TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Mary Barry MD...................................................................... Director	2.00 .................	X			31,440	32,628	2,641
(2) Henry Beck...................................................................... Director	2.00 .................	X			0	0	0
(3) Carmen Cid PhD...................................................................... Director	2.00 .................	X			0	0	0
(4) Carolyn Drescher Thru 218...................................................................... Director	2.00 .................	X			0	0	0
(5) Stephen Larcen PhD...................................................................... Director	2.00 .................	X			0	5,976	0
(6) Steve Lee MD Thru 1217...................................................................... Director	2.00 .................	X			0	0	0
(7) Lynne Quintal-Hill...................................................................... Director	2.00 .................	X			0	0	0
(8) Mark Tramontozzi MD...................................................................... Director	2.00 .................	X			0	67,297	0
(9) James Watson MD...................................................................... Director	2.00 .................	X			0	0	0
(10) Paul Weigle...................................................................... Director	2.00 ................. 60.00	X			0	262,026	60,022
(11) Donna Handley...................................................................... Director and President	2.00 ................. 60.00	X	X		0	399,296	62,413
(12) Diane Wishnafski...................................................................... Chair	3.00 .................	X	X		0	0	0
(13) Deborah Monahan...................................................................... Vice Chair	3.00 .................	X	X		0	0	0
(14) Margaret Marchak...................................................................... Secretary	2.00 ................. 60.00		X		0	691,694	136,350
(15) Anthony Mastroianni...................................................................... VP, Finance	30.00 ................. 30.00		X		0	275,534	57,868
(16) Robert Sidman MD...................................................................... VP, Medical Affairs	30.00 ................. 30.00			X	0	509,023	65,126
(17) Lester Temkin...................................................................... VP, Operations	30.00 ................. 30.00			X	0	316,741	53,744

(A) Name and business address	(B) Description of services	(C) Compensation
Anesthesia Associates of Willimantic PC 1185 Main Street Willimantic,CT06226	Medical Services	967,159
Origin Incorporated 1800 SW 1St Suite 510 Portland,OR97201	Staffing Services	596,183
Morrison Management Specialist 400 Northridge Road Sandy Springs,GA30350	Food Services	595,772
Medpartners Locum Tenens Inc PO Box 405547 Atlanta,GA30384	Staffing Service	530,975
Connecticut Children's Specialty Group 282 Washington Street Hartford,CT06106	Medical Services	476,423
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 26

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Windham Community Memorial Hospital

Employer identification number

06-0646966

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 12, check only one box.)

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

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

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

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

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

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

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

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

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

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

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

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

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

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

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

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

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

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

Windham Community Memorial Hospital

Employer identification number

06-0646966

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization Windham Community Memorial Hospital

Part I Contributors	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
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization Windham Community Memorial Hospital		Employer identification number 06-0646966

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization Windham Community Memorial Hospital			Employer identification number 06-0646966
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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

Windham Community Memorial Hospital

Employer identification number

06-0646966

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

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

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

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

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

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

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

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

Yes

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

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

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

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

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

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

Yes

19,140

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

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

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

19,140

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	Windham Community Memorial Hospital paid annual dues to Connecticut Hospital Association (CHA). CHA conducts lobbying activities on behalf of its members. CHA allocates a portion of their dues as lobbying expenses. The portion of dues allocated as lobbying expenses is calculated under current Medicare rules. CHA conducts lobbying activities under current Medicare rules. In addition,the Organization occasionally asks its employees to volunteer their time to contact state legislators in an effort to lobby on its behalf. The total amount of all dues allocated for lobbying expenses for FY18 was $19,140.

Return Reference

Explanation

Part II-B, Line 1:

Windham Community Memorial Hospital paid annual dues to Connecticut Hospital Association (CHA). CHA conducts lobbying activities on behalf of its members. CHA allocates a portion of their dues as lobbying expenses. The portion of dues allocated as lobbying expenses is calculated under current Medicare rules. CHA conducts lobbying activities under current Medicare rules. In addition,the Organization occasionally asks its employees to volunteer their time to contact state legislators in an effort to lobby on its behalf. The total amount of all dues allocated for lobbying expenses for FY18 was $19,140.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Windham Community Memorial Hospital

Employer identification number

06-0646966

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

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

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

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

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

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

1a	Beginning of year balance ....	2,608,147	2,256,147	2,088,147	2,134,823	1,964,242
b	Contributions ...
c	Net investment earnings, gains, and losses	187,000	352,000	168,000	-37,021	183,301
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...				9,655	12,720
f	Administrative expenses ....
g	End of year balance ......	2,795,147	2,608,147	2,256,147	2,088,147	2,134,823

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

45.000 %

Term endowment SchDMd Bullet

55.000 %

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

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

Yes

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 .....	6,246,331		6,246,331
b	Buildings ....	59,363,498	38,012,566	21,350,932
c	Leasehold improvements	1,283,435	860,259	423,176
d	Equipment ....	59,929,890	52,673,397	7,256,493
e	Other .....	2,343,663		2,343,663
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				37,620,595

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) Assets Held In Trust	5,089,620	C
(B) Invest. Endowment - TEMP	1,493,206	C
(C) Invest. Endowment - PERM	1,197,544	C
(D) Investment in Others JV	215,205	C
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	7,995,575

Part VIII

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

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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)LT Malpractice Claims				2,524,356
(2)Inter-Company Allocation Bond				1,528,855
(3)SERP Assets				51,934
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				4,105,145

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
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	78,102,855
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) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Part V, Line 4:

The Hospital has adopted investment and spending policies for Endowment assets that attempt to provide a predictable stream of funding to mission related programs such as those described in Part III, lines 4a-d while seeking to maintain purchasing power of the endowment assets. Endowment assets include those assets of donor-restricted funds that the Hospital must hold in perpetuity or for a donor-specific period(s). Under this policy, as approved by the Board of Directors, the Endowment assets are invested in a manner that is intended to produce a real return, net of inflation and investment management costs, of a least 4% over the long term. Actual returns in any given year may vary from this amount. The Hospital's Endowment consists of hundreds of individual funds established for a variety of purposes. Net assets associated with Endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions. The income generated by the funds are used mainly for capital expenses.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Windham Community Memorial Hospital

Employer identification number

06-0646966

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

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

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 25000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

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

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	1,388,561		1,388,561	1.440 %
b	Medicaid (from Worksheet 3, column a) . . . . .	18,700,220	16,808,056	1,892,164	1.960 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	20,088,781	16,808,056	3,280,725	3.400 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	43,015	1,290	41,725	0.040 %
f	Health professions education (from Worksheet 5) . . .	57,410	0	57,410	0.060 %
g	Subsidized health services (from Worksheet 6) . . . .	668,716	173,242	495,474	0.510 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	3,502	0	3,502	0 %
j	Total. Other Benefits . .	772,643	174,532	598,111	0.610 %
k	Total. Add lines 7d and 7j .	20,861,424	16,982,588	3,878,836	4.010 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

1,693,000

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. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

17,463,272

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

23,177,166

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

-5,713,894

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(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) 2019

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Windham Community Memorial Hospital 112 Mansfield Avenue Willimantic,CT06226 www.wcmh.org 0061	X	X	X

Schedule H (Form 990) 2019

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)

	Windham Community Memorial Hospital
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 17

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

Yes

6 a

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

Yes

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

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

Yes

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

Hospital facility’s website (list url): See Part V, Page 8

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

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

Yes

If "Yes" (list url): See Part V, Page 8

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

10b

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

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

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

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Windham Community Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

