2025-07-31T14:56:23-05:00 2024-09-30 390859910 BAKER TILLY ADVISORY GROUP LP 66 HUDSON BLVD E SUITE 2200 NEW YORK NY 10001 990 2023-10-01 060646718 MIDDLESEX HOSPITAL MIDD 8603586395 28 CRESCENT STREET MIDDLETOWN CT 06457 SUSAN MARTIN VP FINANCE & TREASURER 8603586395 2025-07-29 1 1 MARY-EVELYN ANTONETTI P00431862 2126976900 2025-07-29 2023 2025-03-06 01:10:19Z VINCENT CAPECE JR 28 CRESCENT STREET MIDDLETOWN CT 06457 626247730 0 X WWW.MIDDLESEXHOSPITAL.ORG X 1895 CT A NON-PROFIT, ACUTE CARE, COMMUNITY HOSPITAL IN MIDDLETOWN, CT. (SEE SCHEDULE O)MIDDLESEX HOSPITAL IS COMMITTED TO PROVIDING HIGH QUALITY INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. THE HOSPITAL RECOGNIZES COMMUNITY TRANSPARENCY AND INTEGRITY AS FUNDAMENTAL RESPONSIBILITIES. 13 12 3749 294 429573 38300 5932612 4909299 486141966 505943479 11470240 21589831 9094420 7212877 512639238 539655486 150290 167590 0 0 270526465 286737465 0 0 995357 215035177 206832793 485711932 493737848 26927306 45917638 557504992 614139759 148816360 146576115 408688632 467563644 X MIDDLESEX HOSPITAL EXISTS TO PROVIDE THE SAFEST, HIGHEST-QUALITY HEALTH CARE AND THE BEST EXPERIENCE POSSIBLE FOR OUR COMMUNITY. (CONTINUED ON SCHEDULE O) 0 0 441919291 167590 511455341 IN MARCH OF 2020, MIDDLESEX HOSPITAL AS PART OF MIDDLESEX HEALTH'S COMMUNITY HEALTH AND WELL-BEING BASED WORK SHIFTED DRAMATICALLY TO ADDRESS THE COVID-19 PANDEMIC AND RESPOND TO COMMUNITY LEVEL NEEDS. MIDDLESEX HOSPITAL CONTINUES TO GO ABOVE AND BEYOND TO PROVIDE THE SAFEST POSSIBLE CARE TO ALL PATIENTS, WHETHER OR NOT THEIR ILLNESS IS RELATED TO THE CORONAVIRUS. MIDDLESEX HOSPITAL CONTINUES TO PROVIDE UPDATES AND ACCESS TO RESOURCES TO HELP MEMBERS OF THE COMMUNITY STAY SAFE AND HEALTHY DURING THESE CHALLENGING TIMES. ARMED WITH SKILLED STAFF, PROGRESSIVE DIAGNOSTIC TOOLS AND ADVANCED SURGICAL TECHNIQUES, THE HOSPITAL WAS WELL POSITIONED TO ENSURE A COMFORTABLE, SAFE ENVIRONMENT FOR EXCEPTIONAL MEDICAL TREATMENT AND RECOVERY. (CONTINUED ON SCHEDULE O)IN THE FISCAL YEAR ENDING 9/30/24, INPATIENT CARE REPRESENTED 11,455 DISCHARGES AND 54,274 PATIENT CARE DAYS. INPATIENT CARE FROM REGISTRATION THROUGH DISCHARGE IS CAREFULLY MANAGED TO EXCEED REGULATORY REQUIREMENTS AND ENSURE QUALITY, PATIENT SATISFACTION, AND BEST PRACTICE WITH EACH ASPECT OF THE INPATIENT EXPERIENCE, INCLUDING ALL ELEMENTS OF CARE FROM NURSING COMPETENCY AND COMPASSION, TO MEAL QUALITY, LAB AND DIAGNOSTIC TESTING, SAFE AND SECURE PHYSICAL SURROUNDINGS TO PATIENT EDUCATION. MIDDLESEX HOSPITAL, LICENSED FOR 275 BEDS AND 22 BASSINETS, PROVIDES ACUTE CARE FROM DEDICATED HEALTH CARE TEAMS WHICH INCLUDE SURGEONS, HOSPITALISTS, FAMILY PRACTITIONERS AND RESIDENTS, MEDICAL STAFF PHYSICIANS, MAGNET NURSES, PHYSICIAN ASSISTANTS, PATIENT CARE TECHNOLOGISTS, DIAGNOSTIC TECHNICIANS, PATHOLOGISTS, ADMINISTRATORS, ENVIRONMENTAL SERVICES, SECURITY, ENGINEERING AND A HOST OF OTHERS WORKING TOGETHER TO ENABLE THE ORGANIZATION'S SUCCESS.THE HOSPITAL UNITS INCLUDING INTENSIVE AND CRITICAL CARE, MEDICAL SURGICAL, ONCOLOGY, ORTHOPEDIC, PULMONOLOGY, VASCULAR AND CARDIOLOGY, GASTROINTESTINAL, MATERNITY, A 20-BED PSYCHIATRIC FLOOR, AND HOSPICE SERVICES SPECIALIZE IN THE SPECIFIC NEEDS OF THEIR PATIENTS AND ARE STAFFED TO ACCOMMODATE THE UNIQUE TREATMENT REQUIREMENTS OF EACH. ALL ANCILLARY SERVICES INCLUDING LABS, RADIOLOGY, FOOD SERVICES, PATHOLOGY, PHARMACY, MEDICAL TRANSCRIPTION AND INFORMATION SERVICES TOO ARE A PART OF THE HOSPITAL TEAM. PATIENT CARE IS DEVELOPED WITH FULL CONSIDERATION OF THE WHOLE INDIVIDUAL, AS THEY ARE ASSIGNED TO CONDITION SPECIFIC CARE PATHWAYS AND SERVICES TO SECURE BEST TREATMENT AND RECOVERY. 441919291 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 1 289 0 1 3749 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 13 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X X SHANNON ST HILAIRE 8603586000 28 CRESCENT STREET MIDDLETOWN CT 06457 VINCENT CAPECE JR PRESIDENT/CEO 40.00 4.00 X X 1465474 0 327312 DAVID C BENOIT DIRECTOR 1.00 3.00 X 0 0 0 JEAN M D'AQUILA DIRECTOR 1.00 4.00 X 0 0 0 JOHN J GAUTHIER DIRECTOR 1.00 3.00 X 0 0 0 ROBERT C HINTON DIRECTOR 1.00 3.00 X 0 0 0 CHANDLER J HOWARD VICE CHAIRMAN 1.00 3.00 X X 0 0 0 JONATHAN D LEVINE MD SECRETARY 1.00 4.00 X X 0 0 0 MARK D LORENZE MD ASST SECRETARY 1.00 3.00 X X 0 0 0 DARRELL G PATASKA CHAIRMAN 1.00 3.00 X X 0 0 0 CHRISTINE H REPASY DIRECTOR 1.00 3.00 X 0 0 0 GARY M WALLACE DIRECTOR 1.00 3.00 X 0 0 0 MARK BERTOLAMI DIRECTOR 1.00 3.00 X 0 0 0 ELIZABETH G JUDD DIRECTOR (JOINED 10/1/23) 1.00 3.00 X 0 0 0 SUSAN MARTIN VP FINANCE/TREASURER 40.00 4.00 X 696091 0 68827 JONATHAN BANKOFF CHAIRMAN EMERGENCY MEDICINE 40.00 0.00 X 501396 0 56892 TODD BISCHOP CHIEF DEPT OF MED 40.00 0.00 X 440341 0 25440 DAVID GIUFFRIDA VP FACILITIES AND SUPPORT SVCS 40.00 0.00 X 516951 0 51049 EVAN JACKSON VP & CIO 40.00 0.00 X 529738 0 100074 DONNA STRONESKI VP HUMAN RESOURCES 40.00 0.00 X 421429 0 64139 DAVID COSENTINO VP QUALITY & PATIENT SAFETY 40.00 0.00 X 571059 0 108448 KELLY HAECKEL VP PATIENT CARE SVCS/CNO 40.00 0.00 X 391175 0 84578 LELAND MCKENNA VP PLANNING & EXTERNAL AFFAIRS 40.00 0.00 X 322825 0 51891 JUSTIN DREW VP AMBULATORY & CLINICAL SVCS 40.00 0.00 X 322658 0 56190 JEFFREY SHELTON CHAIRMAN DEPT PSYCH 40.00 0.00 X 457001 0 44208 THEODORE HARTENSTEIN MED DIRECTOR, UTILIZATION 40.00 0.00 X 506696 0 56442 JUSTIN GORALNIK PULMONOLOGIST 40.00 0.00 X 470423 0 34861 RICARDO PEREZ PULMONOLOGIST 40.00 0.00 X 504207 0 50292 BRIAN MCGUIRE PHYSICIAN 40.00 0.00 X 423850 0 60949 JESSE WAGNER MD FORMER KEY EMPLOYEE 40.00 0.00 X 206816 0 4136 LAURA MARTINO LEFT 122022 FORMER KEY EMPLOYEE 40.00 0.00 X 370265 0 151713 9118395 0 1397441 589 1 1 0 EPIC SYSTEMS 1979 MILKY WAY VERONA WI 53593 TECHNOLOGY SERVICES 5024701 QUEST DIAGNOSTICS INC PO BOX 844217 BOSTON MA 02284 LABORATORY SERVICES 2112123 CAROUSEL INDUSTRIES INC 659 SOUTH COUNTRY TRAIL EXETER RI 02822 IT SERVICES 1942316 EPLUS TECHNOLOGY 13595 DULLES TECHNOLOGY DRIVE HERNDON VA 20171 TECHNOLOGY SERVICES 1502028 MEDIATELY LLC 525 S FLAGLER DRIVE SUITE 300 WEST PALM BEACH FL 33401 MARKETING 1471405 112 1223 231120 2809685 1867271 382095 4909299 NET PATIENT SERVICE REVENUE 621400 500953575 500953575 NET INCOME FROM JOINT VENTURES 900003 4590769 4590769 SPECIMEN LAB 621500 399135 399135 505943479 7635115 7635115 28489 28489 1191825 1174768 17057 17057 17057 84111753 15013608 85185712 13422 -1073959 15000186 13926227 13926227 94447 231120 95314 -867 -867 176910 123028 53882 53882 PURCHASE DISCOUNTS 900003 2374084 2374084 CAFETERIA REVENUE 722514 1201370 1201370 IN-SYSTEM BILLING MANAGEMENT FEES 900003 933029 933029 2634322 2603884 30438 7142805 539655486 511455341 429573 22861273 167590 167590 7526485 6021188 1505297 527491 504472 23019 231319881 211585521 19734360 9823350 9126763 696587 21313411 19615344 1698067 16226847 14928699 1298148 1890863 848503 47003 995357 342908 342908 202930 202930 163464 163464 219493 219493 41070138 31325889 9744249 2313770 33706 2280064 6435428 5536609 898819 17616922 13489687 4127235 8698235 5357038 3341197 1001884 989036 12848 863959 712073 151886 779102 779102 28379514 24874317 3505197 4678017 4675213 2804 MEDICAL SUPPLIES 57077327 57056095 21232 STATE HOSPITAL TAX 30132931 30132931 FOOD 1962137 1952415 9722 DUES & LICENSES 934807 356419 578388 2068964 1850681 218283 493737848 441919291 50823200 995357 1831470 2685252 53706556 60898185 1619641 1103976 54929290 62426314 129187 46592 2088722 1809484 6274581 6215106 616378531 394398072 227172252 221980459 187162423 232608662 316067 258600 22274803 24107129 557504992 614139759 64573412 66081379 132420 0 24740230 21081766 1996879 1284222 57373419 58128748 148816360 146576115 X 388767615 445750847 19921017 21812797 408688632 467563644 557504992 614139759 X 45917638 31854046 -18896672 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 163464 163464 0 PART II-B, LINE 1: MIDDLESEX HOSPITAL PAYS DUES TO BOTH THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE CONNECTICUT HOSPITAL ASSOCIATION (CHA). A PERCENTAGE OF THOSE DUES FUNDED LOBBYING ACTIVITIES DURING THE FISCAL YEAR. THE PORTION OF AHA DUES TOTALED $16,378 AND THE PORTION OF CHA DUES TOTALED $67,753. IN ADDITION, MIDDLESEX HOSPITAL CONTRACTED WITH TWO CONSULTANTS WHO PERFORMED LOBBYING ACTIVITIES. THOSE EXPENSES TOTALED $79,333. 155313000 142000 32486000 153000 187788000 138207000 77000 17164000 135000 155313000 167025000 99000 -28415000 502000 138207000 139852000 140000 27444000 411000 167025000 128949000 11014000 111000 139852000 0.93000 0.00000 0.07000 0 0 14571462 14571462 370601818 246421751 124180067 4011246 2544856 1466390 212098841 141961322 70137519 15095164 3470143 11625021 221980459 EST. SELF-INSURANCE LIABILITIES 27720087 ACCRUED RETIREMENT LIABILITIES 4405926 ASSET RETIREMENT OBLIGATION 633750 THIRD-PARTY SETTLEMENTS 11862907 OTHER LIABILITIES 296302 SECURITY DEPOSITS 4172 HOME CARE 9511 OPERATING LEASE LIABILITIES 13196093 58128748 X PART V, LINE 4: THE WITHOUT DONOR RESTRICTIONS RECORDED IN THE BOARD-DESIGNATED (QUASI-ENDOWMENT) FUNDS ARE ASSETS SET ASIDE BY THE BOARD FOR FUTURE UNSPECIFIED USES AND TO SUPPORT EDUCATION AND OTHER PROGRAMS OVER WHICH THE BOARD RETAINS CONTROL AND MAY, AT ITS DISCRETION, SUBSEQUENTLY USE FOR OTHER PURPOSES. PERMANENT ENDOWMENT FUNDS ARE ASSETS RECEIVED WITH THE DONOR STIPULATION THAT THE PRINCIPAL BE INVESTED IN PERPETUITY AND THAT ONLY THE INCOME EARNED THEREON IS AVAILABLE FOR SPECIFIC OR GENERAL SERVICES, SUCH AS FREE BED FUNDS AND SUPPORT OF HOSPITAL OPERATIONS. THESE ARE NOT IDENTIFIED ON THE AUDIT STATEMENTS IN THIS FASHION FOR FY2024. THEY ARE IN AS EITHER WITH OR WITHOUT DONOR RESTRICTIONS. TEMPORARILY RESTRICTED ENDOWMENT FUNDS ARE ASSETS RESTRICTED BY THE DONOR EITHER AS TO PURPOSE AND/OR AS TO TIME OF EXPENDITURE, SUCH AS EDUCATION, HEALTH SERVICES AND CAPITAL PURCHASES. PART X, LINE 2: BELOW IS AN EXCERPT FROM FOOTNOTE 2 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR MIDDLESEX HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE SYSTEM ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FASB ASC 740, "INCOME TAXES," WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE SYSTEM DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2024 AND 2023. IT IS THE SYSTEM'S POLICY TO RECORD PENALTIES AND INTEREST ASSOCIATED WITH UNCERTAIN TAX PROVISIONS AS A COMPONENT OF OPERATING EXPENSES. AS OF SEPTEMBER 30, 2024 AND 2023, THE SYSTEM DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE SYSTEM'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. TPC GOLF 187800 119700 68100 230 36452 24077 8890 HOSPICE GOLF 109977 83630 26347 3330 8208 12155 875 1 27790 27790 1097 325567 231120 94447 3560 44660 36232 10862 95314 -867 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 1054 3635320 2425521 1209799 0.00250 22628 111056161 74269190 36786971 0.07450 23682 114691481 76694711 37996770 0.07700 22252 2577443 107285 2470158 0.00500 732 14657545 3322618 11334927 0.02300 38350 71775710 42961492 28814218 0.05840 86 264969 0 264969 0.00050 9958 296641 13120 283521 0.00060 71378 89572308 46404515 43167793 0.08750 95060 204263789 123099226 81164563 0.16450 17436 17436 0.00000 30 116592 116592 0.00020 89 24220 24220 0.00000 119 158248 158248 0.00020 0 12835982 1283598 40204094 42050273 -1846179 X 1 1 1 1 MIDDLESEX HOSPITAL 28 CRESCENT STREET MIDDLETOWN CT 06457 WWW.MIDDLESEXHEALTH.ORG 000069 X X X X MIDDLESEX HOSPITAL 1 0 0 1 X X X X X X X X X X 22 1 0 0 1 X SEE STATEMENT X X 1 23 1 SEE STATEMENT 0 1 X 100.000000000000 500.000000000000 X X 1 1 X X X 1 X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X X 1 X 0 X 1 X 0 0 MIDDLESEX HOSPITAL PART V, SECTION B, LINE 3J: IN ADDITION TO THE ELEMENTS SELECTED IN PART V, LINE 3, MIDDLESEX HOSPITAL'S MOST RECENTLY COMPLETED (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EXAMINED HOW SOCIAL DETERMINANTS OF HEALTH AND HEALTH DISPARITIES IMPACT HEALTH OUTCOMES. THE REPORT CONTINUED TO RAISE AWARENESS ABOUT HEALTH-RELATED SOCIAL NEEDS, WELL-BEING AND QUALITY OF LIFE, HEALTH DISPARITIES, AND VULNERABLE POPULATIONS. ACHIEVING HEALTH EQUITY - THE ATTAINMENT OF THE HIGHEST LEVEL OF HEALTH FOR ALL PEOPLE - STARTS WITH ASKING THE APPROPRIATE QUESTIONS RELATIVE TO DETERMINANTS OF HEALTH AND HOW THEY DISPROPORTIONATELY AFFECT CERTAIN GROUPS OF PEOPLE; NEXT STEPS INVOLVE ADDRESSING THE CONDITIONS THAT PREVENT THE REALIZATION OF GOOD HEALTH FOR THESE VULNERABLE OR MARGINALIZED GROUPS. THROUGH EXAMINATION OF THE INFLUENCE OF DETERMINANTS OF HEALTH, IT IS POSSIBLE TO DEVELOP STRATEGIES THAT ELIMINATE PERSISTENT AND PERVASIVE HEALTH DISPARITIES, PROMOTE HEALTH EQUITY, IMPROVE HEALTH OUTCOMES AND REDUCE FINANCIAL COST. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 5: IN COMPLETING ITS MOST RECENT (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), MIDDLESEX HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF ITS COMMUNITY SERVED, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. A COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE WAS FORMED TO PROVIDE INPUT AND GUIDANCE, INCLUDING REVIEW OF THE STUDY'S DATA COMPONENTS; REVIEW AND INPUT ON THE MIDDLESEX HEALTH CHNA COMMUNITY SURVEY; ASSISTANCE WITH SERVICE AREA-WIDE COMMUNITY SURVEY DISSEMINATION; AND REVIEW AND INPUT ON COMMUNITY RESOURCES AND ASSETS. THE ADVISORY COMMITTEE WAS COMPRISED OF STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING LOCAL HEALTH DEPARTMENTS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), COMMUNITY-BASED ORGANIZATIONS, FAITH-BASED ORGANIZATIONS, ADVOCACY GROUPS, SUPPORT PROFESSIONALS EMBEDDED IN THE COMMUNITY (I.E., COMMUNITY HEALTH WORKERS, DOULAS, RECOVERY COACHES, ETC.) AND COMMUNITY MEMBERS TO ENSURE COMMUNITY VOICE WAS REPRESENTED. TO CAPTURE BROAD COMMUNITY INPUT ON HEALTH NEEDS, SOCIAL DETERMINANTS OF HEALTH AND HEALTH EQUITY, MIDDLESEX HOSPITAL ADMINISTERED A COMMUNITY SURVEY FOR ITS CHNA. SURVEY TOPIC AREAS INCLUDED KEY HEALTH ISSUES AND HEALTH BEHAVIORS, HEALTH CARE ACCESS, AND SOCIAL DETERMINANTS OF HEALTH. QUESTIONS RELATED TO COVID-19 WERE ADDED. ALL THE SURVEY RESPONSE OPTIONS WERE POSED IN QUANTITATIVE FORM THROUGH LIKERT SCALES. A QUALITATIVE OPEN-ENDED TEXT BOX WAS PROVIDED AT THE END OF THE SURVEY TO ALLOW FOR COMMENTS. THE EIGHT-QUESTION SURVEY (FIVE FOCUSED QUESTIONS, TWO DEMOGRAPHIC QUESTIONS AND AN OPTION TO ADD COMMENTS) WAS ADMINISTERED ELECTRONICALLY THROUGH THE ONLINE SURVEYMONKEY FORMAT. TO ENSURE RESPONSES FROM A WIDE RANGE OF REPRESENTATIVE COMMUNITY MEMBERS AND LEADERS WITH DIVERSE BACKGROUNDS, PERSPECTIVES AND FIRST-HAND KNOWLEDGE ABOUT THEIR COMMUNITIES, THE SURVEY WAS EXTENSIVELY DISSEMINATED TO AN ARRAY OF SECTOR CONTACTS; FORWARDED TO MULTIPLE COLLABORATIVE E-DISTRIBUTION LISTS; POSTED ON WEBSITES AND SOCIAL MEDIA PLATFORMS; AND INCLUDED IN E-NEWSLETTERS THROUGHOUT MIDDLETOWN, MIDDLESEX COUNTY AND THE PERIPHERY TOWNS OF MIDDLESEX HEALTH'S SERVICE AREA. SECTORS INCLUDED ADVOCACY GROUPS, ALLIANCES/COALITIONS, THE BUSINESS COMMUNITY, EDUCATIONAL INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS, COMMUNITY RESIDENTS, ELECTED OFFICIALS, MUNICIPAL STAFF, FAITH-BASED ORGANIZATIONS, FOUNDATIONS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), LOCAL HEALTH DEPARTMENTS, MENTAL HEALTH ORGANIZATIONS, SUBSTANCE TREATMENT FACILITIES, AND YOUTH AND FAMILY SERVICES. COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE MEMBERS WERE ASKED TO BROADLY SHARE THE COMMUNITY SURVEY LINK, AND ALL SURVEY RECIPIENTS WERE INVITED TO SHARE THE LINK WITH COWORKERS, FRIENDS AND FAMILY OR ANYONE WHO LIVES OR WORKS IN MIDDLESEX COUNTY. A TOTAL OF 204 SURVEYS WERE COMPLETED AND RESPONSE RESULTS ARE INCLUDED IN THE MIDDLESEX HEALTH CHNA COMMUNITY SURVEY SECTION OF THE CHNA. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 7D: MIDDLESEX HOSPITAL POSTED ITS MOST RECENTLY COMPLETED CHNA (2022) ON ITS WEB-SITE (HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT) AND ELECTRONICALLY DISTRIBUTED IT THROUGH THE FOLLOWING DISSEMINATION CHANNELS: THE CHNA ADVISORY COMMITTEE; COMMUNITY MEMBERS; AND EXISTING HOSPITAL-COMMUNITY BASED PARTNERSHIP DISTRIBUTION LISTS. RECIPIENTS WERE ENCOURAGED TO WIDELY SHARE THE ASSESSMENT. PAPER COPIES OF THE CHNA WERE AND WILL CONTINUE TO BE PROVIDED UPON REQUEST. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 11: MIDDLESEX HOSPITAL COMPLETED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2022, AND ITS CHNA IMPLEMENTATION STRATEGY WAS APPROVED BY MIDDLESEX HEALTH'S GOVERNING BODY IN FEBRUARY 2023. A FACILITATED COMMUNITY CONVERSATION WAS HELD TO REVIEW, PRIORITIZE, AND DISCUSS STRATEGIES AND SOLUTIONS FOR THE SIGNIFICANT HEALTH AND HEALTH-RELATED NEEDS IDENTIFIED IN MIDDLESEX HEALTH'S 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THEREBY INFORMING MIDDLESEX HEALTH'S CHNA IMPLEMENTATION STRATEGY. THE RESULTS OF THE COMMUNITY CONVERSATION SERVED AS A GUIDE FOR MIDDLESEX HEALTH'S SELECTION OF PRIORITY AREAS FOR ITS CHNA IMPLEMENTATION STRATEGY. THROUGH THIS PROCESS, THE FOLLOWING HEALTH TOPICS WERE SELECTED AS AREAS OF FOCUS FOR THE IMPLEMENTATION STRATEGY: 1) MENTAL HEALTH ALL AGES; 2) SUBSTANCE USE ISSUES; 3) HEALTHY AGING; 4) MATERNAL CHILD HEALTH; AND 5) CHRONIC DISEASES, WITH SOCIAL DETERMINANTS OF HEALTH, HEALTH EQUITY AND THE IMPACTS OF COVID-19 AS ESSENTIAL COMPONENTS FOR EACH HEALTH AREA. WITH REGARD TO NEEDS THAT ARE NOT BEING ADDRESSED, MIDDLESEX HOSPITAL RECOGNIZES THAT IT CANNOT FOCUS ON EVERY HEALTH AND SOCIAL NEED IDENTIFIED IN MOST CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT AND IS THEREFORE COMMITTED TO ALLOCATING RESOURCES AND IN-KIND TIME TO THE HIGHEST AREAS OF IDENTIFIED NEED AND/OR AREAS WITH GREATEST POTENTIAL FOR IMPACT AND FEASIBILITY (THE SELECTED PRIORITY AREAS). RESOURCE CONSTRAINTS PREVENT THE HOSPITAL FROM ADDRESSING EVERY NEED, AND IN MANY CASES, OTHER LOCAL COMMUNITY BASED ORGANIZATIONS MAY BE BETTER SUITED TO TAKE A LEADERSHIP ROLE IN IMPROVING CERTAIN HEALTH OUTCOMES. AS WITH OUR PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENTS, THE HOSPITAL WILL CONTINUE TO BE A WILLING PARTNER, WHEN ABLE, FOR INITIATIVES NOT RELATED TO ITS SELECTED CHNA IMPLEMENTATION STRATEGY PRIORITY AREAS.EXAMPLES OF MIDDLESEX HEALTH'S INVOLVEMENT IN ADDRESSING IDENTIFIED PRIORITY AREAS ARE OUTLINED BELOW. IN ALL EXAMPLES, A CENTRAL TENET OF THE WORK IS ADVANCING HEALTH EQUITY THROUGH INCLUSION AND INTENTIONALITY AND ALL WORK IS GUIDED BY COMMUNITY VOICE. IN RESPONSE TO THE OPIOID EPIDEMIC AND THE SIGNIFICANT UPWARD TREND SPECIFICALLY FOR FENTANYL INVOLVEMENT FOR ACCIDENTAL DRUG-RELATED DEATHS IN MIDDLESEX HEALTH'S SERVICE AREA DUE TO "ANY OPIOID", MIDDLESEX HEALTH IS A FOUNDING MEMBER OF THE GREATER MIDDLETOWN OPIOIDS TASK FORCE ("TASK FORCE"). THE TASK FORCE IS COMPOSED OF MORE THAN 35 AGENCIES, AND HAS A DISTRIBUTION LIST OF MORE THAN 100 MEMBERS. PARTNER AGENCIES INCLUDE MUNICIPALITIES, HEALTH DEPARTMENTS, POLICE AND FIRE DEPARTMENTS, HEALTH CARE ORGANIZATIONS, PARAMEDIC AND AMBULANCE SERVICES, BEHAVIORAL HEALTH SERVICES, TREATMENT AND RECOVERY SERVICES, HARM REDUCTION SERVICES, FAITH-BASED SERVICES, SCHOOLS AND COLLEGES AND COMMUNITY-BASED ORGANIZATIONS. THE TASK FORCE AIMS TO ENGAGE THE GREATER MIDDLETOWN COMMUNITY IN WORKING TOGETHER TO PROMOTE OPIOID AWARENESS, EDUCATION, PREVENTION, HARM REDUCTION AND ACCESS TO TREATMENT THEREBY REDUCING OPIOID-RELATED OVERDOSES AND DEATH. IT ALSO STRIVES TO BUILD A HEALTHY, SAFE AND DRUG-FREE COMMUNITY, AND TO DEVELOP A COMMUNITY THAT WORKS TOGETHER TO PREVENT AND HELP PEOPLE EXPERIENCING OPIOID USE CHALLENGES. THE TASK FORCE CREATED WORK GROUPS TO ADDRESS PRIORITY AREAS, WHICH INCLUDE RESOURCE AWARENESS, ACCESS TO TREATMENT; EDUCATION AND PREVENTION AND INTERVENTION / HARM REDUCTION. ACCOMPLISHMENTS INCLUDE: 1) CREATION OF A 40-PAGE RESOURCE GUIDE THAT PROVIDES IMPORTANT INFORMATION THAT ADDRESSES A NUMBER OF CONCERNS RELATED TO OPIOID USE - FROM INFORMATION ABOUT WITHDRAWAL MANAGEMENT AND