2022-11-15T08:03:02-06:00 2021-12-31 111986323 MARCUM LLP 555 LONG WHARF DRIVE NEW HAVEN CT 06511 990 2021-03-01 060655139 SILVER HILL HOSPITAL INC SILV 2038012230 208 VALLEY ROAD NEW CANAAN CT 06840 ANDREW GERBER MD PHD PRESIDENT & MEDICAL DIRECTOR 2038012230 2022-11-11 1 ANDREW GERBER MD PHD XXX-XX-XXXX MARY ANTONETTI P00431862 2037819600 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ANDREW GERBER MD PHD 208 VALLEY ROAD NEW CANAAN CT 06840 46165887 0 X WWW.SILVERHILLHOSPITAL.ORG X 1934 CT TO PROVIDE OUR PATIENTS WITH THE BEST AVAILABLE TREATMENT OF MENTAL ILLNESS. SEE SCHEDULE O. 12 11 476 51 0 0 2957859 5901459 32177334 34035056 436115 1999275 1501487 2482075 37072795 44417865 49795 91025 0 0 24813640 24630511 0 0 1318319 15643672 12810358 40507107 37531894 -3434312 6885971 69964996 73348940 17225243 14282517 52739753 59066423 THE MISSION OF SILVER HILL HOSPITAL IS TO PROVIDE OUR PATIENTS WITH THE BEST AVAILABLE TREATMENT OF MENTAL ILLNESS AND ADDICTION; AND TO OFFER CONTINUING SUPPORT, COUNSELING AND EDUCATION TO OUR PATIENTS AND THEIR FAMILIES IN EVERY PHASE OF ILLNESS AND RECOVERY. 0 0 5813010 12405373 INPATIENT TREATMENT IS THE MOST INTENSIVE FORM OF CARE, INDICATED FOR A PHASE OF ILLNESS THAT REQUIRES A GREAT DEAL OF NURSING AND MEDICAL INTERVENTION. BECAUSE PATIENTS ARE USUALLY ACUTELY ILL DURING THIS PHASE OF CARE, OUR INPATIENT TREATMENT PLANS EMPHASIZE DIAGNOSTIC ASSESSMENT, SYMPTOM REDUCTION, AND STABILIZATION. THE HOSPITAL TREATED APPROXIMATELY 620 INPATIENTS DURING THE SHORT YEAR OF 3/1/2021 TO 12/31/2021. 16660390 91025 21521164 THE HOSPITAL'S TRANSITIONAL LIVING PROGRAMS PROVIDE HIGHLY STRUCTURED INTENSIVE TREATMENT FOR PATIENTS WHO ARE READY FOR MORE PSYCHOLOGICAL AND BEHAVIORAL INTERVENTIONS. SET IN RESIDENTIAL, HOME-LIKE SETTINGS, THE TRANSITIONAL PROGRAMS HELP PATIENTS CONTINUE THEIR RECOVERY PROCESS UNTIL THEY ARE READY TO RETURN HOME FOR FURTHER COMMUNITY-BASED TREATMENTS. PATIENTS FOCUS ON DEVELOPING A PSYCHOLOGICAL UNDERSTANDING OF THEIR ILLNESS, OBTAINING INFORMATION ABOUT THEIR ILLNESS, AND DEVELOPING NEW BEHAVIORAL SKILLS TO MANAGE THEIR RECOVERY PROCESS. THE HOSPITAL TREATED APPROXIMATELY 600 TRANSITIONAL LIVING PATIENTS DURING THE SHORT YEAR OF 3/1/2021 TO 12/31/2021. 1648925 2531409 THE HOSPITAL OFFERS SPECIALIZED INTENSIVE OUTPATIENT PROGRAMS (IOPS) FOR ADOLESCENTS AND ADULTS WHO ARE ABLE TO LIVE AT HOME AND DESIRE SUBSTANCE ABUSE TREATMENT AND/OR PSYCHOLOGICAL TREATMENT TO LIVE FULL AND INDEPENDENT LIVES. THE IOPS MEET THREE TIMES A WEEK FOR SIX WEEKS. 24122325 1 1 0 0 0 0 0 0 0 1 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 1 202 0 1 476 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CT NY X RICK MARKELLO 2038012232 208 VALLEY ROAD NEW CANAAN CT 06840 PETER ORTHWEIN DIRECTOR 1.00 X 0 0 0 LANCE LUNDBERG CHAIRMAN & DIRECTOR 3.00 X X 0 0 0 DEANN E MURPHY DIRECTOR (THROUGH 5/21) 1.00 X 0 0 0 WARD F CLEARY ESQ DIRECTOR 1.00 X 0 0 0 LINDA AUTORE DIRECTOR 3.00 X 0 0 0 RICHARD GANNON TREASURER & DIRECTOR 1.00 X X 0 0 0 AMY BAUMAN DIRECTOR (THROUGH 5/21) 1.00 X 0 0 0 RICHARD CANNING DIRECTOR 1.00 X X 0 0 0 PETER FONAGY DIRECTOR 1.00 X 0 0 0 HENK J HARTONG JR DIRECTOR (THROUGH 5/21) 1.00 X 0 0 0 DAVID HUNT SECRETARY & DIRECTOR (THROUGH 5/21) 1.00 X X 0 0 0 JAMES PERAKIS DIRECTOR 1.00 X 0 0 0 DEBORAH SHABECOFF DIRECTOR 1.00 X 0 0 0 DAVID STIFELMAN DIRECTOR (THROUGH 5/21) 1.00 X 0 0 0 MICHAEL HOLMES DIRECTOR 1.00 X 0 0 0 TODD HOLANDER DIRECTOR (THROUGH 5/21) 1.00 X 0 0 0 CHERYL WIESENFELD SECRETARY & DIRECTOR 1.00 X X 0 0 0 ANDREW GERBER MD PHD PRESIDENT & MEDICAL DIRECT 40.00 X X 621567 0 50328 ROSS MARKELLO JOINED 1220 INTERIM CHIEF FINANCIAL OFFICER 40.00 X 0 0 0 KRISTEN WOLFE CHIEF BUSINESS OFFICER 40.00 X 275945 0 27494 TIMOTHY DOUGHERTY CHIEF ADVANCEMENT OFFICER 40.00 X 323655 0 55788 LISA BENTON CHIEF QUALITY OFFICER 40.00 X 272235 0 27412 AYANA THOMAS CHIEF INFORMATION OFFICER 40.00 X 192435 0 18662 SHARON KOWALCHUK CHIEF NURSING OFFICER 40.00 X 181463 0 43195 MICHAEL D GROAT PHD CHIEF CLINICAL OFFICER 40.00 X 412111 0 56828 HOWARD K WEINER PHYSICIAN 40.00 X 376719 0 30828 PETRA M PILGRIM PHYSICIAN 40.00 X 281251 0 25037 ROCCO MAROTTA PHYSICIAN 40.00 X 236622 0 45795 MARGUERITE MERIWETHER BROWN PHYSICIAN 40.00 X 235116 0 17525 ANRI KISSILENKO PHYSICIAN 40.00 X 227437 0 54707 3636556 0 453599 48 0 1 0 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 303682289 FOOD SERVICES 1826789 SOUND CONSTRUCTION INC 52 FLAT ROCK RD EASTON CT 06612 LANDSCAPE PROJECT 867819 YALE NEW HAVEN HEALTH PO BOX 788327 PHILADELPHIA PA 191788327 LAB SERVICES 529458 PHARMACY & THERAPEUTICS CONS POB 487 ATTN AMY VEIVIA CHESHIRE CT 06410 PHARMACEUTICAL SERVICES 403804 OLD SILVER BEACH CONSULTING LLC 10 JAE RD FALMOUTH MA 02540 CONSULTING SERVICES 324157 29 4565400 1336059 133463 5901459 TRANSITIONAL LIVING 623000 21358401 21358401 OUTPATIENT 623000 10145246 10145246 INPATIENT 623000 2531409 2531409 34035056 780453 780453 128808 153626 -24818 -24818 -24818 2806220 1587398 1218822 1218822 1218822 19935 6998 12937 12937 SH-YNHHS TL-GAIN EQUITY INVESTMEN 623000 2103017 2103017 TUTORING 611710 157110 157110 GUEST MEALS 722514 71066 71066 162763 162763 2493956 44417865 36457946 0 2058460 91025 91025 2504875 954055 1125868 424952 18111324 14246687 3414983 449654 2603906 1764985 776192 62729 1410406 1045833 306785 57788 6300 6300 171371 171371 52760 52760 2902660 2014792 771399 116469 219102 70390 2020 146692 2291816 684716 1589590 17510 32228 32228 792504 475438 317066 163479 102567 55573 5339 61281 34226 26720 335 60690 60690 2882764 1864358 1018153 253 908115 908115 CONSULTING AND RECRUITM 1715356 612454 1070682 32220 CREDIT CARD FEES 398945 3512 391055 4378 MEDICATION 150987 150987 37531894 24122325 12091250 1318319 1900 1499 6407500 7908740 1782341 1293545 2827614 3705367 100445 128403 601486 491662 83710877 42807269 40424042 40903608 14187108 14631578 2405216 4284538 1227344 0 69964996 73348940 4657731 4060465 3394689 3277243 9172823 6944809 17225243 