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 066068853 The Norwalk Hospital Association NORW 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 370392771 false X www.norwalkhospital.org X 1893 CT The mission of Norwalk Hospital is to provide uniquely excellent, innovative and compassionate health care with exceptional outcomes. 22 20 2108 524 4615716 0 3857005 4163105 335284118 355229999 1181407 1637037 2204505 2473072 342527035 363503213 1428713 1042576 0 0 178353547 176190042 0 0 0 157435977 161029924 337218237 338262542 5308798 25240671 258806324 347466749 123629682 211769948 135176642 135696801 X The mission of Norwalk Hospital is to provide uniquely excellent, innovative and compassionate health care with exceptional outcomes. false false 41410907 0 47594146 ORTHOPEDICS AND NEUROSPINE SERVICES: Norwalk Hospital provides comprehensive, high-quality orthopedic and neurospine care to residents of Greater Fairfield County, Connecticut through an expert team of board-certified or eligible orthopedists and neurosurgeons who have trained at some of the nations most prestigious hospitals and medical schools. A signature service, our orthopedic and neurospine program features a collaborative, team approach for the evaluation, treatment, and rehabilitation of diseases and conditions affecting the bones, joints, cartilage, muscles, tendons and ligaments. Clinical services provided includes: Arthritis & Joint Pain Treatment, Foot and ankle care, Fracture care, Hand and upper extremity care, including shoulder and elbow replacement surgery), Joint replacement (hip & knee), Spine surgery, Sports Medicine, Trauma care for orthopedic injuries. OrthoNeuro had total Inpatient Discharges of 1,845 for the fiscal year ended 9/30/2011. 35845411 0 40027060 GASTROENTEROLOGY & DIGESTIVE SERVICES: Norwalk Hospital is noted for its advanced gastroenterology program, which is considered to be a leading program in Connecticut as well as in nearby Westchester County, New York, for the diagnosis and treatment of a wide range of digestive diseases and conditions. One of the Hospitals premier signature clinical services, this program features experienced and highly respected gastroenterologists, on the Norwalk Hospital Medical Staff, who see patients in their offices throughout lower Fairfield County as well as at the Hospitals Center for Digestive Diseases. A key component of Norwalk Hospitals digestive diseases service is a colorectal cancer screening program. Colorectal cancers are highly preventable and treatable if caught early. Health experts recommend a screening colonoscopy at age 50 for adults considered at average risk. Colonoscopies are performed by gastroenterologists in the Hospitals modern and nationally accredited Gastrointestinal (GI) Lab. Norwalk Hospital is the only hospital in Connecticut to offer Third Eye Retroscope-enhanced colonoscopies. This new technology has been shown in clinical studies to improve the detection rate of potentially pre-cancerous colon polyps by up to 25%. Once detected, the colon polyps can be removed during the colonoscopy. Several gastroenterologists on the Hospitals medical staff are offering Third Eye Retroscope-enhanced colonoscopies to patients. The Norwalk Hospital Center for Digestive Diseases provides state-of-the-art, academic medical center-level care in a conveniently located, community hospital setting. The Centers widely recognized, fellowship-trained; specialist physicians provide leading-edge diagnostics and treatments for disorders of the esophagus, stomach, small intestine, colon, rectum, gallbladder, pancreas and liver. A leader in advanced endoscopic procedures for the treatments of gastrointestinal disorders, the Center also offers a chronic heartburn program, and, in partnership with Yale School of Medicine, a comprehensive Liver Center. Clinical services provided by the Centers specialist physicians include, but are not limited to: Ablation therapy for Barretts esophagus, Chronic heartburn (GERD) evaluation and treatment, Colon cancer screening, Colonoscopies, Double balloon-assisted enteroscopy, Endoscopic procedures, including endoscopic ultrasound, Inflammatory bowel disease evaluation and treatments, Liver diseases, including Hepatitis C, evaluations and treatments. The Center serves as a major teaching site for the Yale School of Medicine. William Hale, MD, director of gastroenterology and hepatology; Dennis Meighan, DO, director of endoscopy; and Seth A. Gross, MD, director of advanced endoscopy; help train residents and fellows, and also conduct clinical research studies designed to improve care for patients. Gastro & Digestive had total Inpatient Discharges of 1,807 for the fiscal year ended 9/30/2011. 