INPATIENT OR RESIDENTIAL TREATMENT TO INFORMATION ABOUT RECOVERY COACHES AND SUPPORT GROUPS; 2) COLLABORATION WITH THE VILLAGE FOR FAMILIES & CHILDREN TO BRING A RECOVERY VEHICLE PROGRAM TO MIDDLETOWN ONCE A WEEK THAT OFFERS SUPPORT TO INDIVIDUALS IMPACTED BY OPIOID USE BY PROVIDING PEER SUPPORT, CASE MANAGEMENT, HARM REDUCTION RESOURCES AND CONNECTION TO TREATMENT; 3) A HARM-REDUCTION LEAVE-BEHIND KIT INITIATIVE; AND 4) DEVELOPMENT OF A STRATEGY FOR THE CITY OF MIDDLETOWN OPIOIDS SETTLEMENT FUNDS.MIDDLESEX HEALTH IS AN INTEGRAL MEMBER OF THE GREATER MIDDLETOWN HEALTH ENHANCEMENT COMMUNITY COALITION ("GMHEC"). THE GMHEC'S OBJECTIVE IS TO BE A PLACE-BASED INITIATIVE THAT ADVANCES HEALTH EQUITY, SUPPORTS LONG-TERM, COLLABORATIVE AND CROSS-SECTOR EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELL-BEING THROUGH BROAD, SYSTEMIC CHANGE. ITS GOAL IS TO BUILD HEALTHY AND EQUITABLE COMMUNITIES THAT ACTIVELY WORK TOGETHER TO PREVENT THE DEVELOPMENT OF DISEASE. THE COALITION ENGAGES IN INITIATIVES THAT ADVANCE HEALTH EQUITY, IMPROVE THE SOCIAL, ECONOMIC AND PHYSICAL CONDITIONS WITHIN COMMUNITIES THAT ENABLE INDIVIDUALS AND FAMILIES TO MEET BASIC NEEDS, ACHIEVE THEIR HEALTH AND WELL-BEING GOALS AND THRIVE THROUGHOUT THEIR LIVES. THE COALITION HAS A 90+ PERSON DISTRIBUTION LIST AND IS MADE UP OF 35+ DIFFERENT AGENCIES AND INCLUDES COMMUNITY MEMBERS. CENTERING COMMUNITY VOICE IS CRITICAL TO THE COALITION'S PURPOSE, WHICH ENSURES THAT PRIORITY AREAS AND PROGRAMS ARE DEVELOPED IN RESPONSE TO COMMUNITY DESIRES AND NEEDS. THROUGH ITS EXTENSIVE DISTRIBUTION LIST, THE GMHEC IS ABLE TO SHARE INFORMATION ABOUT UPCOMING COMMUNITY HEALTH AND WELL-BEING EVENTS, WHICH HELPS TO INCREASE ATTENDANCE AT THESE EVENTS. MIDDLESEX HEALTH STAFF MEMBERS ARE PART OF GMHEC LEADERSHIP TEAM AND PROVIDE ADMINISTRATIVE AND GRANT WRITING SUPPORT. WITH A STRONG AND COLLABORATIVE STRUCTURE IN PLACE, THE COALITION CONTINUES TO BUILD PARTNERSHIPS, STRENGTHEN COMMUNITY ENGAGEMENT, AND DEVELOP PROGRAMS THAT RESPOND TO IDENTIFIED HEALTH AND WELL-BEING NEEDS.MIDDLESEX HEALTH ALSO PARTICIPATES IN THE GMAHEC'S NUTRITIOUS FOODS SUBCOMMITTEE ("SUBCOMMITTEE") WHICH WAS FORMED TO FULFILL A COMMUNITY NEED FOR MORE EQUITABLE AND SUSTAINABLE ACCESS TO FRESH, NUTRITIOUS FOODS. A MIDDLESEX HEALTH STAFF MEMBER CO-CHAIRS THE HEC NUTRITIOUS FOODS SUBCOMMITTEE. THE SUBCOMMITTEE RECOGNIZES THAT 1) FOOD INSECURITY IS AN ISSUE IN OUR COMMUNITY; 2) THE BENEFITS OF NUTRITIOUS FOODS TO ADDRESS CHRONIC DISEASE PREVENTION AND MANAGEMENT; 3) THE POTENTIAL TO LEVERAGE MULTIPLE COMMUNITY ASSETS TO CREATE SUSTAINABLE, EQUITABLE ACCESS TO HEALTHY FOOD; AND 4) THAT FOOD (GROWING, PREPARING, EATING) IS A POWERFUL VEHICLE FOR COMMUNITY CONNECTION AND WELL-BEING. THROUGH LISTENING SESSIONS AND COMMUNITY SURVEYING THE SUBCOMMITTEE LEARNED THAT ACCESS TO HEALTHY FRUITS AND VEGETABLES WAS A BARRIER FOR MANY IN THE GREATER MIDDLETOWN COMMUNITY AND GROWING ONE'S OWN VEGETABLES WAS A PREFERRED SOLUTION. IN RESPONSE, THE SUBCOMMITTEE HAS A STARTER PLANT INITIATIVES. AS GROWING ONE'S OWN VEGETABLES IS ASSOCIATED WITH GREATER FRUIT AND VEGETABLE INTAKE (ALAIMO, 2023), CONTAINER PLANTING IS A WAY TO GET PEOPLE ENGAGED AND INTERESTED IN HOME VEGETABLE GARDENING. STARTER PLANTS FEATURING VEGETABLES PREFERRED BY THE COMMUNITY (CHERRY TOMATOES, KALE, CALLALOO, CABBAGE, EGGPLANT, PEPPERS) ARE DISTRIBUTED AT COMMUNITY EVENTS ALONG WITH NUTRITIOUS FOODS EDUCATIONAL MATERIAL AVAILABLE IN ENGLISH AND SPANISH. THE SUBCOMMITTEE HAS STARTED TO PLAN FOR A HYDROPONIC GROWING INITIATIVE WHICH IT PLANS TO PILOT. MIDDLESEX HEALTH HAS PARTNERED WITH THE MINISTERIAL HEALTH FELLOWSHIP'S ("MHF") PREGNANT WITH POSSIBILITIES ("PWP") PROGRAM TO ADDRESS PERINATAL HEALTH DISPARITIES FOR BIRTHING PEOPLE OF COLOR. STRIKING RACIAL AND ETHNIC DISPARITIES EXIST IN THE UNITED STATES FOR PREGNANCY AND BIRTH OUTCOMES. BLACK AND AMERICAN INDIAN/ALASKA NATIVE WOMEN ARE 2-3 TIMES MORE LIKELY TO DIE FROM A PREGNANCY-RELATED CAUSE THAN WHITE WOMEN (CDC, 2007-2016). FOR INFANT MORTALITY, BABIES BORN TO BLACK BIRTHING PEOPLE IN CONNECTICUT ARE MORE THAN 4 TIMES AS LIKELY TO DIE BEFORE THEIR FIRST BIRTHDAY THAN BABIES BORN TO WHITE BIRTHING PEOPLE (CT HEALTH FOUNDATION, 2020). PWP IS A COMMUNITY-BASED PROGRAM THAT PROVIDES DOULA SERVICES IN ORDER TO ADDRESS THE SIGNIFICANT DISPARITIES IN PERINATAL OUTCOMES AMONG BIRTHING PEOPLE OF COLOR AND THEIR BABIES. MHF DOULAS ARE EMBEDDED IN THE MIDDLETOWN COMMUNITY. PROVIDING DOULA SUPPORT FOR A BIRTH IS EVIDENCE-BASED CARE AND PWP IS DESIGNED TO BENEFIT PREGNANT PERSONS AND THEIR HEALTHCARE PROVIDERS. WHAT MAKES THE PWP PROGRAM UNIQUE IS THAT PWP PROVIDES PROFESSIONALS WHO ARE TRAINED AND CERTIFIED AS BOTH DOULAS AND COMMUNITY HEALTH WORKERS. AND, DOULA SUPPORT IS PROVIDED BEFORE, DURING AND UP TO ONE YEAR AFTER DELIVERY. THERE IS NO COST FOR PARTICIPATION IN THE PWP PROGRAM. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 13H: MIDDLESEX HOSPITAL'S SLIDING SCALE OUTLINES THE FACTORS THAT IT USES TO DETERMINE FINANCIAL ASSISTANCE DETERMINATIONS: THE FEDERAL POVERTY INCOME GUIDELINES AND NUMBER OF PERSONS IN HOUSEHOLD. PART V, SECTION B, LINE 7A: HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 10A: HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 16A, FAP WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART V, SECTION B, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART V, SECTION B, LINE 16C, FAP PLAIN LANGUANCE SUMMARY WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART V, SECTION B, LINE 20A: WRITTEN NOTICE ABOUT UPCOMING ECAS WAS NOT REQUIRED BECAUSE THE ORGANIZATION DID NOT PURSUE ANY EXTRAORDINARY COLLECTION ACTION'S DURING THE YEAR. IF AN ECA WAS PURSUED IN THE FUTURE, PROPER NOTICE WOULD BE GIVEN. 1 1 - MIDDLESEX HOSPITAL HOMECARE 770 SAYBROOK ROAD MIDDLETOWN CT 06457 HOMECARE SERVICES, REHAB, HEART HEALTH, OTHER SERVICES PART I, LINE 3C: IN GENERAL, MIDDLESEX HOSPITAL ("THE HOSPITAL") USES FPG TO DETERMINE ELIGIBILITY. THERE ARE, HOWEVER, SPECIAL CIRCUMSTANCES (SUCH AS A CATASTROPHIC EVENT) WHICH MAY AFFECT A PATIENT'S ABILITY TO PAY. IN THIS CASE, THE HOSPITAL EVALUATES THE APPLICATION WITH CONSIDERATION GIVEN TO THE PATIENT'S CURRENT SITUATION. WITH SPECIAL CIRCUMSTANCES, IN ORDER TO MAXIMIZE THE AMOUNT OF FINANCIAL ASSISTANCE DISCOUNT, THE FPG THRESHOLD MAY BE IGNORED AND THE HOSPITAL MAY USE THE PATIENT'S ASSETS AND/OR TAX RETURN ITEMIZED DEDUCTIONS TO DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE. PART I, LINE 7: FOR PART 1, LINE 7 SECTIONS (A) FINANCIAL ASSISTANCE AT COST, (B) MEDICAID, (C) COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS, PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, AND (G) SUBSIDIZED HEALTH SERVICES, THE COSTING METHODOLOGY USED IS A HYBRID COST ACCOUNTING/MEDICARE COST-TO-CHARGE RATIO CALCULATION. THE PERCENTAGES ARE DERIVED FROM THE MOST CURRENT MEDICARE COST REPORT AND APPLIED BY CHARGE LINE APPROPRIATELY. INDIRECT COSTS WERE APPLIED TO SUBSIDIZED HEALTH SERVICES. THE MEDICARE COST REPORT DOES NOT ADDRESS ALL AREAS OF THE HOSPITAL IN THE SAME DETAIL, BUT DOES ACCURATELY ADDRESS INPATIENT AND OUTPATIENT, HOMECARE AND TO AN EXTENT PHYSICIAN SERVICES. SECTIONS (E) COMMUNITY HEALTH IMPROVEMENT; PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, (H) RESEARCH, AND (I) CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS ARE COMPRISED (EXCEPT FOR CASH DONATIONS AND IN-KIND MATERIAL DONATIONS) OF 1) SUPPLY EXPENSES; 2) PURCHASED SERVICES; AND 3) THE DIRECT SALARY COSTS FOR HOSPITAL STAFF WHOSE TIME WAS COMPENSATED BY THE HOSPITAL FOR TIME SPENT PARTICIPATING IN ACTIVITIES THAT QUALIFY AS COMMUNITY BENEFITS PLUS THE CURRENT FISCAL YEAR FRINGE BENEFIT RATE. IN ADDITION TO SUBSIDIZED SERVICES, INDIRECT COSTS WERE APPLIED TO A SMALL SELECTION OF SALARIES AND SERVICES UNDER COMMUNITY HEALTH IMPROVEMENT, RESEARCH, AND COMMUNITY BENEFIT OPERATIONS, BUT NOT BROADLY ACROSS ALL COMMUNITY BENEFIT ACTIVITY ENTRIES. PART I, LINE 7G: MIDDLESEX HOSPITAL INCLUDES ITS FAMILY MEDICINE GROUP AS A SUBSIDIZED SERVICE. FOR FY24, 8,540 UNIQUE INDIVIDUALS WERE SERVED WITH A TOTAL HOSPITAL SUBSIDY OF $480,828. MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDE TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS) FOR PRIMARY CARE (MIDDLETOWN SERVICE AREA; LOW INCOME POPULATION), MENTAL HEALTH (MIDDLESEX COUNTY; HIGH NEED GEOGRAPHIC) AND DENTAL HEALTH (CENTRAL MIDDLETOWN; LOW INCOME POPULATION). MIDDLESEX HOSPITAL'S FAMILY MEDICINE GROUP FILLS A VITAL COMMUNITY HEALTH NEED BY PROVIDING ACCESS TO PRIMARY CARE SERVICES. PART I, LINE 6B: SINCE THE INCEPTION OF MIDDLESEX HEALTH'S COMMUNITY BENEFIT POLICY IN 2007, AND PRIOR TO THE MANDATE OF THE AFFORDABLE CARE ACT, CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ORDER TO PRIORITIZE SPECIFIC COMMUNITY BENEFIT INITIATIVES HAS BEEN A CORE ELEMENT OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM. IN ADDITION TO COMPLETING A CHNA, THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVICES ON AN ON-GOING BASIS THROUGH A VARIETY OF METHODS. EXAMPLES INCLUDE UNDERSTANDING THE LOCAL AND STATE-WIDE NEEDS DERIVED FROM: 1) PARTICIPATION IN COMMUNITY HEALTHCARE COALITIONS AND BOARDS, WHICH INCLUDE STRATEGIC PLANNING THAT IS RESPONSIVE TO COMMUNITY NEED; 2) PARTICIPATION IN THE LEADERSHIP TEAM OF THE GREATER MIDDLETOWN HEALTH ENHANCEMENT COMMUNITY (GMHEC) COALITION, A PLACE-BASED INITIATIVE THAT SUPPORTS LONG-TERM, COLLABORATIVE, AND CROSS-SECTOR EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELL-BEING THROUGH BROAD, SYSTEMIC CHANGE BY BUILDING HEALTHY AND EQUITABLE COMMUNITIES THAT ACTIVELY WORK TOGETHER TO PREVENT THE DEVELOPMENT OF DISEASE; 3) PARTICIPATION IN THE STATE'S HOSPITAL ASSOCIATION POPULATION AND COMMUNITY HEALTH INITIATIVES BASED ON STATE-WIDE AND LOCAL COMMUNITY HEALTH ISSUES; 4) ANY REAL-TIME COMMUNITY BASED INPUT, FEED-BACK, RECOMMENDATIONS AND SUGGESTIONS; AND 5) CONTINUOUS ASSESSMENT AND ADJUSTMENTS, WHEN