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

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

See Part V, Page 8

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

See Part V, Page 8

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Page 8

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

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

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

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Windham Community Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	Windham Community Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
Windham Community Memorial Hospital	Part V, Section B, Line 5: To solicit input from key informants and individuals who have broad interest in the health of the community, the Hospital performed surveys, community forums, focus groups and interviews with key informants. The key informants were selected by community leader(s) or liaison(s). Additionally, focus groups were used to identify any other resource. Focus group was conducted on February 14, 2018. Community forums, and individual key informant interviews were conducted between February and May 2018.Key informants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the overall community. They were asked to rate the degrees to which various health issues were of concern in the Eastern Region. Follow up questions were asked to describe why they identified areas as such, and how these might be better addressed. The key informants included Physicians, public health representatives, health professionals, social service providers and a variety of other community leaders including the following:Center for Healthy AgingConnecticut Legal ServicesEastern Connecticut Health Insurance Program (ECHIP)Eastern Connecticut Workforce BoardEastern Highlands Health DistrictGenerationsMansfield Youth ServicesNCDHDNortheast District Department of HealthSt. Joseph's LivingTown of MansfieldUConn Student Health ServicesUnited Services, Inc.Willimantic DCF officeWillimantic Fire DepartmentWillimantic PoliceWindham HospitalWindham Public SchoolsWindham Region Transit District The 2018 CHNA took a close look at social determinants of health such as poverty, housing, transportation, education, fresh food availability, and neighborhood safety. Social determinants of health have become a national priority for identifying and addressing health disparities, and Windham Hospital is committed to addressing these disparities through the Community Health Improvement Plan that will follow this Assessment. Through this process, input was gathered from individuals whose organizations can provide information for the following data elements: * Medically Underserved Areas* Health Professional Shortage Areas* Demographics* Ethnicity Distributions* Median Household Incomes* Homeownership Rates* Poverty Metrics* Unemployment Rates* Educational Metrics* Children in Poverty and Single Parent Households* Linguistically Isolated Populations* Uninsured Population Estimates* Clinical Provider Ratios* Physical Environment Metrics* Crime Rates* General Health Status Indicators* Cancer Prevalence and Screening Indicators* Cardiovascular Disease* Respiratory Disease* Diabetes* Infectious Diseases* Sexually Transmitted Diseases* Births and Prenatal Care* Health Behaviors* Benchmark Metrics (HealthyPeople 2020)
Windham Community Memorial Hospital	Part V, Section B, Line 6a: Natchaug Hospital.Part V, Section B, Line 7a:https://windhamhospital.org/about-us/community-health-needs-assessment
Windham Community Memorial Hospital	Part V, Section B, Line 7d: The needs assessment was published in June 2018 and is available on the Hospital's website. In addition, electronic copies are available upon request.Part V, Section B, Line 10:https://windhamhospital.org/about-us/community-health-needs-assessment
Windham Community Memorial Hospital	Part V, Section B, Line 11: In acknowledging the wide range of priority health issues that emerged from the 2018 CHNA process, the community representatives met on May 16, 2018 to determine the health needs that will be prioritized for action. The review of the identified needs were followed by a wide ranging discussion, after which the representatives were asked to rank each of the needs.Based on data analysis, surveys, focus groups, and interviews performed, the top community health needs and priorities for the Windham Hospital focus area are listed below:Transportation:Transportation was identified as a top social determinant issue in Windham service area. Community members can't get to appointments, including specialists that are far away.* Local transit municipal grant funding is inadequate and requires capping services* No Medicaid funds available* Dial A Ride has a 30 mile radius* Med Cab can't bring kids with them, which is a big issue for many families * EMS fills the gaps and is over stressed with transportation issuesAccess to Care:* Leads to overuse of the ED* Need for bilingual health counselors in community organizations* Need for more smoking cessation programs and awareness* Access to dental care, many have to leave the area* Need for community educational events as part of preventive care* Lack of women's health services and postpartum servicesSubstance Abuse:* Improvements have been made in the last few years* Willimantic continues to be challenged with the stigma of heroin availability and use* The number of drug exposed infants is very high in the areaMental Health:* Undocumented citizens not seeking or accepting care for fear of losing other services* The stigma of mental health difficult to overcome* School based healthcare is the only place that black and Latino males seek behavioral health assistance* Availability of services for children* Home behavioral health services can be 6 - 8 weeks on the waiting list* Need for more providers and more screening servicesAccess to Healthy Food:* High density and proportionality of fast food in the area* Schools have high BMI, poor nutrition, and need for more education and dedicated community dietician* The high cost of healthy food and need for more voucher programs and increasing focus on food donationIn the region, geographically Windham and Killingly/Plainfield scored significantly worse in physical and mental health indicators. In addition, Windham, Killingly/Plainfield, and Brooklyn/Hampton/Canterbury all had higher than state average rates in the following chronic conditions: asthma, arthritis, and diabetes.Lack of coordination among and between providers and community based organizations limits the overall effectiveness of the programs and the funding that is going to help serve the populations most in need. The results were then grouped into 3 Areas of Concern that were addressed in Community Health Improvement Plan (CHIP):1. Enhance Coordination of Services. This category includes Access to Care and Transportation. CHIP addressed this need in the following manner:a.Evaluate and use information exchange portal resources, linking healthcare providers with community based organizationsb. Improve IT resources to enable community focus and better measurement of outcomesc. Develop a playbook for infrastructure, dashboard of health, governance, and community workflowsd. Enable dynamic and up-to-date asset mappinge. Develop innovation network for learning, research, co-creation, and rapid knowledge dissemination (bi-directional communication platform)f. Implement new or increased use of Community Health Workers (CHW)g. Evaluate and use adaptive technology (e.g., geo-fencing, GIS mapping, artificial intelligence, biometric risk assessment, Epic tie-ins)2. Promote Healthy Behaviors and Lifestyle. This category includes Access to Healthy Food and Poor Physical and Mental Health. CHIP addresses this need in the following manner:a. Screen for healthy food need identification in community population and provide assessment at points of care b. Enhance Promotion and Marketing, including adopting 5-2-1-0 initiative, at schools, workplaces, public spaces, faith communities, and healthcare events c. Provide voucher/prescription programs for fruits and vegetablesd. Promote and improve healthy food donation e. Further partnerships with food pantries/banks and food providers and suppliersf. Create more access points for healthy foodsg. Develop urban gardens, community gardens, hospital campus gardens, farmer's markets (fresh food)h. Evaluate and use mobile food programsi. Create and support food policy councils3. Improve community Behavioral Health. This category includes Mental Health and Substance Abuse. CHIP addresses this need in the following manner: a. Embed behavioral health services in primary care (ongoing)b. Recruit more mental health providers, with focus on community outpatient services (e.g., family therapists)c. Implement Recovery Coach program in EDd. Provide more depression screeninge. Further Mental Health First Aid training and grow community behavioral health training at the local levelf. Enhance services in virtual mental health, including tele-psychiatry
Windham Community Memorial Hospital	Part V, Section B, Line 13h: Family eligibility criteria for Financial Assistance also include family size, employment status, financial obligations, and amount and frequency of health care expenses.
Windham Community Memorial Hospital	Part V, Section B, Line 15e: In addition, patients may ask a nurse, physician, chaplain, or staff member from Patient Registration, Patient Financial Services, Case Coordination, or Social Services about initiating the Financial Assistance Application process.Part V, Line 16a, FAP website:https://windhamhospital.org/patients-visitors/for-patients/financial-assistancePart V, Line 16b, FAP Application website:https://windhamhospital.org/patients-visitors/for-patients/financial-assistancePart V, Line 16c, FAP Plain Language Summary website:https://windhamhospital.org/patients-visitors/for-patients/financial-assistance
Windham Community Memorial Hospital	Part V, Section B, Line 16j: Patients are informed directly by staff of the availability of the Financial Assistance Policy.

