2020-08-13T17:35:07-05:00 2019-09-30 440160260 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 64106 990 2018-10-01 060250773 The William W Backus Hospital WILL 8608898331 326 Washington Street Norwich CT 06360 Mark Keise VP, Finance 8608898331 2020-08-13 1 Michael J Engle P00482834 8162216300 199.231.27.235 2020-08-13 17:34:59 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B528C7C86D3B360A0A6E3BCE3B7EF14312B9CEBE 2018 2020-09-22 18:59:49Z Donna Handley 326 Washington Street Norwich CT 06360 419998200 0 X www.Backushospital.org X 1891 CT The William W. Backus Hospital delivers and coordinates a continuum of high-quality health care that is sensitive to the needs of individuals in Eastern Connecticut. The Hospital is committed to being responsive and accountable to those for whose benefit it exists, and to improving the health of its communities. 9 5 1918 365 0 0 2010953 1409368 336843434 404626420 29553068 9634685 659395 667135 369066850 416337608 30545 21450 0 0 140535069 143980654 0 0 751204 193671498 241203303 334237112 385205407 34829738 31132201 600185993 635645137 159824195 193645448 440361798 441999689 X To improve the health and healing of the people and communities we serve. 0 0 43702069 57587330 Hartford HealthCare Cancer Institute:Hartford HealthCare is Connecticut's most comprehensive healthcare network. Our fully integrated health system includes a tertiary-care teaching hospital, an acute-care community teaching hospital, an acute-care hospital and trauma center, two community hospitals. The Hartford HealthCare Cancer Institute encompasses comprehensive cancer centers at six hospitals across Connecticut - Hartford Hospital, The Hospital of Central Connecticut, Backus Hospital, MidState Medical Center, Windham Hospital and Charlotte Hungerford Hospital. Collectively, the cancer programs within the Cancer Institute treat more than 5,000 new cancer patients per year while caring for tens of thousands of existing patients, offering a full range of innovative, evidence-based and personalized treatments designed to meet the needs of each individual patient. Our innovative Institute approach is unlike any other in the state and is among the most highly regarded in the nation. Through our Institute, which is organized around a specific disease and not necessarily location, we can apply best practices throughout our system so that patients receive the same high standards of care no matter where they live or which Hartford HealthCare cancer center they choose. For all of our patients, a dedicated team of oncologists, surgeons, radiologists, pathologists, nurses, clinical researchers, technicians and others collaborate to provide the exact course of care they need. The Institute's multidisciplinary disease management teams meet and collaborate regularly to lend expertise and insight on numerous cancer types, translating into exceptional coordinated care. The Institute's accomplished, fellowship-trained physicians are nationally recognized for their level of sophisticated care in areas such as radiation oncology, medical oncology and surgical oncology. Patients are also cared for in an environment that emphasizes compassion and personal connections, with a team of trained nurse navigators who provide guidance and support to patients and families, from diagnosis to recovery. The Institute also boasts a thriving survivorship program. In 2013, the Hartford HealthCare Cancer Institute became the first community-based cancer program to become a member of the Memorial Sloan Kettering Cancer Alliance, establishing a relationship with one of the world's premier cancer centers. The Institute's membership in the Alliance provides patients in Connecticut access to the most advanced, leading-edge treatments available anywhere. In 2017, the Institute was accredited as a network by the American College of Surgeons Commission on Cancer, one of a select few institutes nationwide to be recognized as a system, rather than individual cancer centers. For patients coming through our doors with a cancer diagnosis, that means three things: standardized care, more options and more hope.More than four years after the Hartford HealthCare Cancer Institute became the charter member of the Memorial Sloan Kettering (MSK) Cancer Alliance, cancer patients now have unprecedented access to the world's most advanced clinical trials. Now, more than ever before, physicians, nurses, pharmacists and researchers are working collaboratively to implement cancer treatment standards and protocols developed at MSK, the premier cancer treatment center in the country. This distinctive cancer care and clinical research partnership means the Hartford HealthCare Cancer Institute brings the most innovative, evidence-based cancer care directly into community settings.During FY19, the Institute had approximately 5,870 new cases across the system were as follows:Hartford Hospital - 3,187Hospital of Central Connecticut - 1,082Backus Hospital - 748MidState Medical Center - 483Windham Hospital - 163Charlotte Hungerford Hospital - 208The five most common types of cancer diagnosed by teams of specialists at the Hartford HealthCare Cancer Institute are cancers of the bladder, breast, colon, lung and prostate. Each patient has a unique scenario requiring a personalized plan.Approximately 1,158 Breast Cancer cases were treated across the system as follows:Hartford Hospital - 613Hospital of Central Connecticut - 217Backus Hospital - 127MidState Medical Center - 120Windham Hospital - 10Charlotte Hungerford Hospital -71Approximately 709 Lung Cancer cases were treated across the system as follows:Hartford Hospital - 438Hospital of Central Connecticut - 115Backus Hospital - 75MidState Medical Center - 56Windham Hospital - 12Charlotte Hungerford Hospital - 13Approximately 876 Prostate Cancer cases were treated