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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 10-01-2012 , 2012, and ending 09-30-2013
BCheck if applicable:
CName of organization
Danbury Hospital
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
24 Hospital Avenue
 
Room/suite
City or town, state or country, and ZIP + 4
Danbury, CT06810
D Employer identification number

06-0646597
E Telephone number

G Gross receipts $ 547,276,911
F Name and address of principal officer:
John M MurphyMD
24 Hospital Avenue
Danbury,CT068106099
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.danburyhospital.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1885
M State of legal domicile: CT
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: To enhance through medical care, education and research the health and well being of individuals in Danbury, Connecticut and surrounding communities in partnership with those we serve.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 10
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 7
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 3,387
6 Total number of volunteers (estimate if necessary) ............. 6 245
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 6,601,598
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -3,024,300
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 11,526,659 13,368,627
9 Program service revenue (Part VIII, line 2g) ......... 507,944,594 505,701,187
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 9,050,540 4,962,417
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,459,961 2,959,530
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 531,981,754 526,991,761
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...   0
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 258,113,598 239,739,538
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 238,779,630 247,006,658
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 496,893,228 486,746,196
19 Revenue less expenses. Subtract line 18 from line 12....... 35,088,526 40,245,565
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 773,883,884 829,018,642
21 Total liabilities (Part X, line 26)............. 329,262,785 342,371,531
22 Net assets or fund balances. Subtract line 21 from line 20..... 444,621,099 486,647,111
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: To improve the health and well being of those we serve.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 396,289,592 including grants of $   ) (Revenue $ 501,187,182 )
Clinical CareDuring FYE2013, approximately 19,000 discharges and 70,000 Emergency Room visits occurred.Below are some of the accolades, accreditations and designations that we have been recognized with:Hospital Accreditation, Joint Commission, 2011-2013Chest Pain Center Accreditation, Society of Chest Paint Centers, 2011Primary Stroke Center Recertification, Joint Commission, 2012Nuclear Medicine Laboratory Accreditation, Intersociental Commission for the Accreditation of Laboratories, 2011Stroke Center Designation, CT Department of Public Health, 2011-2013Center for Weight Loss Surgery Accreditation, 2012Recognized for Exemplary Surgical Outcomes, American College of Surgeons National Surgical Quality Improvement Program, 2011Beacon Award for Excellence in Critical Care, American Association of Critical Care Nurses, 2011Gold Standard Accreditation for Breast Ultrasound, American College of Radiology, 2012Granted two-year certification for Joint and Spine (Orthopedics), Joint Commission Specialty Certification, 2012Awarded Disease Specific Certification (two year) for Hip, Knee and Spine Surgery Programs, Joint Commission Gold Seal of Approval, 2012Heart-Safe Community, CT Department of Public Health, 2012Crimson Award, The Advisory Board, 2011Sleep Center Accreditation, American Academy of Sleep Medicine, 2011Recognized for "Decreasing Inadvertent Perioperative Hypothermia", Institute for Healthcare Improvement, 2011In 2012, Becker's Hospital Review, ranked Danbury Hospital as a top 100 great community hospital. Also in 2012, Cleverly and Associates awarded Danbury Hospital with Community Value Leadership Awards for providing high-quality, high-value services at an appropriate cost.
4b (Code:   ) (Expenses $ 15,112,253 including grants of $   ) (Revenue $ 4,514,005 )
TeachingDanbury Hospital provides a dynamic environment for teaching and research for our graduate medical education programs. The hospital received Accreditation with Commendation from the Joint Commission on Accreditation of Healthcare Organizations, and is approved to sponsor residency programs by the Accreditation Council for Graduate Medical Education of the American Medical Association. As a leading university teaching institution, Danbury Hospital during 2012 established a partnership with the University of Vermont College of Medicine to develop a global clinical health elective for future physicians. As part of a global health certification, first-year medical students conduct research abroad for up to six weeks. Program participants work with their counterparts in other countries to address major health care challenges, sharing techniques and practices and coming home with new skills learned from colleagues across the globe. During the year 1,370 persons participated.
4c (Code:   ) (Expenses $ 2,381,269 including grants of $   ) (Revenue $   )
ResearchThe Danbury Hospital's Research Institute heralds a new era of personalized medicine that holds great promise for the development of targeted therapies as we gain a deeper understanding of the genetic basis of disease. The Institute will enable us to stay on the forefront of the evolving world of molecular medicine and to deliver the benefits of this work to patients at the bedside.In 2013, Danbury Hospital's two year-old Biomedical Research Institute (BRI) continued to push the frontiers of medical science in ways that are meaningful both to the care of our patients and to medicine as a whole. Danbury Hospital has made significant inroads toward personalized cancer treatments tailored to a cancers specific genetic makeup-especially womens cancers. Reinforcing the Hospitals emerging leadership position in this arena, in September 2013, Danbury Hospital launched Connecticuts first Annual OB/GYN Residents Research Day symposium. The integration of research and medical education for obstetricians and gynecologists helps ensure they remain on the cutting edge of medicine.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet413,783,114
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III
Click to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
Yes
 
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
575
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
3,387
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
0
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
No
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
No
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
No
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
No
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
No
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
No
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
No
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
10
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
7
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletMary Jo Pawlak24 Hospital AvenueDanburyCT068106099 (203) 739-8110
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) James Kennedy........................................................................
Chairman
3.00
.......................6.00
X   X       0 0 0
(2) Brian C White........................................................................
Director
1.00
.......................2.00
X           0 0 0
(3) John Patrick To 115........................................................................
Director
1.00
.......................2.00
X           0 0 0
(4) Spencer Houldin........................................................................
Director
1.00
.......................3.00
X           0 0 0
(5) Joseph D Skrzypczak........................................................................
Secretary
1.00
.......................2.00
X   X       0 0 0
(6) Anthea Disney........................................................................
Director
1.00
.......................2.00
X           0 0 0
(7) Richard G Jabara........................................................................
Director
1.00
.......................3.00
X           0 0 0
(8) A Altorelli to 911........................................................................
Director
1.00
.......................2.00
X           0 0 0
(9) David Cyganowski........................................................................
Treasurer
1.00
.......................2.00
X   X       0 0 0
(10) David Kramer MD........................................................................
Director
1.00
.......................2.00
X           0 0 0
(11) Neil Culligan MD........................................................................
Director
1.00
.......................2.00
X           0 0 0
(12) John M MurphyMD........................................................................
President & CEO
40.00
.......................9.00
X   X       1,183,850 0 52,091
(13) Donna Kaplanis........................................................................
Ass't Secretary
40.00
.......................10.00
    X       237,652 0 58,293
(14) Steven H Rosenberg........................................................................
SVP & CFO
40.00
.......................8.00
    X       687,331 0 44,257
(15) Kathleen A Dematteo........................................................................
Chief Information Officer
40.00
.......................0.00
      X     403,035 0 36,415
(16) Morris Gross........................................................................
VP of Facilities
40.00
.......................2.00
      X     294,671 28,560 48,217
(17) Joseph Campbell........................................................................
Chief Risk Compl. Officer
40.00
.......................0.00
      X     262,056 0 60,137
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Michael Daglio........................................................................
Chief Operating Officer
40.00
.......................0.00
      X     456,300 0 43,159
(19) Moreen O Donahue........................................................................
Sr. VP/Chief Nurse Exec.
40.00
.......................1.00
      X     376,521 0 68,362
(20) Phyllis F Zappala........................................................................
Sr. VP Human Resources
40.00
.......................0.00
      X     737,318 0 38,530
(21) Matthew A Miller MD........................................................................
Chief Medical Officer
40.00
.......................4.00
      X     0 616,440 44,146
(22) Carolyn L McKenna........................................................................
General Counsel
40.00
.......................0.00
        X   388,170 0 41,305
(23) Dawn Myles........................................................................
VP,Qual & Pat Sfty
40.00
.......................0.00
        X   272,721 0 26,306
(24) Sally Herlihy........................................................................
VP of Planning
40.00
.......................0.00
        X   298,942 0 54,347
(25) William Delaney MD........................................................................
Physician
40.00
.......................0.00
        X   267,185 0 52,398
(26) Ramin Ahmadi MD........................................................................
Dir. of Educ./Res.
40.00
.......................0.00
        X   295,287 0 42,920
(27) John Borruso MD........................................................................
WCMG Physician
0.00
.......................50.00
          X 0 473,263 27,165
(28) Ruth Gregory........................................................................
Director of Purchasing
0.00
.......................0.00
          X 150,409 0 29,620
(29) Judith Ward........................................................................
VP, Marketing (Former)
0.00
.......................0.00
          X 269,443 0 30,353