14282517 X 48152213 54745867 4587540 4320556 52739753 59066423 69964996 73348940 6885971 -559301 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 213000 100000 29 29 313000 213000 7619 7619 213000 213000 6210 6210 213000 245559 1894 34453 213000 237557 8002 245559 1.00000 0 0 1766721 1766721 54132567 27517500 26615067 13173267 10085448 3087819 14638322 5204321 9434001 40903608 THE SH-YNHHS TRANSITIONAL LIVING TREATMENT PROGRAM PARTNERSHIP 4284538 C 4284538 DUE TO PATIENTS AND THIRD PARTIES 2489063 PROFESSIONAL LIABILITY RESERVE 1527171 PAYCHECK PROTECTION PROGRAM LOAN 2000000 OTHER LIABILITIES 928575 6944809 X 43812802 -559301 -559301 44372103 52760 -6998 45762 44417865 37486132 6998 6998 37479134 52760 52760 37531894 PART V, LINE 4: DONORS HAVE STIPULTED THAT ANY INCOME FROM THE ENDOWMENT FUNDS IS TO BE USED FOR ADOLESCENT AND CHEMICAL DEPENDENCY PROGRAMS. PART X, LINE 2: THE HOSPITAL IS QUALIFIED AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), AND AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. THE INTERNAL REVENUE SERVICE INFORMED THE HOSPITAL BY A LETTER DATED JUNE 23, 1937 THAT THE HOSPITAL'S OPERATIONS ARE DESIGNED IN ACCORDANCE WITH SUCH SECTION OF THE CODE. CERTAIN TRANSACTIONS COULD BE DEEMED "UNRELATED BUSINESS INCOME AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES. THE HOSPITAL RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT NEEDED TO BE RECORDED AT DECEMBER 31, 2021. THE HOSPITAL RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS WITHIN INTEREST. AS OF DECEMBER 31, 2021, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE HOSPITAL'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: LITTLE SHOP INVENTORY EXPENSE -6,998. PART XII, LINE 2D - OTHER ADJUSTMENTS: LITTLE SHOP INVENTORY EXPENSE 6,998. 1 1 1 X 600.000000000000 1 X 900.000000000000 0 1 0 0 115800 115800 115800 115800 0 0.00000 163210 163210 0.00600 48531 48531 0.00180 9281044 8826886 454158 0.03180 61025 61025 0.00220 9553810 8826886 726924 0.04180 9669610 8942686 726924 0.04180 1 264361 258546 91168 167378 X 1 1 1 1 SILVER HILL HOSPITAL 208 VALLEY ROAD NEW CANAAN CT 06840 WWW.SILVERHILLHOSPITAL.ORG H-0006 X SILVER HILL HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X WWW.SILVERHILLHOSPITAL.ORG 1 20 1 WWW.SILVERHILLHOSPITAL.ORG 0 1 X 600.000000000000 900.000000000000 X X 1 1 X X X 1 X WWW.SILVERHILLHOSPITAL.ORG X WWW.SILVERHILLHOSPITAL.ORG X WWW.SILVERHILLHOSPITAL.ORG X X X X X 1 X 0 X 1 X 0 0 SILVER HILL HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY ENGAGEMENT AND FEEDBACK WERE AN INTEGRAL PART OF THE CHNA PROCESS. SILVER HILL HOSPITAL SOUGHT COMMUNITY INPUT THROUGH KEY INFORMANT INTERVIEWS WITH COMMUNITY LEADERS AND PARTNERS. PUBLIC HEALTH AND HEALTH CARE PROFESSIONALS AS WELL AS LEADERS AND REPRESENTATIVES OF NON-PROFIT AND COMMUNITY-BASED ORGANIZATIONS SHARED KNOWLEDGE ABOUT MENTAL HEALTH AND SUBSTANCE ABUSE AND PROVIDED INSIGHT ON THE COMMUNITY, INCLUDING UNDERSERVED POPULATIONS. SEE APPENDIX B OF THE