2011-08-12T14:42:08-05:00 2010-09-30 MARCUM LLP CITY PLACE II 185 ASYLUM STREET HARTFORD CT 06103 990 2009-10-01 060665979 THE WATERBURY HOSPITAL WATE 2035736000 64 ROBBINS STREET WATERBURY CT 06721 darlene stromstad 2035736000 2011-08-12 1 Douglas Farrington 8605498500 2009 2016-02-24 21:20:13Z darlene stromstad 64 ROBBINS STREET WATERBURY CT 06721 255256388 0 X www.waterburyhospital.org X 1951 CT WATERBURY HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE HIGH QUALITY HEALTH CARE SERVICES THROUGH A FAMILY OF PROFESSIONALS AND SERVICES. 17 13 2332 227 3684532 -20002 5193461 6580621 239928524 229011318 -1224178 2513080 7402219 3650743 251300026 241755762 0 0 136916631 127864288 0 401024 116427175 110474594 253343806 238338882 -2043780 3416880 160044637 163030487 62349356 67145451 97695281 95885036 WATERBURY HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE HIGH QUALITY HEALTH CARE SERVICES THROUGH A FAMILY OF PROFESSIONALS AND SERVICES. 0 0 182337445 226405116 Statement of PurposeAs a not-for-profit community hospital, Waterbury Hospital provides quality health care to all area individuals, regardless of race, creed, sex, national origin, age, handicap or ability to pay. However, reimbursement for services is critical to the hospital's stability and long-term operation.See Schedule O for continuation 182337445 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 258 0 1 2332 1 1 1 0 0 0 0 1 1 0 0 0 17 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X X scott bowman 2035737333 64 robbins street waterbury CT 06721 JOHN H TOBIN 40.00 X X 516552 0 285789 DAVID W GRIFFIN ESQ 0.60 X X 0 0 0 CARL CONTADINI 0.30 X X 0 0 0 JACK KELLY 0.30 X X 0 0 0 RONALD D'ANDREA MD 0.20 X 0 0 0 JAMES H GATLING PHD 0.40 X 0 0 0 JOHN A MICHAELS 0.50 X 0 0 0 WILLIAM J PIZZUTO PHD 0.90 X 0 0 0 ANDREW K Skipp 0.20 X 0 0 0 AJ WASSERSTEIN 0.40 X 0 0 0 DAVID J PIZZUTO MD 0.30 X 0 0 0 Frederick L Luedke 0.50 X 0 0 0 OJ Bizzozero Jr MD 0.50 X 0 0 0 Steven L Eisen MD 0.20 X 0 0 0 Patrick McKinley 0.40 X 0 0 0 William E Solberg 0.20 X 0 0 0 Michael A Wilson CPA MBA 0.20 X 0 0 0 COLLEEN SCOTT 40.00 X 295249 0 28282 MARY B PRYBYLO 40.00 X 302443 0 20903 STEVEN SCHNEIDER 40.00 X 352808 0 28341 MARY K MULSTON 40.00 X 192384 0 7425 MARYANNE VOLKRINGER 40.00 X 161253 0 14530 JOCK D LAWRASON 40.00 X 367303 0 20334 CHRISTOPHER J MICHOS 40.00 X 394336 0 19882 DAVID N PODELL 40.00 X 359765 0 27294 MARK W GARBER 40.00 X 354998 0 9005 Jonathan E Hasson 40.00 X 312966 0 19944 3610057 0 481729 149 0 1 0 Price Waterhouse Coopers LLC PO Box 7247-8001 Philadelphia PA 191708001 Consulting Services 11118664 ACCESS REHAB CENTERS LLC 22 TOMPKINS STREET WATERBURY CT 06708 REHAB THERAPY SERVICES 2121556 YALE UNIVERSITY SCHOOL OF MEDICINE 333 CEDAR STREET NEW HAVEN CT 06510 RESIDENCY PROGRAM SERVICE 1810590 QUEST DIAGNOSTICS 2025 COLLECTION CENTER DRIVE CHICAGO IL 60693 LABORATORY SERVICES 1755834 GREATER WATERBURY IMAGING CENTER 64 ROBBINS STREET WATERBURY CT 06708 IMAGING SERVICES 1249200 67 253168 1327462 4523991 476000 6580621 Net Patient Service Re 624100 225365828 225365828 lab service revenue 621500 3508101 3508101 image repairs & mainte 541900 137389 137389 229011318 2370087 2370087 440469 440469 440469 440469 13515996 13373003 142993 142993 142993 69676 253168 127623 -57947 -57947 Partnerships 900099 1631521 1631521 Cafeteria Revenue 722210 772487 772487 Parking 812930 213172 213172 651041 598819 39042 13180 3268221 241755762 226405116 3684532 5085493 2178038 2178038 97159091 88435494 8516054 207543 3804735 3455621 341004 8110 17112424 15616361 1459414 36649 7610000 6803349 790685 15966 1143369 24963 1118406 197916 197916 51000 51000 32892491 23982349 8889082 21060 714992 6651 705130 3211 11225267 9082126 2109517 33624 4253130 819183 3433947 158904 95178 61243 2483 212035 173501 38267 267 1677833 1677833 8736627 8736627 4714744 4714744 Medical/Surgical Suppli 27831119 27831119 Bad Debt 14985815 14985815 Food 1099102 1093468 4010 1624 Dues and Subscriptions 372140 82504 288338 1298 Miscellaneous 208110 120834 18087 69189 238338882 182337445 55600413 401024 15599719 17099522 1101738 1518034 30390471 27165931 658783 133333 584338 634324 1248474 1161757 244832586 206294646 43336543 38537940 11074126 11675881 46719608 55192802 9330837 9910963 160044637 163030487 22896886 25350669 19804928 19007716 19647542 22787066 62349356 67145451 X 49273360 45216062 7764952 8315873 40656969 42353101 97695281 95885036 160044637 163030487 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 1 1 1 1 76923 1 1 0 76923 0 Part IV, Supplemental Information: WATERBURY HOSPITAL CONDUCTED A CAMPAIGN THAT WAS AIMED AT INVOLVING THE COMMUNITY TO HELP INFLUENCE A STATE COMMISSION TO GRANT PERMANENT STATUS TO THE HEART CENTER OF GREATER WATERBURY. THE CAMPAIGN INCLUDED RALLIES, LETTER WRITING AND TRIPS TO HEARINGS IN HARTFORD, CT. 49308865 20 2729359 580620 51457624 50479712 10560 -512662 668745 49308865 0.05420 0.82300 0.12280 1 0 287549 287549 80685320 62193397 18491923 539905 416166 123739 159330630 141256490 18074140 3989182 2428593 1560589 38537940 Funds Held in Trust by Others 39561090 F Greater Waterbury Imaging Center 5431019 F Access Rehab Centers 3641392 F Imaging Partners 440033 F Alliance Medical Group 6119268 F 55192802 Chefa Obligations Discount and Issue Expense, Net of Amortization 575582 Due from Affiliates 6447817 Debt Service Reseve Fund and Debt Service Fund 2602775 Other Receivables 3240 prepaid pension & other investments 281549 9910963 Liabilities of Cosolidated Affiliates 5361355 Reserve For Worker's Comp/Malpractice Liab. Loss 5604931 Minority Interest in Net Assets of Consolidated Affiliates 2930053 Deferred Liab. on Gift Annuity 207562 Asset Retirement Obligation 2639365 Capital Lease Liability 64625 Due to Third-Party Reimbursement Agencies 230310 Accrued Pension Liability 5736056 deferred Liab. on plan investment fund 12809 22787066 241755762 238338882 3416880 553326 -5780451 -5227125 -1810245 270794454 553326 30116887 30670213 240124241 1631521 1631521 241755762 271550848 33211966 33211966 