TY 2015 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) KAREN GOTTLIEB EFF 1012016...................................................................... TRUSTEE	2.0 ................. 0.0	X		0	0	0
(2) FRED AFRAGOLA...................................................................... SECRETARY	2.0 ................. 0.0	X	X	0	0	0
(3) THOMAS AYOUB MD...................................................................... TRUSTEE	18.0 ................. 0.0	X		85,000	0	0
(4) GEORGE BAUER...................................................................... TRUSTEE	2.0 ................. 2.0	X		0	0	0
(5) KATHLEEN LAVORGNA EFF 10116...................................................................... TRUSTEE	2.0 ................. 0.0	X		0	0	0
(6) BARBARA BUTLER...................................................................... TRUSTEE	2.0 ................. 1.0	X		0	0	0
(7) JENNY Y LEE EFF 10116...................................................................... TRUSTEE	2.0 ................. 0.0	X		0	0	0
(8) HOWARD EISON MD...................................................................... TRUSTEE	2.0 ................. 3.0	X		0	0	0
(9) PAUL GAGNE...................................................................... TRUSTEE	2.0 ................. 1.0	X		0	0	0
(10) MARK GUDIS...................................................................... TRUSTEE	2.0 ................. 0.0	X		0	0	0
(11) DAVID KOMANSKY...................................................................... TRUSTEE	2.0 ................. 0.0	X		0	0	0
(12) DAVID LEHN ESQ...................................................................... TRUSTEE	2.0 ................. 1.0	X		0	0	0
(13) VICTOR LISS...................................................................... TRUSTEE	2.0 ................. 4.0	X		0	0	0
(14) ED MAHONY...................................................................... CHAIRMAN	5.0 ................. 2.0	X	X	0	0	0
(15) MICHAEL DAGLIO...................................................................... PRESIDENT	40.0 ................. 8.0	X	X	0	585,528	45,214
(16) GARY REINER...................................................................... TRUSTEE	2.0 ................. 1.0	X		0	0	0
(17) AMY SCHAFRANN...................................................................... TRUSTEE	2.0 ................. 1.0	X		0	0	0

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) ERVIN SHAMES........................................................................ TRUSTEE	2.0 .......................2.0	X				0	0	0
(19) ANDREW WHITTINGHAM........................................................................ VICE CHAIR	4.0 .......................1.0	X	X			0	0	0
(20) RICHARD JABARA........................................................................ TRUSTEE	2.0 .......................4.0	X				0	0	0
(21) JOSEPH D SKRZYPCZAK........................................................................ TRUSTEE	2.0 .......................4.0	X				0	0	0
(22) STEVEN ROSENBERG........................................................................ CFO/TREASURER	5.0 .......................51.0		X			0	781,435	44,044
(23) RENEE MAURIELLO........................................................................ VP NURSING & PATIENT CARE SERV	40.0 .......................0.0			X		385,651	0	35,154
(24) JAMES HAYNES........................................................................ VP OPERATIONS	40.0 .......................0.0			X		312,599	0	36,054
(25) JAMES VARRONE........................................................................ VP SUPPLY CHAIN	4.0 .......................36.0			X		204,529	0	32,348
(26) PATRICK MINICUS........................................................................ VICE PRESIDENT FINANCE	20.0 .......................20.0			X		0	505,208	35,148
(27) ROBERT CAPODANNO........................................................................ PHYSICIAN	40.0 .......................0.0				X	497,657	0	37,804
(28) JASON FISCHEL........................................................................ PHYSICIAN	40.0 .......................0.0				X	484,105	0	32,604
(29) CHRISTOPHER MICHOS........................................................................ PHYSICIAN	40.0 .......................0.0				X	465,540	0	33,604
(30) BRIAN MCGOVERN........................................................................ PHYSICIAN	40.0 .......................0.0				X	645,937	0	40,454
(31) BENJAMIN GREENBLATT........................................................................ CHAIRMAN, EMERGENCY	40.0 .......................0.0				X	478,186	0	35,116

(A) Name and business address	(B) Description of services	(C) Compensation
MORRISON MANAGEMENT SPECIALISTS INC, PO BOX 102289 ATLANTA,GA30342	FOOD SERVICE	3,577,507
RIGHTSOURCING INC, PO BOX 9695 UNIONDALE,NY11555	STAFFING SERVICES	1,780,529
NORWALK RADIOLOGY CONSULTANTS PC, 148 EAST AVENUE NORWALK,CT06851	PHYSICIANS-RADIOLOGY	1,349,854
US SECURITY ASSOCIATES, 200 MANSELL COURT ROSWELL,GA30076	SECURITY SERVICES	1,218,495
CARDIOLOGY ASSOCIATES OF FAIRFELD C, 40 CROSS STREET 200 NORWALK,CT06851	CARDIOLOGY SERVICES	1,187,669
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 50

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization THE NORWALK HOSPITAL ASSOCIATION

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization THE NORWALK HOSPITAL ASSOCIATION		Employer identification number 06-6068853

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization THE NORWALK HOSPITAL ASSOCIATION			Employer identification number 06-6068853
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

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

Yes

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

Yes

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

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

Yes

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

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

Yes

50,110

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

Yes

71,042

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

Other activities? ...................................................................................................................

Yes

154

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

121,314

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

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

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

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

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

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

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

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) 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."

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

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

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

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

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

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

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

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

Part IV

Supplemental Information

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C PART II B - DESCRIPTION OF LOBBYING ACTIVITY	FEDERAL STATE AND LOCAL ELECTED OFFICIALS AND AGENCY HEADS WERE LOBBIED IN SUPPORT OF MAINTAINING PATIENT ACCESS TO ESSENTIAL SERVICES FOR THE UNINSURED AND UNDERSERVED. A PART OF THIS EFFORT, LOBBYISTS AND STAFF TIME ARE INCLUDED IN 1G AND MISCELLANEOUS EXPENSES ARE NOTED IN 1I. MENTAL HEALTH INITIATIVES AND SUBSTANCE ABUSE TREATMENT WERE OF PARTICULAR IMPORTANCE. DUES WERE PAID TO CONNECTICUT HOSPITAL ASSOCIATION (CHA) IN THE AMOUNT OF $256,691 DURING FISCAL 2016. CHA HAS DETERMINED THAT FOR CHA'S FISCAL YEAR ENDING APRIL 30, 2016, 15.46% OF ITS MEMBERSHIP DUES WERE EXPENDED ON ACTIVITIES THAT MEET THE MEDICARE DEFINITION OF UNALLOWABLE LOBBYING (THOSE ACTIVITIES THAT ARE DIRECTLY RELATED TO COMMUNICATIONS WITH LEGISLATORS OR ACTIONS ON SPECIFIC LEGISLATIVE BILLS). CHA CONTINUES TO INVEST RESOURCES ON ADVOCACY EFFORTS AND GOVERNMENTAL INTERACTIONS THAT ARE SUPPORTED BY DUES AND NOT CONSIDERED UNALLOWABLE. DUES WERE PAID TO AMERICAN HOSPITAL ASSOCIATION (AHA) IN THE AMOUNT OF $47,134 DURING FISCAL 2016. AHA HAD DETERMINED THAT 22.12% OF ITS MEMBERSHIP DUES FOR CALENDAR 2016, WERE EXPENDED PM ACTIVITIES THAT MEET THE MEDICARE DEFINITION OF UNALLOWABLE LOBBYING. AHA CONTINUES TO INVEST RESOURCES ON A BROAD RANGE OF ADVOCACY AND REPRESENTATION INITITATIVES TO HELP THE FIELD UNDERSTAND AND RESPOND TO THE LEGISLATIVE AND REGULATORY CHANGES ON THE HORIZON AND TO SUPPORT HOSPITALS AS THEY STRIVE TO DELIVER AN EVER-HIGHER QUALITY OF CARE IN THE FACE OF CHANGES.

Return Reference

Explanation

SCHEDULE C PART II B - DESCRIPTION OF LOBBYING ACTIVITY

FEDERAL STATE AND LOCAL ELECTED OFFICIALS AND AGENCY HEADS WERE LOBBIED IN SUPPORT OF MAINTAINING PATIENT ACCESS TO ESSENTIAL SERVICES FOR THE UNINSURED AND UNDERSERVED. A PART OF THIS EFFORT, LOBBYISTS AND STAFF TIME ARE INCLUDED IN 1G AND MISCELLANEOUS EXPENSES ARE NOTED IN 1I. MENTAL HEALTH INITIATIVES AND SUBSTANCE ABUSE TREATMENT WERE OF PARTICULAR IMPORTANCE. DUES WERE PAID TO CONNECTICUT HOSPITAL ASSOCIATION (CHA) IN THE AMOUNT OF $256,691 DURING FISCAL 2016. CHA HAS DETERMINED THAT FOR CHA'S FISCAL YEAR ENDING APRIL 30, 2016, 15.46% OF ITS MEMBERSHIP DUES WERE EXPENDED ON ACTIVITIES THAT MEET THE MEDICARE DEFINITION OF UNALLOWABLE LOBBYING (THOSE ACTIVITIES THAT ARE DIRECTLY RELATED TO COMMUNICATIONS WITH LEGISLATORS OR ACTIONS ON SPECIFIC LEGISLATIVE BILLS). CHA CONTINUES TO INVEST RESOURCES ON ADVOCACY EFFORTS AND GOVERNMENTAL INTERACTIONS THAT ARE SUPPORTED BY DUES AND NOT CONSIDERED UNALLOWABLE. DUES WERE PAID TO AMERICAN HOSPITAL ASSOCIATION (AHA) IN THE AMOUNT OF $47,134 DURING FISCAL 2016. AHA HAD DETERMINED THAT 22.12% OF ITS MEMBERSHIP DUES FOR CALENDAR 2016, WERE EXPENDED PM ACTIVITIES THAT MEET THE MEDICARE DEFINITION OF UNALLOWABLE LOBBYING. AHA CONTINUES TO INVEST RESOURCES ON A BROAD RANGE OF ADVOCACY AND REPRESENTATION INITITATIVES TO HELP THE FIELD UNDERSTAND AND RESPOND TO THE LEGISLATIVE AND REGULATORY CHANGES ON THE HORIZON AND TO SUPPORT HOSPITALS AS THEY STRIVE TO DELIVER AN EVER-HIGHER QUALITY OF CARE IN THE FACE OF CHANGES.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds 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? ............................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

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

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

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

Yes No

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

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

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

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" on Form 990, Part IV, line 8.

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.

