Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| JOINT VENTURE POLICY FORM 990, PART VI, SECTION B, LINE 16B | WHILE A WRITTEN POLICY HAS NOT BEEN ADOPTED REGARDING THE EVALUATION OF PARTICIPATION IN JOINT VENTURES, MANAGEMENT FOLLOWS A PROCEDURE IN WHICH ALL POSSIBLE JOINT VENTURE ARRANGEMENTS ARE EVALUATED UNDER APPLICABLE FEDERAL TAX LAWS. MANAGEMENT UTILIZED THE SERVICES OF APPROPRIATE CONSULTANTS AND LEGAL COUNSEL TO EVALUATE EACH JOINT VENTURE OPPORTUNITY. THIS EVALUATION ALSO INCLUDES AN ANALYSIS OF HOW THE JOINT VENTURE WILL FURTHER THE HOSPITAL'S MISSION. THE HOSPITAL HAS TAKEN ALL APPROPRIATE STEPS TO SAFEGUARD ITS TAX EXEMPT STATUS WITH RESPECTS TO ALL JOINT VENTURE ARRANGEMENTS. JOINT VENTURE ARRANGEMENTS ARE APPROVED BY THE BOARD OF TRUSTEES. |
| OFFICERS AND TRUSTEES FORM 990, PART VII | DANIEL DEBARBA WAS PRESIDENT OF NORWALK HOSPITAL, DANBURY HOSPITAL AND NEW MILFORD HOSPITAL THRU 11/30/2014. EFFECTIVE 12/1/2014 HE IS PRESIDENT OF DANBURY HOSPITAL ONLY. BOARD TERM EXPIRED 12/31/2014. ED MAHONY - VICE CHAIRMAN AND TRUSTEE THRU 12/31/2014, CHAIRMAN AND TRUSTEE EFFECTIVE 1/1/2015 ANDREW WHITTINGHAM - TRUSTEE ONLY THRU 12/31/2014, VICE CHAIRMAN AND TRUSTEE EFFECTIVE 1/1/2015 MARK GUDIS - TREASURER AND TRUSTEE THRU 12/31/2014, TRUSTEE ONLY EFFECTIVE 1/1/2015 THOMAS AYOUB, MD - TRUSTEE AND CHIEF OF STAFF, COMPENSATION RECEIVED IS FOR SERVICES AS CHIEF OF STAFF OF NORWALK HOSPITAL 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 AMOUNT 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 WORK CAN BE REFLECTED. |
| SCHEDULE H PART V LINE 10A URL IMPLEMENTATION STRATEGY | MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY TO MEET THE SIGNIFICANT COMMUNITY HEALTH NEEDS CAN BE FOUND AT: HTTP://WWW.NORWALKHOSPITAL.ORG/ABOUT-US/ABOUT-NORWALK-HOSPITAL/ COMMUNITY-BENEFIT TITLED GREATER NORWALK CHA CHIP REPORT DECEMBER 2012 |
| FORM 990 - ADDITIONAL DBAS | 24 STEVENS STREET, NORWALK, CT 06850 |
| FORM 990, PART III, LINE 1 - ORGANIZATION MISSION | THE MISSION OF NORWALK HOSPITAL IS TO IMPROVE THE HEALTH OF EVERY PERSON WE SERVE THROUGH THE EFFICIENT DELIVERY OF EXCELLENT, INNOVATIVE AND COMPASSIONATE CARE. VISION 2020: WESTERN CONNECTICUT HEALTH NETWORK (WCHN) OF WHICH NORWALK HOSPITAL IS A MEMBER, WILL BE THE PREFERRED PARTNER IN HEALTH AND PROVIDER OF CARE FOR THE COMMUNITIES WE SERVE AND WILL BE AMONG THE MOST RESPECTED COMMUNITY HEALTHCARE SYSTEMS IN THE NATION. VALUES: OUR VALUES REFLECT WHO WE ARE AS AN ORGANIZATION. THEY PROVIDE CLEAR GUIDANCE AS TO BEHAVIOR EXPECTATIONS AND MOTIVATE US BY PROMOTING A SENSE OF BELONGS AND PRIDE. WE ARE ALL ACCOUNTABLE FOR LIVING UP TO AND DEMONSTRATING THESE VALUES IN OUR DAY-TO-DAY ACTIONS: * EXCELLENCE - WE DELIVER THE HIGHEST QUALITY CARE AND SERVICE AND SURPASS ESTABLISH STANDARDS THROUGH A CONTINUOUS FOCUS