2020-07-21T06:31:21-05:00 2019-09-30 350921680 CROWE LLP 175 POWDER FOREST DRIVE SIMSBURY CT 06089 990 2018-10-01 060646718 Middlesex Hospital MIDD 8603586395 28 CRESCENT STREET MIDDLETOWN CT 06457 SUSAN MARTIN VP FINANCE & TREASURER 2020-07-21 true KRISTIN ANDERSON P01231300 8606789200 2018 2020-09-23 17:36:50Z VINCENT CAPECE JR 28 CRESCENT STREET MIDDLETOWN CT 06457 473725457 false X WWW.MIDDLESEXHOSPITAL.ORG X 1895 CT MIDDLESEX HOSPITAL IS COMMITTED TO PROVIDING HIGH QUALITY INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. THE HOSPITAL RECOGNIZES COMMUNITY TRANSPARENCY AND INTEGRITY AS FUNDAMENTAL RESPONSIBILITIES. 14 13 3430 531 3170035 0 4475172 5787866 431741799 432247273 7819509 9557248 7354445 5078880 451390925 452671267 68500 92500 0 228616625 231814364 0 968124 174660138 178097893 403345263 410004757 48045662 42666510 508825625 528880049 151444638 141997427 357380987 386882622 MIDDLESEX HOSPITAL EXISTS TO PROVIDE THE SAFEST, HIGHEST-QUALITY HEALTH CARE AND THE BEST EXPERIENCE POSSIBLE FOR OUR COMMUNITY. 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 (CONTINUED ON SCHEDULE O) false false 365506325 92500 432443359 IN THE FISCAL YEAR ENDING 9/30/2019, INPATIENT CARE REPRESENTED 13,087 DISCHARGES AND 53,851 PATIENT CARE DAYS. 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. 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. 365506325 true true false true false false false false true true false false false true true false true false false false false false false true false true true true false true true false false false false false false false false true true true false false false false true true true false false true 221 0 true 3430 true true true false false false false true true false false false false false false X 14 13 true false false false true true true true true false false true true true true true true true true true true CT X X X SHANNON ST HILAIRE 8603586000 28 CRESCENT STREET MIDDLETOWN CT 06457 VINCENT CAPECE JR PRESIDENT/CEO 40.0 4.0 X X 1262910 0 285456 BRUCE S MACMILLIAN CHAIRMAN 1.0 3.0 X X 0 0 0 CHANDLER J HOWARD VICE CHAIRMAN 1.0 3.0 X X 0 0 0 JONATHAN D LEVINE MD SECRETARY 1.0 43.0 X X 0 0 0 MARK D LORENZE MD ASST SECRETARY 1.0 0 X X 0 0 0 GERALD P MIGLIACCIO DIRECTOR 1.0 4.0 X 0 0 0 JEAN M D'AQUILA DIRECTOR 1.0 4.0 X 0 0 0 DAVID C BENOIT DIRECTOR 1.0 3.0 X 0 0 0 JOHN J GAUTHIER DIRECTOR 1.0 3.0 X 0 0 0 ROBERT C HINTON DIRECTOR 1.0 3.0 X 0 0 0 DARRELL G PATASKA DIRECTOR 1.0 3.0 X 0 0 0 SABRA R PURTILL DIRECTOR 1.0 3.0 X 0 0 0 CHRISTINE H REPASY DIRECTOR 1.0 3.0 X 0 0 0 R CHRISTOPHER SEATON DIRECTOR 1.0 3.0 X 0 0 0 SUSAN MARTIN VP FINANCE/TREASURER 40.0 4.0 X 543761 0 64792 JESSE WAGNER MD VP QUALITY AND PATIENT SAFETY 40.0 0 X 592191 0 102535 JONATHAN BANKOFF CHAIRMAN EMERGENCY MEDICINE 40.0 0 X 435580 0 45997 RACHEL LOVINS CHIEF DEPT OF MED 40.0 0 X 415195 0 48847 DAVID GIUFFRIDA VP FACILITIES AND SUPPORT SERVICES 40.0 0 X 415107 0 64446 JACQUELYN CALAMARI VP PATIENT CARE SERVICES/CNO 40.0 0 X 393485 0 46344 EVAN JACKSON VP STRATEGIC PLANNING AND CIO 40.0 0 X 386834 0 76480 DONNA STRONESKI VP HUMAN RESOURCES 40.0 0 X 320273 0 43572 THEODORE HARTENSTEIN MEDICAL DIRECTOR, UTILIZATION MANAGEMENT 40.0 0 X 430256 0 39798 JEFFREY SHELTON CHAIRMAN DEPT PSYCH 40.0 0 X 418548 0 32973 MATTHEW DOLAN Emergency Medicine MD 40.0 0 X 411201 0 18357 BRIAN MCGUIRE MEDICAL DIRECTOR ED 40.0 0 X 407889 0 48214 DAVID ANTMAN Emergency Medicine MD 40.0 0 X 374095 0 44071 GREGORY NOKES VP HUMAN RESOURCES 40.0 0 X 155781 0 161 6963106 0 962043 410 true true false ACSYS INTERACTIVE 1577 NEW BRITAIN AVENUE FARMINGTON CT 06032 MARKETING 2821403 ARAMARK CORPORATION 66 OXFORD DRIVE FRANKLIN MA 02038 DIETARY / HOUSEKEEPING 1841179 QUEST DIAGNOSTICS INC 2025 COLLECTION CENTER DRIVE CHICAGO IL 60693 LABORATORY SERVICES 1495592 Cerner Corporation PO Box 959156 St Louis MO 631959156 Technology 1408731 GE Healthcare IITS 15727 Collections Center Drive Chicago IL 60693 Technology 1243658 76 X 34964 233399 3745065 1774438 149013 5787866 Patient Revenues 621110 426551142 426551142 Technical Lab 621500 782600 782600 Specimen Lab 621500 2367879 2367879 Joint Venture Program 900009 2545652 2545652 0 0 0 0 432247273 6505576 6505576 41184 41184 1014560 828040 186520 0 186520 186520 23141373 20130885 3010488 0 3010488 3010488 95265 233399 95265 Cafeteria Revenue 722210 1526239 1526239 Business ineruption proceeds 900009 343222 343222 3022899 3003343 19556 0 4892360 452671267 432443359 3170035 11270007 92500 92500 6141326 5613870 527456 267767 267767 188643712 172418801 16224911 9397584 8649547 748037 13690463 12587456 1103007 13673512 12580491 1093021 7394141 6202427 223590 968124 462548 462548 194658 194658 99111 99111 168722 168722 26787993 21690435 5097558 0 3463705 82615 3381090 7640017 5375909 2264108 12230132 7454870 4775262 7191805 4599876 2591929 1228698 959601 269097 541130 486287 54843 1585705 1585705 23518580 21180596 2337984 3053876 3053876 Medical Supplies 42066093 42066093 State Hospital Tax 32403511 32403511 8067468 6154092 1913376 0 410004757 365506325 43530308 968124 27632430 40883855 32477000 14759476 1174131 1981000 48017606 48355523 0 0 0 1049892 1224315 1275731 1315139 5256310 5007515 594654766 372845984 201848824 221808782 176743045 179344862 0 0 612800 545933 12737856 13653649 508825625 528880049 64537203 58756565 0 0 1010749 964337 43542482 42361422 0 0 0 0 0 0 0 42354204 39915103 151444638 141997427 X 339115292 368990166 10328569 9887659 7937126 8004797 0 0 0 0 0 0 357380987 386882622 508825625 528880049 X 42666510 -2014000 -11150875 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 99111 99111 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY 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 $10,804 AND THE PORTION OF CHA DUES TOTALED $23,887. IN ADDITION, MIDDLESEX HOSPITAL CONTRACTED WITH TWO CONSULTANTS WHO PERFORMED LOBBYING ACTIVITIES. THOSE EXPENSES TOTALLED $64,420. 