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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2015

Page 2

Part III

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

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. 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 ...	26,000,000		26,000,000
b	Buildings	205,903,566	120,727,107	85,176,459
c	Leasehold improvements	11,381,591	5,243,537	6,138,054
d	Equipment ...	290,746,574	244,577,141	46,169,433
e	Other ...	110,140,407	1,647,388	108,493,019
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				271,976,965

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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
(3)Other (A) INT IN INV HELD BY WCHNI	143,647,499	F
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	143,647,499

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1)BEN INT IN NORWALK HOSP. FDN	100,837,121	F
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	100,837,121

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) 457 PLAN ASSET				852,186
(2) CERNER PROJECT ALLOCATION				6,446,721
(3) CONSTRUCT FUND/COST ISSUANCE				256,272
(4) DUE FROM AFFILIATES				2,271,699
(5) ERP PROJECT ALLOCATION				1,073,039
(6) INTEREST IN CRT				7,895,307
(7) IT INTEGRATION PROJECT COSTS				1,375,243
(8) MALPRACTICE RECEIVABLE				17,267,578
(9) MALPRACTICE TRUST				327
(10) OTHER RECEIVABLES				1,725,144
(11) REEF ROAD JOINT VENTURE				1,510,000
(12) ROUNDING				2
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				40,673,518

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
457 PLAN LIABILITY	852,186
ASSET RETIREMENT OBLIGATION	9,240,931
DUE TO AFFILIATES	13,128,049
DUE TO THIRD PARTIES	13,975,507
INTEREST RATE SWAP	2,218,719
LEASE - CURRENT AND LONG TERM	6,666,222
LONG TERM DISABILITY RESERVE	1,705,196
MALPRACTICE PAYABLE	17,267,578
MALPRACTICE RESERVE	2,075,127
WORKERS COMP RESERVE	2,882,832
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	70,012,347
2. Liability for uncertain tax positions. 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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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

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.

Return Reference	Explanation

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

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

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

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

Yes

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

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) . . .			13,235,188	3,887,486	9,347,702	2.470 %
b	Medicaid (from Worksheet 3, column a) . . . . .			69,571,474	46,422,125	23,149,349	6.100 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			82,806,662	50,309,611	32,497,051	8.570 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	11	1,497,043	431,310		431,310	0.110 %
f	Health professions education (from Worksheet 5) . . .	1	2	12,069,004	4,568,893	7,500,111	1.980 %
g	Subsidized health services (from Worksheet 6) . . . .	1	3,032	2,265,401	1,025,867	1,239,534	0.320 %
h	Research (from Worksheet 7) .			518,284	426,677	91,607	0.020 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1		52	100
j	Total. Other Benefits . .	14	1,500,077	15,284,051	6,021,537	9,262,562	2.430 %
k	Total. Add lines 7d and 7j .	14	1,500,077	98,090,713	56,331,148	41,759,613	11.000 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	1	400	619	619
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	9,392	18,746	18,746
7	Community health improvement advocacy	1	12,000	1,431,468	1,431,468	0.380 %
8	Workforce development
9	Other
10	Total	3	21,792	1,450,833	1,450,833	0.380 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,228,622

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. ......

1,888,503

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

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

104,306,378

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

134,222,103

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

-29,915,725

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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

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 %	(e) Physicians' profit % or stock ownership %
1NORWALK SURGERY CTR	AMBULATORY SURGERY CENTER	63.21 %	32.07 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

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, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	NORWALK HOSPITAL 24 STEVENS STREET NORWALK,CT06850 NORWALKHOSPITAL.ORG LICENSE #0053	X	X	X	X

Schedule H (Form 990) 2015

Page 4

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)

	NORWALK HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.NORWALKHOSPITAL.ORG

Other website (list url): SEE PART VI

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE O

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	NORWALK HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART VI

The FAP application form was widely available on a website (list url):

SEE PART VI

A plain language summary of the FAP was widely available on a website (list url):
SEE PART VI

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	NORWALK HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, LINE 5 - ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY	FACILITY: NORWALK HOSPITAL IN CONDUCTING THE CURRENT CHNA (COMPLETED AND APPROVED IN 2013), NORWALK HOSPITAL AND THE NORWALK HEALTH DEPARTMENT ENGAGED IN A COLLABORATIVE COMMUNITY PLANNING PROCESS TO IMPROVE THE HEALTH OF THE GREATER NORWALK AREA RESIDENTS INCLUDING NORWALK, NEW CAANAN, WESTPORT, WESTON, WILTON, DARIEN, AND FAIRFIELD. THE INITIATIVE INCLUDED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY THE HEALTH-RELATED STRENGTHS AND NEEDS OF THE AREA AND A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) TO IDENTIFY PRIORITIES, GOALS, AND IMPLEMENT AND COORDINATE STRATEGIES TO ADDRESS THESE PRIORITY ISSUES ACROSS THE REGION. FINDINGS FROM THE CHNA IDENTIFIED OBESITY, MENTAL HEALTH AND SUBSTANCE ABUSE AS PRIORITIES FOR THE AREA. THE CHNA WAS GUIDED BY A PARTICIPATORY, COLLABORATIVE APPROACH, WHICH EXAMINED HEALTH IN ITS BROADEST SENSE. THIS PROCESS INCLUDED INTEGRATING EXISTING DATA REGARDING SOCIAL, ECONOMIC, AND HEALTH INDICATORS IN THE REGION WITH QUALITATIVE INFORMATION FROM 15 FOCUS GROUPS WITH COMMUNITY RESIDENTS AND SERVICE PROVIDERS AND 17 INTERVIEWS WITH COMMUNITY STAKEHOLDERS. FOCUS GROUPS AND INTERVIEWS WERE CONDUCTED WITH INDIVIDUALS FROM THE 7 MUNICIPALITIES THAT COMPRISE THE GREATER NORWALK AREA, WITH INDIVIDUALS REPRESENTING YOUTH; THE HISPANIC AND AFRICAN AMERICAN COMMUNITIES; INDIVIDUALS RECEIVING SERVICES FROM A FEDERALLY-QUALIFIED HEALTH CENTER; SOCIAL SERVICE, HEALTH CARE, AND MENTAL HEALTH PROVIDERS; BUSINESSES; HOUSING; LAW ENFORCEMENT; AND THE LOCAL GOVERNMENT. THIS QUALITATIVES ASSESSMENT PROCESS ENGAGED OVER 200 INDIVIDUALS. IN CONDUCTING THE CURRENT CHNA, NORWALK HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY IT SERVES. THIS INCLUDED THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. LOCAL COLLABORATORS INCLUDED THE VARIOUS HEALTH DEPARTMENTS, POLICE DEPARTMENTS, PUBLIC HIGH SCHOOLS, SOCIAL SERVICE ORGANIZATIONS AND COMMUNITY HEALTH CENTERS. GOVERNMENT OFFICALS WERE ALSO REPRESENTED AT THE STATE AND LOCAL LEVELS, SUCH AS CONNECTICUT SENATORS AND TOWN MAYORS.
PART V, LINE 6B - CHNA CONDUCTED BY ORGANIZATIONS OTHER THAN THE HOSPITAL	FACILITY: NORWALK HOSPITAL NORWALK HEALTH DEPARTMENT
PART V, LINE 11 - EXPLANATION OF NEEDS NOT ADDRESSED AND REASONS WHY	FACILITY: NORWALK HOSPITAL TO THE BEST OF THE ORGANIZATION'S KNOWLEDGE, ALL PRIORITY HEALTH ISSUES IN THE COMMUNITY ARE BEING ADDRESSED THROUGH THE 2013 CHIP. ANY NEEDS NOT BEING ADDRESSED ARE THOSE THAT NORWALK HOSPITAL DOES NOT HAVE THE FUNDS OR CONTROL OVER, SUCH AS ENVIRONMENTAL HEALTH. IN ORDER TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA, A COMMUNITY HEALTH IMPROVEMENT TASK FORCE WAS CREATED OF OVER 100 COMMUNITY RESIDENTS AND PROFESSIONALS REPRESENTING VARIOUS ORGANIZATIONS. THEY IDENTIFIED MENTAL HEALTH, OBESITY AND SUBSTANCE ABUSE AS THE MAIN PRIORITIES TO ADDRESS. THEY CREATED THE 2013 COMMUNITY HEALTH IMPROVEMENT PLAN WHICH DETAILS SPECIFIC GOALS AND METRICS FOR EACH IDENTIFIED NEED, AND COMMUNITY BENEFIT PROGRAMS THAT WOULD HELP ACHIEVE THESE GOALS. THE NARRATIVE FOR PART II COMMUNITY BUILDING ACTIVITIES DESCRIBES ACTIONS TAKEN TO ADDRESS THE NEEDS IDENTIFIED IN THE 2013 CHNA.
PART V LINE 22 - OTHER BILLING DETERMINATION OF INDIVIDUALS WITHOUT INS.	FACILITY: NORWALK HOSPITAL NORWALK HOSPITAL INTENDS TO BE IN COMPLIANCE WITH THE REGULATIONS REGARDING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY AND OTHER MEDICAL NECESSARY CARE BY THE EFFECTIVE DATE (10/1/16). NORWALK HOSPITAL AS OF 10/01/16 (THE EFFECTIVE DATE OF THE 501R REGULATIONS), BEGAN USING THE 501(R) REGULATION COMPLIANT "LOOK-BACK" METHOD FOR CALCULATING AGB.