ON IMPROVEMENT, INNOVATION AND EDUCATION. * INTEGRITY - WE APPROACH OUR WORK WITH THE HIGHEST STANDARDS OF OPENNESS, HONESTY AND ETHICAL BEHAVIOR, WITH FREEDOM FROM ANY INAPPROPRIATE INFLUENCE OR MOTIVE. * COMPASSION - WE SERVE OTHERS WITH EMPATHY AND A DESIRE TO ALLEVIATE THEIR SUFFERING WHILE HONORING EACH INDIVIDUAL'S DIGNITY AND PRIVACY. * TEAMWORK - WE WORK TOGETHER IN A COOPERATIVE, COORDINATED AND SUPPORTIVE ENVIRONMENT THAT PLACES THE TEAM'S OR ORGANIZATION'S GOALS AHEAD OF INDIVIDUAL GOALS. * FISCAL RESPONSIBILITY - WE ACHIEVE OUR MISSION THROUGH EFFICIENT AND EFFECTIVE USE OF OUR RESOURCES AND PERSONAL ACCOUNTABILITY FOR ENSURING FINANCIAL INTEGRITY AND PERFORMANCE. |
| FORM 990, PART III, LINE 4A - PROGRAM SERVICE ACCOMPLISHMENTS | MEDICINE SERVICE LINE: NORWALK HOSPITAL'S MEDICINE SERVICE LINE CONSISTS OF THE FOLLOWING SERVICES: INPATIENT DISCHARGES: GASTROINTESTINAL 1,151 INFECTIOUS DISEASE 1,081 INTERNAL MEDICINE 754 NEUROLOGY MEDICAL 353 PULMONARY MEDICINE 914 ALL OTHER 1,049 OUTPATIENT SERVICE LINE VOLUME: O/P MEDICINE 5,600 O/P MEDICINE COMMUNITY CLINIC 3,963 O/P MEDICAL ONCOLOGY 2,476 O/P PULMONARY MEDICINE 5,492 OUR DIGESTIVE DISEASE CENTER IS STAFFED BY RENOWNED FELLOWSHIP-TRAINED GASTROENTEROLOGISTS. WE USE ADVANCED DIAGNOSTIC AND TREATMENT TECHNOLOGY IN A COMPASSIONATE AND SUPPORTIVE MANNER. THE FOLLOWING SERVICES ARE PROVIDED: ABLATION THERAPY FOR BARRETT'S ESOPHAGUS, RADIOFREQUENCY ABLATION, COLON CANCER SCREENING, COLONOSCOPY, THIRD EYE RETROSCOPIC, CRYOTHERAPY, DOUBLE BALLOON-ASSISTED ENTEROSCOPY, ENDOSCOPY, ENDOSCOPIC MUCOSAL RESECTION, ENDOSCOPIC ULTRASOUND AND FINE-NEEDLE ASPIRATION, ESOPHAGEL MANOMETRY AND PH TESTING, LACTOSE TOLERANCE TESTING, LINX REFLUX MANAGEMENT SYSTEM FOR TREATMENT OF GERD, WIRELESS CAPSULE ENDOSCOPY AND LAPAROSCOPIC FUNDOPLICATION FOR GERD. NORWALK HOSPITAL'S INFECTIOUS DISEASE SPECIALISTS TREAT THE FULL RANGE OF INFECTIOUS DISEASES, INCLUDING CONDITIONS CAUSED BY LIVING ORGANISMS (BACTERIA, VIRUSES, FUNGI AND PARASITES), HIV, AND RELATED CONDITIONS, LYME DISEASE, CHRONIC AND WOUND-RELATED INFECTION, AND TRAVEL-RELATED INFECTION. OUR DOCTORS HAVE EXPERTISE IN THE PROPER USE OF ANTIBIOTICS AND OTHER ANTI-INFECTIVE MEDICINES TO TREAT DISEASE AND ALSO COLLABORATE WITH PRIMARY CARE DOCTORS, SPECIALISTS AND SURGEONS TO PROVIDE INDIVIDUALIZED TREATMENT FOR EACH PATIENT. WE OFFER EXPERTISE IN TREATMENT OF NEUROLOGICAL DISORDERS, INCLUDING STOKE, EPILEPSY, HEADACHE, PARKINSON'S DISEASE, ALZHEIMER'S DISEASE AND VERTIGO. ONE OF THE NATION'S FIRST HOSPITALS TO EARN PRIMARY STROKE CENTER ACCREDITATION FROM THE JOINT COMMISSION, WE HAVE BEEN REGULARLY RECOGNIZED BY THE CONNECTICUT DEPARTMENT OF PUBLIC HEALTH FOR CONSISTENTLY DEMONSTRATING THE ABILITY TO RAPIDLY DIAGNOSE AND TREAT STROKE. COMMITTED TO REMAINING ON THE FOREFRONT