Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
Natchaug Hospital Inc
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
189 Storrs Road
 
Room/suite
City or town, state or country, and ZIP + 4
Mansfield Center, CT06226
D Employer identification number

06-0966963
E Telephone number

G Gross receipts $ 45,133,242
F Name and address of principal officer:
Stephen W Larcen PHD
189 Storrs Road
Mansfield Center,CT06226
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.NATCHAUG.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1954
M State of legal domicile: CT
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: To provide inpatient and outpatient psychiatric healthcare services.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 12
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 646
6 Total number of volunteers (estimate if necessary) .... 6 52
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 152,730 195,250
9 Program service revenue (Part VIII, line 2g) ......... 43,075,045 44,920,212
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 17,348 17,780
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 43,245,123 45,133,242
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 33,901,449 36,405,653
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet39,626    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 8,786,033 9,166,667
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 42,687,482 45,572,320
19 Revenue less expenses. Subtract line 18 from line 12...... 557,641 -439,078
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 17,697,436 17,348,692
21 Total liabilities (Part X, line 26)............ 8,848,155 9,307,210
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 8,849,281 8,041,482
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: To provide a continuum of accessible, community-based services for those living with psychiatric illness and chemical dependency or emotional and related educational disabilities, with a commitment to the dignity and privacy of those needing service, empowering them to participate in their own care, education and recovery.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 16,115,032 including grants of $   ) (Revenue $ 16,398,525 )
Inpatient TreatmentNatchaug Hospital provides a full range of inpatient psychiatric and substance-abuse treatment for children, adolescents and adults at our 57-bed Mansfield Center facility. The highly qualified, experienced and dedicated professional staff of Natchaug Hospital provides expert care in a supportive, therapeutic setting - helping people regain their stability and return as soon as possible to their own homes. The hospital serves Medicare and Medicaid subscribers and provides care without regard to ability to pay.Intermediate Care (ICC)An acute level of care for a longer length of stay for persons living with prolonged and severe mental illness. Historically, people from Eastern Connecticut who were in need of an extended length of stay were referred to Cedarcrest Hospital in Newington. Natchaug Hospital ICC provides this much-needed care for persons from the Eastern Region, closer to the communities where they live and work. United Services and the Southeastern Mental Health Authority are the Local Mental Health Authorities (LMHA's) responsible for authorizing admission to the Intermediate Care Program. The above includes the authorization of Department of Mental Health and Addiction Services (DMHAS) funds to pay for care in the event the patient is medically indigent, has exhausted his/her Medicare benefit, or has no Medicare hospitalization coverage. Patients are most likely to be referred from Eastern Region hospital inpatient units when it becomes clear that the patient will not be able to safely return to the community following an acute care stay. Upon admission, each patient is assessed by a psychiatrist, a registered nurse and a primary therapist, and a treatment plan is developed. The treatment team works closely with the client, their family and community providers to develop a discharge plan and ensure that community supports are in place.In-Patient Treatment Programs Treats 57 clients on a daily basis at the Mansfield location. Inpatient treatment includes: Comprehensive bio-psycho-social assessment Formulation of a treatment plan developed with the client/family which may include the use of medications Group therapy (a primary treatment approach) Family therapy and individual therapy Formulation of a discharge/aftercare plan Case management services Client referral to in-patient programs: Majority (over 80%) come from emergency rooms Self-referral via phone call or walk-in Referral from a Natchaug Program (PHP, IOP, school) Referral from community providersTypical client experience: The majority of our clients arrive via ambulance through the ambulance entrance. All clients receive an initial assessment by a registered nurse and psychiatrist which is completed within 8 hours of admission. Clients are oriented to the unit, the milieu, and the schedule. Our clients are closely monitored for the first 24-48 hours, depending on presentation and symptoms. Groups are scheduled from morning through evening. In addition, the clients meet with their Primary Therapist and Psychiatrist regularly.Contact with the family/guardian is during the admission process or within the following 48-72 hours. Family meetings are scheduled by the Primary Therapist. The clients on the child and adolescent units attend school in the building for 5 hours per day, with groups during the day, after school, and in the evening. Staffing pattern: Each inpatient unit is staffed 24-7 with: Registered NursesPsychiatristsMental Health Workers Licensed Practical Nurses (Adult Unit only) Also on the clinical treatment team are:Nurse Manager Licensed Primary TherapistsCase Manager (Adult Unit Only)Unit ClerkDieticianCertified Occupational Therapists (COTA)Occupational Therapist (OT)Family Practice Physician on site M-FInpatient Units: Adult rooms all semi-private plus one four-bed room. Child/Adolescent rooms are all private Units include group room space Meals are served in the dining roomOther points:Licensed by Connecticut Department of Public Health.Surveyed by Joint Commission under the Hospital StandardsSurveyed by the Center for Medicaid Services (federal program)
4b (Code:   ) (Expenses $ 8,015,239 including grants of $   ) (Revenue $ 8,044,534 )
Joshua CentersPartial Hospital Program (PHP) The Partial Hospital Program provides four hours of intensive psychiatric support daily for up to five days per week. This is a morning program for adults and an after-school program for children and adolescents. The program can eliminate the need for a hospital stay, and/or help with the transition back to home and regular school after a period of inpatient care.Intensive Outpatient Program (IOP) The Intensive Outpatient Program is somewhat less intense than the PHP, providing three hours of intensive treatment each day for up to five days each week. This program is offered both in the morning and during the evening for adults, after-school for children and adolescents. The IOP program is designed to help continue progress with behavioral health stabilization and recovery.Extended Day Treatment (EDT)This special program, partially funded by the Connecticut Department of Children, supports children and adolescents who have emotional or behavioral health issues that put them at risk of needing psychiatric residential or inpatient care. The Extended Day Treatment program is particularly helpful for children with special needs who are in foster care.Child & Adolescent Treatment Programs:- Treat about 250 children and adolescents daily in all programs/locations- May prevent hospitalization- Aids in transition back to the community following hospitalization- Transportation to PHP, IOP & EDT: Most of this transportation is provided by Natchaug Hospital staff, driving the Hospital vans that pick up clients from their school or home. - Average length of stay in PHP/IOP program, 6 - 8 weeks; EDT and IICAPS, 6 months.Joshua Program treatment services include: - Comprehensive bio-psycho-social assessment- Group Therapy (the primary treatment approach)- Family and individual therapy- Medication management- Occupational and creative rehabilitation therapy- Comprehensive aftercare/discharge planningPartial Hospital Program (PHP): four hours of treatment for up to five days per week Intensive Outpatient program (IOP): three hours of treatment up to five days per week Extended Day Treatment (EDT) is a specialized therapeutic after-school support program that provides structured groups for three hours a day up to five days per week to learn and practice social skills such as group interaction, listening, cooperative leisure activities. Intensive In-Home Child & Adolescent Psychiatric Services(IICAPS): developed and monitored by the Yale University Child Study Center, provides in home services 2-3 times per week to help meet