Schedule H (Form 990) 2019

Page 9

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 - Windham Middle School Health Center 123 Quarry Street Willimantic,CT06226	In-Depth Health and Mental Health Assessment
2	2 - Windham High School Wellness Center 355 High Street Willimantic,CT06226	In-Depth Health and Mental Health Assessment
3	3 - Charles H Barrows STEM Academy 141 Tuckie Road North Windham,CT06256	School Based Health Center
4	4 - Windham Hospital Family Health Center 5 Founders Avenue Suite 201 Willimantic,CT06226	Patient Rehabilitation
5	5 - WCMH Medical Offices 1776 Boston Turnpike Coventry,CT06238	Medical Offices
6	6 - The Center for Women's Health 7 Ledgebrook Drive Mansfield,CT06250	Women's Health Services
7	7 - Storrs Physical Therapy Clinic 1244 Storrs Road Mansfield,CT06250	Patient Rehabilitation
8
9
10

Schedule H (Form 990) 2019

Page 10

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:	The Organization uses Federal Poverty Guidelines (FPG) to determine eligibility. In addition to the FPG, the Hospital also utilizes other eligibility criteria, such as asset level, medical indigence and insurance status. Part I, Line 6a:The Organization submits quarterly reports to Connecticut Hospital Association and Form 990 is submitted to the Connecticut Office of Health Strategy (OHS) annually.
Part I, Line 7:	The Organization utilized an overall cost to charge ratio, (RCC), developed from the Medicare Cost Report. Total expense was adjusted for: medicaid provider taxes, directly identified community benefit expense and community building expenses. This cost to charge ratio was used to calculate costs for Part I lines 7a, b & g. The costs associated with the activities reported on Part I, Line 7e were captured using actual time multiplied by an average salary rate. The costs associated with Line 7h, were the actual costs reported in the organization's general ledger less any industry funded studies. These costs were removed from the calculations above to avoid duplication. Costs reported in Part III, Section B6, were calculated from the Medicare cost report and reduced for Medicare costs previously reported on Part I Lines 7f and g.
Part I, Line 7g:	No physician clinic costs were included in the Subsidized Health Services cost calculations.
Part III, Line 3:	A pre-bad debt financial assistance screening was put in place to identify patients that may be eligible for financial assistance. Pre-bad debt accounts that are identified as meeting the requirements are adjusted as charity care prior to being sent to bad debt. Therefore, any bad debt expense that could have been attributable to charity care at the end of FY18 would be immaterial.
Part III, Line 4:	Please see the text of the footnote that describes bad debt expense beginning on page 26 of the Audited Financial Statement.
Part III, Line 8:	Cost Reports were used to report Medicare allowable costs. Medicare defines allowable costs as those appropriate and helpful in developing and maintaining the operation of patient care facilities and activities. It specifically excludes certain costs that are not directly related to patient care. The hospital incurs additional expense related to the provision of care to Medicare patients that Medicare has deemed non-allowable. This additional expense includes costs of physician services (emergency on-call fees, Hospitalist Programs, recruitment, etc.), advertising costs, cafeteria costs for meals sold to visitors, etc. The Hospital attempts to collect coinsurance and deductibles from Medicare beneficiaries. To the extent collection efforts are unsuccessful, Medicare reimburses the hospital at 65% of unpaid amounts. The table reconciles the shortfall or surplus from Line 7 to the actual surplus or shortfall. The additional costs were allocated to Medicare based upon Medicare's percentage of total allowable costs. The unpaid coinsurance/deductibles were estimated using historical collection results. Any shortfall amounts have not been treated as Community Benefits.
Part III, Line 9b:	Windham Community Memorial Hospital has adopted the Financial Assistance Policy of it's parent company Hartford HealthCare Corporation. The Financial Assistance Policy states: In the event a patient fails to qualify for Financial Assistance or fails to pay their portion of discounted charges pursuant to this policy, and the patient does not pay timely their obligations to Windham Community Memorial Hospital, the Hospital reserves the right to begin collection actions, including but not limited to, imposing wage garnishments or liens on primary residences, instituting legal action and reporting the matter to one or more credit rating agencies. For those patients that qualify for Financial Assistance and who are cooperating in good faith to resolve the Hospital's outstanding accounts, the Hospital may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to outside collection agencies and will cease all collection efforts.No Extraordinary Collection Actions (ECA) will be initiated during the first 120 days following the first post discharge billing statement to a valid address or during the time that patient's Financial Assistance Application is processing. Before initiating any ECA, a notice will be provided to the patient 30 days prior to initiating such event.If the patient applies for assistance within 240 days from the first notification of the self pay balance, and is granted assistance, any ECA's such as negative reporting to a credit bureau or liens that have been filed will be removed.
Part VI, Line 2:	A variety of methods are used to assess needs for programs that we offer to the community. Informal methods to assess needs include feedback from Advisory Councils and support groups. We coordinate closely with the federally qualified health center in Willimantic, which serves the healthcare needs of low income residents, as well as numerous other organizations including the public schools, other non profit organizations, senior centers, and government agencies in our region. Secondary data from other organizations is also utilized to take advantage of other resources such as the United Way, Eastern Highlands Health District, Visiting Nurses, and partner organizations.
Part VI, Line 3:	Windham Community Memorial Hospital provides information about its Financial Assistance Policy as follows: (i) provide signs regarding this Policy and written plain language summary information describing the Policy along with Financial Assistance contact information in the Emergency Department, Labor and Delivery areas and other patient registration areas; (ii) provide to each patient written plain language summary information describing the Policy along with Financial Assistance contact information in admission, patient registration, discharge, billing and collection written communications; (iii) make paper copies of the Policy, financial assistance application, and plain language summary of the Policy available upon request and without charge, both by mail and in public locations in the hospital facility, including the emergency room (if any) and admissions areas; (iv) post the Policy, plain language summary and financial assistance application on the website with clear linkage to such documents on the Windham Community Memorial Hospital's home page; (v) educate all admission and registration personnel regarding the Policy so that they can serve as an informational resource to patients regarding the Policy; and (vi) include the tag line "Please ask about our Financial Assistance Policy" in Windham Community Memorial Hospital's written publications.
Part VI, Line 4:	Windham Community Memorial Hospital services Eastern Connecticut. The total population is 152,842. 73.7% of the population is White with 5.5% Black. People of Hispanic origin make up 12.8% and 7.9% are identified as other. Children age 0-17 make up 18.6%, 18-64 make up 66.8% and seniors account for 14.6% of the population. The population living in poverty is 11.2%. Windham County has an 8.4% unemployment rate. 9.6% do not have a high school diploma and 16.9% do have a Bachelor's Degree.The region is a federally designated as medically underserved area.
Part VI, Line 5:	Windham Community Memorial Hospital was formed to serve its community in 1933 and has been an important resource for nearly 85 years. A regional board governs Windham, Backus, and Natchaug Hospitals. The Board is responsible for maintaining outstanding quality services and credentials its medical staff. All of the Directors reside in our service area and are neither employees, family members, nor contractors of the Hospital. The Windham Hospital Foundation, a related organization, raises funds to assure that the latest advancements in technology are available to our patients, as well as a range of community benefit programs that are not funded by other sources. We are a true community resource as we offer space for other community groups to meet at no charge, bring together other health providers for health fairs and educational sessions for the community, and encourage the involvement of our staff on various boards and councils that promote the overall health of the community.
Part VI, Line 6:	Hartford Healthcare Corporation (HHC) is organized as a support organization to govern, manage and provide support services to its affiliates. HHC, through its affiliates including Windham Community Memorial Hospital, strives to improve health using the "Triple Aim" model: improving quality and experience of care; improving health of the population (population health) and reducing costs. HHC and its affiliates including all supported organizations, develop and implement programs to improve the future of health care in our Southern New England region. This includes initiatives to improve the quality and accessibility of health care; create efficiency on both our internal operations and the utilization of health care; and provide patients with the most technically advanced and compassionate coordinated care. In addition, HHC continues to take important steps toward achieving its vision of being "nationally respected for excellence in patient care and most trusted for personalized, coordinated care. The affiliation with HHC creates a strong, integrated health care delivery system with a full continuum of care across a broader geographic area. This allows small communities easy and expedient access to the more extensive and specialized services the larger hospitals are able to offer. This includes continuing education of health care professionals at all the affiliated institutions through the Center of Education, Simulation and Innovation located at Hartford Hospital.The affiliation further enhances the affiliates' abilities to support their missions, identity, and respective community roles. This is achieved through integrated planning and communication to meet the changing needs of the region. This includes responsible decision making and appropriate sharing of services, resources and technologies, as well as cost containment strategies.
Part VI, Line 7, Reports Filed With States	CT

