2019-08-14T14:02:38-05:00 2018-09-30 111986323 MARCUM LLP 185 ASYLUM STREET HARTFORD CT 06103 990 2017-10-01 060647014 GRIFFIN HOSPITAL GRIF 2037327528 130 DIVISION STREET DERBY CT 06418 JAMES DOWNEY CONTROLLER 2037327528 2019-08-13 1 DOUGLAS FARRINGTON P00370668 8607600600 47.19.127.190 2019-08-13 11:44:21 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 DD44AF68ECC090A8110D92EA04805F7936D9C986 2017 2019-02-21 02:37:17Z PATRICK CHARMEL 130 DIVISION STREET DERBY CT 06418 202532161 0 X GRIFFINHEALTH.ORG X 1908 CT GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT. 19 15 1700 325 1209923 -21370 2514192 2549039 177448476 196367190 387123 493383 2098472 2641158 182448263 202050770 0 0 0 0 89388871 93209758 0 0 0 77165234 92867435 166554105 186077193 15894158 15973577 125430048 134612629 140503727 127205132 -15073679 7407497 X GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT, TO EMPOWERING INDIVIDUALS TO BE ACTIVELY INVOLVED IN DECISIONS AFFECTING THEIR CARE AND WELL-BEING THROUGH ACCESS TO INFORMATION AND EDUCATION, AND TO PROVIDING LEADERSHIP TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE. 0 0 132976453 181358345 GRIFFIN HOSPITAL IS AN ACUTE CARE HOSPITAL PROVIDING MEDICAL CARE TO PATIENTS IN COMMUNITIES SERVED, INCLUDING SUBSIDIZED CARE, CHARITY CARE, AND EDUCATIONAL SERVICES TO HEALTH PROFESSIONALS TO HELP PREPARE THE NEXT GENERATION OF CAREGIVERS. 4310193 12604804 PROVIDE CANCER RELATED RADIOLOGY SERVICES TO THE COMMUNITY. 1892393 2265699 PROVIDE PSYCHIATRIC SERVICES TO THE COMMUNITY ON AN OUTPATIENT BASIS. 439277 1357882 PROVIDE HOSPICE SERVICES TO THE COMMUNITY. 439277 1357882 139618316 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 213 0 1 1700 1 1 1 0 0 0 0 0 0 0 0 0 X 19 15 0 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 CT X JAMES DOWNEY 2037327528 130 DIVISION STREET DERBY CT 06418 JOSEPH ANDREANA TRUSTEE 0.23 0.46 X 0 0 0 JOHN AVERSA DO TRUSTEE 0.23 0.23 X 0 0 0 FREDERICK BROWNE MD TRUSTEE 0.23 40.23 X 0 395696 28752 KENNETH BALDYGA CHAIRMAN 0.23 0.62 X X 0 0 0 JOHN W BETKOWSKI III TRUSTEE 0.23 0.62 X 0 0 0 GREGORY BORIS DO TRUSTEE 0.23 0.15 X 0 0 0 PATRICK A CHARMEL CEO/PRESIDENT, BOD SECRETARY/TREASURER 45.00 5.15 X X 637667 0 33320 DONNA DIGIANVITTORIO TRUSTEE 0.23 0.23 X 0 0 0 NANCY DINARDO TRUSTEE 0.23 0.38 X 0 0 0 KENNETH J DOBULER MD TRUSTEE/PHYSICIAN 40.00 0.23 X 333900 0 32956 JEAN CRUM JONES MPH RD TRUSTEE 0.23 0.23 X 0 0 0 THEMIS KLARIDES TRUSTEE 0.23 0.46 X 0 0 0 MICHAEL LAW TRUSTEE (RESIGNED 5/31/18) 0.23 0.23 X 0 0 0 GEORGE S LOGAN TRUSTEE 0.23 0.46 X 0 0 0 FLOYD MOIR TRUSTEE 0.23 0.23 X 0 0 0 WM NEIL PEARSON MD TRUSTEE 0.23 0.23 X 10466 0 0 MARK PETERSON TRUSTEE 0.23 0.23 X 0 0 0 ROBERT G REISS TRUSTEE (RESIGNED JAN. 2018) 0.23 0.46 X 0 0 0 GERALD T WEINER ESQ TRUSTEE 0.23 0.46 X 0 0 0 PHILLIP WHITE TRUSTEE 0.23 0.23 X 0 0 0 JOHN J ZAPRZALKA TRUSTEE 0.23 0.46 X 0 0 0 MARK O'NEILL CFO/VP FINANCE 40.00 3.00 X 315019 0 9549 ALEXANDER S BALKO CFO/VP FINANCE 40.00 X 0 0 0 MARGARET DEEGAN VP 40.00 X 238577 0 26852 TODD LIU VP 40.00 X 218300 0 26105 BARBARA STUMPO VP 40.00 X 229596 0 26624 KATHLEEN MARTIN VP 40.00 X 210116 0 25985 BENJAMIN ZIGUN PHYSICIAN 40.00 X 266487 0 28598 EDWARD HALSTEAD PHYSICIAN 40.00 X 186462 0 21344 MIHAELA BORAN PHYSICIAN 40.00 X 177654 0 24785 NUMAN GHARAIBEH PHYSICIAN 40.00 X 169661 0 22716 ADAM DWORKIN VP 40.00 X 171020 0 25777 3164925 395696 333363 125 0 1 0 TURNER CONSTRUCTION 50 WATERVIEW DR SHELTON CT 06484 CONSTRUCTION 2936519 UNIDINE CORPORATION PO BOX 360639 PITTSBURGH PA 15251 FOOD SERVICE 2256153 ASCENSION HEALTH ALLIANCE PO BOX 505302 ST LOUIS MO 63105 PURCHASING CONSULTANTS 1010687 MARQUETTE COMMERCIAL FINANCE PO BOX 1450 MINNEAPOLIS MN 55485 CONSULTANTS 583219 GRIFFIN PATHOLOGY CONSULTANTS 1140 FAIRFIELD AVE BRIDGEPORT CT 06605 MEDICAL CONSULTANTS 424229 26 2402939 146100 2549039 PATIENT SERVICE REVENUE 622110 