across the system as follows:Hartford Hospital - 349Hospital of Central Connecticut - 90Backus Hospital - 121MidState Medical Center - 88Windham Hospital - 20Charlotte Hungerford Hospital - 208Approximately 367 Bladder Cancer cases were treated across the system as follows:Hartford Hospital - 139Hospital of Central Connecticut - 54Backus Hospital - 94MidState Medical Center - 55 Windham Hospital - 9Charlotte Hungerford Hospital - 16Approximately 331 Colon Cancer cases were treated across the system as follows:Hartford Hospital - 159Hospital of Central Connecticut - 51Backus Hospital - 14MidState Medical Center - 28Windham Hospital - 8Charlotte Hungerford Hospital - 71Today, Hartford HealthCare is creating a better future for healthcare in Connecticut and beyond. We are a community of caregivers engaged in developing a coordinated, consistent high standard of care. We use research and education as partners in care delivery. We create and engage in meaningful alliances to enhance access to services. We invest in technology and training to develop new pathways to improve the timeliness, efficiency and accuracy of our services. 33921244 38142680 Bone & Joint (Orthopedics):The Orthopedics Department at Backus Hospital offers a full range of services to the communities it serves. As a member of Hartford HealthCare Corporation's network, the Hospital has access to the integrated health network's recognized expertise, ongoing research studies that evaluate new treatments and one of the nation's top training centers for robot-assisted surgery.Backus Hospital offers the latest robotic surgery techniques for hip and knee procedures - Mako technology. Mako is a treatment option for patients that have early to mid-stage degeneration of the hip or knee. With smaller incisions, the robotic arm-assisted technology allows the surgeon to more precisely place the implant for faster recovery and more effective results. This technology is also available at Windham Community Memorial Hospital.At the completion of FY19, the Division of Orthopedics was comprised of nine orthopedic surgeons and ten advanced practice providers. The Hospital maintains its Disease Specific Certification through the Joint Commission for its Total Hip and Total Knee programs.Backus Hospital completed 1,570 total orthopedic cases in FY19 which was down 76 from FY18. Of the 1,570, 251 were total knee replacements and 209 of those were performed with MAKO robotic surgery. Total hip replacement was 160 with 95 of those being performed with MAKO robotic surgery.Backus Hospital performed 24 Globus Robotic Spine surgeries in FY19. The Hospital continues to be part of the Comprehensive Joint Replacement Bundle through CMS and received no payment for the work accomplished in the prior three years of the program. 29602741 21450 35124214 Heart and Vascular:As a member of Hartford HealthCare, Cardiology services at Backus Hospital are provided through the Hartford HealthCare Heart and Vascular Institute. While some of the symptoms of congestive heart failure (CHF) can be managed, patients often need advanced care as the disease progresses. The stress of driving long distances for care and assessment can have a serious impact on the patient's quality of life. The Hartford HealthCare Heart & Vascular Institute advanced CHF patients in the Norwich area now have the option of receiving some of their care close to home. The care provided at Backus location works seamlessly with the Heart & Vascular Institute's Center for Advanced Heart Failure at Hartford Hospital. The program enables patients who have been diagnosed with congestive heart disease to manage their health and improve the quality of their lives through early symptom recognition, continuity of care, diet planning and medication management.At the completion of the Fiscal Year FY19 the, Division of Cardiology was comprised of eight cardiologist and one Advanced Practice provider. Overall, cardiology services grew on average by 11% from FY17 to FY18. Cardiac diagnostic catheterization lab volume decreased by 9%, Echocardiography and cardiac stress testing increased 15%, and Electrophysiology services decreased by 10% from prior year.The Hospital is able to cardiac monitor more than 60 patients with using its remote telemetry capabilities. In addition, our Congenital Heart Failure (CHF) readmission rate for Medicare patients was 11.2%; well below the national average. 245190728 273772196 Other program services include EHR revenue, purchase discounts, contract services and other miscellaneous income. 245190728 273772196 352416782 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 143 0 1 1918 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X X Anthony Mastroianni 8608898331 326 Washington Street Norwich CT 06360 Henry Beck MD Director 1.00 2.00 X 0 0 0 Carmen Cid Director 1.00 2.00 X 0 0 0 David Coletti MD Director 58.00 2.00 X 200833 0 0 Stephen Larcen PHD Director 1.00 2.00 X 0 5358 0 Lynne Quintal-Hill Thru 619 Director 1.00 2.00 X 0 0 0 Mark Tramontozzi MD Director 1.00 59.00 X 0 313350 51649 James Watson MD Director 1.00 2.00 X 0 0 0 Paul Weigle Thru 1218 Director 1.00 59.00 X 0 263917 63229 Diane Wishnafski Director & Chair 2.00 3.00 X X 0 0 0 Mary Barry MD Director & Vice Chair 2.00 58.00 X X 0 211275 10524 Deborah Monahan Thru 619 Director 1.00 2.00 X X 0 0 0 Donna Handley Director & President 20.00 40.00 X X 0 541449 66930 Margaret Marchak Secretary 2.00 58.00 X 0 1116829 82271 Anthony Mastroianni VP, Finance 30.00 30.00 X 0 284624 58875 Robert Sidman MD VP, Medical Affairs 30.00 30.00 X 0 533052 70098 Lester Temkin VP, Operations 30.00 30.00 X 0 341670 56440 Laura Currie VP, Patient Care 30.00 30.00 X 0 147890 33217 Zhenxiang Liu MD Physician 60.00 X 588288 0 68664 Mariano Librojo MD Hospitalist 60.00 X 520280 0 47303 Rukevwe Ehwarieme MD Hospitalist 