124738999 67000 3977000 -166001 128949000 118528000 505000 5702999 -3000 124738999 103326000 451000 14480000 -271000 118528000 122014000 10726000 29414000 103326000 126387000 2000 -2106000 0 2269000 122014000 0.9075 0.0 0.0925 false false 13291125 13291125 331194229 187817844 143376385 2061978 1775250 286728 218930206 179559994 39370212 29177228 3692896 25484332 221808782 ACCRUED RETIREMENT LIABILITIES 3620428 SELF INSURANCE LIABILITIES 24535749 ASSET RETIREMENT OBLIGATION 568645 UNALLOCATED 3RD PARTY 10848297 OTHER 341984 39915103 X Schedule D, Part V, Line 4 Intended uses of endowment funds 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 FY2019. 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. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote 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, 2019 and 2018. 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, 2019 and 2018, 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 173330 114013 59317 0 0 57523 0 0 1795 Hospice Golf 78282 55040 23242 2423 0 8620 10134 0 2064 2 77052 64346 12706 0 0 0 0 0 12706 328664 233399 95265 2423 0 66143 10134 0 16565 95265 0 true true X true X true X 500 true true false true true 4235 7251941 4454888 2797053 0.0068 19376 84214474 56149381 28065093 0.0685 388 1056335 783466 272869 0.0007 0 23999 92522750 61387735 31135015 0.0759 14961 6870932 316577 6554355 0.0160 1396 13768991 2153269 11615722 0.0283 32406 46861660 35408830 11452830 0.0279 31 360672 16771 343901 0.0008 3528 318202 1800 316402 0.0008 0 52322 68180457 37897247 30283210 0.0739 0 76321 160703207 99284982 61418225 0.1498 0 0.0 3614 3614 0.0000 18 126526 24700 101826 0.0002 0 0.0 0 0.0 31 567 567 0.0000 0 0.0 40 62 62 0.0000 0 0.0 0 89 130769 24700 106069 0.0003 false 17273230 1727323 38612666 45808120 -7195454 X true true 1 1 MIDDLESEX HOSPITAL 28 CRESCENT STREET MIDDLETOWN CT 06457 WWW.MIDDLESEXHOSPITAL.ORG 000069 X X X X MIDDLESEX HOSPITAL 1 false false true X X X X X X X X X X 18 true false false true X https://middlesexhealth.org/middlesex-and-the-community/serving-our-community/community-health-needs X X true 16 true https://middlesexhealth.org/middlesex-and-the-community/serving-our-community/community-health-needs false true X 200.0 500.0 X X true true X X X true X https://middlesexhospital.org/patients-and-visitors/financial-assistance-services X https://middlesexhospital.org/patients-and-visitors/financial-assistance-services X https://middlesexhospital.org/patients-and-visitors/financial-assistance-services X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E The significant health needs are a prioritized description of the significant health needs of the community and identified through the CHNA. Schedule H, Part V, Section B, Line 3 Facility , 1 Facility , 1 - MIDDLESEX HOSPITAL. In addition to the elements selected in Part V, line 3, the Middlesex Health 2019 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. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - MIDDLESEX HOSPITAL. When completing its 2019 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 throughout the process, including review of the study's components; review and input on the key informant survey; assistance with service area-wide key informant survey dissemination; review and input on community resources and assets; and final study review. 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, schools, municipalities, foundations, advocacy groups, faith-based organizations and public safety. An effort was made to ensure that medically underserved, low-income and minority populations were represented (see CHNA Report, Appendix - Table A1 - which sets forth represented sectors/communities). To capture broad community input on health needs, social determinants of health and health equity, Middlesex Hospital administered its key informant survey through the online SurveyMonkey format. A focus on social determinants of health and health equity remained as integral sections of the 2019 survey. The 14 question survey was administered through the online SurveyMonkey format and included two separate and distinct URLs for the Community and Middlesex Hospital staff. Surveying staff was included, as they live and work in the Hospital's service area. The surveys were open for completion for a four week time period. The Community e-survey was extensively disseminated to an array of sector contacts in Middletown, Middlesex County and the periphery towns of Middlesex Hospital's primary service area in order to ensure responses from a wide range of representative community members and leaders with diverse backgrounds, perspectives and first-hand knowledge about their communities. Sectors included advocacy groups, alliances/coalitions, the business community, educational institutions, community based organizations, community residents, elected officials, faith-based organizations, foundations, health care organizations (including medical and behavioral), local health departments, mental health organizations, primary care/family medicine practices, public safety organizations (police, fire, emergency management), social services, 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 co-workers/colleagues, friends and family or anyone who lives or works in Middlesex County. The specific Middlesex Hospital e-survey was sent to leadership e-distribution lists (executive staff, directors, managers, supervisors) with a request to share the explanation of purpose and survey URL with individual departmental staff e-distribution lists. A total of 427 surveys were completed, with 239 completed by the Community and 188 completed by Middlesex Hospital staff. The Community and Middlesex Hospital response results were analyzed separately and included throughout the CHNA. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - MIDDLESEX HOSPITAL. Middlesex Hospital posted its 2019 CHNA 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; key informant community partners; community members; and existing Hospital-community based partnership distribution lists. Recipients were encouraged to widely share the assessment. Electronic copies were also distributed to Middlesex Hospital leadership, management staff, medical staff, board of directors, and staff through inclusion in Middlesex Hospital's weekly electronic newsletter. Hard copies of the CHNA were handed out at the Middlesex Health CHNA Implementation Strategy Community Conversation (held on January 28, 2020) and will continue to be provided upon request. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - MIDDLESEX HOSPITAL. Middlesex Hospital's 2016 CHNA Implementation Strategy had four broad priority areas (mental health, substance abuse, aging population, and asthma), and each had specific goals. The actions taken to address the significant health needs identified in the Hospital's previous CHNA (2016) include: Goal 1) Mental Health: Goal 1.1 Improve access to mental health services through interprofessional collaborative practice. To achieve this goal, Middlesex Health implemented an evidence-based integrated care model for mental health treatment within the primary care setting. Mental health clinicians, who are primarily Licensed Clinical Social Workers, are embedded in select primary care offices within the Middlesex Health system. Patients can be referred to therapy within the primary care practice where they receive psychotherapy to address a myriad of issues including depression, anxiety, grief, and trauma. Immediate warm hand-offs between primary care providers and mental health providers can also occur after the primary care visit. The embedded mental health clinicians consult with a staff psychiatrist on a weekly basis to review cases. Goal 1.2 Provide specialized mental health treatment for high risk populations. Action steps included 1) developing the service where, through assessment and intervention, young adults are able to regain and sustain functioning, and remain safe and healthy; 2) renovation of office space in order to accommodate the expansion; and 3) hiring psychiatrists specializing in young adult care. Goal 2) Substance Abuse: Goal 2.1 Develop a treatment program for high-risk patients experiencing severe alcohol use disorders. In order to accomplish this goal, an inpatient unit dedicated solely to patients experiencing acute alcohol withdrawal requiring medical care was created. The unit was identified, protocols were established and staff education was provided. Results have been highly positive, including: 1) no patients requiring transfer to the intensive care unit (ICU) during program launch (compared to a 40% ICU transfer prior to program launch); 2) improved patient satisfaction; 3) increased patient engagement in outpatient care after discharge; 4) increased staff satisfaction; and 5) reduction in staff and patient injuries. Goal 2.2 A) Develop and launch an opioid awareness campaign; B) Increase access to naloxone for patients at high risk for opioid overdose. In November 2017, Middlesex Health piloted a naloxone kit distribution program in its Middletown emergency department (ED) where the ED and pharmacy staff collaborated to develop a naloxone kit distribution policy and pathway. In early 2019, through a grant partnership between the Connecticut Hospital Association and the Department of Mental Health and Addiction Services (DMHAS), Middlesex Health elected to participate in this opportunity and expanded its pilot program of offering Narcan to-go kits to all its ED sites. Middlesex Health is also involved in the DMHAS-funded "How Can We Help?" initiative, a partnership between the Ministerial Health Fellowship, Columbus House and Middlesex Health which provides recovery coach services to survivors of an opioid overdose, individuals at-risk of an opioid overdose, individuals struggling with opioid use, and families of those struggling with opioid use. Goal 3) Aging Population. Design and implement interventions to promote healthy aging in place and improve outcomes for the aging population. The GOT Care! (Geriatrics Outreach and Training with Care) pilot program was successfully completed in June of 2017, followed by a period of required reporting and journal article development to broadly disseminate the model of care and successful outcomes. Program design continues to be underway through 1) assessment of existing geriatric service capacity as well as organizational strengths and barriers; 2) data review from a doctoral dissertation which evaluated GOT Care! outcomes; 3) collaboration with a health care economist to conduct a cost/benefit analysis; and 4) development of a strategic plan to guide the process of designing an interprofessional practice geriatric service line, starting with the in-home comprehensive geriatric assessment. Goal 4) Asthma. Improve asthma outcomes by meeting the Connecticut Asthma Initiative goals. In 2016, the Middlesex County Asthma Coalition was formed, with Middlesex Health serving as administrative lead under its Center for Chronic Care Management. The objective of the coalition is to work collaboratively to address areas of identified asthma need with a focus on those who are most at-risk. An initial area of focus was increasing the use of asthma action plans and promoting patient education techniques for asthma management. Since August 2018, the Connecticut River Area Health District, the Connecticut Department of Public Health and Middlesex Health have been partnering on the Putting in Airs initiative, an asthma home visiting program for children and adults in the defined service area who have poorly controlled asthma. Middlesex Hospital recognizes that it cannot focus on every health and social need identified in its previously conducted 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. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - MIDDLESEX HOSPITAL. 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. 1 MIDDLESEX HOSPITAL HOMECARE 770 SAYBROOK ROAD MIDDLETOWN CT 06457 HOMECARE SERVICES, REHAB, HEART HEALTH, OTHER SERVICES Schedule H, Part I, Line 3c Criteria used for determining eligibility for free or discounted care 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. Schedule H, Part VI, Line 6 Affiliated health care system n/a. Middlesex Hospital is not part of an affiliated health care system. Schedule H, Part VI, Line 7 Additional Information - State filing community benefit report Under the Connecticut General Statutes 19a-127k, hospitals that have a community benefit program in place, as specified by the statute, are required to report biennially to the State of CT. This biennial community benefit reporting is currently under the auspices of the State of Connecticut's Office of Health Strategy. As Middlesex Hospital meets the statute as having a community benefit program in place, it reports biennially to the State of CT's Office of Health Strategy. Schedule H, Part V, Section B, Line 4 The tax year the hospital facility last conducted a CHNA The last CHNA report was approved by the board on 9/27/19 (tax year 2018); certain updates to the report were made and approved by the board on 11/22/19. Schedule H, Part V, Section B, Line 8 Adoption of Implementation Strategy Middlesex Hospital's most recent Implementation Strategy (that relates to Middlesex Hospital's 2019 CHNA) was adopted after the end of the tax year in which its most recent CHNA was completed, but before the 15th day of the fifth month after the end of the tax year in which the CHNA was conducted. This Implementation Strategy was adopted by the board on February 7, 2020. Schedule H, Part I, Line 7g Subsidized Health Services Middlesex Hospital includes its Family Medicine Group as a subsidized service. For FY19, 10,500 unique individuals were served with a total Hospital subsidy of $297,650. 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. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance 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. Schedule H, Part II Community Building Activities The majority of Middlesex Hospital's community based community benefit work is captured under non-community building 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 programs that fall under the scope of community building. Staff members are highly participative in 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 FY19 the Hospital's Community Building Activities totaled $106,069 and served 89 individuals. Examples include (but are not limited to): 1) Disaster Readiness where the Hospital plays a pivotal role by working in collaboration with key community partners to ensure the safety of the community at large during a potential disaster. To prepare for disasters, the Hospital often participates in community disaster preparation and emergency management committees; regular collaborative community education and drills; and hosts yearly radiation drills for the staff of a local nuclear power plant. In addition, the Hospital purchases and stock-piles 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. 2) Workforce Development: the Hospital's Shoreline Medical Center (SMC) has well-developed educational programs 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. Examples of these educational programs include: a) SMC Career Day - 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) SMC World of Work - an educational experience for middle schools students where students learn about specific healthcare fields and the education required for each specialty. Students also receive demonstrations on health care modalities. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount The Bad Debt Expense amount in Part III, line 2 is based on charges and tied to the Hospital's audited financial statements. The Hospital accounts for discounts and payments on patient accounts in determining bad debt expense by reducing bad debt by recoveries on the Hospital's financials. Schedule H, Part III, Line 3 Bad Debt Expense Methodology 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 uncooperative, 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. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote 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 16 of the Middlesex Health System's Consolidated FY19 Audited Financial Statement states: For receivables associated with self-pay patients which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill, the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between discounted rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs 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 Health's 2019 community health needs assessment (CHNA) found that, when extracting the age 65+ population, Middlesex County (18.4%) exceeds Connecticut (16.0%), (Connecticut Data Collaborative, 2013-2017) 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, Middletown and East Hampton fall below the state average of 16.0%. Marlborough, East Haddam, and Durham are on par with the state average, while Middlefield, Cromwell, Clinton, Deep River, Haddam, Portland, Killingworth, Westbrook, Chester, Old Saybrook, Old Lyme, Essex and Lyme considerably exceed the state average with a range of 18.5%-32.4% age 65+ (Connecticut Data Collaborative, 2013-2017). 