the needs of families with children with persistent psychiatric disorders. Client referral to a Child/Adolescent Treatment Program:- Referred from an inpatient program in Connecticut- Community providers (Child & Family Services; United Children & Families; Emergency Rooms)- School systems- Private providers (community psychiatrists or therapists)- Family and friendsTypical client experience in a Child/Adolescent Program:Initial referral phone call results in an intake appointment with a masters level clinician to complete a bio-psycho-social assessment. The client must be accompanied by their parent/guardian. After admission to the Program, the client/guardian meets with the psychiatrist/APRN for treatment planning and medication management.In a treatment day, clients arrive after being picked up from their school (or home) in one of Natchaug Hospital vans and will attend four groups in PHP and three groups in IOP. Groups include a psychotherapy group, educational groups and an activity group. The activity group is led by a Mental Health Worker or a CRS Staff member; all other groups are led by a masters level clinician. Education groups might include managing emotions; dangers of substance abuse; handling relationships, etc. Natchaug Hospital Group Levels: Psychotherapy/Process Group: is based on exploration and analysis of the interaction of a person's thoughts, feelings & beliefs and the group process for the purpose of facilitating an interpersonal change process and is led by a mental health professional with a graduate degree in a clinical discipline. Educational/Skills Group: Involves the acquisition of knowledge and/or skills, improved coping responses, or the sharing of experiences (such as Goals or Wrap-up Group). Group goals are to reduce stress, improve problem solving and learn new coping behaviors. This group is led by a staff member with documented training and/or experience in group leadership. The group includes: Registered Nurses, Certified Occupational Therapy Assistants, Mental Health Workers, Pharmacists, and Dieticians, CRS staff (music, art or recreational therapists).Leisure Activity Groups: involve the client/patient/student within a meeting/group format in order to practice the development of healthy social relationships. This may include a specific activity (art, music, games) planned with the goal of improving attention and/or social interactions; led by a staff member with the desire and supervisor-determined competency to lead a leisure activity group.Other points:Surveyed by Joint Commission using Behavioral Health Standards; PHP/IOP licensed by the Department of Public Health; EDT is licensed by the Department of Children & Families.
4c (Code:   ) (Expenses $ 9,116,636 including grants of $   ) (Revenue $ 10,328,020 )
EducationClinical Day Treatment School Programs (CDT)Natchaug's clinical day treatment programs, which are approved by the Connecticut Department of Education, offer special education services to students in grades 1 - 12 whose social, emotional or behavioral health problems prevent them from functioning successfully in a regular school environment. Each student's individual academic and clinical treatment plan is designed to address their special needs and return them to their regular schools as soon as possible. Natchaug Hospital schools operate in Enfield, Danielson, Mansfield, Norwich, Montville and Windham. Natchaug is also the contracted operator of two schools for the town of Norwich.Natchaug Hospital's Board of Directors serves a number of functions similar to a Board of Education, with responsibilities for the oversight and the implementation of certain State statutes and Federal legislation.Natchaug Hospital School Programs- Each school day, an average of 200 students attend Natchaug Hospital's school programs- Approved by the Connecticut Department of Education: Inpatient School Journey House School Clinical Day Treatment School in six sites - Natchaug contracts with the Norwich Public Schools to provide services located at: Deborah Tennant-Zinewicz Hickory Street SchoolStudents come to the Inpatient School on an emergency basis, and for non-educational reasons; school staff determines if the student receives special education services, and if there is an Individual Education Plan (IEP) to be implemented. Students come to the Journey House School on a planned basis and for non-educational reasons. Each student's school files are evaluated for proper placement in school. Girls who receive special education, Section 504, and regular education all are educated at the Journey School. Students come to the six CDT sites via a Planning and Placement Team (PPT) Meeting from their home school district. They may be placed on a diagnostic basis with PPT meetings every two weeks while psychiatric, psychological and educational assessments are performed. Students also may enter the program already receiving special education services with an IEP (Individualized Education Plan) in place.Students come to the Hickory Street School and DTZ School by placement by the Norwich Board of Education. All students are identified as special education and have an IEP in place.Transportation to all day school programs is provided by the Local Education Authority (LEA) that placed the student; however, transportation during the school day for field trips is often provided using Natchaug vans with school staff driving; sometimes school field trips are transported by outside vendors. Student Referral to the Inpatient and Journey Schools - Placement for non-educational reasons (inpatient or residential treatment admission)Student Referral to the six CDT sites - These are only made by the Local Education Authority (LEA), which is designated by the state to be the "town of nexus," which takes numerous requirements into consideration, such as where the parent resides. Referral to the Hickory and DTZ schools - These are only made by the Norwich Board of EducationDescription of typical day:A typical day in the Inpatient and Journey House School is a five-hour day that covers all academic areas, including electives of Art and PE. A typical day in the CDT schools is similar to any traditional school day, with academic subjects in addition to psycho-educational groups led by school clinicians.
(Code:   ) (Expenses $ 10,708,254 including grants of $   ) (Revenue $ 10,149,133 )
Natchaug Hospital provides inpatient acute behavioral health services for patients at its main site in Mansfield Center. Natchaug Hospital also operates a number of structured day programs providing partial hospital, intensive outpatient, extended day treatment, and outpatient services for persons with behavioral health and substance abuse treatment needs. These programs are provided at a variety of sites throughout eastern Connecticut. The Hospital also provides specialized residential treatment to adolescent girls in the care of the Connecticut Department of Children and Families.
4d Other program services. (Describe in Schedule O.)
(Expenses $ 10,708,254 including grants of $   ) (Revenue $ 10,149,133 )
4e Total program service expensesMediumBullet$ 43,955,161
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
51
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
646
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
14
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
Paul V Maloney
189 Storrs Road
Mansfield Center,CT06226
(860) 456-1311
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Colin K Rice
Director
 2.00 X           0 0 0
(2) Antoinette Ellzey
Director
 2.00 X           0 0 0
(3) Rev Laurence AM LaPointe
Director
 2.00 X           0 0 0
(4) Harriotte W Wilson
Director
 2.00 X           0 0 0
(5) William E Anderson Jr
Director
 2.00 X           0 0 0
(6) Edward S Sawicki MD
Director
 2.00 X           0 0 0
(7) Carol A Wiggins PHD
Chairman
 2.00 X   X       0 0 0
(8) Michael G Pallein CPA
Director
 2.00 X           0 0 0
(9) Pedro J Johnson
Vice Chair
 2.00 X           0 0 0
(10) Karla Harbin Fox Esq
Director
 2.00 X           0 0 0
(11) Stephen W Larcen PHD
President & CEO
 40.00 X   X       0 466,881 70,456
(12) Kimberly A Colfer Esq
Director
 2.00 X           0 0 0
(13) Elizabeth B Ritter
Director
 2.00 X           0 0 0
(14) Dana McGee Esq
Director
 2.00 X           0 0 0
(15) Nancy A Brouillet Esq
Director
 2.00 X           0 0 0
(16) James E Watson
Director
 2.00 X           0 0 0
(17) David Klein PHD
VP & COO, Community Programs
 40.00     X       158,553 0 35,184
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Paul Maloney
CFO
 40.00       X     0 153,591 32,769
(19) Deborah Weidner
CMO
 40.00       X     251,071 0 34,817
(20) Peter J Smith
Psychiatrist
 40.00         X   214,975 0 26,420
(21) Jonathan L Chasen
Psychiatrist
 40.00         X   222,365 0 33,757
(22) Pamela Shuman
Psychiatrist
 40.00         X   172,388 0 26,009
(23) Teodora Andrei
Psychiatrist
 40.00         X   212,219 0 36,005
(24) Paul G Pentz
Psychiatrist
 40.00         X   170,779 0 26,508