COMMUNITY NEEDS ASSESSMENT FOR A LIST OF KEY INFORMANTS.THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM 49 KEY INFORMANTS, INCLUDING PUBLIC HEALTH AND HEALTHCARE PROFESSIONALS, SOCIAL SERVICE PROVIDERS, NOT-PROFIT LEADERS, BUSINESS LEADERS, FAITH BASED ORGANIZATIONS AND OTHER COMMUNITY LEADERS. PARTICIPANTS INCLUDED PUBLIC HEALTH ORGANIZATION PROFESSIONALS, YOUTH AND SOCIAL SERVICE PROVIDERS, EDUCATION/SCHOOL SPECIALISTS, MENTAL HEALTH/SUBSTANCE ABUSE CLINICIANS, GOVERNMENT HOUSING/TRANSPORTATION AGENGIES, AND COMMUNITY MEMBERS. SILVER HILL HOSPITAL PART V, SECTION B, LINE 11: BASED ON FEEDBACK FROM COMMUNITY PARTNERS, INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS, PUBLIC HEALTH EXPERTS, SOCIAL SERVICE ORGANIZATIONS, EDUCATION/SCHOOL ORGANIZATIONS, AND OTHER COMMUNITY REPRESENTATIVES, SILVER HILL HOSPITAL PLANS TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS ON THE FOLLOWING PRIORITIES OVER THE NEXT THREE-YEAR CYCLE: (1) SUBSTANCE MISUSE ISSUES INCLUDING ALCOHOL MISUSE; UNDERAGE DRINKING; VAPING; MARIJUANA, THC, AND CANNABINOIDS; (2) MENTAL HEALTH ISSUES WITH A FOCUS ON DEPRESSION, ANXIETY, AND TRAUMA; (3) ADOLESCENT MENTAL HEALTH WITH A FOCUS ON DEPRESSION AND SUICIDALITY; (4) BARRIERS TO TREATMENT WITH A FOCUS ON NAVIGATING THE MENTAL HEALTHCARE SYSTEM AND STIGMA.THE HOSPITAL PLANS TO ADDRESS:(1) SUBSTANCE MISUSE ISSUES BY: (A) PARTNERING WITH COMMUNITY ORGANIZATIONS TO DEVELOP AND DELIVER EDUCATIONAL PROGRAMMING; (B) HOSTING MEDICAL GRAND ROUNDS TO ENHANCE CLINICIAN KNOWLEDGE AND UNDERSTANDING REGARDING THESE ISSUES; (C) HOSTING AND SPONSORING TRAININGS AND EDUCATIONAL SESSIONS FOR THE DEVELOPMENT OF PEER SUPPORT NETWORKS FOR RECOVERY; (D) PROVIDING ACCESS TO SILVER HILL HOSPITAL PROGRAMS FOR THOSE REQUIRING INPATIENT, RESIDENTIAL, OR INTENSIVE OUTPATIENT TREATMENT; AND (E) OFFERING RECOVERY SUPPORT GROUPS THAT ARE OPEN TO THE COMMUNITY.(2) MENTAL HEALTH ISSUES WITH A FOCUS ON DEPRESSION, ANXIETY, AND TRAUMA BY: (1) PARTNER WITH COMMUNITY ORGANIZATIONS TO DEVELOP AND DELIVER EDUCATIONAL PROGRAMMING BY: (A) HOSTING MEDICAL GRAND ROUNDS TO ENHANCE CLINICIAN KNOWLEDGE AND UNDERSTANDING REGARDING THESE ISSUES; (B) HOSTINGAND SPONSORING TRAININGS AND EDUCATIONAL SESSIONS FOR THE DEVELOPMENT OF PEER SUPPORT NETWORKS; (C) DEVELOPING A TRAUMA FOCUSED TREATMENT TRACK (D) CONTINUING TO EXPAND OUTPATIENT DBT AND WOMEN'S IOP TO MEET COMMUNITY DEMAND; AND (E) PROVIDING ACCESS TO SILVER HILL HOSPITAL PROGRAMS FOR THOSE REQUIRING INPATIENT, RESIDENTIAL, OR INTENSIVE OUTPATIENT TREATMENT.(3) ADDRESS ADOLESCENT MENTAL HEALTH WITH A FOCUS ON DEPRESSION AND SUICIDALITY. PARTNER WITH COMMUNITY ORGANIZATIONS TO DEVELOP AND DELIVER EDUCATIONAL PROGRAMMING BY: (A) HOSTING MEDICAL GRAND ROUNDS TO ENHANCE CLINICIAN KNOWLEDGE AND UNDERSTANDING REGARDING THESE ISSUES; (B) EXPANDING ADOLESCENT IOP TO MEET COMMUNITY DEMAND; AND (C) CONTINUING PARTICIPATION IN COMMUNITY EVENTS ON SUICIDE PREVENTION.