Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 10-01-2015 , and ending 09-30-2016
BCheck if applicable:
CName of organization
THE WATERBURY HOSPITAL
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
64 ROBBINS STREET
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WATERBURY, CT06708
D Employer identification number

06-0665979
E Telephone number

G Gross receipts $ 235,130,518
F Name and address of principal officer:
MARK HOLTZ
64 ROBBINS STREET
WATERBURY,CT06708
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.WATERBURYHOSPITAL.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1951
M State of legal domicile: CT
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: WATERBURY HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE HIGH QUALITY HEALTH CARE SERVICES THROUGH A FAMILY OF PROFESSIONALS AND SERVICES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 10
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 1,823
6 Total number of volunteers (estimate if necessary) ............. 6 96
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 630,069
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -37,740
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 5,068,751 6,445,374
9 Program service revenue (Part VIII, line 2g) ......... 202,809,107 218,688,844
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 3,358,483 3,272,865
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 4,101,763 4,554,794
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 215,338,104 232,961,877
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 117,106,705 117,470,316
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet245,640    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 109,516,554 136,573,921
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 226,623,259 254,044,237
19 Revenue less expenses. Subtract line 18 from line 12....... -11,285,155 -21,082,360
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 152,423,511 136,695,474
21 Total liabilities (Part X, line 26)............. 96,644,358 112,009,298
22 Net assets or fund balances. Subtract line 21 from line 20..... 55,779,153 24,686,176
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: WATERBURY HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE HIGH QUALITY HEALTH CARE SERVICES THROUGH A FAMILY OF PROFESSIONALS AND SERVICES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 211,175,658 including grants of $   ) (Revenue $ 222,694,973 )
STATEMENT OF PURPOSEAS A NOT-FOR-PROFIT COMMUNITY HOSPITAL, WATERBURY HOSPITAL PROVIDES QUALITY HEALTH CARE TO ALL AREA INDIVIDUALS, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, AGE, HANDICAP OR ABILITY TO PAY. HOWEVER, REIMBURSEMENT FOR SERVICES IS CRITICAL TO THE HOSPITAL'S STABILITY AND LONG-TERM OPERATION.SEE SCHEDULE O FOR CONTINUATION
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet211,175,658
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV ........................Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
164
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,823
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
14
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
10
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletSCOTT BOWMAN64 ROBBINS STREET   WATERBURY,CT06708 (203) 573-7333
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) DARLENE STROMSTAD......................................................................
PRESIDENT/TREASURER
 40.00
.................
26.00 		X   X       615,112 0 96,379
(2) CARL D CONTADINI......................................................................
CHAIRMAN
 0.90
.................
0.90 		X   X       0 0 0
(3) JOHN A KELLY JR......................................................................
VICE CHAIRMAIN
 0.90
.................
0.90 		X   X       0 0 0
(4) WILLIAM J PIZZUTO PHD......................................................................
SECRETARY
 0.90
.................
0.90 		X   X       0 0 0
(5) SUNDAE BLACK......................................................................
DIRECTOR
 0.40
.................
0.40 		X           0 0 0
(6) HENRY BORKOWSKI MD......................................................................
DIRECTOR / CAGW - CARDIOLOGIST
 40.00
.................
0.30 		X           556,959 0 38,119
(7) RON J DANDREA MD......................................................................
DIRECTOR
 0.20
.................
0.20 		X           0 0 0
(8) JAMES H GATLING PHD......................................................................
DIRECTOR
 0.40
.................
0.40 		X           0 0 0
(9) PATRICIA MCKINLEY......................................................................
DIRECTOR
 0.40
.................
0.40 		X           0 0 0
(10) JOHN A MICHAELS......................................................................
DIRECTOR
 0.70
.................
0.70 		X           0 0 0
(11) NEIL PETERSEN MD......................................................................
CHIEF OF STAFF
 7.00
.................
0.30 		X           75,000 0 0
(12) DAVID J PIZZUTO MD......................................................................
DIRECTOR / VP MEDICAL SERVICES
 20.00
.................
7.00 		X           164,793 0 6,154
(13) FRANK SHERER......................................................................
DIRECTOR
 0.40
.................
0.40 		X           0 0 0
(14) CARL B SHERTER MD......................................................................
DIRECTOR
 0.30
.................
0.30 		X           0 0 0
(15) SANDRA A IADAROLA......................................................................
CHIEF NURSING OFFICER
 40.00
.................
2.10 		    X       239,003 0 12,962
(16) MICHAEL J CEMENO......................................................................
CHIEF INFORMATION OFFICER
 40.00
.................
7.00 		    X       329,400 0 20,323
(17) RICHARD KROPP......................................................................
VP HUMAN RESOURCES
 40.00
.................
20.00 		    X       84,919 0 11,156
Form 990 (2015)
Form 990 (2015)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) MARK HOLTZ........................................................................
CHIEF OPERATING OFFICER
 40.00
.......................9.00 		    X       226,333 0 21,817
(19) JAMES MOYLAN........................................................................
CHIEF FINANCIAL OFFICER
 40.00
.......................8.00 		    X       254,476 0 0
(20) GUY DISTEFANO........................................................................
CHIEF FINANCIAL OFFICER
 40.00
.......................8.00 		    X       0 0 0
(21) EHSAN ANSARI........................................................................
CAGW - CARDIOLOGIST
 40.00
.......................   		        X   885,601 0 42,480
(22) JOSEPH MORLEY........................................................................
CAGW - CARDIOLOGIST
 40.00
.......................   		        X   865,413 0 42,480
(23) KEVIN KETT........................................................................
CAGW - CARDIOLOGIST
 40.00
.......................   		        X   819,453 0 41,972
(24) STEPHEN WIDMAN........................................................................
CAGW - CARDIOLOGIST
 40.00
.......................   		        X   790,777 0 43,649
(25) MARK RUGGIERO........................................................................
CAGW - CARDIOLOGIST
 40.00
.......................   		        X   786,684 0 41,972
(26) DIANE M WOOLLEY........................................................................
FORMER VP HUMAN RESOURCES
 40.00
.......................5.00 		          X 128,228 0 20,668
(27) EDWARD ROMERO........................................................................
FORMER CHIEF FINANCIAL OFFICER
 40.00
.......................8.00 		          X 115,401 0 22,125






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 6,937,552 0 462,256
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet113
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CROTHALL HEALTHCARE

1500 LIBERTY RIDGE DRIVE
WAYNE,PA19087 		BUILDING SVCS, TRANSPORT SVCS 6,171,325
MORRISON HEALTHCARE

5801 PEACHTREE DUNWOODY RD
ATLANTA,GA30342 		DIETARY SERVICES 3,887,545
CERNER CORPORATION

2800 ROCKCREEK PARKWAY
KANSAS CITY,MO64117 		INFORMATION TECHNOLOGY 1,924,833
ACCESS REHAB CENTERS LLC

22 TOMPKINS ST
WATERBURY,CT06708 		PHYSICAL THERAPY SERVICES 1,326,457
CT COLONY EMERGENCY PHYSICIANS

PO BOX 37889
PHILADELPHIA,PA191017889 		CLINICAL SERVICES 1,225,328
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet79
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e 3,619,809
f All other contributions, gifts, grants, and similar amounts not included above1f 2,825,565
g Noncash contributions included in lines 1a-1f:$ 1,000
h Total.Add lines 1a-1f.......MediumBullet 6,445,374
Program Service RevenueAmt Business Code
2a NET PATIENT SERVICE REVENUE 624100 211,779,037 211,779,037    
b CAW - NET PATIENT SERVICE REVENUE 621110 6,279,738 6,279,738    
c LAB SERVICE REVENUE 621500 373,906   373,906  
d IMAGE REPAIRS & MAINTENANCE 541900 256,163   256,163  
e
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet 218,688,844
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 2,796,480     2,796,480
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   437,679
b Less: rental expenses   0
c Rental income or (loss)   437,679
d Net rental income or (loss)......MediumBullet 437,679     437,679
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 45,244 2,449,753
b Less: cost or other basis and sales expenses 0 2,018,612
c Gain or (loss) 45,244 431,141
d Net gain or (loss).....MediumBullet 476,385     476,385
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a 244,428
b Less: direct expenses ...b 150,029
c Net income or (loss) from fundraising events..MediumBullet 94,399   94,399
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a CAW - OTHER INCOME 621110 1,624,329 1,624,329    
b PARTNERSHIP INCOME 900099 1,442,966 1,442,966    
c OTHER INCOME 900099 572,114 572,114    
d All other revenue .... 383,307 366,720   16,587
e Total. Add lines 11a–11d ...... MediumBullet 4,022,716
12 Total revenue. See Instructions......MediumBullet 232,961,877 222,064,904 630,069 3,821,530
Form 990 (2015)
Form 990 (2015)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 2,889,796 670,337 2,219,459  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 87,704,818 82,334,979 5,307,251 62,588
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,447,630 5,079,904 364,622 3,104
9 Other employee benefits ....... 15,049,616 13,821,338 1,217,067 11,211
10 Payroll taxes ........... 6,378,456 5,835,736 538,139 4,581
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 1,806,797 161,396 1,645,401  
c Accounting ........... 243,170   243,170  
d Lobbying ........... 83,501   83,501  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 592,220   592,220  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 45,723,515 32,598,878 13,124,637  
12 Advertising and promotion .... 755,711 37,979 717,732  
13 Office expenses ....... 9,756,907 7,750,901 2,004,091 1,915
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 4,502,844 1,230,491 3,272,353  
17 Travel ............ 107,751 80,017 27,734  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 136,802 74,295 62,357 150
20 Interest ........... 1,805,096   1,805,096  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 6,089,157   6,089,157  
23 Insurance ... 3,219,532   3,219,532  
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 PENSION WITHDRAWAL EXPE 28,300,000 28,300,000    
b MEDICAL/SURGICAL SUPPLI 26,996,006 26,994,678 1,328  
c IMPAIRMENT OF LONG-LIVE 6,485,028   6,485,028  
d PROVISION FOR RETROSPEC -7,296,457   -7,296,457  
e All other expenses 7,266,341 6,204,729 899,521 162,091
25 Total functional expenses. Add lines 1 through 24e 254,044,237 211,175,658 42,622,939 245,640
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 1,879,927 1 812,242
2 Savings and temporary cash investments ......... 15,571,642 2 7,847,330
3 Pledges and grants receivable, net ...... 3,791,077 3 4,615,260
4 Accounts receivable, net ............. 27,568,580 4 21,527,130
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net ....   7  
8 Inventories for sale or use ........ 3,257,310 8 2,635,674
9 Prepaid expenses and deferred charges ...... 1,531,580 9 1,377,781
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 270,801,696
b Less: accumulated depreciation 10b 249,461,032 30,538,168 10c 21,340,664
11 Investments—publicly traded securities . 9,024,565 11 10,202,207
12 Investments—other securities. See Part IV, line 11 ..... 56,644,352 12 58,647,157
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ............... 1,813,567 14 0
15 Other assets. See Part IV, line 11 ........... 802,743 15 7,690,029
16 Total assets. Add lines 1 through 15 (must equal line 34)... 152,423,511 16 136,695,474
Liabilities 17 Accounts payable and accrued expenses ..... 28,935,144 17 23,447,237
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities ......... 23,789,744 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D 43,919,470 25 88,562,061
26 Total liabilities. Add lines 17 through 25.. 96,644,358 26 112,009,298
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 1,355,351 27 -32,170,513
28 Temporarily restricted net assets ........... 8,220,369 28 8,722,091
29 Permanently restricted net assets 46,203,433 29 48,134,598
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 55,779,153 33 24,686,176
34 Total liabilities and net assets/fund balances ........ 152,423,511 34 136,695,474
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
232,961,877
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
254,044,237
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-21,082,360
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
55,779,153
5
Net unrealized gains (losses) on investments ...............
5
236,898
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-10,247,515
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
24,686,176
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2015)
Form 990 (2015)
Additional Data