60.00 X 359038 0 43415 Nader Bahadory MD Medical Director 60.00 X 358674 0 49590 Andrzej Porebski MD Hospitalist 30.00 30.00 X 398066 7920 66520 David Whitehead Thru 1215 Former Director (ER), Pres. & CEO 0.00 60.00 X 0 1077816 71686 Bimal Patel Thru 917 Former Director (ER) & President 0.00 60.00 X 0 856593 121689 Carolyn Trantalis Former VP, Clinical Svcs. & Ops. 0.00 60.00 X 0 316490 20622 Thomas Vaccarelli Former VP Facilities 0.00 60.00 X 0 333712 66898 Gregory Makowski Former VP, Clinical Laboratory Svcs. 0.00 60.00 X 0 342853 37312 2425179 6694798 1086932 95 1 1 0 Origin Incorporated 1800 SW 1ST Street STE 510 Portland OR 97201 Staffing Services 2755449 Morrison Management Services 400 Northridge Road Sandy Springs GA 30350 Food Services 2054430 Locumtenes Holdings LLC 2655 Northwinds Parkway Alpharetta GA 30009 Staffing Services 1098510 Carlin Construction Company LLC 5 Shaws Cove STE 103 New London CT 06320 Construction Services 948110 CHG Companies Inc PO Box 972651 Dallas TX 75397 Medical Services 802814 52 135574 1273794 1409368 Net Patient Revenue 624100 404626420 404626420 404626420 1131285 1131285 3091617 3584396 -492779 -492779 -492779 8503400 0 8503400 8503400 8503400 26000 135574 76196 -50196 -50196 Cafeteria 722514 1210110 1210110 1210110 416337608 404626420 0 10301820 21450 21450 69167 69167 121644053 114941115 6590225 112713 5324253 5031038 288284 4931 8988554 8493540 486690 8324 7954627 7516554 430707 7366 4774 4774 28527 28527 471214 471214 36318022 33361064 2956958 91731 6533 21342 63856 3370366 2249430 1020715 100221 20610931 12160449 8450482 7113736 6616574 497162 131786 117840 13946 299814 203934 95880 4602160 920432 3681728 35473155 30861645 4611510 9714118 9512847 201271 3090557 3090557 Medical Supplies 63856117 63856117 Hospital Provider Tax 29993740 29993740 Purchased Services 17279547 15594479 1610273 74795 Repairs and Maintenance 6270627 6132860 137767 2482381 1665417 437966 378998 385205407 352416782 32037421 751204 25812049 21303547 155670 53165 39696943 42491110 5047083 5269155 1489299 1910268 338817488 209268926 119024451 129548562 1403979 363604 370012330 378123947 0 0 14919217 14919217 22624972 41662562 600185993 635645137 18429730 23174830 331948 313978 1075164 982031 139987353 169174609 159824195 193645448 X 428429715 429955430 3152408 3340619 8779675 8703640 440361798 441999689 600185993 635645137 X 31132201 4077897 -33572207 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 0 0 0 1 28527 0 0 28527 0 Part II-B, Line 1: The Backus Hospital paid annual dues to Connecticut Hospital Association (CHA). CHA conducts lobbying activities on behalf of its members. CHA allocates a portion of their dues as lobbying expenses. The portion of dues allocated as lobbying expenses is calculated under current Medicare rules. CHA conducts lobbying activities under current Medicare rules. In addition, the Organization occasionally asks its employees to volunteer their time to contact state legislators in an effort to lobby on its behalf. The total amount of all dues allocated for lobbying expenses for FY19 was $28,527. 6212072 193000 6405072 8405072 757000 2950000 6212072 7849631 555441 8405072 7465627 384004 7849631 7558064 -92437 7465627 0.94000 0.06000 0 1 1 8299067 8299067 169226044 110467090 58758954 18930397 16744983 2185414 108585150 82056853 26528297 33776830 33776830 129548562 Investment In Endowment LLC 375460028 F Assets Held In Trust By Others 2663919 F 378123947 Due From Affiliates 27496271 Other Assets 4849 SERP Asset 3436359 Malpractice Claims 9928943 Workers Comp 776801 Patient Refunds 19339 41662562 Tax Exempt Bonds 75910926 Accrued Post Retirement Expenses 52152337 Other Liabilities 20648805 Hospital Provider User Fee 7097239 Accrued Malpractice 9928943 SERP Liability 3436359 169174609 Part V, Line 4: The Hospital has adopted investment and spending policies for Endowment assets that attempt to provide a predictable stream of funding to mission related programs such as those described in Part III, lines 4a-d while seeking to maintain purchasing power of the endowment assets. Endowment assets include those assets of donor-restricted funds that the Hospital must hold in perpetuity or for a donor-specific period(s). Under this policy, as approved by the Board of Directors, the Endowment assets are invested in a manner that is intended to produce a real return, net of inflation and investment management costs, of a least 4% over the long term. Actual returns in any given year may vary from this amount. The Hospital's Endowment consists of hundreds of individual funds established for a variety of purposes. Net assets associated with Endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions. The income generated by the funds are used mainly for capital expenses. Golf Tournament 110700 94300 16400 1686 22806 22331 1295 1272 Seder Golf Tournatment 50874 41274 9600 2241 8840 13595 2130 161574 135574 26000 3927 31646 35926 1295 3402 76196 -50196 1 1 1 X 250.000000000000 1 X 1 1 0 0 2039587 2039587 0.00530 82935364 59150714 23784650 0.06170 84974951 59150714 25824237 0.06700 784510 784510 0.00200 238763 238763 0.00060 633386 622001 11385 0.00000 2000 2000 0.00000 1658659 622001 1036658 0.00270 86633610 59772715 26860895 0.06970 36942 36942 0.00010 672 672 0.00000 37614 37614 0.00010 0 7571797 73955912 88348204 -14392292 X 1 1 1 1 The William W Backus Hospital 326 Washington Street Norwich CT 06360 Backushospital.org 0037 X X X The William W Backus Hospital 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X See Part V, Page 8 X X 1 17 1 See Part V, Page 8 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 The William W. Backus Hospital Part V, Section B, Line 5: To solicit input from key informants and individuals who have broad interest in the health of the community, the Hospital performed surveys, community