34466806 0 37725513 WOMEN'S HEALTH: One of the Hospital's premier signature clinical programs, our Women's and Children's Services features a top notch team of obstetricians/gynecologists, pediatricians, certified nurses midwives, pediatric hospitalists, neonatologists, pediatric specialists, physician assistants and nurses. This team's compassionate and expert care is further enhanced by the onsite availability of full-time perinatologists from Yale University Medical School. Our obstetricians and certified nurse midwives deliver babies in the Hospital's modern, home-like Childbirth Center. The center features in-suite amenities, including beautiful single rooms with private baths and showers, massage therapy for infants and mothers, wireless Internet access and flat-screen televisions. For additional expertise, the Hospital also provides perinatology services, for high-risk pregnancy, as well as reproductive endocrinology services. In addition, advanced, minimally invasive robotic surgery for several gynecologic procedures, including hysterectomies, fibroid removal, vaginal prolapse correction, to stop menorrhagia and to treat certain forms of cervical and uterine cancers, are now available at the Hospital. Women's Health had total Inpatient Discharges of 3,448 for the fiscal year ended 9/30/2011. 171409610 0 225267563 283132734 true true false true false false false false false true false true true true false false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true true true false false true 362 0 true 2108 true true true false false false false false false false false false X 22 20 false false false false true true false true true false false true true true true true false true true true false X TONI HORNE CONTROLLER 2038522071 24 STEVENS STREET NORWALK CT 06850 X Ervin Shames Chairman thru 3.0 X X 0 0 0 Diane M Allison ESQ vice chair 5.0 X X 0 0 0 George P Bauer 2.0 X 0 0 0 Andrew Whittingham 3.0 X X 0 0 0 Joseph Mann 2.0 X X 0 0 0 Fred Afragola 2.0 X 0 0 0 Charles Augenbraun MD 0.0 X 0 0 0 Barbara Butler 3.0 X 0 0 0 Daniel DeBarba 50.0 X X 670785 0 29920 Victor Liss 3.0 X 0 0 0 Michael Marks MD Physician 2.0 X 70833 0 0 David Komansky 2.0 X 0 0 0 David Lehn 2.0 X 0 0 0 Gary Reiner 3.0 X 0 0 0 Roland Stichweh 3.0 X 0 0 0 William J Tamme TRUSTEE THRU 5.0 X 0 0 0 Richard Zelkowitz MD 2.0 X 0 0 0 Robert Ready 2.0 X 0 0 0 Thomas Ayoub 18.0 X 140833 0 0 Maria Borges-Lopez 2.0 X 0 0 0 Paul Gagne MD 2.0 X 0 0 0 Mark Gudis 2.0 X 0 0 0 Ed Kangas 2.0 X 0 0 0 Ed Mahony 2.0 X 0 0 0 Patrick Minicus 50.0 X 354471 0 25050 Eric Mazur 50.0 X 764258 0 44422 Lisa Brady 50.0 X 450445 0 25419 Mary NolaN 50.0 X 372529 0 52575 Anthony Aceto 50.0 X 344257 0 30687 Peter Dodds 25.0 X 432202 0 32628 Michael Carius 50.0 X 537703 0 49348 Arthur Srichman 50.0 X 451345 0 45210 Brian McGovern 50.0 X 534859 0 44459 Stephen Winter 50.0 X 469523 0 45519 Geoffrey Cole X 1248052 0 46796 6842095 0 472033 294 true true false NORWALK RADIOLOGY MAMMOGRAPHY CTR 148 EAST AVENUE NORWALK CT 06851 MEDICAL 3641641 MORRISON MANAGEMENT SPECIALISTS INC PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE 2552365 UNITEX TEXTILE RENTAL 121-123 MEADOW STREET HARTFORD CT 06114 LAUNDRY SERVICES 1403712 COMFORCE TECHNICAL SERVICES INC PO BOX 9695 UNIONDALE NY 11555 STAFFING SERVICES 1338302 APOLLO SECURITY 2150 BOSTON-PROVIDENCE HIGHWAY WALPOLE MA 02081 SECURITY SERVICE 1090981 91 2045335 2086206 31564 4163105 PATIENT REVENUE 621400 345978731 345978731 OTHER MEDICAL SERVICES 900099 1204956 1204956 OTHER OPERATING REVENUE 900099 3430595 3430595 LAB SERVICES 621400 4615716 4615716 355229999 840683 840683 0 0 3842935 3338298 504637 504636 504636 4130293 4000 3334739 3200 795554 800 796354 796354 0 0 354832 213321 141511 141511 CAFETERIA/VENDING 900099 1545998 1545998 LAUNDRY 900099 240000 240000 PARKING 812930 40927 40927 1826925 363503213 350614282 4615716 4110109 1042576 1042576 0 0 0 3359338 3359338 0 128932371 112433635 16498736 9859752 7950078 1909674 23549011 19105759 4443252 10489570 8457910 2031660 0 1607556 1607556 241990 241990 187250 187250 0 0 43564318 35076843 8487475 1746100 97560 1648540 25205434 23906785 1298649 5755534 4042655 1712879 0 16629032 13400413 3228619 537481 449278 88203 0 30559 30250 309 1450895 1445282 5613 0 19041348 14828382 4212966 8216535 8149794 66741 BAD DEBT 20654069 20654069 PHARMACY 6897748 6895018 2730 RADIOLOGY & LAB SUPPLIES 2216493 2213820 2673 SUPPORT - NORWALK COMMUNITY HE 1350000 1350000 DUES, MEMBERSHIPS 701524 192191 509333 4996058 1410436 3585622 338262542 283132734 55129808 0 -3090637 61458676 29401181 0 40941651 37299759 2019947 1387672 2361637 1879253 1831130 2698590 404630251 277722033 111490794 126908218 30190958 30219610 3170899 2729803 36399874 40488764 46485294 258806324 347466749 75538145 105366368 211158 208218 9845000 56060000 7295987 6275846 