2021-08-12T14:16:34-05:00 2020-09-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2019-10-01 060646599 DAY KIMBALL HEALTHCARE INC % PAUL A BEAUDOIN DAYK 8609286541 320 POMFRET STREET PUTNAM CT 06260 PAUL BEAUDOIN CFO 8609286541 2021-02-08 true Brian D Todd P00422601 4178658701 2019 2022-09-23 18:48:47Z DAY KIMBALL HOSPITAL KYLE KRAMER 320 POMFRET STREET PUTNAM CT 06260 119100738 false X WWW.DAYKIMBALL.ORG X 1894 CT DKH IS A SHORT-TERM GENERAL CARE HOSPITAL PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO NORTHEASTERN CT AND BORDER COMMUNITIES IN MA AND RI. 17 13 1027 103 0 0 1226145 3874663 116424929 105590190 682983 501301 11995 9300 118346052 109975454 0 0 0 0 54020714 53503717 0 0 0 56355000 60095355 110375714 113599072 7970338 -3623618 92892711 92107218 108309210 127879055 -15416499 -35771837 THE MISSION OF DAY KIMBALL HEALTHCARE IS TO MEET THE HEALTH NEEDS AND WELL-BEING OF OUR DIVERSE COMMUNITY THROUGH OUR CORE VALUES OF CLINICAL QUALITY, CUSTOMER SERVICE, FISCAL AND ENVIRONMENTAL RESPONSIBILITY AND LOCAL CONTROL. false false 97984013 100718361 DAY KIMBALL HEALTHCARE PROVIDES A COMPREHENSIVE HEALTHCARE SYSTEM OFFERING PRIMARY CARE AND A MULTITUDE OF MEDICAL AND SURGICAL SPECIALTIES ALONG WITH LEADING-EDGE TECHNOLOGY AND SOPHISTICATED DIAGNOSTICS. OUR SERVICE AREA INCLUDES NORTHEAST CONNECTICUT AS WELL AS NEARBY MASSACHUSETTS AND RHODE ISLAND COMMUNITIES. DAY KIMBALL HEALTHCARE'S COMPREHENSIVE NETWORK OFFERS MORE THAN 1,000 EMPLOYEES INCLUDING MORE THAN 200 HIGHLY-SKILLED PHYSICIANS, SURGEONS AND SPECIALISTS. 4739566 4871829 PHYSICIAN OFFICE PROVIDING PRIMARY CARE AND OUTPATIENT VISITS TO NORTHEASTERN CONNECTICUT COMMUNITIES. 102723579 true true false true false false false false false true true true false false true false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false true true true true false false true 106 0 true 1027 true false false false false false false false false false false false false X 17 13 false false false false false true false true true false false true true true true true true true true false X PAUL A BEAUDOIN 8609286541 320 POMFRET STREET PUTNAM CT 06260 X ANNE DIAMOND PRESIDENT AND CEO 40.0 3.0 X 491334 0 2158 PAUL BEAUDOIN CFO 40.0 3.0 X 381097 0 33 ALEXANDRE CARRE MD PHYSICIAN 40.0 0.0 X 357316 0 33 SARA JANE DEASIS MENTAL HEALTH PHYSICIAN 40.0 0.0 X 324687 0 10541 DR PAUL MATTY DIRECTOR 1.0 40.0 X 0 304882 9781 MICHAEL BAUM MD DIRECTOR 1.0 40.0 X 0 302929 9874 JOHN GRAHAM MD CHIEF MEDICAL OFFICER 40.0 1.0 X 300873 0 8430 ANTHONY CHIEFFALO DIRECTOR 1.0 40.0 X 0 303574 1470 JOHN MODICA MD PHYSICIAN 40.0 0.0 X 225916 0 7585 KRISTA MATSEN DIRECTOR 1.0 40.0 X 0 223002 6637 JOHN O'KEEFE CHIEF NURSING OFFICER 40.0 0.0 X 184150 0 7258 CHERYL PETRARCA DIRECTOR OF PATIENT CARE 40.0 0.0 X 167118 0 4239 JEFFREY CORRIGAN VP HUMAN RESOURCES 40.0 0.0 X 169064 0 1462 KRISTEN LESCAULT CLINICAL MANAGER RN 40.0 0.0 X 163992 0 5393 CINDY JANZ HOMECARE/RN 40.0 0.0 X 161805 0 5143 SARAH GINNETTI DIRCTOR OF REVENUE CYCLE 40.0 0.0 X 161402 0 4708 RICHARD LINNEL DIRECTOR OF PATIENT CARE SERV 40.0 0.0 X 159697 0 0 GREGORY HARUBIN