OF RAPID AND EFFECTIVE STROKE CARE, WE CONTINUE TO INCORPORATE THE LATEST EFFECTIVE TREATMENTS. WE OFFER OUTSTANDING DIAGNOSIS, TREATMENT AND CARE FOR PATIENTS WITH ALL TYPES OF PULMONARY CONDITIONS. WE PERFORM SPECIALIZED SERVICES, SUCH AS CARDIOPULMONARY EXERCISE TESTING TO MEASURE DEGREE OF FITNESS AND AID IN THE ASSESSMENT OF SHORTNESS OF BREATH; SPECIFIC DIAGNOSTIC ASTHMA TESTING; AND TESTING TO DETERMINE THE NEED FOR SUPPLEMENTAL OXYGEN FOR EVERYDAY LIVING AND AIR TRAVEL. ALL PROGRAMS ARE ADMINISTERED CONSISTENT WITH NORWALK HOSPITAL'S FINANCIAL ASSISTANCE POLICY. |
| FORM 990, PART III, LINE 4B - PROGRAM SERVICE ACCOMPLISHMENTS | SURGERY SERVICE LINE: NORWALK HOSPITAL'S SURGERY SERVICE LINE CONSISTS OF THE FOLLOWING SERVICES: INPATIENT DISCHARGES: MAJOR JOINT REPLACEMENT 399 TRAUMA SURGERY 354 MINOR GI SURGERY 191 GENERAL SURGERY 158 UROLOGY SURGERY 122 COLON/BOWEL SURGERY 168 OBESITY SURGERY 129 SPINAL SURGERY 131 ALL OTHER INPATIENT SURGERY 361 OUTPATIENT SERVICE LINE VOLUME: ABDOMEN GI SURGERY 545 BREAST SURGERY-NON PLASTIC 450 ENDOSCOPY 6,312 MISC GENERAL SURGERY 992 ORTHO SURGERY 521 UROLOGY 298 PAIN INJECTION PROCEDURES 569 OTOLARY HEAD NECK SURGERY 136 PLASTIC SURGERY 198 ALL OTHER OUTPATIENT SURGERY 724 NORWALK HOSPITAL OFFERS A JOINT REPLACEMENT CENTER, ONE OF OUR CENTERS OF EXCELLENCE. WE OFFER COMPREHENSIVE, MULTIDISCIPLINARY, PERSONALIZED JOINT REPLACEMENT CARE INCLUDING TOTAL HIP REPLACEMENT, TOTAL KNEE REPLACEMENT AND TOTAL SHOULDER REPLACEMENT. AS A LEVEL II TRAUMA CENTER, NORWALK HOSPITAL'S TEAM OF BOARD CERTIFIED SURGEONS PROVIDE IMMEDIATE, 24/7 CARE FOR ACUTE AND LIFE-THREATENING INJURIES TO CHILDREN AND ADULTS. OUR EXPERT GENERAL AND DIGESTIVE DISEASE SURGEONS SPECIALIZE IN MAJOR AND MINOR SURGICAL PROCEDURES OF THE ABDOMEN, DIGESTIVE TRACT, ENDOCRINE SYSTEM, BREASTS, SKIN AND BLOOD VESSELS. NORWALK HOSPITAL UROLOGISTS ARE KNOWN NATIONALLY FOR INNOVATION. PROCEDURES PERFORMED INCLUDE: EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR KIDNEY STONES; LAPAROSCOPIC NEPHRECTOMY, MINIMALLY INVASIVE PHOTO-VAPORIZATION OF THE PROSTATE; MINIMALLY INVASIVE SURGICAL TREATMENT FOR FEMALE INCONTINENCE AND PYELOPLASTY. KNOWN FOR EXCELLENCE AND EXPERTISE, OUR COLON AND RECTAL SURGEONS PERFORM MORE ROBOTIC COLORECTAL SURGERIES THAN ANY OTHER HOSPITAL IN FAIRFIELD COUNTY. CERTIFIED BY THE AMERICAN BOARD OF COLON AND RECTAL SURGEONS, OUR COLORECTAL SURGEONS PROVIDE ADVANCED, INNOVATIVE, PERSONALIZED CARE FOR A WIDE RANGE OF CONDITIONS. OUR SURGEONS ARE EXPERTS IN THE SURGICAL MANAGEMENT OF COLON AND RECTAL CANCER; CROHN'S DISEASE; DIVERTICULITIS, AND ULCERATIVE COLITIS. THE SURGICAL WEIGHT LOSS CENTER IS NATIONALLY ACCREDITED. WE OFFER SEVERAL TYPES OF BARIATRIC SURGERY INCLUDING: LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING; SINGLE INCISION