forums, focus groups and interviews with key informants. The key informants were selected by community leader(s) or liaison(s). Additionally, focus groups were used to identify any other resource. Focus group was conducted on January 16, 2018. Community forums, and individual key informant interviews were conducted between February and May 2018.Key informants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the overall community. They were asked to rate the degrees to which various health issues were of concern in the Eastern Region. Follow-up questions were asked to describe why they identified areas as such, and how these might be better addressed. The key informants included Physicians, public health representatives, health professionals, social service providers and a variety of other community leaders including the following:Center for Healthy Aging Connecticut Legal Services Eastern Connecticut Health Insurance Program (ECHIP) Eastern Connecticut Workforce Board Eastern Highlands Health District Generations Mansfield Youth Services NCDHD Northeast District Department of Health St. Joseph's Living Town of Mansfield UConn Student Health Services United Services, Inc. Willimantic DCF office Willimantic Fire Department Willimantic Police Windham Hospital Windham Public Schools Windham Region Transit District The 2018 CHNA took a close look at social determinants of health such as poverty, housing, transportation, education, fresh food availability, and neighborhood safety. Social determinants of health have become a national priority for identifying and addressing health disparities, and Backus Hospital is committed to addressing these disparities through the Community Health Improvement Plan. Through this process, input was gathered from individuals whose organizations were able to provide information for the following data elements: * Medically Underserved Areas* Health Professional Shortage Areas* Demographics* Ethnicity Distributions* Median Household Incomes* Homeownership Rates* Poverty Metrics* Unemployment Rates* Educational Metrics* Children in Poverty and Single-Parent Households* Linguistically Isolated Populations* Uninsured Population Estimates* Clinical Provider Ratios* Physical Environment Metrics* Crime Rates* General Health Status Indicators* Cancer Prevalence and Screening Indicators* Cardiovascular Disease* Respiratory Disease* Diabetes* Infectious Diseases* Sexually Transmitted Diseases* Births and Prenatal Care* Health Behaviors* Benchmark Metrics (HealthyPeople 2020)Part V, Section B, Line 7ahttps://backushospital.org/about-us/community-health-needs-assessment The William W. Backus Hospital Part V, Section B, Line 7d: The needs assessment was published in June 2018 and is available on the Hospitals website. In addition, electronic copies are available upon request.Part V, Section B, Line 10a:https://backushospital.org/about-us/community-health-needs-assessment The William W. Backus Hospital Part V, Section B, Line 11: After reviewing the Community Health Needs Assessment findings, the community representatives met on May 24, 2018 to determine the health needs to be prioritized for action. There was a review of the identified needs followed by a wide ranging discussion after which the participants were asked to rank each of the needs.Based on data analysis, surveys, focus groups, and interviews performed, the top community health needs and priorities for the Backus Hospital focus area are listed below:Transportation:Transportation was identified as an issue for both accessing health care and for getting to work. * No public buses after 5 p.m.* Lack of transportation is a social determinant issue, and there is no funding to fix public transportation In Norwich, the Rose City Senior Center is a membership program for seniors. It offers extensive transportation services, including shopping trips, medical transport, coordination of out-of-town (or even state) medical transport. The organization often works directly with physician practices to make sure patients get there.Access to Care:* Need for bilingual health counselors in community organizations. In the casino community, people have trouble communicating due to language and cultural barriers. * Overuse of the ED - need to address high-risk patients with better care coordination * Gaps in primary care, including behavioral health services and vaccinations * Need to create a higher value health care system: burden of care is high due to the cost of duplication of services, dislocation of service and poor coordination. The high cost of healthcare expenses reduces the ability to provide other necessary services.* Cost of insuring employees has increased significantly. Individuals are paying more for health insurance and are facing high out of pocket costs * Lack of family services Substance Abuse: * Smoking is still difficult to overcome and there is a need to provide more smoking cessation programs and awareness * Need more treatment options for opioid abuse (as opposed to criminalization) * Need detox centers * Not enough data on the opioid and Mental health issues * Need for more youth based mental health programs * Mental health patients get dumped in the ED -- more and more are not able to be medically and behaviorally handled * Shortage of psychiatrists - difficult to recruit based on comparatively lower pay Access to Healthy Food:* Identified as a top issue is the need for better access to and greater consumption of fruits and vegetables * Inconsistent funding for programs * High cost of healthy food, need for more voucher programs and food donation * Better food educationIn the region, Norwich and Griswold scored significantly worse in healthy weight indicators. In addition, most cities in the region also had higher rates of arthritis. Lack of coordination among and between providers