TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Ervin Shames Chairman thru 12/31/10; Trustee as of 1/1/11	3.0	X	X	0	0
(2) Diane M Allison ESQ vice chair thru 12/31/10; Chairman 1/1/11	5.0	X	X	0	0
(3) George P Bauer Trustee as of 1/1/11	2.0	X		0	0
(4) Andrew Whittingham Treasurer	3.0	X	X	0	0
(5) Joseph Mann Secretary	2.0	X	X	0	0
(6) Fred Afragola Trustee	2.0	X		0	0
(7) Charles Augenbraun MD Trustee (Leave of Absence)	0.0	X		0	0
(8) Barbara Butler Trustee	3.0	X		0	0
(9) Daniel DeBarba President and CEO	50.0	X	X	670,785	29,920
(10) Victor Liss Trustee	3.0	X		0	0
(11) Michael Marks MD Physician Trustee thru 12/31/10	2.0	X		70,833	0
(12) David Komansky Trustee	2.0	X		0	0
(13) David Lehn Trustee	2.0	X		0	0
(14) Gary Reiner Trustee	3.0	X		0	0
(15) Roland Stichweh Trustee	3.0	X		0	0
(16) William J Tamme TRUSTEE THRU 12/31/10 VICE CHAIR 1/1/11	5.0	X		0	0
(17) Richard Zelkowitz MD Trustee	2.0	X		0	0

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Robert Ready Trustee	2.0	X					0	0
(19) Thomas Ayoub Physician/Trustee	18.0	X					140,833	0
(20) Maria Borges-Lopez Trustee as of 1/1/11	2.0	X					0	0
(21) Paul Gagne MD Trustee as of 1/1/11	2.0	X					0	0
(22) Mark Gudis Trustee as of 1/1/11	2.0	X					0	0
(23) Ed Kangas Trustee as of 1/1/11	2.0	X					0	0
(24) Ed Mahony Trustee as of 1/1/11	2.0	X					0	0
(25) Patrick Minicus VP and Chief Financial Officer	50.0		X				354,471	25,050
(26) Eric Mazur VP and Chief Medical Officer	50.0			X			764,258	44,422
(27) Lisa Brady Chief Operating Officer	50.0			X			450,445	25,419
(28) Mary NolaN VP Nursing & Patient Care SVCS	50.0			X			372,529	52,575
(29) Anthony Aceto VP Human Resources	50.0			X			344,257	30,687
(30) Peter Dodds Chairman Surgery	25.0				X		432,202	32,628
(31) Michael Carius Chairman Emergency Department	50.0				X		537,703	49,348
(32) Arthur Srichman Physician	50.0				X		451,345	45,210
(33) Brian McGovern Physician	50.0				X		534,859	44,459
(34) Stephen Winter Physician	50.0				X		469,523	45,519
(35) Geoffrey Cole Former President and CEO						X	1,248,052	46,796

(A) Name and business address	(B) Description of services	(C) Compensation
NORWALK RADIOLOGY MAMMOGRAPHY CTR 148 EAST AVENUE NORWALK,CT06851	MEDICAL	3,641,641
MORRISON MANAGEMENT SPECIALISTS INC PO BOX 102289 ATLANTA,GA30368	FOOD SERVICE	2,552,365
UNITEX TEXTILE RENTAL 121-123 MEADOW STREET HARTFORD,CT06114	LAUNDRY SERVICES	1,403,712
COMFORCE TECHNICAL SERVICES INC PO BOX 9695 UNIONDALE,NY11555	STAFFING SERVICES	1,338,302
APOLLO SECURITY 2150 BOSTON-PROVIDENCE HIGHWAY WALPOLE,MA02081	SECURITY SERVICE	1,090,981
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 91

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	1,042,576	1,042,576
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	3,359,338		3,359,338
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	128,932,371	112,433,635	16,498,736
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	9,859,752	7,950,078	1,909,674
9	Other employee benefits .......	23,549,011	19,105,759	4,443,252
10	Payroll taxes ...........	10,489,570	8,457,910	2,031,660
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	1,607,556		1,607,556
c	Accounting ...........	241,990		241,990
d	Lobbying ...........	187,250		187,250
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	43,564,318	35,076,843	8,487,475
12	Advertising and promotion ....	1,746,100	97,560	1,648,540
13	Office expenses .......	25,205,434	23,906,785	1,298,649
14	Information technology ......	5,755,534	4,042,655	1,712,879
15	Royalties ..	0
16	Occupancy ...........	16,629,032	13,400,413	3,228,619
17	Travel ............	537,481	449,278	88,203
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	30,559	30,250	309
20	Interest ...........	1,450,895	1,445,282	5,613
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	19,041,348	14,828,382	4,212,966
23	Insurance ..............	8,216,535	8,149,794	66,741
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	BAD DEBT	20,654,069	20,654,069
b	PHARMACY	6,897,748	6,895,018	2,730
c	RADIOLOGY & LAB SUPPLIES	2,216,493	2,213,820	2,673
d	SUPPORT - NORWALK COMMUNITY HE	1,350,000	1,350,000
e	DUES, MEMBERSHIPS	701,524	192,191	509,333
f	All other expenses	4,996,058	1,410,436	3,585,622
25	Total functional expenses. Add lines 1 through 24f	338,262,542	283,132,734	55,129,808	0
26	Joint costs. Check here 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

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	-3,090,637	1	61,458,676
2	Savings and temporary cash investments .......	29,401,181	2	0
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	40,941,651	4	37,299,759
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 .............	2,019,947	7	1,387,672
8	Inventories for sale or use ..............	2,361,637	8	1,879,253
9	Prepaid expenses and deferred charges ............	1,831,130	9	2,698,590
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	404,630,251
b	Less: accumulated depreciation. .....	10b	277,722,033	111,490,794	10c	126,908,218
11	Investments—publicly traded securities ..........	30,190,958	11	30,219,610
12	Investments—other securities. See Part IV, line 11 ......	3,170,899	12	2,729,803
13	Investments—program-related. See Part IV, line 11 ..		13	36,399,874
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	40,488,764	15	46,485,294
16	Total assets. Add lines 1 through 15 (must equal line 34)...	258,806,324	16	347,466,749
	17	Accounts payable and accrued expenses .	75,538,145	17	105,366,368
18	Grants payable ..........		18
19	Deferred revenue ..........	211,158	19	208,218
20	Tax-exempt bond liabilities ..........	9,845,000	20	56,060,000
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 ..	7,295,987	23	6,275,846
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	30,739,392	25	43,859,516
26	Total liabilities. Add lines 17 through 25.....	123,629,682	26	211,769,948
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	111,900,980	27	104,824,797
28	Temporarily restricted net assets .....	13,846,953	28	21,432,761
29	Permanently restricted net assets .....	9,428,709	29	9,439,243
	Organizations that do not follow SFAS 117, check here 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 .....	135,176,642	33	135,696,801
34	Total liabilities and net assets/fund balances .....	258,806,324	34	347,466,749

- TIN:

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.

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

The Norwalk Hospital Association

Employer identification number

06-6068853

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.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

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).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

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:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

The Norwalk Hospital Association

Employer identification number

06-6068853

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... 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)

Name of organization The Norwalk Hospital Association
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization The Norwalk Hospital Association
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
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
The Norwalk Hospital Association

Employer identification number

06-6068853

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

(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

(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

(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

(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:

- TIN:

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

The Norwalk Hospital Association

Employer identification number

06-6068853

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

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

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 if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ......................................	Yes No

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

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

(b)

Amount

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:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Yes

505,447

Total. lines 1c through 1i ...................................

505,447

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

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

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

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”.

Dues, assessments and similar amounts from members .....................