30739392 43859516 123629682 211769948 X 111900980 104824797 13846953 21432761 9428709 9439243 135176642 135696801 258806324 347466749 X 25240671 -24720512 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 505447 505447 OTHER ACTIVITIES SCHEDULE C, PART II-B, LINE i NORWALK HOSPITAL ASSOCIATION PAYS MEMBERSHIP DUES TO MEMBER ORGANIZATIONS WHICH MAY ENGAGE IN LOBBYING ACTIVITIES, THEREFORE, A PORTION OF THE DUES MAY BE ATTRIBUTABLE TO LOBBYING ACTIVITIES. NORWALK HOSPITAL ENGAGED THE FIRM BROWN RUDNICK LLP FOR GOVERNMENT RELATIONS IN CONNECTICUT AND ON THE FEDERAL LEVEL. BROWN RUDNICK KEEPS NORWALK HOSPITAL ASSOCIATION APPRAISED OF FEDERAL HEALTHCARE POLICY, GRANT OPPORTUNITIES AND RELATED BILLS & PENDING LEGISLATION THAT MAY BE OF INTEREST TO THE WELL BEING OF THE HOSPITAL. 0 951359 951359 138667910 80861938 57805972 7750166 2697396 5052770 232771161 193034833 39736328 24489655 1127866 23361789 126908218 0 DEFERRED FINANCING FEES 329597 Debt Service Fund 372429 Due from Affiliates 2640682 Debt Service Reserve Fund 15111873 MALPRACTICE TRUST FUND 4567394 Goodwill - NRMC Purchase 15097582 Non-Compete - NRMC Purchase 7547810 CHEFA Bond Issue Expense 198527 CHEFA Bond Discount 101668 UNDERWRITERS DISC CHEFA GHI 436311 MISCELLANEOUS 81421 46485294 0 Due to third party payors 16535753 Malpractice Reserve 9815058 Asset Retirement Obligation 11509090 CHA Trust loan short term 269570 Workers' Comp Reserve 2172120 Long Term Disability Reserve 2541099 Lease - Current and long term 16826 Radiology earnout 1000000 43859516 FIN 48 Footnote Schedule D, Part X, Line 2 There was no fin 48/asc 740 footnote in the audited financial statements. true true X true X true X true true false true false 16080 5977815 2890778 3087037 0.00970 41289 43547244 32174890 11372354 0.03580 57369 49525059 35065668 14459391 0.04550 104 1701952 1814851 4608 1810243 0.00570 3 30 13277969 3924767 9353202 0.02940 1 0 3741223 1893351 1847872 0.00580 0 0 0 0 0.00000 0 0 0 0 0.00000 108 1701982 18834043 5822726 13011317 0.04090 108 1759351 68359102 40888394 27470708 0.08640 true 7146308 1490020 84380371 99105829 -14725458 X true true NORWALK SURGERY CTR AMBULATORY SURGICAL CENTER 0.70000 0.00000 0.25000 1 1 NORWALK HOSPITAL ASSOCIATION

24 STEVENS STREET NORWALK CT 06856

X X X X NORWALK HOSPITAL ASSOCIATION 1 Part I, Line 7, Column F Bad Debt Expense of $20,654,069 has been excluded from the denominator in the calculations for part I, Column F. Part III, Line 4 REVENUES AND PATIENT ACCOUNTS RECEIVABLE ARE RECORDED WHEN PATIENT SERVICES ARE PERFORMED. AMOUNTS RECEIVED FROM CERTAIN PAYORS ARE DIFFERENT FROM THE ESTABLISHED BILLING RATES OF THE VARIOUS PROVIDERS, AND THESE DIFFERENCES ARE ACCOUNTED FOR AS ALLOWANCES. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED. REVENUE UNDER THIRD-PARTY PAYOR AGREEMENTS IS SUBJECT TO AUDIT AND RETROACTIVE ADJUSTMENTS. PROVISIONS FOR ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS AND ADJUSTMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. ADJUSTMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. There is no bad debt footnote in the audited financial statements. PART III, LINE 8 ALL HOSPITALS MUST RECORD PROFITS IN ORDER TO GENERATE THE CAPITAL NEEDED TO INVEST IN FACILITIES AND SERVICES. SERVICES THAT RESPOND TO PUBLIC HEALTH NEEDS PROVIDED TO MEDICARE PATIENTS AT NORWALK HOSPITAL GENERATE NEGATIVE MARGINS AVERAGING AROUND 25 % OF COST. IT IS POSSIBLE THAT SOME OF THESE SERVICES WOULD BE DISCONTINUED IF THE DECISION WAS MADE ON A PURELY FINANCIAL BASIS. FOR THIS REASON, IT WOULD BE APPROPRIATE TO CONSIDER THE MEDICARE PAYMENT SHORTFALL A COMMUNITY BENEFIT. THE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6 WERE COMPUTED USING THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT MULTIPLIED AGAINST MEDICARE CHARGES. PART III, LINE 9B NORWALK HOSPITAL SENDS OUT TWO STATEMENTS BEFORE THE CLAIM THEN CYCLES TO OUR "EARLY OUT" COMPANY, WHO WOULD THEN WORK THE CLAIM FOR THREE MONTHS. OUR STATEMENTS HAVE MESSAGES OR LITERATURE ON THE BOTTOM OF THE STATEMENT ALERTING THE PATIENT TO THE FACT THAT IF THEY FEEL THEY NEED ASSISTANCE IN PAYING THEIR BILLS THEY CAN CALL CUSTOMER SERVICE AND REQUEST A FINANCIAL ASSISTANCE APPLICATION. THEY WOULD HAVE TO FILL IT OUT COMPLETELY, AND PROVIDE US WITH THE REQUESTED PAPERWORK, COPY OF INCOME TAXES BEING ONE OF THEM. IF THE APPLICATION COMES BACK TO US AND IS COMPLETE, WE WILL CHANGE THE FINANCIAL CLASS TO PENDING CHARITY SO THE CLAIM DOES NOT CYCLE TO COLLECTIONS. THE NORWALK HOSPITAL MANAGER, CUSTOMER SERVICE/INSURANCE VERIFICATION AND ASSISTANCE COORDINATOR PROCESS THE APPLICATIONS ON A WEEKLY BASIS. ONCE DETERMINATION IS MADE AS TO WHAT THEY MAY QUALIFY FOR, BASED ON OUR SLIDING SCALE (WHICH IS UPDATED YEARLY BASED ON POVERTY GUIDELINES, FAMILY SIZE, AND