GASTRIC BANDING; LAPAROSCOPIC GASTRIC SLEEVE, LAPAROSCOPIC GASTRIC BYPASS, REVISIONAL BARIATRIC SURGERY AND ROBOTIC BARIATRIC SURGERY. BOARD-CERTIFIED NEUROSURGEONS DIAGNOSE AND TREAT DISORDERS THAT AFFECT ANY PORTION OF THE NERVOUS SYSTEM, INCLUDING THE BRAIN, SPINAL CORD AND PERIPHERAL NERVES. CONDITIONS INCLUDE BRAIN ANEURYSMS, CEREBRAL ANEURYSMS, CHRONIC SUBDURAL HEMATOMA, COMA, CONCUSSIONS, DEGENERATIVE DISC DISEASE, DISC HERNIATION, EPILEPSY, HEAD TRAUMA, SCOLIOSIS, SEIZURES, SPINAL COMPRESSION FRACTURES, SPINAL CORD INJURY, SPINAL CORD TUMORS, STENOSIS, STROKE, AND TORTICOLLIS. ALL PROGRAMS ARE ADMINISTERED CONSISTENT WITH NORWALK HOSPITAL'S FINANCIAL ASSISTANCE POLICY. |
| FORM 990, PART III, LINE 4C - PROGRAM SERVICE ACCOMPLISHMENTS | WOMEN AND CHILDREN'S SERVICE LINE: NORWALK HOSPITAL'S WOMEN'S AND CHILDREN'S DERIVE LINE CONSISTS OF THE FOLLOWING SERVICES: INPATIENT DISCHARGES: ANTE/POST-PARTUM 76 C SECTION DELIVERIES 492 GYN ONCOLOGY 33 GYNECOLOGY 73 VAGINAL DELIVERIES 845 NICU 242 NURSERY 1,128 PEDIATRIC MEDICAL 302 PEDIATRIC SURGERY 30 OUTPATIENT SERVICE LINE VOLUME: GYNECOLOGY 773 ULTRASOUND TESTING 2,849 OBSERVATION 804 PEDIATRIC OP PROCEDURES 4 PEDIATRIC OBSERVATION 548 OUR WOMENS AND CHILDREN'S SERVICES FEATURES A TOP NOTCH TEAM OF OBSTETRICIANS, GYNECOLOGIST, PEDIATRICIANS, CERTIFIED MIDWIVES, PEDIATRIC HOSPITALISTS, NEONATOLOGISTS, PEDIATRIC SPECIALISTS, PHYSICIAN ASSISTANTS AND NURSES. OUR OBSTETRICIANS AND CERTIFIED NURSE MIDWIVES DELIVER BABIES IN THE HOSPITAL'S MODERN, HOME-LIKE CHILD BIRTH CENTER. THE CENTER FEATURES IN-SUITE AMENITIES, INCLUDING PRIVATE ROOMS, MASSAGE THERAPY FOR INFANTS AND MOTHERS AND WIRELESS INTERNET ACCESS. IN ADDITION ADVANCES, MINIMALLY INVASIVE ROBOTIC SURGERY FOR SEVERAL GYNECOLOGIC PROCEDURES, INCLUDING HYSTERECTOMIES, FIBROID REMOVAL, VAGINAL PROLAPSE CORRECTION, TO STOP MENORRHAGIA AND TO TREAT CERTAIN FORMS OF CERVICAL AND UTERINE CANCERS, ARE AVAILABLE AT THE HOSPITAL. THE NORWALK HOSPITAL PEDIATRIC SERVICES INCLUDE THE JEFFREY PETER BAUER NEWBORN INTENSIVE CARE UNIT (NICU), PEDIATRIC INPATIENT CARE, PEDIATRIC SUBSPECIALTY CARE, AND THE PEDIATRIC DEVELOPMENT THERAPY CENTER. ALL PROGRAMS ARE ADMINISTERED CONSISTENT WITH NORWALK HOSPITAL'S FINANCIAL ASSISTANCE POLICY. |
| FORM 990, PART III, LINE 4D - OTHER PROGRAM SERVICES DESCRIPTION | OTHER PROGRAM SERVICES INCLUDE: EMERGENCY SERVICES - NORWALK HOSPITAL PROVIDES A COMPREHENSIVE RANGE OF HIGH-QUALITY EMERGENCY MEDICAL SERVICES, FOR THE MOST CRITICALLY ILL AND INJURED PATIENTS, FROM PRE-HOSPITAL EMS/PARAMEDIC SERVICES TO AN EMERGENCY DEPARTMENT FEATURING A LEVEL II TRAUMA CENTER TO A NATIONALLY RECOGNIZED CRITICAL CARE UNIT. OUR EMERGENCY DEPARTMENT FEATURES MODERN LIFESAVING TECHNOLOGY AND IS STAFFED BY BOARD-CERTIFIED PHYSICIANS AND EXPERIENCED NURSES WITH