501(C)(3) LINE 3 WESTERN CONNECTICUT HEALTH NETWORK 1 WESTERN CONNECTICUT HEALTH NETWORK FOUNDATION 24 HOSPITAL AVENUE DANBURY CT 06810 237425557 ADMINISTRATIVE CONTRIBUTION CT 501(C)(3) LINE 7 WESTERN CONNECTICUT HEALTH NETWORK 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 DANBURY HOSPITAL S 1177528 ACTUAL COST DANBURY HOSPITAL P 1275802 ACTUAL COST WESTERN CONNECTICUT HEALTH NETWORK FOUNDATION C 23073 ACTUAL COST