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

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total      

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

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) right arrow (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) right arrow (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.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2015

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) right arrow (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) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015

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
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
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.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
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).
8
 
 
9a
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.
9a
 
 
b
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.
9b
 
 
c
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.
9c
 
 
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
 
 
b
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

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
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
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
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
No
1
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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
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.
2a
 
 
b
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.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2015

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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on 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 WATERBURY HOSPITAL
  		Employer identification number
06-0665979
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


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(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 WATERBURY HOSPITAL
  		Employer identification number

06-0665979
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 WATERBURY HOSPITAL
  		Employer identification number

06-0665979
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No.from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletInformation 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

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

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

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

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

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the 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


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)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
Yes
 
c
Media advertisements? ...................................................................................................
Yes
 
 
d
Mailings to members, legislators, or the public? .............................................................................
Yes
 
 
e
Publications, or published or broadcast statements? ...........................................................
Yes
 
 
f
Grants to other organizations for lobbying purposes? ..........................................................
Yes
 
50,000
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
Yes
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
Yes
 
 
i
Other activities? ...................................................................................................................
Yes
 
33,501
j
Total. Add lines 1c through 1i ....................................................................................................
83,501
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
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
PART II-B, LINE 1: A PORTION OF THE CT HOSPITAL ASSOCIATION FEES THAT ARE PAID BY THE WATERBURY HOSPITAL IS FOR LOBBYING ACTIVITIES. THE WATERBURY HOSPITAL ALSO PAYS ROY AND LEROY LLC FOR LOBBYING SERVICES TOTALING $50,000.
Schedule C (Form 990 or 990EZ) 2015


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
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 ....    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" 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 .... 53,252,862 59,832,482 58,391,891 54,791,385 48,442,875
b Contributions ...          
c Net investment earnings, gains, and losses 2,783,836 -2,805,083 2,214,558 4,160,381 6,884,672
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		604,308 3,774,537 773,967 559,875 536,162
f Administrative expenses ....          
g End of year balance ...... 55,432,390 53,252,862 59,832,482 58,391,891 54,791,385
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet86.830 %
c
Temporarily restricted endowment SchDMd Bullet13.170 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
Yes
 
(ii) related organizations .................
3a(ii)
 
No
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 ...   287,549 287,549
b Buildings   82,191,981 74,549,112 7,642,869
c Leasehold improvements   654,276 554,113 100,163
d Equipment ...   184,794,752 171,791,117 13,003,635
e Other ...   2,873,138 2,566,690 306,448
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 21,340,664
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other 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) FUNDS HELD IN TRUST BY OTHERS 		45,342,562 F

(B) GREATER WATERBURY IMAGING CENTER 		3,034,700 F

(C) ACCESS REHAB CENTERS 		4,875,985 F

(D) IMAGING PARTNERS 		432,285 F

(E) ALLIANCE MEDICAL GROUP 		4,961,625 F
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 58,647,157
Part VIII
Investments—Program 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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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) OTHER RECEIVABLES 165,128
(2) OTHER INVESTMENTS 228,444
(3) RETROSPECTIVE PREMIUM CREDIT RECEIVABLE 7,296,457
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 7,690,029
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  
LIABILITIES OF CONSOLIDATED AFFILIATES 1,584,834
RESERVE FOR WORKER'S COMP/MALPRACTICE LIAB. LOSS 13,776,227
NONCONTROLLING INTEREST 2,503,706
DEFERRED LIAB. ON GIFT ANNUITY 101,571
ASSET RETIREMENT OBLIGATION 2,980,756
CAPITAL LEASE LIABILITY 3,621,147
ACCRUED PENSION LIABILITY 11,010,742
DEFERRED LIAB. ON SERP 523,948
DUE TO AFFILIATES 18,517,873
DUE TO THIRD-PARTY REIMBURSEMENT AGENCIES 5,641,257
PENSION WITHDRAWAL LIABILITY 28,300,000
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 88,562,061
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

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 ....... 1 265,592,559
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a 236,898
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 34,278,941
e Add lines 2a through 2d ..................... 2e 34,515,839
3 Subtract line 2e from line 1.................. 3 231,076,720
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 592,220
b Other (Describe in Part XIII.) ........... 4b 1,292,937
c Add lines 4a and 4b.................... 4c 1,885,157
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 232,961,877
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 ........... 1 295,486,816
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 42,034,799
e Add lines 2a through 2d.................... 2e 42,034,799
3 Subtract line 2e from line 1................... 3 253,452,017
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 592,220
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c 592,220
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 254,044,237

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
PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED FOR FREE CARE AND GENERAL HOSPITAL OPERATIONS.
PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES. ACCESS, GWIC, CAGW, AND IMAGING PARTNERS LLC ARE PARTNERSHIPS. FOR TAX PURPOSES, THESE PARTNERSHIP ARE PASS-THROUGH ENTITIES. TAXATION DOES NOT OCCUR AT THE PARTNERSHIP LEVEL. ACCORDINGLY, NO PROVISION FOR TAXES IS INCLUDED. AMG IS TAX EXEMPT UNDER SECTION 501(C)(3) OF THE CODE. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2016, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.
PART XI, LINE 2D - OTHER ADJUSTMENTS: INCOME FROM CONSOLIDATED AFFILIATES 34,278,941.
PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME FROM PARTNERSHIP 1,413,474. WATERBURY GASTROENTEROLOGY INCOME 29,492. FUNDRAISING EXPENSES -150,029.
PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSE OF CONSOLIDATED AFFILIATES 41,884,770. FUNDRAISING EXPENSE 150,029.
Schedule D (Form 990) 2015


Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowInformation about Schedule G (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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
Part I
Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.


(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2015
Schedule G (Form 990 or 990-EZ) 2015
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.




VerticalRevenue
(a) Event #1

GALA
(event type) 		(b) Event #2

GOLF TOURNAMENT
(event type) 		(c) Other events

1
(total number) 		(d) Total events
(add col. (a) through col. (c))

1
Gross receipts . . . . .
126,402
95,935
22,091
244,428

2
Less: Contributions . . . .
 
 
 
 
3 Gross income (line 1 minus
line 2) . . . . . .
126,402
95,935
22,091
244,428



VerticalDirectExpenses
4 Cash prizes . . . . .        
5 Noncash prizes . . . .        
6 Rent/facility costs . . . .        
7 Food and beverages . . .        
8 Entertainment . . . .        
9 Other direct expenses . . . 90,369 36,755 22,905 150,029
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow 150,029
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow 94,399
Part III
Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1
Gross revenue . . . . .
 
 
 
 
VerticalDirectExpenses

2
Cash prizes . . . . .
 
 
 
 

3
Noncash prizes . . . .
 
 
 
 

4
Rent/facility costs . . . .
 
 
 
 

5
Other direct expenses . . .
90,369
36,755
22,905
150,029


6

Volunteer labor . . . .
%
%
%


7
Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow
 

8
Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow
 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2015
Schedule G (Form 990 or 990-EZ) 2015
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . .
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility . . . . . . . . . . . . . . . . . .
13a
%
b
An outside facility . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . .
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . .
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2015
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    1,635,320 684,878 950,442 0.380 %
b Medicaid (from Worksheet 3, column a) . . . . .   45,013 54,262,481 44,747,530 9,514,951 3.830 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .   45,013 55,897,801 45,432,408 10,465,393 4.210 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).            
f Health professions education (from Worksheet 5) . . .     14,884,224 8,780,450 6,103,774 2.460 %
g Subsidized health services (from Worksheet 6) . . . .   8,336 9,725,839 5,952,643 3,773,196 1.520 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .   8,336 24,610,063 14,733,093 9,876,970 3.980 %
k Total. Add lines 7d and 7j .   53,349 80,507,864 60,165,501 20,342,363 8.190 %
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 (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support   165 48,559   48,559 0.020 %
4 Environmental improvements            
5 Leadership development and
training for community members		   52 112,077 45,142 66,935 0.030 %
6 Coalition building   30 16,452   16,452 0.010 %
7 Community health improvement advocacy            
8 Workforce development            
9 Other     41,116 30,532 10,584 0 %
10 Total   247 218,204 75,674 142,530 0.060 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
761,283
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
87,878,183
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
91,594,210
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-3,716,027
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 THE WATERBURY HOSPITAL
64 ROBBINS STREET
WATERBURY,CT06708 		X X   X     X      
Schedule H (Form 990) 2015
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)
THE WATERBURY 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): 		1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, PAGE 7
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
THE WATERBURY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
 