238338882 0 238338882 Part V, Line 4: Description of Intended Use of Endowment Funds: The endowment funds are used for free care and general hospital operations. Part XI, Line 8 - Other Adjustments: increase in fair value of funds held in trust by others: 1696113. Alliance Subsidy : -5756613. pension liability adjustment: -1719951. Part XII, Line 2d - Other Adjustments: income from consolidated affiliate: 29989264. Fundraising Expense: 127623. Part XII, Line 4b - Other Adjustments: investment income from partnership: 1631521. Part XIII, Line 2d - Other Adjustments: expense of consolidated affiliate: 33084343. Fundraising Expense: 127623. GALA 171630 135440 36190 36510 38538 GOLF TOURNAMENT 107750 88010 19740 22355 10088 1 43464 29718 13746 850 13859 5423 322844 253168 69676 850 72724 54049 127623 -57947 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 0 1044617 0 1044617 0.00440 43694 45610122 31886815 13723307 0.05760 43694 46654739 31886815 14767924 0.06200 76 28048 12314560 998869 11315691 0.04750 46 7384 17885298 2807580 15077718 0.06330 0 0 0 0 0 0 0 0 16 55911 1172250 272147 900103 0.00380 138 91343 31372108 4078596 27293512 0.11460 138 135037 78026847 35965411 42061436 0.17660 0 0 0 0 0 0 0 0 11 2447 42355 0 42355 0.00020 1 0 100264 0 100264 0.00040 10 1285 254477 0 254477 0.00110 7 82 96710 0 96710 0.00040 0 0 0 0 1 11 607 0 607 0.00000 0 0 0 0 30 3825 494413 494413 0.00210 1 4221504 79482033 75643264 3838769 X 1 1 THE WATERBURY HOSPITAL

64 ROBBINS STREET WATERBURY CT 06708

X X X X Part I, Line 3c: n/a Part III, Line 4: Bad Debt is reported on the based on actual charge writeoffs. Part III, Line 8: In order to see the shortfall for the Medicare program you must look at the number reported on line 7 as well as the shortfall from the health profession education line. The two combined shows a shortfall of $8,779,153. All of this shorfall should be reported as community benefit. The source for this is the 2010 Medicare Cost Report. The hospital cost accounting system shows a shortfall from all Medicare programs including Managed Medicare $15,482,247 (net of bad debt and free care). Part III, Line 9b: We have several credit and collection programs governing patients who qualify for charity care or financial assistance; prompt pay discount; sliding scale; payment arrangements; charity care and free bed funds. Any patient expressing difficulty paying a balance is entitled to apply for financial counseling assistance. Customer Service representatives work with the patients to determine program qualification based on the completion of a financial application. Cases are prepared and presented to the Patient Assistance Committee. Approved cases will be either fully or partially written off to free bed funds or charity care. Part VI, Line 3: We have signage, pt handbook, statement backers & handouts that inform patients of free bed funds etc. The Hospital accepts all patients regardless of their ability to pay. A patient is classified as a charity patient by reference to the established policies of the Hospital. Essentially, these policies define charity services as those services for which no payment is possible. In assessing a patient's inability to pay, the Hospital utilizes the generally recognized poverty income levels for the State, but also includes certain cases where incurred charges are significant when compared to incomes. These charges are not included in net patient service revenues for financial reporting purposes. Part VI, Line 4: Located in a city of 107,000 residents, Waterbury Hospital is centrally located in western Connecticut. It serves the City of Waterbury and its surrounding towns, including Beacon Falls, Bethlehem, Cheshire, Middlebury, Naugatuck, Prospect, Southbury, Thomaston, Watertown, Wolcott, and Woodbury. Overall, the City of Waterbury lags behind the State of Connecticut and the U.S. in key measurable statistics, as seen below:(a) Median Household Income: Waterbury = $39,832; CT = $67,721; U.S. = $51,425(b) Per Capita Money Income: Waterbury = $21,222; CT = $36,468; U.S. = $27,041(c) % of Persons Below Poverty: Waterbury = 20.3%; CT = 8.7%; U.S. = 13.5%(d) % of Owner occupied Homes: Waterbury = 49.7%; CT = 69.5%; U.S. = 66.9%(e) % of High School Graduates or higher: Waterbury = 79.4%; CT = 88.2%; U.S. = 84.6%(f) % with Bachelor's Degree or higher: Waterbury = 16.2%; CT = 35.1%; U.S. = 27.5%(g) % of Children Ages 5-17 in Families in Poverty: Waterbury = 30.6%; CT = 10.4% 16.9%(h) Unemployment Rate, March 2011 12.2% 9.1% 8.8%[Sources: Items (a) through (g): U.S. Census Bureau, 2005 2009 American Community Survey 5 Year Estimates; Item (h): U.S. Bureau of Labor Statistics]Waterbury was once a robust manufacturing center. However, over the past 25 years, the industrial base that was the center of Waterbury's economy for most of the 20th century dwindled, leaving many unemployed. Although there are jobs available in healthcare and service sectors, high unemployment remains a threat for many individuals in the Greater Waterbury area. Part VI, Line 5: As the largest private employer in the City of Waterbury, Waterbury Hospital understands its role as a leader in the community. Many of our programs are specifically targeted at strengthening the welfare and awareness of the citizens within our community. From educating Waterbury's youth about healthcare careers to offering support groups to families who have lost a loved one, Waterbury Hospital remains committed to making the Greater Waterbury area a stronger, more prosperous community.Key Programs: Youth Pipeline Program: "This program was remarkable. What I liked about it the most - and just to let you know I can't believe I'm saying this - was learning..." - From a Youth Pipeline StudentSince its inception in 2001 as a partnership between Waterbury Hospital and Waterbury Public Schools, the mission of our Youth Pipeline Program has remained the same: to close the achievement gap for minority and economically disadvantaged students in Waterbury so they can matriculate and compete