1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,402,350 620,472 321,925
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet24
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
United Community Family Services
34 East Town St
Norwich,CT06360 		Social Workers, RN's 291,248
Mansfield Family Practice
Mansfield Professional Park
Storrs,CT06268 		Physician Consultations 222,645
Medical Staffing Network
PO Box 202996
Dallas,TX75320 		Contract Nurses 215,623
Columbia Ford Inc
PO Box 308
Columbia,CT06237 		Repairs and Maint 128,274
Jackson and Coker
PO Box 277638
Atlanta,GA30384 		Physicain Recruitment 111,363
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet6
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		195,250
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 195,250
Program Service Revenue Business Code
2a Contract Revenue 624,100 44,920,212 44,920,212    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 44,920,212
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 17,780     17,780
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet  
12 Total revenue. See Instructions....MediumBullet 45,133,242 44,920,212 0 17,780
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21    
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,036,622   1,036,622  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 26,738,349 26,717,080   21,269
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 1,658,625 1,594,294 63,130 1,201
9 Other employee benefits ....... 4,776,945 4,591,188 181,817 3,940
10 Payroll taxes ........... 2,195,112 2,109,936 83,549 1,627
11 Fees for services (non-employees):        
a Management ...... 339,938 339,938    
b Legal ......... 59,691   59,691  
c Accounting ........... 134,330   134,330  
d Lobbying ........... 18,394   18,394  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 1,732,316 1,732,316    
12 Advertising and promotion .... 59,906 59,906    
13 Office expenses ....... 2,586,080 2,583,045   3,035
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 659,906 659,906    
17 Travel ............ 145,219 145,219    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 38,276 38,276    
20 Interest ........... 242,189 242,189    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 926,858 926,858    
23 Insurance .............. 478,169 478,169    
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a Purchased Services 714,824 706,270   8,554
b Bad Debt 577,661 577,661    
c Repairs & Maintenance 318,381 318,381    
d Dues & Subscriptions 101,666 101,666    
e Education/Tech Training 32,863 32,863    
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 45,572,320 43,955,161 1,577,533 39,626
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 6,851 1 7,250
2 Savings and temporary cash investments ....... 982,263 2 894,437
3 Pledges and grants receivable, net ......... 269,096 3 241,282
4 Accounts receivable, net ......... 4,221,388 4 4,253,960
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 116,117 8 127,971
9 Prepaid expenses and deferred charges ............ 417,439 9 477,762
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 19,305,009
b Less: accumulated depreciation. ..... 10b 8,127,445 11,430,491 10c 11,177,564
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 253,791 15 168,466
16 Total assets. Add lines 1 through 15 (must equal line 34)... 17,697,436 16 17,348,692
Liabilities 17 Accounts payable and accrued expenses . 4,653,144 17 5,723,526
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 3,762,124 23 3,234,650
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 432,887 25 349,034
26 Total liabilities. Add lines 17 through 25..... 8,848,155 26 9,307,210
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 8,639,928 27 7,868,019
28 Temporarily restricted net assets ..... 209,353 28 173,463
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 8,849,281 33 8,041,482
34 Total liabilities and net assets/fund balances ..... 17,697,436 34 17,348,692
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
45,133,242
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
45,572,320
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
-439,078
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
8,849,281
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-368,721
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
8,041,482
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
Natchaug Hospital Inc
  		Employer identification number