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

THE WATERBURY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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
THE WATERBURY HOSPITAL PART V, SECTION B, LINE 5: IN MAY 2016, INDIVIDUALS FROM HEALTHCARE ORGANIZATIONS, COMMUNITY AGENCIES, SOCIAL SERVICE ORGANIZATIONS, AND AREA NON-PROFITS GATHERED TO REVIEW THE RESULTS OF THE GREATER WATERBURY HEALTH IMPROVEMENT PARTNERSHIP (GWHIP) DATA AND PLANNING FOR THE FUTURE. THE MEETING WAS INITIATED BY PARTNERS OF GWHIP. THE GOAL OF THE MEETING WAS TO DISCUSS THE COMMITMENT TO THE GREATER WATERBURY AREA AND DISCUSS FUTURE PRIORITIZATIONS OF THE ORGANIZATION AND ITS MEMBERS. THE OBJECTIVES OF THE SESSION WERE TO REVIEW COMPILED DATAHAVEN HEALTH AND WELLBEING DATA AND HIGHLIGHT KEY RESEARCH FINDINGS, GATHER FEEDBACK FROM COMMUNITY REPRESENTATIVES ABOUT COMMUNITY HEALTH NEEDS, AND PRIORITIZE THE COMMUNITY HEALTH NEEDS BASED ON SELECT CRITERIA.EXECUTIVE LEADERS OF THE CONNECTICUT COMMUNITY FOUNDATION, THE CITY OF WATERBURY HEALTH DEPARTMENT, AND GWHIP FACILITATED THE PRIORITIZATION SESSION. THE MEETING BEGAN WITH AN ABBREVIATED RESEARCH OVERVIEW, INCLUDING THE RESULTS OF THE PRIMARY AND SECONDARY RESEARCH AND KEY FINDINGS OF THE CHNA.FOLLOWING THE RESEARCH OVERVIEW OF THE DATAHAVEN HEALTH AND WELLBEING DATA, MEETING PARTICIPANTS WERE PROVIDED WITH INFORMATION REGARDING THE PRIORITIZATION PROCESS, CRITERIA TO CONSIDER MOVING FORWARD WITH KEY AREAS OF FOCUS, AND OTHER ASPECTS OF HEALTH IMPROVEMENT PLANNING. IN A LARGE-GROUP FORMAT, ATTENDEES WERE ASKED TO SHARE OPENLY WHAT THEY PERCEIVED TO BE THE NEEDS AND AREAS OF OPPORTUNITY IN THE COMMUNITY AND HOW THEY WOULD FIT INTO THE PRIORITIZATION AREAS.
THE WATERBURY HOSPITAL PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH SAINT MARY'S HOSPITAL AS A PARTNER OF THE GREATER WATERBURY HEALTH IMPROVEMENT PARTNERSHIP.
THE WATERBURY HOSPITAL PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE CONNECTICUT COMMUNITY FOUNDATION, CITY OF WATERBURY HEALTH DEPARTMENT, UNITED WAY, AND STAYWELL HEALTH CENTER AS PARTNERS OF THE GREATER WATERBURY HEALTH IMPROVEMENT PARTNERSHIP.
THE WATERBURY HOSPITAL PART V, SECTION B, LINE 11: THE GREATER WATERBURY HEALTH IMPROVEMENT PARTNERSHIP (GWHIP) REVIEWED THE FINDINGS AND DISCUSSED CROSS-CUTTING APPROACHES TO FURTHER HONE THE PRIORITY AREAS. THE FOLLOWING FOUR PRIORITY AREAS FOR WATERBURY WERE ADOPTED FOR THE 2017-2019 IMPLEMENTATION PLAN IN ORDER TO TOUCH ON SEVERAL HEALTH INITIATIVES: ACCESS TO CARE - INCLUDING MENTAL HEALTH/SUBSTANCE ABUSE, HEALTHY LIFESTYLE - INCLUDING OBESITY AND TOBACCO USE, ASTHMA, AND HEALTH COMMUNICATIONS.WATERBURY HOSPITAL CONTINUES TO BE A PARTNER IN GWHIP AND ACTIVELY PARTICIPATES IN THE WORK GROUPS FOR EACH OF THE HEALTH INITIATIVES IDENTIFIED. IN ADDITION, WATERBURY HOSPITAL HAS ITS OWN IMPLEMENTATION PLAN THAT ILLUSTRATES THE HOSPITAL'S SPECIFIC STRATEGIES AND RESOURCES.ACCESS TO CAREWATERBURY HOSPITAL IS CURRENTLY CHAIRING THE GWHIP ACCESS TO CARE WORKGROUP. THE WORKGROUP IS WORKING ON DEVELOPING INFOGRAPHICS AS A WAY TO HELP PEOPLE NAVIGATE LOCAL HEALTH SYSTEM FOR DIFFERENT AREAS INCLUDING WHEN TO USE ED VS. URGENT CARE VS. PRIMARY CARE, ASTHMA, MENTAL HEALTH, AND DIABETES. THE WORKGROUP ALSO CONTINUES TO WORK ON CREATING THE COMMUNITY CARE TEAM IN ORDER TO PROVIDE CROSS-ORGANIZATION CASE MANAGEMENT FOR HIGH UTILIZATION EMERGENCY DEPARTMENT VISITORS BETWEEN BOTH HOSPITAL EDS AND A COMPREHENSIVE ARRAY OF COMMUNITY ORGANIZATIONS.HEALTHY LIFESTYLETHE HEALTHY LIFESTYLE WORKGROUP IS WORKING ON MAPPING EXISTING COMMUNITY RESOURCES IN ORDER TO HAVE A DATABASE ON WHAT EXISTS AND WHO IN THE COMMUNITY IS DOING WHAT. THE WORKGROUP IS ALSO WORKING ON ESTABLISHING THE STATE OF CT LIVEWELL DIABETES SERIES IN WATERBURY OR HAVING SOME TYPE OF DIABETES EDUCATION AVAILABLE TO THE COMMUNITY.ASTHMAWATERBURY HOSPITAL IS PARTICIPATING IN THE CT HOSPITAL ASSOCIATION ASTHMA INITIATIVE WHICH IS WORKING TOWARDS HAVING AN ASTHMA ACTION PLAN GIVEN TO EVERY PATIENT WHO COMES INTO THE EMERGENCY DEPARTMENT (ED) WITH AN ASTHMA DIAGNOSIS AND PROVIDING EDUCATION ON PROPER USE OF INHALER. THROUGH GWHIP, WE ARE PARTNERING WITH THE WATERBURY HEALTH DEPARTMENT WITH THE PUTTING ON AIRS PROGRAM. THE ED IS REFERRING QUALIFIED PATIENTS TO THE WATERBURY HEALTH DEPARTMENT WITH AN ASTHMA ACTION PLAN. THE PROGRAM IS AN EVIDENCED BASED FREE HOME VISITATION PROGRAM FOCUSING ON INDOOR ASTHMA TRIGGERS AND EDUCATION ABOUT ASTHMA AS A CHRONIC ILLNESS.HEALTH COMMUNICATIONSTHE HEALTH COMMUNICATIONS WORKGROUP WAS A NEW WORK GROUP THAT WAS ADDED AFTER THE 2016 CHNA PROCESS. THE WORKGROUP'S GOAL IS TO INCREASE MESSAGING AND COMMUNICATIONS TO THE PARTNERS, COMMUNITY ORGANIZATIONS, AND THE GREATER WATERBURY COMMUNITY. THEY HAVE IDENTIFIED A VENDOR THAT WILL BE IN CHARGE OF THE WEB DESIGN, SOCIAL MEDIA, LOGO, AND COLOR SCHEME AND THE WORK SHOULD BE COMPLETED BY FALL 2017.WATERBURY HOSPITAL'S PR DEPARTMENT IS CURRENTLY INCLUDING INFORMATION ON COMMUNITY EVENTS AND PROGRAMS ON THE WATERBURY HOSPITAL'S WEBSITE - COMMUNITY CALENDAR, FACEBOOK PAGE, AND EVERGREEN NEWSLETTER.
THE WATERBURY HOSPITAL PART V, SECTION B, LINE 22D: CCR - COST TO CHARGE RATIO
THE WATERBURY HOSPITAL: PART V, SECTION B, LINE 7A:HTTP://WWW.WATERBURYHOSPITAL.ORG/COMMUNITY/CHNA/2016-CHNA-FINAL-REPORT/
THE WATERBURY HOSPITAL: PART V, SECTION B, LINE 10A:HTTP://WWW.WATERBURYHOSPITAL.ORG/COMMUNITY/CHNA/2016-CHNA-IMPLEMENTATION-PLAN/
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 8
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?7
Name and address Type of Facility (describe)
1 1 - CARDIOLOGY ASSOCIATES OF GTR WATERBURY
455 CHASE PARKWAY
WATERBURY,CT06708 		MEDICAL OFFICES, DIAGNOSTIC TESTING
2 2 - BLOOD DRAW STATION
134 GRANDVIEW AVENUE
WATERBURY,CT06708 		BLOOD DRAWING FACILITY
3 3 - BLOOD DRAW STATION
1625 STRAITS TURNPIKE SUITE 304
MIDDLEBURY,CT06762 		BLOOD DRAWING FACILITY/X-RAYS
4 4 - BLOOD DRAW STATION
22 OLD WATERBURY ROAD SUITE 201
SOUTHBURY,CT06488 		BLOOD DRAWING FACILITY
5 5 - BLOOD DRAW STATION
130 SOUTH MAIN STREET
THOMASTON,CT06787 		BLOOD DRAWING FACILITY
6 6 - BLOOD DRAW STATION
51 DEPOT STREET SUITE 212
WATERTOWN,CT06795 		BLOOD DRAWING FACILITY
7 7 - BLOOD DRAW STATION
305 CHURCH STREET SUITE 16
NAUGATUCK,CT06770 		BLOOD DRAWING FACILITY
8
9
10
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 9
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 3C: N/A
PART I, LINE 6A: N/A
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,693,497.
PART II, COMMUNITY BUILDING ACTIVITIES: AS A LEADER IN THE DELIVERY OF HEALTHCARE SERVICES IN THE GREATER WATERBURY AREA, WATERBURY HOSPITAL (WH) IS COMMITTED TO STRENGTHENING THE WELFARE AND AWARENESS OF THE CITIZENS WITHIN ITS COMMUNITY. FROM STRENGTHENING THE CAREER PATHS OF WATERBURY AREA YOUTH; TO SUPPORTING THE UNINSURED AND UNDERINSURED THROUGH THE WATERBURY HEALTH ACCESS PROGRAM AND; PROVIDING TRANSPORT TO AND FROM MEDICAL APPOINTMENTS; WATERBURY HOSPITAL IS REMOVING THE BARRIERS TO QUALITY HEALTH CARE FOR ALL AND REMAINS FIRM IN ITS COMMITMENT TO A HEALTHIER, STRONGER, AND MORE PRODUCTIVE COMMUNITY.YOUTH PIPELINE INITIATIVES - THE WH YOUTH PIPELINE INITIATIVES WERE ESTABLISHED IN 2001 AS A PARTNERSHIP BETWEEN WATERBURY HOSPITAL AND WATERBURY PUBLIC SCHOOLS. THE MISSION OF THE PROGRAM IS: "TO CLOSE THE ACHIEVEMENT GAP FOR MINORITY AND ECONOMICALLY DISADVANTAGED STUDENTS IN WATERBURY SO THEY CAN MATRICULATE AND COMPETE NATIONALLY FOR PLACEMENT IN POST-SECONDARY EDUCATION PROGRAMS IN PREPARATION FOR HEALTH CAREERS". WH IS COMMITTED TO ENHANCING AND ENRICHING THE ACADEMIC OPPORTUNITIES AND PERSONAL JOURNEYS OF OUR YOUTH, WHO ARE THE EMERGING WORKFORCE OF TOMORROW. DURING 2016, WH PROVIDED 52 STUDENTS AND PARENTS IN GREATER WATERBURY WITH UNIQUE EDUCATIONAL PROGRAMS THAT WILL ENHANCE THE OVERALL WELFARE OF OUR COMMUNITY.THE WH YOUTH PIPELINE INITIATIVES HAD FOUR FOCUS AREAS DURING FY 2016, INCLUDING: - PARENT LEADERSHIP TRAINING INSTITUTE (PLTI) - IN 2016, 11 INDIVIDUALS FROM GREATER WATERBURY SUCCESSFULLY COMPLETED WATERBURY'S PLTI, A 20-WEEK CURRICULUM TEACHING LEADERSHIP AND ADVOCACY SKILLS, AS WELL AS INDIVIDUAL COMMUNITY PROJECT PLANNING. PLTI'S CORE MISSION IS TO IMPART LEADERSHIP AND ADVOCACY SKILLS TO PARENTS WHILE SIMULTANEOUSLY EDUCATING THEM ABOUT VOLUNTEERISM, CIVIC LIFE, AND THE PROCESS BY WHICH STATE AND LOCAL GOVERNMENTS ENACT AND CHANGE LAWS. EACH PARTICIPANT COMPLETES AND IMPLEMENTS A COMMUNITY PROJECT. - CHILDREN LEADERSHIP TRAINING INSTITUTE (CLTI) - CLTI IS RUN IN CONNECTION WITH THE PLTI PROGRAM. 