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Windham Community Memorial Hospital

Employer identification number

06-0646966

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Paul Weigle Director	(i) (ii)	0 ------------- 257,561	0 ------------- 4,225	0 ------------- 240	0 ------------- 18,900	0 ------------- 41,122	0 ------------- 322,048	0 ------------- 0
2Donna Handley Director and President	(i) (ii)	0 ------------- 307,528	0 ------------- 70,001	0 ------------- 21,767	0 ------------- 18,900	0 ------------- 43,513	0 ------------- 461,709	0 ------------- 0
3Margaret Marchak Secretary	(i) (ii)	0 ------------- 516,132	0 ------------- 151,455	0 ------------- 24,107	0 ------------- 81,414	0 ------------- 54,936	0 ------------- 828,044	0 ------------- 0
4Anthony Mastroianni VP, Finance	(i) (ii)	0 ------------- 220,365	0 ------------- 54,090	0 ------------- 1,079	0 ------------- 18,900	0 ------------- 38,968	0 ------------- 333,402	0 ------------- 0
5Robert Sidman MD VP, Medical Affairs	(i) (ii)	0 ------------- 410,139	0 ------------- 96,839	0 ------------- 2,045	0 ------------- 18,900	0 ------------- 46,226	0 ------------- 574,149	0 ------------- 0
6Lester Temkin VP, Operations	(i) (ii)	0 ------------- 250,186	0 ------------- 61,223	0 ------------- 5,332	0 ------------- 18,900	0 ------------- 34,844	0 ------------- 370,485	0 ------------- 0
7Kismatkumar Detroja MD Physician	(i) (ii)	294,588 ------------- 0	27,925 ------------- 0	12,978 ------------- 0	18,900 ------------- 0	39,348 ------------- 0	393,739 ------------- 0	0 ------------- 0
8Jong Gil Oh MD Hospitalist	(i) (ii)	256,821 ------------- 0	45,700 ------------- 0	4,327 ------------- 0	18,900 ------------- 0	33,982 ------------- 0	359,730 ------------- 0	0 ------------- 0
9Anne Lovejoy MD Physician	(i) (ii)	226,750 ------------- 0	22,950 ------------- 0	1,246 ------------- 0	17,680 ------------- 0	19,681 ------------- 0	288,307 ------------- 0	0 ------------- 0
10Melisha Cumberland MD Physician	(i) (ii)	195,442 ------------- 0	8,783 ------------- 0	156 ------------- 0	14,367 ------------- 0	13,401 ------------- 0	232,149 ------------- 0	0 ------------- 0
11Julian Munoz MD Physician	(i) (ii)	294,362 ------------- 0	19,510 ------------- 0	2,189 ------------- 0	18,900 ------------- 0	20,693 ------------- 0	355,654 ------------- 0	0 ------------- 0
12David Whitehead Former Director and Pres.	(i) (ii)	0 ------------- 665,725	0 ------------- 231,500	0 ------------- 108,231	0 ------------- 18,900	0 ------------- 55,986	0 ------------- 1,080,342	0 ------------- 0
13Daniel Lohr Former Senior VP/CFO	(i) (ii)	0 ------------- 37,715	0 ------------- 0	0 ------------- 641,097	0 ------------- 2,690	0 ------------- 26,059	0 ------------- 707,561	0 ------------- 640,899
14Carolyn Trantalis Former VP, Clinical Services & Op	(i) (ii)	0 ------------- 259,228	0 ------------- 66,842	0 ------------- 1,270	0 ------------- 18,900	0 ------------- 44,308	0 ------------- 390,548	0 ------------- 0
15Bimal Patel Former Director & President	(i) (ii)	0 ------------- 536,725	0 ------------- 158,242	0 ------------- 8,934	0 ------------- 81,386	0 ------------- 24,324	0 ------------- 809,611	0 ------------- 0
16Gregory Makowski Former VP, HHC Lab Services	(i) (ii)	0 ------------- 258,466	0 ------------- 73,252	0 ------------- 3,706	0 ------------- 18,900	0 ------------- 18,172	0 ------------- 372,496	0 ------------- 0
17Thomas Vaccarelli Former VP, Facilities	(i) (ii)	0 ------------- 228,952	0 ------------- 65,032	0 ------------- 103,406	0 ------------- 24,300	0 ------------- 40,703	0 ------------- 462,393	0 ------------- 102,272

Schedule J (Form 990) 2019

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 3	The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of Windham Community Memorial Hospital, hires an outside consultant, Integrated Healthcare Strategies, a division of Gallagher Benefit Services, Inc., to determine best practices in governing executive compensation. Please refer to compensation narrative reported on Schedule O.
Part I, Line 4b	Hartford HealthCare Corporation, a related organization, maintains a 457(f) Supplemental Executive Retirement Plan (SERP). Participants include certain officers and key employees at the CEO, President, Executive Vice President. Senior Vice President and Vice President levels that are reported by Windham Community Memorial Hospital on its Form 990, Part VII. Contributions are made by Hartford HealthCare Corporation to the plan based on a percentage of the participant's compensation. Participants vest in the plan at the earlier of reaching age 55 and having 5 years of service, death, disability, involuntary separation without reasonable cause, upon reaching age 65 or the occurence of a change in control. Each participant ceases to be eligible for further contributions by Hartford HealthCare Corporation on the date of the participant's separation from service. Participants receive a one-time lump sum payment of the accumulated amount during the 30-day period following the participant's separation from service. 2017 SERP accrual on behalf of the following individuals: Margaret Marchak $62,514 Bimal Patel $62,486 David Whitehead $75,587 Donna Handley $15,077 2017 SERP Payouts were made on behalf of the following individuals: Daniel Lohr $640,899 Thomas Vaccarelli $102,272 David Whitehead $28,467* Donna Handley $5,162* *For these individuals, vesting occurred, causing taxable income. The portion of the vested amount was used to pay the associated tax liability. The remaining balance was deposited into the employee SERP account.
Part I, Line 7	Hartford HealthCare Corporation, a related organization, has a Compensation At Risk Plan that encourages and rewards achievements of significant functional goals. These goals contribute to the organization's strategic and financial direction. The plan utilizes market practice alignment to ensure competitive recruitment and retention. Awards are based on CEO and/or Hartford HealthCare Corporation's Compensation Committee discretionary assessment of overall organization performance and individual contribution to results.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Windham Community Memorial Hospital

Employer identification number

06-0646966

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Robert Sidman	Key Employee	442,515	Dr. Sidman is the Vice President of Medical Affairs at the East Region which includes Windham Community Memorial Hospital (WCMH) In addition, Dr. Sidman provides medical professional services to WCMH (an affiliated entity) in its Emergency Department (ED). The ED is staffed by Northeast Emergency Medicine Specialists (NEMS), a local group of doctors. His services are provided to the hospital through NEMS. Total transaction between NEMS and Hartford Healthcare System for FY18 was $442,515.		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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Windham Community Memorial Hospital