INCOME), THE APPROPRIATE AMOUNT WOULD BE ADJUSTED. PATIENTS ARE CALLED AND NOTIFIED IF THEY QUALIFY AND FOR WHAT AMOUNT. IF THERE IS A REMAINING BALANCE, THE ACCOUNT WOULD THEN BE CHANGED TO SELF-PAY.IF PATIENTS ARE ADMITTED THROUGH THE ER AND ARE SELF-PAY, OUR FINANCIAL COUNSELORS WOULD VISIT THEM TO DISCUSS APPLYING FOR MEDICAID. IF A PATIENT IS STRAIGHT SELF-PAY, OUR POLICY MANDATES THAT THE APPLICANT BE COMPLIANT WITH MEDICAID, AND IF THEY ARE DENIED, THEY CAN THEN APPLY FOR FINANCIAL ASSISTANCE THROUGH THE HOSPITAL, HOWEVER, IF THEY ARE DENIED FOR NON-COMPLIANCY, THEN FINANCIAL ASSISTANCE WOULD NOT BE APPLICABLE. IF A PATIENT IS NOT A CITIZEN AND THEY WOULD NOT QUALIFY FOR EMED (EMERGENCY MEDICAL FOR JUST THAT ONE INPATIENT VISIT), THEY WOULD BE ABLE TO APPLY FOR FINANCIAL ASSISTANCE WITHOUT HAVING TO APPLY FOR MEDICAID SINCE THEY WOULD BE DENIED ANYWAY. IF A PATIENT HAS TO HAVE AN OUTPATIENT PROCEDURE AND DOES NOT HAVE INSURANCE, PATIENT REGISTRATION WILL TRY TO OBTAIN REIMBURSEMENT FROM THAT PATIENT. IF THEY ARE UNABLE TO PAY, THEY WOULD CALL THE PATIENT'S PHYSICIAN TO SEE IF THE PROCEDURE CAN BE POSTPONED UNTIL FINANCIAL ARRANGEMENTS CAN BE MADE. IF THE DOCTOR STATES THEY CAN NOT POSTPONE THE PROCEDURE THEY WOULD ALLOW THE PATIENT TO COME BUT WOULD INSTRUCT THEM TO APPLY FOR MEDICAID AND IF DENIED THEY WOULD APPLY FOR FINANCIAL ASSISTANCE. IF A PATIENT IS FROM AN AFFILIATED FEDERALLY QUALIFIED HEALTH CENTER AND NEEDS TO HAVE SERVICES WHEREBY WE DO NOT HONOR THE DISCOUNT(I.E.: ALL INPATIENT SERVICES, OUTPATIENT IV THERAPY, RADIATION THERAPY, AND HYPERBARIC), AND IS NOT A CITIZEN, THEY WOULD BE REFERRED TO OUR FINANCIAL ASSISTANCE COORDINATOR, TO COMPLETE AN APPLICATION. IF A PATIENT FROM AN AFFILIATED FEDERALLY QUALIFIED HEALTH CENTER IS A CITIZEN, THEY WOULD FIRST NEED TO HAVE APPLIED FOR MEDICAID AND IF DENIED, THEY COULD APPLY FOR ASSISTANCE. OVERALL, PATIENTS CAN CALL CUSTOMER SERVICE, EVEN IF THEY ARE IN COLLECTIONS, TO BE CONSIDERED FOR FINANCIAL ASSISTANCE. IF THEY ARE IN COLLECTIONS AND APPLY, WE WOULD PULL THE ACCOUNT BACK ONCE THE APPLICATION IS RECEIVED WE HAVE A NUMBER OF SCREENS WE FILL OUT IN OUR ACCOUNTING SOFTWARE WHICH DENOTE THE PATIENT HAS APPLIED AND THE STATUS. ALSO, PATIENTS LIVING IN A SHELTER OR THAT ARE HOMELESS ARE ADJUSTED TO CHARITY AS WELL. ADDITIONALLY, ALL IV THERAPY AND RADIATION THERAPY ACCOUNTS THAT HAVE BEEN GRANTED CHARITY ARE ADJUSTED MONTHLY, SINCE THEY ARE BILLED MONTHLY. MEDICAID SPENDDOWN AMOUNTS ARE ALSO ADJUSTED TO CHARITY. BEEN GRANTED CHARITY ARE ADJUSTED MONTHLY, SINCE THEY ARE BILLED MONTHLY. MEDICAID SPENDDOWN AMOUNTS ARE ALSO ADJUSTED TO CHARITY. NEEDS ASSESSMENT Part VI, Question 2 IN FY 2010, AS PART OF NORWALK HOSPITAL'S COMMUNITY OUTREACH STRATEGIC INITIATIVE, NORWALK HOSPITAL AND THE NORWALK HOSPITAL FOUNDATION DEVELOPED COMMUNITY ADVISORY BOARDS REPRESENTING EACH OF THE COMMUNITIES WE SERVE. COMPRISED OF NEIGHBORS, HEALTH DIRECTORS, PUBLIC OFFICIALS, CLERGY, BUSINESS LEADERS, CIVIC GROUP REPRESENTATIVES, ETC.. THESE GROUPS ASSIST THE HOSPITAL IN ASSESSING THE HEALTH CARE NEEDS AND OUTREACH OPPORTUNITIES IN SPECIFIC TOWNS. THE ADVISORY BOARDS PROVIDE INVALUABLE FEEDBACK SO THAT WE CAN CONTINUALLY ENHANCE OUR OUTREACH EFFORTS AND MEET CHANGING HEALTH CARE NEEDS. THE PLANNING DEPARTMENT OF THE HOSPITAL HAS ACCESS TO HOSPITAL, STATEWIDE AND NATIONAL DATABASES THAT TRACK TRENDS AND SERVICE USAGE ON AN ONGOING BASIS IN ORDER TO EVALUATE HOW THE HOSPITAL IS MEETING THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. Patient education of eligibility for assistance Part VI, Question 3 Through the hospital's access management and/or customer service division of the patient account, we inform patients about THE DETAILS OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, ASSIST WITH THE EXPLANATION OF THE FINANCIAL ASSISTANCE APPLICATION IF THE APPLICATION IS REQUIRED, DETERMINE THE AMOUNT OF THE DISCOUNT, INFORM THE PATIENT OF THE HOSPITAL'S FINAL DETERMINATION, AND PROCESS THE DISCOUNT IN THE HOSPITAL'S PATIENT ACCOUNTING SYSTEM. THE ONLY EXCEPTIONS ARE: [1] OUTPATIENT MENTAL HEALTH SERVICES WHERE THE DEPARTMENT OF PSYCHIATRY WILL QUALIFY AND PROCESS FINANCIAL ASSISTANCE APPLICATIONS, AND [2] DENTAL CLINIC WILL QUALIFY AND PROCESS FINANCIAL ASSISTANCE APPLICATIONS. THE PATIENT WILL HAVE 30 DAYS FROM THE RECEIPT OF THE APPLICATION PACKET TO RETURN IT IN ITS ENTIRETY. OTHERWISE, THE NORMAL STATEMENT CYCLE WILL CONTINUE UNDER THE CLASSIFICATION OF SELF PAY. WHEN AN APPLICATION IS RECEIVED, THE ACCOUNT STATUS WILL BE CHANGED TO PENDING FINANCIAL ASSISTANCE AND NO ADDITIONAL STATEMENTS WILL BE SENT TO THE PATIENT UNTIL A FINAL FINANCIAL ASSISTANCE DETERMINATION IS MADE. IF THE PATIENT FILES FOR FINANCIAL ASSISTANCE ONLY AFTER LEGAL ACTION HAS BEEN INITIATED