180134087 178974648 1159439 STATE SUPPLEMENTAL REVENUE 900099 14519400 14519400 OTHER PROGRAM SERVICES 621500 1041307 1041307 TUITION/EDUCATION REVENUE 900099 672396 672396 196367190 375281 375281 327678 0 327678 327678 327678 599368 125 481391 0 117977 125 118102 118102 CAFETERIA INCOME 900099 1043456 1043456 OTHER INCOME 900099 766949 716465 50484 REBATES 900099 503075 503075 2313480 202050770 196427291 1209923 1864517 2565122 394119 2171003 67591661 58392369 9199292 583554 522555 60999 17157722 14536022 2621700 5311699 4446497 865202 226606 226606 242722 242722 20318 20318 11706307 6515213 5191094 1017623 1017623 4133514 3365750 767764 1212918 261564 951354 3400190 2376104 1024086 276976 85228 191748 2149779 1871678 278101 4653650 3615933 1037717 2612792 2016784 596008 MEDICAL & DRUG SUPPLIES 30104750 30104750 STATE HOSPITAL TAX EXP 16746011 16746011 PHYSICIAN FEES 4664539 3773747 890792 BAD DEBTS 2822659 2822659 6876081 3499721 3376360 186077193 139618316 46458877 0 1464 1464 11267637 14468519 13624224 14451556 1017075 2226192 1414943 1557480 172059751 111443431 57733653 60616320 10012134 10368783 3750069 3796018 26608849 27126297 125430048 134612629 25912142 23928878 1253087 1021050 40652000 40652000 7088000 5573000 959361 327052 64639137 55703152 140503727 127205132 X -24145803 -1662465 3161794 3113683 5910330 5956279 -15073679 7407497 125430048 134612629 X 15973577 203398 6304201 X X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 20318 20318 0 PART II-B, LINE 1: THE GRIFFIN HOSPITAL PAID FOR MEMBERSHIP DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION. FOR THE FISCAL YEAR ENDED 9/30/2018, $20,318 OF THE MEMBERSHIP DUES PAID WAS USED FOR LOBBYING ON ISSUES RELEVANT TO THE ORGANIZATION'S EXEMPT PURPOSE. 3579131 247455 6000 3820586 3279717 301914 2500 3579131 3400689 252030 373002 3279717 3517730 -117041 3400689 3409062 134026 25358 3517730 0.00000 0.56540 0.43460 1 0 4002891 4002891 80683687 44277508 36406179 77480485 66085331 11395154 9892688 1080592 8812096 60616320 OTHER RECEIVABLES 751681 DUE FROM AFFILIATES 8670858 OTHER ASSETS & INSURANCE RECOVERABLE 5295102 INTEREST IN NET ASSETS OF AFFILIATE 8959477 INVESTMENT IN AFFILIATE 1957172 DEBT ISSUANCE COSTS 552312 INTEREST RATE SWAP 884459 ACCRUED INTEREST RECEIVABLE 55236 27126297 ACCRUED POSTRETIREMENT BENEFIT LIABILITY 8542152 PROFESSIONAL AND GENERAL LIABILITY LOSS RESERVES 5085857 ACCRUED PENSION LIABILITY 29286147 WORKERS COMPENSATION LOSS RESERVES 1779786 ACCRUED INTEREST PAYABLE 189017 CONDITIONAL ASSET RETIREMENT OBLIGATIONS 95831 ESTIMATED THIRD-PARTY SETTLEMENTS 6807828 DUE TO AFFILIATES 276634 CAPITAL LEASE OBLIGATIONS 3639900 55703152 X 202254168 203398 203398 202050770 0 202050770 186077193 0 186077193 0 186077193 PART V, LINE 4: THE HOSPITAL'S ENDOWMENT FUNDS CONSIST OF DONOR RESTRICTED FUNDS TO BE INVESTED IN PERPETUITY TO PROVIDE A PERMANENT SOURCE OF INCOME. PART X, LINE 2: THE HOSPITAL AND GFP ARE NOT-FOR-PROFIT ORGANIZATIONS, EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL AND GFP ACCOUNT FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2018, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND GFP ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS PENDING OR IN PROGRESS OTHER THAN THE IRS EXAMINATION OF THE HOSPITAL'S FORM 990 AND 990T FOR THE YEAR ENDED SEPTEMBER 30, 2016. 