2012-08-10T06:48:04-05:00 2011-09-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE STE 2600 INDIANAPOLIS IN 46204 990 2010-10-01 061137531 WESTERN CONNECTICUT MEDICAL GROUP PC WEST 2037397294 14 RESEARCH DRIVE BETHEL CT 06801 PATRICK BRODERICK 2012-08-09 3176817000 2010 2016-02-24 21:20:13Z X Patrick Broderick 95 LOCUST AVENUE DANBURY CT 06810 138978872 false X www.westernconnecticutmedicalgroup.org X 1985 CT PLEASE SEE ATTACHMENT 1 9 0 830 0 -6049 -31509 0 0 131101845 138533899 17977 3746 304833 126474 131424655 138664119 0 0 0 0 109233555 122544363 0 0 0 26993840 29951876 136227395 152496239 -4802740 -13832120 24242470 26257390 25575074 15775787 -1332604 10481603 X the mission is to provide safe, innovative, convenient and coordinated primary and specialty health care in the communities we serve and strive to be aware of and respond to our patients NEEDS. We support a commitment to advance the health and wellbeing of people in our community by delivering quality care participating in medical research and medical residency programs and the provision of medical services to patients. false false 54784081 49458625 MEDICINE SUBSPECIALTY - 13 Locations serving areas in Western Connecticut 93,710 patients during fiscal year 2011 109,772 visits during fiscal year 2011 484,348 - Adjusted for Charity Care in FY 2011 29301439 24820968 PRIMARY CARE- 10 Locations serving areas in Western Connecticut and Eastern New York 90,224 patients during fiscal year 2011 90,795 visits during fiscal year 2011 20,203 - Adjusted for Charity Care in FY 2011 20341003 20096375 ANESTHESIOLOGY- 3 Locations serving areas in Western Connecticut 23,134 patients during fiscal year 2011 210,302 - Adjusted for charity care in FY 2011 33798697 44290454 138225220 true false false true false false false false false true false false true true 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 true false false true 563 0 true 830 true true true false false false false false false false false false X 9 0 false false true false true false true true true false false true true true true true true true true false CT NY X X COLLEEN SCOTT 2037397294 14 RESEARCH DRIVE SUITE 201A bethel CT 06804 X PATRICK BRODERICK 50.0 X X 469771 0 7070 MATTHEW MILLER 2.0 X 555802 0 81647 CHARLES HERRICK 50.0 X 392584 0 32213 PIERRE SALDINGER 50.0 X X 663870 0 7996 RAMON KRANWINKEL 50.0 X 589197 0 40744 MARTIN SERRINS 50.0 X X 623634 0 29016 PATRICIA TIETJEN 50.0 X 578457 0 23206 RAUL ARGUELLO 50.0 X 357970 0 21620 SHOHREH SHAHABI 50.0 X 602904 0 11541 DOUG MAGAZU 50.0 X 236848 0 16764 EDWARD KUSHMEREK 50.0 X 289986 0 25789 ALAN DIETZEK 50.0 X 997694 0 46933 HAL WASSERMAN 50.0 X 705866 0 26933 CARY PASSIK 50.0 X 766809 0 44733 KARL KULIKOWSKI 50.0 X 597895 0 22807 WINSTON SHIH 50.0 X 590860 0 28160 9020147 0 467172 240 false true false ALLSCRIPTS 8529 SIX FORKS ROAD RALEIGH NC 27615 COMPUTER SERVICES 2304739 WOMENS HEALTH SERVICES 90 LOCUST AVE DANBURY CT 06810 PHYSCIAN FEES 485333 PREMIER GROUP 6 STONY HILL RoaD SUITE 200 BETHEL CT 06801 STAFFING 230337 ACCURATE ANSWER 16 SADDLE RIDGE Road NEW MILFORD CT 06776 ANSWERING SERVICES 196414 BB COMMERCIAL CLEANING SRVC 36 TAMARACK AVE DANBURY CT 06811 CLEANING SERVICES 171238 10 0 MEDICAL REVENUE 621110 138533899 138533899 138533899 3746 3746 0 0 304642 304642 0 0 0 4062 10111 -6049 -6049 REIMBURSE PROVIDER TESTIMONY 621610 43405 43405 MEDICAL RECORDS 900003 89118 89118 132523 138664119 138666422 -6049 3746 0 0 0 0 8735511 8308932 426579 0 103053453 99190795 3862658 6057144 5739765 317379 0 4698255 3657888 1040367 0 235046 235046 172144 172144 0 0 0 8067294 2251485 5815809 0 3120537 3007131 113406 189019 166141 22878 0 5149563 4525602 623961 429812 401736 28076 0 0 49870 49870 0 1279271 995776 283495 3659795 3192833 466962 BAD DEBT 5256573 5256573 MEMBERSHIP DUES 504392 468275 36117 MAINTENANCE CONTRACTS 373899 21109 352790 BOOKS AND PERIODICALS 108189 84143 24046 REPAIRS/MAINTENANCE 104546 100776 3770 1251926 806390 445536 152496239 138225220 14271019 0 5257 5594 3583516 3208288 10614681 6609543 