(4) ADDRESS BARRIERS TO TREATMENT WITH A FOCUS ON NAVIGATING THE MENTAL HEALTHCARE SYSTEM AND STIGMA BY: (A) INCREASING AWARENESS AND UNDERSTANDING OF MENTAL HEALTH AND ADDICTION ISSUES THROUGH PARTICIPATION IN EDUCATIONAL PROGRAMS, MENTAL HEALTH FAIRS AND WALKS, MEDIA INTERVIEWS,AND SOCIAL MEDIA; (B) CONTINUING TO IMPROVE ADMISSIONS RELATED PROCESSES TO OPTIMIZE PATIENT ACCESS; AND (C) CREATE A WEB-BASED AND PRINT GUIDE TO HELP PATIENTS AND FAMILIES NAVIGATE THE ADDICTION AND MENTAL HEALTHCARE SYSTEMS. SILVER HILL HOSPITAL PART V, SECTION B, LINE 13H: SILVER HILL HOSPITAL, INC. OFFERS FINANCIAL ASSISTANCE, IN THE FORM OF REDUCED RATES, TO QUALIFYING PATIENTS RECEIVING EMERGENCY OR MEDICALLY NECESSARY SERVICES (I.E. INPATIENT LEVEL OF CARE). THE POLICY APPLIES TO PATIENTS THAT HAVE NO INSURANCE OR HAVE EXHAUSTED THEIR INSURANCE BENEFITS, AND HAVE INCOME OF LESS THAN 300% OF THE FEDERAL POVERTY GUIDELINES. COINSURANCE, COPAYMENTS AND DEDUCTIBLES ARE EXCLUDED FROM THE POLICY.THE HOSPITAL ALSO OFFERS FINANCIAL ASSISTANCE TO PATIENTS RECEIVING TREATMENT IN ITS TRANSITIONAL LIVING PROGRAMS. TRANSITION LIVING PROGRAM SERVICES ARE NOT CONSIDERED AN INPATIENT LEVEL OF CARE. TRANSITIONAL LIVING PATIENTS ARE ELIGIBLE FOR DISCOUNTED CARE IF THEY ARE CLINICALLY APPROPRIATE AND MOTIVATED FOR TREATMENT AND HAVE INCOME LEVELS EQUAL TO OR LESS THAN 900% OF THE FEDERAL POVERTY GUIDELINES.THIS POLICY IS AVAILABLE ATHTTPS://SILVERHILLHOSPITAL.ORG/RESOURCES SILVER HILL HOSPITAL PART V, SECTION B, LINE 16J: THE HOSPITAL MAINTAINS A FORMAL, WRITTEN FINANCIAL ASSISTANCE POLICY FOR ITS TRANSITIONAL LIVING PROGRAM. THE POLICY IS AVAILABLE UPON REQUEST. PATIENTS WHO DO NOT HAVE THE FINANCIALABILITY TO PAY FOR SERVICES, MAY APPLY FOR FINANCIAL ASSISTANCE UPON ADMISSION INTO THE PROGRAM. SILVER HILL HOSPITAL PART V, SECTION B, LINE 21D: IT IS THE POLICY OF THE HOSPITAL THAT PATIENTS ASSESSED TO BE SUFFERING FROM A BEHAVIORAL EMERGENCY MEDICAL CONDITION WILL BE ADMITTED, REGARDLESS OF THEIR INSURANCE STATUS OR ABILITY TO PAY, AS REQUIRED BY THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA). SCHEDULE H, PART V, LINE 22 THE HOSPITAL OFFERS FINANCIAL ASSISTANCE, IN THE FORM OF REDUCED RATES, TO QUALIFYING PATIENTS RECEIVING EMERGENCY OR MEDICALLY NECESSARY SERVICES. THE FULL TEXT VERSION OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS AVAILABLE ONLINE AT:HTTPS://SILVERHILLHOSPITAL.ORG/RESOURCES PART I, LINE 3C: THE HOSPITAL USED A FPG OF 300% AS A FACTOR FOR DETERMINING ELIGIBILITY FOR PROVIDING DISCOUNTED CARE FOR MEDICALLY NECESSARY SERVICES. MEDICALLY NECESSARY SERVICES ARE DEFINED BY THE HOSPITAL AS INPATIENT SERVICES.THE HOSPITAL USED A FPG OF 600% AS A FACTOR FOR DETERMINING ELIGIBILITY FOR PROVIDING FREE CARE FOR TRANSITIONAL LIVING SERVICES (NON-INPATIENT SERVICES), AND A FPG OF 900% FOR DETERMINING ELIGIBILITY FOR PROVIDING DISCOUNTED CARE FOR TRANSITIONAL LIVING SERVICES (NON-INPATIENT SERVICES). PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES, WAS USED TO DETERMINE FINANCE ASSISTANCE