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 175 971263 0 971263 0.00530 16128 18934897 13982745 4952152 0.02700 0 0 16303 19906160 13982745 5923415 0.03230 11 87166 1102995 189675 913320 0.00500 1 0 7337619 6151165 1186454 0.00650 3 36518 8853917 6713392 2140525 0.01170 1 0 977442 696930 280512 0.00150 2 239 44240 24407 19833 0.00010 18 123923 18316213 13775569 4540644 0.02480 18 140226 38222373 27758314 10464059 0.05710 1 774954 60694847 65808526 -5113679 X 1 1 1 1 GRIFFIN HOSPITAL 130 DIVISION STREET DERBY CT 06418 WWW.GRIFFINHEALTH.ORG X X X X X GRIFFIN HOSPITAL 1 0 0 1 X X X X X X X X 15 1 0 1 1 X WWW.GRIFFINHEALTH.ORG X SEE PART V, PAGE 8 X 1 16 1 SEE PART V, PAGE 8 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 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 1 0 X X 1 X 0 0 GRIFFIN HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL UTILIZES THE 2016 VALLEY COMMUNITY INDEX (VCI). THE VCI WAS CREATED IN PARTNERSHIP WITH DATAHAVEN, THIS VCI IS THE FIRST SINGLE-SOURCE REPORT OF ITS KIND THAT PROVIDES TIMELY, COMPREHENSIVE SOCIOECONOMIC, EDUCATION, HEALTH, AND WELL-BEING DATA SHAPING OUR REGION. COMMUNITY LEADERS WHO HAVE A FIRM PULSE ON THE NEEDS AND OPPORTUNITIES OF THE VALLEY CAME TOGETHER AS AN ADVISORY COMMITTEE SHARING A COMMON AGENDA TO PROVIDE THE DIRECTION FOR DATA RESEARCH.THIS REPORT IS ALSO COMPLETED TO MEET GRIFFIN HOSPITAL'S IRS REQUIREMENTS IN FORM 990 SCHEDULE H AND NOTICE 2011-52 THAT DISCUSSES THE CREATION OF A COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH ALL TAX-EXEMPT HOSPITALS COMPLETE AS A RESULT OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. THE VCI WAS PRODUCED BY THE VALLEY COMMUNITY FOUNDATION AND DATAHAVEN, SEPTEMBER 2016 AND AUTHORED BYMARY BUCHANAN, PROJECT MANAGER, DATAHAVEN, MARK ABRAHAM, EXECUTIVE DIRECTOR, DATAHAVEN, VALLEY COMMUNITY FOUNDATION STAFF SHARON CLOSIUS, PRESIDENT AND CEO, BETH COLETTE, VALERIE KNIGHT-DIGANGI, JOHN READY, LAURA DOWNS, MORRISON DOWNS ASSOCIATES, PROJECT CONSULTANTSPONSORS AND CONTRIBUTORS INCLUDE: CONNECTICUT COMMUNITY FOUNDATION, LIBERTY BANK FOUNDATION, THE COMMUNITY FOUNDATION FOR GREATER NEW HAVEN, NAUGATUCK VALLEY COUNCIL OF GOVERNMENTS, VALLEY COMMUNITY INDEX ADVISORY COMMITTEE, ALLIANCE FOR PREVENTION & WELLNESS (FORMERLY VSAAC), ANSONIA SCHOOL READINESS, BH CARE, BOYS & GIRLS CLUB OF THE LOWER NAUGATUCK VALLEY, CELEBRATE SHELTON, CENTER STAGE THEATRE, THE COMMUNITY FOUNDATION FOR GREATER NEW HAVEN, CONNECTICUT COMMUNITY FOUNDATION, DERBY EARLY CHILDHOOD COUNCIL, DERBY NECK LIBRARY, DERBY YOUTH SERVICES BUREAU, DOWN TO EARTH CONSULTING SOLUTIONS, GREATER VALLEY CHAMBER OF COMMERCE, GRIFFIN HOSPITAL, HOUSATONIC COUNCIL, BSA, LITERACY VOLUNTEERS OF GREATER NEW HAVEN, MIECHV/TEAM EARLY HEAD START, NAUGATUCK VALLEY COUNCIL OF GOVERNMENTS, NAUGATUCK VALLEY HEALTH DISTRICT, NAUGATUCK YMCA, PARENT CHILD RESOURCE CENTER, SHELTON ECONOMIC DEVELOPMENT CORPORATION, TEAM, INC., VALLEY PARISH NURSE PROGRAM, VALLEY REGIONAL ADULT EDUCATION, VALLEY SHAKESPEARE FESTIVAL, VALLEY UNITED WAY, THE VALLEY VOICE, VALLEY YMCA, VNA OF SOUTH CENTRAL CT, THE WORKPLACE, INC., HOWARD WHITTEMORE MEMORIAL LIBRARY, YALE-GRIFFIN PREVENTION RESEARCH CENTER, REPRESENTATIVES FROM EACH OF THE MUNICIPAL GOVERNMENTS AND SCHOOL DISTRICTS IN THE VALLEY, AND MANY OTHER VOLUNTEERS.THE INDEX ALSO PERFORMED IN-DEPTH INTERVIEWS OVER A THOUSAND VALLEY RESIDENTS REGARDING PERSONAL WELL-BEING. GRIFFIN HOSPITAL PART V, SECTION B, LINE 6B: - NAUGATUCK VALLEY HEALTH DISTRICT- VALLEY COMMUNITY FOUNDATION- DATA HAVEN- VALLEY COMMUNITY INDEX ADVISORY COMMITTEE- GRIFFIN HEALTH SERVICES, INC.- KATHARINE MATTHIES FOUNDATION- CONNECTICUT COMMUNITY FOUNDATION- THE COMMUNITY FOUNDATION FOR GREATER NEW HAVEN- NAUGATUCK VALLEY COUNCIL OF GOVERNMENTS- VALLEY COMMUNITY INDEX ADVISORY COMMITTEE ALLIANCE FOR PREVENTION & WELLNESS (FORMERLY VSAAC)- ANSONIA SCHOOL READINESS- BH CARE- BOYS & GIRLS CLUB OF THE LOWER NAUGATUCK VALLEY- CELEBRATE SHELTON- CONNECTICUT COMMUNITY FOUNDATION DERBY EARLY CHILDHOOD COUNCIL- DERBY NECK LIBRARY- DERBY YOUTH SERVICES BUREAU DOWN TO EARTH CONSULTING SOLUTIONS- GREATER VALLEY CHAMBER OF COMMERCE- GRIFFIN HOSPITAL HOUSATONIC COUNCIL, BSA- LITERACY VOLUNTEERS OF GREATER NEW HAVEN- MIECHV/TEAM EARLY HEAD START NAUGATUCK VALLEY COUNCIL OF GOVERNMENTS- NAUGATUCK VALLEY HEALTH DISTRICT- NAUGATUCK YMCA PARENT CHILD RESOURCE CENTER- SHELTON ECONOMIC DEVELOPMENT CORPORATION- TEAM, INC.