nationally for placement in post secondary education programs in preparation for health careers. As the aforementioned quote captures, Waterbury Hospital has remained dedicated to enhancing and enriching the lives of Waterbury's youth. We take pride in helping students realize their potential as they embark on their academic and personal journeys. To this end, during 2010, Waterbury Hospital continued to provide over 700 students and parents in Greater Waterbury with unique educational programs that will enhance the overall welfare of our community.The Youth Pipeline Program is a multifaceted series with five focus areas during 2010, including: - Providing Early Acquaintance with Careers in Health (PEACH) - Since its inception in 2004, Waterbury Hospital's Providing Early Acquaintance with Careers in Health (PEACH) Program has worked with administrators, teachers, and students at Waterbury's North End Middle School to address projected shortages of healthcare workers and to close the achievement gap for students in Waterbury Public Schools. Through the PEACH Program, students are encouraged to set goals and to enroll in the appropriate math and science courses so they will be on track to matriculate and compete nationally for postsecondary healthcare education at the college level. Annually, Waterbury Hospital offers its PEACH Spring Break Camp, where up to 20 middle school students from Waterbury take part in various shadowing and hands on learning activities at the hospital. During 2010, one hundred students from Education Connection also took part in this unique learning experience. - 9th Grade Mentoring - For the past five years, dozens of Waterbury Hospital employees have served as mentors at Waterbury's Wilby High School. Waterbury Hospital's mentors volunteer for one hour per week for 25 to 30 weeks per school year to help students set goals that will help define their academic and personal goals throughout high school and beyond. In 2010, twenty two Waterbury Hospital staff members worked with over 300 students for a total of 614 hours. - Parent Leadership Training Institute (PLTI) - This past year, sixteen parents in the Greater Waterbury successfully completed Waterbury's PLTI. Waterbury Hospital has hosted our local PLTI since 2000, and the program has trained and graduated over 150 area parents. PLTI's core mission is to impart leadership and advocacy skills to parents while simultaneously educating them about volunteerism, civic life, and the process by which state and local governments enact and change laws. - Wilby High School Afterschool Medical Response Technician (MRT) and Summer Emergency Medical Technician (EMT) Training - In order to address the shortage of emergency medical responders in our area, Waterbury Hospital offered two concurrent programs for students at Wilby High School: an MRT program and an EMT program. Both programs we offered free of charge thanks to grant funding from the Elisha Leavenworth Foundation, the Connecticut Community Foundation, and the Naugatuck Savings Bank Foundation. Students who successfully completed the programs were eligible for either MRT or EMT certification in the State of Connecticut. - Summer Bridge Program - During the summer of 2010, twelve local students participated in our Summer Bridge Program, which provided the students with academic preparation, such as SAT math and SAT English review, job readiness activities, and shadowing. In order to increase the program's diversity, a handful of program slots were allocated for students of Waterbury Hospital employees.Gathering of Remembrance - This past year marked Waterbury Hospital's first annual Gathering of Remembrance. The day is dedicated to remembering those who died in the ICU throughout the year. ICU doctors and nurses coordinate the program to provide support to the family and friends of the deceased. Support Groups - During 2010, Waterbury Hospital hosted several support groups for its patients and their families, including: - SHARE, a support group run by the Family Birthing Center for parents who have lost a baby; - Behavioral Health's parent and sibling support group, which offers emotional assistance to families who have children in treatment; and - Alcoholics Anonymous, which meets weekly throughout the year and is coordinated by our Behavioral Health Department. Part VI, Line 6: Realizing the diverse needs of those in our community, Waterbury Hospital remains dedicated to providing comprehensive health services to ensure every individual has access to appropriate, quality healthcare. During 2010, Waterbury Hospital's spectrum of services continued to have a positive impact on the welfare of Waterbury's citizens. To remain consistent with Waterbury Hospital's mission, many of our services are targeted for vulnerable members of our community, including those who are uninsured or underinsured.Key Programs: Waterbury Health Access Program"I once again am in need, and I'm relying on the Waterbury Health Access Program and their services for assistance with my medication... I find myself suffering economic hardships, and it is comforting to know that this program is there to help. WHAP has given me important information that will and has benefited my health and overall wellbeing." - From a WHAP PatientWaterbury Hospital is aware of the economic needs many patients in our community, and, as a result, we remain committed to the Waterbury Health Access Program. Founded in 2003 as a partnership between Waterbury Hospital, St. Mary's Hospital, StayWell Health Center (FQHC), and the Waterbury Health Department, the Waterbury Health Access Program improves access to high-quality medical care by providing comprehensive case management, pharmacy assistance, and access to primary and sub-specialty medical care for the uninsured and underinsured residents of the Greater Waterbury region. During 2010, the Waterbury Health Access Program saw over 1,600 new clients. Additionally, during Waterbury Hospital's FY 2010, Waterbury Hospital provided $301,277 worth