NECESSARY, OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAMS THROUGH SURVEYS AND PATIENT/PARTICIPANT FEED-BACK. HAVING A STRONG PRESENCE IN COMMUNITY COALITIONS AND PARTNERSHIPS, IN ADDITION TO BEING RESPONSIVE TO THE NEEDS EXPRESSED BY OUR COMMUNITY RESIDENTS, ALLOWS MIDDLESEX HOSPITAL TO CONTINUALLY ASSESS THE HEALTHCARE NEEDS OF OUR COMMUNITY IN BETWEEN COMMUNITY HEALTH NEEDS ASSESSMENT CYCLES. PART II, COMMUNITY BUILDING ACTIVITIES: THE MAJORITY OF MIDDLESEX HOSPITAL'S COMMUNITY BASED HEALTH IMPROVEMENT WORK IS CAPTURED UNDER COMMUNITY BENEFIT CATEGORIES. THE HOSPITAL'S PARTICIPATION IN COMMUNITY BUILDING ACTIVITIES, HOWEVER, HAS A VITAL ROLE IN CONTINUING TO PROMOTE THE HEALTH, WELL-BEING AND SAFETY FOR RESIDENTS IN ITS SERVICE AREA. THE HOSPITAL OFFERS ITS RESOURCES AND EXPERTISE TO SUPPORT AND STRENGTHEN COMMUNITY ASSETS IN A VARIETY OF WAYS THAT FALL UNDER THE SCOPE OF COMMUNITY BUILDING. STAFF MEMBERS PARTICIPATE IN MULTIPLE COMMUNITY PARTNERSHIPS AND COALITIONS, THE SUCCESS OF WHICH ARE GREATLY ENHANCED BY HOSPITAL COLLABORATION - MANY COMMUNITY INITIATIVES WOULD NOT BE AS EFFECTIVE WITHOUT THE HOSPITAL'S ADMINISTRATIVE AND CLINICAL STAFF IN-KIND INVOLVEMENT, SUPPORT AND EXPERTISE.IN FY24 THE HOSPITAL'S COMMUNITY BUILDING EXPENSE TOTALED $158,248, SERVING 119 INDIVIDUALS. EXAMPLES INCLUDE (BUT ARE NOT LIMITED TO): 1) DISASTER READINESS WHERE THE HOSPITAL PLAYS A PIVOTAL ROLE BY PREPARING FOR DISASTERS. EXAMPLES INCLUDE THE HOSPITAL HOSTING YEARLY RADIATION DRILLS FOR THE STAFF OF A LOCAL NUCLEAR POWER PLANT, AND THE HOSPITAL PURCHASING AND STOCK-PILING LARGE QUANTITIES OF EXTENSIVE PANDEMIC SUPPLIES TO BE USED SHOULD A COMMUNITY-WIDE DISASTER OCCUR. INCLUDED IN THIS STOCK-PILE ARE MEDICATIONS FOR INFECTIOUS DISEASE AND CHEMICAL EXPOSURE CURATIVES. THE MAJORITY OF THE VALUE OF THE SUPPLIES, SPACE UTILIZATION AND COSTS ASSOCIATED TO MONITOR AND REPLENISH PANDEMIC PRODUCTS (WITHIN EXPIRATION DATES) ARE ABSORBED BY THE HOSPITAL, AND, 2) WORKFORCE DEVELOPMENT, EXAMPLES INCLUDE: A) THE HOSPITAL'S SHORELINE MEDICAL CENTER (SMC)'S A WELL-DEVELOPED EDUCATIONAL PROGRAM FOR LOCAL STUDENTS INTERESTED IN MEDICAL CAREERS. SHORTAGES OF CERTAIN TRAINED MEDICAL PROFESSIONALS SUCH AS NURSES AND RADIOLOGIC TECHNOLOGISTS SERVED AS THE IMPETUS FOR STARTING THESE PROGRAMS. THE SMC CAREER DAY IS AN EXPERIENTIAL LEARNING EVENT WHERE HIGH SCHOOL STUDENTS INTERACT WITH STAFF MEMBERS FROM A VARIETY OF CLINICAL FIELDS AND PARTICIPATE IN INTERACTIVE MOCK DEMONSTRATIONS / SIMULATIONS, AND, B) TO FURTHER ITS COMMITMENT TO DIVERSITY, EQUITY AND INCLUSION TO ADDRESS DISPARITIES IN HEALTH CARE, MIDDLESEX HEALTH OFFERS THE MIDDLESEX HEALTH MEDICAL EXPLORERS PROGRAM (WORKFORCE DEVELOPMENT) TO ADDRESS THE LACK OF RACIAL AND ETHNIC REPRESENTATION IN HEALTHCARE. BLACK, INDIGENOUS AND LATINO/A/E INDIVIDUALS ARE EXTREMELY UNDERREPRESENTED IN HEALTHCARE PROFESSIONS IN THE UNITED STATES, WHICH CONTRIBUTES TO HEALTH DISPARITIES FOR PEOPLE OF COLOR. IT IS WELL DOCUMENTED THAT THE LACK OF DIVERSITY IN THE HEALTHCARE WORKFORCE HAS A NEGATIVE EFFECT ON PATIENTS OF COLOR. FOSTERING A DIVERSE AND INCLUSIVE WORKFORCE IS CRITICAL TO IMPROVING TRUST AMONG PATIENT-PROVIDER RELATIONSHIPS, INCREASING ACCESS TO CARE AND IMPROVING HEALTHCARE QUALITY AND OUTCOMES AMONG PEOPLE OF COLOR. THE PROGRAM'S OBJECTIVE IS TO CREATE A HEALTHCARE EDUCATIONAL PIPELINE BY INTRODUCING BLACK, INDIGENOUS, AND LATINO/A STUDENTS TO A VARIETY OF HEALTH CARE PROFESSIONS THROUGH AN ENGAGED INTERACTIVE LEARNING EXPERIENCE. THE MEDICAL EXPLORERS PROGRAM PROVIDES AN ON-SITE EXPERIENCE INCLUDING A MULTI-DEPARTMENTAL TOUR, HANDS-ON EXPERIENCES, AND INTERACTIONS WITH CLINICAL STAFF. STUDENTS LEARN ABOUT THE SPECIFICS OF EACH HIGHLIGHTED PROFESSION AND THE STAFF MEMBER'S PATHWAY TO THAT PROFESSION. PART III, LINE 2: DUE TO THE ADOPTION OF ASC NO 2014-09 CONTRACTS WITH CUSTOMERS (TOPIC 606) BAD DEBT EXPENSE IS NO LONGER REPORTED ON THE AUDITED FINANCIAL STATEMENT. RATHER IT IS TREATED AS A PRICE CONCESSION. THE BAD DEBT EXPENSE FOR FY24 WAS $12,835,982. PART III, LINE 3: THE HOSPITAL ESTIMATES THAT 10% OF ITS BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL HAS A WELL-ESTABLISHED PROCESS WITH ITS THIRD PARTY AGENCIES TO CAPTURE AS MANY PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE AS POSSIBLE AND AWARDS FINANCIAL ASSISTANCE TO THOSE PATIENTS IN COLLECTIONS WHO ARE KNOWN TO QUALIFY. ONCE IN COLLECTIONS, THERE ARE TWO METHODS WHICH ENABLE PATIENTS TO RECEIVE FINANCIAL ASSISTANCE AWARDS: 1) PATIENTS EITHER COMPLETE A FINANCIAL ASSISTANCE APPLICATION, MEET ELIGIBILITY CRITERIA AND ARE APPROVED; OR 2) THE THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE HOSPITAL TO COLLECT BALANCES SCREEN FOR FINANCIAL ASSISTANCE ELIGIBILITY. IN ORDER TO ENSURE THAT ALL PATIENTS IN COLLECTIONS ARE AWARE OF FINANCIAL ASSISTANCE AVAILABILITY, THE HOSPITAL REQUIRES THIRD PARTY ORGANIZATIONS TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WITHIN THE POLICY THERE IS A PROVISION WHEREBY COLLECTION AGENCIES, USING GUIDELINES SET FORTH BY THE HOSPITAL, ASSIST THE HOSPITAL IN IDENTIFYING PATIENTS WHO DO NOT HAVE A MEANS TO PAY FOR SERVICES AND THEREFORE QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM WHILE THESE PATIENTS HAVE NOT GONE THROUGH THE FORMAL APPLICATION PROCESS, THEY MEET THE ELIGIBILITY GUIDELINES FOR FINANCIAL ASSISTANCE AS DEFINED BY THE HOSPITAL. THESE PATIENTS ARE THEN TRANSFERRED AND INCLUDED UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE UMBRELLA. WHILE THIS PROCESS CAPTURES THE MAJORITY OF THOSE WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL RECOGNIZES IT WILL STILL HAVE A POPULATION OF PATIENTS WHO COULD POTENTIALLY QUALIFY FOR FINANCIAL ASSISTANCE AND DO NOT RECEIVE AWARDS - THOSE WHO ARE UNRESPONSIVE OR HAVE MOVED AWAY. BAD DEBT DOLLARS ARE NOT INCLUDED IN ANY OF THE HOSPITAL'S PROGRAMMATIC COMMUNITY BENEFIT VALUES AND, WHILE NOTED, ARE NOT INCLUDED IN THE HOSPITAL'S COMMUNITY BENEFIT TOTALS IN ANY HOSPITAL COMMUNITY BENEFIT PUBLICATION. PART III, LINE 4: THE HOSPITAL ESTIMATES A RESERVE FOR UNCOLLECTIBLE ACCOUNTS AGAINST ITS PATIENT ACCOUNTS RECEIVABLES. WHEN BAD DEBTS ARE IDENTIFIED, THEY ARE ACCOUNTED FOR AS A COMPONENT OF THE NET PATIENT REVENUE PROVISION FOR BAD DEBTS NET OF RECOVERIES. PAGE 15 OF THE MIDDLESEX HEALTH SYSTEM'S CONSOLIDATED FY24 AUDITED FINANCIAL STATEMENT STATES: THE SYSTEM DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE FROM THAT CATEGORY OF PAYOR. PART III, LINE 8: THE MEDICARE COST REPORT IS THE COSTING METHODOLOGY SYSTEM USED TO DETERMINE THE AMOUNT REPORTED ON PART III, LINES 5 AND 6. THE HOSPITAL UTILIZES WORKSHEET 6 FOUND IN THE FORM 990 INSTRUCTIONS FOR SCHEDULE H TO CALCULATE ITS SUBSIDIZED SERVICES. THE INSTRUCTIONS STATE THAT "THE FINANCIAL LOSS IS MEASURED AFTER REMOVING LOSSES, MEASURED BY COST, ASSOCIATED WITH BAD DEBT, CHARITY CARE, MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS". GIVEN THAT WORKSHEET 6 DOESN'T SUGGEST REMOVING LOSSES ASSOCIATED WITH MEDICARE, A PORTION OF MEDICARE IS INCLUDED IN THE HOSPITAL'S SUBSIDIZED SERVICE CALCULATIONS. SO AS NOT TO DOUBLE COUNT MEDICARE VALUES IN PART III, SECTION B, LINES 5 AND 6, THE PORTION OF MEDICARE SHORTFALL INCLUDED IN OUR SUBSIDIZED SERVICES CALCULATIONS HAS BEEN SUBTRACTED FROM THE MEDICARE REVENUE AND COSTS DERIVED FROM THE MEDICARE COST REPORT. THE VALUES INDICATED IN PART III, LINES 5 AND 6 ARE THEREFORE WHAT REMAINS AFTER THE MEDICARE REVENUE AND COSTS INCLUDED IN THE SUBSIDIZED SERVICES CALCULATIONS HAS BEEN SUBTRACTED OUT. GIVEN THIS, THE RESULTING VALUES (PART III, LINES 5, 6 AND 7) WOULD NEED TO BE COMBINED WITH THE MEDICARE REVENUE/COSTS INCLUDED IN OUR SUBSIDIZED SERVICES TO GET THE FULL OVERVIEW OF MEDICARE REVENUE, COSTS AND ANY REMAINING SHORTFALL OR SURPLUS. WE AGREE WITH THE CURRENT SUBSIDIZED SERVICES CALCULATION METHODOLOGY THAT ALLOWS THE INCLUSION OF MEDICARE DOLLARS AS THE MEDICARE POPULATION COMPRISES AN IMPORTANT SEGMENT OF THOSE RECEIVING SUBSIDIZED SERVICES CARE. THE HOSPITAL TREATS ALL MEDICARE PATIENTS EQUALLY AND DOES NOT DISCRIMINATE AGAINST LOWER-MARGIN YIELDING SERVICES. AS A NOT-FOR-PROFIT HOSPITAL, MIDDLESEX HOSPITAL IS THE SAFETY-NET IN THE COMMUNITY FOR ALL MEDICARE PATIENTS, REGARDLESS OF LEVEL OF MEDICARE COVERAGE AND REGARDLESS IF A SURPLUS OR DEFICIT RESULTS. THIS OPEN ACCESS FOR MEDICARE PATIENTS PROMOTES ACCESS TO CARE, A FUNDAMENTAL TENET OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM.THERE REMAINS A DISPROPORTIONATE PERCENTAGE OF OLDER ADULTS IN MIDDLESEX COUNTY WHEN COMPARED TO STATE AVERAGES. MIDDLESEX HOSPITAL'S MOST RECENTLY COMPLETED (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOUND THAT, WHEN EXTRACTING THE AGE 65+ POPULATION, MIDDLESEX COUNTY (19.0%) EXCEEDS CONNECTICUT (17.2%), AND THE MAJORITY OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA CONTINUE TO HAVE A GREATER CONCENTRATION OF OLDER ADULTS WHEN COMPARED TO CONNECTICUT. THE TOWNS OF COLCHESTER, MARLBOROUGH AND MIDDLETOWN FALL BELOW THE STATE AVERAGE OF 17.2%. PORTLAND IS ON PAR WITH THE STATE AVERAGE, WHILE CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, HADDAM, KILLINGWORTH, AND MIDDLEFIELD EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 19.1%-24.8%, AND ESSEX, LYME, OLD LYME, OLD SAYBROOK, AND WESTBROOK CONSIDERABLY EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 26.2%-30.9% (CT DATA COLLABORATIVE, 2016-2020). THE TREND OF A DISPROPORTIONATELY HIGHER 65+ OLDER ADULT POPULATION IN THE MAJORITY OF TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA WHEN COMPARED TO THE STATE AVERAGE CONTINUES TO BE EVIDENT FOR POPULATION PROJECTIONS FOR 2030. EXCLUDING MIDDLETOWN (AT 14.9%), THE EXPECTED GROWTH FOR AGE 65+ BY 2030 RANGES FROM 19.5% TO 34.9% IN THE REMAINING 18 TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA COMPARED TO 17.9% FOR CONNECTICUT (CT DATA COLLABORATIVE, AGE 65+ POPULATION PROJECTIONS, 2030). AS MIDDLESEX COUNTY