and community-based organizations limits the overall effectiveness of the programs that are going to help serve the populations most in need.The results were then grouped into 3 Areas of Concern that were addressed in the Community Health Improvement Plan (CHIP):1. Enhance Coordination of Services. This category includes Access to Care and Transportation. CHIP addressed this need in the following manner:a. Evaluate and use information exchange portal resources, linking healthcare providers with community-based organizationsb. Improve IT resources to enable community focus and better measurement of outcomesc. Develop a playbook for infrastructure, dashboard of health, governance, and community workflowsd. Enable dynamic and up-to-date asset mappinge. Develop innovation network for learning, research, co-creation, and rapid knowledge dissemination (bi-directional communication platform)f. Implement new or increased use of Community Health Workers (CHW)g. Evaluate and use adaptive technology (e.g., geo-fencing, GIS mapping, artificial intelligence, biometric risk assessment, Epic tie-ins)2. Promote Healthy Behaviors and Lifestyle. This category includes Access to Healthy Food and Physical and Mental Health. CHIP addresses this need in the following manner:a. Screen for healthy food need identification in community population and provide assessment at points of care b. Enhance Promotion and Marketing c. Provide voucher/prescription programs for fruits and vegetablesd. Promote and improve healthy food donation e. Further partnerships with food pantries/banks and food providers and suppliersf. Create more access points for healthy foodsg. Develop urban gardens, community gardens, hospital campus gardens, farmer's markets (fresh food)h. Evaluate and use mobile food programsi. Create and support food policy councils3. Improve community Behavioral Health. This category includes Mental Health and Substance Abuse. CHIP addresses this need in the following manner: a. Embed behavioral health services in primary care (ongoing)b. Recruit more mental health providers, with focus on community outpatient services (e.g., family therapists)c. Implement Recovery Coach program in EDd. Provide more depression screening growth and at more points of care with referrals (including at public schools). e. Further Mental Health First Aid training and grow community behavioral health training at the local levelf. Enhance services in virtual mental health, including tele-psychiatry The William W. Backus Hospital Part V, Section B, Line 13h: Family eligibility criteria for financial assistance also include family size, employment status, financial obligations, and amount and frequency of the health care expenses. The William W. Backus Hospital Part V, Section B, Line 15e: In addition, patients may ask a nurse, physician, chaplain, or staff member from Patient Registration, Patient Financial Services, Case Coordination, or Social Services about initiating the Financial Assistance Application process. Part V, Section B, Line 16a: FAP Website:https://backushospital.org/patients-visitors/patients/billing-insurance/financial-assistancePart V, Section B, Line 16b: FAP Application Website:https://backushospital.org/patients-visitors/patients/billing-insurance/financial-assistancePart V, Section B, Line 16c: FAP Plain Language Summary:https://backushospital.org/patients-visitors/patients/billing-insurance/financial-assistance The William W. Backus Hospital Part V, Section B, Line 16j: Patients are informed directly by staff of the availability of the Financial Assistance Policy. 9 1 - Backus Outpatient Care Center 111 Salem Turnpike Norwich CT 06360 Outpatient Services 2 - Medical Office Building 330 Washington Street Norwich CT 06360 Medical Office 3 - Colchester Backus Health Center 163 Broadway Colchester CT 06415 Primary Care 4 - Harford HealthCare Health Center 350 Liberty Street Pawcatuck CT 06379 Primary Care 5 - Backus Outpatient Care Center 42 Town Street Norwich CT 06360 Outpatient Services 6 - Family Health Center at Crossroads 196 Parkway South Waterford CT 06385 Primary Care/Rehab/Outpatient 7 - Infectious Disease Clinic 107 Lafayette Street Norwich CT 06360 Outpatient Services 8 - Plainfield Medical Office 584 Norwich Road Plainfield CT 06374 Medical Office 9 - Plainfield Emergency Center 582 Norwich Road Plainfield CT 06374 Emergency Services Part I, Line 3c: The Organization uses Federal Poverty Guidelines (FPG) to determine eligibility. In addition, the Hospital takes into consideration, medical indigency, insurance status, underinsurance status, and other family eligibility criteria such as family size, employment and financial obligations. Part I, Line 6a:Although the Organization does not prepare a formal Community Benefits Reports, it does submit a quarterly report to The Connecticut Hospital Association and Form 990 is submitted to the Connecticut Office of Health Strategy (OHS) annually. Part I, Line 7: The Organization utilized an overall Cost to Charge Ratio (RCC), developed from the Medicare Cost Report. Total expense was adjusted for: Medicaid provider taxes, directly identified community benefit expense and community building expenses. This Cost to Charge Ratio was used to calculate costs for Part I, Line 7a & b. The costs associated with the activities reported on Part I, Line 7e were captured using actual time multiplied by an average salary rate. The costs associated with Line 7h, were the actual costs reported in the organization's general ledger less any industry funded studies. These costs were removed from the calculations to avoid duplication. Costs reported in Part III, Section B6, were calculated from the Medicare cost report and reduced for Medicare costs previously reported in Part I, Lines 7f &g. Part I, Line 7g: No physician clinic costs were included in the