10 CHILDREN PARTICIPATED IN THE PROGRAM IN 2016. - UCONN PEOPLE EMPOWERING PEOPLE (PEP) - THE PROGRAM INCLUDED A 10-WEEK PARENT LEADERSHIP AND ADVOCACY REGIMEN THROUGH WHICH 9 PARTICIPANTS SUCCESSFULLY COMPLETED THE PEP COURSE. UCONN PEP IS A PERSONAL, FAMILY, AND LEADERSHIP DEVELOPMENT PROGRAM WITH A STRONG COMMUNITY FOCUS. PEP IS DESIGNED TO BUILD ON THE UNIQUE STRENGTHS AND LIFE EXPERIENCES OF PARTICIPANTS AND EMPHASIZES THE CONNECTION BETWEEN AN INDIVIDUAL AND COMMUNITY ACTION. PARTICIPANTS WORK INDIVIDUALLY OR COLLABORATIVELY TO CREATE A COMMUNITY PROJECT WHICH IS COMPLETED AS PORTION OF THE PROGRAM. - WH SUMMER BRIDGE PROGRAM - DURING THE SUMMER OF 2016, 22 STUDENTS FROM WATERBURY, GRADES 6-11, PARTICIPATED IN THE WH SUMMER BRIDGE PROGRAM. 100% OF MEALS WERE SECURED FOR THE PROGRAM FROM CITY OF WATERBURY SUMMER FOOD PROGRAM.STUDENTS COMPLETED THE FOLLOWING MODULES: - 13.5 HOURS OF MATH (PRE- ALGEBRA, ALGEBRA II, ADVANCED MATH) REVIEW SESSIONS - 14 HOURS OF ENGLISH LANGUAGE ARTS AND SECOND ANNUAL WH GREAT DEBATE - 18 HOURS OF SAT VOCABULARY - 13.5 HOURS OF PROJECT CITIZEN (CIVICS COURSE) - 6.5 HOURS OF SAT VOCAB - 9 HOURS OF PRACTICAL MONEY SKILLS - 9 HOURS OF TEAM BUILDING - 13 HOURS OF POETRY INSTRUCTION AND PARTICIPATION IN THE ANNUAL WH POETRY SLAM - 6 HOURS SCIENCE MODULE AT STONE ACADEMY - 6 HOURS OF SOCIAL DETERMINANTS OF HEALTH DOCUMENTARIES AND ACTIVE DISCUSSIONS WITH THE WATERBURY HEALTH DEPT. - HEALTH & NUTRITION FAIR HOSTED BY THE STUDENTS INCLUDING PRESENTATIONS ON OBESITY - FIELDTRIPS INCLUDED: HAMMONASSET STATE PARK (EDUCATIONAL SESSION AT MEIGS POINT NATURE CENTER), THE HAROLD LEEVER CANCER CENTER, LYMAN ORCHARD, AND MYSTIC AQUARIUM.SUPPORT GROUPS - DURING 2016, WATERBURY HOSPITAL HOSTED SEVERAL SUPPORT GROUPS FOR ITS PATIENTS AND THEIR FAMILIES, INCLUDING: - BEHAVIORAL HEALTH'S PARENT AND SIBLING SUPPORT GROUP, WHICH OFFERS EMOTIONAL ASSISTANCE TO FAMILIES WHO HAVE CHILDREN IN TREATMENT; AND - ALCOHOLICS ANONYMOUS, SERVES OVER 4,000 PEOPLE ANNUALLY, MEETS WEEKLY THROUGHOUT THE YEAR, AND IS COORDINATED BY OUR BEHAVIORAL HEALTH DEPARTMENT.
PART III, LINE 2: OVERALL COST TO CHARGE RATIO USED IN CALCULATION.
PART III, LINE 3: FINANCIAL ASSISTANCE (CHARITY CARE) IS A SEPARATE NUMBER, AND NOT INCLUDED IN THE AMOUNT REPORTED ON LINE 2.
PART III, LINE 4: THE HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS POSSIBLE. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED FEDERAL POVERTY INCOME LEVELS, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES AND ASSETS. THESE SERVICES ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES FOR FINANCIAL REPORTING PURPOSES. EFFECTIVE OCTOBER 1, 2013, THE HOSPITAL CHANGED ITS CHARITY CARE POLICY TO DISCOUNT ALL SELF PAY RECEIVABLES BY 50% UPON FINAL BILLING.
PART III, LINE 8: COSTING METHODOLOGY USED TO COMPUTE THE MEDICARE SHORTFALL AND ANY ASSOCIATED COMMUNITY BENEFIT IS A COMBINATION OF THE AMOUNT REPORTED ON LINE 7 AS WELL AS THE HEALTH PROFESSION EDUCATION LINE. A TOTAL SHORTFALL OF $5,068,780 WAS DERIVED FROM THE 2016 MEDICARE COST REPORT USING AN AHA APPROVED FORM FOR SCHEDULE H WORKSHEET B PPS AND IPF HOSPITALS. ALL OF THIS SHORTFALL SHOULD BE REPORTED AS A COMMUNITY BENEFIT. THE HOSPITAL COST ACCOUNTING SYSTEM SHOWS A SHORTFALL FROM ALL MEDICARE PROGRAMS (INCLUDING MANAGED MEDICARE) OF $9,819,801 (NET OF BAD DEBT AND FREE CARE).
PART III, LINE 9B: WE HAVE SEVERAL CREDIT AND COLLECTION PROGRAMS GOVERNING PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE; PROMPT PAY DISCOUNT; SLIDING SCALE; PAYMENT ARRANGEMENTS; CHARITY CARE AND FREE BED FUNDS. ANY PATIENT EXPRESSING DIFFICULTY PAYING A BALANCE IS ENTITLED TO APPLY FOR FINANCIAL COUNSELING ASSISTANCE. CUSTOMER SERVICE REPRESENTATIVES WORK WITH THE PATIENTS TO DETERMINE PROGRAM QUALIFICATION BASED ON THE COMPLETION OF A FINANCIAL APPLICATION. CASES ARE PREPARED AND PRESENTED TO THE PATIENT ASSISTANCE COMMITTEE. APPROVED CASES WILL BE EITHER FULLY OR PARTIALLY WRITTEN OFF TO FREE BED FUNDS OR CHARITY CARE.
PART VI, LINE 2: IN ORDER TO ACCESS THE HEALTH CARE NEEDS OF THE COMMUNITY, WATERBURY HOSPITAL CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT IN PARTNERSHIP WITH OTHER COMMUNITY ORGANIZATIONS INCLUDING SAINT MARY'S HOSPITAL, STAYWELL HEALTH CENTER, WATERBURY HEALTH DEPARTMENT, UNITED WAY, AND THE CONNECTICUT COMMUNITY FOUNDATION. THE PARTNERSHIP, ALSO KNOWN AS THE GREATER WATERBURY HEALTH IMPROVEMENT PARTNERSHIP (GWHIP), REVIEWED THE FINDINGS AND DISCUSSED CROSS-CUTTING APPROACHES TO FURTHER HONE THE PRIORITY AREAS. THE FOLLOWING FOUR PRIORITY AREAS FOR WATERBURY WERE ADOPTED FOR THE 2017-2019 IMPLEMENTATION PLAN IN ORDER TO TOUCH ON SEVERAL HEALTH INITIATIVES: ACCESS TO CARE - INCLUDING MENTAL HEALTH/SUBSTANCE ABUSE, HEALTHY LIFESTYLE - INCLUDING OBESITY AND TOBACCO USE, ASTHMA, AND HEALTH COMMUNICATIONS.WATERBURY HOSPITAL CONTINUES TO BE A PARTNER IN GWHIP AND ACTIVELY PARTICIPATES IN THE WORK GROUPS FOR EACH OF THE HEALTH INITIATIVES IDENTIFIED. IN ADDITION, WATERBURY HOSPITAL HAS ITS OWN IMPLEMENTATION PLAN THAT ILLUSTRATES THE HOSPITAL'S SPECIFIC STRATEGIES AND RESOURCES.
PART VI, LINE 3: WE HAVE SIGNAGE, PT HANDBOOK, STATEMENT BACKERS & HANDOUTS THAT INFORM PATIENTS OF FREE BED FUNDS ETC. THE HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS POSSIBLE. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES. THESE CHARGES ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES FOR FINANCIAL REPORTING PURPOSES.
PART VI, LINE 4: THE HOSPITAL'S TOTAL SERVICE AREA COMPRISES 35 ZIP CODES, WHICH INCLUDE THE CITY OF WATERBURY AND 17 SURROUNDING TOWNS. THE PRIMARY SERVICE AREA WHICH COVERS NINE US CENSUS ZIP CODE TABULATION AREAS (ZCTAS) INCLUDES WATERBURY, NAUGATUCK, PROSPECT AND WOLCOTT HAS A POPULATION OF APPROXIMATELY 168,000. THE SECONDARY SERVICE AREA INCLUDES BEACON FALLS, BETHLEHEM, CHESHIRE, MIDDLEBURY, MORRIS, OXFORD, PLYMOUTH, SOUTHBURY, THOMASTON, WATERTOWN AND WOODBURY HAS A POPULATION OF APPROXIMATELY 133,000.THE COMBINED POPULATION FOR THESE COMMUNITIES IS ROUGHLY 301,000 RESIDENTS, WITH THE MAJORITY OF PATIENTS LIVING IN THE CITY OF WATERBURY WHICH IS PARTICULARLY ECONOMICALLY DISTRESSED. THE MEDIAN HOUSEHOLD INCOME IS $41,136, WHICH IS SIGNIFICANTLY LESS THAN THE OVERALL SERVICE AREA, WHICH IS APPROXIMATELY $70,000. THE UNEMPLOYMENT RATE IN THE CITY OF WATERBURY IN SEPTEMBER 2015 WAS 10.7%. THIS IS HIGHER THAN THE STATE OF CONNECTICUT UNEMPLOYM MENT RATE OF 6.6%. APPROXIMATELY 31.6% OF THE POPULATION IN WATERBURY SPEAKS A LANGUAGE OTHER THAN ENGLISH IN THE HOME. THIS IS HIGHER THAN THE STATE OF CONNECTICUT WHERE 20.8% OF THE POPULATION SPEAKS A LANGUAGE OTHER THAN ENGLISH IN THE HOME. IN ADDITION, 24.2% OF FAMILIES IN WATERBURY HAVE POVERTY STATUS COMPARED TO 10.5% IN CONNECTICUT.CENTRAL WATERBURY HAS BEEN DESIGNATED A MEDICALLY UNDERSERVED AREA (MUA) AND MEDICALLY UNDERSERVED POPULATION (MUP) BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA). HRSA HAS ALSO DESIGNATED CENTRAL WATERBURY AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY MEDICAL CARE, DENTAL CARE AND MENTAL HEALTH.
PART VI, LINE 5: WATERBURY HOSPITAL HAS SPECIFIC PROGRAMS AND RESOURCES THAT SUPPORT ONGOING EFFORTS TO ADDRESS THE IDENTIFIED COMMUNITY HEALTH PRIORITIES AND WE PARTICIPATE IN A VARIETY OF COMMUNITY EVENTS THROUGHOUT THE YEAR. WE ALSO CONTINUE TO PARTICIPATE IN THE GREATER WATERBURY HEALTH IMPROVEMENT PARTNERSHIP (GWHIP) WHICH CREATES OPPORTUNITIES FOR COLLECTIVE IMPACT, FOSTERS GREATER COLLABORATION COMMUNITY-WIDE, AND HELPS MAKE BETTER USE OF RESOURCES BY ELIMINATING DUPLICATION OF EFFORT WHEREVER POSSIBLE.
PART VI, LINE 6: N/A
PART VI, LINE 7, REPORTS FILED WITH STATES CT
Schedule H (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1DARLENE STROMSTADPRESIDENT/TREASURER (i)