of donated services to WHAP patients.Behavioral Health - Waterbury Hospital's Center for Behavioral Health is one of the region's largest, providing comprehensive inpatient and outpatient services and a variety of support groups. Our Behavioral Health Department boasts a Crisis Center, which provided services to over 2,300 individuals during 2010. Be Well Bus - In order to ensure that patients have access to medical appointments, at the hospital and at local physicians' offices, Waterbury Hospital's Be Well Bus provides transportation services to patients from Waterbury and eleven of its surrounding towns. During 2010, the Be Well Bus completed over 4,000 transports to and from medical appointments.Heart Center of Greater Waterbury - Formed in collaboration with Saint Mary's Hospital, the Heart Center of Greater Waterbury provides diverse medical support initiatives to help educate residents in the Greater Waterbury community about pertinent health and wellness issues. This past year, the Heart Center conducted a series of health fairs and various health and wellness education sessions, including "Ask the Nurse," which provides patients with complimentary blood pressure screenings and health awareness education. Additionally, with support from the American Heart Association, the Heart Center also hosted a "Freedom from Smoking" series to help our residents kick the habit.Family Birthing Center - Providing a child-centered focus, Waterbury Hospital's Family Birthing Center offers expectant parents a variety of classes to prepare them for their baby's arrival. Between breast feeding, childbirth, and infant care classes, our Family Birthing Center provided vital instruction to over 300 parents last year. Thank God I'm Female - For the past 19 years, Waterbury Hospital's "Thank God I'm Female" has served as an annual women's wellness forum that features 40 educational booths and health-related giveaways. The ultimate goal of the forum is to educate its nearly 500 participants about stress, mental well being, heart health, diet, osteoporosis and bone health, change of life, and more. Evergreen 50 Club - Waterbury Hospital's Evergreen 50 Club is an organization comprised of over 15,000 members over the age of 50. The Club offers wellness programming, Medicare counseling, and health education presentations on a variety of topics are presented by health care professionals. Presentation topics include: holistic health, varicose vein treatment, heart disease, summer skin care, weight loss, blood pressure, bladder screenings, joint care and replacement, and resolving adverse outcomes with patients and families. Annually, the Evergreen 50 Club hosts a health fair for its members, which provides free flu shots and healthcare screenings. Yale Primary Care Research Day - Through collaboration with St. Mary's Hospital in Waterbury, CT, Waterbury Hospital hosted its annual Yale Primary Care Research Day. During the day, physicians and medical students present research projects to the community.Waterbury Hospital ID Clinic - Maintained with federal funding from Ryan White Part C for Early Intervention Services from the U.S. Department of Health and Human Services HIV AIDS Bureau, Ryan White Part A from the City of New Haven, the Connecticut Department of Public Health, Yale University, MAC AIDS Fund, and Waterbury Hospital, the Waterbury Hospital Infectious Disease Clinic (WHIC) is the largest HIV/AIDS outpatient clinic in the area. WHIC provides (1) on site primary and specialty services, (2) medical case management, (3) individualized medication adherence services, (4) mental health and substance abuse services, (5) nutrition counseling, (6) individualized HIV education, (7) laboratory testing, and (8) radiology services. In 2010, Waterbury Hospital donated $218,734 worth of lab testing to ensure that uninsured PLWHA's received the care they needed at the Clinic. Furthermore, last year, WHIC coordinated World AIDS Day at Waterbury Hospital, which served as a day of recognition for people living with HIV/AIDS in the Waterbury area.Project Photography at Waterbury Hospital - Established in 2007 to encourage non compliant HIV/AIDS patients in the Greater Waterbury Area to become more proactive in the self management of their disease, Project Photography has positively transformed its participant's self-esteem and confidence. Patient projects include: (1) enrolling in photography classes at Naugatuck Valley Community College, (2) taking field trips to Boston, (3) donating framed photographs to the hospital's annual fundraising gala, (4) producing holiday greeting cards for the hospital, (5) creating team portraits at the hospital's fundraising golf tournament, and (6) constructing photography exhibits at the hospital, Barnes & Noble Bookstore, and Silas Bronson Library in Waterbury. Emergency Department HIV Testing - Since 2008, patients visiting Waterbury Hospital's Emergency Department are offered free HIV testing while waiting to be evaluated or treated for other symptoms. The program has successfully served as a model for other health care institutions across the state. Tested patients obtain their test results within 20 minutes; HIV positive test results are sent to an outside lab for verification and are typically available within one week. Pre- and post-test counseling is also provided for patients who are tested. Waterbury Hospital launched the HIV testing initiative as a way of identifying the undiagnosed portion of Connecticut's population, getting those newly diagnosed individuals into care, and preventing the transmission of the virus to others. Part VI, Line 7: n/a CT X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 JOHN H TOBIN 516552 0 0 0 0 0 250000 0 35789 0 802341 0 0 0 COLLEEN SCOTT 295249 0 0 0 0 0 0 0 28282 0 323531 0 0 0 MARY B PRYBYLO 302443 0 0 0 0 0 0 0 20903 0 323346 0 0 0 STEVEN SCHNEIDER 352808 0 0 0 0 0 0 0 28341 0 381149 0 0 0 MARY K MULSTON 192384 0 0 0 0 0 0 0 7425 0 199809 0 0 0 MARYANNE VOLKRINGER 161253 0 0 0 0 0 0 0 14530 0 175783 0 0 0 JOCK D LAWRASON 367303 0 0 0 0 0 0 0 20334 0 387637 0 0 0 CHRISTOPHER J MICHOS 394336 0 0 0 0 0 0 0 19882 0 414218 0 0 0 DAVID N PODELL 359765 0 0 0 0 0 0 0 27294 0 387059 0 0 0 MARK W GARBER 354998 0 0 0 0 0 0 0 9005 0 364003 0 0 0 Jonathan E Hasson 312966 0 0 0 0 0 0 0 19944 0 332910 0 0 0 Part I, Line 4b: JOHN TOBIN SERP CONTRIBUTION: $250,000 david pizzuto trustee 75000 Waterbury Hospital paid Mr. Pizzuto a total of $75,000 for a Chief of Staff stipend. 