Employer identification number

06-0646966

Return Reference	Explanation
Form 990, Part VI, Section A, line 6	Windham Community Memorial Hospital is organized as a non-stock not for profit entity. Hartford HealthCare Corporation is the sole member.
Form 990, Part VI, Section A, line 7a	The sole member of the organization has the authority to approve/remove members of the governing body.
Form 990, Part VI, Section A, line 7b	The sole member of the organization has the right to review, approve, disapprove and deny significant transactions such as mergers, acquisitions, dissolutions etc.
Form 990, Part VI, Section B, line 11b	The Form 990 was prepared by Hartford HealthCare's Tax Department. It was then reviewed by an independent accounting firm. It was then forwarded to the organization's top management including the VP of Finance for review. The final Form was provided to the entire Board prior to submission to the Internal Revenue Services (IRS). Once the entire review process was completed, the Form was signed by the VP, Fiance and then filed with the IRS.
Form 990, Part VI, Section B, line 12c	The Hospital's board has adopted the policy of the member, Hartford HealthCare Corporation (HHC). HHC's Conflict of Interest Policy (Policy) requires all covered individuals, including board members and officers, to provide a disclosure of relationships that create or have the appearance of creating a conflict of interest or commitment. The Policy requires updates if changes in circumstances arise during the year that either (a) create a new potential conflict of interest or commitment or (b) change or eliminate a conflict of interest or commitment previously disclosed. Conflict of interest disclosure statements are maintained by the HHC Office of Compliance and Integrity (OCI). Employee disclosures are reviewed by OCI in collaboration with the Covered Individuals' supervisor when deemed appropriate, to determine if there is a potential conflict. Oversight review of employee disclosures is provided by the Conflict of Interest Committee ("COIC") (the Committee) which includes representation from the Medical Staff, the Legal Department, Human Services, Supply Chain Management and Compliance. The Committee assesses and may recommend the conflicting interest either be (a) eliminated for continued relationship with HHC/Windham Community Memorial Hospital, or, (b) managed through a management plan. Board member disclosures are reported to the HHC Nominating and Governance Committee for determinations of conflicts and the management of them, where applicable.
Form 990, Part VI, Section B, line 15	The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of Windham Community Memorial Hospital, hires an outside consultant, Integrated Healthcare Strategies, a division of Gallagher Benefit Services, Inc., to determine best practices in governing executive compensation. The following steps were taken: - The use of an Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of Windham Community Memorial Hospital, established and regularly reviews Executive Compensation Philosophy; - The Committee regularly reviews scope and depth of positions taking into account complexity and the financial impact and accountability of all "disqualified persons; - National peer groups are selected for comparative purposes based on organizational size, operating revenue, geography and other relevant factors; - Analysis of current total compensation versus market is performed by independent third party compensation consulting firm and is then reviewed by the committee; - Recommendations are made based on market data analysis to ensure appropriate competitive positioning within parameters of compensation philosophy; -The CEO compensation is reviewed by the Committee and is based on comparative market information and organizational performance; - All changes are reviewed and approved by the Executive Compensation Committee; The compensation determination process for the CEO is reviewed on an annual basis. All other executive compensation is regularly reviewed for scope and depth of positions taking into account complexity and the financial impact and accountability.
Form 990, Part VI, Section C, line 18	The Hospital's Form 990, 990T and form 1023 and its attachments are available upon request.
Form 990, Part VI, Section C, line 19	The Hospital's Financial Statements, Governing Documents and the Conflict of Interest Policy are available for inspection upon request at the Organization's address.
Form 990, Part XI, line 9:	Change In Pension and Post-Retirement Funding Status Obligation 8,676,058. Transfer to Affiliated Entities 7,843,869. K-1 Income (Loss) Pass Thru Entities -86,685.
Form 990, Part XII, Line 3b:	Although the organization was not required to undergo a-133 Federal Audit, the results were included in a Consolidated A-133 Audit performed at the parent level-Hartford HealthCare Corporation.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Windham Community Memorial Hospital