1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,580,891 1,118,263 798,021
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet488
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
TOWERS WATSON PENNSLYVANIA INCPO BOX 8500PHILADELPHIAPA19178 INVEST. CONSULTANTS 1,078,583
SLAM COLLABORATIVEPO BOX 12BRATTLEBORVT053020012 ARCHITECTS 2,103,548
ROBINSON & COLE LLP280 TRUMBULL STREETHARTFORDCT06103 ATTORNEYS 1,808,700
PRICE WATERHOUSE COOPERS LLCPO BOX 7247PHILADELPHIAPA19170 CONSULTANTS 688,773
DANBURY RADIOLOGICAL ASSOCIATESPO BOX 417407BOSTONMA02241 RADIOLOGY SERVICES 1,121,059
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet41
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 10,129,901
e Government grants (contributions)1e 2,700,964
f All other contributions, gifts, grants, and
similar amounts not included above
1f
537,762
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 13,368,627
 Program Service Revenue Business Code
2a Routine Patient 621990 33,632,537 33,632,537    
b Rental Inc.-Affl. Exempt 532000 2,005,889 1,834,891   170,998
c Medicare/Medicaid Pay'ts 621990 200,661,614 200,661,614    
d Contract Lab 621500 5,906,818   5,906,818  
e Ancillary Service 621400 261,662,270 261,662,270    
f All other program service revenue . 1,832,059 1,832,059    
g Total. Add lines 2a–2f........MediumBullet 505,701,187
 Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 3,153,021     3,153,021
4 Income from investment of tax-exempt bond proceeds..MediumBullet 75,227     75,227
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 881,706  
b Less: rental expenses 186,926  
c Rental income or (loss) 694,780  
d Net rental income or (loss).......MediumBullet 694,780   694,780  
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 21,395,791 87,500
b Less: cost or other basis and sales expenses 19,383,832 365,290
c Gain or (loss) 2,011,959 -277,790
d Net gain or (loss)..........MediumBullet 1,734,169     1,734,169
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 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...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 329,548
b Less: cost of goods sold ..b 349,102
c Net income or (loss) from sales of inventory..MediumBullet -19,554     -19,554
Miscellaneous Revenue Business Code
11a St. George Income 900099 1,463,878     1,463,878
b Research Clin. Trial Inc. 900099 207,264     207,264
c Administrative Services 561000 212,228     212,228
d All other revenue .... 400,934     400,934
e Total. Add lines 11a–11d ...... MediumBullet 2,284,304
12 Total revenue. See Instructions......MediumBullet 526,991,761 499,623,371 6,601,598 7,398,165
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
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 United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. 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 .... 5,189,495 1,872,303 3,317,192  
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 186,329,133 155,454,396 30,874,737  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 7,095,080 5,919,425 1,175,655  
9 Other employee benefits ....... 27,344,598 22,813,598 4,531,000  
10 Payroll taxes ........... 13,781,232 11,497,682 2,283,550  
11 Fees for services (non-employees):        
a Management ...... 808,280   808,280  
b Legal ......... 1,628,696   1,628,696  
c Accounting ........... 573,077   573,077  
d Lobbying ........... 84,745 70,703 14,042  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 570,498   570,498  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 83,275,892 69,477,076 13,798,816  
12 Advertising and promotion .... 514,414 429,176 85,238  
13 Office expenses ....... 6,847,908 5,713,210 1,134,698  
14 Information technology ...... 11,797,958 9,843,036 1,954,922  
15 Royalties .. 0      
16 Occupancy ........... 10,924,848 9,114,601 1,810,247  
17 Travel ............ 380,404 317,371 63,033  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 383,002 319,539 63,463  
20 Interest ........... 4,059,358 3,386,722 672,636  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 30,005,652 25,033,715 4,971,937  
23 Insurance .............. 6,364,735 5,581,123 783,612  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Professional Membership 2,534,353 2,114,411 419,942  
b Equipment Rent and Maint. 8,616,845 7,189,034 1,427,811  
c Medical Supplies 77,635,993 77,635,993    
d
e All other expenses 0      
25 Total functional expenses. Add lines 1 through 24e 486,746,196 413,783,114 72,963,082 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 3,243 1 45,152
2 Savings and temporary cash investments ......... 53,639,526 2 58,648,181
3 Pledges and grants receivable, net ...........   3 0
4 Accounts receivable, net ............. 60,038,935 4 57,504,970
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6 0
7 Notes and loans receivable, net ............. 5,793,756 7 3,884,061
8 Inventories for sale or use .............. 9,333,372 8 9,521,995
9 Prepaid expenses and deferred charges .......... 4,130,837 9 3,019,935
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 631,888,505
b Less: accumulated depreciation ..... 10b 328,300,919 242,235,095 10c 303,587,586
11 Investments—publicly traded securities .......... 274,027,038 11 244,739,925
12 Investments—other securities. See Part IV, line 11 .....   12 0
13 Investments—program-related. See Part IV, line 11 .....   13 0
14 Intangible assets ...............   14 0
15 Other assets. See Part IV, line 11 ........... 124,682,082 15 148,066,837
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 773,883,884 16 829,018,642
Liabilities 17 Accounts payable and accrued expenses ......... 48,879,428 17 64,629,230
18 Grants payable .................   18  
19 Deferred revenue ................ 3,549,882 19 3,011,210
20 Tax-exempt bond liabilities ............. 251,135,000 20 249,580,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other 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 ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 25,698,475 25 25,151,091
26 Total liabilities. Add lines 17 through 25......... 329,262,785 26 342,371,531
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 386,002,265 27 400,930,008
28 Temporarily restricted net assets ........... 29,794,088 28 56,603,735
29 Permanently restricted net assets ........... 28,824,746 29 29,113,368
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 444,621,099 33 486,647,111
34 Total liabilities and net assets/fund balances ........ 773,883,884 34 829,018,642
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
526,991,761
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
486,746,196
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
40,245,565
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
444,621,099
5
Net unrealized gains (losses) on investments ...............
5
5,199,125
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-3,418,678
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
486,647,111
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID: 12000229
Software Version: 2012v2.0
SCHEDULE A
(Form 990 or 990EZ)

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

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data


Software ID: 12000229
Software Version: 2012v2.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Danbury Hospital
 
Employer identification number

06-0646597
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Danbury Hospital
 
Employer identification number

06-0646597
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Danbury Hospital
 
Employer identification number

06-0646597
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  

Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID: 12000229
Software Version: 2012v2.0
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
2012
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 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in)
(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e))
         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))
         
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
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)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
Yes
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
Yes
 
22
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
34,894
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
108,083
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
1,050
i
Other activities? ..........................
Yes
 
2,565
j
Total. Add lines 1c through 1i ...............................
146,614
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description Dues were paid to CHA in the amount of $365,760,of which 9.54% of this amount were expended on lobbying.Only state and local officials were lobbied during 2013. As part of this miscellaneous office expense such as phone, computer supplies, refreshment etc. were incurred and were reflected on line #1i accordingly.Direct contact with legislators and state leaders to redesign care delivery, improve access to care and create an environment where reform could thrive.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID: 12000229
Software Version: 2012v2.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 1        
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........
         
f Administrative expenses ....          
g End of year balance ...... 1        
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   3,846,356 3,846,356
b Buildings ................   290,816,065 162,404,245 128,411,820
c Leasehold improvements ............   8,554,914 2,757,815 5,797,099
d Equipment ................   222,804,494 163,138,859 59,665,635
e Other .................   105,866,676   105,866,676
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 303,587,586
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Other Receivables 4,959,144
(2) Morrison Deposit 96,418
(3) Investment in WCHIC, LTD. 21,618,216
(4) Interest in WCHN Foundation, Inc. 106,193,031
(5) Due From Related Parties 8,991,050
(6) Bulk Accounts Net of Reserve 652,622
(7) Bond Issuance Cost 4,366,529
(8) Bond Escrow Fund 1,189,827

Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 148,066,837
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
Reserve For Workers Compensation 6,467,838
Malpractice Trust Fund Reserve 9,596,000
Due To 3rd Parties 8,710,029
Asset Retirement Obligation 377,224





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 25,151,091
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 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 XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII 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 XIII.) ............ 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 XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Part V, Line 4 Part V, Line 4: Intended uses of the endowment fund. The intended use of the endowment funds are to provide supplemental/sole financial support for a variety of Danbury Hospital programs and services.
Schedule D (Form 990) 2012

Additional Data


Software ID: 12000229
Software Version: 2012v2.0




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Part I
General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. 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? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region
(f) Total expenditures
for and investments
in region
CENTRAL AMER./CARIBBEAN 1 1 Operating Expenses Malpractice Ins. 15,948,386
CENTRAL AMER./CARIBBEAN 1 1 Investment Malpractice Ins. 21,618,215
CENTRAL AMER./CARIBBEAN 1 1 Revenue Malpractice Ins. 0
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 3 3 37,566,601
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 3 3 37,566,601
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)
(c) Region (d) Purpose of
grant
(e) Amount of
cash grant
(f) Manner of
cash
disbursement
(g) Amount of
of non-cash
assistance
(h) Description
of non-cash
assistance
(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant
(e) Manner of cash
disbursement
(f) Amount of
non-cash
assistance
(g) Description
of non-cash
assistance
(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2012
Additional Data


Software ID: 12000229
Software Version: 2012v2.0



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
    10,697,159 4,058,590 6,638,569 1.360 %
b Medicaid (from Worksheet 3,
column a) ....
    77,354,405 48,611,673 28,742,732 5.910 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
           