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).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

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
OTHER ACTIVITIES	SCHEDULE C, PART II-B, LINE i	NORWALK HOSPITAL ASSOCIATION PAYS MEMBERSHIP DUES TO MEMBER ORGANIZATIONS WHICH MAY ENGAGE IN LOBBYING ACTIVITIES, THEREFORE, A PORTION OF THE DUES MAY BE ATTRIBUTABLE TO LOBBYING ACTIVITIES. NORWALK HOSPITAL ENGAGED THE FIRM BROWN RUDNICK LLP FOR GOVERNMENT RELATIONS IN CONNECTICUT AND ON THE FEDERAL LEVEL. BROWN RUDNICK KEEPS NORWALK HOSPITAL ASSOCIATION APPRAISED OF FEDERAL HEALTHCARE POLICY, GRANT OPPORTUNITIES AND RELATED BILLS & PENDING LEGISLATION THAT MAY BE OF INTEREST TO THE WELL BEING OF THE HOSPITAL.

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

The Norwalk Hospital Association

Employer identification number

06-6068853

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 .......

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? ............

Yes No

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. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

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)? ....................................

Yes No

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.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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 ......

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, 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 .................	0	951,359		951,359
b	Buildings ................		138,667,910	80,861,938	57,805,972
c	Leasehold improvements ............		7,750,166	2,697,396	5,052,770
d	Equipment ................		232,771,161	193,034,833	39,736,328
e	Other .................		24,489,655	1,127,866	23,361,789
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........					126,908,218

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther 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.)

Part VIII

InvestmentsProgram 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.)		0

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DEFERRED FINANCING FEES				329,597
(2) Debt Service Fund				372,429
(3) Due from Affiliates				2,640,682
(4) Debt Service Reserve Fund				15,111,873
(5) MALPRACTICE TRUST FUND				4,567,394
(6) Goodwill - NRMC Purchase				15,097,582
(7) Non-Compete - NRMC Purchase				7,547,810
(8) CHEFA Bond Issue Expense				198,527
(9) CHEFA Bond Discount				101,668
(10) UNDERWRITERS DISC CHEFA GHI				436,311
(11) MISCELLANEOUS				81,421
Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........				46,485,294

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
Due to third party payors		16,535,753
Malpractice Reserve		9,815,058
Asset Retirement Obligation		11,509,090
CHA Trust loan short term		269,570
Workers' Comp Reserve		2,172,120
Long Term Disability Reserve		2,541,099
Lease - Current and long term		16,826
Radiology earnout		1,000,000

Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		43,859,516
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

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
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
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
9	Total adjustments (net). Add lines 4 - 8 .............................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

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
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
3	Subtract line 2e from line 1.....................		3
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
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
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
3	Subtract line 2e from line 1.....................		3
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
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......		5

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
FIN 48 Footnote	Schedule D, Part X, Line 2	There was no fin 48/asc 740 footnote in the audited financial statements.

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

The Norwalk Hospital Association

Employer identification number

06-6068853

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

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:

Yes

100% 150% 200% Other

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: .....

Yes

200% 250% 300% 350% 400% Other

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.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

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?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(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) ..		16,080	5,977,815	2,890,778	3,087,037	0.970 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .		41,289	43,547,244	32,174,890	11,372,354	3.580 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....		57,369	49,525,059	35,065,668	14,459,391	4.550 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	104	1,701,952	1,814,851	4,608	1,810,243	0.570 %
f Health professions education (from Worksheet 5) ..	3	30	13,277,969	3,924,767	9,353,202	2.940 %
g Subsidized health services (from Worksheet 6) ..	1	0	3,741,223	1,893,351	1,847,872	0.580 %
h Research (from Worksheet 7)		0	0	0	0	0 %
i Cash and in-kind contributions to community groups (from Worksheet 8) ..		0	0	0	0	0 %
jTotal Other Benefits ...	108	1,701,982	18,834,043	5,822,726	13,011,317	4.090 %
kTotal. Add lines 7d and 7j. ..	108	1,759,351	68,359,102	40,888,394	27,470,708	8.640 %

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

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense (at cost).....

7,146,308

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

1,490,020

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

Enter total revenue received from Medicare (including DSH and IME).....

84,380,371

Enter Medicare allowable costs of care relating to payments on line 5.....

99,105,829

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-14,725,458

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

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......

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 %
1NORWALK SURGERY CTR	AMBULATORY SURGICAL CENTER	70.000 %	0 %	25.000 %
2
3
4
5
6
7
8
9
10
11
12
13

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		Other (Describe)
1	NORWALK HOSPITAL ASSOCIATION 24 STEVENS STREET NORWALK,CT06856	X	X	X	X

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:NORWALK HOSPITAL ASSOCIATION

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

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

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

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?
Name and address		Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10