(ii)		 533,998
-------------
0 		81,114
-------------
0 		0
-------------
0 		82,950
-------------
0 		13,429
-------------
0 		711,491
-------------
0 		0
-------------
0
2HENRY BORKOWSKI MDDIRECTOR / CAGW - CARDIOLOGIST (i)

(ii)		 556,959
-------------
0 		0
-------------
0 		0
-------------
0 		25,950
-------------
0 		12,169
-------------
0 		595,078
-------------
0 		0
-------------
0
3DAVID J PIZZUTO MDDIRECTOR / VP MEDICAL SERVICES (i)

(ii)		 143,124
-------------
0 		21,669
-------------
0 		0
-------------
0 		2,602
-------------
0 		3,552
-------------
0 		170,947
-------------
0 		0
-------------
0
4SANDRA A IADAROLACHIEF NURSING OFFICER (i)

(ii)		 204,254
-------------
0 		34,749
-------------
0 		0
-------------
0 		3,816
-------------
0 		9,146
-------------
0 		251,965
-------------
0 		0
-------------
0
5MICHAEL J CEMENOCHIEF INFORMATION OFFICER (i)

(ii)		 285,522
-------------
0 		43,878
-------------
0 		0
-------------
0 		5,325
-------------
0 		14,998
-------------
0 		349,723
-------------
0 		0
-------------
0
6MARK HOLTZCHIEF OPERATING OFFICER (i)

(ii)		 226,333
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		21,817
-------------
0 		248,150
-------------
0 		0
-------------
0
7JAMES MOYLANCHIEF FINANCIAL OFFICER (i)

(ii)		 254,476
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		254,476
-------------
0 		0
-------------
0
8EHSAN ANSARICAGW - CARDIOLOGIST (i)

(ii)		 885,601
-------------
0 		0
-------------
0 		0
-------------
0 		25,950
-------------
0 		16,530
-------------
0 		928,081
-------------
0 		0
-------------
0
9JOSEPH MORLEYCAGW - CARDIOLOGIST (i)

(ii)		 865,413
-------------
0 		0
-------------
0 		0
-------------
0 		25,950
-------------
0 		16,530
-------------
0 		907,893
-------------
0 		0
-------------
0
10KEVIN KETTCAGW - CARDIOLOGIST (i)

(ii)		 819,453
-------------
0 		0
-------------
0 		0
-------------
0 		25,950
-------------
0 		16,022
-------------
0 		861,425
-------------
0 		0
-------------
0
11STEPHEN WIDMANCAGW - CARDIOLOGIST (i)

(ii)		 790,777
-------------
0 		0
-------------
0 		0
-------------
0 		25,950
-------------
0 		17,699
-------------
0 		834,426
-------------
0 		0
-------------
0
12MARK RUGGIEROCAGW - CARDIOLOGIST (i)

(ii)		 786,684
-------------
0 		0
-------------
0 		0
-------------
0 		25,950
-------------
0 		16,022
-------------
0 		828,656
-------------
0 		0
-------------
0
13DIANE M WOOLLEYFORMER VP HUMAN RESOURCES (i)

(ii)		 105,728
-------------
0 		22,500
-------------
0 		0
-------------
0 		3,562
-------------
0 		17,106
-------------
0 		148,896
-------------
0 		0
-------------
0
14EDWARD ROMEROFORMER CHIEF FINANCIAL OFFICER (i)

(ii)		 98,061
-------------
0 		17,340
-------------
0 		0
-------------
0 		3,521
-------------
0 		18,604
-------------
0 		137,526
-------------
0 		0
-------------
0
Schedule J (Form 990) 2015

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 4B DARLENE STROMSTAD'S SERP CONTRIBUTION: $75,000
Schedule J (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
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
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?
Yes No
(1) NEIL PETERSEN MD TRUSTEE 75,000 STIPEND FOR SERVING AS CHIEF OF STAFF   No
(2) NEIL PETERSEN MD TRUSTEE 707,750 DR. NEIL PETERSEN IS AN EMPLOYEE OF WATERBURY ANESTHESIOLOGY ASSOCIATES, WHICH PROVIDED ANESTHESIA SERVICES FOR THE WATERBURY HOSPITAL.   No
(3) CARL B SHERTER MD TRUSTEE 568,078 DR. CARL B. SHERTER IS AN EMPLOYEE OF WATERBURY PULMONARY ASSOCIATES, WHICH PROVIDED PULMONARY SERVICES FOR THE WATERBURY HOSPITAL.   No
(4) HENRY BORKOWSKI MD TRUSTEE 138,880 RENT FOR CARDIOLOGY ASSOCIATES OF GREATER WATERBURY, LLC OFFICE SPACE   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2015


Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
Return Reference Explanation
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED): TOTAL COMMUNITY BENEFITS FOR FY 2016 BY CATEGORY: A. COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS BENEFIT: $5,830,171 PERSONS SERVED: 28,032 - COMMUNITY HEALTH EDUCATION - COMMUNITY-BASED CLINICAL SERVICES - HEALTH CARE SUPPORT SERVICES B. HEALTH PROFESSIONS EDUCATION BENEFIT: $7,323,386 PERSONS SERVED: 83 - PHYSICIANS/MEDICAL STUDENTS - NURSES/NURSING STUDENTS - OTHER HEALTH PROFESSIONS EDUCATION - SCHOLARSHIPS/FUNDING FOR PROFESSIONAL EDUCATION - OTHER D. RESEARCH BENEFIT: $726 PERSONS SERVED: 2 - CLINICAL RESEARCH - COMMUNITY HEALTH RESEARCH E. FINANCIAL AND IN-KIND CONTRIBUTIONS BENEFIT: $0 PERSONS SERVED: N/A - CASH DONATIONS - IN-KIND DONATIONS F. COMMUNITY BUILDING ACTIVITIES BENEFIT: $142,530 PERSONS SERVED: 247 - COMMUNITY SUPPORT - ENVIRONMENTAL IMPROVEMENTS - LEADERSHIP DEVELOPMENT/TRAINING COMMUNITY MEMBERS/ YOUTH PIPELINE - COALITION BUILDING - OTHER G. COMMUNITY BENEFIT OPERATIONS BENEFIT: $141,879 PERSONS SERVED: N/A - DEDICATED STAFF SUBTOTAL FOR COMMUNITY BENEFITS: $13,438,692 SUBTOTAL FOR PERSONS SERVED: 28,364 TRADITIONAL CHARITY CARE COSTS - FREE CARE: $950,442 - BAD DEBT: $761,283 - UNPAID MEDICAID COSTS: $9,514,951 (PERSONS SERVED: 45,013) - UNPAID MEDICARE COSTS: $3,716,027 (PERSONS SERVED: 62,701) SUBTOTAL FOR CHARITY CARE COSTS BENEFIT: $14,942,703 (PERSONS SERVED: 107,714) TOTAL BENEFIT - FY 2016: $28,381,395 (PERSONS SERVED: 136,078) CATEGORY A: COMMUNITY HEALTH IMPROVEMENT SERVICES TOTAL BENEFIT: $5,830,171 TOTAL PERSONS SERVED: 28,032 REALIZING THE DIVERSE NEEDS OF RESIDENTS IN OUR COMMUNITY, WATERBURY HOSPITAL (WH) REMAINS DEDICATED TO PROVIDING COMPREHENSIVE HEALTH SERVICES TO ENSURE EVERY INDIVIDUAL HAS ACCESS TO APPROPRIATE, QUALITY HEALTHCARE. DURING 2016, WATERBURY HOSPITAL'S SPECTRUM OF SERVICES CONTINUED TO HAVE A POSITIVE IMPACT ON THE WELFARE OF WATERBURY'S CITIZENS. TO REMAIN CONSISTENT WITH WATERBURY HOSPITAL'S MISSION, MANY OF OUR SERVICES ARE TARGETED FOR VULNERABLE MEMBERS OF OUR COMMUNITY, INCLUDING THOSE WHO ARE UNINSURED OR UNDERINSURED. WATERBURY HEALTH ACCESS PROGRAM (WHAP) - WATERBURY HOSPITAL IS AWARE OF THE ECONOMIC NEEDS MANY PATIENTS IN OUR COMMUNITY, AND, AS A RESULT, WE REMAIN COMMITTED TO THE WATERBURY HEALTH ACCESS PROGRAM. FOUNDED IN 2003 AS A PARTNERSHIP BETWEEN WATERBURY HOSPITAL, ST. MARY'S HOSPITAL, AND STAYWELL HEALTH CENTER (FQHC), WHAP IMPROVES ACCESS TO HIGH-QUALITY MEDICAL CARE BY PROVIDING COMPREHENSIVE CASE MANAGEMENT, PHARMACY ASSISTANCE, AND ACCESS TO PRIMARY AND SUB-SPECIALTY MEDICAL CARE FOR THE UNINSURED AND UNDERINSURED RESIDENTS OF THE GREATER WATERBURY REGION. WITH THE INSTITUTION OF THE ACA, WHAP WORKERS HAVE BECOME ACCESS HEALTH CT ASSISTERS, HAVE INCREASED THEIR NAVIGATION SERVICES TO INCLUDE THE MEDICAID POPULATION, AND CONTINUE TO ADD TO ITS REPERTOIRE ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH FOR THOSE WHO ARE IDENTIFIED AS HIGH UTILIZERS WITH CHRONIC HEALTH CONDITIONS. DURING FY 2016, WHAP HAD OVER 5,256 ACTIVE CLIENTS. ADDITIONALLY, WATERBURY HOSPITAL PROVIDED $176,384 WORTH OF DONATED SERVICES TO WHAP'S PATIENTS. BEHAVIORAL HEALTH - WATERBURY HOSPITAL'S CENTER FOR BEHAVIORAL HEALTH IS ONE OF THE REGION'S LARGEST SERVICE PROVIDERS OFFERING A FULL CONTINUUM OF CARE FOR CHILDREN, ADOLESCENTS AND ADULTS. OUR SERVICES ALSO OUTREACH TO THE COMMUNITY THROUGH REGULAR PARTICIPATION IN HEALTH FAIRS, ELECTED MEMBERSHIP IN THE NORTHWEST REGIONAL MENTAL HEALTH BOARD, AS A HOST SITE TO NUMEROUS TWELVE-STEP MEETINGS AND THE PROVISION OF CASE MANAGEMENT AS WELL AS ACUTE SERVICES TO THE HOMELESS WITHIN THE CITY OF WATERBURY. BEHAVIORAL HEALTH CLINICIANS CAN ENGAGE CLIENTS TO HELP FACILITATE THEIR ENTRANCE INTO TREATMENT. WE PROVIDE PHONE SUPPORT, REFERRALS AND TRIAGING TEN HOURS A DAY SEVEN DAYS A WEEK. WITHIN OUR CRISIS CENTER WE OFFER SHORT TERM SERVICES TO HELP INDIVIDUALS OBTAIN MORE PERMANENT TREATMENT THAT BEST MEETS THEIR NEEDS. AMBULATORY SERVICES INCLUDE PARTIAL HOSPITAL PROGRAMS, INTENSIVE OUTPATIENT SERVICES, GROUP, INDIVIDUAL THERAPY AND MEDICATION MANAGEMENT TO PATIENTS EXPERIENCING MENTAL ILLNESS AND/ OR A SUBSTANCE USE DISORDER. FOR INDIVIDUALS EXPERIENCING ACUTE SYMPTOMS WE OFFER INPATIENT TREATMENT TO ADOLESCENTS AGED 12 AND UP AS WELL AS ADULT SERVICES. OUR EFFORTS ARE AIMED AT PROMOTING THE BENEFITS OF CLINICAL TREATMENT AS WELL AS POSITIVE LIFESTYLE CHOICES. EVERY EFFORT IS MADE TO EDUCATE CLIENTS, THEIR FAMILIES AND THE COMMUNITY ABOUT MENTAL ILLNESS AND THE IMPACT TREATMENT CAN HAVE ON ONE'S ILLNESS. THE ULTIMATE GOAL IS TO HELP PEOPLE FEEL BETTER, REDUCE OR RESOLVE SYMPTOMS AND TO MINIMIZE THE STIGMA OF MENTAL ILLNESS. BE WELL BUS - IN ORDER TO ENSURE THAT PATIENTS HAVE ACCESS TO MEDICAL APPOINTMENTS, AT THE HOSPITAL AND AT LOCAL PHYSICIANS' OFFICES, WATERBURY HOSPITAL'S BE WELL BUS PROVIDES TRANSPORTATION SERVICES TO PATIENTS FROM WATERBURY AND ELEVEN OF ITS SURROUNDING TOWNS. WH HAS CONTRACTED WITH VPNE, A TRANSPORTATION COMPANY TO OFFER THE BUS SERVICE. COMMUNITIES SERVED INCLUDE: WATERBURY, WATERTOWN, THOMASTON, SOUTHBURY, MIDDLEBURY, NAUGATUCK, WOLCOTT, AND BEACON FALLS. HEART CENTER OF GREATER WATERBURY - FORMED IN COLLABORATION WITH SAINT MARY'S HOSPITAL, THE HEART CENTER OF GREATER WATERBURY PROVIDES DIVERSE MEDICAL SUPPORT INITIATIVES TO HELP EDUCATE RESIDENTS IN THE GREATER WATERBURY COMMUNITY ABOUT PERTINENT HEALTH AND WELLNESS ISSUES. THIS PAST YEAR, THE HEART CENTER CONDUCTED A SERIES OF HEALTH FAIRS AND VARIOUS HEALTH AND WELLNESS EDUCATION SESSIONS, INCLUDING "HEALTH SCREENINGS," WHICH PROVIDES PATIENTS WITH COMPLIMENTARY BLOOD PRESSURE SCREENINGS AND HEALTH AWARENESS EDUCATION. EVERGREEN 50 CLUB - THE EVERGREEN 50 CLUB HAS 9,200 MEMBERS OVER THE AGE OF 50. THE CLUB OFFERS FITNESS CLASSES INCLUDING WEIGHT TRAINING AND PILATES, WELLNESS CLASSES, AND HEALTH EDUCATION PRESENTATIONS ON A VARIETY OF TOPICS ARE PRESENTED BY HEALTHCARE PROFESSIONALS.
FORM 990, PART III, LINE 4A WATERBURY HOSPITAL INFECTIOUS DISEASE CLINIC (WHIC) - THE WHIC PROVIDES PATIENTS WITH ON-SITE PRIMARY AND SPECIALTY SERVICES, INDIVIDUALIZED MEDICATION ADHERENCE SERVICES, MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES, NUTRITION COUNSELING, INDIVIDUALIZED HIV EDUCATION, LABORATORY TESTING, AND RADIOLOGY SERVICES. WHIC'S PROVIDERS INCLUDE THREE BOARD-CERTIFIED/BOARD-ELIGIBLE INFECTIOUS DISEASE SPECIALISTS AS WELL AS AN ADVANCED PRACTITIONER NURSE AND A REGISTERED DIETICIAN, ALL WITH EXPERTISE IN THE MANAGEMENT OF PATIENTS WITH HIV/AIDS. IN FY 2016, WHIC SERVED AROUND 452 PEOPLE LIVING WITH HIV/AIDS (PLWHA).
FORM 990, PART III, LINE 4A CATEGORY B: HEALTH PROFESSIONS EDUCATION TOTAL BENEFIT: $7,323,386 TOTAL PERSONS SERVED: 83 SINCE IT FIRST AFFILIATED WITH THE YALE UNIVERSITY SCHOOL OF MEDICINE IN 1973, WATERBURY HOSPITAL HAS SERVED AS THE CLINICAL TRAINING SITE FOR THOUSANDS OF MEDICAL PROFESSIONALS IN TRAINING. DURING FY 2016, STUDENTS COMPLETED CLINICAL ROTATIONS, INTERNSHIPS, AND SHADOWING EXPERIENCES AT WATERBURY HOSPITAL. WATERBURY HOSPITAL INTERNAL MEDICINE RESIDENCY PROGRAM THE YALE-WATERBURY INTERNAL MEDICINE RESIDENCY PROGRAM, INITIATED THREE YEARS AGO, IS SPONSORED BY YALE-NEW HAVEN HOSPITAL AND AFFILIATED WITH YALE UNIVERSITY. ACTIVITIES INCLUDE PARTICIPATION IN RESEARCH DAYS AT YALE AND WATERBURY HOSPITAL/SAINT MARY'S HOSPITAL, HOME AND OFFICE VISITS FOR CLINIC PATIENTS AND EDUCATION SEMINARS HELD AT WATERBURY HOSPITAL AND YALE UNIVERSITY. WE CURRENTLY HAVE 41 RESIDENTS IN OUR PROGRAM. THE CHASE OUTPATIENT CENTER IS THE HUB OF OUTPATIENT SERVICES FOR OUR RESIDENTS. OTHER RESIDENCY PROGRAMS WATERBURY HOSPITAL ALSO HAS A SURGERY RESIDENCY PROGRAM. THE PROGRAM IS AFFILIATED WITH YALE UNIVERSITY, UNIVERSITY OF CONNECTICUT MEDICAL CENTER, AND QUINNIPIAC UNIVERSITY SCHOOL OF MEDICINE. THIS PROGRAM PROVIDES A FULL SPECTRUM OF SURGICAL EXPERIENCES FOR THE HOSPITAL'S RESIDENTS. GENERAL SURGERY AND MEDICINE TRAINING PROGRAMS INCLUDES ACCESS TO GENERAL SURGERY, ENT, UROLOGY, PLASTICS, GYN, NEUROSURGERY AND ORTHOPEDIC CASES. WATERBURY HOSPITAL HAS A PHARMACY RESIDENCY PROGRAM. TWO STUDENTS ARE ENROLLED IN THE PHARMACY RESIDENCY PROGRAM. WATERBURY HOSPITAL'S PGY-1 PROGRAM IS ACCREDITED BY THE AMERICAN SOCIETY OF HEALTH-SYSTEM PHARMACISTS (ASHP). TWO RESIDENT POSITIONS WILL BE AVAILABLE EACH YEAR. THE MISSION OF THE PHARMACY RESIDENCY PROGRAM IS TO BE CLINICALLY FOCUSED AND TO SHARE RESPONSIBILITY FOR THE OPTIMAL OUTCOME OF PATIENT DRUG THERAPIES. 