COSTS REPORTED. A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO DETERMINE THE AMOUNT OF INPATIENT CARE THAT WAS SUBSIDIZED IN THE TAX YEAR ENDING 12/31/2021. ALL OTHER EXPENSES REPORTED ARE ACTUAL COSTS. PART III, LINE 2: BAD DEBT EXPENSE IS ESTIMATED BASED ON HISTORICAL AND EXPECTED WRITE-OFFS AND NET COLLECTIONS, AS WELL AS AGING STATUS. A COST TO CHARGE RATIO FROM WORKSHEET 2 WAS APPLIED TO BAD DEBT EXPENSE REPORTED IN THE AUDITED FINANCIAL STATEMENTS IN ORDER TO DETERMINE THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2. PART III, LINE 3: BAD DEBT EXPENSE IS MAINLY COMPRISED OF UNCOLLECTIBLE CO-PAYS AND DEDUCTIBLES FROM PATIENTS WITH INSURANCE. CO-INSURANCE AND DEDUCTIBLE BALANCES ARE EXCLUDED FROM THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: EXCERPT FROM THE AUDITED FINANCIAL STATEMENT, FOOTNOTE 2 - NET PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE:PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PRIVATE PAYERS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED. THESE AMOUNTS ARE BASED ON HISTORICAL AND EXPECTED PRICE CONCESSIONS AND NET COLLECTIONS AS WELL AS AGING STATUS. BASED ON HISTORICAL EXPERIENCE, A PORTION OF THE HOSPITAL'S SELF-PAY PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. IMPLICIT PRICE CONCESSIONS ARE RECORDED AS A DIRECT REDUCTION TO NET PATIENT SERVICE REVENUE AND ARE BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE. PART III, LINE 8: N/A PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY STATES THE FOLLOWING: PATIENT ACCOUNTS WILL WORK WITH PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE TO DEVELOP A REASONABLE BUDGET/PAYMENT PLAN. DELINQUENT SELF-PAY BALANCES FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE MAY BE SENT TO OUTSIDE COLLECTION AGENCIES; HOWEVER THE HOSPITAL WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIONS (ECA) AGAINST THESE PATIENTS. PART VI, LINE 2: IN ADDITION TO THE CHNA, THE SILVER HILL HOSPITAL STAFF ASSESSES THE NEED FOR ADDITIONAL PROGRAMMING BASED ON SERVICE AVAILABILITY FOR OUR DISCHARGING PATIENT POPULATION. THE HOSPITAL ALSO RECEIVES INPUT FROM COMMUNITY-BASED CLINICIANS TO IDENTIFY NEEDS WITHIN THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: SOCIAL WORKERS HAVE A COMPREHENSIVE VIEW OF A PATIENT'S FINANCIAL AND SOCIAL SITUATION AND ARE KNOWLEDGEABLE ABOUT THE ELIGIBILITY CRITERIA FOR ENTITLEMENT PROGRAMS. IT IS THE ASSIGNED RESPONSIBILITY OF THE SOCIAL WORKER TO INFORM PATIENTS AND THEIR FAMILIES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS.PATIENTS WHO DO NOT HAVE THE FINANCIAL ABILITY TO PAY FOR SERVICES, ARE EDUCATED ABOUT SILVER HILL HOSPITAL'S FINANCIAL ASSISTANCE AND SCHOLARSHIP PROGRAMS BY A SPECIALLY TRAINED STAFF MEMBER. THE STAFF MEMBER PROVIDES PATIENTS AND THEIR FAMILIES WITH THE FINANCIAL GUIDELINES AND SUPPORTING DOCUMENTATION REQUIRED FOR OBTAINING FINANCIAL ASSISTANCE/ SCHOLARSHIPS. PART VI, LINE 4: COMMUNITY INFORMATION: APPROXIMATELY 29% OF THE PATIENT POPULATION IS FROM CONNECTICUT, 38% FROM NEW YORK AND 33% FROM OTHER AREAS. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH: SILVER HILL HOSPITAL FURTHERS ITS EXEMPT PURPOSE OF PROMOTING HEALTH OF THE COMMUNITY THROUGH A DIVERSE BOARD OF DIRECTORS WHOSE MEMBERS CONTRIBUTE THROUGH THEIR UNIQUE TALENTS AND RESOURCES TOWARD THE HOSPITAL'S MISSION OF HEALING AND THE CARE OF ITS PATIENTS. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM: N/A FORM 990, PART VI, LINE 7 STATE FILING OF THE COMMUNITY BENEFIT REPORT: DURING TAX YEAR ENDING 12/31/2021, THE HOSPITAL WAS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF CONNECTICUT. 1 NEW CANAAN POLICE DEPARTMENT 174 SOUTH AVE NEW CANAAN CT 06840 066002043 GOVT 10000 0 DONATION NEW CANNAAN VOLUNTEER AMBULANCE CORPORATION PO BOX 598 NEW CANAAN CT 06840 237300265 501(C)(3) 10000 0 DONATION NEW CANAAN FIRE DEPARTMENT PO BOX 963 NEW CANAAN CT 06840 066062229 501(C)(3) 10000 0 DONATION NEW CANAAN COMMUNITY FOUNDATION 111 CHERRY STREET NEW CANAAN CT 06840 060970466 501(C)(3) 50000 0 DONATION 4 0 PART I, LINE 2: A. THE AMOUNTS REPORTED ON SCHEDULE I ARE ASSISTANCE TO SUPPORT LOCAL GOVERNMENT DEPARTMENTS AND 501(C )(3) ORGANIZATIONS. DUE TO THE NATURE OF THESE PAYMENTS TO TRUSTEE GRANTEES, ELIGIBILITY DETERMINATION AND POST-GRANT MONITORING IS NOT APPLICABLE. X 0 1 X X X X 0 0 0 0 0 0 0 1 0 ANDREW GERBER MD PHD PRESIDENT & MEDICAL DIRECT 549887 0 71500 0 180 0 19500 0 30828 0 671895 0 0 0 MICHAEL D GROAT PHD CHIEF CLINICAL OFFICER 372819 0 34048 0 5244 0 26000 0 30828 0 468939 0 0 0 HOWARD K WEINER PHYSICIAN 376203 0 0 0 516 0 0 0 30828 0 407547 0 0 0 TIMOTHY DOUGHERTY CHIEF ADVANCEMENT OFFICER 284139 0 39000 0 516 0 24960 0 30828 0 379443 0 0 0 PETRA M PILGRIM PHYSICIAN 281131 0 0 0 120 0 14100 0 10937 0 306288 0 0 0 KRISTEN WOLFE CHIEF BUSINESS OFFICER 251462 0 24375 0 108 0 5382 0 22112 0 303439 0 0 0 LISA BENTON CHIEF QUALITY OFFICER 239219 0 32500 0 516 0 3120 0 24292 0 299647 0 0 0 ROCCO MAROTTA PHYSICIAN 234150 0 0 0 2472 0 26000 0 19795 0 282417 0 0 0 ANRI KISSILENKO PHYSICIAN 226921 0 0 0 516 0 23879 0 30828 0 282144 0 0 0 MARGUERITE MERIWETHER BROWN PHYSICIAN 234840 0 0 0 276 0 0 0 17525 0 252641 0 0 0 SHARON KOWALCHUK CHIEF NURSING OFFICER 179939 0 0 0 1524 0 23400 0 19795 0 224658 0 0 0 AYANA THOMAS CHIEF INFORMATION OFFICER 168808 0 13542 0 10085 0 1354 0 17308 0 211097 0 0 0 PART I, LINE 1B THE CHIEF CLINICAL OFFICER RECEIVED A TAX GROSS-UP PAYMENT OF $4,952 RELATED TO HIS BONUS. ADDITIONALLY, THE CHIEF INFORMATION OFFICER RECEIVED A MOVING REIMBURSEMENT PAYMENT OF $10,000. BOTH PAYMENTS WERE INCLUDED IN TAXABLE COMPENSATION AND ARE REPORTED IN SCHEDULE J, PART II, COLUMN B(III). PART I, LINE 7 THE CHIEF EXECUTIVE OFFICER, CHIEF CLINICAL OFFICER, CHIEF ADVANCEMENT OFFICER, CHIEF BUSINESS OFFICER, CHIEF QUALITY OFFICER, AND CHIEF INFORMATION OFFICER WERE ELIGIBLE FOR INCENTIVE COMPENSATION BASED ON THE ACHIEVEMENT OF PERFORMANCE GOALS ESTABLISHED AND APPROVED BY THE BOARD OF DIRECTORS. IN CALENDAR YEAR 2021, THE AFOREMENTIONED INDIVIDUALS RECEIVED COMPENSATION FOR ACHIEVEMENT OF INCENTIVE GOALS RELATED TO THE FISCAL YEAR ENDING FEBRUARY 28, 2021. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(II). X 1 51840 APPRAISAL X 6 81623 FMV 0 1 0 PART I, COLUMN (B): THE AMOUNT IN COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART 1, LINE 1 THE MISSION OF SILVER HILL HOSPITAL IS TO PROVIDE OUR PATIENTS WITH THE BEST AVAILABLE TREATMENT OF MENTAL ILLNESS AND ADDICTION; AND TO OFFER CONTINUING SUPPORT, COUNSELING AND EDUCATION TO OUR PATIENTS AND THEIR FAMILIES IN EVERY PHASE OF ILLNESS AND RECOVERY. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION'S INTERIM CHIEF FINANCIAL OFFICER BECAME A FULL-TIME EMPLOYEE AS OF JANUARY 1, 2022. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW BY ORGANIZATION THE FORM 990 OF THE ORGANIZATION IS PREPARED BY THE FINANCE DEPARTMENT OF SILVER HILL HOSPITAL BASED ON THE BOOKS AND RECORDS OF THE ORGANIZATION. THE DRAFT RETURN AND ALL SUPPORTING DOCUMENTATION ARE PROVIDED TO THE ORGANIZATION'S INDEPENDENT ACCOUNTANTS FOR REVIEW AND FINAL PREPARATION OF THE RETURN. THE FINAL VERSION OF THE FORM 990 IS THEN REVIEWED BY THE INTERIM CFO AND PRESDIENT & MEDICAL DIRECTOR. THE FINAL VERSION OF THE FORM 990 IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY FOR THEIR REVIEW AND COMMENTS BEFORE FILING THE FORM WITH THE INTERNAL REVENUE SERVICES. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE WITH CONFLICT OF INTEREST POLICY THE HOSPITAL REQUIRES THE BOARD OF DIRECTORS AND OFFICERS TO COMPLETE A NOTIFICATION OF COMPLIANCE QUESTIONNAIRE AT THE END OF EACH TAX YEAR. THE FINANCE DEPARTMENT REVIEWS THE QUESTIONNAIRES FOR DETERMINATION OF POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICTS OF INTEREST ARE MADE KNOWN TO THE BOARD FOR RESOLUTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATION EACH YEAR, OR WHEN OTHERWISE REQUIRED, THE BOARD OF DIRECTORS APPOINTS A COMPENSATION SUB-COMMITTEE OF INDEPENDENT DIRECTORS TO REVIEW THE COMPENSATION OF THE PRESIDENT AND MEDICAL DIRECTOR. THE SUB-COMMITTEE REVIEWS THE FORM 990'S OF SIMILAR ORGANIZATIONS AS WELL AS AMERICAN HOSPITAL ASSOCIATION SURVEYS, AND MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. ANY DELIBERATIONS AND DECISIONS OF THE COMPENSATION SUB-COMMITTEE ARE DOCUMENTED IN THE MEETING MINUTES OF THE COMPENSATION SUB COMMITTEE. THE HOSPITAL ENGAGES A THIRD PARTY TO CONDUCT A SALARY SURVEY OF ALL OTHER HOSPITAL POSITIONS. THE SURVEY IS CONDUCTED EVERY TWO YEARS. THE MOST RECENT SURVEY WAS CONDUCTED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AVAILABILITY THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. THE SH-YNHHS TRANSITIONAL LIVING TREATMENT PROGRAM PARTNERSHIP 208 VALLEY ROAD NEW CANAAN CT 06840 843028517 HEALTHCARE SERVICES CT SILVER HILL HOSPITAL RELATED 2424001 4998214 0 1 0.75000 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 THE SH-YNHHS TRANSITIONAL LIVING PARTNERSHIP S 225000 BOOK VALUE