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 2020, 2030, and 2040. For 2020, excluding Middletown and Colchester (at 14.3% and 15.2%), the expected growth for age 65+ ranges from 17.3% to 30.0% in the remaining seventeen towns in Middlesex Health's service area compared to 16.1% for Connecticut. For 2030, excluding Middletown (at 14.9%), the expected growth for age 65+ ranges from 19.5% to 34.9% for the remaining eighteen towns in Middlesex Health's service area compared to 17.9% for Connecticut. For 2040, excluding Middletown (at 13.9%), the expected growth for age 65+ ranges from 18.5% to 36.4% in the remaining eighteen towns in Middlesex Health's service area compared to 17.3% for Connecticut (Connecticut State Data Center, 2015-2040 Projections). 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. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance 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. Schedule H, Part V, Section B, Line 16a FAP website - MIDDLESEX HOSPITAL: Line 16a URL: https://middlesexhospital.org/patients-and-visitors/financial-assistance-services; Schedule H, Part V, Section B, Line 16b FAP Application website - MIDDLESEX HOSPITAL: Line 16b URL: https://middlesexhospital.org/patients-and-visitors/financial-assistance-services; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - MIDDLESEX HOSPITAL: Line 16c URL: https://middlesexhospital.org/patients-and-visitors/financial-assistance-services; Schedule H, Part VI, Line 2 Needs assessment 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 state's Hospital Association population and community health initiatives based on state-wide and local community health issues; 3) any real-time community based input, feed-back, recommendations and suggestions; and 4) 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. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance 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 aid 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 the patient if he/she 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. The Hospital has a team of financial counselors who are available to assist the patient 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. An important addition to Middlesex Hospital's financial assistance process has been the development of the Financial Assistance Workgroup several years ago. Workgroup tasks include: increasing awareness regarding financial assistance availability; continuous monitoring of appropriateness, feasibility and accessibility of the Hospital's financial assistance practices; and a comprehensive communications strategy for increasing awareness for financial assistance. In FY19, Middlesex Hospital granted $2,797,053 of financial assistance to 4,235 unique recipients and absorbed $28,337,962 in unpaid costs of Medicaid (total of Medicaid including managed care and LIA), serving 19,764 individuals. Schedule H, Part VI, Line 4 Community information 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. Middlesex Hospital Health's service area includes twenty-four municipalities. 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 square miles) is the smallest county of the eight counties in Connecticut, and is the sixth in population size (Connecticut Data Collaborative, 2017). Municipality sizes by land mass vary throughout the county, from 54 square miles (East Haddam) to 10 square miles (Essex), with Middletown having 41 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. Of the total state of Connecticut population (3,588,184), 4.6% (163,410) reside in Middlesex County. With a population of 46,478 (Connecticut Data Collaborative, 2017), 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 16,100; Portland, East Haddam, Haddam, Old Lyme, Durham, Westbrook, Essex, Killingworth, and Marlborough have populations between 5,000 and 9,999; and Chester, Deep River, Middlefield, 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, Portland, and Westbrook are considered rural. For the age distributions, Middlesex County is below state averages in the 0-44 age categories and has a higher percentage of residents in the 45-54, 55-64, 65-74, 75-84, and 85+ age ranges when compared to the state. When extracting age 65+, Middlesex County (18.4%) exceeds Connecticut (16.0%), 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, Middletown and East Hampton fall below the state average of 16.0%. Marlborough, East Haddam, and Durham are on par with the state average, while Middlefield, Cromwell, Clinton, Deep River, Haddam, Portland, Killingworth, Westbrook, Chester, Old Saybrook, Old Lyme, Essex and Lyme considerably exceed the state average with a range of 18.5%-32.4% age 65+ (Connecticut Data Collaborative, 2013-2017). Middletown has a more diverse 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 83.7% White, non-Hispanic; 5.5% Black or African American, non-Hispanic; 6.4% Hispanic or Latino; 3.2% Asian, non-Hispanic; 2.1% two or more races, non-Hispanic (U.S. Census Quick Facts 2017; Vintage 2018 Population Estimates Program). Middletown's race and Hispanic or Latino Origin composition is 69.5%% White, non-Hispanic; 13.6% Black or African American, non-Hispanic; 9.2% Hispanic or Latino; 5.6% Asian, non-Hispanic; 2.9% two or more races, non-Hispanic (U.S. Census Quick Facts 