Schedule H (Form 990) 2015

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Part VFacility Information (continued)

Section D. 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?12
Name and address		Type of Facility (describe)
1	NORWALK HOSP RADIOLOGY & MAMMOGRAPHY CTR 148 EAST AVENUE SUITE 1R NORWALK,CT06851	RADIOLOGY AND MAMMOGRAPHY CENTER
2	NORWALK SURGERY CENTER LLC 40 CROSS STREET NORWALK,CT06851	AMBULATORY SURGERY CENTER
3	NORWALK HOSP OUTPATIENT REHAB SERVICES 520 WEST AVENUE NORWALK,CT06850	OUTPATIENT REHABILITATION FACILITY
4	NORWALK HOSPITAL SLEEP DISORDER CENTER 520 WEST AVENUE NORWALK,CT06850	SLEEP DISORDER SERVICES
5	NORWALK BLOOD COLLECTION CENTER 40 CROSS STREET NORWALK,CT06851	BLOOD COLLECTION
6	WESTPORT BLOOD COLLECTION CENTER 728 POST ROAD EAST WESTPORT,CT06880	BLOOD COLLECTION
7	CROSS ST RADIOLOGY 40 CROSS STREET NORWALK,CT06851	RADIOLOGY SERVICES
8	NEW CANAAN BLOOD COLLECTION CENTER 25-30 EAST AVENUE NEW CANAAN,CT06840	BLOOD COLLECTION
9	NORWALK HOSPITAL NEW CANAAN RADIOLOGY 28-30 EAST AVENUE NEW CANAAN,CT06840	RADIOLOGY SERVICES
10	NORWALK HOSPITAL WESTPORT RADIOLOGY 728 POST ROAD EAST WESTPORT,CT06880	RADIOLOGY SERVICES
11	OCCUPATIONAL HLTH & REHAB SRVCS 45 GROVE STREET NEW CAANAN,CT06840	OUTPATIENT REHABILITATION SERVICES
12	NORWALK BLOOD COLLECTION CENTER 148 EAST AVENUE NORWALK,CT06851	BLOOD COLLECTION