d Total Financial Assistance
and Means-Tested
Government Programs .
    88,051,564 52,670,263 35,381,301 7.270 %
Other Benefits
    227,938   227,938 0.050 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
    15,112,253 4,514,005 10,598,248 2.180 %
g Subsidized health services
(from Worksheet 6) ..
    1,254,298 718,854 535,444 0.110 %
h Research (from Worksheet 7)     2,381,269   2,381,269 0.490 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
    32,551   32,551 0.010 %
j Total. Other Benefits ..     19,008,309 5,232,859 13,775,450 2.840 %
k Total. Add lines 7d and 7j .     107,059,873 57,903,122 49,156,751 10.110 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
17,114,070
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
1,084,843
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
165,830,458
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
209,901,588
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-44,071,130
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Danbury Hospital
24 Hospital Avenue
Danbury,CT06810
www.danburyhospital.org
X X   X     X   Diagnostic & Dialysis  
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Danbury Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b   No
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 400.0000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.0000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?22
Name and address Type of Facility (describe)
1 Danbury Hospital Research Institute
131 West Street
Danbury,CT06813
Diagnostic
2 Wellness on Wheels
24 Hospital Avenue
Danbury,CT06810
Outpatient-Physician Clinic
3 Newtown Laboratory
14-18 Church Hill Road
Newtown,CT06470
Diagnostic
4 Bethel Laboratory
68 Stony Hill Road
Bethel,CT06801
Diagnostic
5 Ridgefield Specimen Collection Facility
10 South Street
Ridgefield,CT06877
Diagnostic
6 Danbury Hospital Diabetes Education Center
41 Germantown Road
Danbury,CT06810
Education Center
7 Danbury Hospital Laboratory Center in Brookfield
60 Old New Milford Road Unit 1C
Brookfield,CT06804
Diagnostic
8 Danbury Hospital Southbury Laboratory
22 Old Waterbury Road Suite 101
Southbury,CT06488
Diagnostic
9 Danbury Hospital Laboratory Center of New Milford
120 Park Lane Suite A201
New Milford,CT06776
Diagnostic
10 Sleep Lab
Southbury Heritage Hotel 522 Herita
Southbury,CT06488
Diagnostic
11 Center for Child & Adol Treat
152 West Street
Danbury,CT06810
Outpatient-Physician Clinic
12 Danbury Hospital Laboratory
79 Sandpit Road
Danbury,CT06810
Diagnostic
13 The Anticoagulation Center
41 Germantown Road
Danbury,CT06810
Diagnostic
14 Physical Medicine Center of Southbury
22 Old Waterbury Road Suite 101
Southbury,CT06488
Outpatient-Physician Clinic
15 Pulmonary Services
33 Germantown Road
Danbury,CT06810
Diagnostic
16 Comm Ctr for Behaviorial Health
152 West Street
Danbury,CT06810
Outpatient-Physician Clinic
17 Danbury Hospital Sleep Lab II
25 Lake Avenue-Extension
Danbury,CT06810
Diagnostic
18 Southbury Cardiovascular Diagnostics
22 Old Waterbury Road
Southbury,CT06488
Diagnostic
19 Breast Imaging Center
20 Germantown Road
Danbury,CT06810
Diagnostic
20 Main Street Rehabilitation Center
235 Main Street
Danbury,CT06810
Rehabilitation
21 Siefert & Ford Community Health Ctr
70 Main Street
Danbury,CT06810
Outpatient Physician Clinic
22 Danbury Hospital Ridgefield Surg Ctr
901 Ethan Allen Highway
Ridgefield,CT06877
Outpatient Surgical Center
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
  Part VI - Additional Information Schedule H, OtherOver 50% of the Board Members are independent and do not get paid by Danbury Hospital. Danbury Hospital has an open medical staff.Surplus funds are used to provide innovative technology to clinical care in addition to expanding our service area. See details in how we "furthered our exempt purposes".
  Part V - Explanation of Number of Facility Type 14 Diagnostic Centers5 Outpatient Physician Clinics1 Outpatient Surgical Center1 Rehabilitation Center1 Education Center
  Part VI - States Where Community Benefit Report Filed CT
  Part VI - Affilated Health Care System Roles and Promotion Western Connecticut Health Network, Inc. (parent)Western Connecticut Health Network's mission is to improve the health and well being of those we serve, which helps to further the hospital's exempt purpose. Danbury HospitalDanbury Hospital provides medical services to the community regardless of the individual's ability to pay. Services include routine inpatient ancillary and outpatient care in support of the hospital's mission statement,to improve the health and well being of those we serve. For 2013, Danbury Hospital provided $4,954,000 in charity care.New Milford HospitalNew Milford Hospital's mission is to provide outstanding health care to the communities they serve through an uncompromising focus on clinical quality, compassionate service, and the creation of a medical"safe haven" for their patients and their families. For 2013, New Milford Hospital provided $670,900 in charity care.Western Connecticut Medical GroupThe mission at Western Connecticut Medical Group is to provide safe, innovative, convenient and coordinated primary and specialty health care in the communities they serve and strive to be aware of and respond to their patients needs. They support a commitment to advance the health and well-being of individuals in their community by delivering quality care, participating in medical research and medical residency programs and the provision of medical services to patients. For 2013, Western Connecticut Medical Group provided $1,794,739 in charity care.Western Connecticut Health Network Foundation, Inc.Western Connecticut Health Network Foundation Inc.'s mission is to raise funds, reinvest and administer these funds and make distributions to Danbury Hospital and other not-for-profit health care affiliates.Western Connecticut Health Network AffiliatesWestern Connecticut Health Network Affiliates principal purpose is to provide outpatient health care services in various locations and also provide ambulance services to Danbury and surrounding towns, while serving those that cannot afford the care. Approximately $11,000 in charity care was provided during 2013.Business Systems, Inc.Business Systems, Inc, is a taxable corporation whose main business is the operation of Danbury Pharmacy, a retail pharmacy. The Pharmacy's revenue is comprised of prescription sales, over the counter sales, and wholesale sales (medical and surgical supplies) sold to office practices and clinicians that are not covered by insurance programs. At the end of 2013 the Danbury Pharmacy was sold to Walgreen's Pharmacy.Western Connecticut Home Care, Inc.Western Connecticut Home Care, Inc. (WCHC) provides state of the art clinical services ranging from pediatric patients to the elderly utilizing best practice in home care to meet the needs of their patients. For 2013, WCHC provided $587,777 for charity care.Eastern New York Medical ServicesEastern New York Medical Services (ENYMS) was formed in April, 2013. The mission at ENYMS is to provide safe, innovative, convenient and coordinated primary and gastro health care in the communities we serve and strive to be aware of and respond to our patients needs. For 2013, ENYMS provided approximately $1,000 for charity care.
  Part VI - Explanation Of How Organization Furthers Its Exempt Purpose The values and attitudes shared by our staff - from our receptionists to our physician and how we express them day-to-day create that experience, and form our Networks brand of care. At Western Connecticut Health Network (WCHN) we expect all staff to embody a set of common values that guide behavior and decision-making in every interaction with patients, visitors or callers. In 2013, we recommitted to these values. TEAMWORKTrimming Treatment TimeWhen a heart attack strikes, every moment until intervention matters. In 2013, the CHA recognized WCHNs successful efforts to substantially reduce this critical time period with its John D. Thompson Award, a prestigious honor given for excellence in the delivery of healthcare through the use of data. The Award recognized the culmination of seven years of collaborative work of a multi-functional team.Personal Side of Cancer CareOur Networks team of cancer care professionals extends beyond our outstanding oncologists and clinicians who oversee treatment. We take a personalized, more holistic approach to care, providing additional services that ease the patients journey, removing or mitigating the practical barriers to successful treatment. The most recent addition to the WCHN cancer care team is the Oncology Financial Navigator staff members dedicated to helping uninsured, underinsured, and simply concerned patients understand their insurance benefits and how they can pay for their cancer treatment drugs.INNOVATIONBariatrics and BeyondComputer-assisted robotic surgery is successfully used for hundreds of surgeries at Danbury Hospital each year. In 2013, minimally invasive robotic surgery was applied to both general and weight loss surgeries. The option to use robotic surgery, where appropriate, can amplify the surgeon's skills and improve the patient's outcome. Opening a New DoorWCHN opened a new 6,000-square-foot Breast Imaging Center in 2013, making preventative and diagnostic breast care more convenient and comfortable for every patient, every day. The center is equipped with the latest in imaging technology, as it provides a spa-like atmosphere. Perhaps the biggest improvement is that all aspects of breast care are offered under a single roof Saving the BrainA partnership formed in 2013 between Danbury Hospital and Westchester Medical Center giving Danbury Hospital stroke patients who meet certain medical criteria the option of a new treatment that may help to reduce the effects of a stroke and improve outcomes. The new option is interventional stroke therapy and FDA approved technology that uses X-ray guidance and a catheter.Simulation Saves LivesThe ability to quickly diagnose a patient with cardiovascular disease can often mean the difference between life and death; saving time means saving heat muscle. Patient simulators are a safe and convenient tool for training medical staff. Thats why in 2013, Danbury Hospital used a grant for $71,800 from the Connecticut Health and Education Facilities Authority (CHEFA), as part of its Client Grant Program, to purchase Ultrasonography/Transthoracic Echocardiography Simulator equipment for its simulation laboratory.Spotlight on Inpatient PediatricsA lifetime of health and wellness begins in childhood, which is why Danbury Hospital continues to invest in the care of our pediatric population. In 2013, we made a number of improvements to ensure that our communities children of all ages have access to high quality emergency and acute care, with staff specifically trained and dedicated to pediatrics.The Hub for Community Health CareThe Emergency Department at Danbury Hospital serves as a hub for the health care needs of the community, as both the source of acute care and a link for patient follow up with community physicians. Expansion of the Danbury Hospital Emergency Department is well underway and scheduled for completion in Spring 2014, in conjunction with Hospitals patient Tower addition. The new ED can accommodate up to 90,000 visits per year double the capacity of the existing ED. It will provide comfortable, private rooms for patients, with upgrades that will improve safety and expediency of treatment. A state-of-the-art heliport atop the ED roof will be ready to receive or transport the most urgent cases.A strong, local hospital is central to the overall health of the community - serving as a crucial medical resource to patients and also a business partner in the region. Danbury Hospital is committed to being both for many years to come. UNDERSTANDINGSeeing the Bigger, Global PictureIn 2012, the Western Connecticut Health Networks Global Health Education Program was established, with a very big vision: to improve the worlds health care, by advancing disease research, sharing knowledge and fostering humanitarianism through international collaboration, even if its one physician at a time. The opportunity for medical students and residents to gain global health experience strengthens our medical education and research program and distinguishes from most others.A New Forum for Cancer FindingsWCHN has made significant inroads toward personalized cancer treatments tailored to a cancers specific genetic makeup-especially womens cancers. The integration of research and medical education for obstetricians and gynecologists helps ensure they remain on the cutting edge of medicine. Nurses in the KnowThe WCHN Nurse Education Department fosters life-long learning and development for nurses. In 2013, the Cora Spratt Center for Nursing Education and Research Center at Danbury Hospital continued to advocate for the advancement of the nursing profession by offering numerous educational opportunities for our network nurses as well as nurses from other health care organizations.Helping the Community Help ItselfTo create a "new picture of health," we've used the strength of our network to help our community members better navigate an evolving, often complex, health care system. Through education, interaction and outreach, we keep residents informed about changes in the health care environment and the local resources available to help them manage their own health. We direct them to the right care in the right place and at the right time. Examples of our efforts included the following:-WCHN clinicians from our behavioral health staff, primary care clinic and affiliated Visiting Nurses Association, helped serve more than 200 homeless people in a single day at Project Homeless Connect, a one-day, comprehensive "health fair" for the needy or homeless. Patients were given flu shots and physical and dental exams - an example of how we help our community's less fortunate residents avoid emergency room visits.-The network's Lyme Disease Registry continues to collect data to study ways to prevent, diagnose and potentially treat those with Lyme and lingering symptoms. -Our network took a leadership role to ensure a behavioral health safety net for the Sandy Hook community following the tragic shooting. We provided a grant to fund a behavior health navigator for Newtown's schools to support the mental health and well-being of the community's families.Our work on a Community Health Needs Assessment, that involved collaboration with local educators, community agencies, faith groups and other health care organizations, progressed in 2013 into a finalized Community Health Improvement Plan. The plan will address four priority community needs: chronic disease prevention; substance abuse and related mental health issues; seniors' health and housing; and awareness and access to health care services. Initiatives are underway to improve the health of our region's residents by providing information and expanding access through creative strategies and partnerships.The Physician PipelineAs health care reform unfolds and the country's population ages, we are preparing to meet the needs of a growing patient population. That's why the recruitment of physicians and group practices to our Network is a priority - so we can offer more patients with easier, more convenient access to primary and specialty care. Residents in our communities do not need to travel far to receive high quality care. Bigger, Stronger, Better - TogetherCreating a new picture of health is what our affiliation with Norwalk Hospital is all about.As a result of this affiliation, over time our patients will experience easier, more convenient access to the high quality care of a regional healthcare system, including more primary care and sub-specialty physicians within the same network. We will be able to provide patients even better quality care and an improved overall experience throughout our network, by integrating care and treatment approaches across the system. And we'll have the capacity and efficiencies to manage the growing patient volume. Exceptional Donors, Exceptional DreamsAs hospitals and the healthcare industry face unprecedented financial challenges, advancements in patient care depend more than ever upon p
  Part VI - Community Information The Hospital's primary service area is the City of Danbury and surrounding suburban towns that make up northern Fairfield county. The region is very diverse requiring diverse programming and education. Constituents are predominantly employed and are fairly well-educated. Poverty levels are below other areas in CT. The exception to this generalization is the City of Danbury as the urban core that is the most diverse community with a large undocumented population not captured on census.