0 Steven Eisen Trustee 95004 Waterbury Hospital paid Dr. Eisen a total of $95,004 for EEG readings. 0 Form 990, Part VI, Section A, line 6 GREATER WATERBURY HEALTH NETWORK, INC. IS SOLE MEMBER. Form 990, Part VI, Section A, line 7a GREATER WATERBURY HEALTH NETWORK, INC. ELECTS HOSPITAL BOARD. Form 990, Part VI, Section A, line 7b GREATER WATERBURY HEALTH NETWORK, INC. HAS RESERVED POWERS FOR HOSPITAL TRANSACTIONS. Form 990, Part VI, Section B, line 11 REVIEWED AND APPROVED BY ORGANIZATION'S AUDIT COMMITTEE. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE AUDIT COMMITTEE BEFORE IT IS FILED. Form 990, Part VI, Section B, line 12c THE HOSPITAL COMPLIANCE OFFICER REVIEWS ANNUALLY THE SUBMISSION OF POTENTIAL/ACTUAL CONFLICT DECLARATIONS. THEY ARE ALSO REVIEWED ANNUALLY AT THE BOARD'S COMPLIANCE AND ETHICS COMMITTEE MEETING AND RECOMMENDATIONS FOR ACTION ARE MADE TO THE FULL BOARD AS NECESSARY. ADDITIONALLY, RESPONSES ARE PROFILED, BY MEMBER, FOR EACH COMMITTEE OF THE BOARD/NETWORK, AND DISTRIBUTED AT EACH COMMITTEE MEETING AS A WAY TO PROMOTE TRANSPARENCY. THE COMMITTEE CHAIR AND MEMBERS SHARE RESPONSIBILITY IN IDENTIFYING AND MANAGING THESE DECLARED CONFLICTS OF INTEREST WHEN MAKING BUSINESS DECISIONS ON BEHALF OF THE HOSPITAL. Form 990, Part VI, Section B, line 15 EXECUTIVE COMPENSATION IS UNDER THE PURVIEW OF THE BOARD OF TRUSTEES. THERE IS A COMPENSATION COMMITTEE AND THEY ALWAYS USE THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTANT WHO USES NATIONAL, STATE AND REGIONAL COMPENSATION SURVEY DATA FOR SIMILAR TAX EXEMPT COMMUNITY HOSPITALS. Form 990, Part VI, Section C, line 19 FINANCIAL RESULTS ARE MADE AVAILABLE IN THE ANNUAL REPORT TO THE COMMUNITY. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. Form 990, Part VII, Section A: Average hours per week devoted to related organizations: John H. Tobin - 5.00 hrs David W. Griffin, Esq. - 0.60 hrs Carl Contadini - 0.30 hrs Jack Kelly - 0.30 hrs Ronald D'Andrea, MD - 0.20 hrs James H. Gatling, Ph.D - 0.40 hrs John A. Michaels - 0.50 hrs William J. Pizzuto, Ph.D - 0.90 hrs Andrew K. Skipp - 0.20 hrs AJ Wasserstein - 0.40 hrs David J. Pizzuto, MD - 0.30 hrs Frederick L. Luedke - 0.50 hrs O.J. Bizzozero, Jr., MD - 0.50 hrs Steven L. Eisen, MD - 0.20 hrs Patricia McKinley - 0.40 hrs William E. Solberg - 0.20 hrs Michael A. Wilson, CPA, MBA - 0.20 hrs Colleen Scott - 5.00 hrs Mary B. Prybylo - 5.00 hrs Mary K. Mulston - 5.00 hrs Steven E. Schneider - 5.00 hrs Maryanne Volkringer - 5.00 hrs Form 990, Part XI, Line 2c: The audit committee and the board of directors has the responsibility for oversight of the audit. The audit committee makes recommendations to the board of directors in regard to the selection of an independent auditor. Form 990, Part III, Line 4a, Program Service Accomplishments (Continued): Total Community Benefits for FY 2010 by Category: Category / Benefit Community Health Improvement Services and Community Benefit Operations = $11,315,691 - Community Health Education - Community-Based Clinical Services - Health Care Support Services - Other Health Professions Education = $15,077,718 - Physicians/Medical Students - Nurses/Nursing Students - Other Health Professions Education - Scholarships/Funding for Professional Education Financial and In-Kind Contributions = $900,103 - Cash Donations - In-Kind Donations Community Building Activities = $494,413 - Community Support - Environmental Improvements - Leadership Development/Training Community Members/ Youth Pipeline - Coalition Building - Workforce Development Subtotal for Community Benefits = $27,787,925 Traditional Charity Care Costs - Free Care = $1,044,617 - Bad Debt = $5,080,191 - Unpaid Medicaid Costs = $13,723,307 - Unpaid Medicare Costs = $(11,409,417) Subtotal for Charity Care Costs Benefit = $8,438,698 TOTAL BENEFIT - FY 2010 = $36,226,623 Category A:Community Health Improvement Services and Community Benefit Operations TOTAL BENEFIT: $11,315,691 TOTAL PERSONS SERVED: 28,048 Realizing the diverse needs of those in our community, Waterbury Hospital remains dedicated to providing comprehensive health services to ensure every individual has access to appropriate, quality healthcare. During 2010, Waterbury Hospital's spectrum of services continued to have a positive impact on the welfare of Waterbury's citizens. To remain consistent with Waterbury Hospital's mission, many of our services are targeted for vulnerable members of our community, including those who are uninsured or underinsured. Key Programs: Waterbury Health Access Program "I once again am in need, and I'm relying on the Waterbury Health Access Program and their services for assistance with my medication...I find myself suffering economic hardships, and it is comforting to know that this program is there to help. WHAP has given me important information that will and has benefited my health and overall wellbeing." - From a WHAP Patient Waterbury Hospital is aware of the economic needs many patients in our community, and, as a result, we remain committed to the Waterbury Health Access Program. Founded in 2003 as a partnership between Waterbury Hospital, St. Mary's Hospital, StayWell Health Center (FQHC), and the Waterbury Health Department, the Waterbury Health Access Program improves access to high-quality medical care by providing comprehensive case management, pharmacy assistance, and access to primary and sub-specialty medical care for the uninsured and underinsured residents of the Greater Waterbury region. During 2010, the Waterbury Health Access Program saw over 1,600 new clients. Additionally, during Waterbury