Schedule H (Form 990) 2015

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
PART I, LINE 6A - RELATED ORGANIZATION COMMUNITY BENEFIT REPORT	LINE 6A & 6B: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS SUBMITTED ON SCHEDULE H 990 FORM ANNUALLY. IT CONTAINS THE ORGANIZATION'S COMMUNITY BENEFIT PROGRAMS AND SERVICES' DESCRIPTIONS AND FINANCIAL DATA. THE FORM IS MADE AVAILABLE TO THE PUBLIC ON THE OFFICE OF HEALTH CARE ACCESS' WEBSITE: HTTP://WWW.CT.GOV/DPH/CWP/VIEW.ASP?A=3902&G=585448 PART I, LINE 7G - COSTS ASSOCIATED WITH PHYSICIANS CLINICS SUBSIDIZED HEALTH SERVICES LINE G - NORWALK HOSPITAL RECEIVES A DHMAS GRANT FROM THE STATE OF CONNECTICUT FOR THE OUTPATIENT PSYCHIATRIC CLINIC. THESE DOLLARS HELP OFFSET THE SHORTFALL FROM UNDER OR UNINSURED PATIENTS.
PART III, LINE 2 - METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE	BAD DEBT EXPENSE IS A FUNCTION OF ACTUAL BAD DEBT WRITE-OFFS AND ESTIMATED BAD DEBTS FOR BALANCES STILL IN ACCOUNTS RECEIVABLE (AR) AS OF THE MEASUREMENT DATE. THE HOSPITAL CALCULATES THE ESTIMATED BAD DEBTS IN AR BY COMPUTING HISTORICAL PAYMENT % BY PAYOR, SERVICE TYPE AND BY ACCOUNT AGE AND APPLIES THOSE PERCENTAGES ADJUSTED FOR PRICE INCREASE TO CURRENT AR.
PART III, LINE 3 METHODOLOGY OF EST AMOUNT & RATIONALE FOR INC COM BENEFIT	THE PERCENT OF CHARITY CARE APPLICATIONS UNDER NORWALK HOSPITAL'S FINANCIAL ASSISTANCE POLICY THAT RESULTED IN A DISCOUNT WAS 44.66%. WE APPLIED THIS % TO OUR BAD DEBT EXPENSE OF $4,228,622 TO ARRIVE AT OUR ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER NORWALK HOSPITAL'S FINANCIAL ASSISTANCE POLICY OF $1,888,503.
PART III, LINE 4 - BAD DEBT EXPENSE	PATIENT ACCOUNTS RECEIVABLE RESULT FROM THE HEALTH CARE SERVICES PROVIDED BY THE HOSPITAL. ADDITIONS TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RESULT FROM THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE HOSPITAL'S 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 HOSPITAL'S COLLECTION EFFORTS. THE HOSPITAL'S 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 UNCOLLECTIBLE ACCOUNTS; 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 HOSPITAL'S PRIMARY CONCENTRATION OF CREDIT RISK IS PATIENT ACCOUNTS RECEIVABLE, WHICH CONSISTS OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS.
PART III, LINE 8 - EXPLANATION OF SHORTFALL AS COMMUNITY BENEFIT	ALL HOSPITALS MUST RECORD PROFITS IN ORDER TO GENERATE THE CAPITAL NEEDED TO INVEST IN FACILITIES AND SERVICES. SERVICES THAT RESPOND TO PUBLIC HEALTH NEEDS PROVIDED TO MEDICARE PATIENTS AT NORWALK HOSPITAL GENERATE NEGATIVE MARGINS AVERAGING AROUND 25% OF COST. IT IS POSSIBLE THAT SOME OF THESE SERVICES WOULD BE DISCONTINUED IF THE DECISION WAS MADE ON A PURELY FINANCIAL BASIS. FOR THIS REASON, IT WOULD BE APPROPRIATE TO CONSIDER THE MEDICARE PAYMENT SHORTFALL A COMMUNITY BENEFIT. THE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6 WERE COMPUTED USING THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT MULTIPLIED AGAINST MEDICARE CHARGES.
PART III, LINE 9B - PROVISIONS ON COLLECTION PRACTICES FOR QUAL. PATIENTS	NORWALK HOSPITAL COLLECTION PRACTICES CONSIST PRIMARILY OF BILLING NOTICES AND FOLLOW UP COURTESY CALLS. THE PATIENT IS NOTIFIED OF THE FINANCIAL ASSISTANCE PROGRAM WITH EACH WRITTEN NOTIFICATION AND AT EACH POINT OF SERVICE. NOTIFICATION IS SHARED BY POSTINGS AND VERBAL NOTIFICATION AT THE TIME THE PROCEDURE IS SCHEDULED. IF AT ANY TIME DURING THE COLLECTION PROCESS A PATIENT WOULD LIKE TO PARTICIPATE IN THE FINANCIAL ASSISTANCE PROGRAM COLLECTION ACTIVITY CEASES. THE PATIENT IS THEN SENT AN APPLICATION AND WORKS WITH THE FINANCIAL COUNSELING TEAM FOR APPROVAL OF FULL OR PARTIAL DISCOUNT.
PART VI - NEEDS ASSESSMENT	IN 2012 (COMPLETED AND APPROVED IN 2013) NORWALK HOSPITAL AND THE NORWALK HEALTH DEPARTMENT ENGAGED IN A COLLABORATIVE COMMUNITY PLANNING PROCESS TO IMPROVE THE HEALTH OF THE GREATER NORWALK AREA RESIDENTS. THE INITIATIVE INCLUDED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY THE HEALTH-RELATED STRENGTHS AND NEEDS OF THE AREA AND A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) TO IDENTIFY THE PRIORITIES, GOALS AND IMPLEMENT AND COORDINATE STRATEGIES TO ADDRESS THESE PRIORITY ISSUES ACROSS THE REGION. THE CHNA WAS GUIDED BY A COLLABORATIVE APPROACH, WHICH INCLUDED INTEGRATING EXISTING HEALTH INDICATORS, SOCIAL AND ECONOMIC DATA WITH QUALITATIVE INFORMATION FROM COMMUNITY RESIDENTS AND STAKEHOLDERS. FOCUS GROUPS AND INTERVIEWS WERE CONDUCTED WITH PARTICIPATION FROM YOUTH, ETHNIC COMMUNITIES, SOCIAL SERVICES, HEALTH CARE PROVIDER BUSINESSES, LAW ENFORCEMENT AND LOCAL GOVERNMENT AGENCIES. FOR EXAMPLE, MID-FAIRFIELD CHILD GUIDANCE CENTER PARTICIPATED IN THESE FOCUS GROUPS AND INTERVIEWS. THROUGH THE PROCESS, THEY WERE ABLE TO IDENTIFY MENTAL HEALTH/SUBSTANCE ABUSE AS A PRIORITY NEED. THEY ALSO PROVIDED DATA AND INPUT ON BARRIERS AND CHALLENGES TO ACCESS AND QUALITY CARE FOR CHILDREN IN THE AREA, AS WELL AS STRATEGIES ON HOW TO ENHANCE TREATMENT AND CARE. THROUGH WESTERN CT HEALTH NETWORK'S ANNUAL PLANNING PROCESS, AN ENVIRONMENTAL ASSESSMENT IS CONDUCTED TO IDENTIFY HEALTHCARE GAPS AND NEEDS OF THE SERVICE AREA COMMUNITY BROUGHT ABOUT BY LOCAL AND NATIONAL TRENDS IN ECONOMIC, LEGISLATIVE, DEMOGRAPHIC, HEALTHCARE INDUSTRY AND OTHER ENVIRONMENTAL FACTORS. THESE FORCES ARE INCORPORATED IN MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY BY HELPING TO FRAME THE PRIORITIES, GOALS AND INITIATIVES OF WESTERN CT HEALTH NETWORK'S LONG RANGE AND ANNUAL STRATEGIC PLANS. IN 2015, NORWALK HOSPITAL, ALONG WITH THE NORWALK HEALTH DEPARTMENT AND COMMUNITY MEMBERS, BEGAN THE PROCESS TO CREATE THE 2016 CHNA. COMMUNITY FORUMS WERE HELD IN 2016 TO DISCUSS RESULTS AND INDENTIFY PRIORITY ISSUES FROM THE COMMUNITY WELLBEING SURVEY CONDUCTED BY DATAHAVEN, A NON-PROFIT ORGANIZATION THAT WORKS TO IMPROVE QUALITY OF LIKE BY COLLECTING, INTERPRETING, AND SHARING PUBLIC DATA FOR EFFECTIVE DECISION MAKING. A KEY INFORMANT SURVEY WAS ALSO DEVELOPED AND DISTRIBUTED TO 200 COMMUNITY LEADERS IN THE NORWALK HOSPITAL AREA FURTHER DETAILS ON THE 2016 CHNA AND CHIP WILL BE PROVIDED IN NEXT YEAR'S SCHEDULE H, 990 REPORT.
PART VI - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	THE PATIENT IS NOTIFIED OF THE FINANCIAL ASSISTANCE PROGRAM (FAP) WITH EACH WRITTEN NOTIFICATION AND AT EACH POINT OF SERVICE. NOTIFICATION IS SHARED BY POSTINGS AND VERBAL NOTIFICATION AT THE TIME THE PROCEDURE IS SCHEDULED. THE FACILITY ALSO EMPLOYS FINANCIAL COUNSELORS TO FACILITATE PATIENT EDUCATION REGARDING ALL PROGRAMS AVAILABLE TO INCLUDE STATE, LOCAL AND INTERNAL. IF AT ANY TIME IN THE COLLECTION PROCESS A PATIENT WOULD LIKE TO PARTICIPATE IN THE FAP, COLLECTION ACTIVITY CEASES. THE PATIENT IS THEN SENT AN APPLICATION AND WORKS WITH THE FINANCIAL COUNSELING TEAM FOR APPROVAL OF FULL OR PARTIAL DISCOUNT. PART VI - COMMUNITY INFORMATION NORWALK HOSPITAL SERVES AN AREA WITH A POPULATION OF ABOUT 161,400 PEOPLE. THE PRIMARY SERVICE AREA INCLUDES NORWALK, NEW CANAAN, WESTPORT, WESTON AND WILTON, CT, AND THE SECONDARY SERVICE AREA INCLUDES FAIRFIELD, DARIEN, REDDING, RIDGEFIELD (IN FAIRFIELD COUNTY, CT) AND SOUTH SALEM (IN WESTCHESTER COUNTY, NY). THIS SERVICE AREA IS COMPRISED OF A DENSELY POPULATED CORE OF THE URBAN/SUBURBAN CITY OF NORWALK SURROUNDED BY PREDOMINANTLY AFFLUENT RESIDENTIAL TOWNS. NO OTHER GENERAL MEDICAL/SURGICAL HOSPITALS ARE LOCATED IN THIS SERVICE AREA. THIS AREA IS HOME TO A DIVERSE SOCIO-ECONOMIC POPULATION, FROM THE AFFLUENT TO THE MEDICALLY UNDERSERVED. NORWALK HAS A MEDIAN HOUSEHOLD INCOME OF $76,051, AND A POVERTY RATE OF 8.1%. THE OVERALL UNINSURED POPULATION RATE FOR THE STATE IS ESTIMATED TO BE 3.8%. ALTHOUGH THE POPULATION OF THE PRIMARY AND SECONDARY SERVICE AREAS IS EXPECTED TO REMAIN VIRTUALLY UNCHANGED FROM 2010 TO 2020, THE COHORT AGED 65 AND OVER IS EXPECTED TO HAVE A COMPOUND ANNUAL GROWTH RATE OF 2.36%, WHILE THE AGE 20-44 AGE COHORT'S RATE IS 0.06% OVER THE SAME TIME PERIOD.
PART VI - COMMUNITY BUILDING ACTIVITIES	RELATED TO PART II, LINE #6, COALITION BUILDING, TOTALING $18,746 in conducting the current chna, norwalk hospital collaborated with various community organizations to develop, implement, and monitor strategies to address identified priorities in the chip. workgroups were created for obesity, and mental health/substance abuse. the community benefit in the coalition building category was provided through planning and development meetings, as wells as programs for each priority area: mental health and substance abuse: In april 2014, norwalk hospital launched a community care team with the goal of targeting mental health and substance abuse populations. the formation of the greater norwalk community care team (CCT) has allowed us to deliver enhanced care to individuals with complex medical and psychosocial challenges. this broad community initiative provides wrap around services to individuals with housing instability suffering from mental health and/or substance abuse issues or serious medical conditions. norwalk hospital's greater norwalk cct consists of approximately 20 representatives from local programs, agencies and institutions. the cct meets weekly in the community to develop, review, implement, and monitor treatment plans for vulnerable populations. the cct navigator works to improve outcomes by referring targeted individuals to appropriate community-based mental health and substance abuse services and serving as a liaison to coordinate and leverage existing community-based resources. as of september 30, 2016, individualized care plans have been developed for more than 200 individuals. outcomes for patients with care plans in place include maintained sobriety, mental health stabilization, improved access to cre, a 27% reduction in inappropriate emergency department (ed) visits and reduced homelessness with more than 50 individuals assisted in finding stable housing. a pilot collaborative outreach team effort between western connecticut health network and sacred heart university (shu) has been created as an extension of the greater norwalk cct. the collaboration brings shu students (in areas of nursing, occupational therapy, social work) together with wchn staff to focus on high-risk emergency department frequent users to further engage clients and spearhead a medically integrated approach to deliver better healthcare to our most vulnerable patients. this approach is based on the camden coalition care management model where multi-disciplinary care teams connect quickly with high risk patients (in clients' homes) to address their complex needs. this approach has demonstrated an improvement in quality of care, reduced costs and reduced unnecessary emergency department visits and inpatient stays - synonymous with the triple aim approach. the western connecticut health network, which includes norwalk hospital, has formed a medicare shared savings program accountable care organization (aco) to work together to provide higher-quality coordinated care for our patients, while helping to slow health care cost growth. the aco will also help to provide better care to medicare's seniors and people with disabilities. in addition to helping us serve our community members in a more comprehensive way, the aco will help us identify gaps in care. high-quality care is defined by meeting 33 quality measure benchmarks in 4 domains: patient caregiver experience; care coordination; patient safety; preventative health; at-risk populations. the aco has defined processes and procedures to promote evidence-based medicine and patient engagement and must report on quality and cost measures. it must also meet patient-centeredness