Subsidized Health Services cost calculations. Part II, Community Building Activities: Backus Hospital interacts with the community to address needs and facilitate appropriate responses. For FY 2019, Backus expended $37,614 on community building activities. Part III, Line 3: A pre bad debt financial assistance screening is in place to identify patients that may be eligible for financial assistance. Pre bad debt accounts that are identified as meeting the requirements are adjusted prior to being sent to bad debt. Therefore, any bad debt expense that could have been attributable to charity care at the end of FY 2019 would be immaterial. Part III, Line 4: Please see the text of the footnote that describes bad debt expense beginning on page 26 of the Audited Financial Statement. Part III, Line 8: Cost Reports were used to report Medicare allowable costs. Medicare defines allowable costs as those appropriate and helpful in developing and maintaining the operation of patient care facilities and activities. It specifically excludes certain costs that are not directly related to patient care. The hospital incurs additional expense related to the provision of care to Medicare patients that Medicare has deemed non-allowable. This additional expense includes costs of physician services (emergency on-call fees, Hospitalist Programs, recruitment, etc.), advertising costs, cafeteria costs for meals sold to visitors, etc. The Hospital attempts to collect coinsurance and deductibles from Medicare beneficiaries. To the extent collection efforts are unsuccessful; Medicare reimburses the hospital at 65% of unpaid amounts. The table reconciles the shortfall or surplus from Line 7 to the actual surplus or shortfall. The additional costs were allocated to Medicare based upon Medicare's percentage of total allowable costs. The unpaid coinsurance/deductibles were estimated using historical collection results. Any shortfall amounts have not been treated as Community Benefits. Part III, Line 9b: The William W. Backus Hospital has adopted the Financial Assistance Policy of its Parent Company, Hartford HealthCare Corporation. The following is included in the Financial Assistance Policy: Patients who are deemed ineligible for financial assistance or who receive a partial discount and do not pay their bills may be subject to the following Extraordinary Collection Action (ECAs):*Wage Garnishments*Liens on primary and secondary residences, bank or investment accounts, or other assets*Legal actions and reporting the matter to one or more credit rating agencies*Other ECAs not listed aboveIf an individual has not submitted an application within the first 120 days from the date on which Hartford HealthCare first issues its first, post-discharge billing statement, then Hartford HealthCare may begin engaging in the ECAs described above.ECAs may begin after the first 120 days from the date on which Hartford HealthCare issues its first, post-discharge billing statement. If the patient applies for assistance within 240 days from the first notification of the self-pay balance, and is granted assistance, Hartford HealthCare will take all reasonable available measures to remove any collection actions such as negative reporting to a credit bureau or liens that have been filed.Before Hartford HealthCare initiates any collection actions, it will issue a written notice to the last known address of record for the patient (or his/her family) that describes the specific collection activities it intends to initiate (or resume), provides a deadline after which such action(s) will be initiated (or resumed), and includes a plain language summary of this Policy. ECAs can begin no sooner than 30 days from the date written notice is transmitted. Patients who are ineligible for financial assistance, or qualify for partial financial assistance and who are cooperating in good faith to resolve the outstanding accounts, may be offered extended payment plans. No further collection action will be taken as long as the patient continues to meet the terms of the payment plan. Part VI, Line 2: Backus Hospital uses Emergency Room data to track medical conditions such as falls, flu, drug overdoses, etc. and the same approach is taken in our outpatient clinics. Periodically information is surveyed to determine additional patient needs. Information is also tracked from other entities such as area non profits, governmental agencies and public schools. Part VI, Line 3: Backus Hospital provides information about its financial assistance policy as follows: (1) Provides signage, brochures and/or a written plain language summary describing the policy along with financial assistance contact information in the emergency department, labor and delivery areas, discharge paperwork, other patient registration/admission areas, as well as in billing and collection communication.(2) Makes paper copies of the policy, financial assistance application, and plain language summary of the policy available upon request and without charge, by mail.(3) Posts the policy, plain language summary and financial assistance application on the website with clear linkage to such documents on the Hartford HealthCare and each affiliated hospital's home page.(4) Educates all admission and registration personnel, financial counselors, billing and collection specialists and social workers regarding the policy so that they can serve as an informational resource to patients.(5) Includes the tag line 'Please ask about our Financial Assistance Policy" in applicable Hartford HealthCare written publications. Part VI, Line 4: In 2018, the total population of the Backus Hospital primary service area is 273,115. 72.1% of the population is white with 6.8% black. People of Hispanic origin make up 12.9% and 8.2% are identified as other. Children age 0-17 make up 20.6%, 18-64 64.1% and seniors account for 15.4% of the population. The population living in poverty is 9.9%. The unemployment rate is 7.7% in New London County. 