FOLLOWING REASONABLE COLLECTION EFFORTS, THE PATIENT WILL BE ENTITLED TO FILE A FINANCIAL ASSISTANCE APPLICATION BUT WILL BE RESPONSIBLE FOR ANY LEGAL FEE COSTS AND/OR COURT COSTS INCURRED UP TO THE POINT OF TIME OF THE APPLICATION. THE EXISTENCE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM WILL BE POSTED IN BOTH ENGLISH AND SPANISH AT ALL REGISTRATION POINTS WITHIN THE HOSPITAL. THE FOLLOWING PATIENTS WILL RECEIVE A FINANCIAL ASSISTANCE APPLICATION, ALSO AVAILABLE IN BOTH ENGLISH AND SPANISH, BY PATIENT ACCESS PERSONNEL AT THE TIME OF REGISTRATION: A. ALL ED PATIENTS WHO PRESENT TO THE EMERGENCY ROOM AS SELF PAY B. ANY PATIENT WHO INDICATES AN INABILITY TO PAY HOSPITAL PATIENT STATEMENTS WILL CLEARLY INDICATE THE EXISTENCE OF A FINANCIAL ASSISTANCE PROGRAM INCLUDING CUSTOMER SERVICE TELEPHONE NUMBERS. COMMUNITY INFORMATION Part VI, Question 4 NORWALK HOSPITAL IS A NOT-FOR-PROFIT ACUTE CARE COMMUNITY TEACHING HOSPITAL WHICH IS LICENSED FOR 328 BEDS. THE HOSPITAL HAS OVER 500 PHYSICIANS ON ITS ACTIVE MEDICAL STAFF, MANY OF WHOM TRAINED AT THE NATION'S LEADING MEDICAL SCHOOLS AND HOSPITALS, AND 2,000 HEALTH PROFESSIONALS AND SUPPORT PERSONNEL. NORWALK HOSPITAL SERVES AN AREA POPULATION OF ABOUT 270,000 IN LOWER FAIRFIELD COUNTY. THE SERVICE AREAS INCLUDE PRIMARILY NORWALK, NEW CANAAN, WESTPORT, WESTON AND WILTON; AS WELL AS DARIEN, FAIRFIELD, REDDING AND RIDGEFIELD. THERE ARE FIVE OTHER HOSPITALS IN NORWALK HOSPITAL'S PRIMARY SERVICE AREA. A DIVERSE SOCIO-ECONOMIC POPULATION, NORWALK HOSPITAL SERVES AN AGING POPULATION, FROM THE AFFLUENT TO THE MEDICALLY UNDERSERVED. THE AVERAGE HOUSEHOLD INCOME IN THE NORWALK HOSPITAL'S SERVICE AREA IS $163,887, AND THE ESTIMATED UNINSURED POPULATION IN THE CITY OF NORWALK IS 15%. THE PERCENTAGE OF POPULATION THAT IS 65+ IS EXPECTED TO INCREASE FROM 13.9% IN 2010, TO 15.6% IN 2015, AND WOMEN OF CHILDBEARING-AGE (18-44) ARE FORECAST TO DECLINE 2.5% OVER THIS SAME PERIOD OF TIME. PROMOTION OF COMMUNITY HEALTH Part VI, Question 5 NORWALK HOSPITAL PROVIDES A VAST ASSORTMENT OF SERVICES TO THE COMMUNITY FREE OF CHARGE AND FURTHER CARRIES OUT ITS CITIZENSHIP BY MEETING THE NEEDS OF THE UNDERSERVED, WHICH INCLUDES ABOUT 44 PERCENT OF ITS PATIENTS. THE HOSPITAL MAKES AVAILABLE TO THE COMMUNITY, WITHOUT REGARD FOR ABILITY TO PAY, AN IMPRESSIVE LIST OF SPECIALTIES, SUCH AS: CHILDBIRTH CENTER: NORWALK HOSPITAL PROVIDES EXCEPTIONAL MATERNITY AND PEDIATRIC SERVICES. THE OBSTETRICIANS ARE SUPPORTED BY HIGHLY SKILLED NURSES, CERTIFIED NURSE MIDWIVES, PHYSICIAN ASSISTANTS, NEONATOLOGISTS, AND YALE PERINATOLOGISTS TO HELP MANAGE HIGH-RISK PREGNANCIES. THE HOSPITAL ALSO OFFERS COMPREHENSIVE CHILDBIRTH EDUCATION AND SUPPORT PROGRAMS. THE SMILOW FAMILY BREAST HEALTH CENTER: THE SMILOW CENTER ADDRESSES BREAST CARE IN A SEAMLESS MANNER, BEGINNING WITH COMMUNITY EDUCATION AND SCREENING. FOCUSING ON RAPID DIAGNOSIS, THE PROGRAM PROVIDES ON-GOING SUPPORT THROUGHOUT THE PROCESS OF REFERRAL AND SCHEDULING TO ALL NEEDED SERVICES AND PHYSICIANS. TRAUMA CENTER: NORWALK HOSPITAL IS DESIGNATED AS A LEVEL II TRAUMA CENTER, WHICH IS DEDICATED TO THE SURVIVAL AND RESTORATION OF PATIENTS TO THEIR BEST FUNCTIONAL OUTCOME. STROKE PROGRAM: NORWALK HOSPITAL HAS EARNED THE GOLD SEAL OF APPROVAL FOR STROKE CARE. THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS HAS AWARDED NORWALK HOSPITAL PRIMARY STROKE CENTER CERTIFICATION "FOR DEMONSTRATING THAT ITS STROKE CARE PROGRAM FOLLOWS NATIONAL STANDARDS AND GUIDELINES THAT CAN SIGNIFICANTLY IMPROVE OUTCOMES FOR STROKE PATIENTS." CANCER DIAGNOSTICS AND THERAPY: A COMPREHENSIVE PROGRAM THROUGH THE WHITTINGHAM CANCER CENTER BRINGS TO SOUTHWESTERN CONNECTICUT THE LATEST KNOWLEDGE, TECHNIQUES, AND TECHNOLOGY FOR THE DIAGNOSIS AND TREATMENT OF CANCER. THE CANCER CENTER IS COMMITTED TO ASSURING A FULL SPECTRUM OF ONCOLOGY SERVICES TO THE PEOPLE OF OUR COMMUNITY. FROM PREVENTION AND SCREENINGS, TO DIAGNOSIS AND TREATMENT, THE STAFF IS CONTINUALLY RESPONDING TO THE CHANGING NEEDS OF HEALTHCARE AND CANCER PATIENTS. SURGICAL SERVICES: NORWALK HOSPITAL'S DEDICATED SURGICAL STAFF OFFERS HIGH QUALITY SURGICAL CARE. NORWALK HOSPITAL'S OUTSTANDING SURGEONS ARE IN THE FOREFRONT OF SURGICAL PROCEDURES INCLUDING LAPAROSCOPIC SURGERY, MAJOR JOINT REPLACEMENT, AND UROLOGICAL SERVICES. SLEEP CENTER: A NATIONALLY ACCREDITED CENTER PROVIDES FOR DIAGNOSIS AND MANAGEMENT OF THE FULL RANGE OF SLEEP DISORDERS, INCLUDING SLEEP APNEA AND INSOMNIA. THE CENTER CONDUCTS INTERNATIONAL RESEARCH TRIALS THAT KEEP IT AT THE FOREFRONT OF NEW AND DEVELOPING THERAPIES. BARIATRIC CENTER: THE NORWALK HOSPITAL BARIATRIC CENTER HAS BEEN NAMED AN AMERICAN SOCIETY FOR BARIATRIC SURGERY (ASBS) BARIATRIC SURGERY CENTER OF EXCELLENCE. THE ASBS CENTER OF EXCELLENCE DESIGNATION RECOGNIZES SURGICAL PROGRAMS