2017; Vintage 2018 Population Estimates Program). The median household income in Middlesex County ($81,673) is higher than the state of Connecticut average ($73,781) [Connecticut Data Collaborative, 2017]. There is a significant range between the towns in Middlesex County, with Middletown at the lower bound ($63,914) and Durham at the highest level ($116,232) [Connecticut Data Collaborative, 2017]. There are significant median household income disparities among the Black or African American Alone ($44,554 for Middletown and $47,642 for Middlesex County) and Hispanic or Latino populations ($47,313 for Middletown and $71,131 for Middlesex County) when compared to White Alone Not Hispanic or Latino ($69,509 for Middletown and $84,402 for Middlesex County) [Connecticut Data Collaborative, 2013-2017]. For poverty status, Middletown's Total (11.3%) and Under 18 (15.5%) poverty rates exceed Connecticut's rate of 10.1% and 13.5% respectively (Connecticut Data Collaborative, 2013-2017), with the towns of Clinton, Colchester, Cromwell, Deep River, Middlefield and Portland experiencing increased poverty status for the Under 18 category relative to the other towns in Middlesex Hospital's service area. Total and Under 18 poverty rates are significantly more pronounced among the Black or African American Alone (Total: 20.3% for Middletown and 17.8% for Middlesex County & Under 18: 30.0% for Middletown and 26.9% for Middlesex County) and Hispanic or Latino populations (Total: 25.1% for Middletown and 17.4% for Middlesex County & Under 18: 27.9% for Middletown and 23.0% for Middlesex County) when compared to White Alone Not Hispanic or Latino (Total: 8.0% for Middletown and 5.9% for Middlesex County & Under 18: 10.0% for Middletown and 5.6% for Middlesex County) [Connecticut Data Collaborative, 2013-2017]. The educational attainment for Middlesex County mirrors Connecticut, except in the outer bounds (percent of No High School Diploma and percent of Bachelor's Degree or Higher) for Middlesex County which indicate somewhat better rates when benchmarked against Connecticut (American Community Survey (ACS) 5-year; DataHaven Analysis 2017). The unemployment rates for the towns in Middlesex Heath's service area are lower than Connecticut's average of 4.1% (Connecticut Data Collaborative, 2018), except for Middletown, which mirrors the state rate. 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 (40.7%), the percentage of households in the towns that are cost-burdened is high, ranging from 26.9% - 35.8%. The towns of Middletown and Westbrook compare to Connecticut, while Clinton, Lyme, Deep River and Old Saybrook exceed the state average with a range of 43.3% - 47.9% experiencing housing cost-burden (Connecticut Data Collaborative, 2013-2017). All towns in Middlesex Health's service area have a lower uninsured rate when compared to Connecticut (6.4%), except Clinton (8.1%), Deep River (8.1%) and Westbrook (6.9%). Deep River is the only town in Middlesex Health's service area that has a slightly lower private insurance rate when compared to Connecticut. All towns in Middlesex Health's service area have a lower percentage of public health insurance when compared to Connecticut (33.4%), except Old Saybrook (41.6%), Lyme (40.1%), Old Lyme (37.2%), Essex (36.7%) and Chester (35.3%), which is likely due to higher Medicare enrollment given the age distribution of those towns (Connecticut Data Collaborative, 2013-2017). In 2019, the percent of hospital discharges for Medicaid/SAGA/Uninsured combined were: 18.5% inpatient; 14% outpatient; 31% Emergency Department non-admission; and, for the following services: 40% newborn; 44% inpatient psychiatry; 13% 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 a lack of access to primary care services. Schedule H, Part VI, Line 5 Promotion of community health 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 FY19 was $61,418,225 (excluding Community Building) with 76,321 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. Almost 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 (Center for Chronic Care Management disease management outpatient programs for adult asthma; child asthma; diabetes education and disease management; medical nutrition therapy; smoking cessation; chronic heart failure; and childhood weight management). In FY19, the Hospital's Community Health Improvement Services served 14,961 individuals at a total cost of $6,301,720 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 FY19, the Hospital's Health Professions Education category served 1,396 individuals at a total cost of $11,615,722 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, Hospice, Diabetes Education, and Wound Care. In FY19 the Hospital's subsidized services served 32,406 people with a total cost of $11,452,830 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 breast, lung, prostate, colorectal, among others. For FY19, the Hospital's associated costs for all (non-industry) research projects totaled $343,901 and served 31 individuals. Financial and In-Kind Contributions: Middlesex Hospital supports the community in the form of financial and in-kind contributions. The Hospital's in-kind contributions include equipment, food, linens and medical supplies that are donated both locally and globally. Other in-kind donations include cafeteria discounts for YMCA residents and staff coordination of community support drives. The Hospital's main campus and satellite locations make meeting space available, free-of-charge and on an on-going basis, for many community groups that would otherwise struggle to pay for space. In addition, each year the Hospital makes substantial cash donations to carefully selected