criteria such as the use of patient and caregiver assessments or individualized care team which will align with our current greater norwalk cct initiative to improve management of complex patients and reduced unnecessary emergency department visits and admissions. the aco serves approximately 100,000 medicare beneficiaries throughout our region. obesity/healthy lifestyles: project lean (learning with energy from activity and nutrition) is an innovative, community-wide program collaborative between norwalk hospital, norwalk health department, jefferson and kendall elementary schools, and pepperidge farm, inc., which is designed to actively engage approximately 600 elementary school children with a hands-on interactive curriculum to combat childhood obesity. project lean's goal is to improve attitudes, increase knowledge, and keep body mass index at or below the center for disease control and prevention average gains through nutrition education and increased activity. the aim is to improve the overall health of the students through healthy nutrition and exercise with the goal to make a sustainable difference in their lives. since weight problems in childhood often continue into adulthood, targeting this age group allows us to make a lasting effect on healthy living minimizing future potential medical risks and significantly impacting the battle against obesity. additionally, implementing this program at this point in children's lives greatly increases the chances the children will retain the information as they age. we stress the benefit of the entire family working together to lead a healthy, active lifestyle and give them the skills to do so. with the objective to increase physical activity among community members and those working within the community, the norwalker neighborhood walking project was developed. the project plan identified sixteen neighborhoods in norwalk and mapped out walking routes in each (a total of 44 walking routes). user-friendly neighborhood maps were designed and distributed throughout the community to residents and businesses to help promote access to the designated walking routes. walking routes range from approximately a half-mile to three-and-a-half-miles, and conditions walkers can expect, such as wheelchair and stroller friendly access and terrain conditions, are outlined for each route. in 2015, all 44 walking routes were audited, utilizing the center for disease control and prevention walkability audit tool, and several routes were updated, redesigned and gis mapped. throughout 2016, norwalk's mayor hosted a norwalker walk each weekend encouraging norwalk residents to join him on one of the 44 featured norwalker routes. he engaged community members (ranging from 20-40 weekly participants) in discussion along the weekly walks. as an advocate for wellness, the mayor emphasized the importance of physical activity for overall health and well-being. to further increase awareness of the norwalker program and promote physical activity among community members, the workgroup held a spring event on june 4, 2016. more than 100 community members attended, which featured a 1.0 mile walk led by the mayor of norwalk and senator bob duff. health and wellness information booths from local organizations; norwalk grows, norwalk acts, shoprite supermarkets, norwalk health department, american heart association, norwalk early childhood development, norwalk public library, etc. provided health and wellness information to attendees. the greater norwalk healthy restaurant initiative (hri) was developed to help meeting the goal of increasing access to and consumption of healthy and affordable foods. this healthy restaurant program will help restaurants in the greater norwalk area highlight healthy menu options to diners of all ages. the primary purpose of this initiative is to provide community members in the greater norwalk area healthy menu options when dining out. the program is voluntary for restaurant owners, and twenty area restaurants from fairfield, weston, wilton, norwalk and new canaan have elected to participate and commit to the program. participating restaurant owners/chefs are working with the hri program coordinator and registered dietitian (rd) to assess the nutritional value of a current menu option or receive guidance in the development of healthy entrees. once a meal(s) meet the established nutritional criteria, it will be highlighted as a healthy menu option on the menu (identified with a healthy for life branded sticker) and the restaurant designated as a "healthy restaurant" participating in the hri. menu options that do not meet the nutritional criteria are assessed by the rd and chef and in collaboration they develop a solution and ultimately make adjustments to the recipe. *to help increase the amount of physical activity among preschool, elementary, middle and high school students throughout the school day, the move more in schools toolkit is being developed under the guidance of members from several area boards of education, school nurses, administrators, educators and community members. the comprehensive guide will provide simple, yet specific, concrete strategies to incorporate more physical activity into the day. appendices offer educators hands-on activities that are easily incorpora
PART VI - AFFILIATED HEALTHCARE SYSTEM ROLES AND PROMOTION	WESTERN CONNECTICUT HEALTH NETWORK (WCHN) IS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM COMPRISED OF THREE COMMUNITY HOSPITALS AND THEIR AFFILIATED ENTITIES. IN ADDITION TO DANBURY HOSPITAL, ITS NEW MILFORD HOSPITAL CAMPUS, AND NORWALK HOSPITAL, THE CONTINUUM OF CARE INCLUDES A LARGE MEDICAL GROUP, HOME HEALTH CARE SERVICES, A NATIONALLY RENOWNED BIOMEDICAL RESEARCH INSTITUTE, THE WCHN FOUNDATION AND NORWALK HOSPITAL FOUNDATION, AND OTHER RELATED AFFILIATES. WCHN'S MISSION IS TO IMPROVE THE HEALTH OF EVERY PERSON WE SERVE THROUGH THE EFFICIENT DELIVERY OF EXCELLENT, INNOVATIVE AND COMPASSIONATE CARE. FOR FY2016, WCHN PROVIDED APPROXIMATELY $23,863,188 IN TOTAL CHARITY CARE. DANBURY HOSPITAL, ITS NEW MILFORD HOSPITAL CAMPUS AND NORWALK HOSPITAL PROVIDED 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 AS NOTED ABOVE. FOR FY2016, CHARITY CARE WAS WAS PROVIDED IN THE FOLLOWING AMOUNTS: NORWALK HOSPITAL, APPROXIMATELY $9,347,702, DANBURY HOSPITAL AND ITS NEW MILFORD HOSPITAL CAMPUS, APPROXIMATELY $13,086,486. WESTERN CONNECTICUT MEDICAL GROUP: THE MISSION OF 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 FY2016, WCMG PROVIDED $1,382,000 IN CHARITY CARE. 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. NORWALK HOSPITAL FOUNDATION'S MISSION IS TO RAISE FUNDS, REINVEST AND ADMINISTER THESE FUNDS AND MAKE DISTRIBUTIONS TO NORWALK HOSPITAL AND OTHER NOT-FOR-PROFIT NORWALK HOSPITAL AFFILIATES. WESTERN 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. 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 FY2016, WCHC PROVIDED $47,000 IN CHARITY CARE. EASTERN 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.
PART VI - STATES WHERE COMMUNITY BENEFIT REPORT FILED	CT
ADDITIONAL INFORMATION	PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH IN ORDER TO PROMOTE THE HEALTH OF THE COMMUNITY, NORWALK HOSPITAL IS RESPONSIBLE FOR COORDINATING THE SERVICES OF THE HOSPITAL WITH THOSE OTHER HEALTH, EDUCATION, AND SOCIAL SERVICES IN THE COMMUNITY. THESE SERVICES ARE PROMOTED IN ORDER TO OPTIMIZE THE AVAILABILITY OF A FULL SCOPE OF SERVICES IN A COST-EFFECTIVE MANNER. IN FY16, NORWALK HOSPITAL SERVED OVER 1.5 MILLION PERSONS THROUGH OVER 470 COMMUNITY HEALTH OCCURRENCES. HOSPITAL STAFF AND AFFILIATED PHYSICIANS PARTICIPATED IN HEALTH FAIRS, COMMUNITY EDUCATION LECTURES AND SREENINGS WITH CONNUNITY ORGANIZATIONS. THE HEALTH TALK SHOWS AIRED ON CABLEVISION AND REACHED 1.275 MILLION. NORWALK HOSPITAL ALSO OFFERS PROGRAMS AND FINANCIAL SUPPORT TO THE CITY OF NORWALK AND SURROUNDING AREAS. EXAMPLES INCLUDE THE NORWALK COMMUNITY HEALTH CENTER (A FQHC) AND PROGRAM SUPPORT TO THE AMERICARES FREE CLINIC. NORWAK HOSPITAL SUB-SPECIALTY CLINICS ARE ALSO STAFFED BY VOLUNTEER-ATTENDING PHYSICIANS FOR UNDERSERVED PATIENTS. PART I, LINE 7E - COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS NORWALK HOSPITAL PROVIDED COMMUNITY BENEFIT THROUGH VARIOUS PROGRAMS AND EVENTS THAT WERE MADE AVAILABLE TO THE COMMUNITY AT LARGE. BELOW IS A LIST OF ALL THE PROGRAMS OFFERED WITH A BRIEF DESCRIPTION: CANCER: 614 SERVED THROUGH BEREAVEMENT GROUPS, CANCER ED. AT FAIRS AND TALKS DIABETES: 135 SERVED THROUGH HEALTH FAIRS ECONOMIC DEVELOPMENT: 149 SERVED THROUGH CHAMBER EXPOS AND TALKS SENIOR OUTREACH: 198 SERVED THROUGH SENIOR-ORIENTED FAIRS FAMILY/PARENTING ED.: 50 SERVED THROUGH "WHAT EVERY GIRL WANTS TO KNOW" TALK AT PERKIN AUDITORIUM HEALTH FAIRS: 14,702 SERVED THROUGH THE DAY-LONG KIDSFEST, PLUS FAIRS HELD AT CHURCHES, CORPORATIONS, LIBRARIES, ETC. HEART DISEASE: 720 SERVED THROUGH HANDS FOR LIFE EVENTS AND TALKS LECTURES: 1.476 MILLION SERVED THROUGH HEALTH TALK SHOWS (INCLUDING REPEATS), SCHOOLS, LIBRARIES AND CORPORATIONS. HEALTH TALK AIRS ON CABLEVISION; 51 SHOWS AIRED WITH A VIEWERSHIP OF 25,000 PER SHOW. NUTRITION/WELLNESS: 3,234 SERVED THROUGH LECTURES, PROJECT LEAN PROGRAM AND THE AMERICARES CLINICS. SUPPORT GROUPS: 127 SERVED THROUGH THE BARIATRIC AND BREAST CANCER SUPPORT GROUPS. SCHEDULE H - PART I, LINE 7F - HEALTH PROFESSIONAL EDUCATION - NORWALK HOSPITAL HAS AN ACGME ACCREDITED MEDICAL RESIDENCY PROGRAM PARTNERED WITH YALE UNIVERSITY SCHOOL OF MEDICINE. APPROXIMATELY 58 RESIDENTS AND FELLOWS ROTATE IN THE MEDICINE, RADIOLOGY, GASTROENTEROLOGY, PULMONARY OR SLEEP PROGRAMS. THE ASSOCIATED COSTS AND REVENUES ARE DERIVED FROM THE MEDICARE COST REPORT. SCHEDULE H - PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES - NORWALK HOSPITAL RECEIVES AS DHMAS GRANT FROM THE STATE OF CONNECTICUT FOR THE OUTPATIENT PSYCHIATRIC CLINIC. THESE DOLLARS HELP OFFSET THE SHORTFALL FROM UNDER OR UNISURED PATIENTS. PART II LINE #6, COALITION BUILDING AS STATED IN PART VI, LINE 2, NORWALK HOSPITAL BEGAN THE PROCESS IN MAY 2015 TO DEVELOP THE 2016 CHNA. THIS INCLUDES CHNA AND COMMUNITY COALITION BUILDING MEETINGS THAT CONTRIBUTED TO THE TOTAL COALITION BUILDING AMOUNT. FURTHER DETAILS ON THE 2016 CHNA AND CHIP WILL BE PROVIDED IN THE FOLLOWING SCHEDULE H, 990 REPORT. PART II, LINE #3, COMMUNITY SUPPORT AND LINE #7, COMMUNITY HEALTH IMPROVEMENT ADVOCACY TOTALING $82,087: COMMUNITY SUPPORT WAS PROVIDED THROUGH NONMONETARY DONATIONS TO BENEFIT KIDS IN CRISIS, GOBBLE GIVE BACK, AND NURSES WEEK COLLECTION FOR THE DEPARTMENT OF CHILDREN AND FAMILIES. STATE AND LOCAL ELECTED OFFICIALS AND AGENCY HEADS WERE LOBBIED IN SUPPORT OF MAINTAINING PATIENT ACCESS TO ESSENTIAL SERVICES FOR THE UNINSURED AND UNDERINSURED. THE TOTAL ADVOCACY INVESTMENT FOR FY2016 OS $81,468, WHICH INCLUDES INDIRECT AND DIRECT STAFFIN COSTS. FOR FY2016, NORWALK HOSPITAL PROVIDED $1,350,000 IN SUPPORT FOR NORWALK COMMUNITY HEALTH CENTER. PART V LINE 5 - THE MOST RECENTLY COMPLETED CHNA WAS MADE AVAILABLE ON: A) NORWALK HOSPITAL'S WEBSITE: WWW.NORWALKHEALTH.ORG B) ON THE CT HOSPITAL ASSOCIATION'S WEBSITE: HTTP://WWW.CHIME.ORG/ADVOCACY/COMMUNITY-HEALTH/ ON THE CITY OF NORWALK WEBSITE: WWW.NORWALKCT.ORG/DOCUMENTCENTER/VIEW/4397 AND ON THE NORWALK HEALTH DEPARTMENT'S WEBSITE: HTTP://WWW.CT.GOV/DPH/LIB/DPH/OHCA/COMMUNITY_NEEDS_ASSESSMENT/CHNA/2014/NO RWALK_HOSPITAL.PDF C) IS AVAILABLE UPON REQUEST FROM THE HOSPITAL FACILITY. PART V, SECTION B, LINES 16B AND 16C - FAP IS MADE AVAILABLE ON THE FOLLOWING LINKS HTTP://WWW.NORWALKHOSPITAL.ORG/PATIENT-AND-VISITORS-INFO/BILLING/BILLING/F INANCIAL-ASSISTANCE-POLICY