  Part VI - Patient Education of Eligibility for Assistance One barrier to health care outlined in the Community Needs Assessment was that so many people were uninsured or underinsured. To help eliminate this barrier to needed care, in 2013 WCHN actively advocated for Access Health CT, the states new health insurance marketplace, using grass roots communication to encourage enrollment in Access Health CT. WCHN held in-service trainings for our staff, participated in community educational forums and enrollment fairs, and distributed promotional materials throughout the Network and region. Our hospitals are now considered by the state a model hospital for promoting the significant benefits of insurance enrollment. Danbury Hospital has messages on all statements providing information regarding how the patient can get assistance with their hospital bill. Also signs are posted throughout the hospital and counselors are avaiable to provide further assistance.All uninsured inpatients are interviewed by financial counselors and assessed for eligibility for assistance programs. The hospital provides informational handouts to all uninsured patients at the time of registration which refers them to financial counseling if they would like assistance with their bills. Further, the hospital mails notices to all self-pay accounts referring them to financial counseling if they need assistance. The collection department will also refer patients to financial counseling when a patient indicates that they cannot afford their balances;and finally, schedulers refer uninsured patients to financial counseling prior to their test or procedure.
  Part VI - Needs Assessment Effective strategies to improve community health involve active collaboration and commitment among health providers, public and community health agencies, educators, worksites, community and faith-based organizations and groups, and the public they serve. The organization collaborates with community partners for assessment of community health needs and action planning. Danbury Hospital, and its affiliate partner, New Milford Hospital, participated in the development of a Community Report Card for the Housatonic Valley Region, a 10-district municipality that includes Danbury and New Milford, CT. The other eight towns are Bridgewater, Brookfield, New Fairfield, Newtown, Redding, Ridgefield and Sherman, CT, all towns within the primary service area of both hospitals. Developing a plan for health improvement in our region involves collective action by and sharing of expertise and resources across agencies and organizations in both the public and private sectors. Activities:1.Community Report Card (CRC) for Western Connecticut produced with indicators, including: community population and demographic data, economic stability, education, health status, health and lifestyle behaviors and risk factors, chronic and communicable diseases, and older adult health survey and focus group findings. Additional data from the CT Association of Directors of Healths Health Equity Index related to social determinants of health and health outcomes and United Way of CTs Infoline 2-1-1 database of health-related programs and services was included.2.CRC Steering Committee developed - including leads from the City of Danbury Department of Health and Human Services, Western CT Health Network/Danbury Hospital-New Milford Hospital, United Way of Western Connecticut, New Milford Health Department, and the Regional YMCA of Western CT.3.EDUCATION CONNECTIONs Center for Healthy Schools & Communities met with the CRC Steering Committee to review the objectives and desired outcomes for these facilitated discussions. 4.Two Community Health Conversations with key community stakeholders in October 2012 - held in two locations (Danbury and New Milford, CT) to ensure accessibility by key stakeholders throughout the region. Attendees included a total of 52 representatives from hospitals; community health centers; school-based health centers; Visiting Nurse Associations/Services; municipal health, education, social service, senior centers and fire departments; non-profit organizations; and a legislators office. Geographically, all 10 HVR municipalities were represented either directly or through regional agencies and organizations. During the Conversations, the need for collective commitment and responsibility in the prioritization of health issues and development of an action plan for health improvement were emphasized.5.Priority Health areas identified - Participants in Conversations universally agreed that the Priority Health Issues (PHI) most representative of needs in the region were 1) prevention/reduction of most prevalent chronic diseases/health conditions (specifically obesity, hypertension, and type II diabetes), by addressing underlying risk factors; 2) substance use/abuse and co-related mental health issues; 3) older adult health, housing and social support needs; and 4) improved awareness and utilization of existing health and social programs and services. Each of these areas also recognizes that disparities in health care access and outcomes need to be addressed. Upon reaching consensus on the priority health issues, participants self-selected a workgroup to join based on their interests and expertise. Overall, data obtained from the Conversations provided high quality information needed to begin the community health improvement action planning process in the region. A broad diversity of community stakeholders attended both sessions, conversations were dynamic, and stakeholders were actively engaged in the process and expressed commitment to working together in the future to address the identified priority health issues.6.Health Improvement Action Planning - Throughout 2013, the CRC Steering Committee and PHI workgroups continued to meet to further develop and refine their action plans. Consistent with each teams vision and mission, and informed by the CRC and Community Conversation findings, a Community Health Improvement Action Plan for Western CT by PHI has been developed. The plan addresses four priority community needs: substance abuse and related mental health issues; seniors health and housing; chronic disease prevention; and health care access. It is important to note that Action Plans are dynamic documents and are influenced by emerging needs. With this in mind, the workgroups will continue to meet at least quarterly to expand upon, modify, and refine their PHI objectives, strategies, and action steps and to collectively evaluate progress towards achieving health improvement in the region.7.Board Endorsement The Community Report Card and Health Improvement Action Plan have been endorsed by the BOD and documents are available on the organizations website and available upon request.8.To create a new picture of health, our community members must be more engaged in order to best navigate an evolving health care system. Weve used the strength of our network, through education, interaction and outreach, to keep our residents informed about the changing health care environment, and how available local resources can help them manage their own health while directing them to the right care in the right place and at the right time. 9.We survey our consumers on a regular and ongoing basis for their opinions and concerns.We continued to promote a healthy lifestyle within the community, emphasizing the individuals responsibility as a partner in wellness. The Networks partnership with the Spirit of Women program, has engaged many women, typically the primary caregivers in their households, with special events, publications and online information. Our 2013 Day of Dance and Girls Night Out, social and informational events focused on primary and preventative care, screenings and early cancer detection, and healthy habits, drew capacity crowds.
Number of Hospital Faciltiy - 1 Part V, Line 14g - Other Means Hospital Facility Publicized the Policy Danbury Hospital has messages on all statements providing information regarding how the patient can get assistance with their hospital bill. Counselors are also available to provide further assistance.
Number of Hospital Faciltiy - 1 Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment New Milford Hospital
Number of Hospital Faciltiy - 1 Part V, Line 3 - Account Input from Person Who Represent the Community Effective strategies to improve community health involve active collaboration and commitment among health providers, public and community health agencies, educators, worksites, community and faith-based organizations and groups, and the public they serve. The organization collaborates with community partners for assessment of community health needs and action planning. Danbury Hospital, and its affiliate partner, New Milford Hospital, participated in the development of a Community Report Card for the Housatonic Valley Region, a 10-district municipality that includes Danbury and New Milford, CT. The other eight towns are Bridgewater, Brookfield, New Fairfield, Newtown, Redding, Ridgefield and Sherman, CT, all towns within the primary service area of both hospitals. Developing a plan for health improvement in our region involves collective action by and sharing of expertise and resources across agencies and organizations in both the public and private sectors.
  Part III, Line 9b - Provisions On Collection Practices For Qualified Patients It is the policy of Danbury Hospital to provide "Financial Assistance" (either free care or reduced patient obligations) to persons or families where: (i) there is limited or no health insurance available; (ii) the patient fails to qualify for governmental assistance (for example Medicare or Medicaid); (iii) the patient cooperates with the Hospital in providing the requested information; (iv) the patient demonstrates financial need; and (v) Danbury Hospital makes an administrative determination that Financial Assistance is appropriate. After the Hospital determines that a patient is eligible for Financial Assistance, the Hospital will determine the amount of Financial Assistance available to the patient by utilizing the Charitable Assistance Guidelines, which are based upon the most recent federal poverty guidelines.Danbury Hospital shall regularly review this Financial Assistance Policy to ensure that at all times it: (i) reflects the philosophy and mission of the Hospital; (ii) explains the decision processes of who may be eligible for Financial Assistance and in what amounts; and (iii) complies with all applicable state and federal laws, rules, and regulations concerning the provision of financial assistance to indigent patients.Consistent with this mission, Danbury Hospital recognizes its obligation to the community it serves to provide financial assistance to indigent persons within the community.In furtherance of its charitable mission, Danbury Hospital will provide both (i) emergency treatment to any person requiring such care; and (ii) essential, non-emergent care to patients who are permanent residents of its primary service area who meet the conditions and criteria set forth in this Policy, without regard to the patients' ability to pay for such care. Elective procedures generally will not be considered essential, non-emergent care and usually will not be eligible for Financial Assistance.Danbury Hospital will collect from individuals on financial assistance if they received a partial charitable discount. All patients can apply for charitable care on balances they feel that they cannot afford.
  Part III, Line 8 - Explanation Of Shortfall As Community Benefit Danbury Hospital's Medicare shortfall should be treated as a community benefit as the organization strives to provide 24/7 coverage, improved patient access, highest clinical quality as well as addressing the needs of the community by offering critical services to our geographic area. As a result, the organization must balance the cost of these programs against the continued decreasing government reimbursement levels, uninsured population and community needs.A cost accounting system is used to calculate the shortfall, which is Medicare Net Patient Revenue less applicable costs.
  Part III, Line 4 - Bad Debt Expense The Hospitals estimation of the allowance for uncollectible accounts is based primarily upon the type and age of the patient accounts receivable and the effectiveness of the Hospitals collection efforts. The Hospitals policy is to reserve a portion of all self-pay receivables, including amounts due from the uninsured and amounts related to co-payments and deductibles, as these charges are recorded. On a monthly basis, the Hospital reviews its accounts receivable balances and various analytics to support the basis for its estimates. These efforts primarily consist of reviewing the following: Historical write-off and collection experience using a hindsight or look-back approach; Revenue and volume trends by payor, particularly the self-pay components; Changes in the aging and payor mix of accounts receivable, including increased focus on accounts due from the uninsured and accounts that represent co-payments and deductibles due from patients; Cash collections as a percentage of net patient revenue less the provision for bad debt; and Trending of days revenue in accounts receivable The Hospital regularly performs hindsight procedures to evaluate historical write-off and collection experience throughout the year to assist in determining the reasonableness of its process for estimating the allowance for uncollectible accounts. The Hospitals primary concentration of credit risk is patient accounts receivable, which consists of amounts owed by various governmental agencies, insurance companies and private patients. The Hospital manages the receivables by regularly reviewing its patient accounts and contracts, and by providing appropriate allowances for uncollectible amounts. Significant concentrations of gross patient accounts receivable include 32% and 13%, and 30% and 14%, for Medicare and Medicaid, respectively, at September 30, 2013 and 2012, respectively.
  Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit It is the policy of the Hospital to provide necessary care to all persons seeking treatment without discrimination on the grounds of age, race, creed, national origin or any other grounds unrelated to an individual's need for the service or the availability of the needed service at the Hospital. A patient is classified as a charity care patient by reference to established policies of the Hospital. Essentially, these policies define charity services as those services for which no payment is anticipated. In assessing a patient's inability to pay, the Hospital utilizes the generally recognized federal poverty income guidelines, but also includes certain cases where incurred charges are significant when compared to a responsible party's income and their countable assets. Those charges are not included in net patient service revenue for financial reporting purposes.When private pay patients are sent to the collection agency their account is considered to be a bad debt. Subsequently, Medicaid may be granted for some of those patients. At that time those accounts would become charity care or a community benefit.
  Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense Bad Debt expense is per the audited financial statements.
  Part I, Line 7g - Costs Associated With Physicans Clinics There are no physician clinics included in this amount.
  Part I, Line 7 - Explanation of Costing Methodology Charity Care At Cost Percentage:Total Gross Patient charges written off to charity (Income Statement) * Patient Cost to Charge % (see below) = Total Community Benefit Expense Total Community Benefit Expenses - Revenue from Uncompensated Care Pools and programs (DHS * % of cost of uncompensated care shown on the OCHA Schedule 500) = Net community benefits expensesNet community benefits expenses * total expenses = % of total expensesRatio Cost To Charge CalculationTotal Operating Expenses divided by Adjusted Patient Care Cost (Bad Debt, Other Operating Income and Intercompany Income are removed from the total operating expenses)Adjusted Patient Care Cost divided by Gross Patient Charges
  Part I, Line 6a - Related Organization Community Benefit Report The Community Benefit report is reported on a Network basis.
Schedule H (Form 990) 2012
Additional Data