Hospital's FY 2010, Waterbury Hospital provided $301,277 worth of donated services to WHAP patients. Behavioral Health - Waterbury Hospital's Center for Behavioral Health is one of the region's largest, providing comprehensive inpatient and outpatient services and a variety of support groups. Our Behavioral Health Department boasts a Crisis Center, which provided services to over 2,300 individuals during 2010. Be Well Bus - In order to ensure that patients have access to medical appointments, at the hospital and at local physicians' offices, Waterbury Hospital's Be Well Bus provides transportation services to patients from Waterbury and eleven of its surrounding towns. During 2010, the Be Well Bus completed over 4,000 transports to and from medical appointments. Heart Center of Greater Waterbury - Formed in collaboration with Saint Mary's Hospital, the Heart Center of Greater Waterbury provides diverse medical support initiatives to help educate residents in the Greater Waterbury community about pertinent health and wellness issues. This past year, the Heart Center conducted a series of health fairs and various health and wellness education sessions, including "Ask the Nurse," which provides patients with complimentary blood pressure screenings and health awareness education. Additionally, with support from the American Heart Association, the Heart Center also hosted a "Freedom from Smoking" series to help our residents kick the habit. Family Birthing Center - Providing a child-centered focus, Waterbury Hospital's Family Birthing Center offers expectant parents a variety of classes to prepare them for their baby's arrival. Between breast feeding, childbirth, and infant care classes, our Family Birthing Center provided vital instruction to over 300 parents last year. Thank God I'm Female - For the past 19 years, Waterbury Hospital's "Thank God I'm Female" has served as an annual women's wellness forum that features 40 educational booths and health-related giveaways. The ultimate goal of the forum is to educate its nearly 500 participants about stress, mental well-being, heart health, diet, osteoporosis and bone health, change of life, and more. Evergreen 50 Club - Waterbury Hospital's Evergreen 50 Club is an organization comprised of over 15,000 members over the age of 50. The Club offers wellness programming, Medicare counseling, and health education presentations on a variety of topics are presented by health care professionals. Presentation topics include: holistic health, varicose vein treatment, heart disease, summer skin care, weight loss, blood pressure, bladder screenings, joint care and replacement, and resolving adverse outcomes with patients and families. Annually, the Evergreen 50 Club hosts a health fair for its members, which provides free flu shots and healthcare screenings. Yale Primary Care Research Day - Through collaboration with St. Mary's Hospital in Waterbury, CT, Waterbury Hospital hosted its annual Yale Primary Care Research Day. During the day, physicians and medical students present research projects to the community. Waterbury Hospital ID Clinic - Maintained with federal funding from Ryan White Part C for Early Intervention Services from the U.S. Department of Health and Human Services HIV AIDS Bureau, Ryan White Part A from the City of New Haven, the Connecticut Department of Public Health, Yale University, MAC AIDS Fund, and Waterbury Hospital, the Waterbury Hospital Infectious Disease Clinic (WHIC) is the largest HIV/AIDS outpatient clinic in the area. WHIC provides (1) on-site primary and specialty services, (2) medical case management, (3) individualized medication adherence services, (4) mental health and substance abuse services, (5) nutrition counseling, (6) individualized HIV education, (7) laboratory testing, and (8) radiology services. In 2010, Waterbury Hospital donated $218,734 worth of lab testing to ensure that uninsured PLWHA's received the care they needed at the Clinic. Furthermore, last year, WHIC coordinated World AIDS Day at Waterbury Hospital, which served as a day of recognition for people living with HIV/AIDS in the Waterbury area. Project Photography at Waterbury Hospital - Established in 2007 to encourage non-compliant HIV/AIDS patients in the Greater Waterbury Area to become more proactive in the self-management of their disease, Project Photography has positively transformed its participant's self-esteem and confidence. Patient projects include: (1) enrolling in photography classes at Naugatuck Valley Community College, (2) taking field trips to Boston, (3) donating framed photographs to the hospital's annual fundraising gala, (4) producing holiday greeting cards for the hospital, (5) creating team portraits at the hospital's fundraising golf tournament, and (6) constructing photography exhibits at the hospital, Barnes & Noble Bookstore, and Silas Bronson Library in Waterbury. Emergency Department HIV Testing - Since 2008, patients visiting Waterbury Hospital's Emergency Department are offered free HIV testing while waiting to be evaluated or treated for other symptoms. The program has successfully served as a model for other health care institutions across the state. Tested patients obtain their test results within 20 minutes; HIV-positive test results are sent to an outside lab for verification and are typically available within one week. Pre- and post-test counseling is also provided for patients who are tested. Waterbury Hospital launched the HIV testing initiative as a way of identifying the undiagnosed portion of Connecticut's population, getting those newly diagnosed individuals into care, and preventing the transmission of the virus to others. Category B: Health Professions Education TOTAL BENEFIT: $15,077,718.00 TOTAL PERSONS SERVED: 7,384 Since it first affiliated with the Yale University School of Medicine in 1973, Waterbury Hospital has served as the clinical training site for thousands of medical professionals in training. During 2010, students completed clinical rotations, internships, and