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

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

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

Yes

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

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

Any related organization?

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Yes

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

Yes

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

For persons listed on 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 ............

Were any amounts reported on 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 .............................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1MICHAEL DAGLIOPRESIDENT	(i) (ii)	0 ------------- 433,029	0 ------------- 150,000	0 ------------- 2,499	0 ------------- 15,600	0 ------------- 29,614	0 ------------- 630,742	0 ------------- 0
2STEVEN ROSENBERGCFO/TREASURER	(i) (ii)	0 ------------- 567,570	0 ------------- 190,000	0 ------------- 23,865	0 ------------- 13,000	0 ------------- 31,044	0 ------------- 825,479	0 ------------- 0
3RENEE MAURIELLOVP NURSING & PATIENT CARE SERV	(i) (ii)	318,060 ------------- 0	65,331 ------------- 0	2,260 ------------- 0	13,250 ------------- 0	21,904 ------------- 0	420,805 ------------- 0	0 ------------- 0
4JAMES HAYNESVP OPERATIONS	(i) (ii)	221,483 ------------- 0	55,000 ------------- 0	36,116 ------------- 0	15,900 ------------- 0	20,154 ------------- 0	348,653 ------------- 0	0 ------------- 0
5JAMES VARRONEVP SUPPLY CHAIN	(i) (ii)	162,269 ------------- 0	30,000 ------------- 0	12,260 ------------- 0	12,494 ------------- 0	19,854 ------------- 0	236,877 ------------- 0	0 ------------- 0
6PATRICK MINICUSVICE PRESIDENT FINANCE	(i) (ii)	0 ------------- 386,548	0 ------------- 100,000	0 ------------- 18,660	0 ------------- 3,719	0 ------------- 31,429	0 ------------- 540,356	0 ------------- 0
7ROBERT CAPODANNOPHYSICIAN	(i) (ii)	269,898 ------------- 0	225,442 ------------- 0	2,317 ------------- 0	15,900 ------------- 0	21,904 ------------- 0	535,461 ------------- 0	0 ------------- 0
8JASON FISCHELPHYSICIAN	(i) (ii)	280,255 ------------- 0	194,834 ------------- 0	9,016 ------------- 0	13,250 ------------- 0	19,354 ------------- 0	516,709 ------------- 0	0 ------------- 0
9CHRISTOPHER MICHOSPHYSICIAN	(i) (ii)	261,004 ------------- 0	201,165 ------------- 0	3,371 ------------- 0	13,250 ------------- 0	20,354 ------------- 0	499,144 ------------- 0	0 ------------- 0
10BRIAN MCGOVERNPHYSICIAN	(i) (ii)	281,561 ------------- 0	335,009 ------------- 0	29,367 ------------- 0	18,550 ------------- 0	21,904 ------------- 0	686,391 ------------- 0	0 ------------- 0
11BENJAMIN GREENBLATTCHAIRMAN, EMERGENCY	(i) (ii)	397,609 ------------- 0	79,759 ------------- 0	818 ------------- 0	13,250 ------------- 0	21,866 ------------- 0	513,302 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
PART I, LINE 4 - RECEIVED SEVERANCE, SUPPL NQ RETIRE, EQUITY BASED COMP	SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS: WESTERN CONNECTICUT HEALTH NETWORK (WCHN) HAS ESTABLISHED THREE SEPARATE SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS (SERP). THESE PLANS PROVIDE SUPPLEMENTAL RETIREMENT BENEFITS TO KEY MEMBERS OF THE EXECUTIVE GROUP. UNDER THE AGREEMENTS FOR SERP PLANS #1 AND #2, AMOUNTS PROMISED TO ELIGIBLE EXECUTIVES ARE BASED ON TARGETED RETIREMENT BENEFITS AND THE PAYMENT OF BENEFITS IS SUBJECT TO VESTING. THE BENEFITS AT THE VESTED AGE ARE PROVIDED IN THE FORM OF AN ACTUARIAL EQUIVALENT LUMP SUM PLUS TAX GROSS-UP AMOUNT TO THE PARTICIPANTS. WCHN HAS ON ITS BOOKS AN ACCRUAL FOR THE PARTICIPANTS OF THE SERP, WHICH IS MAINTAINED SOLELY FOR ACCOUNTING PURPOSES AND IS UNFUNDED. SERP PLAN #1 - DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2016 NO INDIVIDUALS LISTED IN PART VII OR SCHEDULE J, PART II PARTICIPATED IN SERP PLAN #1. SERP PLAN #2 - DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2016 NO PAYMENTS WERE MADE TO STEVEN H. ROSENBERG, CFO OF WCHN, PARTICIPANT OF SERP PLAN #2. SERP PLAN #3 - EARNINGS AND LOSSES ON THE INVESTMENTS SELECTED BY PARTICIPANTS OF SERP #3 ARE ADDED TO THE BALANCE OF THE ACCOUNT. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2016, NO PAYMENTS WERE MADE TO MICHAEL DAGLIO, CHIEF OPERATING OFFICER, PARTICIPANT OF SERP PLAN #3.
PART I, LINE 6 - COMPENSATION CONTINGENT ON NET EARNINGS OF RELATED ORGS	SUMMARY OF EXECUTIVE INCENTIVE PLAN THE PLAN IS ADMINISTERED BY THE EXECUTIVE COMPENSATION COMMITTEE (THE COMMITTEE) OF WESTERN CONNECTICUT HEALTH NETWORK, INC. (WHCN) ELIGIBILITY TO PARTICIPATE IN THE PLAN IS LIMITED TO THOSE EXEMPT EXECUTIVES EMPLOYED BY WCHN AND ITS SUBSIDIARIES (THE NETWORK) DURING THE PLAN YEAR WHO ARE IN POSITIONS IN WHICH THEIR DECISIONS, ACTIONS AND COUNSEL SIGNIFICANTLY AFFECT THE OPERATIONS OF THE NETWORK. THE COMMITTEE, WITH INPUT PROVIDED BY SENIOR MANAGEMENT OF THE NETWORK WILL DETERMINE WHICH ELIGIBLE EXECUTIVE EMPLOYEES OF THE NETWORK WILL PARTICIPATE IN THE PLAN. PRIOR TO THE BEGINNING OF EACH PLAN YEAR, OR AS SOON THEREAFTER AS PRACTICABLE, THE COMMITTEE WILL ESTABLISH TARGET AND MAXIMUM AWARD OPPORTUNITY FOR THE PARTICIPANTS, IN THE APPROPRIATE TIER IN THE PLAN, ALONG WITH A TEAM SCORECARD OF PLAN MEASURES. SOON AFTER THE CLOSE OF THE PLAN YEAR, ACTUAL ORGANIZATION AND INDIVIDUAL PERFORMANCE AND RESULTS WILL BE MEASURED AND ASSESSED IN COMPARISON TO PUBLISHED GOALS AND EXPECTATIONS ESTABLISHED FOR SUCH PLAN YEAR. RECOMMENDATIONS FOR INDIVIDUAL INCENTIVE AWARDS WILL BE PREPARED AND SUBMITTED TO THE COMMITTEE FOR EVALUATION AND APPROVAL. NOTWITHSTANDING ANY OTHER PROVISION OF THE PLAN, AT THE DISCRETION OF THE COMMITTEE, AWARDS MAY NOT BE PAID UNDER THE PLAN FOR ANY PLAN YEAR IF THE LEVEL OF PERFORMANCE SPECIFIED IN ONE OR MORE NETWORK LEVEL "CIRCUIT BREAKER GOALS" IS NOT ACHIEVED DURING THE PLAN YEAR.
PART III - ADDITIONAL INFORMATION	THE ORGANIZATION RELIED ON RELATED ORGANIZATIONS, WESTERN CONNECTICUT HEALTH NETWORK, INC. WHICH USED THE FOLLOWING METHODS DESCRIBED BELOW TO ESTABLISH TOP MANAGEMENT'S COMPENSATION: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -WRITTEN EMPLOYMENT CONTRACT -COMPENSATION SURVEY OR STUDY -APPROVAL BY BOARD OR COMPENSATION COMMITTEE

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
THE NORWALK HOSPITAL ASSOCIATION

Employer identification number
06-6068853

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	ST OF CT HLTH & EDUC FAC	06-0806186	000000000	12-09-2010	46,840,000	SEE PART VI		X		X		X
B	ST OF CT HLTH & EDUC FAC	06-0806186	000000000	12-07-2012	82,000,000	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	16,350,000		3,940,000
2 Amount of bonds legally defeased ..............	0		0
3 Total proceeds of issue ..................	46,844,821		82,014,610
4 Gross proceeds in reserve funds .............	0		0
5 Capitalized interest from proceeds .............	1,010,853		0
6 Proceeds in refunding escrows ...............	0		0
7 Issuance costs from proceeds ...............	829,268		639,886
8 Credit enhancement from proceeds .............	0		0
9 Working capital expenditures from proceeds .............	463,600		0
10 Capital expenditures from proceeds .............	44,541,100		81,374,724
11 Other spent proceeds .............	0		0
12 Other unspent proceeds .............	0		0
13 Year of substantial completion .............	2013		2017
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X
16 Has the final allocation of proceeds been made? ..........	X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		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		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X			X

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

Cat. No. 50193E

Schedule K (Form 990) 2015

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		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	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		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 ....	1.570 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0.460 %
6 Total of lines 4 and 5 .............	2.030 %
7 Does the bond issue meet the private security or payment test? ...		X		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		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? .............		X		X
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		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X
b Exception to rebate? ........		X		X
c No rebate due? .........		X		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X
b Name of provider ..........	0		PEOPLES UNITED BANK
c Term of hedge .........			12 %
d Was the hedge superintegrated? ......				X
e Was the hedge terminated? ........				X

Schedule K (Form 990) 2015

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		X
b Name of provider ..........	0		0
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		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
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		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference

Explanation

ADDITIONAL INFORMATION

part i - bond issue, (a) issuer name - a chefa series g, h and i - state of connecticut health and educational facilities authority. part i - bond issue, (a) issuer name - b chefa series j - state of connecticut health and educational facilities authority part i - bond issue, (f) description of purpose a chefa series g, h and i. the proceeds of the bond were used for construction of a parking garage and for the purchase of other capital equipment. part i - bond issue, (f) description of purpose - b chefa series j the proceeds of the bond are being used for construction of an ambulatory pavilion and for the purchase of other capital equipment. part ii - proceeds, a chefa series g, h and i - total proceeds of issue includes interest income of $4,821 received on the construction fund, cost of issuance fund and capitalized interest fund. part ii - proceeds, b chefa series j - total proceeds of issue includes interest income of $14,610 received on the construction fund and cost of issuance fund part iii - private business use - a chefa series g, h and i - private business use is based on physician reserved spaces in financed parking garage. these reserved spaces are used by both employees and attending physicians visiting hospital patients to further the hospital's mission. part iii - private business use - b chefa series j - no private business use in fiscal 2016 - the portion of the pavilion complete and occupied does not include any private business use. a portion of the cancer center which will be located in the new pavilion and will be dedicated to cancer research once the pavilion is complete and operational. the funding of the pavilion will include $30,000,000 of philanthropy and approximately $2,300,000 of working capital. these amounts will be allocated to the portion of the pavilion that will be used by outside entities. part iii, line 9 post issuance compliance - nonqualified bonds effective 1/1/2014, western connecticut health network (wchn) became the sole corporate member of norwalk health services corporation and a corporate affiliation was completed. norwalk health services corporation and all subsidiaries are covered under the policies of wchn and as such, the tax exempt debt policy applies to norwalk hospital as of 1/1/2014. part iv - arbitrage line 4b - name of provider - chefa series j people's united bank part v - procedures to undertake corrective action effective 1/1/2014, western connecticut health network (wchn) became the sole corporate member of Norwalk Health Services Corporation and a corporate affiliation was completed. Norwalk Health Services Corporation and all subsidiaries are covered under the policies of WCHN and as such, the tax exempt debt policy applies to Norwalk Hospital as of 1/1/2014.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JILLENE MAHONY	SEE PART V	66,036	COMPENSATION		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
SCHEDULE L, PART IV	JILLENE MAHONY IS THE DAUGHTER OF ED MAHONY, NORWALK HOSPITAL CHAIRMAN OF THE BOARD. SHE IS EMPLOYED AS A NURSE AT THE HOSPITAL EFFECTIVE FEBRUARY 2016.