Software ID: 12000229
Software Version: 2012v2.0
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
2012
Open to Public Inspection
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
Yes
 
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)William Delaney MDPhysician (i)
(ii)
239,662
 
24,478
 
3,045
 
22,040
 
30,358
 
319,583
 
 
 
(2)Steven H RosenbergSVP & CFO (i)
(ii)
503,434
 
160,000
 
23,897
 
12,500
 
31,757
 
731,588
 
 
 
(3)Sally HerlihyVP of Planning (i)
(ii)
221,961
 
75,180
 
1,801
 
22,040
 
32,307
 
353,289
 
 
 
(4)Ruth GregoryDirector of Purchasing (i)
(ii)
133,988
 
15,000
 
1,421
 
17,447
 
12,173
 
180,029
 
 
 
(5)Ramin Ahmadi MDDir. of Educ./Res. (i)
(ii)
234,140
 
60,000
 
1,147
 
12,500
 
30,420
 
338,207
 
 
 
(6)Phyllis F ZappalaSr. VP Human Resources (i)
(ii)
315,181
 
398,265
 
23,872
 
22,040
 
16,490
 
775,848
 
 
 
(7)Morris GrossVP of Facilities (i)
(ii)
235,057
28,560
55,000
 
4,614
 
22,040
 
26,177
 
342,888
28,560
 
 
(8)Moreen O DonahueSr. VP/Chief Nurse Exec. (i)
(ii)
286,053
 
80,000
 
10,468
 
22,040
 
46,322
 
444,883
 
 
 
(9)Michael DaglioChief Operating Officer (i)
(ii)
345,294
 
110,000
 
1,006
 
12,500
 
30,659
 
499,459
 
 
 
(10)Matthew A Miller MDChief Medical Officer (i)
(ii)
 
427,629
 
155,000
 
33,811
 
22,040
 
22,106
 
660,586
 
 
(11)Kathleen A DematteoChief Information Officer (i)
(ii)
280,165
 
100,000
 
22,870
 
22,040
 
14,375
 
439,450
 
 
 
(12)Judith WardVP, Marketing (Former) (i)
(ii)
 
 
 
 
269,443
 
 
 
30,353
 
299,796
 
 
 
(13)Joseph CampbellChief Risk Compl. Officer (i)
(ii)
213,896
 
45,000
 
3,160
 
22,040
 
38,097
 
322,193
 
 
 
(14)John M MurphyMDPresident & CEO (i)
(ii)
796,683
 
380,000
 
7,167
 
12,500
 
39,591
 
1,235,941
 
 
 
(15)John Borruso MDWCMG Physician (i)
(ii)
 
436,807
 
15,000
 
21,456
 
22,040
 
5,125
 
500,428
 
 
(16)Donna KaplanisAss't Secretary (i)
(ii)
195,315
 
40,000
 
2,337
 
22,040
 
36,253
 
295,945
 
 
 
(17)Dawn MylesVP,Qual & Pat Sfty (i)
(ii)
211,753
 
60,000
 
968
 
17,500
 
8,806
 
299,027
 
 
 
(18)Carolyn L McKennaGeneral Counsel (i)
(ii)
286,736
 
100,000
 
1,434
 
12,500
 
28,805
 
429,475
 
 
 
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Sch J, Part III, Additional Information Part III, Additional Information The organization relied on a related organization, Western Connecticut Health Network, Inc. which used the following methods described below to establish top management's compensation:-Compensation committee.-Independent compensation.-Written employment contract.-Compensation survey or study.-Approval by board or compensation committee.
Sch J, Part I, Line 6b Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or Summary of Executive Incentive Plan The Plan is administered by the Executive Compensation Committee of Western Connecticut Health Network, Inc. Eligibility to participate in the Plan is limited to those who are in positions in which their decisions, actions and counsel significantly affect the operations of Western Connecticut Health Network, Inc. and its subsidiaries.The Committee will establish the target award opportunity (expressed as a percentage of base salary) for each participant in the Plan.Prior to the beginning of each Plan year, or as soon thereafter as practicable, performance measures are established for each participant in the Plan.Incentive awards are modified or eliminated if the level of performance specified is not achieved. Notwithstanding any other provision of the Plan, incentive awards can be affected based on individual executive performance.
Schedule J (Form 990) 2012

Additional Data


Software ID: 12000229
Software Version: 2012v2.0
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Danbury Hospital
 
Employer identification number
06-0646597
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
Yes No Yes No Yes No
A CHEFA RevBondsSeries H
 
06-0806186 20774UCL7 03-16-2006 40,924,665 See Part V For Purpose   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 1,945,000      
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 42,742,900      
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . . 2,237,472      
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 603,787      
8 Credit enhancement from proceeds . . . . . . . . . . . 828,469      
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 39,070,172      
11 Other spent proceeds . . . . . . . . . . . . . .        
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2007
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
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 of bond-financed property? . . . . . . . . . . . .   X            
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any 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 . . SchKMediumBullet 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 . . . . . . . SchKMediumBullet   %   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X            
b Exception to rebate? . . . . . . . .   X            
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .                
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . .  
 