DIRECTOR FACILITIES MGMT 40.0 0.0 X 147318 0 4359 PETER DEARY VICE CHAIRMAN 1.0 1.0 X X 0 0 0 EDWIN HIGGINS DIRECTOR 1.0 0.0 X 0 0 0 KEVIN JOHNSTON DIRECTOR 1.0 0.0 X 0 0 0 R KYLE KRAMER DIRECTOR 1.0 0.0 X 0 0 0 SHAWN MCNERNEY DIRECTOR 1.0 1.0 X 0 0 0 JEFFREY PAUL TREASURER 1.0 0.0 X X 0 0 0 KATHY ROCHA SECRETARY 1.0 1.0 X X 0 0 0 JANICE THURLOW CHAIRWOMAN 1.0 0.0 X X 0 0 0 NANCY WEISS DIRECTOR 1.0 1.0 X 0 0 0 STEVEN WEXLER MD MEDICAL STAFF REPRESENTATIVE 1.0 0.0 X 0 0 0 KAREN COLE SECRETARY 1.0 0.0 X X 0 0 0 STEVEN SCHIMMEL MD MEDICAN STAFF REP 1.0 0.0 X 0 0 0 JOSEPH ADILETTA CHAIRMAN 1.0 3.0 X X 0 0 0 3395769 1134387 89104 67 false true false SODEXO OPERATIONS LLC 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 NUTRITIONAL 1429275 SHIPMAN GOODWIN LLP ONE CONSTITUTION PLAZA HARTFORD CT 061031919 LEGAL 674328 ORTHOPEDIC ASSOC OF PUTNAM 35 KENNEDY DR PUTNAM CT 06260 PHYSICIAN SERVICES 570321 SHERIDAN HEALTHCARE OF RI PO BOX 74883 ATLANTA GA 303744883 HEALTHCARE SERVICES 399351 EASTERN CT HEMA ONCOLOGY 330 WASHINGTON ST SUITE 220 NORWICH CT 06360 ONCOLOGY SERVICES 286673 15 3115236 759427 3874663 NET PATIENT SERVICE REVENUE 621110 100718361 100718361 OTHER 900099 3634845 3634845 CAFETERIA 722514 460071 460071 PHARMACY 446110 459225 459225 AFFILIATED ORGANIZATION RENT 531120 317688 317688 105590190 514317 514317 0 0 183221 173921 9300 0 9300 9300 8938347 8950020 1343 -11673 -1343 -13016 -13016 0 0 0 0 0 0 0 0 0 0 109975454 105590190 510601 0 0 0 0 2810242 1765094 1045148 0 41029942 37475080 3554862 950608 846829 103779 5324777 4768651 556126 3388148 3032543 355605 0 1217406 1217406 151293 151293 50000 50000 0 88251 88251 13252069 11861189 1390880 316563 283338 33225 4218223 3775496 442727 3582554 3206544 376010 0 2257822 2020851 236971 167799 150188 17611 0 5992 5363 629 2082841 1864235 218606 0 4307350 3855269 452081 4212312 3770206 442106 MEDICAL SUPPLIES & DRUGS 12042729 12042729 PROVIDER TAX 10787518 10787518 REPAIRS & MAINTENANCE 1063474 951856 111618 LICENSES, DUES, SUBSCRIPTION 291159 260600 30559 113599072 102723579 10875493 0 0 0 11353167 15104316 160824 124777 11815382 12380738 0 0 0 0 0 0 2558071 2935957 1422342 152192 136614079 95630349 43787410 40983730 487495 556263 17414401 17914022 0 0 0 0 3893619 1955223 92892711 92107218 26425424 30055670 0 0 0 0 20717385 19523889 0 0 0 0 9995880 9406337 60326 11157 51110195 68882002 108309210 127879055 X -21526967 -42335888 6110468 6564051 -15416499 -35771837 92892711 92107218 X -3623618 492805 -17224525 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 50000 50000 false SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: DAY KIMBALL HOSPITAL PAID DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION DURING THE FISCAL YEAR. A PORTION OF THESE DUES MAY BE ATTRIBUTABLE TO LOBBYING EXPENSES. 