- GRIFFIN HOSPITAL VALLEY PARISH NURSE PROGRAM- VALLEY REGIONAL ADULT EDUCATION- VALLEY SHAKESPEARE FESTIVAL VALLEY UNITED WAY- THE VALLEY VOICE- VALLEY YMCA- VNA OF SOUTH CENTRAL CT- THE WORKPLACE, INC.- HOWARD WHITMORE MEMORIAL LIBRARY- YALE-GRIFFIN PREVENTION RESEARCH CENTER COMMUNITY- VALLEY COUNCIL FOR HEALTH & HUMAN SERVICESGRIFFIN HOSPITAL:PART V, SECTION B, LINE 7B: HTTPS://WWW.GRIFFINHEALTH.ORG/PORTALS/0/DOCUMENTS/CHNA/2016-VALLEY-COMMUNITY-INDEX.PDF?VER=2016-12-29-103131-717&TIMESTAMP=1483105329014GRIFFIN HOSPITAL:PART V, SECTION B, LINE 10A: HTTP://WWW.NVHD.ORG/PERCH/RESOURCES/2016-2018-CHIP-FINAL-2.PDF GRIFFIN HOSPITAL PART V, SECTION B, LINE 11: THE SIGNIFICANT NEEDS IDENTIFIED IN THE HOSPITAL'S MOST RECENT CHNA ARE BEING ADDRESSED THROUGH THE DEVELOPMENT OF THE VALLEY COMMUNITY HEALTH IMPROVEMENT PLAN FOR 2016-2018.AS A RESULT OF THE COMMUNITY CONVERSATIONS UTILIZING DATA FROM THE 2016 VALLEY COMMUNITY INDEX (WHICH SERVED AS GRIFFIN HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT), SEVEN (7) CRITICAL POPULATION HEALTH FOCUS AREAS EMERGED AND A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WAS ESTABLISHED. CHIP WAS DEVELOPED IN CONJUNCTION WITH NAUGATUCK VALLEY HEALTH DISTRICT AND OTHER COMMUNITY PARTNERS. THE CHIP AREAS OF FOCUS ARE: 1. CREATION OF BEHAVIORAL HEALTH/SUBSTANCE ABUSE COMMUNITY ACTION TEAM (MIDDLESEX HOSPITAL MODEL) 2. CHRONIC DISEASE MANAGEMENT (DIABETES, CHF, COPD, ETC.) 3. OPIATE/ADDICTION PREVENTION & TREATMENT 4. CHILDHOOD OBESITY PREVENTION (VITAHLS) 5. EARLY DETECTION OF LUNG CANCER & SMOKING CESSATION 6. ASTHMA PREVENTION & SELF-MANAGEMENT (PART OF STATEWIDE CHA ASTHMA INITIATIVE) 7. HEALTHY HOMES GRIFFIN HOSPITAL PART V, SECTION B, LINE 13B: INVESTMENT, IRA, CHECKING ACCT, REAL ESTATE GRIFFIN HOSPITAL PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.GRIFFINHEALTH.ORG/GRIFFIN-HOSPITAL/BILLING-INSURANCE/FINANCIAL-ASSISTANCE-PROGRAM GRIFFIN HOSPITAL PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.GRIFFINHEALTH.ORG/GRIFFIN-HOSPITAL/BILLING-INSURANCE/FINANCIAL-ASSISTANCE-PROGRAM GRIFFIN HOSPITAL PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.GRIFFINHEALTH.ORG/GRIFFIN-HOSPITAL/BILLING-INSURANCE/FINANCIAL-ASSISTANCE-PROGRAM 4 1 - GRIFFIN IMAGING & DIAGNOSTICS CENTER 2 IVY BROOK ROAD SUITE 130 SHELTON CT 06484 IMAGING CENTER 2 - GRIFFIN HOSP OCCUPATIONAL MEDICINE CTR 10 PROGRESS DRIVE SHELTON CT 06484 OCCUPATIONAL MEDICINE 3 - GRIFFIN HOSPITAL BLOOD DRAWING STATION 22 WAKEFIELD AVENUE ANSONIA CT 06418 BLOOD DRAWING STATION 4 - CHARGER HEALTH CENTER 20 PULASKI HIGHWAY ANSONIA CT 06401 SCHOOL BASED HEALTH CENTER PART I, LINE 3C: GRIFFIN HOSPITAL CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE CARE OR DISCOUNTED CARE INCLUDE ELIGIBILITY REQUIREMENTS. ALL GUARANTORS WITH FAMILY INCOME EQUAL TO OR BELOW TWO HUNDRED PERCENT OF THE FEDERAL POVERTY STANDARD ADJUSTED FOR FAMILY SIZE SHALL BE DETERMINED TO BE INDIGENT PERSONS QUALIFYING FOR CHARITY SPONSORSHIP FOR THE FULL AMOUNT OF HOSPITAL CHARGES RELATED TO APPROPRIATE HOSPITAL-BASED MEDICAL SERVICES THAT ARE NOT COVERED BY PRIVATE OR PUBLIC THIRD-PARTY SPONSORSHIP. ALL GUARANTORS WITH FAMILY INCOME BETWEEN TWO HUNDRED ONE (250%) AND FOUR HUNDRED PERCENT (400%) OF THE FEDERAL POVERTY STANDARD ADJUSTED FOR FAMILY SIZE SHALL BE DETERMINED TO BE INDIGENT PERSONS QUALIFYING FOR DISCOUNTS FROM CHARGES RELATED TO APPROPRIATE HOSPITAL BASED MEDICAL SERVICES IN ACCORDANCE WITH THE SLIDING FEE SCHEDULE IN ATTACHMENT A AND POLICIES REGARDING INDIVIDUAL FINANCIAL CIRCUMSTANCES BASED ON THE BELOW CRITERIA: A. ELIGIBILITY SHALL BE BASED ON FINANCIAL NEED AT THE TIME OF APPLICATION BY COMPARING TOTAL FAMILY INCOME WITH THE CURRENT FEDERAL POVERTY GUIDELINES. IF A FAMILY'S TOTAL INCOME IS GREATER THAN 100% OF THE FEDERAL POVERTY GUIDELINE FAMILY ASSETS OTHER THAN EXEMPT ASSETS LISTED BELOW MAY BE CONSIDERED AS A SOURCE OF PAYMENT. B. EXEMPT ASSETS (BASED ON MEDICARE EXEMPTED ASSETS) LISTED BELOW SHOULD NOT BE ADDED TO FAMILY WORTH FOR CHARITY REVIEW: I. FAMILY PRINCIPAL RESIDENCE II. NECESSARY MOTOR VEHICLES REQUIRED FOR EMPLOYMENT, REQUIRED FOR ACCESS TO TREATMENT, OR MODIFIED FOR OPERATION OR TRANSPORT OF A DISABLED PERSON III. PERSONAL EFFECTS AND HOUSEHOLD GOODS IV. RESOURCES NECESSARY FOR SELF-SUPPORT. ALL RESOURCES OF BOTH SPOUSES ARE CONSIDERED TOGETHER. 