 
 
 
 
 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . .  
 
 
 
 
 
 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Supplemental Information Part VI Series HProceeds from the sales of Series H Bonds were used, together with other monies available to 1) finance a portion of the costs of the Series H project, 2) to fund capitalized interest, if any on the Series H Bonds, and 3) to pay certain costs of issuance and bond insurance premiums incurred in connection with the issuance of Series H Bonds. Part II, Line #3 includes investment earnings of $1,818,235.Part III, Line #4:Private Business Usage percentage of 4.69%, reflected on line #4 was not reduced by the remediation of $1,945,000. The average Private Business Usage percentage over the over the life of the bond is only 2%.Part IV, Line #2cThe date that the rebate computation was performed was March, 2014.
Schedule K (Form 990) 2012

Additional Data


Software ID: 12000229
Software Version: 2012v2.0

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
2012
Open to Public
Inspection
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Identifier Return Reference Explanation
  FORM 990, PART VII (ADDT'L INFORMATION) For those officers and top 5 employees, for which only 40 hours is noted to reflect paid hours, actual hours worked exceeded this amount.Note: All amounts in column F, of Part VII,"Estimated Amount of Other Compensation", represent benefits, and do not reflect any compensation for which the average amount of time worked can be reflected.
  Form 990, Part VI, Section A, Line 1b David Kramer, MD and Neil Culligan, MD were not considered to be independent, since they both received stipends during the year exceeding $10,000.
  Form 990, Part VI, Line 7A The sole member shall be responsible for electing, at the annual meeting of the membership, the members of the Board of Directors of the Hospital to serve for three year terms and until their successors are elected and have qualified.
  Form 990, Part VI, Line #6 Western Connecticut Health Network, Inc. is the sole member of Danbury Hospital.
  FORM 990, PART IX, COLUMN D ALTHOUGH CONTRIBUTIONS ARE REFLECTED ON LINE #1 OF PAGE #1 ON FORM 990,ALL FUNDRAISING EXPENSES WERE INCURRED BY THE WESTERN CONNECTICUT HEALTH NETWORK FOUNDATION, INC..
Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Decreases EQUITY TRANSFER TO WCHN-W/O OF INTERCOMPANY = -$28604162
Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Decreases CHANGE IN INVESTMENT OF WHCIC = -$2101411
Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases CHANGE IN EQUITY INTEREST OF WCHNF = $27286895
Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available The information that has been posted on Danbury Hospital's website for 2013 includes:The most current audited financial statements.Also included is the Code of Business Ethics, Information about our Compliance Program, and a copy of our policy regarding Preventing of Fraud, Waste and Abuse.All governing documents required by law are made available upon request.The conflict of interest policy is available upon request.
Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees Compensation for Other Officers and Key Employees:Compensation review and approval process is identical to the process for the CEO and executives noted in 15A above.
Form 990, Part VI, Line 15a Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management Compensation of CEO:In order to achieve its mission and its overall performance objectives, Western Connecticut Health Network, Inc. employs a performance-based total compensation program for its senior executives that is market competitive, compliant with regulatory guidelines, and representative of best practices. Eligible executives are generally direct reports of the CEO along with other executives designated by the CEO. To meet Western Connecticut Health Network Inc.'s total compensation objectives for executives, the following survey sources are used for comparison purposes: -Blend of national Confidential Source, IHS, and Hay Group points healthcare data (where data available), plus 15% geographic differential. Title match data cuts selected based on revenue size.-For Physician executives, surveys covering physician compensation in accredited medical schools (AAMC) are used in combination with proprietary surveys compiled by nationally known consulting firm, Sullivan Cotter and the Medical Group Management Association (MGMA).Western Connecticut Health Network, Inc. targets cash compensation at market competitive levels. Base salary plus short-term (annual) incentive awards (total cash) approximate market competitive levels for total cash compensation. Executive performance is expected to meet or exceed predetermined operational and financial metrics.Other factors, such as competitive market forces, job performance, unique qualifications, and/or individual job responsibilities are also considered in Western Connecticut Health Network, Inc's executive compensation decisions.Roles of the Committee on Governance and Key Executives in the Executive Compensation Process- The Committee on Governance in consultation with the CEO and the SVP HR selects the outside compensation consultants. The current consultant is the Hay Group, whose purpose is to provide a valid independent assessment of the relevent market rates and pay practices for healthcare executives, physician executives and for physicians in general.- The compensation consulting firm compiles appropriate market data, job evaluation and ranking information for all executives and physicians of the organization, excluding the CEO, and will supply this material to the CEO and SVP HR for review and agreement. Once the report is final, it will be supplied to the Committee on Governance for their consideration and acceptance.-The Committee on Governance determines the CEO's salary based on overall performance and market data supplied by the outside market consultant.The last executive compensation evaluation by an outside consultant was done in December, 2013.
Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts The Organization's Process for Monitoring and Enforcing Conflicts of InterestThe Western Connecticut Health Network and its affiliates' (The Network)Conflict of Interest Policy provides that annually, its Representatives shall sign a statement affirming that they disclosed all potential conflicts, as documented in the Conflict of Interest Policy. In addition, General Counsel is part of the routine contracts review process and watches for potential conflicts with any of The Network's Representatives.Who Is Covered By the PolicyThe Network's Conflict of Interest Policy covers each director, officer and manager of The Network, also referred to as "Representatives". Level At Which Determinations of Whether There Is a Conflict In connection with any actual or possible conflict of interest, an interested person must disclose the facts of the conflict. The Compliance Officer and the Audit Committe review and evaluate each disclosure to determine if there is a conflict of interest. After presentation of a potential tranaction or arrangement is made by an interested person, the remaining disinterested Board or Committee members shall decide if a conflict of interest exist. Level That Reviews and Determines What To Do If There Is a ConflictAfter exercising due diligence the full Board would determine what actions should be taken for all conflicts by Officers and Directors. Any conflicts occurring by a manager are reviewed by the Compliance Committee to determine what further action should be taken.Restrictions on The Conflicted PersonNo director having a conflict of interest on any matter shall vote on that matter or be counted in determining the quorum for the meeting at which the vote is taken, even when permitted by law. No Representative having a conflict of interest on any matter shall use his or her personal influence on the matter.If the Board of Directors, in its sole discretion, determines that any Representative has conflicts of interest sufficient in number and/or importance that the effectiveness of such individual on behalf of The Network may be significantly impaired, the Board may ask the individual to resign.
Form 990, Part VI, Line 11b Form 990, Part VI, Line 11b: Form 990 Review Process Steven Rosenberg, CFO, will review the 990 prior to it being sent to the IRS. A preliminary 990, is presented to the Audit Committee in June, who reviews it on behalf of the Board. E&Y is on hand to review the 990 with the Audit Committee and answer any questions. Prior to the 990 being filed with the IRS, the Board will receive a full and accurate copy on a secured website for their review.
Form 990, Part VI, Line 7b Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The duties and responsibilities of the sole member shall include, among others, the following:Electing at the annual meeting of the membership, the members of the Board of Directors of the hospital to serve for three year terms and until their successors are elected and have qualified:Filling vacancies on the Board of Directors, which occur between elections; reviewing, making, and approving changes in the bylaws; insuring that the objective, purposes and goals of Danbury Hospital as stated in the charter of the Danbury Hospital, Inc. are properly and effectively carried out by the Board of Directors; delegating as appropriate, to the Board of Directors, policy-making functions, the supervision of the Hospital's operations and the control over the Hospital's assets.The Board shall be required to approve the fundamental decisions listed below by the Hospital:-Approval of all operating and capital budgets of the Hospital.-Approval of unbudgeted expenditures over a certain amount.-Approval of any advances of assets or loans by the Hospital, or the incurring of any indebtedness, secured or unsecured, which exceeds such an amount established by the Board.-Appointment of the Hospital's auditors, legal counsel and other consultants.-The procurement of insurance.-Approval of investment policies.-Approval of any agreement or transaction involving an amount greater than established by the Board with another corporation or entity, including affiliated entities.-Approval of joint ventures.-Approval of any amedment or restatement of the Hospital's certificate of incorporation, bylaws, purposes, membership and rights and responsibilities.-Approval of the creation of any corporation of which the Hospital is the sole member or controlling member; the merger or consolidation of the Hospital with another corporation; and the reorganization, liquidation or dissolution of the Hospital or any corporation of which the Hospital is the sole member or controlling member.-Approval of any sale, lease, exchange, or other disposition of all or substantially all the property or assets of the Hospital.-Election and removal of the members of the Board and its officers.-Creation of any committee, other than the Governance Committee.-Approval of the adoption of or any amendment to the policies and procedures governing inhdemnification of directors and officers of the Hospital.-Approval of any conveyance of, or the granting of mortgages, trusts, deeds or the creation of other liens on, any real property assets of the Hospital.-Approval of the strategic plan of the Hospital.-Approval of any change to the employee pension or other employee benefit plans for or on behalf of the Hospital.-Approval of the engagement in managed care and other third party payor contracting on behalf of the Hospital.-Approval of any commencement, cessation, location, relocation or consolidation of significant clinical services provided by the Hospital and to approve or initiate the filing of any application for a certificate of need by the Hospital.-Approval of system-wide quality, performance and credentialing standards and procedures to which the Hospital is expected to adhere.-Approval of any physician compensation arrangements.
Form 990, Part VI, Line 4 Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents The following significant change was made to the by laws of Danbury Hospital, during the fiscal year ending September 30, 2013:The term of the Chair was changed to allow a person to complete his two-year term as Chair once they exceed their third full term. Thereafter, they will be eligible for re-election to the board after one year without serving. Previously, directors were eligible for elecion to a fourth term.
Form 990, Part VI, Line 2 Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Richard Jabara and James Kennedy, both directors of Danbury Hospital have a business relationship.
    Client Note 1 - FORM 990, GENERAL EXPLANATION ATTACHMENT========================================FORM 990, PART II, COLUMN D============================ALTHOUGH CONTRIBUTIONS ARE REFLECTED ON LINE #1 OF PAGE #1 ON FORM 990,ALL FUNDRAISING EXPENSES WERE INCURRED BY THE DANBURY HOSPITALDEVELOPMENT FUND, INC..FORM 990, PART IV - TAX-EXEMPT BOND LIABILITIES (ADDITIONAL INFORMATION)========================================================================HOSPITAL REVENUE BONDS FINANCED WITH THE STATE OF CONNECTICUT HEALTH AND EDUCATIONAL FACILITIESSERIES G - $42,420,000SERIES H - $41,560,000SERIES J - $35,580,000UNEXPENDED BOND PROCEEDS AS OF 9/30/2008 IS $0.FORM 990, PART VII, LIST OF OFFICERS, DIRECTORS AND TRUSTEES (ADDT'L INFOR.)============================================================================FOR ALL OFFICERS AND THE TOP 5 EMPLOYEES, ALTHOUGH ONLY 40 HOURS IS NOTED TO REFLECT PAID HOURS, ACTUALLY WORKED HOURS EXCEEDED THIS AMOUNT.A STIPEND WAS PAID TO DAVID KRAMER, MD, A DIRECTOR, DURING THE YEAR FORSPINE SURGERY CO-DIRECTORSHIP.A STIPEND WAS PAID TO NEIL CULLIGAN,MD, A DIRECTOR, DURING THE YEAR FOR STROKE PROGRAMDIRECTORSHIP.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID: 12000229
Software Version: 2012v2.0
SCHEDULE R
(Form 990)