ADVANCED SKILLS. FOR PATIENTS EXPERIENCING A STROKE, NORWALK HOSPITAL IS CERTIFIED AS A STROKE CENTER BY THE JOINT COMMISSION. FOR PATIENTS EXPERIENCING AN ACUTE HEART ATTACK, NORWALK HOSPITAL IS CERTIFIED AS A PRIMARY ANGIOPLASTY CENTER. ONCE IDENTIFIED AS A CANDIDATE BY EMS OR BY THE EMERGENCY PHYSICIAN, A CRITICAL PATHWAY ENSURES THE RAPID EVALUATION OF THE PATIENT AND MOVEMENT TO THE CARDIAC CATH LAB FOR DEFINITIVE CARE TO MINIMIZE LONG-TERM CONSEQUENCES. NORWALK HOSPITAL'S CRITICAL CARE UNIT HAS BEEN NATIONALLY RECOGNIZED FOR THE EXEMPLARY LEVEL OF CARE PROVIDED. THE UNIT'S NURSES HAVE BEEN AWARDED THE BEACON AWARD FOR CRITICAL CARE EXCELLENCE BY THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES THREE TIMES. THE EMERGENCY DEPARTMENT HAD 36,759 TREATED AND RELEASED VISITS 9/30/2015. CARDIOVASCULAR SERVICES - NORWALK HOSPITAL OFFERS A PREMIER CARDIOVASCULAR PROGRAM TO MEET THE NEEDS OF PATIENTS WITH CARDIAC AND VASCULAR PROBLEMS. LED BY A SPECIALIST TEAM OF CARDIOLOGISTS, INTERVENTIONAL CARDIOLOGISTS AND VASCULAR SURGEONS, THIS PROGRAM HAS ACHIEVED WIDE ACCLAIM FOR PROVIDING LEADING-EDGE PREVENTION, DIAGNOSIS, TREATMENT AND REHABILITATION OF CARDIOVASCULAR DISEASE. ONE OF NORWALK HOSPITAL'S SIGNATURE CLINICAL SERVICES, OUR CARDIOVASCULAR PROGRAM OFFERS OUTSTANDING INPATIENT AND OUTPATIENT CARE FOR THOSE SUFFERING A HEART ATTACK OR FROM HEART DISEASE, CONGESTIVE HEART FAILURE, ANGINA, ATHEROSCLEROSIS, AND VASCULAR CONDITIONS, INCLUDING AORTIC ANEURYSMS, CAROTID ARTERY STENOSIS, DEEP VEIN THROMBOSIS AND PERIPHERAL ARTERY DISEASE. ADDITIONALLY, THE HOSPITAL HAS ON STAFF SEVERAL INTERVENTIONAL CARDIOLOGISTS WHO PERFORM DIAGNOSTIC CARDIAC CATHERIZATIONS AND EMERGENCY CARDIAC ANGIOPLASTY AMONG OTHER INVASIVE PROCEDURES. OUR CARDIAC REHABILITATION PROGRAM HELPS CARDIAC PATIENTS LIVE LIFE TO THE FULLEST AND IS ACCREDITED BY THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION FOR PROVIDING THE HIGHEST STANDARD OF CARE. CARDIOVASCULAR SERVICES HAD 1,37 INPATIENT DISCHARGES; 4,743 OUTPATIENT VOLUME FOR THE FISCAL YEAR ENDED 9/30/2015. PSYCHIATRY - NORWALK HOSPITAL PROVIDES INPATIENT PSYCHIATRIC SERVICES FOR ADULT AND GERIATRIC PATIENTS. THE 20 BED UNIT PROVIDES INDIVIDUALIZED CARE FOR PATIENTS WITH ACUTE PSYCHIATRIC ILLNESS, COMPLEX MEDICAL-PSYCHIATRIC ILLNESS OR A NEED FOR DUAL-DIAGNOSIS DETOXIFICATION. NORWALK HOSPITAL ALSO PROVIDES AN INTENSIVE OUTPATIENT PROGRAM, OFFERING BOTH INDIVIDUAL TREATMENT AND GROUP THERAPY. PSYCHIATRY HAD INPATIENT DISCHARGES OF 537 AND 9,523 BILLED MONTHS FOR THE FISCAL YEAR ENDED 9/30/2015. RADIOLOGY - NORWALK HOSPITAL OFFERS A VARIETY OF RADIOLOGY SERVICES INCLUDING, CT, PET/CT, CT LUNG SCREENING, VIRTUAL COLONOGRAPHY, MRI AND OPEN MRI, ULTRASOUND, BONE DENSITY MEASUREMENT/OSTEOPOROSIS SCREENING, GENERAL X-RAY, DIGITAL MAMMOGRAPHY, DIGITAL