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 7, Column F		Bad Debt Expense of $20,654,069 has been excluded from the denominator in the calculations for part I, Column F. Part III, Line 4 REVENUES AND PATIENT ACCOUNTS RECEIVABLE ARE RECORDED WHEN PATIENT SERVICES ARE PERFORMED. AMOUNTS RECEIVED FROM CERTAIN PAYORS ARE DIFFERENT FROM THE ESTABLISHED BILLING RATES OF THE VARIOUS PROVIDERS, AND THESE DIFFERENCES ARE ACCOUNTED FOR AS ALLOWANCES. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED. REVENUE UNDER THIRD-PARTY PAYOR AGREEMENTS IS SUBJECT TO AUDIT AND RETROACTIVE ADJUSTMENTS. PROVISIONS FOR ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS AND ADJUSTMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. ADJUSTMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. There is no bad debt footnote in the audited financial statements.
PART III, LINE 8		ALL HOSPITALS MUST RECORD PROFITS IN ORDER TO GENERATE THE CAPITAL NEEDED TO INVEST IN FACILITIES AND SERVICES. SERVICES THAT RESPOND TO PUBLIC HEALTH NEEDS PROVIDED TO MEDICARE PATIENTS AT NORWALK HOSPITAL GENERATE NEGATIVE MARGINS AVERAGING AROUND 25 % OF COST. IT IS POSSIBLE THAT SOME OF THESE SERVICES WOULD BE DISCONTINUED IF THE DECISION WAS MADE ON A PURELY FINANCIAL BASIS. FOR THIS REASON, IT WOULD BE APPROPRIATE TO CONSIDER THE MEDICARE PAYMENT SHORTFALL A COMMUNITY BENEFIT. THE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6 WERE COMPUTED USING THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT MULTIPLIED AGAINST MEDICARE CHARGES.
PART III, LINE 9B		NORWALK HOSPITAL SENDS OUT TWO STATEMENTS BEFORE THE CLAIM THEN CYCLES TO OUR "EARLY OUT" COMPANY, WHO WOULD THEN WORK THE CLAIM FOR THREE MONTHS. OUR STATEMENTS HAVE MESSAGES OR LITERATURE ON THE BOTTOM OF THE STATEMENT ALERTING THE PATIENT TO THE FACT THAT IF THEY FEEL THEY NEED ASSISTANCE IN PAYING THEIR BILLS THEY CAN CALL CUSTOMER SERVICE AND REQUEST A FINANCIAL ASSISTANCE APPLICATION. THEY WOULD HAVE TO FILL IT OUT COMPLETELY, AND PROVIDE US WITH THE REQUESTED PAPERWORK, COPY OF INCOME TAXES BEING ONE OF THEM. IF THE APPLICATION COMES BACK TO US AND IS COMPLETE, WE WILL CHANGE THE FINANCIAL CLASS TO PENDING CHARITY SO THE CLAIM DOES NOT CYCLE TO COLLECTIONS. THE NORWALK HOSPITAL MANAGER, CUSTOMER SERVICE/INSURANCE VERIFICATION AND ASSISTANCE COORDINATOR PROCESS THE APPLICATIONS ON A WEEKLY BASIS. ONCE DETERMINATION IS MADE AS TO WHAT THEY MAY QUALIFY FOR, BASED ON OUR SLIDING SCALE (WHICH IS UPDATED YEARLY BASED ON POVERTY GUIDELINES, FAMILY SIZE, AND INCOME), THE APPROPRIATE AMOUNT WOULD BE ADJUSTED. PATIENTS ARE CALLED AND NOTIFIED IF THEY QUALIFY AND FOR WHAT AMOUNT. IF THERE IS A REMAINING BALANCE, THE ACCOUNT WOULD THEN BE CHANGED TO SELF-PAY.IF PATIENTS ARE ADMITTED THROUGH THE ER AND ARE SELF-PAY, OUR FINANCIAL COUNSELORS WOULD VISIT THEM TO DISCUSS APPLYING FOR MEDICAID. IF A PATIENT IS STRAIGHT SELF-PAY, OUR POLICY MANDATES THAT THE APPLICANT BE COMPLIANT WITH MEDICAID, AND IF THEY ARE DENIED, THEY CAN THEN APPLY FOR FINANCIAL ASSISTANCE THROUGH THE HOSPITAL, HOWEVER, IF THEY ARE DENIED FOR NON-COMPLIANCY, THEN FINANCIAL ASSISTANCE WOULD NOT BE APPLICABLE. IF A PATIENT IS NOT A CITIZEN AND THEY WOULD NOT QUALIFY FOR EMED (EMERGENCY MEDICAL FOR JUST THAT ONE INPATIENT VISIT), THEY WOULD BE ABLE TO APPLY FOR FINANCIAL ASSISTANCE WITHOUT HAVING TO APPLY FOR MEDICAID SINCE THEY WOULD BE DENIED ANYWAY. IF A PATIENT HAS TO HAVE AN OUTPATIENT PROCEDURE AND DOES NOT HAVE INSURANCE, PATIENT REGISTRATION WILL TRY TO OBTAIN REIMBURSEMENT FROM THAT PATIENT. IF THEY ARE UNABLE TO PAY, THEY WOULD CALL THE PATIENT'S PHYSICIAN TO SEE IF THE PROCEDURE CAN BE POSTPONED UNTIL FINANCIAL ARRANGEMENTS CAN BE MADE. IF THE DOCTOR STATES THEY CAN NOT POSTPONE THE PROCEDURE THEY WOULD ALLOW THE PATIENT TO COME BUT WOULD INSTRUCT THEM TO APPLY FOR MEDICAID AND IF DENIED THEY WOULD APPLY FOR FINANCIAL ASSISTANCE. IF A PATIENT IS FROM AN AFFILIATED FEDERALLY QUALIFIED HEALTH CENTER AND NEEDS TO HAVE SERVICES WHEREBY WE DO NOT HONOR THE DISCOUNT(I.E.: ALL INPATIENT SERVICES, OUTPATIENT IV THERAPY, RADIATION THERAPY, AND HYPERBARIC), AND IS NOT A CITIZEN, THEY WOULD BE REFERRED TO OUR FINANCIAL ASSISTANCE COORDINATOR, TO COMPLETE AN APPLICATION. IF A PATIENT FROM AN AFFILIATED FEDERALLY QUALIFIED HEALTH CENTER IS A CITIZEN, THEY WOULD FIRST NEED TO HAVE APPLIED FOR MEDICAID AND IF DENIED, THEY COULD APPLY FOR ASSISTANCE. OVERALL, PATIENTS CAN CALL CUSTOMER SERVICE, EVEN IF THEY ARE IN COLLECTIONS, TO BE CONSIDERED FOR FINANCIAL ASSISTANCE. IF THEY ARE IN COLLECTIONS AND APPLY, WE WOULD PULL THE ACCOUNT BACK ONCE THE APPLICATION IS RECEIVED WE HAVE A NUMBER OF SCREENS WE FILL OUT IN OUR ACCOUNTING SOFTWARE WHICH DENOTE THE PATIENT HAS APPLIED AND THE STATUS. ALSO, PATIENTS LIVING IN A SHELTER OR THAT ARE HOMELESS ARE ADJUSTED TO CHARITY AS WELL. ADDITIONALLY, ALL IV THERAPY AND RADIATION THERAPY ACCOUNTS THAT HAVE BEEN GRANTED CHARITY ARE ADJUSTED MONTHLY, SINCE THEY ARE BILLED MONTHLY. MEDICAID SPENDDOWN AMOUNTS ARE ALSO ADJUSTED TO CHARITY. BEEN GRANTED CHARITY ARE ADJUSTED MONTHLY, SINCE THEY ARE BILLED MONTHLY. MEDICAID SPENDDOWN AMOUNTS ARE ALSO ADJUSTED TO CHARITY.
NEEDS ASSESSMENT	Part VI, Question 2	IN FY 2010, AS PART OF NORWALK HOSPITAL'S COMMUNITY OUTREACH STRATEGIC INITIATIVE, NORWALK HOSPITAL AND THE NORWALK HOSPITAL FOUNDATION DEVELOPED COMMUNITY ADVISORY BOARDS REPRESENTING EACH OF THE COMMUNITIES WE SERVE. COMPRISED OF NEIGHBORS, HEALTH DIRECTORS, PUBLIC OFFICIALS, CLERGY, BUSINESS LEADERS, CIVIC GROUP REPRESENTATIVES, ETC.. THESE GROUPS ASSIST THE HOSPITAL IN ASSESSING THE HEALTH CARE NEEDS AND OUTREACH OPPORTUNITIES IN SPECIFIC TOWNS. THE ADVISORY BOARDS PROVIDE INVALUABLE FEEDBACK SO THAT WE CAN CONTINUALLY ENHANCE OUR OUTREACH EFFORTS AND MEET CHANGING HEALTH CARE NEEDS. THE PLANNING DEPARTMENT OF THE HOSPITAL HAS ACCESS TO HOSPITAL, STATEWIDE AND NATIONAL DATABASES THAT TRACK TRENDS AND SERVICE USAGE ON AN ONGOING BASIS IN ORDER TO EVALUATE HOW THE HOSPITAL IS MEETING THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE.
Patient education of eligibility for assistance	Part VI, Question 3	Through the hospital's access management and/or customer service division of the patient account, we inform patients about THE DETAILS OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, ASSIST WITH THE EXPLANATION OF THE FINANCIAL ASSISTANCE APPLICATION IF THE APPLICATION IS REQUIRED, DETERMINE THE AMOUNT OF THE DISCOUNT, INFORM THE PATIENT OF THE HOSPITAL'S FINAL DETERMINATION, AND PROCESS THE DISCOUNT IN THE HOSPITAL'S PATIENT ACCOUNTING SYSTEM. THE ONLY EXCEPTIONS ARE: [1] OUTPATIENT MENTAL HEALTH SERVICES WHERE THE DEPARTMENT OF PSYCHIATRY WILL QUALIFY AND PROCESS FINANCIAL ASSISTANCE APPLICATIONS, AND [2] DENTAL CLINIC WILL QUALIFY AND PROCESS FINANCIAL ASSISTANCE APPLICATIONS. THE PATIENT WILL HAVE 30 DAYS FROM THE RECEIPT OF THE APPLICATION PACKET TO RETURN IT IN ITS ENTIRETY. OTHERWISE, THE NORMAL STATEMENT CYCLE WILL CONTINUE UNDER THE CLASSIFICATION OF SELF PAY. WHEN AN APPLICATION IS RECEIVED, THE ACCOUNT STATUS WILL BE CHANGED TO PENDING FINANCIAL ASSISTANCE AND NO ADDITIONAL STATEMENTS WILL BE SENT TO THE PATIENT UNTIL A FINAL FINANCIAL ASSISTANCE DETERMINATION IS MADE. IF THE PATIENT FILES FOR FINANCIAL ASSISTANCE ONLY AFTER LEGAL ACTION HAS BEEN INITIATED FOLLOWING REASONABLE COLLECTION EFFORTS, THE PATIENT WILL BE ENTITLED TO FILE A FINANCIAL ASSISTANCE APPLICATION BUT WILL BE RESPONSIBLE FOR ANY LEGAL FEE COSTS AND/OR COURT COSTS INCURRED UP TO THE POINT OF TIME OF THE APPLICATION. THE EXISTENCE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM WILL BE POSTED IN BOTH ENGLISH AND SPANISH AT ALL REGISTRATION POINTS WITHIN THE HOSPITAL. THE FOLLOWING PATIENTS WILL RECEIVE A FINANCIAL ASSISTANCE APPLICATION, ALSO AVAILABLE IN BOTH ENGLISH AND SPANISH, BY PATIENT ACCESS PERSONNEL AT THE TIME OF REGISTRATION: A. ALL ED PATIENTS WHO PRESENT TO THE EMERGENCY ROOM AS SELF PAY B. ANY PATIENT WHO INDICATES AN INABILITY TO PAY HOSPITAL PATIENT STATEMENTS WILL CLEARLY INDICATE THE EXISTENCE OF A FINANCIAL ASSISTANCE PROGRAM INCLUDING CUSTOMER SERVICE TELEPHONE NUMBERS.