3. CHARITY WILL BE ASSIGNED USING THE MOST RECENTLY PUBLISHED FEDERAL POVERTY STANDARDS AND EVALUATED ON THE ADJUSTED FAMILY INCOME AS EXPLAINED ABOVE FOR THOSE ABOVE 250% OF SUCH STANDARDS. 4. DOCUMENTATION WILL BE REQUESTED AND IN MOST CASES WILL BE REQUIRED TO ESTABLISH ELIGIBILITY FOR CHARITY CARE. IN THE EVENT THAT THE GUARANTOR IS NOT ABLE TO PROVIDE THE DOCUMENTATION DESCRIED ABOVE, THE HOSPITAL SHALL RELY UPON WRITTEN AND SIGNED STATEMENTS FORM THE GUARANTOR TO MAKE A FINAL DETERMINATION OF ELIGIBILITY FOR CLASSIFICATION AS AN INDIGENT PERSON. PART I, LINE 6A: GRIFFIN HOSPITAL CONSTANTLY UPDATES THEIR WEBSITE WITH THE MOST CURRENT COMMUNITY BENEFIT REPORTING.PART I, LINE 6B:GRIFFIN HOSPITAL POSTS ITS COMMUNITY BENEFIT REPORT AND INFORMATION ON THE HOSPITAL WEBSITE GRIFFINHEALTH.ORG. PART I, LINE 7: CHARITY CARE AND OTHER COMMUNITY BENEFITS TABLE WERE CALCULATED USING A COST ACCOUNTING SYSTEM OR COST TO CHARGE RATIO. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND ASSIGNS COST TO INDIVIDUAL SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,822,659. PART III, LINE 2: GRIFFIN HOSPITAL BAD DEBT EXPENSE IS DETERMINED USING UNCOLLECTED ACCOUNTS NET OF ANY BAD DEBT RECOVERY MULTIPLIED BY THE COST TO CHARGE RATIO. GRIFFIN HOSPITAL HAS A WRITTEN POLICY ABOUT WHEN AND UNDER WHOSE AUTHORITY PATIENT DEBT IS ADVANCED FOR COLLECTION AND SHALL USE ITS BEST EFFORTS TO ENSURE THAT THE PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. CHARITY APPROVAL WILL AFFECT ALL ACCOUNTS FOR WHICH THE APPROVED GUARANTOR IS RESPONSIBLE. THE APPROVED CHARITY PERCENTAGE WILL BE APPLIED TO ALL EXISTING ACCOUNTS WITH DEBIT BALANCES. ACCOUNTS MAY ALSO BE RETURNED FROM BAD DEBT STATUS IF FINANCIAL CIRCUMSTANCES WARRANT AND CHARITY MAY BE APPLIED. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FREE CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAT IT'S ESTABLISHED AND CONTRACTUAL RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FREE CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. PART III, LINE 3: GRIFFIN HOSPITAL DOES NOT ATTRIBUTE ANY BAD DEBT TO COMMUNITY BENEFIT EXPENSE. UNCOLLECTED BALANCES ARE REVIEWED AT MANY STAGES TO DETERMINE IF THEY FALL UNDER UNINSURED OR FREE CARE ASSISTANCE. PART III, LINE 4: GRIFFIN HOSPITAL AND SUBSIDIARY NOTES TO CONSOLIDATED FINANCIAL STATEMENTS SEPTEMBER 30, 2018ALLOWANCE FOR DOUBTFUL ACCOUNTS - PAGE 17THE HOSPITAL'S ESTIMATION OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED PRIMARILY UPON THE TYPE AND AGE OF THE PATIENT ACCOUNTS RECEIVABLE AND THE EFFECTIVENESS OF THE HOSPITAL'S COLLECTION EFFORTS. THE HOSPITAL'S POLICY IS TO RESERVE A PORTION OF ALL SELF-PAY RECEIVABLES, INCLUDING AMOUNTS DUE FROM THE UNINSURED AND AMOUNTS RELATED TO CO-PAYMENTS AND DEDUCTIBLES, AS THE CHARGES ARE RECORDED. ON A MONTHLY BASIS, THE HOSPITAL REVIEWS ITS ACCOUNTS RECEIVABLE BALANCES, THE EFFECTIVENESS OF THE HOSPITAL'S RESERVE POLICIES AND VARIOUS ANALYTICS TO SUPPORT THE BASIS FOR ITS ESTIMATES. THESE EFFORTS PRIMARILY CONSIST OF REVIEWING THE FOLLOWING: - REVENUE AND VOLUME TRENDS BY PAYOR, PARTICULARLY THE SELF-PAY COMPONENTS; - CHANGES IN THE AGING AND PAYOR MIX OF ACCOUNTS RECEIVABLE, INCLUDING INCREASED FOCUS ON ACCOUNTS DUE FROM THE UNINSURED AND ACCOUNTS THAT REPRESENT CO-PAYMENTS AND DEDUCTIBLES DUE FROM PATIENTS; - VARIOUS ALLOWANCE COVERAGE STATISTICS.THE HOSPITAL REGULARLY