HAS A DISPROPORTIONATE LEVEL OF COMMUNITY MEMBERS AGE 65+ WHEN COMPARED TO STATE AVERAGES, THE SHORTFALL THAT THE HOSPITAL EXPERIENCES IN PROVIDING CRITICAL HEALTHCARE SERVICES TO THE MEDICARE POPULATION SHOULD BE CONSIDERED A COMMUNITY BENEFIT WITHIN THE HOSPITAL'S SUBSIDIZED SERVICES, WHICH THOSE AGE 65+ ALSO RELY HEAVILY ON FOR CARE. THE HOSPITAL FILLS A HEALTHCARE DELIVERY GAP FOR MEDICARE PATIENTS, ONE WHICH WOULD BE DETRIMENTAL TO THE COMMUNITY IF THE HOSPITAL WAS NOT PRESENT. PART III, LINE 9B: MIDDLESEX HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. THE POLICY STATES THAT PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE WILL BE RESPONSIBLE FOR PAYING ANY BALANCE REMAINING AFTER THE FINANCIAL ASSISTANCE ALLOWANCE HAS BEEN APPLIED (THAT IS, IF 100% FINANCIAL ASSISTANCE HAS NOT BEEN AWARDED). THE POLICY ALSO OUTLINES THE PROCESS FOR PAYING OUTSTANDING BALANCES SHOULD THE PATIENT BE FOUND TO HAVE THE MEANS TO PAY A PARTIAL AMOUNT AFTER THE HOSPITAL'S FINANCIAL ASSISTANCE DETERMINATION CRITERIA HAS BEEN APPLIED. FOR SUCH BALANCES, THE HOSPITAL WILL NOTIFY THE PATIENT OF HIS/HER LIABILITY. IF PAYMENT IS NOT MADE, THE POLICY STATES THAT THE HOSPITAL WILL USE APPROPRIATE METHODS TO PURSUE COLLECTION, WHICH MAY INCLUDE COLLECTIONS AGENCIES. THIS PRACTICE IS BROADLY UTILIZED FOR ALL PATIENTS WITH OUTSTANDING BALANCES. THE HOSPITAL MAKES EVERY EFFORT TO ENSURE THAT ALL PATIENTS KNOW PAYMENT PLANS ARE AVAILABLE FOR ANY BALANCE, INCLUDING THOSE PATIENTS WHO HAVE A BALANCE LEFT OVER AFTER A FINANCIAL ASSISTANCE AWARD HAS BEEN APPLIED. IN ORDER TO CAPTURE THE PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE HOSPITAL HAS PROVISIONS IN ITS COLLECTION POLICY. IN THE CASE WHERE PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE DO NOT COMPLETE A FINANCIAL ASSISTANCE APPLICATION AND ARE PLACED INTO COLLECTIONS, THE THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE HOSPITAL TO COLLECT BALANCES SCREEN FOR FINANCIAL ASSISTANCE ELIGIBILITY. THE THIRD PARTY ORGANIZATIONS FOLLOW HOSPITAL POLICY BY ALERTING ALL PATIENTS IN COLLECTIONS TO THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WITHIN THE HOSPITAL'S COLLECTION POLICY THERE IS A PROVISION WHEREBY COLLECTION AGENCIES, USING GUIDELINES SET FORTH BY THE HOSPITAL, ASSIST THE HOSPITAL IN IDENTIFYING PATIENTS WHO DO NOT HAVE A MEANS TO PAY FOR SERVICES AND THEREFORE QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM WHILE THESE PATIENTS HAVE NOT GONE THROUGH THE FORMAL APPLICATION PROCESS, THEY MEET THE ELIGIBILITY GUIDELINES FOR FINANCIAL ASSISTANCE AS DEFINED BY THE HOSPITAL. THESE PATIENTS ARE THEN TRANSFERRED AND INCLUDED UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE UMBRELLA. THIS PROCESS WAS PUT IN PLACE BY THE HOSPITAL IN ORDER TO CAPTURE AS MANY PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE AS POSSIBLE. PART VI, LINE 2: SINCE THE INCEPTION OF MIDDLESEX HEALTH'S COMMUNITY BENEFIT POLICY IN 2007, AND PRIOR TO THE MANDATE OF THE AFFORDABLE CARE ACT, CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ORDER TO PRIORITIZE SPECIFIC COMMUNITY BENEFIT INITIATIVES HAS BEEN A CORE ELEMENT OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM. IN ADDITION TO COMPLETING A CHNA, THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVICES ON AN ON-GOING BASIS THROUGH A VARIETY OF METHODS. EXAMPLES INCLUDE UNDERSTANDING THE LOCAL AND STATE-WIDE NEEDS DERIVED FROM: 1) PARTICIPATION IN COMMUNITY HEALTHCARE COALITIONS AND BOARDS, WHICH INCLUDE STRATEGIC PLANNING THAT IS RESPONSIVE TO COMMUNITY NEED; 2) PARTICIPATION IN THE LEADERSHIP TEAM OF THE GREATER MIDDLETOWN HEALTH ENHANCEMENT COMMUNITY (GMHEC) COALITION, A PLACE-BASED INITIATIVE THAT SUPPORTS LONG-TERM, COLLABORATIVE, AND CROSS-SECTOR EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELL-BEING THROUGH BROAD, SYSTEMIC CHANGE BY BUILDING HEALTHY AND EQUITABLE COMMUNITIES THAT ACTIVELY WORK TOGETHER TO PREVENT THE DEVELOPMENT OF DISEASE; 3) PARTICIPATION IN THE STATE'S HOSPITAL ASSOCIATION POPULATION AND COMMUNITY HEALTH INITIATIVES BASED ON STATE-WIDE AND LOCAL COMMUNITY HEALTH ISSUES; 4) ANY REAL-TIME COMMUNITY BASED INPUT, FEED-BACK, RECOMMENDATIONS AND SUGGESTIONS; AND 5) CONTINUOUS ASSESSMENT AND ADJUSTMENTS, WHEN NECESSARY, OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAMS THROUGH SURVEYS AND PATIENT/PARTICIPANT FEED-BACK. HAVING A STRONG PRESENCE IN COMMUNITY COALITIONS AND PARTNERSHIPS, IN ADDITION TO BEING RESPONSIVE TO THE NEEDS EXPRESSED BY OUR COMMUNITY RESIDENTS, ALLOWS MIDDLESEX HOSPITAL TO CONTINUALLY ASSESS THE HEALTHCARE NEEDS OF OUR COMMUNITY IN BETWEEN COMMUNITY HEALTH NEEDS ASSESSMENT CYCLES. PART VI, LINE 3: GREAT CONCERN IS TAKEN TO ENSURE THAT PATIENTS ARE APPRISED OF THE AVAILABILITY OF FEDERAL/STATE/LOCAL GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE PLAN. NOTICE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS DISPLAYED CONSPICUOUSLY IN ENGLISH AND SPANISH AT THE ENTRY OF EACH FACILITY AND AT ALL PATIENT REGISTRATION POINTS. THE NOTIFICATION INCLUDES AN OVERVIEW OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM; THE AVAILABILITY OF FREE BED FUNDS AND OTHER FINANCIAL ASSISTANCE; SLIDING SCALE; AND FINANCIAL COUNSELOR CONTACT INFORMATION. AT THE TIME OF REGISTRATION, HOSPITAL ACCESS STAFF REVIEWS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND ASKS PATIENTS IF THEY WOULD LIKE A FINANCIAL ASSISTANCE PACKAGE. BUILT INTO THE REGISTRATION DATABASE IS A REQUIRED FINANCIAL ASSISTANCE FIELD WHICH MUST BE COMPLETED AS PART OF THE ADMISSIONS PROCESS. ONCE THE PATIENT EXPRESSES THE DESIRE TO RECEIVE A FINANCIAL ASSISTANCE PACKAGE, PAPERWORK WITH PATIENT NAME AND MEDICAL RECORD IS AUTOMATICALLY PRINTED AT THE REGISTRATION STATION AND HANDED TO THE PATIENT. OTHER METHODS OF COMMUNICATION TO INCREASE AWARENESS REGARDING THE FINANCIAL ASSISTANCE AND FREE BED FUND PROGRAM INCLUDE 1) A FINANCIAL ASSISTANCE BROCHURE THAT AIDS PATIENTS IN THE PROCESS, ANSWERS KEY QUESTIONS AND PROVIDES EASY ACCESS FOR HELP (AVAILABLE AT MULTIPLE HOSPITAL DEPARTMENTS AND LOCATIONS, INCLUDING KIOSKS AT EVERY HOSPITAL ENTRY POINT); 2) A SEPARATE AND DISTINCT FINANCIAL ASSISTANCE SERVICES SECTION ON THE HOSPITAL'S WEB-SITE (HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES) WHICH INCLUDES APPLICATION, INSTRUCTIONS, AND SLIDING SCALE; 3) INCLUSION OF FINANCIAL ASSISTANCE INFORMATION IN THE HOSPITAL'S INPATIENT ADMISSIONS BOOKLET; 4) NOTICE OF THE PROGRAM AND FINANCIAL COUNSELOR CONTACT INFORMATION ON EVERY BILLING STATEMENT; 5) NOTIFICATION AT DISCHARGE; AND 6) A LETTER OUTLINING THE PROGRAM SENT TO EVERY SELF-PAY PATIENT FOLLOWING DISCHARGE. MIDDLESEX HEALTH'S FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN THE TOP 15 LANGUAGES IN ITS SERVICE AREA AND THIS AVAILABILITY IS COMMUNICATED ON THE BACK OF THE STATEMENT IN EACH LANGUAGE.THE HOSPITAL HAS A TEAM OF FINANCIAL COUNSELORS WHO ARE AVAILABLE TO ASSIST PATIENTS THROUGH THE APPLICATION PROCESS EITHER BY PHONE OR VISIT. THE ROLE OF THE COUNSELORS IS TO HELP PATIENTS NAVIGATE THE HOSPITAL'S FINANCIAL ASSISTANCE PROCESS AND TO AID IN APPLICATION FOR MEDICAID/STATE PROGRAMS. ALL COUNSELORS RECEIVE DEPARTMENTAL TRAINING ON THE IMPORTANCE OF ASSISTING PATIENTS IN NEED OF STATE/GOVERNMENTAL OR HOSPITAL FINANCIAL ASSISTANCE, THE HOSPITAL'S FINANCIAL ASSISTANCE PROTOCOLS, SYSTEMS, NEW PROGRAM ENHANCEMENTS, AND HOW TO PROVIDE SUPPORT AND FOLLOW-UP FOR MEDICAID/STATE ENROLLMENT. THE HOSPITAL'S SOCIAL WORKERS ALSO ASSIST PATIENTS WITH COMPLETION OF HOSPITAL FINANCIAL ASSISTANCE APPLICATIONS AS WELL AS MEDICAID/STATE APPLICATIONS.IN FY24, MIDDLESEX HOSPITAL GRANTED $1,209,799 IN FINANCIAL ASSISTANCE TO 1,054 UNIQUE RECIPIENTS AND ABSORBED $36,786,972 IN UNPAID COSTS OF MEDICAID, SERVING 22,628 INDIVIDUALS. PART VI, LINE 4: MIDDLESEX HOSPITAL IS THE SOLE HOSPITAL PROVIDER IN ITS SERVICE AREA, WHICH INCLUDES THE LARGE GEOGRAPHIC AREA OF MIDDLESEX COUNTY AND SURROUNDING TOWNS. IT ENCOMPASSES 24 MUNICIPALITIES, INCLUDING THE 15 TOWNS OF MIDDLESEX COUNTY. THERE ARE NINETEEN TOWNS IN ITS PRIMARY SERVICE AREA: CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, ESSEX, HADDAM, KILLINGWORTH, MIDDLEFIELD, MIDDLETOWN, OLD SAYBROOK, PORTLAND, AND WESTBROOK (THE FIFTEEN TOWNS OF MIDDLESEX COUNTY) AND COLCHESTER, LYME, MARLBOROUGH AND OLD LYME; AND, FIVE TOWNS IN ITS SECONDARY SERVICE AREA: GUILFORD, HEBRON, MADISON, MERIDEN, AND ROCKY HILL. BY LAND AREA, MIDDLESEX COUNTY (369.3 SQUARE MILES) IS THE SMALLEST COUNTY OF THE EIGHT COUNTIES IN CONNECTICUT AND IS THE SIXTH IN POPULATION SIZE (U.S. CENSUS, 2020). MUNICIPALITY SIZES BY LAND MASS VARY THROUGHOUT THE COUNTY, FROM 10.40 SQUARE MILES (ESSEX) TO 54.25 SQUARE MILES (EAST HADDAM) WITH MIDDLETOWN HAVING 41.02 SQUARE MILES OF LAND AREA. THE CITY OF MIDDLETOWN (ZIP CODE 06457) IS CENTRALLY LOCATED 16 MILES SOUTH OF HARTFORD. THE POPULATION IN MIDDLETOWN IS ECONOMICALLY AND RACIALLY / ETHNICALLY MORE DIVERSE WHEN COMPARED TO OTHER MUNICIPALITIES IN MIDDLESEX COUNTY AND IS ONE OF THE FEW COMMUNITIES IN CONNECTICUT TO INCLUDE URBAN, SUBURBAN, AND RURAL CHARACTERISTICS. THE DATA THAT FOLLOWS IS PER MIDDLESEX HEALTH'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT (2022).OF THE TOTAL STATE OF CONNECTICUT POPULATION (3,605,597), 4.6% (164,759) RESIDE IN MIDDLESEX COUNTY (U.S. CENSUS, 2021). WITH A POPULATION OF 47,108 (U.S. CENSUS, 2021), MIDDLETOWN IS THE LARGEST MUNICIPALITY IN MIDDLESEX COUNTY. THE REMAINING TOWNS IN MIDDLESEX HEALTH'S PRIMARY SERVICE AREA FALL INTO THREE POPULATION RANGES. COLCHESTER, CROMWELL, CLINTON, EAST HAMPTON AND OLD SAYBROOK HAVE POPULATIONS BETWEEN 10,000 AND 15,600. PORTLAND, EAST HADDAM, HADDAM, OLD LYME, DURHAM, WESTBROOK, ESSEX, KILLINGWORTH AND MARLBOROUGH HAVE POPULATIONS BETWEEN 5,000 AND 9,999. DEEP RIVER, MIDDLEFIELD, CHESTER AND LYME HAVE POPULATIONS LESS THAN 5,000. THE CONNECTICUT OFFICE OF RURAL HEALTH (CT-ORH) DEFINES RURAL AS ALL TOWNS WITH A POPULATION CENSUS