10.6% do not have a high school diploma and 14.8% do have a Bachelor's Degree.The region is a federally designated medically underserved area. Part VI, Line 5: A Regional Board governs Backus, Windham and Natchaug Hospitals. The board is responsible for maintaining outstanding quality services and credentials its medical staff. All of the directors either reside or work in our service area. Part VI, Line 6: Hartford Healthcare Corporation (HHC) is organized as a support organization to govern, manage and provide support services to its affiliates. HHC, through its affiliates including The William W Backus Hospital, strives to improve health using the "Triple Aim" model: improving quality and experience of care; improving health of the population (population health) and reducing costs. HHC and it's affiliates including all supported organizations, develop and implement programs to improve the health care in our Southern New England region. This includes initiatives to improve the quality and accessibility of health care, create efficiency on both our internal operations and the utilization of health care, and provide patients with the most technically advanced and compassionate coordinated care. In addition, HHC continues to take important steps toward achieving its vision of being "nationally respected for excellence in patient care and most trusted for personalized, coordinated care."The affiliation with HHC creates a strong, integrated health care delivery system with a full continuum of care across a broader geographic area. This allows the small communities easy and expedient access to the more extensive and specialized services the hospital is able to offer. This includes continuing education of health care professionals at all the affiliated institutions through the Center of Education, Simulation and Innovation located at Hartford Hospital. The affiliation further enhances the hospitals' abilities to support their missions, identity, and respective community roles. This is achieved through integrated planning and communication to meet the changing needs of the region. This includes responsible decision making and appropriate sharing of services, resources and technologies, as well as containment strategies. Part VI, Line 7, Reports Filed With States CT 1 American Heart Association PO Box 4002012 Des Moines IA 50340 135613797 501(c)(3) 20000 To support the mission of The American Heart Association. 1 Part I, Line 2: Upon issuing the grant, the hospital attaches a letter that restricts the use of the funds for a specific purpose. All of the grants are made to public charities to assist in funding their exempt programs. Therefore, extensive monitoring of the use of these funds by these entities is not warranted. X X X X 1 1 0 0 0 0 0 1 0 David Coletti MD Director 200833 0 0 0 0 0 0 0 0 0 200833 0 0 0 Mark Tramontozzi MD Director 0 311766 0 0 0 1584 0 17384 0 34265 0 364999 0 0 Paul Weigle Thru 1218 Director 0 254280 0 1508 0 8129 0 19250 0 43979 0 327146 0 0 Mary Barry MD Director & Vice Chair 0 211275 0 0 0 0 0 0 0 10524 0 221799 0 0 Donna Handley Director & President 0 358758 0 129097 0 53594 0 19250 0 47680 0 608379 0 0 Margaret Marchak Secretary 0 492829 0 228567 0 395433 0 19250 0 63021 0 1199100 0 276628 Anthony Mastroianni VP, Finance 0 216180 0 67337 0 1107 0 19067 0 39808 0 343499 0 0 Robert Sidman MD VP, Medical Affairs 0 395308 0 135644 0 2100 0 19250 0 50848 0 603150 0 0 Lester Temkin VP, Operations 0 251975 0 84204 0 5491 0 19250 0 37190 0 398110 0 0 Zhenxiang Liu MD Physician 552932 0 34508 0 848 0 19250 0 49414 0 656952 0 0 0 Mariano Librojo MD Hospitalist 489176 0 30907 0 197 0 19250 0 28053 0 567583 0 0 0 Rukevwe Ehwarieme MD Hospitalist 317489 0 41392 0 157 0 19250 0 24165 0 402453 0 0 0 Nader Bahadory MD Medical Director 341426 0 16107 0 1141 0 19250 0 30340 0 408264 0 0 0 Andrzej Porebski MD Hospitalist 357197 7920 40020 0 849 0 19250 0 47270 0 464586 7920 0 0 David Whitehead Thru 1215 Former Director (ER), Pres. & CEO 0 622184 0 340914 0 114718 0 19250 0 52436 0 1149502 0 0 Bimal Patel Thru 917 Former Director (ER) & President 0 588312 0 256454 0 11827 0 94832 0 26857 0 978282 0 0 Carolyn Trantalis Former VP, Clinical Svcs. & Ops. 0 38236 0 0 0 278254 0 2009 0 18613 0 337112 0 0 Thomas Vaccarelli Former VP Facilities 0 231956 0 81077 0 20679 0 24750 0 42148 0 400610 0 0 Gregory Makowski Former VP, Clinical Laboratory Svcs. 0 263956 0 75112 0 3785 0 19250 0 18062 0 380165 0 0 Part I, Line 3 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of Backus Hospital, hires an outside consultant, Human Resources and Compensation Consulting Practice of Gallagher to determine best practices in governing executive compensation. Please refer to compensation narrative reported on Schedule O. Part I, Lines 4a-b In 2018, Carolyn Trantalis, Former VP, Clinical Services & Operations, received a lump sum severance payment in the amount of $278,024. Hartford HealthCare Corporation, a related organization, maintains a 457(f) Supplemental Executive Retirement Plan (SERP). Participants include certain officers and key employees at the President & CEO, Executive Vice President and Senior Vice President levels that are reported by Windham Community Memorial Hospital on its Form 990, Part VII. Contributions are made by Hartford HealthCare Corporation to the plan based on a percentage of the participant's compensation. Participants vest in the plan at the earlier of reaching age 55 and having 5 years of service, death, disability, involuntary separation without reasonable cause, upon reaching age 65 or the occurence of a change in control. Each participant ceases to be eligible for further contributions by Hartford HealthCare Corporation on the date of the participant's separation from service. Participants receive a one-time lump sum payment of the accumulated amount during the 30-day period following the participant's separation from service. 