06-0966963
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
Natchaug Hospital Inc
  		Employer identification number

06-0966963
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
Natchaug Hospital Inc
  		Employer identification number

06-0966963
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
18,394
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
 
No
 
j
Total. lines 1c through 1i ...................................
18,394
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Explanation of Other Lobbying Activities: Part II-B, Line 1i: Natchaug Hospital paid Kenneth L. Przybysz LLC and Connecticut Hospital Association (CHA) for their lobbying efforts on behalf of the organization during the fiscal year. Both CHA and Mr. Przybysz lobbies Connecticut State Legislators in the interest of a group of specialty hospitals in the State of Connecticut.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 195,898   195,898
b Buildings ................ 13,073,413   4,320,573 8,752,840
c Leasehold improvements ............ 1,053,868   224,605 829,263
d Equipment ................ 3,989,515   2,914,515 1,075,000
e Other ................. 992,315   667,752 324,563
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 11,177,564
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
Due To Affiliated Corporation 349,034








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 349,034
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 45,133,242
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 45,572,320
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 -439,078
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 -368,721
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 -368,721
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -807,799
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 44,552,973
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e 0
3 Subtract line 2e from line 1..................... 3 44,552,973
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b 580,269
c Add lines 4a and 4b....................... 4c 580,269
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 45,133,242
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 45,052,417
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e 0
3 Subtract line 2e from line 1..................... 3 45,052,417
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b 519,904
c Add lines 4a and 4b....................... 4c 519,904
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 45,572,321
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Part XI, Line 8 - Other Adjustments:   Change in Net Assets Related to Pension Plan -368721.
Part XII, Line 4b - Other Adjustments:   Patient Service Revenue On Tax Return Not On AFS 452461. Restricted Contributions Not Reported In Operations 127808.
Part XIII, Line 4b - Other Adjustments:   Patient Service Revenue On Tax Return Not On AFS 452461. Rounding 1. Net Assets Released From Restrictions 67442.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    237,546   237,546 0.530 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    13,252,302 11,262,594 1,989,708 4.420 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....     2,631,329 2,498,775 132,554 0.290 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		    16,121,177 13,761,369 2,359,808 5.240 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    335,593   335,593 0.750 %
f Health professions education
(from Worksheet 5) .. 		    181,070 8,000 173,070 0.380 %
g Subsidized health services
(from Worksheet 6) .. 		    627,813   627,813 1.400 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    313,765   313,765 0.700 %
jTotal Other Benefits ...     1,458,241 8,000 1,450,241 3.230 %
kTotal. Add lines 7d and 7j. ..     17,579,418 13,769,369 3,810,049 8.470 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
559,797
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
142,972
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
3,267,397
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
3,714,925
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-447,528
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 Natchaug Hospital
189 Storrs Rd PO Box 260
Mansfield Center,CT06250 		X                
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Natchaug Hospital Inc
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?9
Name and address Type of Facility (Describe)
1 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
2 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
3 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
4 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
5 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
6 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
7 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
8 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
9 Care Plus
1353 Gold Star Highway
Center Groton,CT06340 		Day Treatment Center
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    Part I, Line 3c: Natchaug Hospital used Federal Poverty Guidelines to determine eligibility.
    Part I, Line 7: The organization used cost to charge ratio as determined by the Medicare Cost Report.
    Part I, Line 7g: No physician clinic costs were included in the Subsidized Health Services cost calculations.
    Part I, L7 Col(f): The Bad Debt Expenses included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 577,661.
    Part III, Line 4: The organization's financial statements are provided in accordance with Generally Accepted Accounting Principles (GAAP). GAAP does not require a footnote for bad debt expenses, however, the charity care footnote reads as follows: "A patient is classified as a charity patient by reference to the established policies of the Hospital. Essentially, these policies define charity care services as those services for which no payment is anticipated. In assessing a patient's inability to pay, the Hospital utilizes the generally recognized poverty income levels for the State of Connecticut, but also includes certain cases where incurred charges are significant when compared to patients' incomes." In the event a patient fails to qualify for financial assistance or fails to pay their portion of discounted charges, and the patient does not pay timely their obligation to the Hospital, the Hospital reserves the right to institute and pursue collection actions and to pursue any remedies available at law or in equity, including but not limited to, imposing wage garnishments or filing and foreclosing on liens on primary residences or other assets, instituting and prosecuting legal actions and reporting the matter to one or more credit rating agencies. In the event the Hospital is unable to collect, the outstanding amounts are written off as bad debt. For those patients who qualify for financial assistance and are cooperating in good faith to resolve outstanding accounts, the Hospital may offer extended payment plans and will not impose collection efforts described above.The organization used cost to charge ratio as determined by the Medicare Cost Report. The Audited Financial Statement amount is the total amount of bad debt at contracted rates. The amount reported on Part III Line 2 is the corresponding cost determined by taking those services, grossing them back up to charge and then applying the Medicare Cost Report determined Cost to Charge ratio. The amount reported on Part III, Line 3 was determined by reviewing the demographics as well as the insurance plans of the patients for whom accounts were written off as Bad Debt during the year and extrapolating the likelihood that they would be eligible under the Hospital's Charity Care Program.
    Part III, Line 8: Providing care for those in need, including Medicare and Medicaid patients, and serving all patients regardless of ability to pay are an essential part of the community benefit standard, as well as our mission in our community. We serve these patients without regard to the payment shortfall. Therefore, Medicare shortfall should be considered a community benefit.The organization used a cost to charge ratio as determined by the Medicare Cost report.
    Part III, Line 9b: The following is included in the Natchaug Hospital's Financial Assistance Policy: For those patients that qualify for financial assistance and who are cooperating in good faith to resolve the Hospital's outstanding accounts, the Hospital may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to outside collection agencies and will cease all collection efforts.