186591 243785 119335 177699 16142714 7709054 6254429 8433660 191177 148891 3287484 7429930 24242470 26257390 8836272 13741545 763426 1042268 917010 697874 15058366 294100 25575074 15775787 X 1000 1000 -1333604 10480603 -1332604 10481603 24242470 26257390 X -13832120 25646327 X false true true X false X 143640 160329 303969 109544284 116231509 121548488 131374921 138666422 617365624 109687924 116391838 121548488 131374921 138666422 617669593 617669593 429692 488325 457479 358176 308388 2042060 429692 488325 457479 358176 308388 2042060 110117616 116880163 122005967 131733097 138974810 619711653 0.99670 0.99632 0.00330 0.00368 X false false false true 9923 false false false false false 9923 false false PART II-B, LINE 1D-MAILINGS TO MEMBERS, LEGISLATORS, OR the PUBLIC THE DOLLARS RELATED TO LOBBYING ACTIVITIES REPRESENTS APPROXIMATELY 1.9% OF THE TOTAL MEMBERSHIP DUES EXPENDITURES. ALL LOBBYING DOLLARS ARE A PORTION OF MEMBERSHIP DUES PAID. 280724 235856 44868 5835082 2563051 3272031 10026908 4910147 5116761 8433660 457B ASSET 5200013 CASH VALUE LIFE INSURANCE 1008912 DANBURY HOSPITAL RECEIVABLE 47899 DHCC RECEIVABLE 13925 NEW MILFORD RECEIVABLE 1101688 MISCELLANEOUS RECEIVABLE 15120 SOUTHBURY RENT RECEIVABLE 42373 7429930 0 I/C DANBURY HOSPITAL 294100 294100 PART X- FIN 48 FOOTNOTE There is no FIN 48 (asc 740) footnote in the audited financial statements. X X false false false false false false true false false PATRICK BRODERICK 346376 0 120544 0 2851 0 0 0 7070 0 476841 0 0 0 MATTHEW MILLER 422561 0 125000 0 8241 0 60540 0 21107 0 637449 0 0 0 DOUG MAGAZU 201336 0 35000 0 512 0 16500 0 264 0 253612 0 0 0 CHARLES HERRICK 315637 0 75000 0 1947 0 22000 0 10213 0 424797 0 0 0 PIERRE SALDINGER 541434 0 120000 0 2436 0 0 0 7996 0 671866 0 0 0 RAMON KRANWINKEL 468606 0 90000 0 30591 0 38500 0 2244 0 629941 0 0 0 MARTIN SERRINS 497334 0 120000 0 6300 0 22000 0 7016 0 652650 0 0 0 PATRICIA TIETJEN 474644 0 100000 0 3813 0 22000 0 1206 0 601663 0 0 0 RAUL ARGUELLO 286630 0 70000 0 1340 0 16500 0 5120 0 379590 0 0 0 ALAN DIETZEK 763107 0 227852 0 6735 0 38500 0 8433 0 1044627 0 0 0 EDWARD KUSHMEREK 247061 0 40000 0 2925 0 22000 0 3789 0 315775 0 0 0 HAL WASSERMAN 591494 0 109320 0 5052 0 22000 0 4933 0 732799 0 0 0 CARY PASSIK 629042 0 132683 0 5084 0 37300 0 7433 0 811542 0 0 0 SHOHREH SHAHABI 470636 0 130000 0 2268 0 7000 0 4541 0 614445 0 0 0 KARL KULIKOWSKI 535933 0 60655 0 1307 0 16500 0 6307 0 620702 0 0 0 WINSTON SHIH 371990 0 215973 0 2897 0 22000 0 6160 0 619020 0 0 0 PART I, LINE 6 Compensation Contingent on Net Earnings or Related Organization The Plan will be administered subject to the Board policy on Executive Compensation by the Committee on Governance serving as the Executive Compensation Committee (the Committee) of the Board of Directors of Western Connecticut Health Network, Inc. (WCHN). The Committee may in its sole discretion interpret the Plan, prescribe any rules and regulations necessary or appropriate for administration of the Plan and make such other determinations and take such actions as it deems necessary or advisable. The Plan year will begin October 1, 2010 and end September 30, 2011. The measurement period for award purposes will be the same. Eligibility to participate in the Plan will be limited to those who are in positions in which their decisions, actions, and counsel significantly affect the operations of WCHN and its subsidiaries, as determined by the Committee and with input provided by senior management. Prior to the start of each Plan year, or as soon as practicable thereafter, the Committee, with input provided by senior management, will determine which eligible individuals will participate in the Plan with respect to such Plan year and they will be listed accordingly. In determining which eligible individuals will participate, the Committee will take in to account the extent to which eligible individuals are in positions in which their decisions, actions and counsel significantly affect the overall performance of WCHN and its affiliates. To be considered