PERFORMS HINDSIGHT PROCEDURES TO EVALUATE HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE THROUGHOUT THE YEAR TO ASSIST IN DETERMINING THE REASONABLENESS OF ITS PROCESS FOR ESTIMATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.GRIFFIN HOSPITAL AND SUBSIDIARY NOTES TO CONSOLIDATED FINANCIAL STATEMENTS SEPTEMBER 30, 2018MEASURING CHARITY CARE - PAGE 17-18THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FREE CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED AND CONTRACTUAL RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FREE CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE.A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS POSSIBLE. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED FEDERAL POVERTY INCOME LEVELS, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES AND ASSETS.SELF-PAY REVENUES ARE DERIVED PRIMARILY FROM PATIENTS WHO DO NOT HAVE ANY FORM OF HEALTH CARE COVERAGE. THE HOSPITAL EVALUATES THESE PATIENTS, AFTER THE PATIENT'S MEDICAL CONDITION IS DETERMINED TO BE STABLE, FOR THEIR ABILITY TO PAY BASED UPON FEDERAL AND STATE POVERTY GUIDELINES, QUALIFICATIONS FOR MEDICAID OR OTHER GOVERNMENTAL ASSISTANCE PROGRAMS, AS WELL AS THE HOSPITAL'S POLICY FOR CHARITY CARE. FOR THE YEARS ENDED SEPTEMBER 30, 2018 AND 2017, THE HOSPITAL ESTIMATES THAT ITS COSTS OF CARE PROVIDED UNDER ITS CHARITY CARE PROGRAMS APPROXIMATED $1,002,000 AND $1,040,000, RESPECTIVELY.THE HOSPITAL'S MANAGEMENT ESTIMATES ITS COSTS OF CARE PROVIDED UNDER ITS CHARITY CARE PROGRAMS UTILIZING A CALCULATED RATIO OF COSTS TO GROSS CHARGES MULTIPLIED BY THE HOSPITAL'S GROSS CHARITY CARE CHARGES PROVIDED. THE HOSPITAL'S GROSS CHARITY CARE CHARGES INCLUDE ONLY SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE TO PAY AND QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. TO THE EXTENT THE HOSPITAL RECEIVES REIMBURSEMENT THROUGH THE VARIOUS GOVERNMENTAL ASSISTANCE PROGRAMS IN WHICH IT PARTICIPATES TO SUBSIDIZE ITS CARE OF INDIGENT PATIENTS, THE HOSPITAL DOES NOT INCLUDE THESE PATIENTS' CHARGES IN ITS COST OF CARE PROVIDED UNDER ITS CHARITY CARE PROGRAM. ADDITIONALLY, THE HOSPITAL DOES NOT REPORT A CHARITY CARE PATIENT'S CHARGES IN REVENUES OR IN THE PROVISION FOR DOUBTFUL ACCOUNTS AS IT IS THE HOSPITAL'S POLICY NOT TO PURSUE COLLECTION OF AMOUNTS RELATED TO THESE PATIENTS. PART III, LINE 8: GRIFFIN HOSPITAL BELIEVES THAT ALL OF THE $5.114 MILLION SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THIS YEAR MEDICARE ACCOUNTED FOR 2.6% OF HOSPITAL EXPENSES THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. PART III, LINE 9B: GRIFFIN HOSPITAL HAS A WRITTEN POLICY ABOUT WHEN AND UNDER WHOSE AUTHORITY PATIENT DEBT IS ADVANCED FOR COLLECTION AND SHALL USE ITS BEST EFFORTS TO ENSURE THE PATIENT AMOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. GRIFFIN WILL ENSURE THAT PRACTICES TO BE USED BY THEIR OUTSIDE COLLECTION AGENCIES WILL CONFORM TO THE STANDARDS SET FORTH IN THIS POLICY AND SHALL OBTAIN WRITTEN COMMITMENTS FROM SUCH AGENCIES AT TIME OF BILLING. GRIFFIN WILL PROVIDE TO ALL LOW INCOME UNINSURED PATIENTS THE SAME INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED TO ALL OTHER PATIENTS WHO RECEIVE CARE AT THE HOSPITAL FOR PATIENTS WHO HAVE AN APPLICATION PENDING DETERMINATION FOR EITHER GOVERNMENT SPONSORED COVERAGE OR FOR THE HOSPITAL OWN FINANCIAL ASSISTANCE PROGRAM GRIFFIN WILL NOT KNOWINGLY SEND THAT PATIENT BILL TO A COLLECTION AGENCY. IF A PATIENT DOES NOT MAINTAIN THE AGREED UPON PAYMENT SCHEDULE THE AMOUNT WILL BE FORWARDED TO AN OUTSIDE COLLECTION AGENCY AT THE FULL REMAINING BALANCE. IF IT IS LATER DETERMINED BY THE GRIFFIN HOSPITAL OR A COLLECTION AGENCY ACTING ON BEHALF OF GRIFFIN HOSPITAL THAT THE PATIENT FINANCIAL CONDITIONS HAVE CHANGED AND THE PATIENT WAS UNABLE TO PAY THE OUTSTANDING ACCOUNT BALANCES AN OVERRIDE MAY BE APPLIED BY THE BUSINESS SERVICES