1-YEAR OF CONCENTRATED TRAINING IN ALL ASPECTS OF PHARMACY PRACTICE IS PROVIDED IN ADDITION TO LEARNING ACTIVITY ROTATIONS THAT ACCOMMODATE THE RESIDENT'S PREVIOUS EXPERIENCES AND CURRENT GOALS. THIS PROGRAM SATISFIES THE ASHP PGY-1 REQUIRED OUTCOMES. ROTATIONS INCLUDED ARE: - PHARMACY OPERATIONS (FOUR WEEKS) - INTERNAL MEDICINE (EIGHT WEEKS) - CRITICAL CARE (EIGHT WEEKS) - EMERGENCY MEDICINE (SIX WEEKS) - PSYCHIATRY (FOUR WEEKS) - PHARMACY ADMINISTRATION (SIX WEEKS) - PAIN MANAGEMENT (FOUR WEEKS) - PHARMACY INFORMATICS (FOUR WEEKS) - AMBULATORY CARE (LONGITUDINAL) PHYSICIAN'S ASSISTANT (PA) STUDENTS - P.A. STUDENTS FROM QUINNIPIAC UNIVERSITY COMPLETED CLINICAL ROUNDS IN SEVERAL DEPARTMENTS AROUND THE HOSPITAL, INCLUDING THE OPERATING ROOM, EMERGENCY DEPARTMENT, BEHAVIORAL HEALTH, AND RADIOLOGY. THE EXPERIENCE IS DESIGNED FOR THE STUDENT TO LEARN TO APPLY THE KNOWLEDGE GAINED FROM DIDACTIC COURSE WORK IN MEDICINE, SURGERY, AND THE BASIC AND BEHAVIORAL SCIENCES INTO THE CLINICAL ARENA RESULTING IN THE ABILITY TO SUCCESSFULLY MANAGE PATIENTS IN A THOROUGH AND COMPREHENSIVE MANNER. THE PRIMARY GOAL OF CLINICAL ROTATIONS IS TO EXPOSE THE STUDENT TO PATIENTS OF ALL AGES, PATIENTS IN A VARIETY OF DIFFERENT SETTINGS, AND PATIENTS WITH A BROAD RANGE OF MEDICAL, SURGICAL, AND PSYCHOSOCIAL PROBLEMS. THE P.A. STUDENTS PARTICIPATE IN: - HISTORY TAKING - EXAMINING THE PATIENT - ASSISTING IN AND/OR PERFORMING DIAGNOSTIC TESTING - ASSISTING IN AND/OR PERFORMING THERAPEUTIC TASKS - ORAL PRESENTATIONS - MEDICAL DOCUMENTATION OF THE PATIENT ENCOUNTER - FORMULATING A DIFFERENTIAL DIAGNOSIS AND PROBLEM LIST - FORMULATING A TREATMENT PLAN - COUNSELING OF PATIENTS REGARDING MEDICATION, DIET, AND LIFESTYLE CHANGES SUCH AS SMOKING CESSATION, EXERCISE, AND WELL-BEING. RADIOLOGY STUDENTS FROM NVCC - THE NAUGATUCK VALLEY COMMUNITY COLLEGE (NVCC) RADIOLOGY STUDENTS ARE INVOLVED WITH MANY ACTIVITIES WHILE ASSIGNED TO WATERBURY HOSPITAL. UNDER THE SUPERVISION OF A NVCC CLINICAL INSTRUCTOR AND HOSPITAL RADIOLOGIC TECHNOLOGISTS, THE STUDENTS ARE ASSIGNED TO THE VARIOUS RADIOGRAPHIC SUITES AND MODALITIES. DURING THEIR ASSIGNMENT, STUDENTS ARE PERFORMING OR ASSISTING WITH RADIOGRAPHIC PROCEDURES, INCLUDING CHEST X-RAYS, SKELETAL EXAMS, FLUOROSCOPIC PROCEDURES, MOBILE X-RAYS IN THE VARIOUS PATIENT UNITS, AND SURGICAL CASES. THE STUDENTS ALSO INCREASE THE NUMBER OF INDIVIDUALS AVAILABLE IN THE DEPARTMENT TO ASSIST IN MOVING AND TRANSPORTING PATIENTS AS WELL AS CHAPERONING SENSITIVE EXAMS. IN ADDITION TO THE DIAGNOSTIC RADIOLOGY THE STUDENTS ARE ASSIGNED TO EXPERIENCES IN INTERVENTIONAL RADIOLOGY, CT, MRI, NUCLEAR MEDICINE, AND ULTRASOUND. WATERBURY HOSPITAL'S AFFILIATION WITH NVCC AS A CLINICAL SITE FOR STUDENTS HAS MANY BENEFITS. PERHAPS THE SINGLE MOST IMPORTANT BENEFIT IS THE HOSPITAL HAS A CONTINUOUS STREAM OF POTENTIAL RADIOLOGY EMPLOYEES. STUDENTS ARE IN THE PROGRAM FOR 22 MONTHS AND IN THAT TIME BECOME VERY FAMILIAR WITH THE HOSPITAL EQUIPMENT, ROUTINES, PERSONAL, AND MISSION. THIS PROVIDES WATERBURY HOSPITAL WITH NEW EMPLOYEES WHO HAVE A STRONG SKILL SET AND PROVEN DEDICATION TO THE HOSPITAL COMMUNITY.
FORM 990, PART III, LINE 4A CATEGORY D: RESEARCH TOTAL BENEFIT: $726 TOTAL PERSON SERVED: 2 DURING 2016, WATERBURY HOSPITAL PARTICIPATED IN SEVERAL CLINICAL TRIALS THAT BENEFITED RESIDENTS IN GREATER WATERBURY INCLUDING: THE FECAL TRANSPLANT STUDY, WHICH ENROLLS PATIENTS WITH RESISTANT CLOSTRIDIUM DIFFICILE COLITIS WHO HAVE HAD 2 OR MORE RELAPSES OF COLITIS IN SPITE OF ANTIBIOTIC THERAPY. CATEGORY F: COMMUNITY BUILDING ACTIVITIES TOTAL BENEFIT: $142,530 TOTAL PERSONS SERVED: 247 AS A LEADER IN THE DELIVERY OF HEALTHCARE SERVICES IN THE GREATER WATERBURY AREA, WATERBURY HOSPITAL (WH) IS COMMITTED TO STRENGTHENING THE WELFARE AND AWARENESS OF THE CITIZENS WITHIN ITS COMMUNITY. FROM STRENGTHENING THE CAREER PATHS OF WATERBURY AREA YOUTH; TO SUPPORTING THE UNINSURED AND UNDERINSURED THROUGH THE WATERBURY HEALTH ACCESS PROGRAM AND; PROVIDING TRANSPORT TO AND FROM MEDICAL APPOINTMENTS; WATERBURY HOSPITAL IS REMOVING THE BARRIERS TO QUALITY HEALTH CARE FOR ALL AND REMAINS FIRM IN ITS COMMITMENT TO A HEALTHIER, STRONGER, AND MORE PRODUCTIVE COMMUNITY. YOUTH PIPELINE INITIATIVES - THE WATERBURY HOSPITAL YOUTH PIPELINE INITIATIVES WERE ESTABLISHED IN 2001 AS A PARTNERSHIP BETWEEN WATERBURY HOSPITAL AND WATERBURY PUBLIC SCHOOLS. THE MISSION OF THE PROGRAM IS: "TO CLOSE THE ACHIEVEMENT GAP FOR MINORITY AND ECONOMICALLY DISADVANTAGED STUDENTS IN WATERBURY SO THEY CAN MATRICULATE AND COMPETE NATIONALLY FOR PLACEMENT IN POST-SECONDARY EDUCATION PROGRAMS IN PREPARATION FOR HEALTH CAREERS". WATERBURY HOSPITAL IS COMMITTED TO ENHANCING AND ENRICHING THE ACADEMIC OPPORTUNITIES AND PERSONAL JOURNEYS OF OUR YOUTH, WHO ARE THE EMERGING WORKFORCE OF TOMORROW. DURING 2016, WATERBURY HOSPITAL PROVIDED 52 STUDENTS AND PARENTS IN GREATER WATERBURY WITH UNIQUE EDUCATIONAL PROGRAMS THAT WILL ENHANCE THE OVERALL WELFARE OF OUR COMMUNITY. THE WH YOUTH PIPELINE INITIATIVES HAD FOUR FOCUS AREAS DURING FY 2016, INCLUDING: - PARENT LEADERSHIP TRAINING INSTITUTE (PLTI) - IN 2016, 11 INDIVIDUALS FROM GREATER WATERBURY SUCCESSFULLY COMPLETED WATERBURY'S PLTI, A 20-WEEK CURRICULUM TEACHING LEADERSHIP AND ADVOCACY SKILLS, AS WELL AS INDIVIDUAL COMMUNITY PROJECT PLANNING. PLTI'S CORE MISSION IS TO IMPART LEADERSHIP AND ADVOCACY SKILLS TO PARENTS WHILE SIMULTANEOUSLY EDUCATING THEM ABOUT VOLUNTEERISM, CIVIC LIFE, AND THE PROCESS BY WHICH STATE AND LOCAL GOVERNMENTS ENACT AND CHANGE LAWS. EACH PARTICIPANT COMPLETES AND IMPLEMENTS A COMMUNITY PROJECT. - CHILDREN LEADERSHIP TRAINING INSTITUTE (CLTI) - CLTI IS RUN IN CONNECTION WITH THE PLTI PROGRAM. 10 CHILDREN PARTICIPATED IN THE PROGRAM IN 2016. - UCONN PEOPLE EMPOWERING PEOPLE (PEP) - THE PROGRAM INCLUDED A 10-WEEK PARENT LEADERSHIP AND ADVOCACY REGIMEN THROUGH WHICH 9 PARTICIPANTS SUCCESSFULLY COMPLETED THE PEP COURSE. UCONN PEP IS A PERSONAL, FAMILY AND LEADERSHIP DEVELOPMENT PROGRAM WITH A STRONG COMMUNITY FOCUS. PEP IS DESIGNED TO BUILD ON THE UNIQUE STRENGTHS AND LIFE EXPERIENCES OF PARTICIPANTS AND EMPHASIZES THE CONNECTION BETWEEN INDIVIDUAL AND COMMUNITY ACTION. PARTICIPANTS WORK INDIVIDUALLY OR COLLABORATIVELY TO CREATE A COMMUNITY PROJECT WHICH IS COMPLETED AS PORTION OF THE PROGRAM. - WH SUMMER BRIDGE PROGRAM - DURING THE SUMMER OF 2016, TWENTY-TWO STUDENTS FROM WATERBURY, GRADES 6-11, PARTICIPATED IN THE WH SUMMER BRIDGE PROGRAM. 100% OF MEALS WERE SECURED FOR THE PROGRAM FROM CITY OF WATERBURY SUMMER FOOD PROGRAM. STUDENTS COMPLETED THE FOLLOWING MODULES: - 13.5 HOURS OF MATH (PRE- ALGEBRA, ALGEBRA II, ADVANCED MATH) REVIEW SESSIONS - 14 HOURS OF ENGLISH LANGUAGE ARTS AND SECOND ANNUAL WH GREAT DEBATE - 18 HOURS OF SAT VOCABULARY - 13.5 HOURS OF PROJECT CITIZEN (CIVICS COURSE) - 6.5 HOURS OF SAT VOCAB - 9 HOURS OF PRACTICAL MONEY SKILLS - 9 HOURS OF TEAM BUILDING - 13 HOURS OF POETRY INSTRUCTION AND PARTICIPATION IN THE ANNUAL WH POETRY SLAM - 6 HOURS SCIENCE MODULE AT STONE ACADEMY - 6 HOURS OF SOCIAL DETERMINANTS OF HEALTH DOCUMENTARIES AND ACTIVE DISCUSSIONS WITH THE WATERBURY HEALTH DEPT. - HEALTH & NUTRITION FAIR HOSTED BY THE STUDENTS INCLUDING PRESENTATIONS ON OBESITY - FIELDTRIPS INCLUDED: HAMMONASSET STATE PARK (EDUCATIONAL SESSION AT MEIGS POINT NATURE CENTER), THE HAROLD LEEVER CANCER CENTER, LYMAN ORCHARD, AND MYSTIC AQUARIUM.
FORM 990, PART III, LINE 4A SUPPORT GROUPS - DURING 2016, WATERBURY HOSPITAL HOSTED SEVERAL SUPPORT GROUPS FOR ITS PATIENTS AND THEIR FAMILIES, INCLUDING: - BEHAVIORAL HEALTH'S PARENT AND SIBLING SUPPORT GROUP, WHICH OFFERS EMOTIONAL ASSISTANCE TO FAMILIES WHO HAVE CHILDREN IN TREATMENT; AND - ALCOHOLICS ANONYMOUS, SERVES OVER 4,000 PEOPLE ANNUALLY, MEETS WEEKLY THROUGHOUT THE YEAR, AND IS COORDINATED BY OUR BEHAVIORAL HEALTH DEPARTMENT. CATEGORY G: COMMUNITY BENEFIT OPERATIONS TOTAL BENEFIT: $141,879 TOTAL PERSON SERVED: N/A THE GREATER WATERBURY HEALTH IMPROVEMENT PARTNERSHIP (GWHIP) - WATERBURY HOSPITAL IS ONE OF THE FOUNDERS OF GWHIP. THE PARTNERSHIP FOCUSES ON ADDRESSING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE IDENTIFIED FOUR PRIORITY AREAS FOR GREATER WATERBURY. WATERBURY HOSPITAL EMPLOYEES PARTICIPATE AND CONTRIBUTE IN THE STEERING COMMITTEE AND IN THE PRIORITY WORKGROUPS.
FORM 990, PART VI, SECTION A, LINE 3 WATERBURY HOSPITAL EMPLOYED JAMES MOYLAN (DBA JAMES MOYLAN CONSULTING) TO PERFORM THE DUTIES OF CHIEF FINANCIAL OFFICER FROM APRIL 1, 2015 UNTIL APRIL 30, 2016. IN CY 2015 HE WAS PAID $254,476 BY THE HOSPITAL; $245,431 WAS FOR HIS DUTIES AS CFO AND $9,045 WAS FOR CONSULTING WORK. IN FY 2016, MR. MOYLAN WAS PAID A TOTAL OF $318,628 BY THE HOSPITAL; $223,865 WAS FOR HIS DUTIES AS INTERIM CFO. $94,763 WAS FOR CONSULTING WORK RELATED TO THE TRANSACTION WITH PROSPECT MEDICAL HOLDINGS.
FORM 990, PART VI, SECTION A, LINE 6 GREATER WATERBURY HEALTH NETWORK, INC. IS SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A GREATER WATERBURY HEALTH NETWORK, INC. ELECTS HOSPITAL BOARD.
FORM 990, PART VI, SECTION A, LINE 7B GREATER WATERBURY HEALTH NETWORK, INC. HAS RESERVED POWERS FOR HOSPITAL TRANSACTIONS.
FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED AND APPROVED BY THE ORGANIZATION'S AUDIT COMMITTEE. A COPY OF THE FORM 990 IS THEN MADE AVAILABLE TO EACH BOARD MEMBER BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL COMPLIANCE OFFICER REVIEWS ANNUALLY THE SUBMISSION OF POTENTIAL/ACTUAL CONFLICT DECLARATIONS. THEY ARE ALSO REVIEWED ANNUALLY AT THE BOARD'S COMPLIANCE AND ETHICS COMMITTEE MEETING AND RECOMMENDATIONS FOR ACTION ARE MADE TO THE FULL BOARD AS NECESSARY. ADDITIONALLY, RESPONSES ARE PROFILED, BY MEMBER, FOR EACH COMMITTEE OF THE BOARD/NETWORK, AND DISTRIBUTED AT EACH COMMITTEE MEETING AS A WAY TO PROMOTE TRANSPARENCY. THE COMMITTEE CHAIR AND MEMBERS SHARE RESPONSIBILITY IN IDENTIFYING AND MANAGING THESE DECLARED CONFLICTS OF INTEREST WHEN MAKING BUSINESS DECISIONS ON BEHALF OF THE HOSPITAL.
FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION IS UNDER THE PURVIEW OF THE BOARD OF TRUSTEES. THERE IS A COMPENSATION COMMITTEE AND THEY ALWAYS USE THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTANT WHO USES NATIONAL, STATE AND REGIONAL COMPENSATION SURVEY DATA FOR SIMILAR TAX EXEMPT COMMUNITY HOSPITALS.
FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL RESULTS ARE MADE AVAILABLE IN THE ANNUAL REPORT TO THE COMMUNITY. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 84,059. MANAGEMENT AND GENERAL EXPENSES 2,489,554. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,573,613. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 23,380,978. MANAGEMENT AND GENERAL EXPENSES 10,635,083. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,016,061. PROFESSIONAL MEDICAL FEES: PROGRAM SERVICE EXPENSES 9,133,841. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,133,841.
FORM 990, PART XI, LINE 9: INCREASE IN FAIR VALUE OF FUNDS HELD IN TRUST BY OTHERS 1,931,165. ALLIANCE SUBSIDY -9,766,889. PENSION LIABILITY ADJUSTMENTS -2,511,843. INTEREST RATE SWAP ADJUSTMENT 129,544. INCOME FROM WATERBURY GASTROENTEROLGY -29,492.
FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE AND THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE AUDIT COMMITTEE MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS IN REGARD TO THE SELECTION OF AN INDEPENDENT AUDITOR.
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