COMMUNITY INFORMATION	Part VI, Question 4	NORWALK HOSPITAL IS A NOT-FOR-PROFIT ACUTE CARE COMMUNITY TEACHING HOSPITAL WHICH IS LICENSED FOR 328 BEDS. THE HOSPITAL HAS OVER 500 PHYSICIANS ON ITS ACTIVE MEDICAL STAFF, MANY OF WHOM TRAINED AT THE NATION'S LEADING MEDICAL SCHOOLS AND HOSPITALS, AND 2,000 HEALTH PROFESSIONALS AND SUPPORT PERSONNEL. NORWALK HOSPITAL SERVES AN AREA POPULATION OF ABOUT 270,000 IN LOWER FAIRFIELD COUNTY. THE SERVICE AREAS INCLUDE PRIMARILY NORWALK, NEW CANAAN, WESTPORT, WESTON AND WILTON; AS WELL AS DARIEN, FAIRFIELD, REDDING AND RIDGEFIELD. THERE ARE FIVE OTHER HOSPITALS IN NORWALK HOSPITAL'S PRIMARY SERVICE AREA. A DIVERSE SOCIO-ECONOMIC POPULATION, NORWALK HOSPITAL SERVES AN AGING POPULATION, FROM THE AFFLUENT TO THE MEDICALLY UNDERSERVED. THE AVERAGE HOUSEHOLD INCOME IN THE NORWALK HOSPITAL'S SERVICE AREA IS $163,887, AND THE ESTIMATED UNINSURED POPULATION IN THE CITY OF NORWALK IS 15%. THE PERCENTAGE OF POPULATION THAT IS 65+ IS EXPECTED TO INCREASE FROM 13.9% IN 2010, TO 15.6% IN 2015, AND WOMEN OF CHILDBEARING-AGE (18-44) ARE FORECAST TO DECLINE 2.5% OVER THIS SAME PERIOD OF TIME.
PROMOTION OF COMMUNITY HEALTH	Part VI, Question 5	NORWALK HOSPITAL PROVIDES A VAST ASSORTMENT OF SERVICES TO THE COMMUNITY FREE OF CHARGE AND FURTHER CARRIES OUT ITS CITIZENSHIP BY MEETING THE NEEDS OF THE UNDERSERVED, WHICH INCLUDES ABOUT 44 PERCENT OF ITS PATIENTS. THE HOSPITAL MAKES AVAILABLE TO THE COMMUNITY, WITHOUT REGARD FOR ABILITY TO PAY, AN IMPRESSIVE LIST OF SPECIALTIES, SUCH AS: CHILDBIRTH CENTER: NORWALK HOSPITAL PROVIDES EXCEPTIONAL MATERNITY AND PEDIATRIC SERVICES. THE OBSTETRICIANS ARE SUPPORTED BY HIGHLY SKILLED NURSES, CERTIFIED NURSE MIDWIVES, PHYSICIAN ASSISTANTS, NEONATOLOGISTS, AND YALE PERINATOLOGISTS TO HELP MANAGE HIGH-RISK PREGNANCIES. THE HOSPITAL ALSO OFFERS COMPREHENSIVE CHILDBIRTH EDUCATION AND SUPPORT PROGRAMS. THE SMILOW FAMILY BREAST HEALTH CENTER: THE SMILOW CENTER ADDRESSES BREAST CARE IN A SEAMLESS MANNER, BEGINNING WITH COMMUNITY EDUCATION AND SCREENING. FOCUSING ON RAPID DIAGNOSIS, THE PROGRAM PROVIDES ON-GOING SUPPORT THROUGHOUT THE PROCESS OF REFERRAL AND SCHEDULING TO ALL NEEDED SERVICES AND PHYSICIANS. TRAUMA CENTER: NORWALK HOSPITAL IS DESIGNATED AS A LEVEL II TRAUMA CENTER, WHICH IS DEDICATED TO THE SURVIVAL AND RESTORATION OF PATIENTS TO THEIR BEST FUNCTIONAL OUTCOME. STROKE PROGRAM: NORWALK HOSPITAL HAS EARNED THE GOLD SEAL OF APPROVAL FOR STROKE CARE. THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS HAS AWARDED NORWALK HOSPITAL PRIMARY STROKE CENTER CERTIFICATION "FOR DEMONSTRATING THAT ITS STROKE CARE PROGRAM FOLLOWS NATIONAL STANDARDS AND GUIDELINES THAT CAN SIGNIFICANTLY IMPROVE OUTCOMES FOR STROKE PATIENTS." CANCER DIAGNOSTICS AND THERAPY: A COMPREHENSIVE PROGRAM THROUGH THE WHITTINGHAM CANCER CENTER BRINGS TO SOUTHWESTERN CONNECTICUT THE LATEST KNOWLEDGE, TECHNIQUES, AND TECHNOLOGY FOR THE DIAGNOSIS AND TREATMENT OF CANCER. THE CANCER CENTER IS COMMITTED TO ASSURING A FULL SPECTRUM OF ONCOLOGY SERVICES TO THE PEOPLE OF OUR COMMUNITY. FROM PREVENTION AND SCREENINGS, TO DIAGNOSIS AND TREATMENT, THE STAFF IS CONTINUALLY RESPONDING TO THE CHANGING NEEDS OF HEALTHCARE AND CANCER PATIENTS. SURGICAL SERVICES: NORWALK HOSPITAL'S DEDICATED SURGICAL STAFF OFFERS HIGH QUALITY SURGICAL CARE. NORWALK HOSPITAL'S OUTSTANDING SURGEONS ARE IN THE FOREFRONT OF SURGICAL PROCEDURES INCLUDING LAPAROSCOPIC SURGERY, MAJOR JOINT REPLACEMENT, AND UROLOGICAL SERVICES. SLEEP CENTER: A NATIONALLY ACCREDITED CENTER PROVIDES FOR DIAGNOSIS AND MANAGEMENT OF THE FULL RANGE OF SLEEP DISORDERS, INCLUDING SLEEP APNEA AND INSOMNIA. THE CENTER CONDUCTS INTERNATIONAL RESEARCH TRIALS THAT KEEP IT AT THE FOREFRONT OF NEW AND DEVELOPING THERAPIES. BARIATRIC CENTER: THE NORWALK HOSPITAL BARIATRIC CENTER HAS BEEN NAMED AN AMERICAN SOCIETY FOR BARIATRIC SURGERY (ASBS) BARIATRIC SURGERY CENTER OF EXCELLENCE. THE ASBS CENTER OF EXCELLENCE DESIGNATION RECOGNIZES SURGICAL PROGRAMS WITH A DEMONSTRATED TRACK RECORD OF FAVORABLE OUTCOMES IN BARIATRIC SURGERY. WOUND CARE AND HYPERBARIC MEDICINE CENTER: AS A REFERRAL CENTER FOR COMPREHENSIVE WOUND MANAGEMENT, THE CENTER HAS HAD VERY SUCCESSFUL RESULTS BY PROVIDING ADVANCED TREATMENT TO CURE WOUNDS THAT PREVIOUSLY WOULD NOT HEAL. NORWALK HOSPITAL HAS MORE THAN TWENTY-FIVE YEARS OF EXPERIENCE IN PROVIDING HYPERBARIC OXYGEN THERAPY, PIONEERING AS THE FIRST HOSPITAL-BASED HYPERBARIC SERVICE IN NEW ENGLAND. TWENTY-FIVE PERCENT OF PEOPLE WITH NON-HEALING WOUNDS BENEFIT FROM RECEIVING HYPERBARIC OXYGEN THERAPY. MANY PATIENTS WITH NON-HEALING WOUNDS ARE REFERRED TO NORWALK HOSPITAL FOR ASSESSMENT BECAUSE OF THIS EXPERTISE. COMMUNITY HEALTH CENTER: NORWALK HOSPITAL IS A FINANCIAL SPONSOR FOR THE NORWALK COMMUNITY HEALTH CENTER, A COMMUNITY-BASED FEDERALLY QUALIFIED HEALTH CENTER, WHICH OFFERS COMPREHENSIVE HEALTHCARE AT AFFORDABLE PRICES TO RESIDENTS OF A MEDICALLY UNDERSERVED COMMUNITY. OTHER COMMUNITITY Benefit Activities: WOMEN WITH LIMITED OR NO HEALTH INSURANCE MAY BE ELIGIBLE FOR FREE MAMMOGRAMS, BREAST EXAMS, AND "PAP" PROCEDURES IN AN EARLY DETECTION PROGRAM OFFERED AT NORWALK HOSPITAL THROUGH THE CONNECTICUT BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM. THE MEDICAL STAFF PROVIDES AN ANNUAL WELLNESS SERIES, NOW IN ITS 29TH YEAR, FOR THE COMMUNITY AND THE SECTION OF PULMONARY MEDICINE HAS BEEN OFFERING FREE SMOKING CESSATION PROGRAMS TWICE A YEAR FOR OVER 30 YEARS. NORWALK HOSPITAL OFFERS A WIDE RANGE OF COMMUNITY SERVICES BOTH AT THE HOSPITAL AND IN THE COMMUNITY. HOSPITAL ASSOCIATES AND AFFILIATED PHYSICIANS PROVIDE WELLNESS PROGRAMS TO SCHOOLS, CIVIC GROUPS, CHURCHES, AND OFFER COMMUNITY HEALTH FAIRS AND SCREENINGS. Examples of promoting health of community: Norwalk Hospital staff and affiliated MDs participate in health fairs, community education lectures and screenings with community YMCAs, senior centers, schools, Department of Health, etc. In collaboration with the State of CT Dept. of Health and the CDC, Norwalk Hospital offers the CT Breast and Cervical Cancer Early Detection Program and promotes this program to the community. Norwalk Hospital offers program and financial support to the Norwalk Community Health Center, a FQHC. Norwalk Hospital specialty clinics are staffed by volunteer attending physicians for surgical, GI, pulmonary, cardiology, orthopaedics, podiatry, physiology, nephrology, neurology for underserved patients.
AFFILIATED HEALTH CARE SYSTEM	Part VI, Question 6	In order to promote the health of the community Norwalk Hospital is responsible for coordinating the services of the hospital with those of other health, education and social services in the community (e.g. long-term care facilities, community outreach, health promotion/illness prevention organizations, etc.) in order to optimize the availability of a full scope of services in a cost-effective manner. As a not-for-profit organization, Norwalk Hospital provides needed medical care to all, including those who cannot pay for it. (This comes from our vision and values statement. We are currently a one system hospital, no affiliated hospitals.)