11512363 672481 375000 71856 11737988 12101552 233920 750000 73109 11512363 11812302 863836 500000 74586 12101552 9884933 16104 2005447 94182 11812302 9568620 548627 753291 878996 106609 9884933 0.79000 0.21000 false false 0 3378743 3378743 0 87517428 59340071 28177357 0 45036467 36290278 8746189 0 681441 681441 40983730 INV IN VHA COALITION 80000 C FUNDS HEAD IN TRUST BY OTHERS 3538724 F INVESTMENT IN REAL ESTATE 132251 C BOARD RESTRICTED ENDOW FUNDS 13043612 F DONOR RESTRICTED ENDOW FUNDS 1119435 F 17914022 0 PENSION LIABILITIES 53362699 EST AMT DUE TO THIRD PARTIES 12143483 DEFERRED GAIN ON LIABILITIES 1375820 INSURANCE CLAIMS 2000000 68882002 107269168 492805 -2971553 -2478748 109747916 227538 227538 109975454 110749394 173921 173921 110575473 3023599 3023599 113599072 SCHEDULE D, PART X, LINE 4 ENDOWMENT FUND: THE HOSPITAL'S ENDOWMENT CONSISTS OF MULTIPLE FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES INCLUDING CAPITAL EXPENDITURES, OPERATIONS, AND OTHER DONOR-SPECIFIED RESTRICTIONS. SCHEDULE D, PART V, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $( 2,935,348) PENSION/PROFESSIONAL LIABILITY EXPENSE ( 88,251) INVESTMENT MANAGEMENT FEES 52,046 NET ASSETS RELEASED FROM RESTRICTION ------------- $( 2,971,553) SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VII, LINE 12, BUT NOT ON LINE 1: $( 173,921) RENT EXPENSE 401,459 TEMPORARILY RESTRICTED CONTRIBUTIONS ------------- $ 227,538 SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ 173,921 RENT EXPENSE SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 2,935,348 PENSION/PROFESSIONAL LIABILITY EXPENSE 88,251 INVESTMENT MANAGEMENT FEES ------------- $ 3,023,599 true true X true X 250. true X true true true false true true 66752 66752 0.00060 32464185 22620876 9843309 0.08660 32530937 22620876 9910061 0.08720 4186 4186 127402 127402 0.00110 6853151 5263158 1589993 0.01400 6984739 5263158 1721581 0.01510 39515676 27884034 11631642 0.10230 true 4283289 159731 25362835 30705668 -5342833 X true true 1 1 DAY KIMBALL HEALTHCARE 320 POMFRET STREET PUTNAM CT 06260 WWW.DAYKIMBALL.ORG 0043 X X X DAY KIMBALL HEALTHCARE 1 false false true X X X X X X X X X 17 true true false true X SEE PART V, SECTION C X true 18 true SEE PART V, SECTION C false true X 250. 250. X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X true X false false SCHEDULE H, PART V, LINE 5 COMMUNITY INPUT: DAY KIMBALL HOSPITAL CONDUCTED A COMPREHENSIVE NEEDS ASSESSMENT UTILIZING FOCUS GROUPS AND PHONE SURVEYS OF COUNTY RESIDENTS ALONG WITH STATE AND FEDERAL DATA TO IDENTIFY AND PRIORITIZE THE HEALTHCARE NEEDS IN WINDHAM COUNTY. A BROAD RANGE OF INFORMATION WAS COLLECTED FROM THE FOLLOWING SOURCES: - ANONYMOUS PAPER AND ELECTRONIC SURVEYS TO EMPLOYEES AND DKH CORPORATORS FOCUSING ON ACCESS, QUALITY, AND SERVICES NEEDED. - INTERVIEWS WITH MORE THAN 50 COMMUNITY LEADERS. - DAY KIMBALL HEALTHCARE BOARD OF DIRECTORS. - DATA REVIEW FROM MULTIPLE PUBLICLY REPORTED RESOURCES SCHEDULE H, PART V, LINE 6A CHNA CONDUCTED WITH OTHER HOSPITALS: DAY KIMBALL HOSPITAL CONDUCTED ITS NEEDS ASSESSMENT IN CONJUNCTION WITH THE WINDHAM COUNTY HEALTHCARE CONSORTIUM. THE MEMBERS OF THIS CONSORTIUM INCLUDE WINDHAM HOSPITAL, DAY KIMBALL HOSPITAL, NATCHAUG HOSPITAL, GENERATIONS FAMILY HEALTH CENTER, UNITED SERVICES, VNA EAST, NORTHEAST DISTRICT DEPARTMENT OF HEALTH AND COMMUNITY HELATH RESOURCES (CHR). SCHEDULE H, PART V, LINE 7A CHNA