mission-driven community organizations throughout its service area. The Hospital's FY19 support for financial and in-kind contributions totaled $316,402, serving 3,528 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 production and implementation. Middlesex Hospital has a dedicated Director of community benefit 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 FY19 Community Benefit Operations expense totaled $252,635. Schedule H, Part VI, Line 7 State filing of community benefit report CT true Community Foundation of Middlesex County 211 South Main Street Middletown CT 06457 061477711 501(c)(3) 5000 General Support Middlesex County Chamber of Commerce Inc 393 Main Street Middletown CT 06457 060452410 501(c)(6) 48000 General Support Florida Hospital Association RESEARCH AND EDUCATION FOUNDATION 307 Park Lake Circle Orlando FL 32803 596151162 501(c)(3) 10000 General Support HEALTH ASSISTANCE INTERVENTION EDUCATION NETWORK FOR CONNECTICUT 1210 Mill Street East Berlin CT 06023 510642913 501(c)(3) 5000 General Support Eugene O'Neill Theater 305 Great Neck Road Waterford CT 06385 066070900 501(c)(3) 14500 General Support Friends of Long Hill Estate 421 Wadsworth Street Middletown CT 06457 061546991 501(c)(3) 5000 general support Connecticut River Museum 67 Main Street Essex CT 06426 237417579 501(c)(3) 5000 General Support 6 1 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. 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 X X true true X X X X X false false false false false false false false false VINCENT CAPECE JR PRESIDENT/CEO 730342 0 253050 0 279518 0 244671 0 40785 0 1548366 0 251283 0 SUSAN MARTIN VP FINANCE/TREASURER 408504 0 98000 0 37257 0 35817 0 28975 0 608553 0 18197 0 GREGORY NOKES VP HUMAN RESOURCES 29301 0 80000 0 46480 0 0 0 161 0 155942 0 27980 0 JESSE WAGNER MD VP QUALITY AND PATIENT SAFETY 414146 0 113150 0 64895 0 64760 0 37775 0 694726 0 46395 0 JONATHAN BANKOFF CHAIRMAN EMERGENCY MEDICINE 397830 0 37750 0 0 0 16085 0 29912 0 481577 0 0 0 RACHEL LOVINS CHIEF DEPT OF MED 366118 0 47000 0 2077 0 16200 0 32647 0 464042 0 0 0 DAVID GIUFFRIDA VP FACILITIES AND SUPPORT SERVICES 280087 0 87000 0 48020 0 47995 0 16451 0 479553 0 29520 0 JACQUELYN CALAMARI VP PATIENT CARE SERVICES/CNO 278233 0 68000 0 47252 0 21600 0 24744 0 439829 0 29260 0 EVAN JACKSON VP STRATEGIC PLANNING AND CIO 289302 0 77000 0 20532 0 44272 0 32208 0 463314 0 0 0 DONNA STRONESKI VP HUMAN RESOURCES 258273 0 62000 0 0 0 38030 0 5542 0 363845 0 0 0 THEODORE HARTENSTEIN MEDICAL DIRECTOR, UTILIZATION MANAGEMENT 390256 0 40000 0 0 0 8143 0 31655 0 470054 0 0 0 JEFFREY SHELTON CHAIRMAN DEPT PSYCH 365048 0 53500 0 0 0 11159 0 21814 0 451521 0 0 0 MATTHEW DOLAN Emergency Medicine MD 335926 0 75275 0 0 0 5400 0 12957 0 429558 0 0 0 BRIAN MCGUIRE MEDICAL DIRECTOR ED 284725 0 104664 0 18500 0 15702 0 32512 0 456103 0 0 0 DAVID ANTMAN Emergency Medicine MD 287341 0 86754 0 0 0 12980 0 31091 0 418166 0 0 0 Schedule J, Part I, Line 1a Travel for companions TRAVEL FOR COMPANIONS - THE HOSPITAL'S POLICY PROVIDES FOR SPOUSAL OR "SIGNIFICANT OTHER" TRAVEL IN CERTAIN INSTANCES RELATED TO BUSINESS ACTIVITIES AND PRESCRIBES THE PROPER TAX TREATMENT OF THAT BENEFIT. THIS BENEFIT IS TREATED AS TAXABLE COMPENSATION WHEN APPLICABLE. EVAN JACKSON SUSAN MARTIN VINCENT CAPECE Schedule J, Part I, Line 1a Health or social club dues or initiation fees 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 (VINCENT CAPECE) ACCORDING TO IRS RULES AND REGULATIONS. Schedule J, Part I, Line 1a Personal services REPRESENTS TAX PLANNING AND/OR TAX PERSONAL SERVICES - PREPARATION FEES FOR ONE MEMBER OF THE EXECUTIVE STAFF. THIS BENEFIT WAS TREATED AS TAXABLE COMPENSATION. EVAN JACKSON A STATE OF CT HEALTH & EDUCATIONAL FACILITIES AUTH 060806186 20774YAW7 2011-07-26 33803383 SERIES N REFINANCE 10/9/1997 (SERIES H & I) true false false B State of CT Health & Educational Facilities Authority 060806186 20774YWD5 2015-05-19 19491965 SERIES O Refinance 12/7/2006 (Series L) false false false C STATE OF CT HEALTH & EDUCATIONAL FACILITES AUTHORITY 060806186 000000000 2016-06-10 9683000 SERIES P REFINANCE 6/10/2016 (SERIES M) false false false D STATE OF CT HEALTH & EDUCATIONAL FACILITIES AUTH 060806186 000000000 2017-11-21 9069272 SERIES Q REFINANCE 10/26/2010 (SERIES N) false false false A 16740000 7600000 33803651 0 0 0 537971 0 0 0 33265690 0 2011 true false true true B 2455000 0 19491965 0 0 0 388960 0 0 0 19103010 0 2015 false true true true C 2693767 0 9683000 0 0 0 193660 0 0 0 9489340 0 2016 false true true true D 322611 0 9366990 0 8397800 181425 0 0 0 788341 0 false true false true A 0.0 B false false false false 0.0 0.0 0.0 false false true C 0.0 D 0.0 A false false false true false false false false true B false true false false false false false false true C false true false false false false false false true D false true false false false false false false true A true B true C true D true Schedule K, Part II, Line 3 COLUMN A and Column D Bonds THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS IS investment earnings. Schedule K, Part III Column B and Column C Bonds The organization has determined that all management / service contracts meet the safe harbor under Rev. Proc. 2017-13, 2017-6 I.R.B. 787. Schedule K, Part VI Supplemental Information Series N bonds were split between Middlesex Health Services which issued $5,637,382 and Middlesex Hospital which issued $33,803,383. Schedule K, Part VI Supplemental Information Series Q bonds were split between Middlesex Health Services which issued $2,529,728 and Middlesex Hospital which issued $9,069,272. Schedule K, Part IV, Line 2c COLUMN A Issuer name: STATE OF CT HEALTH & EDUCATIONAL FACILITIES AUTH. The