    Part VI, Line 2: Natchaug Hospital organized an eight member consortium of community health providers during FY2011 to conduct a community health needs assessment of the towns of Windham County. These towns are overlapping primary service areas for the eight health care providers in our consortium. Focus groups and telephone surveys were completed during the third quarter of 2011. The results are being presented to Consortium members during the fourth quarter of 2011. Members will reconvene in January 2012 to draft action plans to address identified needs. In addition to the Windham County Health Needs Assessment, Natchaug Hospital will also review, during FY12, the health needs components of FY11 Community Needs Assessments conducted by the New London United Way, the William Backus Hospital, and the Eastern CT Health Network so as to identify behavioral health needs of residents in our primary service area. The 21 towns of New London County and the 15 towns of Windham County comprise most of the towns of our primary service area, and those communities with the greatest health care needs. The educational needs assessment conducted during 2009 of providers and educators in the 12 town region of Greater Essex/Old Saybrook regarding access to services for emotionally disturbed youth continues to inform program development to better serve this region, including the addition of a second classroom planned for January 2012. Surveys are conducted to assess the effectiveness of community benefit activities, and to assess whether Natchaug Hospital is meeting the needs of health care providers in the region. Natchaug Hospital assesses data from the Connecticut Hospital Association (CHA) and providers throughout the state regarding bed availability and days in emergency departments while awaiting admission. Data from health needs assessments are also reviewed. Needs are also assessed through Systems of Care meetings, and by tracking waiting lists for admission to programs.
    Part VI, Line 3: Natchaug Hospital adopted Hartford HealthCare's Charity Care Policy, which is displayed in all client waiting areas, sent in summary form with our monthly statements, included as part of the monthly statements sent by our collection agency, distributed individually by front desk staff & social services and displayed on both the Natchaug Hospital and the Hartford HealthCare websites. The Notice states in English and Spanish: NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE. Financial assistance is offered by Natchaug Hospital which provides a reduced cost rate for medically necessary services incurred by state of Connecticut legal residents whose household income does not exceed 250% of the Federal Income Poverty Guidelines for a family unit. Patients must meet the State of CT definition of "uninsured", and need to apply and be denied eligibility for any medical or health care coverage provided under the General Assistance Program or the CT Medicaid program, or not be eligibile for coverage under Medicare or CHAMPUS programs, or any other governmental or privately sponsor health or accident insurance. Patients must furnish proof of income to qualify for Financial Assistance. There are Financial Counselors available to assist patients with the application for Financial Assistance. Clients are encouraged to contact Financial Counseling at 860 456 1311, X 236 for more information.
    Part VI, Line 4: Natchaug Hospital admits residents of, on average, 150 of Connecticut's 169 towns and six states each year. Natchaug Hospital's service area is comprised of 62 towns, primarily east of the Connecticut River, which together represent approximately half the State's land area. Natchaug Hospital's clients represent urban, suburban and rural areas. Admissions reflect the demographics and prevalence of behavioral health illnesses of the region: during FY 2011, admissions were composed of 44.6% female, 55.4% male; .67% American Indian or Alaskan Native, .43% Asian, 7.07% African American, 83.62 Caucasian, .11% Native Hawaiian, 4.6% other or unknown; 61.5% of clients were age 19 or older, 28.1% were between 12 and 18 years of age, 10.4% were age 4 to 11. The majority of Natchaug Hospital clients (approximately 76%) are financially stressed, as measured by the number of students meeting Federal free/reduced lunch criteria and the number of clients overall who are un insured or participating in a public support plan such as HUSKY, Medicaid or Medicare.
    Part VI, Line 6: Natchaug Hospital's ten-site network of community based partial hospital, intensive outpatient and special education programs is unique within the state for its depth, breadth and accessibility. All of our Board Member and management reside within our service area. Our all volunteer Board of Directors represent the communities we serve. Natchaug Hospital's Chief Medical Officer, Dr. Weidner, is also serving as Medical Director of Behavioral Health Services at Windham Hospital, where she works with all Windham Hospital psychiatrists and physicians to assure quality care and enhanced coordination of services in inpatient and emergency department settings.Natchaug Hospital President & CEO, Stephen Larcen, is also serving as interim President & CEO of Windham Hospital, the general hospital serving our region, facilitating coordination of and improved access to care for residents in the region. Natchaug Hospital leadership continues to advocate for changes to the Federal adult Medicaid (IMD) restriction on reimbursement for emergency admissions from general hospitals to psychiatric hospitals. As the only free-standing psychiatric hospital in the state, Natchaug Hospital will participate in the CMS Demonstration project now that Connecticut has been chosen by CMS.Natchaug Hospital offers the use of its facilities, for free, to recovery support groups, including AA, Al Anon, ACOA, NAMI and other community groups. With regular weekly and monthly meetings, annual attendance was greater than 2,750.Natchaug Hospital staff actively contributes to the community. For example, Program Director Peter DeRosa serves on the Eastern Connecticut Chamber of Commerce's Health Advisory Committee and as a Chamber Trustee. Natchaug's Director of School Programs, Jill Bourbeau, serves as the Past President of Connecticut Association of Private Special Education Facilities (CAPSEF), where she also sits on the Strategic Planning, Finance and Membership committees. Paul Kindall, Program Director of Natchaug's Enfield Joshua Center, serves on Healthy Enfield, and at least three Natchaug staff serve on their local Boards of Education, and Dr. Larcen serves on his town's Board of Finance. At least three Program Directors serve their region's Systems of Care, and the Human Services Advisory Board for the Mansfield Town Council includes a representative from Natchaug. Natchaug Hospital provided nine Professional Development seminars on behavioral health topics for professionals working with school age youth (school nurses, guidance counselors, teachers, etc), for free. The goals of these seminars are to (1) help identify treatable behavioral conditions as early as possible and (2) to improve awareness of effective classroom management of behaviorally challenged youth.
    Part VI, Line 7: Natchaug Hospital is an Affiliate of Hartford HealthCare Corporation (HHC). HHC strives to provide compassionate care designed to deliver the necessary health services needed by the community. The Strategic Planning and Community Benefit Committee of the HHC Board of Directors ensures the oversight for these services by each hospital community. In addition, HHC continues to take important steps toward achieving its vision of being "nationally respected for excellence in patient care and most trusted for personalized, coordinated care."HHC affiliation creates a strong integrated health care delivery system with a full continuum of care across a broader geographic area. This allows the small communities easy and expedient access to the more extensive and specialized services the larger hospitals are able to offer. This includes continuing education of health care professionals at all the affiliated institutions through the Center of Education, Simulation and Innovation located at Hartford Hospital, the largest of the system hospitals.The affiliation further enhances the hospitals' abilities to support their missions, identity, and respective community roles. This is achieved through integrated planning and communication to meet the changing needs of the region. This includes responsible decision making and appropriate sharing of services, resources and technologies, as well as cost containment strategies.
Reports Filed With States Part VI, Line 7 CT
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Stephen W Larcen PHD (i)
(ii)		 0
354,829 		0
73,122 		0
38,930 		0
45,900 		0
24,556 		0
537,337 		0
0
(2) David Klein PHD (i)
(ii)		 148,922
0 		9,606
0 		25
0 		11,109
0 		24,075
0 		193,737
0 		0
0
(3) Paul Maloney (i)
(ii)		 0
147,440 		0
5,906 		0
245 		0
15,689 		0
17,080 		0
186,360 		0
0
(4) Deborah Weidner (i)
(ii)		 238,404
0 		7,834
0 		4,833
0 		12,250
0 		22,567
0 		285,888
0 		0
0
(5) Peter J Smith (i)
(ii)		 208,224
0 		5,717
0 		1,034
0 		9,431
0 		16,989
0 		241,395
0 		0
0
(6) Jonathan L Chasen (i)
(ii)		 213,496
0 		6,886
0 		1,983
0 		11,526
0 		22,231
0 		256,122
0 		0
0
(7) Pamela Shuman (i)
(ii)		 168,959
0 		0
0 		3,429
0 		9,696
0 		16,313
0 		198,397
0 		0
0
(8) Teodora Andrei (i)
(ii)		 211,853
0 		0
0 		366
0 		11,100
0 		24,905
0 		248,224
0 		0
0
(9) Paul G Pentz (i)
(ii)		 170,582
0 		0
0 		197
0 		11,038
0 		15,470
0 		197,287
0 		0
0







Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) See Part V See Part V 264,598 See Part V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
  Business Transactions Involving Interested Persons: (a) Name of Person: William E. Anderson, Jr. (b) Relationship Between Interested Person and Organization: Director(c) Amount of Transactions: $264,598(d) Descrpiton of Transactions: Mr. Anderson is a board member at Natchaug Hospital. Mr. Anderson is currently an executive at the Savings Institute Bank & Trust. The bank does business with Windham Community Memorial Hospital and Natchaug Hospital. The Hospital paid the bank $264,598 for interest and principal payments on an outstanding loan.(e) Sharing of Organization's Revenue? No
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Identifier Return Reference Explanation
Form 990, Part VI, Section A, line 1   There were some board members whose term expired in June, 2011. As a result, they were not considered voting members at the end of the tax year.
Form 990, Part VI, Section A, line 6   Natchaug Hospital is organized as a non-stock not for profit entity. Hartford HealthCare Corporation is the sole member.
Form 990, Part VI, Section A, line 7a   The sole member of the organization has the authority to approve/deny members of the governing body.
Form 990, Part VI, Section A, line 7b   The sole member of the organization has the right to review, approve, disapprove and deny significant transactions such as mergers, acquisitions, dissolutions etc.
Form 990, Part VI, Section B, line 11   The Form 990 was prepared by Hartford HealthCare Corporation's Tax Department. It was then reviewed by an independent accounting firm. It was then forwarded to the organization's top management including the CFO for review. The Form was then made available to the board for review. Once the entire review process was completed, the form was signed by the CFO and then filed with the Internal Revenue Service.
  Form 990, Part VI, Section B, line 12c The hospital's board has adopted the policy of the member organization, Hartford HealthCare Corporation. All directors and officers of the organization shall complete and sign a Conflict of Interest statement. The statement includes an itemization and description of any actual or potential conflict of interest and all material facts related thereto for such director or officer by virtue of his or her activities or the activities of related persons. Directors and officers are urged to be inclusive in this disclosure since the disclosure of potential and actual conflicts of interest is essential to ensuring discussion of the conflict. Conflict of Interest disclosure statements shall be returned to the Compliance Officer. All disclosures made will be reviewed by the Compliance Officer and the Director of Compliance & Audit, under the direction of the Chairman and the President, who shall exercise good faith judgment as to whether a conflict exists. The Chairman and President shall be responsible for monitoring transactions or arrangements in which a director or officer may have a conflict of interest and for assuring that the director or officer serves the hospital's best interests. The Compliance Officer, Director of Compliance & Audit, Chairman and/or President may consult with any director or officer and obtain information necessary for an ordinarily prudent person to make a judgment as to whether a conflict exists and each director and officer shall cooperate with such requests. The Compliance Officer, Director of Compliance & Audit, Chairman and/or the President shall provide guidance to the director or officer and to the board of directors as to the appropriate course of action. The Chairman and the President shall seek the advice and approval of the full Board of Directors in determining whether a conflict of interest exists and that the director or officer serves the organization's best interests. When a conflict of interest is discovered, such director and/or officer with the conflict will be required to refrain from participating in any discussion or action concerning such conflicted situation in accordance with the section entitled "Restraint on Participation" set forth in the Conflict of Interest policy. If, after completing and signing the annual disclosure statement, an actual or potential conflict arises, the director or officer with the conflict shall promptly notify the Compliance Officer and Director of Compliance & Audit in writing.
  Form 990, Part VI, Section B, line 15 The CEO and CFO scales are reviewed annually against surveys and reviewed and approved by the Hartford HealthCare Corporation Compensation Committee. Other executives are reviewed annually against market using Connecticut Hospital Association (CHA) data, Hartford Hospital (HH) data and appropriate published compensation surveys periodically and reviewed with the Hospital's independent Executive Committee of the Board annually.
  Form 990, Part VI, Section C, line 19 Form 990 and Form 1023 and its attachments are available upon request. The Hospital's governing documents, financial statements and Conflict of Interest statements are also made available upon request.
Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Change in Net Assets Related to Pension Plan -368721. Total to Form 990, Part XI, Line 5: -368721.
  Part XII, Line 2 The organization's financial statements were audited by an independent accounting firm. In addition, the organization has a committee that assumes responsibility for oversight of the audit of its financial statements.
Average Hours Per Week Form 990 Part VII, Column B Certain employees listed on Part VII of Form 990 share their time between Natchaug Hospital and other related organizations. These are all full time employees that average 40-60 hours per week. Their hours and salaries are allocated between Hartford Hospital and Natchaug Hospital for expenditure purposes.
Form 5471 Disclosure   DISCLOSURE STATEMENT RELATED TO FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, FILED ON BEHALF OF THE TAXPAYER UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: HARTFORD HOSPITAL ADDRESS: 80 SEYMOUR STREET, PO BOX 5037 HARTFORD, CT 06102-5037 IDENTIFYING NUMBER OF U.S. TAX RETURN WITH WHICH THE FORMS 5471 WERE OR WILL BE FILED: 06-0646668 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Natchaug Hospital Inc
 