DIRECTOR. THE UNCOLLECTED DEBT WILL BE TRANSFERRED TO FINANCIAL ASSISTANCE BY THE SUPERVISOR AFTER REVIEW. THE MEDICARE COSTS WERE OBTAINED FROM THE HOSPITAL'S INTERNAL COST ACCOUNTING SYSTEM. PART VI, LINE 2: GRIFFIN HOSPITAL ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY BY WORKING COLLABORATIVELY WITH THE NAUGATUCK VALLEY HEALTH DISTRICT, THE VALLEY COUNCIL FOR HEALTH AND HUMAN SERVICES, THE ALLIANCE FOR PREVENTION & WELLNESS (FORMERLY VSAAC), AND OUR VALLEY PARISH NURSES COMMUNITY OUTREACH PROGRAM, THE HOSPITAL PROACTIVELY ADDRESS ISSUE AREAS SUCH AS CHILDHOOD OBESITY, EARLY DETECTION SCREENING FOR CANCER, CHILDHOOD ASTHMA, AND SUBSTANCE ABUSE PREVENTION. GRIFFIN HOSPITAL IS FOCUSED ON POPULATION HEALTH WHICH INCLUDES PREVENTION AND WELLNESS PROGRAMS. PART VI, LINE 3: FINANCIAL ASSISTANCE BROCHURE AND POSTERS ARE LOCATED THROUGHOUT THE HOSPITAL (CHILDBIRTH AREA, ER AREA, CUSTOMER SERVICE AREA) IN ENGLISH AND SPANISH EXPLAINING THE FINANCIAL ASSISTANCE POLICY AND HOW TO CONTACT THE FINANCIAL COUNSELORS. BROCHURES ARE ALSO DISTRIBUTED AT COMMUNITY EVENTS.AT REGISTRATION THE ADMITTING REGISTRAR WHO WILL IDENTIFY THE PATIENT AS HAVING NO MEDICAL INSURANCE (SELF-PAY).THE PATIENT WILL BE GIVEN A FINANCIAL ASSISTANCE PAMPHLET THAT WILL IDENTIFY ALL GRIFFIN HOSPITAL FINANCIAL ASSISTANCE PROGRAMS. THE PAMPHLET ALSO INCLUDES HOSPITAL CONTACTS FOR PATIENTS SEEKING STATE WELFARE OR OTHER STATE PROGRAMS. PART VI, LINE 4: GRIFFIN HOSPITAL, LICENSED BY THE STATE OF CONNECTICUT FOR 160 BEDS AND 15 BASSINETS, IS A GENERAL ACUTE CARE HOSPITAL SERVING A PRIMARY SERVICE AREA (PSA) OF SIX TOWNS, THAT COMPRISE THE LOWER NAUGATUCK VALLEY INCLUDING ANSONIA, DERBY, SEYMOUR, SHELTON, OXFORD, BEACON FALLS AND SURROUNDING TOWNS INCLUDING BETHANY, MIDDLEBURY, MILFORD, MONROE, NAUGATUCK, ORANGE, PROSPECT, SOUTHBURY, STRATFORD, TRUMBULL, WOODBRIDGE AND WOODBURY.IN THE VALLEY, ANSONIA, DERBY, AND NAUGATUCK CONTAIN THE DIVERSE NEIGHBORHOODS AND MANUFACTURING LEGACIES THAT ARE COMMON TO URBAN PERIPHERY TOWNS THROUGHOUT THE STATE. BEACON FALLS AND SEYMOUR SHARE SOME OF THE CHARACTERISTICS OF RURAL TOWNS, WHILE OXFORD AND SHELTON ARE MORE TYPICAL OF HIGHER-INCOME SUBURBAN AREAS. GIVEN THIS VARIETY, THE REGION IS A MICROCOSM OF CONNECTICUT AS A WHOLE.THE VALLEY IS A COMMUNITY OF CONNECTICUT TOWNS LOCATED IN NEW HAVEN AND FAIRFIELD COUNTIES. IT LIES ALONG THE HOUSATONIC AND NAUGATUCK RIVERS AND IS CONNECTED TO CITY CENTERS ALONG I-95 BETWEEN NEW YORK AND NEW HAVEN, AS WELL AS ALONG ROUTE 8 TO WATERBURY. WE DEFINE THE VALLEY AS THE SEVEN TOWNS THAT COLLABORATED TO WIN THE ALL-AMERICA CITY AWARD IN THE YEAR 2000: ANSONIA, BEACON FALLS, DERBY, NAUGATUCK, OXFORD, SEYMOUR, AND SHELTON. THE TOWNS SHARE A SPIRITED COMMUNITY CULTURE AND STRONG INSTITUTIONS, WHICH COLLABORATE ON INITIATIVES IN CIVIC VITALITY, HEALTH AND HUMAN SERVICES, ECONOMIC DEVELOPMENT, AND QUALITY OF LIFE. THE COLLABORATIVE WORK IT TOOK BY MANY TO BE RECOGNIZED AS PART OF THE 20-TOWN NAUGATUCK VALLEY CORRIDOR, A FEDERALLY-DESIGNATED ECONOMIC DEVELOPMENT DISTRICT (EDD), IS A PRIME EXAMPLE OF HOW VALLEY LEADERS COME TOGETHER FOR THE GREATER GOOD. THE VALLEY HAS A COMMON HISTORY AND IDENTITY, BUT EACH OF ITS TOWNS HAS ITS OWN UNIQUE CHARACTERISTICS. THE REGION'S DEMOGRAPHICS AND ECONOMY ARE CONSTANTLY CHANGING IN RESPONSE TO OUTSIDE FORCES; THESE CHANGES AFFECT THE REGION'S NEIGHBORHOODS IN DIFFERENT WAYS. TOWN CENTERS OFFER A LARGE SHARE OF RENTAL OR AFFORDABLE HOUSING UNITS, WHICH ARE ATTRACTIVE TO YOUNGER WORKERS, SINGLE ADULTS, AND OTHER HOUSEHOLDS THAT WOULD PREFER TO RENT FOR ECONOMIC OR LIFESTYLE REASONS. IN OTHER NEIGHBORHOODS, NEWER HOMES AND LARGER LOTS CONTINUE TO ATTRACT HOMEOWNERS WITH HIGH INCOMES. THE VARIETY OF NEIGHBORHOODS AND RESIDENTS WHO CHOOSE TO LIVE IN THE AREA HELP MAKE THE VALLEY A RESILIENT COMMUNITY WITH A RICH TRADITION OF IMMIGRATION AND MIGRATION. THE