OF 10,000 OR LESS AND A POPULATION DENSITY OF 500 OR LESS PEOPLE PER SQUARE MILE. BASED ON THIS METRIC, THE TOWNS OF CHESTER, DEEP RIVER, DURHAM, EAST HADDAM, HADDAM, KILLINGWORTH, LYME, MARLBOROUGH, MIDDLEFIELD, OLD LYME AND WESTBROOK ARE CONSIDERED RURAL. FOR THE AGE DISTRIBUTIONS, MIDDLESEX COUNTY IS LOWER THAN THE STATE AVERAGE IN THE 0-19 AND 20-44 AGE GROUPS AND EXCEEDS THE STATE AVERAGE IN THE 45-64 AND 65+ AGE GROUPS. MIDDLETOWN IS LOWER THAN THE STATE AVERAGE IN THE 0-19 AGE GROUP, IS SIGNIFICANTLY HIGHER THAN THE STATE AVERAGE IN THE 20-44 AGE GROUP AND LOWER THAN THE STATE AVERAGE IN THE 45-64 AND 65+ AGE GROUPS. WHEN EXTRACTING AGE 65+, MIDDLESEX COUNTY (19.0%) EXCEEDS CONNECTICUT (17.2%), AND THE MAJORITY OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA CONTINUE TO HAVE A GREATER CONCENTRATION OF OLDER ADULTS WHEN COMPARED TO CONNECTICUT. THE TOWNS OF COLCHESTER, MARLBOROUGH AND MIDDLETOWN FALL BELOW THE STATE AVERAGE OF 17.2%. PORTLAND IS ON PAR WITH THE STATE AVERAGE, WHILE CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, HADDAM, KILLINGWORTH, AND MIDDLEFIELD EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 19.1%-24.8%, AND ESSEX, LYME, OLD LYME, OLD SAYBROOK, AND WESTBROOK CONSIDERABLY EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 26.2%-30.9% (CT DATA COLLABORATIVE, 2016-2020).MIDDLETOWN HAS A MORE DIVERSE RACIAL / ETHNIC DEMOGRAPHIC RELATIVE TO THE OTHER TOWNS IN MIDDLESEX COUNTY AND RESEMBLES CONNECTICUT EXCEPT IN THE HISPANIC OR LATINO CATEGORY, WHERE MIDDLETOWN HAS A SMALLER POPULATION. MIDDLESEX COUNTY'S RACE AND HISPANIC OR LATINO ORIGIN COMPOSITION IS 82.4% WHITE, NON-HISPANIC; 6% BLACK OR AFRICAN AMERICAN, NON-HISPANIC; 7.1% HISPANIC OR LATINO; 3.3% ASIAN, NON-HISPANIC; 2.2% TWO OR MORE RACES, NON-HISPANIC (U.S. CENSUS QUICK FACTS 2021). MIDDLETOWN'S RACE AND HISPANIC OR LATINO ORIGIN COMPOSITION IS 66.8% WHITE, NON-HISPANIC; 15.8% BLACK OR AFRICAN AMERICAN, NON-HISPANIC; 10.3% HISPANIC OR LATINO; 6% ASIAN, NON-HISPANIC; 4.2% TWO OR MORE RACES, NON-HISPANIC (U.S. CENSUS QUICK FACTS 2021).THE MEDIAN HOUSEHOLD INCOME PER TOWN IN MIDDLESEX HEALTH'S SERVICE AREA RANGES FROM $62,022 (MIDDLETOWN) TO $130,635 (DURHAM) AND ALL TOWNS EXCEPT MIDDLETOWN, MIDDLEFIELD AND WESTBROOK EXCEED CONNECTICUT'S MEDIAN INCOME OF $79,855 (CONNECTICUT DATA COLLABORATIVE, 2016-2020). THERE ARE SIGNIFICANT MEDIAN HOUSEHOLD INCOME DISPARITIES WHEN DATA POINTS ARE DISAGGREGATED BY RACE AND ETHNICITY AND COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO. IN MIDDLETOWN, WHITE HOUSEHOLDS EARN 1.6 TIMES MORE THAN BLACK HOUSEHOLDS AND 1.8 TIMES MORE THAN HISPANIC OR LATINO HOUSEHOLDS. IN MIDDLESEX COUNTY, WHITE HOUSEHOLDS EARN 1.8 TIMES MORE THAN BLACK HOUSEHOLDS AND 1.6 TIMES MORE THAN HISPANIC OR LATINO HOUSEHOLDS. WHILE THE GAP IS NARROWER, WHITE HOUSEHOLDS EARN 1.1 TIMES MORE (MIDDLETOWN) AND 1.4 TIMES MORE (MIDDLESEX COUNTY) THAN ASIAN HOUSEHOLDS. FOR POVERTY STATUS, THE TOTAL POVERTY RATE FOR MIDDLETOWN AT 12.3% EXCEEDS THE STATE OF CONNECTICUT AT 9.8%. THE TOTAL POVERTY RATES FOR MIDDLEFIELD (8.5%) AND MARLBOROUGH (8.4%) EXCEED THE MIDDLESEX COUNTY TOTAL POVERTY RATE OF 7.1%. THE UNDER 18 POVERTY RATE FOR MIDDLETOWN AT 16.1% EXCEEDS THE STATE OF CONNECTICUT AT 13.0%. THE UNDER 18 POVERTY RATES FOR THE TOWNS OF COLCHESTER (11.6%), PORTLAND (10.9%), MIDDLEFIELD (9.3%) AND EAST HAMPTON (8.7%) EXCEED THE MIDDLESEX COUNTY UNDER 18 POVERTY RATE OF 8.3% (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2016-2020).POVERTY RATES ARE SIGNIFICANTLY MORE PRONOUNCED AMONG BLACK OR AFRICAN AMERICAN ALONE, HISPANIC OR LATINO, AND TWO OR MORE RACES POPULATIONS IN MIDDLETOWN AND MIDDLESEX COUNTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO FOR THE TOTAL AND UNDER 18 CATEGORIES. BLACK OR AFRICAN AMERICAN ALONE RESIDENTS ARE 2.5 TIMES MORE LIKELY (MIDDLETOWN) AND 3.2 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. HISPANIC OR LATINO RESIDENTS ARE 4.1 TIMES MORE LIKELY (MIDDLETOWN) AND 3.8 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. ASIAN ALONE RESIDENTS ARE 1.2 TIMES MORE LIKELY (MIDDLETOWN) AND 2 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. RESIDENTS WITH TWO OR MORE RACES ARE 2.7 TIMES MORE LIKELY (MIDDLETOWN) AND 3.1 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: CONNECTICUT DATA COLLABORATIVE, 2015-2019). UNDER AGE 18 BLACK OR AFRICAN AMERICAN ALONE YOUTH ARE 2.9 TIMES MORE LIKELY (MIDDLETOWN) AND 5.5 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER 18 AGE WHITE ALONE NOT HISPANIC OR LATINO YOUTH. UNDER AGE 18 HISPANIC OR LATINO YOUTH ARE 5.1 TIMES MORE LIKELY (MIDDLETOWN) AND 5.8 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER AGE 18 WHITE ALONE NOT HISPANIC OR LATINO YOUTH. UNDER AGE 18 YOUTH WITH TWO OR MORE RACES ARE 2.1 TIMES MORE LIKELY (MIDDLETOWN) AND 2.3 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER AGE 18 YOUTH WHITE ALONE NOT HISPANIC OR LATINO YOUTH (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: CONNECTICUT DATA COLLABORATIVE, 2015-2019).WHILE THE MAJORITY OF TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA EXPERIENCE A LOWER HOUSING COST-BURDEN RATE (HOUSEHOLDS THAT SPEND AT LEAST 30% OF THEIR ANNUAL HOUSEHOLD INCOME ON HOUSING COSTS) WHEN COMPARED TO CONNECTICUT (39.6%), FOR THIS COHORT, THE PERCENTAGE OF HOUSEHOLDS IN THE TOWNS THAT ARE COST-BURDENED IS HIGH, RANGING FROM 22% - 37.8%. THE TOWNS OF CLINTON, LYME, AND MIDDLETOWN COMPARED TO CONNECTICUT, WHILE CHESTER, OLD SAYBROOK, AND WESTBROOK EXCEED THE STATE AVERAGE WITH A RANGE OF 41.2% - 43.6% EXPERIENCING HOUSING COST-BURDEN (CONNECTICUT DATA COLLABORATIVE, 2015-2019).(CONTINUED AT END) PART VI, LINE 5: AS MIDDLESEX HOSPITAL IS A COMMUNITY HOSPITAL, INVOLVING COMMUNITY MEMBERS IN KEY FUNCTIONS HAS ALWAYS BEEN A PRIORITY. MIDDLESEX HOSPITAL'S BOARD IS COMPRISED MAINLY OF COMMUNITY MEMBERS WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS NOR CONTRACTORS OF THE ORGANIZATION, BUT ARE LONG-TERM RESIDENTS WHOSE PRIMARY INTEREST IS THE HEALTH AND WELL-BEING OF THE COMMUNITY AT LARGE. MIDDLESEX HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY BASED ON THE HOSPITAL'S CURRENT AND PROJECTED PATIENT CARE, TEACHING AND RESEARCH NEEDS, AND OVERALL COMMUNITY NEED. MEDICAL STAFF INPUT AND PARTICIPATION IS HIGHLY VALUED BY THE HOSPITAL AS EVIDENCED BY INCLUSION IN THE HOSPITAL'S MEDICAL EXECUTIVE COMMITTEE, THE MEDICAL STAFF COUNCIL AND COUNTLESS OTHER WORKING COMMITTEES. MIDDLESEX HOSPITAL HAS A FORMAL PROCESS FOR ALLOCATION OF SURPLUS FUNDS; A MULTIDISCIPLINARY CAPITAL BUDGETING COMMITTEE MEETS AND SETS PRIORITIES FOR INVESTMENTS IN PATIENT CARE, EDUCATION AND RESEARCH, AND PHYSICAL STRUCTURE. THE APPROACH TAKES INTO CONSIDERATION PATIENT, COMMUNITY AND STAFF NEEDS. EACH YEAR THE HOSPITAL ALLOCATES A PORTION OF SURPLUS FUNDING TO A WIDE ARRAY OF COMMUNITY BENEFIT PROGRAMS AND SERVICE LINES, INCLUDING SUBSTANTIAL HEALTH AND WELLNESS ACTIVITIES AND INITIATIVES, SUBSIDIZED SERVICES, MEDICAL EDUCATION, RESEARCH AND HEALTH ASSESSMENT COSTS. CONTINUOUS DEDICATION TO THE COMMUNITIES IT SERVES REMAINS THE HALLMARK OF MIDDLESEX HOSPITAL'S VISION, MISSION, AND STRATEGIC PLANNING. AMBITIOUS COMMUNITY BENEFIT GOALS, THE INCORPORATION OF COMMUNITY BENEFIT INTO ANNUAL ORGANIZATIONAL PLANNING, AND THE PROVISION OF COMMUNITY BENEFIT PROGRAMS THAT TARGET THE COMMUNITY'S MOST VULNERABLE AND AT-RISK POPULATIONS HAS ALLOWED THE HOSPITAL TO PUT A FORMAL STRUCTURE AROUND ITS FUNDAMENTAL PURPOSE. THE HOSPITAL'S COMMUNITY BENEFIT TOTAL FOR FY24 WAS $81,164,563 (EXCLUDING COMMUNITY BUILDING) WITH 95,060 SERVED (EXCLUDING COMMUNITY BUILDING). THE FOLLOWING IS AN OVERVIEW OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM: COMMUNITY HEALTH IMPROVEMENT SERVICES: THE HOSPITAL UNDERWRITES A VAST RANGE OF COMMUNITY HEALTH EDUCATION AND HEALTH IMPROVEMENT PROGRAMS, NONE OF WHICH ARE DEVELOPED FOR MARKETING PURPOSES, ALL OF WHICH ARE SUPPORTED AS A MEANS OF FULFILLING THE HOSPITAL'S MISSION TO SERVE ITS COMMUNITY. 100% OF THE TIME THESE SERVICES ARE OFFERED FREE OF CHARGE (IN THE RARE INSTANCE WHERE A NOMINAL FEE IS ASSESSED THE COST OF PROVIDING THE SERVICE IS NOT COVERED). COMMUNITY HEALTH EDUCATION IS PROVIDED TO THE COMMUNITY AT LARGE. SOME OF THE PROGRAMS REPRESENT ONE TIME EVENTS, HOWEVER MOST ARE ONGOING AND OVER THE YEARS HAVE BECOME ENTRENCHED IN THE COMMUNITY AS A SOURCE OF SUPPORT AND CONTINUED EDUCATION FOR A HEALTHFUL FUTURE. EXAMPLES OF COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE (BUT ARE NOT LIMITED TO): 1) HEALTH EDUCATION (COMMUNITY EDUCATION PRESENTATIONS; HEALTH AND WELLNESS EVENTS/HEALTH FAIRS; SUPPORT GROUPS; LARGE SCALE CANCER AWARENESS AND EDUCATIONAL EVENTS; AND THE AVAILABILITY OF HEALTH LITERATURE); 2) COMMUNITY-BASED CLINICAL SERVICES (CLINICS AND SCREENINGS; ANNUAL FLU SHOTS; BLOOD PRESSURE CLINICS); AND 3) HEALTHCARE SUPPORT SERVICES OFFERED TO INCREASE ACCESS AND QUALITY OF CARE TO INDIVIDUALS, ESPECIALLY THOSE LIVING IN POVERTY AND / OR OTHER VULNERABLE POPULATIONS. IN FY24, THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT SERVICES SERVED 22,252 INDIVIDUALS AT A TOTAL COST OF $2,308,645 TO THE HOSPITAL. HEALTH PROFESSIONS EDUCATION: HELPING TO PREPARE FUTURE HEALTH CARE PROFESSIONALS IS A LONG-STANDING COMMITMENT OF MIDDLESEX HOSPITAL AND DISTINGUISHING CHARACTERISTIC THAT CONSTITUTES A SIGNIFICANT COMMUNITY BENEFIT. THE HOSPITAL'S FAMILY MEDICINE RESIDENCY PROGRAM GRADUATES FAMILY PRACTICE PHYSICIANS, MANY OF WHOM CONTINUE TO PRACTICE IN THE MIDDLESEX COUNTY AREA AFTER THEIR TRAINING IS COMPLETE. THIS IS ESPECIALLY IMPORTANT GIVEN THAT MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA (MUA) EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDES TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS THAT MIDDLESEX COUNTY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY MEDICAL CARE. THE HOSPITAL ALSO WELCOMES MEDICAL AND NURSING STUDENT INTERNS AND PROVIDES