Employer identification number

06-0646966

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Hartford Hospital 80 Seymour Street Hartford,CT06102 06-0646668	Healthcare Services	CT	501(C)(3)	3	Hartford HealthCare Corporation	Yes
(2)Windham Hospital Foundation Inc 112 Mansfield Avenue Willimantic,CT06226 56-2546632	Supporting Organization	CT	501(C)(3)	12(A)	Windham Community Memorial Hospital	Yes
(3)MidState Medical Center 435 Lewis Avenue Meriden,CT06451 06-0646715	Healthcare Services	CT	501(C)(3)	3	Hartford HealthCare Corporation	Yes
(4)Hartford HealthCare Corporation One State Street Suite 19 Hartford,CT06103 22-2672834	Support & Management Svcs.to HH and Affiliates	CT	501(C)(3)	12(C)	N/A		No
(5)Natchaug Hospital Inc 189 Storrs Road Mansfield Ctr,CT06226 06-0966963	Behavioral Health	CT	501(C)(3)	3	Hartford HealthCare Corporation	Yes
(6)Hartford HealthCare At Home Inc 1290 Silas Deane Hwy Suite 4B Wethersfield,CT06109 06-0646938	Home Healthcare	CT	501(C)(3)	10	Hartford HealthCare Corporation	Yes
(7)Rushford Center Inc 883 Paddock Avenue Meriden,CT06450 06-0932875	Substance Abuse Healthcare Services	CT	501(C)(3)	10	Hartford HealthCare Corporation	Yes
(8)Hartford Hospital Auxiliary co Hartford Hospital 80 Seymour Street Hartford,CT06115 06-6040747	Fundraising	CT	501(C)(3)	12(a)	Hartford Hospital	Yes
(9)Hartford HealthCare Senior Services Inc 45 Meriden Avenue Southington,CT06489 22-2635676	Sub-Acute & Long Term Healthcare	CT	501(C)(3)	10	Hartford HealthCare Corporation	Yes
(10)Hartford HealthCare Independence at Home Inc 1290 Silas Deane Hwy Suite 4B Wethersfield,CT06109 06-1161422	Home Healthcare	CT	501(C)(3)	10	Hartford HealthCare At Home Inc	Yes
(11)WCMH Women's Auxiliary Inc 112 Mansfield Avenue Willimantic,CT06226 06-0677728	Fundraising	CT	501(C)(3)	12(a)	Windham Community Memorial Hospital	Yes
(12)The Hospital of Central CT and Bradley Memorial 100 Grand Street New Britain,CT06050 06-0646768	Healthcare Services	CT	501(C)(3)	3	Hartford HealthCare Corporation	Yes
(13)Rushford Foundation Inc 883 Paddock Avenue Meriden,CT06450 06-1432692	Supporting Organization	CT	501(C)(3)	12(a)	Rushford Center Inc	Yes
(14)The Orchards of Southington 34 Hobart Street Southington,CT06489 06-1490803	Residential Services for Senior Care	CT	501(C)(3)	10	Hartford HealthCare Senior Services Inc	Yes
(15)Mulberry Gardens of Southington LLC 58 Mulberry Street Plantsville,CT06479 82-0586577	Assisted Living & Adult Day Care Facility	CT	501(C)(3)	10	Hartford HealthCare Senior Services Inc	Yes
(16)MidState Medical Center Auxiliary 435 Lewis Avenue Meriden,CT06451 06-6063082	Fundraising	CT	501(C)(3)	12(a)	MidState Medical Center	Yes
(17)Hartford HealthCare Medical Group Inc 1290 Silas Deane Hwy 2nd Floor Wethersfield,CT06109 45-4456939	Medical Services	CT	501(C)(3)	10	Hartford HealthCare Corporation	Yes
(18)Hartford HealthCare ACO Inc 1290 Silas Deane Hwy 2nd Floor Wethersfield,CT06109 46-0886367	Government Contracts	CT	501(C)(3)	7	HHC PhysiciansCare Inc	Yes
(19)The Charlotte Hungerford Hospital 540 Litchfield Street Torrington,CT06790 06-0646678	Healthcare Services	CT	501(C)(3)	3	Hartford HealthCare Corporation	Yes
(20)The William W Backus Hospital 326 Washington Street Norwich,CT06360 06-0250773	Support Organization	CT	501(C)(3)	3	Hartford HealthCare Corporation	Yes
(21)Backus HealthCare Inc 326 Washington Street Norwich,CT06360 22-2481794	Support Organization	CT	501(C)(3)	12(a)	Hartford HealthCare Corporation	Yes
(22)Caring for Colleagues Employee Crisis Fund 100 Grand Street New Britain,CT06052 22-4469178	Employee Fund	CT	501(C)(3)	7	Hartford HealthCare Corporation	Yes
(23)Hartford HealthCare Endowment LLC 80 Seymour Street Hartford,CT06102 45-4181103	Investment Management	CT	501(C)(3)	12(a)	Hartford HealthCare Corporation	Yes
(24)Connecticut Health System Inc 80 Seymour Street Hartford,CT06102 22-2779421	Coordination of Health Delivery	CT	501(C)(3)	12(c)	Hartford HealthCare Corporation	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) New Britain MRI Limited Partnership 100 Grand Street New Britain,CT06050 06-1271349	Magnetic Resonance Imaging	CT	N/A
(2) Ambulance Service of Manchester LLC PO Box 300 Manchester,CT06450 06-1557358	Ambulatory Services	CT	N/A
(3) Connecticut Imaging Partners LLC 111 Founders Plaza East Hartford,CT06108 13-4298940	Imaging Services	CT	N/A
(4) Glastonbury Endoscopy Center LLC 300 Western Blvd Suite B Glastonbury,CT06033 26-1721234	Endoscopy Services	CT	N/A
(5) Glastonbury Surgery Center LLC 195 Eastern Boulevard Glastonbury,CT06033 26-2600828	Surgery Services	CT	N/A
(6) Hartford-Middlesex Clinical System LLC 80 Seymour Street Hartford,CT06110 06-1543605	Affiliate Support Services	CT	N/A
(7) Med-East Assoc LLC 1703 West Main Street Willimantic,CT06226 06-1469575	Outpatient Care Clinic	CT	N/A	Related	-47,898	134,038		No			No	50.000 %
(8) Urology Center of NW CT LLC 538 Litchfield Street Torrington,CT06790 58-2674029	Equipment Rental	CT	N/A
(9) HHC Southington Surgery Center LLC 100 Avon Meadow Lane Avon,CT06001 46-5500829	Surgery Services	CT	N/A
(10) Constitution Surgery Center 174 Cross Road Waterford,CT06385 06-1574704	Surgery Services	CT	N/A
(11) CT GI Endoscopy Center LLC 4 Northwestern Drive Bloomfield,CT06002 06-1573358	GI Services	CT	N/A
(12) HHC Hartford Surgery Center LLC 100 Avon Meadow Lane Avon,CT06001 81-2637261	Surgery Services	CT	N/A
(13) HHC Urgent Care Go Health LLC 2711 Centerville Road Suite 400 Willmington,DE19808 81-5112698	Urgent Care	DE	N/A
(14) Wallingford Endoscopy Center LLC 85 Seymout Street Suite 1000 Hartford,CT06106 82-4601730	Endoscopy Services	CT	N/A
(15) Central Connecticut Endoscopy Center 440 New Britain Avenue Plainville,CT06062 14-1855010	Endoscopy Services	CT	N/A
(16) Advanced Medical Imaging of NW Ct LLC 57 Commercial Blvd Torrington,CT06790 06-1594854	Magnetic Resonance Imaging	CT	N/A
(17) The Endoscopy Center of Northwest Connecticut LLC 245 Alvord Park Road Torrington,CT06790 06-1609993	Endoscopy Services	CT	N/A
(18) Omni Home Health Services E CT LLC dba Backus Home HealthCare Case Street 317 Norwich,CT06860 06-1458837	Home Health Care	CT	N/A

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) Hartford HealthCare Indemnity Services Ltd FB Perry Blvd 40 Church Street Hamilton BD	Captive Insurance	BD	N/A	C				Yes
(2) CenConn Services Inc 100 Grand Street New Britain,CT06050 22-2836001	Holding Company	CT	N/A	C				Yes
(3) Hartford Physician Services PC 80 Seymour Street Hartford,CT06102 06-1254082	Medical Services	CT	N/A	C				Yes
(4) Meriden Imaging Center 101 North Plains Industrial Road Meriden,CT06429 06-1541468	Imaging	CT	N/A	S				Yes
(5) Aetna Ambulance Service Inc PO BOX 1150 Manchester,CT06045 06-0795431	Ambulance Services	CT	N/A	C				Yes
(6) Metro Wheelchair Service Inc PO BOX 300 Manchester,CT06045 06-0878432	Wheelchair Services	CT	N/A	C				Yes
(7) WWB Corporation 326 Washington Street Norwich,CT06360 06-1094836	Holding Company	CT	N/A	C				Yes
(8) ConnCare Inc 326 Washington Street Norwich,CT06360 06-1387598	Health Care Services	CT	N/A	C				Yes
(9) Backus Medical Center Condo Assoc Inc 330 Washington Street Norwich,CT06360 06-1542647	Condo Association	CT	N/A	C				Yes
(10) Windham Professional Office Condominium Association Inc 1120 Mansfield Avenue Willimantic,CT06226 06-1090041	Condo Association	CT	Windham Community Memorial Hospital	C	36,000	328,613	60.000 %	Yes
(11) MidState Medical Group PC 435 Lewis Avenue Meriden,CT06450 20-4327968	Medical Services	CT	N/A	C				Yes
(12) HHMOB Corporation 80 Seymour Street PO Box 5037 Hartford,CT06102 06-1140244	Real Estate & Parking	CT	N/A	C				Yes
(13) Litchfield County Healthcare 540 Litchfield Street Torrington,CT06790 06-1227655	Medical Services	CT	N/A	C				Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Hartford Hospital	A	6,759	FMV
(2) Hartford Hospital	M	733,087	FMV
(3) Hartford Hospital	O	256,377	FMV
(4) Hartford Hospital	P	1,253,458	FMV
(5) Hartford Hospital	R	66,480	FMV
(6) Hartford Hospital	S	2,002,500	FMV
(7) Hartford HealthCare Medical Group Inc	A	566,758	FMV
(8) Hartford HealthCare Medical Group Inc	M	646,766	FMV
(9) Hartford HealthCare Medical Group Inc	O	649,983	FMV
(10) Hartford HealthCare Medical Group Inc	Q	65,307	FMV
(11) Hartford HealthCare Medical Group Inc	S	1,011,394	FMV
(12) Natchaug Hospital	M	82,569	FMV
(13) Natchaug Hospital	S	422,152	FMV
(14) The William W Backus Hospital	L	83,249	FMV
(15) The William W Backus Hospital	M	189,142	FMV
(16) the William W Backus Hospital	O	470,234	FMV
(17) The William W Backus Hospital	R	133,806	FMV
(18) The William W Backus Hospital	S	468,576	FMV
(19) Hartford Healthcare Rehab Ntwk	R	124,726	FMV
(20) Hartford Healthcare Rehab Ntwk	S	269,820	FMV
(21) Hartford HealthCare at Home Inc	O	96,539	FMV
(22) Hartford HealthCare at Home Inc	S	72,501	FMV
(23) Windham Hospital Foundation	Q	162,717	FMV