WITH A DEMONSTRATED TRACK RECORD OF FAVORABLE OUTCOMES IN BARIATRIC SURGERY. WOUND CARE AND HYPERBARIC MEDICINE CENTER: AS A REFERRAL CENTER FOR COMPREHENSIVE WOUND MANAGEMENT, THE CENTER HAS HAD VERY SUCCESSFUL RESULTS BY PROVIDING ADVANCED TREATMENT TO CURE WOUNDS THAT PREVIOUSLY WOULD NOT HEAL. NORWALK HOSPITAL HAS MORE THAN TWENTY-FIVE YEARS OF EXPERIENCE IN PROVIDING HYPERBARIC OXYGEN THERAPY, PIONEERING AS THE FIRST HOSPITAL-BASED HYPERBARIC SERVICE IN NEW ENGLAND. TWENTY-FIVE PERCENT OF PEOPLE WITH NON-HEALING WOUNDS BENEFIT FROM RECEIVING HYPERBARIC OXYGEN THERAPY. MANY PATIENTS WITH NON-HEALING WOUNDS ARE REFERRED TO NORWALK HOSPITAL FOR ASSESSMENT BECAUSE OF THIS EXPERTISE. COMMUNITY HEALTH CENTER: NORWALK HOSPITAL IS A FINANCIAL SPONSOR FOR THE NORWALK COMMUNITY HEALTH CENTER, A COMMUNITY-BASED FEDERALLY QUALIFIED HEALTH CENTER, WHICH OFFERS COMPREHENSIVE HEALTHCARE AT AFFORDABLE PRICES TO RESIDENTS OF A MEDICALLY UNDERSERVED COMMUNITY. OTHER COMMUNITITY Benefit Activities: WOMEN WITH LIMITED OR NO HEALTH INSURANCE MAY BE ELIGIBLE FOR FREE MAMMOGRAMS, BREAST EXAMS, AND "PAP" PROCEDURES IN AN EARLY DETECTION PROGRAM OFFERED AT NORWALK HOSPITAL THROUGH THE CONNECTICUT BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM. THE MEDICAL STAFF PROVIDES AN ANNUAL WELLNESS SERIES, NOW IN ITS 29TH YEAR, FOR THE COMMUNITY AND THE SECTION OF PULMONARY MEDICINE HAS BEEN OFFERING FREE SMOKING CESSATION PROGRAMS TWICE A YEAR FOR OVER 30 YEARS. NORWALK HOSPITAL OFFERS A WIDE RANGE OF COMMUNITY SERVICES BOTH AT THE HOSPITAL AND IN THE COMMUNITY. HOSPITAL ASSOCIATES AND AFFILIATED PHYSICIANS PROVIDE WELLNESS PROGRAMS TO SCHOOLS, CIVIC GROUPS, CHURCHES, AND OFFER COMMUNITY HEALTH FAIRS AND SCREENINGS. Examples of promoting health of community: Norwalk Hospital staff and affiliated MDs participate in health fairs, community education lectures and screenings with community YMCAs, senior centers, schools, Department of Health, etc. In collaboration with the State of CT Dept. of Health and the CDC, Norwalk Hospital offers the CT Breast and Cervical Cancer Early Detection Program and promotes this program to the community. Norwalk Hospital offers program and financial support to the Norwalk Community Health Center, a FQHC. Norwalk Hospital specialty clinics are staffed by volunteer attending physicians for surgical, GI, pulmonary, cardiology, orthopaedics, podiatry, physiology, nephrology, neurology for underserved patients. AFFILIATED HEALTH CARE SYSTEM Part VI, Question 6 In order to promote the health of the community Norwalk Hospital is responsible for coordinating the services of the hospital with those of other health, education and social services in the community (e.g. long-term care facilities, community outreach, health promotion/illness prevention organizations, etc.) in order to optimize the availability of a full scope of services in a cost-effective manner. As a not-for-profit organization, Norwalk Hospital provides needed medical care to all, including those who cannot pay for it. (This comes from our vision and values statement. We are currently a one system hospital, no affiliated hospitals.) true Norwalk Hospital Foundation 24 Stevens Street Norwalk CT 06850 222577708 501(c)(3) 1042576 0 n/a n/a Fund Operations 1 0 Form 990, Schedule I, line 2 Description of Organization's Procedures for Monitoring the Use of Grants Funds are provided to Norwalk Hospital Foundation, a related 501(c)(3) organization, which is subject to the same policies and procedures as Norwalk Hospital Association. X false true true true false false false false false true false Daniel DeBarba 416638 0 210000 0 44147 0 11025 0 18895 0 700705 0 0 0 Patrick Minicus 244411 0 83008 0 27052 0 7656 0 17394 0 379521 0 0 0 Geoffrey Cole 202525 0 100247 0 945280 0 30767 0 16029 0 1294848 0 0 0 Eric Mazur 571892 0 114443 0 77923 0 30028 0 14394 0 808680 0 0 0 Lisa Brady 340144 0 108609 0 1692 0 11025 0 14394 0 475864 0 0 0 Mary NolaN 272147 0 59032 0 41350 0 36781 0 15794 0 425104 0 0 0 Anthony Aceto 250680 0 61851 0 31726 0 16293 0 14394 0 374944 0 0 0 Peter Dodds 360000 0 0 0 72202 0 32628 0 0 0 464830 0 0 0 Michael Carius 359523 0 78219 0 99961 0 33654 0 15694 0 587051 0 0 0 Arthur Srichman 223771 0 167241 0 60333 0 29316 0 15894 0 496555 0 0 0 Brian McGovern 246739 0 261740 0 26380 0 20066 0 24393 0 579318 0 0 0 Stephen Winter 331634 0 60201 0 77688 0 31125 0 14394 0 515042 0 0 0 Supplemental Compensation Information Schedule J, Part I, LINE 1A: 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 1B THE TAX GROSS-UP FOR THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN WAS APPROVED BY THE BOARD IN 1996 WHEN THE PLAN WAS CREATED. THIS DECISION WAS REACHED WITH THE ADVICE OF OUTSIDE COUNSEL AND A COMPENSATION CONSULTING FIRM. IN