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

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Danbury Hospital
 
Employer identification number

06-0646597
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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" to 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 entity?
Yes No
(1) Eastern NY Medical Services PC

14 Research Drive Suite 201A

Bethel,CT06810
45-5431389
PHYSICIAN SVC. NY 501(C)(3) 9 WCHN
 
Yes
 
(2) The New Milford Hospital Inc

21 Elm Street

New Milford,CT06776
06-0669121
ACUTE CARE CT 501(C)(3) 3 WCHN
 
Yes
 
(3) Western CT Medical Group PC

14 Research Drive Suite 201A

Bethel,CT06801
06-1137531
PHYSICIAN SVC. CT 501(C)(3) 9 WCHN
 
Yes
 
(4) Western CT Home Care Inc

4 Liberty Street

Danbury,CT06810
06-0655138
HOME HLTHCARE CT 501(C)(3) 9 WCHN
 
Yes
 
(5) West CT Health Network Foundation

24 Hospital Avenue

Danbury,CT06810
23-7425557
ADMIN CONTRIB CT 501(C)(3) 7 WCHN
 
Yes
 
(6) Western CT Health Network Inc

24 Hospital Avenue

Danbury,CT06810
22-2594977
PROGRAM DEVLP CT 501(C)(3) 11, TYPE 2 NA
 
 
No
(7) West CT Health Network Affiliates

95 Locust Avenue

Danbury,CT06810
22-2594968
OP HLTHCR SVC. CT 501(C)(3) 9 WCHN
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



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

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




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



(k)
Percentage
ownership


Yes No Yes No
(1) Ridgefield Surgical Center LLC

901 Ethan Allen Hwy Suite 105
Ridgefield,CT06877
22-2594977
INACTIVE CT WCHN
 
N/A       No     No  
(2) New Milford MRI JV LLC

21 Elm Street
New Milford,CT06776
27-1877801
INACTIVE CT NMH
 
N/A       No     No  










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) West CT Health Network Insur Co LTD

23 Lime Tree Bay PO Box 1051
Grand Cayman    
CJ
98-0438151
MALPRCTICE   DH
 
C Corp. 13,846,966 68,029,592 100.000 % Yes  
(2) Medical Services of Danbury

24 Hospital Avenue
Danbury,CT06811
06-1635945
Healthcare CT WCMG
 
C Corp.       Yes  
(3) Foundation for Comm Healthcare

95 Locust Avenue
Danbury,CT06810
06-1437131
INACTIVE CT WCHN
 
C Corp.       Yes  
(4) Business Systems Inc

95 Locust Avenue
Danbury,CT06810
06-1119262
PHARMACY CT WCHN
 
C Corp.       Yes  






Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) West CT Health Network Insur Co LTD

r 10,503,802 Cost
(2) West CT Health Network Insur Co LTD

q 10,753,691 Cost
(3) West CT Health Network Insur Co LTD

p 13,223,000 Cost
(4) Business Systems Inc

q 2,765,000 Cost
(5) Eastern NY Medical Services PC

r 67,383 Cost
(6) The New Milford Hospital Inc

s 1,286,806  
(7) The New Milford Hospital Inc

r 14,691,438 Cost
(8) The New Milford Hospital Inc

q 17,388,307 Cost
(9) The New Milford Hospital Inc

o 3,668,357 Cost
(10) The New Milford Hospital Inc

l 467,243 Cost
(11) Western CT Medical Group PC

s 622,888 Cost
(12) Western CT Medical Group PC

r 49,997,090 Cost
(13) Western CT Medical Group PC

q 2,170,307 Cost
(14) Western CT Medical Group PC

o 209,589 Cost
(15) Western CT Medical Group PC

m 52,041,883 Cost
(16) Western CT Medical Group PC

l 2,035,013 Cost
(17) Western CT Medical Group PC

a 1,842,891 Cost
(18) Western CT Home Care Inc

r 1,177,528 Cost
(19) Western CT Home Care Inc

q 1,275,802 Cost
(20) West CT Health Network Foundation

r 2,750,738 Cost
(21) West CT Health Network Foundation

q 6,797,439 Cost
(22) West CT Health Network Foundation

k 56,258 Cost
(23) West CT Health Network Foundation

c 10,129,901 Cost
(24) West CT Health Network Foundation

a 77,528 Cost
(25) West CT Health Network Affiliates

r 6,618,926 Cost
(26) West CT Health Network Affiliates

q 6,846,443 Cost
(27) West CT Health Network Affiliates

m 467,768 Cost
(28) West CT Health Network Affiliates

l 180,567 Cost
(29) West CT Health Network Affiliates

a 93,470 Cost
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
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: 12000229
Software Version: 2012v2.0