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
The Norwalk Hospital Association

Employer identification number
06-6068853

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) Norwalk Hospital Foundation24 Stevens Street Norwalk,CT06850	22-2577708	501(c)(3)	1,042,576	0	n/a	n/a	Fund Operations

Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image

Enter total number of other organizations ................................ . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2010

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
Form 990, Schedule I, line 2	Description of Organization's Procedures for Monitoring the Use of Grants	Funds are provided to Norwalk Hospital Foundation, a related 501(c)(3) organization, which is subject to the same policies and procedures as Norwalk Hospital Association.

Schedule I (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

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

The Norwalk Hospital Association

Employer identification number

06-6068853

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

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? ....

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ...............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

Yes

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

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
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) Daniel DeBarba	(i) (ii)	416,638 0	210,000 0	44,147 0	11,025 0	18,895 0	700,705 0	0 0
(2) Patrick Minicus	(i) (ii)	244,411 0	83,008 0	27,052 0	7,656 0	17,394 0	379,521 0	0 0
(3) Geoffrey Cole	(i) (ii)	202,525 0	100,247 0	945,280 0	30,767 0	16,029 0	1,294,848 0	0 0
(4) Eric Mazur	(i) (ii)	571,892 0	114,443 0	77,923 0	30,028 0	14,394 0	808,680 0	0 0
(5) Lisa Brady	(i) (ii)	340,144 0	108,609 0	1,692 0	11,025 0	14,394 0	475,864 0	0 0
(6) Mary NolaN	(i) (ii)	272,147 0	59,032 0	41,350 0	36,781 0	15,794 0	425,104 0	0 0
(7) Anthony Aceto	(i) (ii)	250,680 0	61,851 0	31,726 0	16,293 0	14,394 0	374,944 0	0 0
(8) Peter Dodds	(i) (ii)	360,000 0	0 0	72,202 0	32,628 0	0 0	464,830 0	0 0
(9) Michael Carius	(i) (ii)	359,523 0	78,219 0	99,961 0	33,654 0	15,694 0	587,051 0	0 0
(10) Arthur Srichman	(i) (ii)	223,771 0	167,241 0	60,333 0	29,316 0	15,894 0	496,555 0	0 0
(11) Brian McGovern	(i) (ii)	246,739 0	261,740 0	26,380 0	20,066 0	24,393 0	579,318 0	0 0
(12) Stephen Winter	(i) (ii)	331,634 0	60,201 0	77,688 0	31,125 0	14,394 0	515,042 0	0 0

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
Supplemental Compensation Information	Schedule J, Part I, LINE 1A:	TAX GROSS-UP PAYMENTS ARE PROVIDED ON TAXABLE BENEFITS IN ACCORDANCE WITH THE NORWALK HOSPITAL ASSOCIATION'S SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, DESCRIBED BELOW IN RESPONSE TO LINE 4B. ADDITIONALLY, TAX GROSS UP PAYMENTS ARE PROVIDED FOR TAXABLE MOVING EXPENSES AND ON THE TAXATION OF THE FORMER CEO'S PERSONAL USE OF A HOSPITAL-OWNED AUTOMOBILE PRIOR TO HIS TERMINATION AS CEO(FOR CALENDAR YEAR 2010 ONLY). ALL TAX GROSS-UP PAYMENTS ARE TREATED AS TAXABLE COMPENSATION TO THE INDIVIDUALS RECEIVING SUCH PAYMENTS.
Supplemental Compensation Information	Schedule J, Part I, LINE 1B	THE TAX GROSS-UP FOR THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN WAS APPROVED BY THE BOARD IN 1996 WHEN THE PLAN WAS CREATED. THIS DECISION WAS REACHED WITH THE ADVICE OF OUTSIDE COUNSEL AND A COMPENSATION CONSULTING FIRM. IN GENERAL, TAX GROSS-UP DECISIONS ARE MADE ON A CASE BY CASE BASIS RELATED TO SPECIFIC ELEMENTS AND THE INTENTION OF ANY PARTICULAR COMPENSATION PLAN OR PROGRAM. THESE DECISIONS ARE REACHED IN CONCERT WITH, BUT NOT LIMITED TO, THE FOLLOWING PARTIES: CEO OR OTHER EXECUTIVES, HUMAN RESOURCES, ACCOUNTING, PAYROLL, OUTSIDE COUNSEL, OUTSIDE TAX ADVISORS, AND OUTSIDE COMPENSATION CONSULTANTS. THIS PROCESS ENSURES, TO THE GREATEST DEGREE POSSIBLE, THAT ANY TAX GROSS-UP DECISIONS ARE IN COMPLIANCE WITH ANY IRS REGULATIONS AND PREVAILING GOOD MANAGEMENT PRACTICES. Although this is the policy followed, there is no formal written policy/procedure regarding this at this time.
Supplemental Compensation Information	SCHEDULE J, PART I, LINE 4A	Geoffrey Cole RECEIVED part of a two year severance arrangement based upon his COMPENSATION AT THE TIME OF TERMINATION. THE AMOUNT PAID during the year, $862,249, has BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B(III).
Supplemental Compensation Information	SCHEDULE J, PART I, LINE 4B:	NORWALK HOSPITAL Association HAS ESTABLISHED the Norwalk Hospital Senior Deferred Compensation Plan, Primarly for the purpose of providing a program of deferred compensation for Daniel Debarba, President and CEO, amounts promised under the plan are based on targeted retirement benefits. The payment of benefits under the plan is subject to vesting, no amounts were vested or reported as taxable income on Mr. Debarba's 2010 W2.
Supplemental Compensation Information	Schedule J, Part III, Line 7	Bonuses are provided based on a goals system. Goals are established for eligible employees at the beginning of the fiscal year. Bonuses are paid in accordance with the overall financial performance of the hospital as well as the employee's success in meeting or exceeding those goals.