BREAST TOMOSYNTHESIS, BREAST MRI AND ULTRASOUND, STEREOTACTIC, MRI-GUIDED AND ULTRASOUND GUIDED BREAST BIOPSY, NUCLEAR MEDICINE, INTERVENTIONAL RADIOLOGY, CANCER SCREENING, STEREOTACTIC RADIOSURGERY, INTENSITY-MODULATED RADIATION THERAPY (IMRT) AND PROSTATE CANCER TREATMENT WITH RADIOACTIVE SEEDS. RADIOLOGY SERVICES PERFORMED 66,068 PROCEDURES FOR THE FISCAL YEAR ENDED 9/30/2015. PATHOLOGY AND LABORATORY MEDICINE - THE DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE IS FULLY ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLOGISTS. THE DEPARTMENT PROVIDES COMPREHENSIVE ANATOMIC AND CLINICAL PATHOLOGY TESTING SERVICES INCLUDING: BLOOD BANK & TRANSFUSION SERVICES, CLINICAL CHEMISTRY, MICROBIOLOGY, CYTOLOGY, HEMATOLOGY/COAGULATION/URINALYSIS, IMMUNOLOGY AND FLOW CYTOMETRY, SURGICAL PATHOLOGY, AUTOPSY SERVICE, CYTOGENETIC AND MOLECULAR DIAGNOSTICS AND BLOOD COLLECTION. THE PATHOLOGY AND LABORATORY DEPARTMENT PERFORM APPROXIMATELY, 1.5 MILLION TESTS EVERY YEAR, UTILIZING THE LATEST TECHNOLOGY IN ROBOTIC AUTOMATION AND BARCODE SPECIMEN TRACKING. |
| FORM 990, PART VI, LINE 2 | BUSINESS OR FAMILY RELATIONSHIP OF OFFICERS, DIRECTORS, ETC. A BUSINESS RELATIONSHIP EXISTS BETWEEN FRED AFRAGOLA, VICTOR LISS AND GEORGE BAUER A BUSINESS RELATIONSHIP EXISTS BETWEEN RICHARD JABARA AND ERVIN SHAMES |
| FORM 990, PART VI, LINE 6 | EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDERS AS OF SEPTEMBER 30, 2014 NORWALK HEALTH SERVICES CORPORATION, INC. (NHSC) IS THE SOLE MEMBER OF NORWALK HOSPITAL ASSOCIATION (NHA) AND APPOINTS NHA'S TRUSTEES. ON OCTOBER 1, 2014 NHSC MERGED INTO WESTERN CONNECTICUT HEALTH NETWORK (WCHN), WCHN BECAME THE SOLE CORPORATE MEMBER OF NHA. |
| FORM 990, PART VI, LINE 7A | HOW MEMBERS OR SHAREHOLDERS ELECT GOVERNING BODY THE SOLE MEMBER SHALL BE RESPONSIBLE FOR ELECTING, AT THE ANNUAL MEETING OF THE MEMBERSHIP, THE MEMBERS OF THE BOARD OF TRUSTEES OF THE HOSPITAL TO SERVE FOR THREE YEAR TERMS AND UNTIL THEIR SUCCESSORS ARE ELECTED AND HAVE QUALIFIED. |
| FORM 990, PART VI,LINE 7B | DECISIONS OF GOVERNING BODY APPROVAL OF MEMBERS OR SHAREHOLDERS CERTAIN FUNDAMENTAL DECISIONS TO BE UNDERTAKEN BY THE HOSPITAL REQUIRE APPROVAL OF THE MEMBER. |
| FORM 990, PART VI, LINE 11B | FORM 990 REVIEW PROCESS STEVEN ROSENBERG, CFO OF WCHN, 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 12C | EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS THE ORGANIZATION'S PROCESS FOR MONITORING AND ENFORCING CONFLICTS OF INTEREST THE 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 POLICY THE 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 COMMITTEE REVIEW AND EVALUATE EACH DISCLOSURE TO DETERMINE IF THERE IS A CONFLICT OF INTEREST. AFTER PRESENTATION OF A POTENTIAL TRANSACTION OR ARRANGEMENT IS MADE BY AN INTERESTED PERSON, THE REMAINING DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXIST. LEVEL THAT REVIEWS AND DETERMINES WHAT TO DO IF THERE IS A CONFLICT AFTER 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 PERSON NO 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 15B | COMPENSATION REVIEW & APPROVAL PROCESS- OFFICERS & KEY EMPLOYEES 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 COMPENSATION COMMITTEE AND KEY EXECUTIVES IN THE EXECUTIVE COMPENSATION PROCESS - THE COMPENSATION COMMITTEE IN CONSULTATION WITH THE CEO AND THE SVP HUMAN RESOURCES (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 COMPENSATION COMMITTEE FOR THEIR CONSIDERATION AND ACCEPTANCE. -THE COMPENSATION COMMITTEE DETERMINES THE CEO'S SALARY BASED ON OVERALL PERFORMANCE AND MARKET DATA SUPPLIED BY THE OUTSIDE COMPENSATION CONSULTANT. THE LAST EXECUTIVE COMPENSATION EVALUATION BY AN OUTSIDE CONSULTANT WAS DONE IN DECEMBER, 2015. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES: COMPENSATION REVIEW AND APPROVAL PROCESS IS IDENTICAL TO THE PROCESS FOR THE CEO AND EXECUTIVES. |
| FORM 990, PART VI LINE 19 | OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE ALL GOVERNING DOCUMENTS REQUIRED BY LAW AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE BY REQUEST. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS OR FUND BALANCES CHANGE IN INTEREST RATE SWAP $ -2,928,568 CHANGE IN PENSION OBLIGATION -28,544,535 DECREASE IN BEN INT CHARITABLE REMAINDER TRUST -452,051 INCREASE BEN INTEREST IN NHF - PERM RESTRICTED 6,800 INCREASE BEN INTEREST IN NHF - TEMP RESTRICTED 22,383,231 INCREASE BEN INTEREST IN NHF - UNRESTRICTED 28,094,926 NET ASSET TRANSFER NORWALK HOSP PHYSICIANS & SURG -776,179 NET UNRESTRICTED CHANGES IN JOINT VENTURE 3,911,974 NORWALK SURGERY CENTER / JOINT VENTURE INCOME -3,771,482 TRANSFER FROM NORWALK HEALTH CARE, INC 270,131 TRANSFER FROM NORWALK HOSPITAL FOUNDATION 9,800 ------------ TOTAL $ 18,204,047 ------------ |
| FORM 990 PART IX LINE 11G | DESCRIPTION:AGENCY & TEMP HELP TOTAL FEES:1996594 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION EXPENSE TOTAL FEES:1878207 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT MANAGEMENT TOTAL FEES:9383073 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CORPORATE DEPTS ALLOCATIONS TOTAL FEES:5336947 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER TOTAL FEES:664455 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:4963673 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PATIENT CARE & ADMIN SERVICES TOTAL FEES:6496272 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES TOTAL FEES:8103372 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES - CONSULTING TOTAL FEES:2332523 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES - PHARMACY TOTAL FEES:4025155 |
| Software ID: | |
| Software Version: |