AVAILABILITY: THE ORGANIZATION'S CHNA REPORT WAS MADE AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/ABOUT-DAY-KIMBALL-HEALTHCARE/IN-THE-COMMUNITY/ SCHEDULE H, PART V, LINE 10A IMPLEMENTATION STRATEGY AVAILABILITY: THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/ABOUT-DAY-KIMBALL-HEALTHCARE/IN-THE/COMMUNITY/ SCHEDULE H, PART V, LINE 11 ADDRESSING IDENTIFIED NEEDS: MOST OF THE HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT ARE ALREADY ADDRESSED BY DAY KIMBALL HOSPITAL, EITHER BY DIRECT DELIVERY OF SERVICE TO THE COMMUNITY OR THROUGH OUR COLLABORATIONS WITH SUCH ORGANIZATIONS AS HEALTHQUEST. THESE INCLUDE SERVICES AND PROGRAMS SUCH AS: - EXPANDING OUR INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES - PARTNERING WITH WHOLESOME WAVE, WIC, AND THE LOCAL FARMER'S MARKET TO SUBSIDIZE MARKET COUPONS, DOUBLING THEIR VALUE, FOR FAMILIES WITH CHILDREN - WORKING WITH HEALTHQUEST AS AN ACTIVE MEMBER AND FUNDER ON SUCH PROGRAMS AS FOLLOW THE FIFTY, HEART HEALTH, PROGRAM FOR WOMEN AND WRITE STEPS, AN ELEMENTARY SCHOOL-BASED WALKING AND WRITING PROGRAM TO IMPROVE HEALTH (IN PARTICULAR OBESITY IN CHILDREN) AND EDUCATION - BECOMING A SMOKE-FREE ORGANIZATION AND OFFERING SMOKING CESSATION CLASSES TO OUR EMPLOYEES AND CONTINUING TO OFFER CLASSES TO THE COMMUNITY - OFFERING DIABETES CARE MANAGEMENT SERVICES IN ALL OUR PRIMARY CARE OFFICES - IMPLEMENTING A SERIES OF COMMUNITY-BASED FLU SHOT CLINICS TO IMPROVE ACCESS - EXPANDING OUR SLEEP LAB WITH IN-HOME TESTING NOW AVAILABLE - CONDUCTING EDUCATIONAL SEMINARS ON COLON CANCER AND COLONOSCOPIES HOSTED BY OUR SPECIALTY TEAM OF PROVIDERS SCHEDULE H, PART V, LINES 16A, 16B, & 16C FINANCIAL ASSISTANCE POLICY AVAILABILITY: THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE POLICY APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/RESOURCES/FINANCIAL-SERVICES/ 11 PLAINFIELD HEALTHCARE CENTER 31 DOW ROAD/12 LATHROP ROAD PLAINFIELD CT 06374 PRIMARY CARE; PEDIATRICS DANIELSON HEALTHCARE CENTER 55 GREEN HOLLOW ROAD DANIELSON CT 06239 DIAGNOSTIC IMAGING DANIELSON MEDICAL ASSOCIATES 45 GREEN HOLLOW ROAD DANIELSON CT 06239 PRIMARY CARE SERVICES PUTNAM SURGICAL ASSOCIATES 346 POMFRET STREET PUTNAM CT 06260 CONSULTATIVE AND SURGICAL SERVICES WOODSTOCK MEDICAL ASSOCIATES 168 ROUTE 171 SOUTH WOODSTOCK CT 06267 INTERNAL MEDICINE NORTHEAST CONNECTICUT DERMATOLOGY 55 GREEN HOLLOW ROAD DANIELSON CT 06239 DERMATOLOGY SERVICES MEDICAL CENTER OF NORTHEAST CONNECTICUT 612 HARTFORD DRIVE DAYVILLE CT 06241 INTERNAL MEDICINE POMFRET STREET FAMILY MEDICAL ASSOCIATES 346 POMFRET STREET PUTNAM CT 06260 PRIMARY CARE SERVICES PUTNAM HEALTHCARE CENTER 6-12 SOUTH MAIN STREET PUTNAM CT 06260 LAB AND THERAPY SERVICES DAY KIMBALL HOMEMAKERS 24-32 SOUTH MAIN STREET PUTNAM CT 06260 UNSKILLED HOMECARE SERVICES ST LUKE'S FAMILY PRACTICE 7 KENNEDY DRIVE PUTNAM CT 06260 PRIMARY CARE SERVICES SCHEDULE H, PART I, LINES 3A, 3B, & 3C DETERMINING ELIGIBILITY FOR FREE & DISCOUNTED CARE: TO QUALIFY FOR FREE CARE, AN INDIVIDUAL MUST MEET ALL OF THE CRITERIA: - SINGLE ACCOUNT BALANCE OF $250 OR GREATER OR ACCOUNTS SPANNING SIX MONTHS