GENERAL, TAX GROSS-UP DECISIONS ARE MADE ON A CASE BY CASE BASIS RELATED TO SPECIFIC ELEMENTS AND THE INTENTION OF ANY PARTICULAR COMPENSATION PLAN OR PROGRAM. THESE DECISIONS ARE REACHED IN CONCERT WITH, BUT NOT LIMITED TO, THE FOLLOWING PARTIES: CEO OR OTHER EXECUTIVES, HUMAN RESOURCES, ACCOUNTING, PAYROLL, OUTSIDE COUNSEL, OUTSIDE TAX ADVISORS, AND OUTSIDE COMPENSATION CONSULTANTS. THIS PROCESS ENSURES, TO THE GREATEST DEGREE POSSIBLE, THAT ANY TAX GROSS-UP DECISIONS ARE IN COMPLIANCE WITH ANY IRS REGULATIONS AND PREVAILING GOOD MANAGEMENT PRACTICES. Although this is the policy followed, there is no formal written policy/procedure regarding this at this time. Supplemental Compensation Information SCHEDULE J, PART I, LINE 4A Geoffrey 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 Information SCHEDULE J, PART I, LINE 4B: NORWALK HOSPITAL Association HAS ESTABLISHED the Norwalk Hospital Senior Deferred Compensation Plan, Primarly for the purpose of providing a program of deferred compensation for Daniel Debarba, President and CEO, amounts promised under the plan are based on targeted retirement benefits. 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 W2. Supplemental Compensation Information Schedule J, Part III, 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. STATE OF CT HEALTH & EDU FACILITIES AUTHORITY 060806186 2010-12-09 46840000 SEE PART V false false false 0 0 46844170 0 494062 0 829268 0 463600 31106035 0 13951207 2012 false false false true false true false false false 0.00000 0.00510 0.00510 false false false false Na 0. false false false Na 0. false false false SCHEDULE K, PART I USE OF BOND PROCEEDS THE PROCEEDS OF THE BOND ARE BEING USED FOR Construction of a parking garage and for the purchase of other capital equipment. FORM 990, PART I, LINE 1 & PART III, LINE 1 ORGANIZATION'S MISSION The mission of Norwalk Hospital is to provide uniquely excellent, innovative and compassionate health care with exceptional outcomes. Vision: Norwalk Hospital will be the hospital of choice for patients, physicians, and health care professionals, recognized for delivering innovative clinical services with compassion. We are guided by these values Patient-centered: honoring each individuals dignity, privacy, and confidentiality, empowering patients and their families as partners in their care, facilitating simple, convenient ways for patients and their families to use our programs and services Excellence: setting the highest standards for safety, clinical outcomes and personal service, and continuously measuring, monitoring and raising those standards Innovation: continuously pioneering new and better ways to deliver care, including bringing state-of-the-art technology to real-world care delivery, research and prevention of illness Leadership: attracting and developing throughout the organization people who are recognized as exceptional leaders and who subscribe to these values Teamwork: Working together to achieve our mission and goals in a cooperative, respectful, open environment Trust and Fairness: We foster a climate of openness in which all who work here treat one another with trust and fairness, we support open communication to enhance this climate Education: providing nationally recognized medical education programs for future providers, participating in clinical research and offering a range of educational programs to our patients and the community to enhance their health and well-being Financial Responsibility: being accountable as financial stewards for constant improvement in the efficiency and effectiveness of service delivery, coordinating the services of Norwalk Hospital with those of other health, education, and social services in the community (e.g. long-term care facilities, community outreach, health promotion/illness prevention organizations, etc.) in order to optimize the availability of a full scope of services in a cost-effective manner Charity: as a not-for-profit organization, providing needed medical care to all, including those who cannot pay for it. FORM 990, Part III, Line 4 Other Program Service Descriptions Other Program Services Include: ED treated and Released; Cardiovascular services; Cancer services; Pulmonary & Respiratory services; Rehab services; All Other Surgical services; Pediatric services; Psychiatry services; All Other Medical services; and All Other lab services DESCRIPTION OF CLASSES OF MEMBERS OF STOCKHOLDERS Form 990, Part VI, SECTION A, LINES 6 & 7 NORWALK HEALTH SERVICES CORPORATION, INC. IS THE SOLE MEMBER OF NORWALK HOSPITAL ASSOCIATION (NHA) AND APPOINTS NHA'S BOARD OF DIRECTORS. Describe the Process used by Management &/or Governing Body to Review 990 Form 990, Part VI, line 11 NORWALK HOSPITAL ASSOCIATION'S (NHA) FORM 990 IS PREPARED WITH THE