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
The Norwalk Hospital Association

Employer identification number
06-6068853

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	STATE OF CT HEALTH & EDU FACILITIES AUTHORITY	06-0806186		12-09-2010	46,840,000	SEE PART V		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .	0
2 Amount of bonds defeased . . . .	0
3 Total proceeds of issue . . . .	46,844,170
4 Gross proceeds in reserve funds . .	0
5 Capitalized interest from proceeds.	494,062
6 Proceeds in refunding escrow. . . . .	0
7 Issuance costs from proceeds . . .	829,268
8 Credit enhancement from proceeds.	0
9 Working capital expenditures from proceeds . .	463,600
10 Capital expenditures from proceeds . .	31,106,035
11 Other spent proceeds . .	0
12 Other unspent proceeds. . .	13,951,207
13 Year of substantial completion . . .	2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?		X
15 Were the bonds issued as part of an advance refunding issue?		X
16 Has the final allocation of proceeds been made? . .		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .	X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2010

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use?		X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .	0.510 %
6 Total of lines 4 and 5 . . .. . . . . .	0.510 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X
2 Is the bond issue a variable rate issue?		X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?		X
b Name of provider .	Na
c Term of hedge . .	0.
d Was the hedge superintegrated? .		X
e Was a hedge terminated? .		X
4a Were gross proceeds invested in a GIC? .		X
b Name of provider .	Na
c Term of GIC . .	0.
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .		X
5 Were any gross proceeds invested beyond an available temporary period? .		X
6 Did the bond issue qualify for an exception to rebate? . . .		X

Schedule K (Form 990) 2010

Page 3

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation
SCHEDULE K, PART I	USE OF BOND PROCEEDS	THE PROCEEDS OF THE BOND ARE BEING USED FOR Construction of a parking garage and for the purchase of other capital equipment.

Schedule K (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

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

The Norwalk Hospital Association

Employer identification number

06-6068853

Identifier	Return Reference	Explanation
FORM 990, PART I, LINE 1 & PART III, LINE 1	ORGANIZATION'S MISSION	The mission of Norwalk Hospital is to provide uniquely excellent, innovative and compassionate health care with exceptional outcomes. Vision: Norwalk Hospital will be the hospital of choice for patients, physicians, and health care professionals, recognized for delivering innovative clinical services with compassion. We are guided by these values Patient-centered: honoring each individuals dignity, privacy, and confidentiality, empowering patients and their families as partners in their care, facilitating simple, convenient ways for patients and their families to use our programs and services Excellence: setting the highest standards for safety, clinical outcomes and personal service, and continuously measuring, monitoring and raising those standards Innovation: continuously pioneering new and better ways to deliver care, including bringing state-of-the-art technology to real-world care delivery, research and prevention of illness Leadership: attracting and developing throughout the organization people who are recognized as exceptional leaders and who subscribe to these values Teamwork: Working together to achieve our mission and goals in a cooperative, respectful, open environment Trust and Fairness: We foster a climate of openness in which all who work here treat one another with trust and fairness, we support open communication to enhance this climate Education: providing nationally recognized medical education programs for future providers, participating in clinical research and offering a range of educational programs to our patients and the community to enhance their health and well-being Financial Responsibility: being accountable as financial stewards for constant improvement in the efficiency and effectiveness of service delivery, coordinating the services of Norwalk Hospital with those of other health, education, and social services in the community (e.g. long-term care facilities, community outreach, health promotion/illness prevention organizations, etc.) in order to optimize the availability of a full scope of services in a cost-effective manner Charity: as a not-for-profit organization, providing needed medical care to all, including those who cannot pay for it. FORM 990, Part III, Line 4 Other Program Service Descriptions Other Program Services Include: ED treated and Released; Cardiovascular services; Cancer services; Pulmonary & Respiratory services; Rehab services; All Other Surgical services; Pediatric services; Psychiatry services; All Other Medical services; and All Other lab services
DESCRIPTION OF CLASSES OF MEMBERS OF STOCKHOLDERS	Form 990, Part VI, SECTION A, LINES 6 & 7	NORWALK HEALTH SERVICES CORPORATION, INC. IS THE SOLE MEMBER OF NORWALK HOSPITAL ASSOCIATION (NHA) AND APPOINTS NHA'S BOARD OF DIRECTORS.
Describe the Process used by Management &/or Governing Body to Review 990	Form 990, Part VI, line 11	NORWALK HOSPITAL ASSOCIATION'S (NHA) FORM 990 IS PREPARED WITH THE ASSISTANCE OF ERNST & YOUNG LLP AND REVIEWED BY NHA'S INTERNAL MANAGEMENT. FOLLOWING THAT REVIEW, NHA'S INTERNAL MANAGEMENT PRESENTS THE FORM 990 TO THE AUDIT COMMITTEE FOR REVIEW AND COMMENT. THE COMPLETED FORM 990 IS PROVIDED, via email, TO ALL MEMBERS OF THE BOARD OF Trustees PRIOR TO THE FORM BEING FILED WITH THE IRS.
Description of Process to Monitor Transactions for Conflicts of Interest	FORM 990, PART VI, LINE 12C	MONITORING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY PROVIDES THAT ANNUALLY, EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL SIGN A STATEMENT AFFIRMING THAT SUCH PERSON RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, READ AND UNDERSTANDS THE POLICY AND AGREES TO COMPLY WITH THE POLICY. ADDITIONALLY, THE SIGNED STATEMENT AFFIRMS THAT THE PERSON UNDERSTANDS THE Hospital IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, THE Hospital MUST ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. ENFORCEMENT FAILURE TO COMPLY WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY SHALL CONSTITUTE GROUNDS FOR REMOVAL OF A PERSON COVERED BY THE POLICY AS A BOARD MEMBER OR BOARD COMMITTEE MEMBER, AND, IN THE CASE OF KEY MANAGEMENT PERSONNEL, TERMINATION OF EMPLOYMENT. WHO IS COVERED? THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS. LEVEL OF DETERMINATION AND REVIEW OF CONFLICTS IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER PRESENTATION OF A POTENTIAL TRANSACTION OR ARRANGEMENT IS MADE BY AN INTERESTED PERSON, THE REMAINING DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE IF THE Hospital CAN OBTAIN, WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, THE GOVERNING BOARD OR COMMITTEE SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. RESTRICTIONS PLACED ON CONFLICTED PERSONS IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS.
Written Document Retention & Destruction Policy	Form 990, Part VI, line 14	NORWALK HOSPITAL ASSOCIATION (NHA) IS IN THE PROCESS OF DRAFTING A FORMAL WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY.
Offices & Positions for Which Process was Used, & Year Process was Begun	Form 990, Part VI, line 15a & 15b	AN OUTSIDE CONSULTING FIRM CONDUCTS AN EXECUTIVE COMPENSATION ANALYSIS UTILIZING THIRD-PARTY, BLINDED SURVEY DATA SOURCES. THE CONSULTANT THEN PRESENTS FINDINGS TO THE COMPENSATION COMMITTEE OF THE BOARD, WHO DECIDE WHAT ACTION TO TAKE, IF ANY, FOR EACH EXECUTIVE. THIS PROCEDURE ONLY APPLIES TO THE PRESIDENT, VICE PRESIDENTS, AND CERTAIN KEY EMPLOYEES. FOR THOSE KEY EMPLOYEES WHOSE SALARIES ARE NOT SUBJECT TO THE COMPENSATION COMMITTEE REVIEW, THEIR RESPECTIVE VICE PRESIDENTS ASSESS THEIR PERFORMANCE AND DETERMINE SALARY INCREASES BASED ON THE GUIDELINES ESTABLISHED BY THE ANNUAL REVIEW PROGRAM AND FINAL REVIEW RATINGS. COMPENSATION DECISIONS ALSO EMPLOY EXTERNAL MARKET SURVEY DATA AND INTERNAL ANALYSIS BASED ON NORWALK HOSPITAL ASSOCIATION'S SALARY RANGES. THIS PROCESS IS UNDERTAKEN EACH YEAR.
Joint Venture Policy	Form 990, PART VI, Section B, Line 16B	WHILE A WRITTEN POLICY HAS NOT BEEN ADOPTED REGARDING THE EVALUATION OF PARTICIPATION IN JOINT VENTURES, MANAGEMENT FOLLOWS A PROCEDURE IN WHICH ALL POSSIBLE JOINT VENTURE ARRANGEMENTS ARE EVALUATED UNDER APPLICABLE FEDERAL TAX LAWS. MANAGEMENT UTILIZES THE SERVICES OF APPROPRIATE CONSULTANTS AND LEGAL COUNSEL TO EVALUATE EACH JOINT VENTURE OPPORTUNITY. THIS EVALUATION ALSO INCLUDES AN ANALYSIS OF HOW THE JOINT VENTURE WILL FURTHER THE HOSPITAL'S MISSION. THE HOSPITAL HAS TAKEN ALL APPROPRIATE STEPS TO SAFEGUARD ITS TAX EXEMPT STATUS WITH RESPECT TO ALL JOINT VENTURE ARRANGEMENTS. JOINT VENTURE ARRANGEMENTS ARE APPROVED BY THE BOARD OF TRUSTEES.
Governing documents, etc. available to the public	FORM 990, PART VI, LINE 19	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Hours devoted to a RELATED ORGANIZATION	FORM 990, PART VII	THE INDIVIDUALS LISTED BELOW WORKED THE FOLLOWING HOURS PER WEEK FOR A RELATED ORGANIZATION DURING THE FISCAL YEAR: ERVIN SHAMES 4 DIANE ALLISON 3 GEORGE BAUER 2 ANDREW WHITTINGHAM 1 JOSEPH MANN 1 FRED AFGRAGOLA 3 BARBARA BUTLER 2 DANIEL DEBARBA 8 VICTOR LISS 3 DAVID KOMANSKY 1 DAVID LEHN 3 MICHAEL MARKS 51 GARY REINER 1 ROLAND STICHWEH 1 WILLIAM TAMME 3 RICHARD ZELKOWITZ 2 ROBERT READY 3 THOMAS AYOUB 1 MARIA BORGES-LOPEZ 1 PAUL GAGNE 1 MARK GUDIS 1 ED KANGAS 1 ED MAHONEY 2
Other Changes in Net Assets or Fund Balances	Part XI, Line 5	Unrealized Loss (1,455,301) Trans FCMS (4,642,266) Trans NHF (765,289) Trans NHF 322,298 Trans NSC (2,100,000) Trans NHSC 1,914,719 Pension (25,149,518) Temp Restr. 7,585,808 Perm Restr. 10,534 PY NSC Contr. (700,000) PY NSC Loss 258,904 K-1 Joint Venture 2010 (400) _____________ Line 5 Total (24,720,511)
Compensation Committee	Schedule J, Part I, Line 3	The Compensation Committee is from Norwalk Health Services Corporation (NHSC) as per the NHSC Bylaws.