TOTALING $500 OR GREATER (INDIVIDUAL) OR ACCOUNTS SPANNING SIX MONTHS TOTALING $1000 OR GREATER FOR 2 OR MORE FAMILY MEMBERS (UNDER SAME GUARANTOR). - ANNUAL INCOME IS LESS THAN 250% OF THE CURRENT FEDERAL INCOME POVERTY LEVEL (FPL). - LIQUID ASSETS MUST NOT EXCEED $100,000 (INCLUDES STOCKS, BONDS, CASH, 401K, IRA, CD, PROPERTY AND BUSINESS VALUE, AND RECREATIONAL VEHICLES). TO QUALIFY FOR A 75% CHARITY CARE DISCOUNT, AN INDIVIDUAL MUST MEET ALL OF THE FOLLOWING CRITERIA: - SINGLE ACCOUNT BALANCE OF $250 OR GREATER OR ACCOUNTS SPANNING SIX MONTHS TOTALING $500 OR GREATER (INDIVIDUAL) OR ACCOUNTS SPANNING SIX MONTHS TOTALING $1000 OR GREATER FOR 2 OR MORE FAMILY MEMBERS (UNDER SAME GUARANTOR). - ANNUAL INCOME IS LESS THAN 250% OF THE CURRENT FEDERAL INCOME POVERTY LEVEL (FPL). - LIQUID ASSETS MUST NOT EXCEED $100,000 INCLUDING (STOCKS, BONDS, CASH, 401, IRA, CD, PROPERTY AND BUSINESS VALUE AND RECREATIONAL VEHICLES). - INSURED PATIENTS WHO HAVE NO ADDITIONAL COVERAGE (AND HAVE DOCUMENTATION THAT THEY HAVE EXHAUSTED THEIR INSURANCE) FOR THE REMAINDER OF THEIR PLAN YEAR WILL BE DEEMED "UNINSURED" UNDER SECTION A OF THIS POLICY. IF GRANTED CHARITY CARE, IT WILL BE ONE-TIME GRANTING. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COSTING METHODOLOGY THAT WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS DAY KIMBALL HOSPITAL'S COST-TO-CHARGE RATIO THAT WAS REPORTED IN THE FY2020 MEDICARE COST REPORT. SCHEDULE H, PART I, LINE 7G SUBSIDIZED SERVICES: DAY KIMBALL HOSPITAL PARTNERS WITH NORTHEASTERN CONNECTICUT COUNCIL OF GOVERNMENTS (NECCOG) TO PROVIDE LOCAL PARAMEDIC INTERCEPT SERVICES. DAY KIMBALL HOSPITAL AND NECCOG AGREED THAT THE ABSENCE OF PARAMEDIC INTERCEPT SERVICES IN NORTHEASTERN CONNECTICUT, COMPRISED OF MANY RURAL TOWNS, WOULD CREATE A SIGNIFICANT DEFICIENCY IN THE AVAILABILITY AND ACCESSIBILITY OF MEDICAL SERVICES IN THE COMMUNITY. THE HOSPITAL PROVIDES CERTAIN MONETARY AND IN-KIND SERVICES FOR THE PROVISION OF PARAMEDIC INTERCEPT SERVICES. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR IS EQUAL TO TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF FORM 990. SCHEDULE H, PART III, LINE A, LINE 2 BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2020. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS ESTIMATED USING THE PERCENTAGE OF THE POPULATION THAT IS BELOW THE POVERTY LINE IN THE HOSPITAL'S SERVICE AREA. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT RATIONALE: THE SHORTFALLS BETWEEN DAY KIMBALL HOSPITAL'S MEDICARE COSTS AND PAYMENTS ARE CONSIDERED COMMUNITY BENEFIT BECAUSE THE SERVICES WERE PROVIDED BY DAY KIMBALL HOSPITAL EVEN THOUGH THE COSTS WERE NOT COVERED OR REIMBURSED. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 WAS GROSS CHARGES REDUCED BY THE COST TO CHARGE RATIO THAT WAS REPORTED IN THE FY2020 MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION B, LINE 9B COLLECTION POLICY: IT IS THE PHILOSOPHY AND POLICY OF DAY KIMBALL HOSPITAL THAT MEDICALLY NECESSARY HEALTH CARE SERVICES SHOULD BE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE POLICY WAS BEEN WRITTEN IN ACCORDANCE WITH SECTION 9007 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACT), SIGNED INTO LAW ON MARCH 23, 2010, WHICH ADDS NEW SECTIONS 501(R) AND 4959 TO THE INTERNAL REVENUE CODE. SECTION 510(R) INCLUDES A SERIES OF SPECIFIC REQUIREMENTS FOR HOSPITALS TO RECEIVE AND MAINTAIN SECTION 501(C)(3) "TAX EXEMPT" STATUS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: DAY KIMBALL HOSPITAL HAS RECENTLY COMPLETED A COMMUNITY NEEDS ASSESSMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS UNDERTAKEN TO IDENTIFY SPECIFIC HEALTH CARE NEEDS IN WINDHAM COUNTY. FOCUS GROUPS, TELEPHONE SURVEYS AND STATE AND FEDERAL DATA WAS USED TO IDENTIFY THE SPECIFIC HEALTH CARE NEEDS DURING THIS ASSESSMENT. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ALL PATIENTS WHO ARE UNINSURED ARE REFERRED TO THE FINANCIAL COUNSELING DEPARTMENT; INPATIENTS ARE ALL VISITED BY A FINANCIAL COUNSELOR (OR GIVEN A FINANCIAL COUNSELING PACKET) PRIOR TO DISCHARGE WITH ALL OF THE AVAILABLE PROGRAMS THAT ARE AVAILABLE THROUGH OUR FINANCIAL ASSISTANCE (CHARITY CARE) POLICY. ANY SCHEDULED PATIENTS WHO ARE UNINSURED ARE CALLED BY THE FINANCIAL COUNSELORS IN ADVANCE TO PROVIDE ALL OF THE OPTIONS INCLUDING SCREENING FOR MEDICAID ASSISTANCE, CHARITY CARE, AS WELL AS SEVERAL OTHER LOCAL FUNDING SOURCES THAT THEY MAY QUALIFY FOR. ALL PATIENT STATEMENTS HAVE INFORMATION ABOUT OUR CHARITY CARE POLICY AS WELL AS DOWNLOADABLE CHARITY CARE APPLICATION. ALL OF OUR THIRD PARTY VENDORS, INCLUDING OUR BAD DEBT AGENCIES AND OUR LONG TERM PATIENT FINANCING PROGRAM THROUGH CAREPAYMENT ALSO PROVIDE OUR CHARITY CARE POLICY TO PATIENTS UPON REQUEST. OUR FINANCIAL ASSISTANCE GUIDELINES ARE ALSO POSTED IN ALL PATIENT REGISTRATION AREAS OF THE HOSPITAL. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: DAY KIMBALL HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF 13 TOWNS IN THE NORTHEASTERN CORNER OF CONNECTICUT AS WELL AS BORDERING MASSACHUSETTS AND RHODE ISLAND TOWNS. DAY KIMBALL'S SERVICE AREA IS OVER 438 SQUARE MILES AND CONTAINS APPROXIMATELY 116,192 IN WINDHAM COUNTY. THE POPULATION RANGES FROM LONG-TERM, MULTI-GENERATIONAL FAMILIES TO NEWLY IMMIGRATED RESIDENTS FROM URBAN AREAS. ACCORDING TO THE 2010 CENSUS, 11.7% OF THE POPULATION IS UNDER POVERTY LEVEL AND 14.3% ARE OVER AGE 65. THERE IS A WIDE RANGE OF SOCIO-ECONOMIC FACTORS INCLUDING VERY HIGH INCOME TO POVERTY; ADVANCED EDUCATION TO INCOMPLETE HIGH SCHOOL. THE MEDIAN HOUSEHOLD INCOME IN 2010 IN WINDHAM COUNTY WAS $58,489 (THE LOWEST INCOME OF ANY COUNTY IN THE STATE OF CONNECTICUT), WHILE THE STATE MEDIAN WAS $69,519. ACCORDING TO THE HEALTHY CONNECTICUT 2020 STATE HEALTH ASSESSMENT THAT WAS RELEASED IN MARCH 2014 THE LEADING CAUSE OF DEATH IN CONNECTICUT ARE HEART DISEASE AND CANCER. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: THE MISSION OF DAY KIMBALL HOSPITAL IS TO MEET THE HEALTH NEEDS OF OUR COMMUNITY THROUGH OUR CORE VALUES OF CLINICAL QUALITY, CUSTOMER SERVICE, FISCAL RESPONSIBILITY AND LOCAL CONTROL. DAY KIMBALL HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND PHYSICIANS. THE MEDICAL STAFF IS OPEN TO ALL PHYSICIANS IN THE COMMUNITY WHO MEET MEMBERSHIP AND CLINICAL PRIVILEGE REQUIREMENTS. INPATIENT, OUTPATIENT AND EMERGENCY SERVICES THAT ARE MEDICALLY NECESSARY ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. SCHEDULE H, PART VI, LINE 6 AFFILIATE STRUCTURE: DAY KIMBALL HOSPITAL HAS A RELATIONSHIP WITH UMASS MEMORIAL MEDICAL CENTER AS ITS TERTIARY CARE SITE. WHEN PATIENTS' CARE REQUIRES SPECIALIZED TREATMENTS, DAY KIMBALL COLLABORATES WITH PROMINENT MEDICAL CENTERS TO PROVIDE THE CARE THEY NEED. FOR INSTANCE, DAY KIMBALL PARTNERS WITH UMASS MEMORIAL MEDICAL CENTER IN WORCESTER, MA, FOR CARDIAC CARE AND HAS DEVELOPED A SYSTEMATIC APPROACH TO STABILIZING AND TRANSPORTING HEART ATTACK PATIENTS TO UMASS FOR FURTHER TREATMENT. X true true X X X false false false false false false false true false SARA JANE DEASIS MENTAL HEALTH PHYSICIAN 324687 0 0 0 0 0 8400 0 2141 0 335228 0 0 0 PAUL BEAUDOIN CFO 321344 0 59753 0 0 0 0 0 33 0 381130 0 0 0 ANNE DIAMOND PRESIDENT AND CEO 491334 0 0 0 0 0 0 0 2158 0 493492 0 0 0 MICHAEL BAUM MD DIRECTOR 0 302929 0 0 0 0 0 8400 0 1474 0 312803 0 0 ANTHONY CHIEFFALO DIRECTOR 0 303574 0 0 0 0 0 0 0 1470 0 305044 0 0 DR PAUL MATTY DIRECTOR 0 304882 0 0 0 0 0 8400 0 1381 0 314663 0 0 KRISTA MATSEN DIRECTOR 0 223002 0 0 0 0 0 6501 0 136 0 229639 0 0 JOHN GRAHAM MD CHIEF MEDICAL OFFICER 300873 0 0 0 0 0 8400 0 30 0 309303 0 0 0 JOHN MODICA MD PHYSICIAN 225916 0 0 0 0 0 6924 0 661 0 233501 0 0 0 ALEXANDRE CARRE MD PHYSICIAN 357316 0 0 0 0 0 0 0 33 0 357349 0 0 0 CHERYL PETRARCA DIRECTOR OF PATIENT CARE 167118 0 0 0 0 0 4190 0 49 0 171357 0 0 0 CINDY JANZ HOMECARE/RN 161805 0 0 0 0 0 4476 0 667 0 166948 0 0 0 SARAH GINNETTI DIRCTOR OF REVENUE CYCLE 161402 0 0 0 0 0 0 0 4708 0 166110 0 0 0 JOHN O'KEEFE CHIEF NURSING OFFICER 184150 0 0 0 0 0 5793 0 1465 0 191408 0 0 0 KRISTEN LESCAULT CLINICAL MANAGER RN 163992 0 0 0 0 0 0 0 5393 0 169385 0 0 0 RICHARD LINNEL DIRECTOR OF PATIENT CARE SERV 159697 0 0 0 0 0 0 0 0 0 159697 0 0 0 JEFFREY CORRIGAN VP HUMAN RESOURCES 169064 0 0 0 0 0 0 0 1462 0 170526 0 0 0 JOANNE ASHTON CLINICAL COORDINATOR RN 151642 0 0 0 0 0 0 0 7282 0 158924 0 0 0 GREGORY HARUBIN DIRECTOR FACILITIES MGMT 147318 0 0 0 0 0 0 0 4359 0 151677 0 0 0 SCHEDULE J, PART I, LINE 1A HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: ANNE DIAMOND, CEO, RECEIVED A HOUSING ALLOWANCE. THE ALLOWANCE WAS TAXABLE IN THE YEAR RECEIVED. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: BONUSES AWARDED DURING THE YEAR WERE EITHER STIPENDS FOR AN INDIVIDUAL SERVING AS A DEPARTMENT OF COMMITTEE CHAIRPERSON OR INCENTIVE PAYMENTS FOR RVU'S WORKED. A STATE OF CONNECTICUT HEALTH AND EDUCATIONAL 060806186 20774YPC5 2013-06-06 30330000 EMERGENCY DEPARTMENT EXPANSION false false false A 0 0 30330000 2340522 1170295 15485409 606600 0 0 10723350 3824 0 2014 true false true true A false false false false 0 false false false true A false true false false false false 0 false 0 false true A true SCHEDULE K, PART I(F) DESCRIPTION OF PURPOSE: CURRENT REFUNDING AND EMERGENCY DEPARTMENT EXPANSION AND RENOVATION. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT THE GOVERNING BODY: THE HOSPITAL HAS MORE THAN 400 CORPORATORS WHO ARE DEDICATED TO THE HOSPITAL'S MISSION. CORPORATORS ARE INDIVIDUALS INTERESTED IN THE PURPOSES OF THE HOSPITAL AND REPRESENT THE COMMUNITIES SERVED. CORPORATORS HAVE THE RIGHT TO PARTICIPATE IN THE ELECTION OF DIRECTORS AND OFFICERS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990: FORM 990 IS REVIEWED BY PAUL A. BEAUDOIN, CFO, PRIOR TO FILING. A COPY OF THE 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING BOARD MEMBERS, ADMINISTRATION, THE MEDICAL STAFF, AND ALL OTHER EMPLOYEES TO FILL OUT A CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. IF ANY CHANGE IN THE FORM ARISES THROUGHOUT THE YEAR, IT IS REQUIRED TO BE REPORTED PROMPTLY TO THE CHAIR OF THE BOARD OF DIRECTORS OR THE PRESIDENT OF DAY KIMBALL HOSPITAL. IN THE EVENT A POTENTIAL CONFLICT OF INTEREST HAS A DIRECT IMPLICATION FOR PATIENT CARE, THE INSTITUTION MAY CONVENE AN ETHICS COMMITTEE MEETING TO ASSIST IN THE RESOLUTION OF THE ISSUE. IF AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE AFFECTED EMPLOYEE WILL REFRAIN FROM FURTHER PARTICIPATION IN MATTERS TO WHICH THE CONFLICT RELATES UNTIL THE QUESTION OF CONFLICT HAS BEEN RESOLVED. FORM 990, PART VI, SECTION C, LINE 15A & 15B COMPENSATION OF TOP MANAGEMENT: THE ORGANIZATION REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES ON A REGULAR BASIS. COMPENSATION ADJUSTMENTS ARE SUBJECT TO BOARD APPROVAL AND THE PROCESS AND CONCLUSIONS ARE DOCUMENTED IN THE BOARD MINUTES. THE COMPENSATION REVIEW INCLUDES AN ANALYSIS OF COMPARABILITY DATA. IN APRIL 2019, GALLAGHER GROUP PREPARED AN ANNUAL HOSPITAL WAGE SURVEY FOR THE CONNECTICUT, MASSACHUSETTS AND RHODE ISLAND HOSPITAL ASSOCIATIONS AVAILABLE FOR USE BY MEMBER HOSPITALS. THIS SURVEY WAS USED BY DAY KIMBALL HEALTHCARE IN THE COMPENSATION DETERMINATION PROCESS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A COMPENSATION OF BOARD OF DIRECTORS: NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. DIRECTORS WITH COMPENSATION LISTED ON PART VII ARE EITHER EMPLOYEES OF THE FILING ORGANIZATION, OR EMPLOYEES AND/OR INDEPENDENT CONTRACTORS FOR A RELATED ORGANIZATION, DAY KIMBALL MEDICAL GROUP. THEY ARE COMPENSATED FOR THEIR DUTIES IN THAT CAPACITY. FORM 990, PART XI, LINE 9 CHANGES IN NET ASSETS: $( 9,645,286) TRANSFER TO AFFILIATE ( 7,728,692) CHANGE IN DEFINED BENEFIT PENSION PLAN 149,453 CHANGE IN INTEREST IN BENEFICIAL TRUST ------------ $(17,224,525) PHYSICIAN SERVICES OF NORTHEAST CT 45 GREEN HOLLOW ROAD DANIELSON CT 06239 262565797 PHYSICIAN SVC CT DK HLTHCR DAY KIMBALL HOMEMAKERS 320 POMFRET STREET PUTNAM CT 06260 061136893 HOMEMAKERS CT 501(C)(3) 10 DKH HLTHCR true DAY KIMBALL MEDICAL GROUP INC 320 POMFRET STREET PUTNAM CT 06260 454077626 PHYS SERVICES CT 501(C)(3) 10 DKH HLTHCR true DAY KIMBALL HEALTHCARE FOUNDATION INC 309 POMFRET STREET PUTNAM CT 06260 833150493 SUPPORT CT 501(C)(3) 12A I DKH HLTHCR true false false false false false false false false false true false false false false false true false true false DAY KIMBALL MEDICAL GROUP R 9645286 COST DAY KIMBALL MEDICAL GROUP J 317688 COST