Schedule R (Form 990) 2019

Page 4

Part VI

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

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

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: The mission of Windham Community Memorial Hospital is to offer comprehensive services in an environment where innovation and teaching are integral to care; where we are proud to serve patients and one another; where meeting the challenge of complex medical needs is viewed as a defining competency; and where quality and safety of care are a constant.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	674
6	Total number of volunteers (estimate if necessary) .............	6	173
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	82,556
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	590,123	218,991
9	Program service revenue (Part VIII, line 2g) .........	81,000,188	95,798,858
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	187,611	442,743
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,047,097	1,044,917
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	82,825,019	97,505,509
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)	42,634,907	41,414,925
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 60,825
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	42,704,065	55,224,281
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	85,338,972	96,639,206
19	Revenue less expenses. Subtract line 18 from line 12.......	-2,513,953	866,303
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	64,908,948	67,289,632
21	Total liabilities (Part X, line 26).............	110,384,280	94,652,946
22	Net assets or fund balances. Subtract line 21 from line 20.....	-45,475,332	-27,363,314

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 12,687,703 including grants of $ ) (Revenue $ 13,058,474 )
	Bone & Joint (Orthopedics):The Orthopedics Department at Windham Hospital offers a full range of services to the communities it serves. As a member of Hartford HealthCare Corporation's network, the Hospital has access to the integrated health network's recognized expertise, ongoing research studies that evaluate new treatments and one of the nation's top training centers for robot-assisted surgery.Orthopedics services provided by the Hospital include:Advanced ImagingOur radiology services target disorders of the bones, joints and soft tissues, including:* MRI* Multi-slice CT* Nuclear scintigraph* Minimally-invasive needle biopsies under image guidance using ultrasound, fluoroscope or CT* Spinal injectionsWindham Hospital surgeons utilize the Robotic Arm Interactive Orthopedic System (RIO) which allows them to personalize partial and total joint replacement surgery more accurately than with conventional instruments.Mako Technology:Mako is a treatment option if you have early to mid-stage degeneration of your hip or knee. With smaller incisions, the robotic arm-assisted technology allows the surgeon to more precisely place your implant for faster recovery and more effective results. This technology is available at Windham Hospital.In addition, the Hospital also serves patients with issues in the following areas:* Hand & Upper Extremity* Hip* Knee* Osteoporosis* Shoulder* Spine* Sports Medicine* Total ReplacementsWindham Hospital completed 877 total orthopedic cases in FY18 which was down by 36 cases from FY17. Of the 877 cases in FY18, 115 were Total Knee Replacements and 112 of those were performed with MAKO robotic surgery. Total Hip Replacement was 71 with 1 of those being performed with MAKO robotic surgery. Windham also performed 11 Globus Robotic Spine surgeries in FY18.

4b	(Code: ) (Expenses $ 11,845,739 including grants of $ ) (Revenue $ 9,578,051 )
	Hartford HealthCare Cancer Institute:Hartford HealthCare is Connecticut's most comprehensive healthcare network. Our fully integrated health system includes a tertiary-care teaching hospital, an acute-care community teaching hospital, an acute-care hospital and trauma center, two community hospitals. The Hartford HealthCare Cancer Institute encompasses comprehensive cancer centers at five hospitals across Connecticut - Hartford Hospital, The Hospital of Central Connecticut, Backus Hospital, Midstate Medical Center and Windham Hospital. Collectively, the cancer programs within the Cancer Institute treat more than 5,000 new cancer patients per year while caring for tens of thousands of existing patients, offering a full range of innovative, evidence-based and personalized treatments designed to meet the needs of each individual patient. Our innovative Institute approach is unlike any other in the state and is among the most highly regarded in the nation. Through our Institute, which is organized around a specific disease and not necessarily location, we can apply best practices throughout our system so that patients receive the same high standards of care no matter where they live or which Hartford HealthCare cancer center they choose. For all of our patients, a dedicated team of oncologists, surgeons, radiologists, pathologists, nurses, clinical researchers, technicians and others collaborate to provide the exact course of care they need. The Institute's multidisciplinary disease management teams meet and collaborate regularly to lend expertise and insight on numerous cancer types, translating into exceptional coordinated care. The Institute's accomplished, fellowship-trained physicians are nationally recognized for their level of sophisticated care in areas such as radiation oncology, medical oncology and surgical oncology. Patients are also cared for in an environment that emphasizes compassion and personal connections, with a team of trained nurse navigators who provide guidance and support to patients and families, from diagnosis to recovery. The Institute also boasts a thriving survivorship program. In 2013, the Hartford HealthCare Cancer Institute became the first community-based cancer program to become a member of the Memorial Sloan Kettering Cancer Alliance, establishing a relationship with one of the world's premier cancer centers. The Institute's membership in the Alliance provides patients in Connecticut access to the most advanced, leading-edge treatments available anywhere. In 2017, the Institute was accredited as a network by the American College of Surgeons Commission on Cancer, one of a select few institutes nationwide to be recognized as a system, rather than individual cancer centers. For patients coming through our doors with a cancer diagnosis, that means three things: standardized care, more options and more hope.More than four years after the Hartford HealthCare Cancer Institute became the charter member of the Memorial Sloan Kettering (MSK) Cancer Alliance, cancer patients now have unprecedented access to the world's most advanced clinical trials. And more than ever before, physicians, nurses, pharmacists and researchers are working collaboratively to implement cancer treatment standards and protocols developed at MSK, the premier cancer treatment center in the country. This distinctive cancer care and clinical research partnership means the Hartford HealthCare Cancer Institute brings the most innovative, evidence-based cancer care directly into community settings.During FY18, the Institute had 5,598 new cases across the system were as follows:Hartford Hospital - 3,132Hospital of Central Connecticut - 1,013Backus Hospital - 765MidState Medical Center - 516Windham Hospital - 172The five most common types of cancer diagnosed by teams of specialists at the Hartford HealthCare Cancer Institute are cancers of the bladder, breast, colon, lung and prostate. Each patient has a unique scenario requiring a personalized plan.1,101 Breast Cancer cases were treated across the system as follows:Hartford Hospital - 571Hospital of Central Connecticut - 251Backus Hospital - 123MidState Medical Center - 122Windham Hospital - 34726 Lung Cancer cases were treated across the system as follows:Hartford Hospital - 392Hospital of Central Connecticut - 142Backus Hospital - 109MidState Medical Center - 59Windham Hospital - 24676 Prostate Cancer cases were treated across the system as follows:Hartford Hospital - 386Hospital of Central Connecticut - 98Backus Hospital - 110MidState Medical Center - 62Windham Hospital - 20370 Bladder Cancer cases were treated across the system as follows:Hartford Hospital - 175Hospital of Central Connecticut - 79Backus Hospital - 57MidState Medical Center - 46 Windham Hospital - 13241 Colon Cancer cases were treated across the system as follows:Hartford Hospital - 137Hospital of Central Connecticut - 42Backus Hospital - 26MidState Medical Center - 36 Today, Hartford HealthCare is creating a better future for healthcare in Connecticut and beyond. We are a community of caregivers engaged in developing a coordinated, consistent high standard of care. We use research and education as partners in care delivery. We create and engage in meaningful alliances to enhance access to services. We invest in technology and training to develop new pathways to improve the timeliness, efficiency and accuracy of our services.