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

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.
FORM 990, OFFICERS AND TRUSTEES, PART VII	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-B ENEFIT TITLED GREATER NORWALK CHA CHIP REPORT DECEMBER 2012
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 MISSSION 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 1,067 INFECTIOUS DISEASE 1,073 INTERNAL MEDICINE 794 NEUROLOGY MEDICAL 322 PULMONARY MEDICINE 883 ALL OTHER 1,241 OUTPATIENT SERVICE LINE VOLUME: O/P MEDICINE 5,291 O/P MEDICINE COMMUNITY CLINIC 3,924 O/P MEDICAL ONCOLOGY 5,860 O/P PULMONARY MEDICINE 5,504 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 STROKE, 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 483 TRAUMA SURGERY 339 MINOR GI SURGERY 209 GENERAL SURGERY 227 UROLOGY SURGERY 125 COLON/BOWEL SURGERY 183 OBESITY SURGERY 124 SPINAL SURGERY 132 ALL OTHER INPATIENT SURGERY 389 OUTPATIENT SERVICE LINE VOLUME: ABDOMEN GI SURGERY 316 BREAST SURGERY-NON PLASTIC 248 ENDOSCOPY 6,502 MISC GENERAL SURGERY 799 ORTHO SURGERY 445 UROLOGY 400 PAIN INJECTION PROCEDURES 740 OTOLARY HEAD NECK SURGERY 118 PLASTIC SURGERY 385 ALL OTHER OUTPATIENT SURGERY 929 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 86 C SECTION DELIVERIES 448 GYN ONCOLOGY 33 GYNECOLOGY 70 VAGINAL DELIVERIES 793 NICU 212 NURSERY 1,077 PEDIATRIC MEDICAL 229 PEDIATRIC SURGERY 19 OUTPATIENT SERVICE LINE VOLUME: GYNECOLOGY 740 ULTRASOUND TESTING 3,037 OBSERVATION 737 PEDIATRIC OP PROCEDURES 148 PEDIATRIC OBSERVATION 505 OUR WOMEN'S 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 38,061 TREATED AND RELEASED VISITS 9/30/2016. 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 1,374 INPATIENT DISCHARGES; 4,286 OUTPATIENT VOLUME FOR THE FISCAL YEAR ENDED 9/30/2016. 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 675 AND 5,898 BILLED MONTHS FOR THE FISCAL YEAR ENDED 9/30/2016. 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 65,787 PROCEDURES FOR THE FISCAL YEAR ENDED 9/30/2016. 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 4 - SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS CHANGES IN GOVERNING DOCUMENTS FORM 990, PART VI, QUESTION 4 THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE BYLAWS OF NORWALK HOSPITAL ASSOCIATION FOR THE FISCAL YEAR ENDED SEPTEMBER 30,2016: SECTION 3.2. THIS SECTION OF THE BYLAWS OUTLINES THE NUMBER AND COMPOSITION OF THE NORWALK HOSPITAL ASSOCIATION ("NHA") BOARD OF DIRECTORS. THIS SECTION WAS AMENDED TO REMOVE THE REQUIREMENT THAT NHA'S BOARD OF DIRECTORS MUST, AT ALL TIMES, INCLUDE AT LEAST TWO INDIVIDUALS WHO ALSO SERVE AS DIRECTORS OF THE MEMBER (WESTERN CONNECTICUT HEALTH NETWORK) AND DANBURY HOSPITAL (A RELATED ORGANIZATION). SECTION 5.3. THIS SECTION OF THE BYLAWS OUTLINES THE POWERS AND RESPONSIBILITIES OF THE BUDGET AND FINANCE COMMITTEE. THIS SECTION OF THE BYLAWS WAS REMOVED ENTIRELY.
FORM 990, PART VI, LINE 6	EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDERS WESTERN CONNECTICUT HEALTH NETWORK, INC. (WCHN), IS THE SOLE 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 THE APPROVAL BY THE MEMBER. A) THE ACTIONS LISTED BELOW, TAKEN FOR THE HOSPITAL OR IN ITS CAPACITY VOTING AS A SHAREHOLDER OR MEMBER OF A SUBSIDIARY ("DANBURY SUBSIDIARY") SHALL NOT REQUIRE APPROVAL BY THE BOARD AND ARE RESERVED SOLELY TO THE MEMBER: -THE AMENDMENT OF THE HOSPITAL'S BYLAWS; -THE ELECTION OR REMOVAL OF A DIRECTOR; -APPROVAL OF INVESTMENT POLICIES; -APPROVAL OF THE ADOPTION OF OR AMENDMENT TO ANY QUALIFIED OR ANY NON-QUALIFIED BENEFIT PLAN; -APPROVAL OF THE ADOPTION OF OR ANY AMENDMENT TO THE POLICIES AND PROCEDURES GOVERNING A) INDEMNIFICATION OF DIRECTORS AND OFFICERS OF THE HOSPITAL OR ANY DANBURY SUBSIDIARY; B) CONFLICTS OR DUALITIES OF INTEREST; C) ACCOUNTING AND INVESTMENT STANDARDS AND PRACTICES AND D) SUCH OTHER POLICIES THE MEMBER MAY DETERMINE; -APPROVAL OF SYSTEM-WIDE QUALITY, PERFORMANCE AND CREDENTIALING STANDARDS AND PROCEDURES TO WHICH THE HOSPITAL OR ANY DANBURY SUBSIDIARY IS EXPECTED TO ADHERE; AND -APPROVAL OF REGULATORY COMPLIANCE AND METHODOLOGY FOR PHYSICIAN COMPENSATION ARRANGEMENTS. THE ACTIONS LISTED BELOW, TAKEN FOR THE HOSPITAL OR IN ITS CAPACITY VOTING AS A SHAREHOLDER OR MEMBER OF A DANBURY SUBSIDIARY, WHICH REQUIRE APPROVAL OF THE BOARD, MUST ALSO BE APPROVED BY THE MEMBER: -THE ELECTION AND REMOVAL OF A DIRECTOR OF A DANBURY SUBSIDIARY; -THE ELECTION OF THE OFFICERS OF THE HOSPITAL; -APPROVAL OF ALL OPERATING AND CAPITAL BUDGETS OF THE HOSPITAL AND DANBURY SUBSIDIARY; -APPROVAL OF ANY AMENDMENT OR RESTATEMENT OF THE HOSPITAL'S CERTIFICATE OF INCORPORATION, BYLAWS, OR OPERATING AGREEMENT OF ANY DANBURY SUBSIDIARY; -APPROVAL OF ANY SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL THE PROPERTY OR ASSETS OF THE HOSPITAL OR ANY DANBURY SUBIDIARY; -APPROVAL OF THE CREATION OF ANY CORPORATION OF WHICH THE HOSPITAL OR A DANBURY SUBSIDIARY IS THE SOLE OR CONTROLLING MEMBER OR SOLE OR CONTROLLING SHAREHOLDER; THE MERGER OR CONSOLIDATION OF THE HOSPITAL OR ANY DANBURY SUBIDIARY WITH ANOTHER CORPORATION; AND THE REORGANIZATION, LIQUIDATION OR DISSOLUTION OF THE HOSPITAL OR ANY DANBURY SUBSIDIARY; -APPROVAL OF ANY LOANS BY THE HOSPITAL OR ANY DANBURY SUBSIDIARY, OR THE INCURRING OF ANY INDEBTEDNESS, SECURED OR UNSECURED, WHICH EXCEEDS TWO MILLION DOLLARS ($2.0 MILLION) OR WHICH HAS A TERM LONGER THAN ONE YEAR; -APPROVAL OF UNBUDGETED EXPENDITURES IN EXCESS OF TWO MILLION DOLLARS ($2.0 MILLION) OR ANY INCREASE IN ANY APPROVED ANNUAL OPERATING OR CAPITAL BUDGET. -APPROVAL OF ANY AGREEMENT OR TRANSACTION OF THE HOSPITAL OR ANY DANBURY SUBSIDIARY INVOLVING AN AMOUNT GREATER THAN TWO MILLION DOLLARS ($2.0 MILLION) WITH ANOTHER INDIVIDUAL OR ENTITY; -APPROVAL OF THE AFFILIATION OF THE HOSPITAL OR ANY DANBURY SUBSIDIARY WITH ANY OTHER ENTITY FOR THE PURPOSES OF THE JOINT CONDUCT OF BUSINESS; -CREATION OF ANY COMMITTEE WHICH SHALL HAVE THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OR ON BEHALF OF ANY DANBURY SUBSIDIARY; -APPROVAL OF ANY CONVEYANCE OF, OR THE GRANTING OF MORTGAGES OR TRUSTS ON ANY REAL PROPERTY ASSETS OF THE HOSPITAL OR OF ANY DANBURY SUBSIDIARY; -APPROVAL OF THE STRATEGIC PLAN OF THE HOSPITAL AND OF ANY DANBURY SUBSIDIARY; AND -APPROVAL OF ANY COMMENCEMENT, CESSATION, LOCATION, RELOCATION OR CONSOLIDATION OF SIGNIFICANT CLINICAL SERVICES PROVIDED BY THE HOSPITAL OR ANY DANBURY SUBSIDIARY.
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) APPROXIMATES A RANGE BETWEEN THE 50TH AND 75TH PERCENTILES 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 KORN FERRY 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, 2016. 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 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCES CHANGE IN PENSION OBLIGATION...................... 28,772,311. DECREASE BEN INT IN NHF - TEMPORARY RESTRICTED.... -22,516,838. INCREASE BEN INTEREST IN NHF - PERM RESTRICTED.... 121,035. INCREASE BEN INTEREST IN NHF - UNRESTRICTED....... 24,910,524. INCREASE IN BEN INT CHARITABLE REMAINER TRUST..... 339,521. NET UNRESTRICTED CHANGES IN JOINT VENTURE......... 3,677,927. NORWALK SURG. CENTER/JOINT VENTURE INCOME......... -3,469,202. PEN RELATED CHAN. OTHER THAN NET PERIODIC BENEF COST 6,123,771. TRANSFER FROM NORWALK HOSPITAL FOUNDATION......... 12,422,644. TOTAL 50,381,693.
FORM 990 PART IX LINE 11G	DESCRIPTION:AGENCY & TEMP HELP TOTAL FEES:2863162
FORM 990 PART IX LINE 11G	DESCRIPTION:COLLECTION EXPENSE TOTAL FEES:1615906
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACT MANAGEMENT TOTAL FEES:9179484
FORM 990 PART IX LINE 11G	DESCRIPTION:CORPORATE DEPT. ALLOCATIONS TOTAL FEES:14604454
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER TOTAL FEES:822430
FORM 990 PART IX LINE 11G	DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:4834746
FORM 990 PART IX LINE 11G	DESCRIPTION:PATIENT CARE & ADMIN SERVICES TOTAL FEES:4017177
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:10626144
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES - CONSULTING TOTAL FEES:2484419
FORM 990 PART IX LINE 11G	DESCRIPTION:STRATEGIC SUPPORT TO WCMG TOTAL FEES:21741619

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

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- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE NORWALK HOSPITAL ASSOCIATION