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:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

The Norwalk Hospital Association

Employer identification number

06-6068853

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
(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	Yes	No
(1) Fairfield County Medical Services Inc 24 Stevens Street Norwalk,CT06850 06-1522078	PHYS PRACTICE	CT	501(c)(3)	11B	NHA
(2) NHC DBA Honey Hill Rehab & Nursing Ctr 34 Midrock Drive Norwalk,CT06851 22-2577722	NURSING REHAB	CT	501(c)(3)	9	NHSC
(3) Norwalk Health Services Corp 24 Stevens Street Norwalk,CT06850 22-2577711	SUPPORT SVCS	CT	501(c)(3)	11B	NA
(4) Norwalk Hospital Foundation 34 Maple Street Norwalk,CT06856 22-2577708	FUNDRAISING	CT	501(c)(3)	7	NHSC
(5) Advanced Center for Rehab Medicine 24 Stevens Street Norwalk,CT06850 06-1304799	INACTIVE	CT	501(c)(3)	11B	NHSC

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Norwalk Surgery Center LLC 27-2394942 40 Cross Street NORWALK Norwalk,CT06850	SURGERY CENTER	CT	NONE	RELATED	-642,803	3,044,485		No	0		No	70.000 %

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)
(1) Maple Street Indemnity Company Ltd 40 Church St PO Box 2062 Hamilton HM HX BD 98-0549862	Captive Insurance	BD	NHSC	C-Corp
(2) SWC CORPORATION 24 STEVENS STREET NORWALK,CT06850 22-2577718	PHARMACY	CT	NHSC	C-CORP

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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
(1) Fairfield County Medical Services Inc	i	133,194
(2) Fairfield County Medical Services Inc	l	4,229,918
(3) Fairfield County Medical Services Inc	p	9,581,910
(4) Maple Street Indemnity Company LTD	q	6,000,000
(5) Norwalk Health Care	k	1,580,698
(6) Norwalk Health Care	p	551,936
(7) Norwalk Health Care	r	288,302
(8) Norwalk Health Services Corporation	r	1,914,723
(9) Norwalk Health Services Corporation	q	180,000
(10) Norwalk Hospital Foundation	b	1,042,576
(11) Norwalk Hospital Foundation	c	2,045,335
(12) Norwalk Hospital Foundation	k	65,160
(13) Norwalk Hospital Foundation	p	1,459,740
(14) Norwalk Hospital Foundation	q	765,289
(15) Norwalk Hospital Foundation	r	2,050,000
(16) Norwalk Surgery Center	b	2,100,000
(17) SWC Corporation	k	138,000
(18) SWC Corporation	l	3,412,305
(19) SWC Corporation	p	232,206
(20) SWC Corporation	q	5,410,900
(21) SWC Corporation	r	2,230,900

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: The mission of Norwalk Hospital is to provide uniquely excellent, innovative and compassionate health care with exceptional outcomes.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	20
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	2,108
6	Total number of volunteers (estimate if necessary) ....	6	524
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	4,615,716
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,857,005	4,163,105
9	Program service revenue (Part VIII, line 2g) .........	335,284,118	355,229,999
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,181,407	1,637,037
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,204,505	2,473,072
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	342,527,035	363,503,213
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,428,713	1,042,576
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)	178,353,547	176,190,042
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	157,435,977	161,029,924
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	337,218,237	338,262,542
19	Revenue less expenses. Subtract line 18 from line 12......	5,308,798	25,240,671
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	258,806,324	347,466,749
21	Total liabilities (Part X, line 26)............	123,629,682	211,769,948
22	Net assets or fund balances. Subtract line 21 from line 20 .....	135,176,642	135,696,801

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 41,410,907 including grants of $ 0 ) (Revenue $ 47,594,146 )
	ORTHOPEDICS AND NEUROSPINE SERVICES: Norwalk Hospital provides comprehensive, high-quality orthopedic and neurospine care to residents of Greater Fairfield County, Connecticut through an expert team of board-certified or eligible orthopedists and neurosurgeons who have trained at some of the nations most prestigious hospitals and medical schools. A signature service, our orthopedic and neurospine program features a collaborative, team approach for the evaluation, treatment, and rehabilitation of diseases and conditions affecting the bones, joints, cartilage, muscles, tendons and ligaments. Clinical services provided includes: Arthritis & Joint Pain Treatment, Foot and ankle care, Fracture care, Hand and upper extremity care, including shoulder and elbow replacement surgery), Joint replacement (hip & knee), Spine surgery, Sports Medicine, Trauma care for orthopedic injuries. OrthoNeuro had total Inpatient Discharges of 1,845 for the fiscal year ended 9/30/2011.