4c	(Code: ) (Expenses $ 9,618,153 including grants of $ ) (Revenue $ 10,445,627 )
	Heart and Vascular:As a member of Hartford HealthCare, Cardiology services at Windham Hospital are provided through the Hartford HealthCare Heart and Vascular Institute. This arrangement brings advanced, coordinated and evidence-based care close to home for the residents of Eastern Connecticut. Cardiologists are board-certified to help patients with high cholesterol, high blood pressure, ischemia, peripheral arterial disease of the legs, mitral valve issues or other cardiac-related disease. Services and physician staffing at Windham Hospital has grown and the team currently offers:* General cardiology care* Full cardiac testing at the Hospital (including stress testing, cardiopulmonary testing, cardiac MRI, carotid artery duplex scan, vascular studies, myocardial viability studies, transesophageal echocardiogram and electrophysiology studies)* A focus on non-invasive imaging (including myocardial perfusion imaging and cardiac blood pool scans)* MonitoringMore advanced care - including the state's only Atrial Fibrillation Center, bypass surgery, cardiac catheterization and angioplasty, robotic ablation and minimally invasive mitral valve repair is available at Hartford Hospital, a member of the Hartford HealthCare integrated network.At the completion of the Fiscal Year FY18 the, Division of Cardiology was comprised of three cardiologist and one Advanced Practice provider. Overall, cardiology services grew on average by 15% from FY17 to FY18. Echocardiography increased by 9% and cardiac stress testing increased 110% from FY17 to FY18, the large increase in volume correlates to a third provider being hired at Windham Hospital in FY18. The Hospital is now able to cardiac monitor patients with its remote telemetry capabilities.Our Congenital Heart Failure (CHF) readmission rate for Medicare patients was 13.6% below the national average. The hospital has a CHF bridge clinic which provides extra support to patients with CHF who are discharged from the Hospital and may need additional support with their diagnosis.

	(Code: ) (Expenses $ 53,758,954 including grants of $ ) (Revenue $ 62,909,884 )
	Committed to excellence in quality and service for the region, Windham Community Memorial Hospital boasts a state-of-the-art Emergency Department that consistently ranks in the highest percentiles of customer satisfaction. The Hospital also offers convenient and modern satellite services including two Physical Therapy and Rehabilitation Clinics and a Center for Women's Health offering mammography, bone density, and integrative health.There are on-campus support services for patients of Windham Community Memorial Hospital including a Cardiac Rehabilitation Center and Lipid Clinic, Pulmonary Rehabilitation and Pain Management Services. Community education is an important component of Windham Community Memorial Hospital's vision to improve the health of the community. To achieve this goal - diabetes education, childbirth education, integrative health services, cancer support groups, and ongoing community health forums are offered. In addition to the programs referred to above, the Hospital provides services/programs including but not limited to the following:Cardiology ServicesDiabetes & EndocrinologyEmergency CareFamily & Primary CareHeadache CenterHospital MedicineImaging & RadiologyIntegrative HealthMedical Weight LossMovement DisordersNeuroscience InstituteOrthopedicsPain ManagementParamedic ProgramPhysical TherapyPulmonary & Respiratory ServicesSenior ServicesSleep MedicineSpine CareSurgical Weight LossUrologyWomen's HealthWound Care & Surgical ClinicSupport Services

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 53,758,954 including grants of $ ) (Revenue $ 62,909,884 )
4e	Total program service expenses87,910,549

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(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
(A) Name and title
(18) Kismatkumar Detroja MD........................................................................ Physician	60.00 .......................	X		335,491	0	58,248
(19) Jong Gil Oh MD........................................................................ Hospitalist	60.00 .......................	X		306,848	0	52,882
(20) Anne Lovejoy MD........................................................................ Physician	60.00 .......................	X		250,946	0	37,361
(21) Melisha Cumberland MD........................................................................ Physician	60.00 .......................	X		204,381	0	27,768
(22) Julian Munoz MD........................................................................ Physician	60.00 .......................	X		316,061	0	39,593
(23) David Whitehead........................................................................ Former Director and Pres.	0.00 .......................60.00		X	0	1,005,456	74,886
(24) Daniel Lohr........................................................................ Former Senior VP/CFO	0.00 .......................60.00		X	0	678,812	28,749
(25) Carolyn Trantalis........................................................................ Former VP, Clinical Services & Op	0.00 .......................0.00		X	0	327,340	63,208
(26) Bimal Patel........................................................................ Former Director & President	0.00 .......................60.00		X	0	703,901	105,710
(27) Gregory Makowski........................................................................ Former VP, HHC Lab Services	0.00 .......................0.00		X	0	335,424	37,072
(28) Thomas Vaccarelli........................................................................ Former VP, Facilities	0.00 .......................0.00		X	0	397,390	65,003

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,445,167	6,008,538	1,028,644

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	22,230

f	All other contributions, gifts, grants, and similar amounts not included above		1f	196,761

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		218,991

		Business Code
2a	Program Revenue	621400	95,798,858	95,798,858
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		95,798,858

3 Investment income (including dividends, interest, and othersimilar amounts) ......			247,584			247,584
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,055,310	6a
b	Less: rental expenses		415,385	6b
c	Rental income or (loss)		639,925	6c
d	Net rental income or (loss).......			639,925			639,925
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		195,159	7a
b	Less: cost or other basis and sales expenses		0	7b
c	Gain or (loss)		195,159	7c
d	Net gain or (loss).........			195,159			195,159
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Cafeteria Revenue		722514	211,814			211,814
b	Other Operating Revenue		900099	110,622	110,622
c	Income (Loss) Pass Thru Entities		900003	82,556		82,556
d	All other revenue ....
e	Total. Add lines 11a–11d ......			404,992
12	Total revenue. See instructions.....			97,505,509	95,909,480	82,556	1,294,482

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
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........	34,519,626	32,879,167	1,592,659	47,800
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	49,259	46,918	2,273	68
9	Other employee benefits .......	4,484,865	4,271,733	206,922	6,210
10	Payroll taxes ...........	2,361,175	2,235,680	121,838	3,657
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	3,505		3,505
c	Accounting ...........
d	Lobbying ...........	19,140		19,140
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	6,993	6,993
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	5,229,076	5,229,076
12	Advertising and promotion ....	750		750
13	Office expenses .......	1,226,303	1,037,153	188,277	873
14	Information technology ......	4,779,830	2,915,696	1,864,134
15	Royalties ..
16	Occupancy ...........	1,876,274	1,779,521	96,753
17	Travel ............	28,048	25,804	2,244
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	83,244	63,154	18,913	1,177
20	Interest ...........	1,580,232	1,563,597	16,635
21	Payments to affiliates .......	12,637,612	9,351,833	3,285,779
22	Depreciation, depletion, and amortization ..	3,454,525	3,454,525
23	Insurance ...	651,962	651,962
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	Medical Supplies	14,993,533	14,993,533
b	Purchased Services	4,973,372	4,088,678	883,654	1,040
c	Repairs & Maintenance	2,016,913	1,886,069	130,844
d	Hospital Provider Tax	1,307,141	1,307,141
e	All other expenses	355,828	122,316	233,512
25	Total functional expenses. Add lines 1 through 24e	96,639,206	87,910,549	8,667,832	60,825
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			6,415,907	1	6,338,157
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......			24,847	3
4	Accounts receivable, net .............			7,223,603	4	9,053,659
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			831,497	8	1,396,965
9	Prepaid expenses and deferred charges ......			632,494	9	715,629
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	129,166,817
b	Less: accumulated depreciation	10b	91,546,222	37,446,481	10c	37,620,595
11	Investments—publicly traded securities .			59,469	11	63,907
12	Investments—other securities. See Part IV, line 11 .....			7,626,645	12	7,995,575
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			4,648,005	15	4,105,145
16	Total assets. Add lines 1 through 15 (must equal line 33)...			64,908,948	16	67,289,632

17	Accounts payable and accrued expenses .....	8,400,392	17	7,125,014
18	Grants payable ...		18
19	Deferred revenue .........	10,488,283	19	9,207,352
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	229,125	24	217,725
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	91,266,480	25	78,102,855
26	Total liabilities. Add lines 17 through 25..	110,384,280	26	94,652,946

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-45,475,332	32	-27,363,314
33	Total liabilities and net assets/fund balances ........	64,908,948	33	67,289,632