shadowing experiences at Waterbury Hospital. Key Programs: Nursing and Certified Nurse's Aid Students - During 2010, nursing and Certified Nurse's Aid (CNA) students from Naugatuck Valley Community College, Western Connecticut State University, UCONN, Quinnipiac University, Bridgeport Hospital School of Nursing, Kaynor High School, Wilby High School, Porter & Chester Institute, Watertown High School, and Yale University completed clinical rotations at Waterbury Hospital. During their time at the hospital, these students worked in over eighteen departments, ranging from the Emergency Department to the Child Care Center. Student Nurse Intern Program (SNI) - The SNI program is available for nursing students entering their senior year. The program provides these student nurses with shadowing opportunities so they can apply their content knowledge to authentic patient care situations. Staff RNs serve as the students' mentors as the students accompany them on their medical rounds. The goals of the program are: (1) to provide the student nurses with the knowledge and skills necessary to pass the NCLEX exam and (2) to socialize the student nurse in an attempt to decrease the stress of assimilating into the hospital's work environment, should they be hired as Graduate Nurses at Waterbury Hospital. Physician's Assistant (PA) Students - Over 20 P.A. students from Quinnipiac University and UCONN completed clinical rounds in several departments around the hospital, including the Operating Room, Emergency Department, Behavioral Health, and Radiology. The experience is designed for the student to learn to apply the knowledge gained from didactic course work in medicine, surgery, and the basic and behavioral sciences into the clinical arena resulting in the ability to successfully manage patients in a thorough and comprehensive manner. The primary goal of clinical rotations is to expose the student to patients of all ages, patients in a variety of different settings, and patients with a broad range of medical, surgical, and psychosocial problems. The P.A. students participate in: - history taking - examining the patient - assisting in and/or performing diagnostic testing - assisting in and/or performing therapeutic tasks - oral presentations - medical documentation of the patient encounter - formulating a differential diagnosis and problem list - formulating a treatment plan - counseling of patients regarding medication, diet, and lifestyle changes such as smoking cessation, exercise, and well-being PharmD Students from UCONN - Waterbury Hospital Pharmacy Department provides rotations in Critical Care, Infectious Disease, and Institutional Pharmacy for PharmD students completing their final year. The Critical Care and Infectious Disease rotations require the students to perform Case Presentations, Journal Club Presentations, SOAP presentations and participate in rounds with the medical team. A pharmacist oversees the students as they actively participate in rounds and also provides instruction for format and content of their presentations. The Institutional Pharmacy Experience consists of, but is not limited to, learning how to calculate, mix and determine stabilities and sterilities of IV medications. Pharmacists and Pharmacy Technicians facilitate the education and training for the Institutional Rotation. Throughout all three rotations the students learn to provide drug information. The students are an asset to the pharmacist as drug information questions arise. This is the perfect opportunity for the student to utilize what they have learned while providing support for the clinicians at Waterbury Hospital. Waterbury Hospital Pharmacy is enriched while providing these rotations to Doctor of Pharmacy candidates. Training new pharmacists allows for constant review of our policies and procedures to remain current with new technology and drug information. During 2010, fourteen pharmacy students completed rotations at Waterbury Hospital. Radiology Students from NVCC - The Naugatuck Valley Community College (NVCC) Radiology students are involved with many activities while assigned to Waterbury Hospital. Under the supervision of a NVCC clinical instructor and hospital radiologic technologists, the students are assigned to the various radiographic suites and modalities. During their assignment, students are performing or assisting with radiographic procedures, including chest x-rays, skeletal exams, fluoroscopic procedures, mobile x-rays in the various patient units, and surgical cases. The students also increase the number of individuals available in the department to assist in moving and transporting patients as well as chaperoning sensitive exams. In addition to the diagnostic radiology the students are assigned to experiences in Interventional Radiology, CT, MRI, Nuclear Medicine, and Ultrasound. Students work in these modalities under the direct supervision of the hospital staff. Waterbury Hospital's affiliation with NVCC as a clinical site for students has many benefits. Perhaps the single most important benefit is the hospital has a continuous stream of potential radiology employees. Students are in the program for 22 months and in that time become very familiar with the hospital equipment, routines, personal, and mission. This provides Waterbury Hospital with new employees who have a strong skill set and proven dedication to the hospital community. Other Clinical Students - Waterbury Hospital also hosted the following students from diverse clinical backgrounds: - Drug & Alcohol students from Gateway Community College and Naugatuck Valley Community College - Marriage & Family Therapy students from UCONN, St. Joseph's College, and Southern Connecticut State University - Occupational Therapy students from Quinnipiac University - Art Therapy students from Albertus Magnus College - Dietetic students from St. Joseph's College, UCONN, Lincoln Tech, and Bowling Green State University - Med Tech students from UCONN Category E: Financial & In-Kind Contributions TOTAL BENEFIT: $900,103.00 