calculation for computing no rebate due was performed on 07/26/2016 ANNE CALAMARI - LCSW COORDINATOR FAMILY MEMBER of J. CALAMARI 136004 Employment Arrangement false GUIFFRIDA ELECTRIC CO Entity more than 35% owned by FAMILY MEMBER of D. GUIFFRIDA, a key employee 1052011 Indpendent Contractor Arrangement false Ruth Wagner - Registered Nurse Family Member of J Wagner, a key employee 84407 Employment Arrangement false Schedule L, Part IV RELATED PARTIES ANNE CALAMARI, LCSW COORDINATOR, IS THE DAUGHTER OF JACQUELYN CALAMARI, VP NURSING. ANNE CALAMARI'S WAGES FOR 10/01/18 TO 09/30/19 TOTALED $136,004. COS GIUFFRIDA AND GIULIO GIUFFRIDA, FATHER AND UNCLE OF DAVID GIUFFRIDA, RESPECTIVELY, ARE OWNERS OF GIUFFRIDA ELECTRIC. GUIFFRIDA ELECTRIC PROVIDES ELECTRICAL CONTRACTING SERVICES TO MIDDLESEX HOSPITAL SINCE 1970. AMOUNTS PAID BY THE HOSPITAL FOR SERVICES RENDERED DURING FY19 TOTALED $1,052,011. RUTH WAGNER, CCU REGISTERED NURSE, IS THE WIFE OF JESSE WAGNER, VP QUALITY & SAFETY. RUTH WAGNER'S WAGES FOR 10/01/18 TO 09/30/19 TOTALED $84,407. X 4 149013 Other - Selling Price 0 false true false Schedule M, Part I Explanations of reporting method for number of contributions Securities - Publicly traded - Reporting on count of donors Form 990, Part III, Line 1 ORGANIZATION'S MISSION 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, Line 2 Family/business relationships amongst interested persons JEAN D'AQUILA & CHANDLER HOWARD - Business relationship, VINCENT CAPECE & CHANDLER HOWARD - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF THE HOSPITAL IS MIDDLESEX HEALTH SYSTEM, INC. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE SOLE MEMBER, MIDDLESEX HEALTH SYSTEM, INC. HAS THE RIGHT TO ANNUALLY ELECT THE BOARD OF DIRECTORS OF THE HOSPITAL. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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 ON ITS BEHALF. Form 990, Part VI, Line 11b Review of form 990 by governing body 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, Line 12c Conflict of interest policy 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 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, Line 15a Process to establish compensation of top management official THE COMPENSATION OF THE PRESIDENT/CEO IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE. THE COMMITTEE HAS A CHARTER AND A POLICY STATEMENT SETTING FORTH A PROCESS AND CERTAIN GUIDELINES FOR DETERMINING COMPENSATION. WHICH INCLUDES A BASE SALARY AND AND INCENTIVE COMPENSATION WITHIN A RANGE SET BY THE POLICY. FOLLOWING THE CLOSE OF EACH FISCAL YEAR, THE COMMITTEE RECEIVES MARKET ANALYSIS FROM AND INDEPENDENT CONSULTANT REGARDING COMPENSATION AT PEER GROUPS OF COMPARABLE HOSPITALS AND HEALTH SYSTEMS. COMPENSATION IS COMPARED TO BENCHMARKS WITH RESPECT TO CASH COMPENSATION AND TOTAL COMPENSATION INCLUDING FRINGE BENEFITS. THE INDEPENDENT CONSULTANT PROVIDES A WRITTEN OPINION ANNUALLY CONFIRMING THAT THE COMPENSATION AS ADJUSTED BY THIS PROCESS, IS "REASONABLE" WITHIN APPLICABLE IRS GUIDELINES. THE COMPENSATION IS APPROVED BY THE COMMITTEE AND DOCUMENTED IN THE MINUTES. THE LAST COMPENSATION REVIEW OCCURRED 12/2018. Form 990, Part VI, Line 15b Process to establish compensation of other employees THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE WHICH HAS A CHARTER AND A POLICY STATEMENT SETTING FORTH A PROCESS AND CERTAIN GUIDELINES FOR DETERMINING COMPENSATION, WHICH INCLUDES A BASE SALARY AND THE OPPORTUNITY FOR INCENTIVE COMPENSATION WITHIN A RANGE SET BY THE POLICY. FOLLOWING THE CLOSE OF EACH FISCAL YEAR, THE COMMITTEE RECEIVES MARKET ANALYSIS FROM AN INDEPENDENT CONSULTANT REGARDING COMPENSATION AT PEER GROUPS OF COMPARABLE HOSPITALS AND HEALTH SYSTEMS. POSITIONS WITHIN THE EXECUTIVE TEAM ARE COMPARED TO BENCHMARK POSITIONS 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, AND APPROVES OR MODIFIES THEM. THE CONSULTANT PROVIDES A WRITTEN OPINION ANNUALLY CONFIRMING THAT THE COMPENSATION OF THE EXECUTIVES, AS ADJUSTED BY THIS PROCESS, IS "REASONABLE" WITHIN APPLICABLE IRS GUIDELINES. THE COMPENSATION OF THESE OTHER OFFICERS AND KEY EMPLOYEES IS APPROVED BY THE COMMITTEE AND DOCUMENTED IN THE MINUTES. THE LAST COMPENSATION REVIEW OCCURRED 12/2018. Form 990, Part VI, Line 19 Required documents available to the public 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 VIII, Line 11d Other Miscellaneous Revenue all Other Revenue - Total Revenue: 3022899, Related or Exempt Function Revenue: 3003343, Unrelated Business Revenue: 19556, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances EXPENDITURES FROM RESTRICTED FUNDS - -1284000; Transfer to System - -10698000; Transfer from Resources - 260000; Transfer from Primary Care - 496000; Change in Assets Held in Trust - 75125; MIDDLESEX HEALTH SYSTEM INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676137 SUPPORT CT 501(c)(3) Type II NA false MIDDLESEX HEALTH SERVICES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676140 ASST. LIVING CT 501(c)(3) 10 MIDDLESEX HEALTH SYSTEM false MIDDLESEX HOSPITAL FOUNDATION 28 CRESCENT STREET MIDDLETOWN CT 06457 273720822 SUPPORT CT 501(c)(3) Type II MIDDLESEX HOSPITAL true MHS PRIMARY CARE INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061472743 HEALTHCARE CT 501(c)(3) Type II MIDDLESEX HEALTH SYSTEM false MIDDLESEX HEALTH RESOURCES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061089925 HEALTHCARE CT MIDDLESEX HEALTH SYSTEM C Corporation false INTEGRATED RESOURCES FOR THE MIDDLESEX AREA LLC 28 CRESCENT STREET MIDDLETOWN CT 06457 061462230 OUTPATIENT CARE CT MIDDLESEX HEALTH SYSTEM C Corporation false false true false true false false false false false true true false false false true true true false true