ASSISTANCE OF ERNST & YOUNG LLP AND REVIEWED BY NHA'S INTERNAL MANAGEMENT. FOLLOWING THAT REVIEW, NHA'S 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 Trustees PRIOR TO THE FORM BEING FILED WITH THE IRS. Description of Process to Monitor Transactions for Conflicts of Interest FORM 990, PART VI, LINE 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 THE Hospital IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, THE Hospital 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 Hospital 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. Written Document Retention & Destruction Policy Form 990, Part VI, line 14 NORWALK HOSPITAL ASSOCIATION (NHA) 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 15a & 15b AN OUTSIDE CONSULTING FIRM CONDUCTS AN EXECUTIVE COMPENSATION ANALYSIS UTILIZING THIRD-PARTY, BLINDED SURVEY DATA SOURCES. THE CONSULTANT THEN PRESENTS FINDINGS TO THE COMPENSATION COMMITTEE OF THE BOARD, WHO DECIDE WHAT ACTION TO TAKE, IF ANY, FOR EACH EXECUTIVE. THIS PROCEDURE ONLY APPLIES TO THE PRESIDENT, VICE PRESIDENTS, AND CERTAIN KEY EMPLOYEES. FOR THOSE KEY EMPLOYEES WHOSE SALARIES ARE NOT SUBJECT TO THE COMPENSATION COMMITTEE REVIEW, THEIR RESPECTIVE VICE PRESIDENTS ASSESS THEIR PERFORMANCE AND DETERMINE 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. THIS PROCESS IS UNDERTAKEN EACH YEAR. Joint Venture Policy Form 990, PART VI, Section B, Line 16B WHILE A WRITTEN POLICY HAS NOT BEEN ADOPTED REGARDING THE EVALUATION OF PARTICIPATION IN JOINT VENTURES, MANAGEMENT FOLLOWS A PROCEDURE IN WHICH ALL POSSIBLE JOINT VENTURE ARRANGEMENTS ARE EVALUATED UNDER APPLICABLE FEDERAL TAX LAWS. MANAGEMENT UTILIZES THE SERVICES OF APPROPRIATE CONSULTANTS AND LEGAL COUNSEL TO EVALUATE EACH JOINT VENTURE OPPORTUNITY. THIS EVALUATION ALSO INCLUDES AN ANALYSIS OF HOW THE JOINT VENTURE WILL FURTHER THE HOSPITAL'S MISSION. THE HOSPITAL HAS TAKEN ALL APPROPRIATE STEPS TO SAFEGUARD ITS TAX EXEMPT STATUS WITH RESPECT TO ALL JOINT VENTURE ARRANGEMENTS. JOINT VENTURE ARRANGEMENTS ARE APPROVED BY THE BOARD OF TRUSTEES. Governing documents, etc. available to the public FORM 990, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. Hours devoted to a RELATED ORGANIZATION FORM 990, PART VII THE INDIVIDUALS LISTED BELOW WORKED THE FOLLOWING HOURS PER WEEK FOR A RELATED ORGANIZATION DURING THE FISCAL YEAR: ERVIN SHAMES 4 DIANE ALLISON 3 GEORGE BAUER 2 ANDREW WHITTINGHAM 1 JOSEPH MANN 1 FRED AFGRAGOLA 3 BARBARA BUTLER 2 DANIEL DEBARBA 8 VICTOR LISS 3 DAVID KOMANSKY 1 DAVID LEHN 3 MICHAEL MARKS 51 GARY REINER 1 ROLAND STICHWEH 1 WILLIAM TAMME 3 RICHARD ZELKOWITZ 2 ROBERT READY 3 THOMAS AYOUB 1 MARIA BORGES-LOPEZ 1 PAUL GAGNE 1 MARK GUDIS 1 ED KANGAS 1 ED MAHONEY 2 Other Changes in Net Assets or Fund Balances Part XI, Line 5 Unrealized Loss (1,455,301) Trans FCMS (4,642,266) Trans NHF (765,289) Trans NHF 322,298 Trans NSC (2,100,000) Trans NHSC 1,914,719 Pension (25,149,518) Temp Restr. 7,585,808 Perm Restr. 10,534 PY NSC Contr. (700,000) PY NSC Loss 258,904 K-1 Joint Venture 2010 (400) _____________ Line 5 Total (24,720,511) Compensation Committee Schedule J, Part I, Line 3 The Compensation Committee is from Norwalk Health Services Corporation (NHSC) as per the NHSC Bylaws. Fairfield County Medical Services Inc 24 Stevens Street Norwalk CT 06850 061522078 PHYS PRACTICE CT 501(c)(3) 11B NHA NHC DBA Honey Hill Rehab & Nursing Ctr 34 Midrock Drive Norwalk CT 06851 222577722 NURSING REHAB CT 501(c)(3) 9 NHSC Norwalk Health Services Corp 24 Stevens Street Norwalk CT 06850 222577711 SUPPORT SVCS CT 501(c)(3) 11B NA Norwalk Hospital Foundation 34 Maple Street Norwalk CT 06856 222577708 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 Norwalk Surgery Center LLC 27-2394942 40 Cross Street NORWALK Norwalk CT 06850 SURGERY CENTER CT NONE RELATED -642803 3044485 false 0 false 0.70000 Maple Street Indemnity Company Ltd 40 Church St PO Box 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 true true false false false false false true false true true false false true true true true Fairfield County Medical Services Inc i 133194 Fairfield County Medical Services Inc l 4229918 Fairfield County Medical Services Inc p 9581910 Maple Street Indemnity Company LTD q 6000000 Norwalk Health Care k 1580698 Norwalk Health Care p 551936 Norwalk Health Care r 288302 Norwalk Health Services Corporation r 1914723 Norwalk Health Services Corporation q 180000 Norwalk Hospital Foundation b 1042576 Norwalk Hospital Foundation c 2045335 Norwalk Hospital Foundation k 65160 Norwalk Hospital Foundation p 1459740 Norwalk Hospital Foundation q 765289 Norwalk Hospital Foundation r 2050000 Norwalk Surgery Center b 2100000 SWC Corporation k 138000 SWC Corporation l 3412305 SWC Corporation p 232206 SWC Corporation q 5410900 SWC Corporation r 2230900