4b	(Code: ) (Expenses $ 35,845,411 including grants of $ 0 ) (Revenue $ 40,027,060 )
	GASTROENTEROLOGY & DIGESTIVE SERVICES: Norwalk Hospital is noted for its advanced gastroenterology program, which is considered to be a leading program in Connecticut as well as in nearby Westchester County, New York, for the diagnosis and treatment of a wide range of digestive diseases and conditions. One of the Hospitals premier signature clinical services, this program features experienced and highly respected gastroenterologists, on the Norwalk Hospital Medical Staff, who see patients in their offices throughout lower Fairfield County as well as at the Hospitals Center for Digestive Diseases. A key component of Norwalk Hospitals digestive diseases service is a colorectal cancer screening program. Colorectal cancers are highly preventable and treatable if caught early. Health experts recommend a screening colonoscopy at age 50 for adults considered at average risk. Colonoscopies are performed by gastroenterologists in the Hospitals modern and nationally accredited Gastrointestinal (GI) Lab. Norwalk Hospital is the only hospital in Connecticut to offer Third Eye Retroscope-enhanced colonoscopies. This new technology has been shown in clinical studies to improve the detection rate of potentially pre-cancerous colon polyps by up to 25%. Once detected, the colon polyps can be removed during the colonoscopy. Several gastroenterologists on the Hospitals medical staff are offering Third Eye Retroscope-enhanced colonoscopies to patients. The Norwalk Hospital Center for Digestive Diseases provides state-of-the-art, academic medical center-level care in a conveniently located, community hospital setting. The Centers widely recognized, fellowship-trained; specialist physicians provide leading-edge diagnostics and treatments for disorders of the esophagus, stomach, small intestine, colon, rectum, gallbladder, pancreas and liver. A leader in advanced endoscopic procedures for the treatments of gastrointestinal disorders, the Center also offers a chronic heartburn program, and, in partnership with Yale School of Medicine, a comprehensive Liver Center. Clinical services provided by the Centers specialist physicians include, but are not limited to: Ablation therapy for Barretts esophagus, Chronic heartburn (GERD) evaluation and treatment, Colon cancer screening, Colonoscopies, Double balloon-assisted enteroscopy, Endoscopic procedures, including endoscopic ultrasound, Inflammatory bowel disease evaluation and treatments, Liver diseases, including Hepatitis C, evaluations and treatments. The Center serves as a major teaching site for the Yale School of Medicine. William Hale, MD, director of gastroenterology and hepatology; Dennis Meighan, DO, director of endoscopy; and Seth A. Gross, MD, director of advanced endoscopy; help train residents and fellows, and also conduct clinical research studies designed to improve care for patients. Gastro & Digestive had total Inpatient Discharges of 1,807 for the fiscal year ended 9/30/2011.

4c	(Code: ) (Expenses $ 34,466,806 including grants of $ 0 ) (Revenue $ 37,725,513 )
	WOMEN'S HEALTH: One of the Hospital's premier signature clinical programs, our Women's and Children's Services features a top notch team of obstetricians/gynecologists, pediatricians, certified nurses midwives, pediatric hospitalists, neonatologists, pediatric specialists, physician assistants and nurses. This team's compassionate and expert care is further enhanced by the onsite availability of full-time perinatologists from Yale University Medical School. Our obstetricians and certified nurse midwives deliver babies in the Hospital's modern, home-like Childbirth Center. The center features in-suite amenities, including beautiful single rooms with private baths and showers, massage therapy for infants and mothers, wireless Internet access and flat-screen televisions. For additional expertise, the Hospital also provides perinatology services, for high-risk pregnancy, as well as reproductive endocrinology services. In addition, advanced, minimally invasive robotic surgery for several gynecologic procedures, including hysterectomies, fibroid removal, vaginal prolapse correction, to stop menorrhagia and to treat certain forms of cervical and uterine cancers, are now available at the Hospital. Women's Health had total Inpatient Discharges of 3,448 for the fiscal year ended 9/30/2011.

4d	Other program services. (Describe in Schedule O.)
	(Expenses $ 171,409,610 including grants of $ 0 ) (Revenue $ 225,267,563 )
4e	Total program service expenses$ 283,132,734

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	6,842,095	0	472,033

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		2,045,335
e	Government grants (contributions)1e		2,086,206

f	All other contributions, gifts, grants, and similar amounts not included above1f		31,564
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			4,163,105
			Business Code
2a	PATIENT REVENUE		621,400	345,978,731	345,978,731
b	OTHER MEDICAL SERVICES		900,099	1,204,956	1,204,956
c	OTHER OPERATING REVENUE		900,099	3,430,595	3,430,595
d	LAB SERVICES		621,400	4,615,716		4,615,716
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			355,229,999
3	Investment income (including dividends, interest
	and other similar amounts).....			840,683			840,683
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross Rents	3,842,935
b	Less: rental expenses	3,338,298
c	Rental income or (loss)	504,637
d	Net rental income or (loss).......			504,636			504,636
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	4,130,293	4,000
b	Less: cost or other basis and sales expenses	3,334,739	3,200
c	Gain or (loss)	795,554	800
d	Net gain or (loss)..........			796,354			796,354
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..			0
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...			0
10a	Gross sales of inventory, less returns and allowances .
	a		354,832
b	Less: cost of goods sold ..b		213,321
c	Net income or (loss) from sales of inventory..			141,511			141,511
Miscellaneous Revenue			Business Code
11a	CAFETERIA/VENDING		900,099	1,545,998			1,545,998
b	LAUNDRY		900,099	240,000			240,000
c	PARKING		812,930	40,927			40,927
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,826,925
12	Total revenue. See Instructions....			363,503,213	350,614,282	4,615,716	4,110,109


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			-3,090,637	1	61,458,676
2	Savings and temporary cash investments .......			29,401,181	2	0
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			40,941,651	4	37,299,759
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 .............			2,019,947	7	1,387,672
8	Inventories for sale or use ..............			2,361,637	8	1,879,253
9	Prepaid expenses and deferred charges ............			1,831,130	9	2,698,590
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	404,630,251
b	Less: accumulated depreciation. .....	10b	277,722,033	111,490,794	10c	126,908,218
11	Investments—publicly traded securities ..........			30,190,958	11	30,219,610
12	Investments—other securities. See Part IV, line 11 ......			3,170,899	12	2,729,803
13	Investments—program-related. See Part IV, line 11 ..				13	36,399,874
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			40,488,764	15	46,485,294
16	Total assets. Add lines 1 through 15 (must equal line 34)...			258,806,324	16	347,466,749
17	Accounts payable and accrued expenses .			75,538,145	17	105,366,368
18	Grants payable ..........				18
19	Deferred revenue ..........			211,158	19	208,218
20	Tax-exempt bond liabilities ..........			9,845,000	20	56,060,000
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 ..			7,295,987	23	6,275,846
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			30,739,392	25	43,859,516
26	Total liabilities. Add lines 17 through 25.....			123,629,682	26	211,769,948
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			111,900,980	27	104,824,797
28	Temporarily restricted net assets .....			13,846,953	28	21,432,761
29	Permanently restricted net assets .....			9,428,709	29	9,439,243
	Organizations that do not follow SFAS 117, check here 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 .....			135,176,642	33	135,696,801
34	Total liabilities and net assets/fund balances .....			258,806,324	34	347,466,749