TOTAL PERSONS SERVED: 55,911 Waterbury Hospital continues to provide financial and in-kind contributions to members of our community. From United Way donations from hospital employees to parking vouchers for patients, Waterbury Hospital provided $900,103.00 worth of financial and in-kind support during 2010. Local agencies receiving donations included: - Chabad Lubavitch - Easter Seals - Palace Theater - Project Homeless Connect - United Way of Greater Waterbury - VNA Health at Home - Waterbury Symphony Orchestra - Waterbury Regional Chamber Category F: Community Building Activities TOTAL BENEFIT: $494,413.00 TOTAL PERSONS SERVED: 3,979 As the largest private employer in the City of Waterbury, Waterbury Hospital understands its role as a leader in the community. Many of our programs are specifically targeted at strengthening the welfare and awareness of the citizens within our community. From educating Waterbury's youth about healthcare careers to offering support groups to families who have lost a loved one, Waterbury Hospital remains committed to making the Greater Waterbury area a stronger, more prosperous community. Key Programs: Youth Pipeline Program: "This program was remarkable. What I liked about it the most - and just to let you know I can't believe I'm saying this - was learning..." - From a Youth Pipeline Student Since its inception in 2001 as a partnership between Waterbury Hospital and Waterbury Public Schools, the mission of our Youth Pipeline Program has remained the same: to close the achievement gap for minority and economically disadvantaged students in Waterbury so they can matriculate and compete nationally for placement in post-secondary education programs in preparation for health careers. As the aforementioned quote captures, Waterbury Hospital has remained dedicated to enhancing and enriching the lives of Waterbury's youth. We take pride in helping students realize their potential as they embark on their academic and personal journeys. To this end, during 2010, Waterbury Hospital continued to provide over 700 students and parents in Greater Waterbury with unique educational programs that will enhance the overall welfare of our community. The Youth Pipeline Program is a multifaceted series with five focus areas during 2010, including: - Providing Early Acquaintance with Careers in Health (PEACH) - Since its inception in 2004, Waterbury Hospital's Providing Early Acquaintance with Careers in Health (PEACH) Program has worked with administrators, teachers, and students at Waterbury's North End Middle School to address projected shortages of healthcare workers and to close the achievement gap for students in Waterbury Public Schools. Through the PEACH Program, students are encouraged to set goals and to enroll in the appropriate math and science courses so they will be on track to matriculate and compete nationally for postsecondary healthcare education at the college level. Annually, Waterbury Hospital offers its PEACH Spring Break Camp, where up to 20 middle school students from Waterbury take part in various shadowing and hands-on learning activities at the hospital. During 2010, one-hundred students from Education Connection also took part in this unique learning experience. - 9th Grade Mentoring - For the past five years, dozens of Waterbury Hospital employees have served as mentors at Waterbury's Wilby High School. Waterbury Hospital's mentors volunteer for one hour per week for 25 to 30 weeks per school year to help students set goals that will help define their academic and personal goals throughout high school and beyond. In 2010, twenty-two Waterbury Hospital staff members worked with over 300 students for a total of 614 hours. - Parent Leadership Training Institute (PLTI) - This past year, sixteen parents in the Greater Waterbury successfully completed Waterbury's PLTI. Waterbury Hospital has hosted our local PLTI since 2000, and the program has trained and graduated over 150 area parents. PLTI's core mission is to impart leadership and advocacy skills to parents while simultaneously educating them about volunteerism, civic life, and the process by which state and local governments enact and change laws. - Wilby High School Afterschool Medical Response Technician (MRT) and Summer Emergency Medical Technician (EMT) Training - In order to address the shortage of emergency medical responders in our area, Waterbury Hospital offered two concurrent programs for students at Wilby High School: an MRT program and an EMT program. Both programs we offered free of charge thanks to grant funding from the Elisha Leavenworth Foundation, the Connecticut Community Foundation, and the Naugatuck Savings Bank Foundation. Students who successfully completed the programs were eligible for either MRT or EMT certification in the State of Connecticut. - Summer Bridge Program - During the summer of 2010, twelve local students participated in our Summer Bridge Program, which provided the students with academic preparation, such as SAT math and SAT English review, job readiness activities, and shadowing. In order to increase the program's diversity, a handful of program slots were allocated for students of Waterbury Hospital employees. Gathering of Remembrance - This past year marked Waterbury Hospital's first annual Gathering of Remembrance. The day is dedicated to remembering those who died in the ICU throughout the year. ICU doctors and nurses coordinate the program to provide support to the family and friends of the deceased. Support Groups - During 2010, Waterbury Hospital hosted several support groups for its patients and their families, including: - SHARE, a support group run by the Family Birthing Center for parents who have lost a baby; - Behavioral Health's parent and sibling support group, which offers emotional assistance to families who have children in treatment; and - Alcoholics Anonymous, which meets weekly throughout the year and is coordinated by our Behavioral Health Department. 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