ON-SITE TRAINING DURING CLINICAL ROTATIONS. NURSING STUDENTS FROM LOCAL COLLEGES AND PROGRAMS RECEIVE HANDS-ON MENTORSHIP IN THE MAJORITY OF CLINICAL SERVICE LINES YEAR-ROUND. OTHER HEALTHCARE PROFESSIONAL EDUCATION INCLUDES THE HOSPITAL'S RADIOLOGY SCHOOL (WHICH OPERATES AT A LOSS FOR THE HOSPITAL) AND CLINICAL/NON-CLINICAL EDUCATIONAL STUDENT TRAINING IN MULTIPLE FIELDS. IN FY24, THE HOSPITAL'S HEALTH PROFESSIONS EDUCATION CATEGORY SERVED 732 INDIVIDUALS AT A TOTAL COST OF $11,334,927 TO THE HOSPITAL. SUBSIDIZED HEALTH SERVICES: THE HOSPITAL'S SUBSIDIZED HEALTH SERVICES REPRESENT A SIGNIFICANT PORTION OF MIDDLESEX HOSPITAL'S ANNUAL COMMUNITY BENEFIT AGGREGATE FINANCIALS AND NUMBERS SERVED. SUBSIDIZED SERVICES ARE PARTICULAR CLINICAL PROGRAMS PROVIDED TO THE COMMUNITY DESPITE A FINANCIAL LOSS, WITH NEGATIVE MARGINS REMAINING AFTER SPECIFIC DOLLARS (FINANCIAL ASSISTANCE AND BAD DEBT) AND SHORTFALLS (MEDICAID) ARE REMOVED. IN ORDER TO QUALIFY AS A SUBSIDIZED SERVICE, THE PROGRAM MUST MEET CERTAIN HEALTH DELIVERY CRITERIA; MEET AN IDENTIFIED NEED IN THE COMMUNITY; AND WOULD BECOME UNAVAILABLE OR THE RESPONSIBILITY OF A GOVERNMENTAL OR ANOTHER NOT-FOR-PROFIT AGENCY TO PROVIDE IF THE HOSPITAL DISCONTINUED THE SERVICE. MIDDLESEX HOSPITAL'S SUBSIDIZED SERVICES INCLUDE FAMILY PRACTICE SERVICES, BEHAVIORAL HEALTH (INPATIENT AND OUTPATIENT), HOMECARE, PARAMEDICS, CENTER FOR CHRONIC CARE MANAGEMENT DISEASE MANAGEMENT OUTPATIENT PROGRAMS (ADULT ASTHMA; CHILD ASTHMA; DIABETES EDUCATION AND DISEASE MANAGEMENT; MEDICAL NUTRITION THERAPY; SMOKING CESSATION; CHRONIC HEART FAILURE; AND CHILDHOOD WEIGHT MANAGEMENT); WIC (SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN); AMBULATORY INFUSION; WOUND CARE AND MULTISPECIALTY GROUP (WHICH INCLUDES PHYSICIAN SPECIALTY OUTPATIENT CLINICS FOR ENDOCRINE / GENDER MEDICINE; RHEUMATOLOGY; INFECTIOUS DISEASE; PULMONOLOGY; NEUROLOGY, WHICH ARE SERVICES THAT WOULD BE UNAVAILABLE IN THE COMMUNITY IF MIDDLESEX HEALTH DID NOT OFFER THEM, THE COMMUNITY'S CAPACITY TO PROVIDE THE SERVICES WOULD BE BELOW THE COMMUNITY'S NEED, AND THE SERVICES WOULD BECOME THE RESPONSIBILITY OF GOVERNMENT OR ANOTHER TAX-EXEMPT ORGANIZATION IF MIDDLESEX HEALTH DID NOT OFFER THEM). IN FY24 THE HOSPITAL'S SUBSIDIZED SERVICES SERVED 38,350 PEOPLE WITH A TOTAL COST OF $28,814,217 TO THE HOSPITAL. RESEARCH: MIDDLESEX HOSPITAL CONDUCTS RESEARCH IN THE DOMAINS OF CLINICAL AND COMMUNITY HEALTH. CLINICAL EXAMPLES INCLUDE NATIONAL TRIALS BY THE HOSPITAL'S CANCER CENTER. FOR FY24, THE HOSPITAL'S ASSOCIATED COSTS FOR ALL (NON-INDUSTRY) RESEARCH PROJECTS TOTALED $264,969 AND SERVED 86 INDIVIDUALS. FINANCIAL AND IN-KIND CONTRIBUTIONS: MIDDLESEX HOSPITAL SUPPORTS THE COMMUNITY IN THE FORM OF FINANCIAL AND IN-KIND CONTRIBUTIONS. EACH YEAR THE HOSPITAL MAKES SUBSTANTIAL CASH DONATIONS TO CAREFULLY SELECTED MISSION-DRIVEN COMMUNITY ORGANIZATIONS THROUGHOUT ITS SERVICE AREA. THE HOSPITAL'S FY24 SUPPORT FOR FINANCIAL AND IN-KIND CONTRIBUTIONS TOTALED $283,521, SERVING 9,958 INDIVIDUALS. COMMUNITY BENEFIT OPERATIONS: COMMUNITY BENEFIT OPERATIONS INCLUDE ACTIVITIES AND COSTS ASSOCIATED WITH COMMUNITY BENEFIT STRATEGIC PLANNING, ADMINISTRATION, ANNUAL GOAL ATTAINMENT, AND COMMUNITY HEALTH NEEDS ASSESSMENT (AND CHNA IMPLEMENTATION STRATEGY) PRODUCTION AND IMPLEMENTATION. MIDDLESEX HOSPITAL HAS A DEDICATED DIRECTOR OF COMMUNITY HEALTH IMPROVEMENT WHO OVERSEES THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM AND A REPORTING STRUCTURE THAT OVERSEES COMMUNITY BENEFIT PLANNING AND OPERATIONS. OUTSIDE OF ON-GOING COMMUNITY BENEFIT ACTIVITIES, KEY COMPONENTS OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM IS CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOPING A CHNA IMPLEMENTATION STRATEGY EVERY THREE TAXABLE YEARS, ENSURING THAT THE CHNA IMPLEMENTATION STRATEGY GOALS ARE ADDRESSED THROUGH COLLABORATION WITH COMMUNITY PARTNERS, AND FOCUSING ON HEALTH EQUITY AND HEALTH-RELATED SOCIAL NEEDS. THE HOSPITAL'S FY24 COMMUNITY BENEFIT OPERATIONS EXPENSE TOTALED $161,513. PART VI, LINE 6: THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. MIDDLESEX HEALTH IS A FULLY COMPREHENSIVE NETWORK OF EXPERT HEALTH CARE PROVIDERS THAT HAS CONVENIENT LOCATIONS THROUGHOUT CENTRAL CONNECTICUT AND THE SHORELINE. MEMBERS OF THE COMMUNITY ARE ALWAYS CLOSE TO CARE FOR EVERY FAMILY MEMBER AT EVERY AGE. MIDDLESEX HEALTH PROVIDES THE BEST CARE POSSIBLE FOR JUST ABOUT ALL ITS COMMUNITY MEMBERS' HEALTH AND WELLNESS NEEDS. THE ORGANIZATIONS INCLUDED IN THE AFFILIATED HEALTH CARE SYSTEM ARE AS FOLLOWS: MIDDLESEX HOSPITAL - A NON-PROFIT, ACUTE CARE, COMMUNITY HOSPITAL IN MIDDLETOWN, CT MIDDLESEX HEALTH SERVICES - PROVIDING INTEGRATIVE MEDICINE SERVICES TO THE COMMUNITY. MHS PRIMARY CARE - PROVIDES PATIENT-CENTERED, COMPASSIONATE CARE TO ALL MEMBERS OF THE COMMUNITY. MIDDLESEX HOSPITAL FOUNDATION - SUPPORTS MIDDLESEX HOSPITAL. MIDDLESEX HEALTH SYSTEM - PARENT OF AND PROVIDES FUNDRAISING SERVICES FOR MIDDLESEX HOSPITAL. PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT: CONNECTICUT GENERAL STATUTES 19A-127K REQUIRES THAT ON OR AFTER JANUARY 1, 2023, EACH HOSPITAL IN CONNECTICUT SUBMIT ANNUAL COMMUNITY BENEFIT PROGRAM REPORTING TO THE CONNECTICUT OFFICE OF HEALTH STRATEGY. AS MIDDLESEX HOSPITAL MEETS THE STATUTE AS HAVING A COMMUNITY BENEFIT PROGRAM IN PLACE, IT REPORTS ANNUALLY TO THE STATE OF CONNECTICUT'S OFFICE OF HEALTH STRATEGY. PART VI, QUESTION 4 - COMMUNITY INFORMATION (CONTINUED): FOR HEALTH INSURANCE STATUS, UNDER AGE 18, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (3.0%), EXCEPT CLINTON (3.4%), ESSEX (4.9%) AND OLD LYME (4.7%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. FOR HEALTH INSURANCE STATUS, AGES 18-64, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (7.5%), EXCEPT DEEP RIVER (12.8%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. FOR HEALTH INSURANCE STATUS, AGES 65+, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (0.6%), EXCEPT DEEP RIVER (1.0%) AND KILLINGWORTH (2.9%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. IN 2024, THE PERCENT OF HOSPITAL DISCHARGES FOR MEDICAID/SAGA/UNINSURED COMBINED WERE: 19% INPATIENT; 14% OUTPATIENT; 27% EMERGENCY DEPARTMENT NON-ADMISSION; AND, FOR THE FOLLOWING SERVICES: 35% MATERNITY; 37% NEWBORN; 49% INPATIENT PSYCHIATRY; 11% OUTPATIENT SURGERY AND 14% OTHER OUTPATIENT SERVICES. MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDE TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS) FOR PRIMARY CARE (MIDDLETOWN SERVICE AREA; LOW INCOME POPULATION), MENTAL HEALTH (MIDDLESEX COUNTY; HIGH NEED GEOGRAPHIC) AND DENTAL HEALTH (CENTRAL MIDDLETOWN; LOW INCOME POPULATION). 1 MIDDLESEX CHAMBER OF COMMERCE 393 MAIN STREET MIDDLETOWN CT 06457 060452410 501(C)(6) 65100 0 GENERAL SUPPORT HAVEN 1210 MILL STREET EAST BERLIN CT 06023 510642913 501(C)(3) 10000 0 GENERAL SUPPORT COMMUNITY FOUNDATION OF MIDDLESEX COUNTY 211 SOUTH MAIN STREET MIDDLETOWN CT 06457 061477711 501(C)(3) 10000 0 2024 BECKY THATCHER RIVER CRUISE SUPPORT VARSITY COMMUNICATIONS INC 5720 204TH ST SUITE 100 LYNNWOOD WA 98036 911430177 17000 0 2024 CT GOLF SHOW SPONSORSHIP CONNECTICUT STATE GOLF ASSOCIATION 35 COLD SPRING ROAD SUITE 212 ROCKY HILL CT 06067 222587856 501(C)(3) 35000 0 CSGA SPONSORSHIP ST VINCENT DEPAUL FOUNDATION 617 MAIN STREET MIDDLETOWN CT 06457 061387081 501(C)(3) 5490 0 GENERAL SUPPORT 4 2 PART I, LINE 2: THE PUBLIC RELATIONS DEPARTMENT HAS A POLICY REGARDING WHICH ORGANIZATIONS THEY ARE WILLING TO PARTNER WITH AND GIVE GRANTS OR ASSISTANCE. THEN ONCE THE GRANT OR ASSISTANCE IS AWARDED THE PUBLIC RELATIONS DEPARTMENT WORKS CLOSELY WITH EACH OF THE ORGANIZATIONS TO ENSURE THAT THE GRANT OR ASSISTANCE IS USED FOR THE INTENDED PURPOSES. THIS IS DONE BY CONTACT AND ATTENDANCE AT THE SPONSORED EVENTS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 VINCENT CAPECE JR PRESIDENT/CEO 876759 0 280500 0 308215 0 291900 0 35412 0 1792786 0 283573 0 SUSAN MARTIN VP FINANCE/TREASURER 499406 0 102500 0 94185 0 41595 0 27232 0 764918 0 83493 0 DAVID COSENTINO VP QUALITY & PATIENT SAFETY 465920 0 100500 0 4639 0 73751 0 34697 0 679507 0 0 0 EVAN JACKSON VP & CIO 403090 0 80000 0 46648 0 64300 0 35774 0 629812 0 41817 0 DAVID GIUFFRIDA VP FACILITIES AND SUPPORT SVCS 367704 0 0 0 149247 0 35650 0 15399 0 568000 0 143105 0 THEODORE HARTENSTEIN MED DIRECTOR, UTILIZATION 493046 0 13200 0 450 0 19800 0 36642 0 563138 0 0 0 JONATHAN BANKOFF CHAIRMAN EMERGENCY MEDICINE 482196 0 18750 0 450 0 23100 0 33792 0 558288 0 0 0 RICARDO PEREZ PULMONOLOGIST 366227 0 137710 0 270 0 16500 0 33792 0 554499 0 0 0 LAURA MARTINO LEFT 122022 FORMER KEY EMPLOYEE 6557 0 70000 0 293708 0 1535 0 150178 0 521978 0 293474 0 JUSTIN GORALNIK PULMONOLOGIST 324563 0 145559 0 301 0 16433 0 18428 0 505284 0 0 0 JEFFREY SHELTON CHAIRMAN DEPT PSYCH 443351 0 13200 0 450 0 19800 0 24408 0 501209 0 0 0 DONNA STRONESKI VP HUMAN RESOURCES 333985 0 50500 0 36944 0 59950 0 4189 0 485568 0 32118 0 BRIAN MCGUIRE PHYSICIAN 309469 0 113691 0 690 0 24157 0 36792 0 484799 0 0 0 KELLY HAECKEL VP PATIENT CARE SVCS/CNO 315060 0 67500 0 8615 0 51610 0 32968 0 475753 0 6018 0 TODD BISCHOP CHIEF DEPT OF MED 404781 0 35110 0 450 0 23100 0 2340 0 465781 0 0 0 JUSTIN DREW VP AMBULATORY & CLINICAL SVCS 275969 0 43000 0 3689 0 49169 0 7021 0 378848 0 0 0 LELAND MCKENNA VP PLANNING & EXTERNAL AFFAIRS 277021 0 43000 0 2804 0 46316 0 5575 0 374716 0 0 0 JESSE WAGNER MD FORMER KEY EMPLOYEE 151014 0 1045 0 54757 0 4136 0 0 0 210952 0 54757 0 PART I, LINE 1A SOCIAL CLUB DUES - REPRESENTS A CORPORATE MEMBERSHIP AT A GOLF CLUB USED FOR VARIOUS BUSINESS PURPOSES. THE ASSOCIATED COST IS INCLUDED IN THE TAXABLE COMPENSATION OF THE EXECUTIVE STAFF MEMBER ACCORDING TO IRS RULES AND REGULATIONS. THIS BENEFIT WAS PROVIDED TO THE FOLLOWING INDIVIDUAL: VINCENT CAPECE PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED COMPENSATION FROM A SERP, WHICH WAS INCLUDED IN PART II, COLUMN B(III) AND COLUMN F: VINCENT CAPECE = $283,573 SUSAN MARTIN = $83,493 EVAN JACKSON = $41,817 DAVID GIUFFRIDA = $143,105 DONNA STRONESKI = $32,118 KELLY HAECKEL = $6,018 LAURA MARTINO = $293,474 JESSE WAGNER, MD = $54,757 SERP CONTRIBUTIONS WERE MADE FOR THE FOLLOWING INDIVIDUALS AND ARE INCLUDED IN PART II, COLUMN C: VINCENT CAPECE = $265,500 SUSAN MARTIN = $15,195 DAVID CONSENTINO = $47,351 EVAN JACKSON = $41,200 DAVID GIUFFRIDA = $9,250 DONNA STRONESKI = $33,550 KELLY HAECKEL = $32,150 JUSTIN DREW = $28,500 LELAND MCKENNA = $28,500 PART II, COLUMN (B)(II) - BONUS & INCENTIVE COMPENSATION: THE AMOUNTS REPRESENT INCENTIVE COMPENSATION PAYMENTS MADE IN CALENDAR YEAR 2023. PAYMENTS INCLUDE AMOUNTS EARNED IN 2022 AND DEFERRED, WHERE APPLICABLE. A CHEFA - SERIES O 060806186 20774YWD5 2015-05-19 19491965 REFINANCE L BONDS 0 0 0 B CHEFA - SERIES P 060806186 2016-06-10 9683000 REFINANCE M BONDS 0 0 0 C CHEFA - SERIES Q 060806186 2017-11-21 11599000 REFINANCE N BONDS 0 0 0 A 6030000 19491965 388960 19103010 2015 0 1 1 1 B 7207646 10347540 193660 10153880 2016 0 1 1 1 C 5886636 11599000 231980 11367020 2021 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CHEFA - SERIES O DATE THE REBATE COMPUTATION WAS PERFORMED: 05/19/2020 ISSUER NAME: CHEFA - SERIES P DATE THE REBATE COMPUTATION WAS PERFORMED: 06/10/2021 ISSUER NAME: CHEFA - SERIES Q DATE THE REBATE COMPUTATION WAS PERFORMED: 11/21/2022 SCHEDULE K, PART II, LINE 3: SERIES P BONDS (COLUMN B) AND SERIES Q BONDS (COLUMN C) - THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS IS INVESTMENT EARNINGS. SCHEDULE K, PART II, LINE 11: THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES O BONDS (COLUMN A) WAS USED TO REFUND THE CHEFA SERIES L BONDS DATED DECEMBER 7, 2006. THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES P BONDS (COLUMN B) WAS USED TO REFUND THE CHEFA SERIES M BONDS DATED DECEMBER 7, 2006. THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES Q BONDS (COLUMN C) WAS USED TO PARTIALLY REFUND THE CHEFA SERIES N BONDS DATED JULY 26, 2011. IN ADDITION, $736 WAS A PREPAYMENT OF INTEREST. SCHEDULE K, PART III, LINE 3: SERIES O BONDS (COLUMN A) AND SERIES P BONDS (COLUMN B) - THE ORGANIZATION HAS DETERMINED THAT ALL MANAGEMENT/SERVICE CONTRACTS MEET THE SAFE HARBOR UNDER REV. PROC. 2017-13, 2017-6 I.R.B. 787. DAVID GIUFFRIDA KEY EMPLOYEE 672912 SEE PART V 0 JESSE WAGNER MD FORMER KEY EMPLOYEE 72014 SEE PART V 0 DAVID COSENTINO KEY EMPLOYEE 340382 SEE PART V 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 5973190 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 1951430 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 1264503 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 169741 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 625000 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 210214 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 384931 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF INTERESTED PERSON: DAVID GIUFFRIDA(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN INDEPENDENT CONTRACTOR ARRANGEMENT WITH GUIFFRIDA ELECTRIC, CO., WHICH IS MORE THAN 35% OWNED BY A FAMILY MEMBER OF DAVID GIUFFRIDA.(A) NAME OF INTERESTED PERSON: JESSE WAGNER, MD(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN EMPLOYMENT ARRANGEMENT WITH RUTH WAGNER, REGISTERED NURSE, WHO IS A FAMILY MEMBER OF JESSE WAGNER, MD.(A) NAME OF INTERESTED PERSON: DAVID COSENTINO(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN EMPLOYMENT ARRANGEMENT WITH MEGAN COSENTINO, WHO IS A FAMILY MEMBER OF DAVID COSENTINO. X 6 382095 FMV 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN B IS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: MIDDLESEX HOSPITAL IS AN ACUTE CARE GENERAL HOSPITAL SERVING THE RESIDENTS OF MIDDLESEX COUNTY AND VARIOUS SURROUNDING COMMUNITIES PROVIDING SELECTED HIGH-QUALITY INPATIENT AND OUTPATIENT HEALTH SERVICES. THE HOSPITAL MAINTAINS FORMAL RELATIONSHIPS WITH SPECIALIZED PROVIDERS TO ASSURE COORDINATION OF CARE WHEN SERVICES ARE NOT LOCALLY AVAILABLE. AN INTEGRAL PART OF THE CORE PROGRAMS, SPANNING THEIR TRADITIONAL DIAGNOSTIC AND TREATMENT SERVICES, ARE THE SCORES OF SPECIAL PROGRAMS OFFERED TO THE COMMUNITIES SERVED, MANY OF WHICH FOCUS ON THE DISADVANTAGED AND UNDERSERVED, THOSE SPECIAL POPULATIONS SUCH AS MINORITIES, OLDER PERSONS, PERSONS LIVING IN POVERTY WITH DISABILITIES, CHRONICALLY MENTALLY ILL PERSONS, AND OTHER DISENFRANCHISED PERSONS. MANY OTHER SPECIAL PROGRAMS WITH A FOCUS TO REACH OUT TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF ECONOMIC CONDITION OR SOCIAL STATUS RESPOND TO PUBLIC HEALTH NEEDS AND INVOLVE EDUCATION OR RESEARCH THAT IMPROVES OVERALL COMMUNITY HEALTH. ALL OF THESE SPECIAL PROGRAMS ARE OFFERED FREE OF CHARGE OR OFFERED AT A RATE THAT IS CONSIDERABLY LESS THAN THE COST OF PROVIDING THEM. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE HOSPITAL IS MIDDLESEX HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, MIDDLESEX HEALTH SYSTEM, INC. HAS THE RIGHT TO ANNUALLY ELECT THE BOARD OF DIRECTORS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, MIDDLESEX HEALTH SYSTEM, INC., HAS ALL RIGHTS CONFERRED BY LAW, THE CERTIFICATE OF INCORPORATION AND MIDDLESEX HOSPITAL BY-LAWS, BY VOTE OF ITS BOARD OF DIRECTORS, ITS PRESIDENT, OR BY OR THROUGH ANY OTHER PERSON(S) DESIGNATED BY ITS BOARD OF DIRECTORS IN ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF THE FORM 990 IS PROVIDED TO EACH BOARD MEMBER FOR THEIR REVIEW AND CHANGES FROM PRIOR YEAR ARE HIGHLIGHTED. ANY QUESTIONS OR COMMENTS THEY HAVE ARE PRESENTED TO EXECUTIVE MANAGEMENT. A COMPLETE COPY OF THE FINAL FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST FORMS ARE DISTRIBUTED ANNUALLY TO KEY EMPLOYEES, OFFICERS, AND THE BOARD OF DIRECTORS. RESPONSES ARE RETURNED TO, TRACKED, AND REVIEWED BY THE SYSTEM COMPLIANCE OFFICER. MATERIAL CONFLICTS ARE REPORTED TO THE AUDIT COMMITTEE FOR REVIEW AND DETERMINATION. IN ADDITION TO COMPLETING THE ANNUAL CONFLICT OF INTEREST FORM, BOARD MEMBERS MUST IMMEDIATELY DISCLOSE ANY INTEREST AND ALL MATERIAL FACTS TO THE BOARD OF DIRECTORS, AS THEY OCCUR. THE BOARD THEN REVIEWS THE FACTS AND MAKES THE DETERMINATION AS TO WHETHER A SIGNIFICANT CONFLICT OF INTEREST EXISTS. IF SO, THE BOARD FOLLOWS DISABLING GUIDELINES TO DETERMINE IF THE BOARD MEMBER SHOULD BE ASKED TO RESIGN OR BE REMOVED. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE TEAM COMPENSATION IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. THE COMMITTEE HAS A CHARTER AND A POLICY STATEMENT SETTING FORTH A PROCESS AND CERTAIN GUIDELINES FOR DETERMINING COMPENSATION. EXECUTIVES RECEIVE A BASE SALARY AND HAVE THE OPPORTUNITY FOR INCENTIVE COMPENSATION WITHIN A RANGE SET BY THE POLICY. FOLLOWING THE CLOSE OF EACH FISCAL YEAR, THE COMMITTEE RECEIVES A MARKET ANALYSIS FROM INDEPENDENT CONSULTANTS REGARDING COMPENSATION AT PEER GROUPS OF COMPARABLE HOSPITALS AND HEALTH SYSTEMS. POSITIONS WITHIN THE THE EXECUTIVE TEAM ARE COMPARED TO BENCHMARK POSITIONS WITHIN THIS MARKET DATA AND THEIR COMPENSATION IS COMPARED TO THE DATA BOTH WITH RESPECT TO CASH COMPENSATION AND TOTAL COMPENSATION INCLUDING FRINGE BENEFITS. THE CEO RECOMMENDS THE INCENTIVE AWARDS AND BASE SALARY ADJUSTMENTS TO THE COMPENSATION OF THE EXECUTIVES WHO REPORT TO HIM, AND THE COMMITTEE REVIEWS THOSE RECOMMENDATIONS, APPROVES OR MODIFIES THEM, AND ALSO DETERMINES ANY INCENTIVE AWARD AND BASE SALARY ADJUSTMENT FOR THE CEO. THE CONSULTANTS PROVIDE A WRITTEN OPINION ANNUALLY CONFIRMING THAT THE COMPENSATION OF THE EXECUTIVES, AS ADJUSTED BY THIS PROCESS, IS "REASONABLE" WITHIN APPLICABLE IRS GUIDELINES. KEY EMPLOYEE COMPENSATION IS SET FOLLOWING THE GUIDELINES SET FORTH IN THE HOSPITAL COMPENSATION POLICY. THE OBJECTIVE OF THIS POLICY IS TO PAY EMPLOYEES BASED UPON HOSPITAL NEED, THE PROPER EXTERNAL LABOR MARKET AND PERFORMANCE. THE LAST COMPENSATION REVIEW OCCURRED 12/2023. FORM 990, PART VI, SECTION C, LINE 19 MIDDLESEX HOSPITAL MAINTAINS A QUALITY AND COMPLIANCE SECTION ON ITS WEBSITE, MIDDLESEXHOSPITAL.ORG. THE HOSPITAL POSTS THE MOST CURRENT AUDITED FINANCIAL STATEMENTS AND FORM 990 WITH THOSE OF OTHER AFFILIATES AS THEY BECOME AVAILABLE, AS WELL AS STATEMENTS AND FORMS FROM AT LEAST TWO PREVIOUS FISCAL YEARS. THE HOSPITAL'S CONFLICT OF INTEREST POLICY IS ALSO POSTED ON THE WEBSITE IN THE VENDORS AND SUPPLIERS SECTION. IN ADDITION, THE ORGANIZATION'S FORM 990 IS AVAILABLE AT WWW.GUIDESTAR.ORG AND UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER (TO) / FROM MIDDLESEX HEALTH SYSTEM, INC. -659,547. TRANSFER (TO) / FROM MHS PRIMARY CARE -20,394,190. TRANSFER (TO) / FROM RESOURCES 1,571,953. CHANGE IN ASSETS HELD IN TRUST 585,112. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 3B: MIDDLESEX HOSPITAL DOES NOT HAVE A SEPARATE AUDIT PERFORMED UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. MIDDLESEX HOSPITAL IS INCLUDED IN THE A-133 AUDIT PERFORMED FOR MIDDLESEX HEALTH SYSTEM FOR PURPOSES OF THE A-133 AUDIT. THE RELEVANT ACTIVITIES AND EXPENDITURES OF MIDDLESEX HOSPITAL ARE REVIEWED AND THE RESULTS ARE INCLUDED IN THE SINGLE A-133 AUDIT REPORT FOR MIDDLESEX HEALTH SYSTEM. MIDDLESEX HEALTH SYSTEM INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676137 SUPPORT CT 501(C)(3) LINE 12B, II N/A 0 MIDDLESEX HEALTH SERVICES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676140 HEALTHCARE CT 501(C)(3) LINE 10 MIDDLESEX HEALTH SYSTEM INC 0 MIDDLESEX HOSPITAL FOUNDATION INC 28 CRESCENT STREET MIDDLETOWN CT 06457 273720822 SUPPORT CT 501(C)(3) LINE 12B, II MIDDLESEX HOSPITAL 1 MHS PRIMARY CARE INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061472743 HEALTHCARE CT 501(C)(3) LINE 10 MIDDLESEX HEALTH SYSTEM INC 0 MIDDLESEX HEALTH RESOURCES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061089925 RENTAL REAL ESTATE CT N/A C 0 INTEGRATED RESOURCES FOR THE MIDDLESEX AREA LLC 28 CRESCENT STREET MIDDLETOWN CT 06457 061462230 OUTPATIENT CARE CT N/A C 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1