Employer identification number

06-0966963
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Hartford Hospital

80 Seymour Street

Hartford,CT06102
06-0646668 		Health Services CT 501 (c) (3) 3 Hartford HealthCare Corp
 
Yes
 
(2) Windham Community Memorial Hospital

112 Mansfield Avenue

Willimantic,CT06226
06-0646966 		Health Services CT 501 (c) (3) 3 Hartford HealthCare Corp
 
Yes
 
(3) Windham Hospital Foundation Inc

112 Mansfield Avenue

Willimantic,CT06226
56-2546632 		Supporting Organization CT 501 (c) (3) 11 (a) Windham Community Memorial Hospital
 
Yes
 
(4) Midstate Medical Center

435 Lewis Avenue

Meriden,CT06451
06-0646715 		Health Services CT 501 (c) (3) 3 Hartford HealthCare Corp
 
Yes
 
(5) Hartford HealthCare Corp

80 Seymour Street

Hartford,CT06102
22-2672834 		Support and Management Svcs. to Hartford Hospital and Affiliates CT 501 (c) (3) 11 (c) N/A
Yes
 
(6) VNA Health Care Inc

103 Woodland Street

Hartford,CT06105
06-0646938 		Home Healthcare CT 501 (c) (3) 7 Hartford HealthCare Corp
 
Yes
 
(7) Rushford Center Inc

883 Paddock Avenue

Meriden,CT06450
06-0932875 		Substance Abuse Healthcare Services CT 501 (c) (3) 7 Hartford HealthCare Corp
 
Yes
 
(8) Hartford Hospital Auxiliary co Hartford Hospital

80 Seymour Street

Hartford,CT06115
06-6040747 		Fundraising CT 501 (c) (3) 11 (c) Hartford Hospital
 
Yes
 
(9) Connecticut Health System Inc

80 Seymour Street

Hartford,CT06102
22-2779421 		Coordination of Health Delivery CT 501 (c) (3) 11 (c) N/A
Yes
 
(10) Institute of Living

200 Retreat Avenue

Hartford,CT06106
06-0646683 		Psychiatric Services CT 501 (c) (3) 11 (c) Hartford HealthCare Corp
 