Employer identification number

06-6068853

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)NORWALK HOSPITAL FOUNDATION INC 24 STEVENS STREET NORWALK,CT06850 25-2577708	FUNDRAISING	CT	501(C)(3)	7	NHA	Yes
(2)ADVANCED CENTER FOR REHABILITATION 24 STEVENS STREET NORWALK,CT06850 06-1304799	INACTIVE	CT	501(C)(3)	11 TYPE 2	WCHN	Yes
(3)DANBURY HOSPITAL 24 HOSPITAL AVENUE DANBURY,CT06810 06-0646597	ACUTE CARE	CT	501(C)(3)	3	WCHN	Yes
(4)WESTERN CONNECTICUT HEALTH NETWORK 24 HOSPITAL AVENUE DANBURY,CT06810 22-2594977	PRGM DEVELOP	CT	501(C)(3)	11 TYPE 2	NA		No
(5)WESTERN CT HEALTH NETWORK AFFILIATES 24 HOSPITAL AVENUE DANBURY,CT06810 22-2594968	HLTH CARE SV	CT	501(C)(3)	9	WCHN	Yes
(6)DH AND NMH FOUNDATION INC 24 HOSPITAL AVENUE DANBURY,CT06810 23-7425557	ADMIN CONTRIB	CT	501(C)(3)	7	WCHN	Yes
(7)WESTERN CONNECTICUT HOME CARE INC 4 LIBERTY STREET DANBURY,CT06810 06-0655138	HOME HLTHCARE	CT	501(C)(3)	9	WCHN	Yes
(8)WESTERN CT MEDICAL GROUP INC 14 RESEARCH DRIVE SUITE 201A BETHEL,CT06801 06-1137531	PHYS PRACTICE	CT	501(C)(3)	9	WCHN	Yes
(9)EASTERN NY MEDICAL SERVICES PC 14 RESEARCH DRIVE SUITE 201A BETHEL,CT06801 45-5431389	PHYS PRACTICE	NY	501(C)(3)	9	WCHN	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) NORWALK SURGERY CENTER LLC 40 CROSS ST NORWALK,CT06850 27-2394942	SURGERY CENTER	CT	NONE	RELATED	3,469,202	4,542,773		No			No	63.210 %
(2) NEW MILFORD MRI JV LLC 21 ELM STREET NEW MILFORD,CT06776 27-1877801	INACTIVE	CT	NMH		0	0		No			No
(3) WCHN INVESTMENTS LLC 24 HOSPITAL AVENUE DANBURY,CT06810 47-5523212	INVESTMENTS	CT	WCHN	RELATED	8,192,762	143,647,499		No			No	32.850 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) SWC CORPORATION 24 STEVENS STREET NORWALK,CT06850 22-2577718	PHARMACY	CT	WCHN	C CORP	0	0	Yes
(2) MEDICAL SERVICES OF DANBURY 24 HOSPITAL AVENUE DANBURY,CT06811 06-1635945	HEALTHCARE	CT	WCMG	C CORP	0	0	Yes
(3) WESTERN CT HEALTH NETWORK INSU 23 LIME TREE BAY PO BOX 105 GRAND CAYMAN CJ 98-0438151	INSURANCE CAPTIVE	CJ	DANBURY HOSP	C CORP	0	0	Yes

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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

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

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

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

Yes

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

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

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

Yes

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

Yes

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

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

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

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) NORWALK HOSPITAL FOUNDATION INC	C	2,903,188	COST
(2) NORWALK HOSPITAL FOUNDATION INC	J	43,200	COST
(3) NORWALK HOSPITAL FOUNDATION INC	O	18,964	COST
(4) NORWALK HOSPITAL FOUNDATION INC	Q	215,734	COST
(5) NORWALK HOSPITAL FOUNDATION INC	S	2,963,380	COST
(6) DANBURY HOSPITAL	I	763,789	COST
(7) DANBURY HOSPITAL	K	301,000	COST
(8) DANBURY HOSPITAL	M	15,854,127	COST
(9) DANBURY HOSPITAL	O	13,528,574	COST
(10) DANBURY HOSPITAL	P	18,581,095	COST
(11) DANBURY HOSPITAL	R	46,010,857	COST
(12) WESTERN CT HEALTH NETWORK AFFILIATES	O	133,881	COST
(13) WESTERN CT HEALTH NETWORK AFFILIATES	Q	10,800	COST
(14) WESTERN CT HEALTH NETWORK AFFILIATES	S	114,449	COST
(15) WESTERN CT MEDICAL GROUP INC	J	901,532	COST
(16) WESTERN CT MEDICAL GROUP INC	M	28,092,161	COST
(17) WESTERN CT MEDICAL GROUP INC	O	849,812	COST
(18) WESTERN CT MEDICAL GROUP INC	Q	186,904	COST
(19) WESTERN CT MEDICAL GROUP INC	R	25,864,235	COST
(20) SWC CORPORATION	J	28,532	COST
(21) SWC CORPORATION	M	3,264,294	COST
(22) SWC CORPORATION	P	21,709	COST
(23) SWC CORPORATION	Q	603,278	COST
(24) SWC CORPORATION	S	3,364,180	COST
(25) WESTERN CT HEALTH NETWORK INSURANCE CO	R	2,094,155	COST

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation
PART III - PARTNERSHIP FULL NAME, ADDRESS, FEIN	NORWALK SURGERY CENTER, LLC - 27-2394942 40 CROSS STREET NORWALK, CT 06850 NEW MILFORD MRI JV, LLC - 27-1877801 21 ELM STREET NEW MILFORD, CT 06776 WCHN INVESTMENTS, LLC - 47-5523212 24 HOSPITAL AVENUE DANBURY, CT 06810

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: 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.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	20
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	2,079
6	Total number of volunteers (estimate if necessary) .............	6	410
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	2,588,912
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-1,758,108

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,369,032	2,700,928
9	Program service revenue (Part VIII, line 2g) .........	365,394,458	380,818,071
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,203,481	4,804,006
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,768,162	2,548,700
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	377,735,133	390,871,705
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	16,234,828	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	176,528,299	177,639,277
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	161,645,152	201,570,725
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	354,408,279	379,210,002
19	Revenue less expenses. Subtract line 18 from line 12.......	23,326,854	11,661,703
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	639,545,087	638,508,505
21	Total liabilities (Part X, line 26).............	289,830,942	221,238,468
22	Net assets or fund balances. Subtract line 21 from line 20.....	349,714,145	417,270,037

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 122,063,388 including grants of $ ) (Revenue $ 111,310,801 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ 86,347,845 including grants of $ ) (Revenue $ 83,413,546 )
	SEE SCHEDULE O

4c	(Code: ) (Expenses $ 37,319,450 including grants of $ ) (Revenue $ 34,682,772 )
	SEE SCHEDULE O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 77,217,427 including grants of $ ) (Revenue $ 151,410,952 )
4e	Total program service expenses322,948,110

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,559,204	1,872,171	407,544

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,016,953
e	Government grants (contributions)		1e	1,683,975

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		2,700,928

		Business Code
2a	NET PATIENT SERVICE REV	621400	369,664,379	369,664,379
b	NORWALK SURGERY CENTER JV	900099	3,469,202	3,469,202
c	LAB SERVICES REVENUE	621500	2,588,899		2,588,899
d	OTHER MEDICAL SERVICES	900099	1,355,651	1,355,651
e	OTHER	900099	1,174,043	1,174,043
f	All other program service revenue.			2,565,897	2,565,897
g Total.Add lines 2a–2f.....			380,818,071

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			4,804,006		13	4,803,993
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		3,821,936
b	Less: rental expenses		3,408,850
c	Rental income or (loss)	0	413,086
d	Net rental income or (loss)......			413,086			413,086
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		363,353
b	Less: cost of goods sold ..b		167,897
c	Net income or (loss) from sales of inventory..			195,456			195,456
Business Code			Miscellaneous Revenue
11a	CAFETERIA/VENDING		900099	1,800,431			1,800,431
b	PARKING		900099	139,727			139,727
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,940,158
12	Total revenue. See Instructions......			390,871,705	378,229,172	2,588,912	7,352,693

1	Grants and other assistance to domestic organizations and domestic governments. 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 ....	892,780		892,780
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	138,378,710	119,082,809	19,295,901
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,534,999	3,967,932	567,067
9	Other employee benefits .......	25,325,564	22,209,656	3,115,908
10	Payroll taxes ...........	8,507,224	7,427,495	1,079,729
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	924,906		924,906
c	Accounting ...........	0		0
d	Lobbying ...........	121,314		121,314
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	72,789,541	58,731,666	14,057,875
12	Advertising and promotion ....	28,503	26,407	2,096
13	Office expenses .......	1,517,505	815,461	702,044
14	Information technology ......	3,192,659	2,743,809	448,850
15	Royalties ..	0
16	Occupancy ...........	16,411,030	11,951,224	4,459,806
17	Travel ............	660,275	601,661	58,614
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	24,607	24,607
20	Interest ...........	2,666,380	639,708	2,026,672
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	22,949,810	16,548,898	6,400,912
23	Insurance ...	2,433,100	2,404,221	28,879	0
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	PHARMACY	28,012,046	28,012,046
b	MEDICAL SUPPLIES	20,654,628	20,654,628
c	HOSPITAL TAX	20,153,761	20,153,761
d	RADIOLOGY & LAB SUPPLIES	4,245,276	4,245,276
e	All other expenses	4,785,384	2,706,845	2,078,539
25	Total functional expenses. Add lines 1 through 24e	379,210,002	322,948,110	56,261,892	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			43,468,380	1	14,672,648
2	Savings and temporary cash investments .........			0	2	15,836,057
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			44,469,740	4	46,916,152
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	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
				0	6	0
7	Notes and loans receivable, net ....			61,725	7	53,027
8	Inventories for sale or use ........			2,725,505	8	3,163,878
9	Prepaid expenses and deferred charges ......			1,688,811	9	731,340
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	644,172,138
b	Less: accumulated depreciation	10b	372,195,173	269,175,967	10c	271,976,965
11	Investments—publicly traded securities .			123,434,544	11	0
12	Investments—other securities. See Part IV, line 11 .....			7,411,876	12	143,647,499
13	Investments—program-related. See Part IV, line 11 ..			98,322,402	13	100,837,121
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			48,786,137	15	40,673,818
16	Total assets. Add lines 1 through 15 (must equal line 34)...			639,545,087	16	638,508,505

17	Accounts payable and accrued expenses .....	51,194,090	17	47,704,607
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	114,265,000	20	103,521,514
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	124,371,852	25	70,012,347
26	Total liabilities. Add lines 17 through 25..	289,830,942	26	221,238,468

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	280,584,110	27	370,196,285
28	Temporarily restricted net assets ...........	59,661,583	28	37,484,265
29	Permanently restricted net assets	9,468,452	29	9,589,487
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	349,714,145	33	417,270,037
34	Total liabilities and net assets/fund balances ........	639,545,087	34	638,508,505