2018 SERP accrual on behalf of the following individuals: Bimal Patel $75,582 2018 SERP Payouts were made on behalf of the following individuals: David Whitehead $26,618* Donna Handley $14,312* Margaret Marchak $117,856* *For these individuals, vesting occurred, causing taxable income. This portion of the vested amount was used to pay the associated tax liability. The remaining balance was deposited into the employee SERP account. Part I, Line 7 Hartford HealthCare Corporation, a related organization, has a Compensation At Risk Plan that encourages and rewards achievements of significant functional goals. These goals contribute to the organization's strategic and financial direction. The plan utilizes market practice alignment to ensure competitive recruitment and retention. Awards are based on CEO and/or Hartford HealthCare Corporation's Compensation Committee discretionary assessment of overall organization performance and individual contribution to results. Form 990, Part VI, Section A, line 6 Backus Hospital is organized as a non-stock not for profit entity. Hartford HealthCare Corporation is the sole member. Form 990, Part VI, Section A, line 7a The sole member of the organization has the authority to approve/remove members of the governing body. Form 990, Part VI, Section A, line 7b The sole member of the organization has the right to review, approve, disapprove and deny significant transactions such as mergers, acquisitions, dissolutions, etc. Form 990, Part VI, Section B, line 11b The Form 990 was prepared by Hartford HealthCare's Tax Department. It was then reviewed by an independent accounting firm. It was then forwarded to the VP of Finance for review. The final Form was provided to the entire Board prior to submission to the Internal Revenue Services (IRS). Once the entire review process was completed, the Form was signed by the VP, Finance and then filed with the IRS. Form 990, Part VI, Section B, line 12c The Hospital's board has adopted the policy of the member, Hartford HealthCare Corporation (HHC). HHC's Conflict of Interest Policy (Policy) requires all covered individuals, including board members and officers, to provide a disclosure of relationships that create or have the appearance of creating a conflict of interest or commitment. The Policy requires updates if changes in circumstances arise during the year that either (a) create a new potential conflict of interest or commitment or (b) change or eliminate a conflict of interest or commitment previously disclosed. Conflict of interest disclosure statements are maintained by the HHC Office of Compliance and Integrity (OCI). Employee disclosures are reviewed by OCI in collaboration with the Covered Individuals' supervisor when deemed appropriate, to determine if there is a potential conflict. Oversight review of employee disclosures is provided by the Respective Network or Region Executive Leadership Team (ELT). The ELT assesses and may recommend the conflicting interest either be (a) eliminated for continued relationship with HHC/HHC Affiliate, or, (b) managed through a management plan. Board member disclosures are reported to the HHC Nominating and Governance Committee for determinations of conflicts and the management of them, where applicable. Form 990, Part VI, Section B, line 15 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of Backus Hospital, hires an outside consultant, Human Resources and Compensation Consulting Practice of Gallagher to determine best practices in governing executive compensation. The following steps were taken: - The use of an Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of The William W. Backus Hospital, established and regularly reviews Executive Compensation Philosophy; - The Committee regularly reviews scope and depth of positions taking into account complexity and the financial impact and accountability of all "disqualified persons; - National peer groups are selected for comparative purposes based on organizational size, operating revenue, geography and other relevant factors; - Analysis of current total compensation versus market is performed by independent third party compensation consulting firm and is then reviewed by the committee; - Recommendations are made based on market data analysis to ensure appropriate competitive positioning within parameters of compensation philosophy; -The CEO compensation is reviewed by the Committee and is based on comparative market information and organizational performance; - All changes are reviewed and approved by the Executive Compensation Committee; The compensation determination process for the CEO is reviewed on an annual basis. All other executive compensation is regularly reviewed for scope and depth of positions taking into account complexity and the financial impact and accountability. Form 990, Part VI, Section C, line 18 The Hospital's Form 990, 990T and form 1023 and its attachments are available upon request. Form 990, Part VI, Section C, line 19 The Hospital's Financial Statements, Governing Documents and the Conflict of Interest Policy are available for inspection upon request at the Organization's address. Form 990, Part XI, line 9: Transfer To/From Affiliates -7,190,617. Change In Pension and Post-Retirement Funding Obligations -27,403,360. Joint Venture Beginning Fund Balance 1,021,768. Rounding 2. Form 990 Part XII, Line 3a & 3b Although the Organization was not required to undergo A-133 Federal Auidt, the results were included in a consolidated A-133 performed at the parent level Hartford HealthCare Corporation. 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