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach 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 WATERBURY HOSPITAL
 
Employer identification number

06-0665979
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
(1) CARDIOLOGY ASSOCIATES OF GREATER WATERBURY LLC
455 CHASE PARKWAY
WATERBURY,CT06708
27-3828899 		CARDIOLOGY PRACTICE CT -6,385,952 993,545 THE WATERBURY HOSPITAL
 










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?
Yes No
(1)GREATER WATERBURY HEALTH NETWORK INC
64 ROBBINS STREET

WATERBURY,CT06721
22-2572044 		HEALTH CARE MANAGEMENT CT 501(C)(3) 11 TYPE 1 N/A
 
No
(2)GREATER WATERBURY HEALTH SERVICES INC
64 ROBBINS STREET

WATERBURY,CT06708
22-2572042 		HEALTH SERVICES CT 501(C)(3) 9 GREATER WATERBURY HEALTH NETWORK INC
 
 
No
(3)ALLIANCE MEDICAL GROUP INC
1625 STRAITS TURNPIKE SUITE 211

MIDDLEBURY,CT06762
26-3520540 		HEALTH SERVICES CT 501(C)(3) 9 THE WATERBURY HOSPITAL
 
Yes
 








For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
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
Yes No Yes No
(1) ACCESS REHAB CENTERS LLC

22 TOMPKINS STREET
WATERBURY,CT06708
06-1527429 		THERAPY SERVICES CT THE WATERBURY HOSPITAL
  		RELATED 706,835 2,644,212   No     No 65.000 %
(2) GREATER WATERBURY IMAGING CENTER LLP

64 ROBBINS STREET
WATERBURY,CT06721
06-1242903 		IMAGING SERVICES CT THE WATERBURY HOSPITAL
  		RELATED 570,804 1,659,409   No     No 63.640 %
(3) IMAGING PARTNERS LLC

134 GRANDVIEW AVENUE
WATERBURY,CT06708
06-1617047 		IMAGING SERVICES CT THE WATERBURY HOSPITAL
  		RELATED 154,004 365,974   No     No 85.000 %
(4) WATERBURY GASTROENTEROLOGY CO-MANAGEMENT COMPANY LLC

64 ROBBINS STREET
WATERBURY,CT06721
27-2417014 		MEDICAL SERVICES CT THE WATERBURY HOSPITAL
  		RELATED 29,492 228,059   No     No 45.450 %
(5) MATTATUCK MEDICAL ASSOCIATES LLP

134 GRANDVIEW AVENUE
WATERBURY,CT06708
06-0906129 		MEDICAL SERVICES CT  
RELATED 5,566 -133,741   No     No 10.490 %
(6) WATERBURY MEDICAL ASSOCIATES LLP

140 GRANDVIEW AVENUE SUITE 208
WATERBURY,CT06708
06-0995734 		MEDICAL SERVICES CT  
RELATED 13,961 -21,068   No     No 16.120 %


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












Schedule R (Form 990) 2015
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
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) ACCESS REHAB CENTERS LLC

 J 70,355  
(2) ACCESS REHAB CENTERS LLC

 M 1,266,581  
(3) ALLIANCE MEDICAL GROUP

 K 17,048  
(4) GREATER WATERBURY IMAGING CENTER LLP

 A 105,628  
(5) GREATER WATERBURY IMAGING CENTER LLP

 M 1,086,450  
(6) ALLIANCE MEDICAL GROUP

 R 9,766,889  
Schedule R (Form 990) 2015
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2015
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
Schedule R (Form 990) 2015

Additional Data


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