for participation, an individual must be in an incentive eligible position for no less than 6 months of the respective Plan year. Incentive awards will be prorated as appropriate to reflect partial Plan year participation. Eligible individuals must be employed by WCHN at the time of executive incentive award distribution. The Committee will establish the target award opportunity (expressed as a percentage of base salary) for each participant in the Plan. The target award is the amount paid to participants for actual performance that meets expectations. To recognize a range of performance above the "target" level, participants may earn one-half to one and one-half times the target award opportunities based on actual performance. A threshold of performance must be achieved in order for participants to earn awards. Prior to the beginning of each Plan year, or as soon thereafter as practicable, weighting for the performance measures included in the Plan will be determined for each participant in accordance with the nature of each participant's stated goals and responsibilities (i.e. organizational, functional/individual, etc.). Prior to the beginning of each Plan year, or as soon thereafter as practicable, performance measures and performance levels will be established for each participant in the Plan. Incentive awards will be modified or eliminated if at the level of performance specified in the circuit breaker is not achieved. The circuit breaker will be established by the Committee prior to the beginning of each fiscal year or as soon thereafter as practicable. If EBITA is less than basic, full elimination of incentive award will occur. Notwithstanding, any other provision of the Plan, incentive awards can be affected by an individual modifier (based on individual executive performance) at the level specified in the Plan. SUPPLEMENTAL INFORMATION Form 990, Part I, Line 3 INDEPENDENT TRUSTEES There are no independent trustees due to compensation paid to trustees for their services as physicians rather than for their board service. However, the organization is part of an integrated health care delivery system of entities which have community boards which are responsible for certain oversight and policy decisions. Form 990, Part III, Line 4d OTHER PROGRAM SERVICES All other program services include Surgery, OBGYN, Pediatrics, Psychology, Pathology, and Administration. Form 990, Part VI, Line 4 SIGNIFICANT CHANGES TO ITS GOVERNING DOCUMENTS The Articles of Amendment were already provided to the IRS and were filed previously. The organization had a name change from Danbury Office of Physician Services, P.C. to Western Connecticut Medical Group, P.C. Form 990, Part VI, Line 6 EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDER Western Connecticut Medical Group is a stock corporation with stock issued to its physician membership. Form 990, Part VI, line 7a ELECTION OF MEMBERS OF THE GOVERNING BODY The Board of Trustees are automatic appointments based on their specific positions as full-time salaried POSITIONS at the Hospital and therefore, Trustees are not elected to the Board. Form 990, Part VI, Line 7b APPROVALS BY MEMBERS, STOCKHOLDERS, OR OTHER PERSONS The by-laws require that the Members must vote to approve, amend, alter or repeal the corporation's by-laws. Form 990 Part VI, Line 11B FORM 990 REVIEW PROCESS The organization provides a copy of the completed 990 forms to the Audit Committee for review. The forms are reviewed by the Chief Financial Officer, president, and Executive Director. ernst & young conducts a review of the return for completeness and accuracy. Form 990 Part VI, Line 12c EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy by requiring all physicians and Management to sign a conflict of interest disclosure. The documents are then reviewed by the compliance committee. If the board or committee has reasonable cause to believe that a representative has failed to disclose a personal or outside interest that could constitute a conflict of interest, it shall