Yes
 
(11) VNA Resources Inc

103 Woodland Street

Hartford,CT06105
06-1161422 		Home Healthcare CT 501 (c) (3) 9 VNA Health Care Inc
 
Yes
 
(12) The Hatch Hospital Corp

112 Mansfield Avenue

Willimantic,CT06226
06-6076412 		Health Services CT 501 (c) (3) 3 Windham Community Memorial Hospital
 
Yes
 
(13) WCMH Women's Auxiliary Inc

112 Mansfield Avenue

Willimantic,CT06226
06-0677728 		Fundraising CT 501 (c) (3) 11 (a) Windham Community Memorial Hospital
 
Yes
 
(14) The Hospital of Central CT and Bradley Memorial

100 Grand Street

New Britain,CT06050
06-0646768 		Health Services CT 501 (c) (3) 3 Central CT Health Alliance
 
Yes
 
(15) Central CT Senior Health Svcs dba Southington Care

45 Meriden Avenue

Southington,CT06489
22-2635676 		Sub-Acute & Long Term Healthcare CT 501 (c) (3) 9 Central CT Health Alliance
 
Yes
 
(16) Bradley Health Services

100 Grand Street

New Britain,CT06050
06-1367014 		Health Services CT 501 (c) (3) 9 Central CT Health Alliance
 
Yes
 
(17) Central CT Health Alliance

100 Grand Street

New Britain,CT06050
22-2785033 		Support and Management Svcs. to THOCC and Affiliates - Shell CT 501 (c) (3) 11 (b) Hartford HealthCare Corp
 
Yes
 
(18) VNA of Central CT Inc

205 West Main Street

New Britain,CT06050
06-0646940 		Public Health Nursing & Home Care CT 501 (c) (3) 9 Central CT Health Alliance
 
Yes
 
(19) The Orchards of Southington

34 Hobart Street

Southington,CT06489
06-1490803 		Residential Services for Senior Citizens CT 501 (c) (3) 9 Central CT Senior Health Services Inc
 
Yes
 
(20) Community Mental Health Affiliates

270 John Downey Drive

New Britain,CT06051
06-0934544 		Mental Health & Substance Abuse Treatment Provider CT 501 (c) (3) 7 Central CT Health Alliance
 
Yes
 
(21) Mulberry Gardens of Southingtn LLC

58 Mulberry Street

Plantsville,CT06479
82-0586577 		Assisted Living & Adult Day Care Facility CT 501 (c) (3) 9 Central Ct Senior Health Services Inc
 
Yes
 
(22) Midstate Medical Center Auxiliary

435 Lewis Avenue

Meriden,CT06451
06-6063082 		Fundraising CT 501 (c) (3) 3 Midstate Medical Center
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Central CT Sports Medicine Ctr LLC

15 Masairio Drive Suite 104
Berlin,CT06037
22-3196509 		Physical Therapy CT N/A
                  
(2) New Britain MRI Limited Partnership

100 Grand Street
New Britain,CT06050
06-1271349 		Magnetic Resonance Imaging CT N/A
                  
(3) New Britain Occupational Health Center LLC

440 New Britain Avenue
Plainville,CT06062
06-1484904 		Occupational Healthcare CT N/A
                  
(4) Hartford HealthCare Endowment LLC

80 Seymour Street
Hartford,CT06102
45-4181103 		Endowment Management CT N/A
                  
(5) Ambulance Service of Manchester LLC

111 Founders Plaza
East Hartford,CT06108
06-1557358 		Imaging Services CT N/A
                  
(6) Glastonbury Endoscopy Center LLC

300 Western Blvd Suite B
Glastonbury,CT06033
26-1721234 		Endoscopy Services CT N/A
                  
(7) Glastonbury Surgery Center LLC

195 Eastern Boulevard
Glastonbury,CT06033
26-2600828 		Surgery Services CT N/A
                  
(8) Hartford-Middlesex Clinical System LLC

80 Seymour Street
Hartford,CT06110
06-1543605 		Affiliate Support Services CT N/A
                  
(9) Med East Assoc LLC

1703 West Main Street
Willimantic,CT06226
06-1469575 		Outpatient Care Clinic CT N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) HHMOB Corporation & Subsidiary
80 Seymour Street
Hartford,CT06102
06-1140244 		Real Estate Parking CT N/A
 C      
(2) CHS Insurance LTD
40 Church Street
  Hamilton  
BD
Captive Insurance BD N/A
 C      
(3) Windham Health Services Inc
112 Mansfield Avenue
Willimantic,CT06226
06-1461101 		Home Healthcare CT N/A
 C      
(4) Windham Physician Hospital Organization
112 Mansfield Avenue
Willimantic,CT06226
06-1441614 		Medical Services CT N/A
 C      
(5) Windham Family Medical Services
112 Mansfield Avenue
Willimantic,CT06226
06-1491649 		Medical Services CT N/A
 C      
(6) CenConn Services Inc
100 Grand Street
New Britain,CT06050
22-2836001 		Investment Management CT N/A
 C      
(7) Grand Indemnity Co LTD FB Perry Building
40 Church Street
  Hamilton  
BD
98-0609499 		Professional Liability BD N/A
 C      
(8) Hartford Physician Services PC
80 Seymour Street
Hartford,CT06102
06-1254082 		Medical Services CT N/A
 C      
(9) Meriden Imaging Center
101 North Plains Industrial Road
Meriden,CT06429
06-1541468 		Imaging CT N/A
 S      
(10) Hartford Physician Hospital Organization Inc
80 Seymour Street
Hartford,CT06102
22-2785918 		Physician & Hospital Support CT N/A
 C      
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Hartford Hospital

 O 191,468 FMV
(2) Windham Community Memorial Hospital

 L 209,444 FMV
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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