inform the representative of the basis for that belief and give the Representative an opportunity to explain the alleged failure to disclose. If, after hearing that response of the Representative and making such further investigation as may be warranted in the circumstances, the Board or committee determines that the Representatives has in fact failed to disclose a personal or outside interest that could constitute a conflict of interest, the Board shall take appropriate disciplinary and corrective action. DISCIPLINARY ACTION MAY RESULT IN TERMINATION OF EMPLOYMENT OR THE REFUSAL OF WESTERN CONNECTICUT MEDICAL GROUP TO DEFEND THE EMPLOYEE WITH A MATTER THAT WAS NOT DISCLOSED BUT OTHERWISE MAY HAVE BEEN ELIGIBLE TO BE DEFENDED BY WESTERN CONNECTICUT MEDICAL GROUP. Form 990, Part VI, Lines 15A AND 15B COMPENSATION REVIEW & APPROVAL PROCESS FOR OFFICERS & KEY EMPLOYEES Compensation for the Executive Director and CFO positions, Edward Kusmerek and Douglas Magazu, respectively, are reviewed and based on outside market data from a third party vendor. The review was last performed in 2009 while searching for a candidate to fill the Executive Director Position. Compensation is further reviewed by the Human Resources Department and the WCMG Board of Directors. Form 990, Part VI, Line 19 OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Certain documents are also available on the Network's web site. Form 990, Part VII Hours Explanation Matthew A. Miller, MD is paid by Western Connecticut Medical Group for the services he provides to a related organization. Form 990, Part XI, Line 5 Other Changes in net assets or fund balances Other Changes in net assets or fund balances includes a $25,646,327 transfer from Danbury Hospital. The taxpayer's Form 5471 filing requirements have been or will be satisfied by Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, TIN: 06-0646597, the majority shareholder of Western Connecticut Healthcare Insurance Co., Ltd. Danbury Hospital has filed or will file the Form 5471 and applicable schedules with the IRS. DANBURY HOSPITAL 24 HOSPITAL AVE DANBURY CT 06801 060646597 acute care CT 501(C)(3) 3 WCTHN WESTERN CONNECTICUT HEALTH NETWORK INC 24 HOSPITAL AVE DANBURY CT 06810 222594977 PROGRAM DEVLP CT 501(C)(3) 11 TYPE 2 NA WESTERN CT HEALTH NETWORK AFFILIATES 95 LOCUST AVE DANBURY CT 06801 222594968 OUTPATIENT CT 501(C)(3) 9 WCTHN WESTERN CONNECTICUT HEALTH NETWORK FNDN 24 Hospital Ave DANBURY CT 06801 237425557 ADMIN CONTRIB CT 501(C)(3) 7 WCTHN WESTERN CONNECTICUT HOMECARE INC 4 Liberty Street DANBURY CT 06810 060655138 HOME HLTHCRE CT 501(C)(3) 9 WCTHN REGIONAL HOSPICE OF WESTERN CONNECTICUT 405 MAIN STREET DANBURY CT 06810 061178847 PATIENT CARE CT 501(C)(3) 7 WCTHN NEW MILFORD HOSPITAL 21 ELM STREET DANBURY CT 06776 060669121 ACUTE CARE CT 501(C)(3) 3 WCTHN NEW MILFORD HOSPITAL FOUNDATION 21 ELM ST NEW MILFORD CT 06776 222515011 ADMIN CONTRIB CT 501(C)(3) 7 NM HOSPITAL NEW MILFORD VISITING NURSES ASSOCIATION 68 PARK LANE RD NEW MILFORD CT 06776 060653153 HOME CARE CT 501(C)(3) 9 NM HOSPITAL NEW MILFORD MRI 21 ELM ST NEW MILFORD CT 06810 271877801 IMAGING SVC CT NA N/A 0 0 false 0 false 0.00000 RIDGEFIELD SURGical 901 ETHAN ALLEN RIDGEFIELD CT 06877 222594977 HEALTH CARE CT NA N/A 0 0 false 0 false 0.00000 MEDICAL SERVICES OF DANBURY 24 HOSPITAL AVE DANBURY CT 06811 061635945 HEALTHCARE CT WCMG C CORP 0 0 1.00000 BUSINESS SYSTEMS INC 95 LOCUST AVENUE DANBURY CT 06810 061119262 PHARMACY CT NA C CORP 0 0 0.00000 WESTERN CT HEALTHCARE INSURANCE COMPANY 10 MAIN STREET GRAND CAYMAN CAYMAN ISLANDS CJ 1051 980438151 MALPRACTICE CJ NA C CORP 0 0 0.00000 FOUNDATION FOR COMMUNITY HEALTHCARE 95 LOCUST AVE DANBURY CT 06810 061437131 INACTIVE CT NA C CORP 0 0 0.00000 true true false false false false false false true true true true true false true true false DANBURY HOSPITAL J 1621484 DANBURY HOSPITAL C 25646327 DANBURY HOSPITAL J 129886 DANBURY HOSPITAL I 668473 DANBURY HOSPITAL K 40419665 DANBURY HOSPITAL N 2193042 DANBURY HOSPITAL O 376132 DANBURY HOSPITAL R 46735661