VALLEY'S LEGACY OF AGRICULTURAL AND INDUSTRIAL PRODUCTION ARISES FROM ITS LOCATION ALONG TWO MAJOR RIVERS. TODAY, THE ECONOMY OF THE VALLEY COMMUNITIES IS SIGNIFICANTLY INFLUENCED BY THE CONTINUED DEVELOPMENT ALONG THE ROUTE 8 CORRIDOR, WHICH HAS RESULTED IN BOTH OPPORTUNITIES AND CHALLENGES. SHELTON, IN PARTICULAR, HAS EXPERIENCED NEW COMMERCIAL AND OFFICE DEVELOPMENT BY VIRTUE OF ITS LOCATION AND INFRASTRUCTURE. ITS STRONG FINANCIAL BASE, HOWEVER, CAN MASK THE ECONOMIC CHALLENGES THAT OTHER TOWNS FACE. LEVELS OF PERSONAL WELL-BEING ARE NOT EVENLY DISTRIBUTED ACROSS THE VALLEY'S POPULATION. AN INCREASINGLY DIVERSE POPULATION AND A GROWING NUMBER OF SENIORS PRESENT NEW NEEDS AND OPPORTUNITIES. INCOMES VARY BY TOWN, AND MORE PEOPLE, ESPECIALLY CHILDREN, LIVE IN ECONOMIC HARDSHIP. CANCER, HEART DISEASE, AND ACCIDENTS ARE LEADING CAUSES OF PREMATURE DEATHS. ALMOST HALF OF VALLEY WORKERS EARN LESS WHAT IS CONSIDERED NECESSARY TO COVER COSTS OF LIVING IN THE REGION. PART VI, LINE 5: AS A PATIENT-CENTERED HEALTH CARE SYSTEM, GRIFFIN HOSPITAL IS COMMITTED TO PARTNERING WITH OUR COMMUNITY TO PROMOTE WELLNESS THROUGH A WIDE VARIETY OF PROGRAMS AND SERVICES.GRIFFIN-SPONSORED EVENTS AS A PROUD MEMBER OF THE NAUGATUCK VALLEY COMMUNITY, GRIFFIN HOSPITAL WORKS IN TANDEM WITH OTHER COMMUNITY ORGANIZATIONS TO STRENGTHEN OUR CITIZENS, ENCOURAGE POSITIVE RELATIONSHIPS, FACILITATE ONGOING WELLNESS AND PROVIDE ONGOING SUPPORT TO THOSE IN NEEDS.VALLEY PARISH NURSE PROGRAM VALLEY PARISH NURSES SERVE AS COORDINATORS BETWEEN THE CLERGY, PARISH AND RESOURCES IN THE COMMUNITY, SUCH AS HOSPITALS AND OTHER SOCIAL SERVICE AGENCIES.MOBILE HEALTH RESOURCE CENTER- THE GRIFFIN HOSPITAL MOBILE HEALTH RESOURCE VAN IS A CUSTOM BUILT WINNEBAGO THAT TRAVELS TO VARIOUS LOCATIONS THROUGHOUT THE LOWER NAUGATUCK VALLEY, SUCH AS SENIOR CENTERS, SHOPPING CENTERS, NEIGHBORHOODS, COMPANIES AND COMMUNITY EVENTS AND FAIRS.ADVANCE CARE PLANNING PLAN NOW TO ENSURE THAT YOUR WISHES FOR END-OF-LIFE DECISIONS ARE UNDERSTOOD, RESPECTED, AND HONORED BY LOVED ONES AND HEALTHCARE PROVIDERS.HEALTH INITIATIVE FOR MEN (HIM)- THE GOAL OF THE HIM IS TO INFLUENCE MEN TO SEE THEIR PHYSICIAN ANNUALLY, AND TO BE SCREENED FOR VARIOUS DISEASES THAT RESPOND BETTER TO TREATMENT IF DETECTED EARLY.VALLEY WOMEN'S HEALTH INITIATIVE THE VALLEY WOMEN'S HEALTH INITIATIVE (WHI) IS COMPRISED OF MEMBERS OF THE COMMUNITY WORKING TOWARD A COMMON GOAL OF ADDRESSING AND IMPROVING WOMEN'S HEALTH ISSUES INCLUDING BREAST CANCER AWARENESS AND HEART DISEASE.WOMEN'S HEART WELLNESS COMMITTEE A COMMUNITY INITIATIVE FOCUSED ON EDUCATION, OUTREACH, AND PREVENTION.HEALTH RESOURCE CENTER - THE COMMUNITY HEALTH RESOURCE CENTER (HRC) AT GRIFFIN HOSPITAL IS A TRADITIONAL FREE LENDING LIBRARY THAT PROVIDES AN ARRAY OF MEDICAL AND HEALTH INFORMATION.HEALTHY U EDUCATIONAL SERIES HEALTHY U IS A SERIES OF WELLNESS TALKS FEATURING GRIFFIN HOSPITAL MEDICAL EXPERTS AND COMMUNITY PARTNERS PROVIDING TRUSTED HEALTH INFORMATION AND ANSWERS TO QUESTIONS ON A WIDE RANGE OF TOPICS. ALL TALKS ARE FREE AND OPEN TO THE PUBLIC.MINI MED SCHOOL FREE PROGRAM FOR THE LAYPERSON WITH LITTLE OR NO MEDICAL BACKGROUND, PROVIDING A UNIQUE OPPORTUNITY TO GAIN A GREATER UNDERSTANDING OF HOW THE HUMAN BODY WORKS, INSIGHT INTO COMMON DISORDERS OF THE VARIOUS ORGAN SYSTEMS, AS WELL AS INFORMATION ABOUT DISEASE PREVENTION.PERSONAL EMERGENCY PREPAREDNESS GRIFFIN HOSPITAL DEPARTMENT OF EMERGENCY MANAGEMENT (EM) HELPS TO PREPARE THE COMMUNITY IN CASE OF A DISASTER OR EMERGENCY SITUATION. THIS PAGE PROVIDES SAFETY AND PREPAREDNESS TIPS AS WELL AS IMPORTANT LOCAL AND GOVERNMENTAL CONTACTS.PLANETREE WELLNESS EDUCATION SERIES GRIFFIN HOSPITAL'S PLANETREE EDUCATION IS PROUD TO OFFER THIS FREE HEALTH EMPOWERMENT SERIES OF FUN AND EDUCATIONAL TALKS FOR MEMBERS OF OUR COMMUNITY.SAFE KIDS GRIFFIN HOSPITAL'S SAFE KIDS GREATER NAUGATUCK VALLEY COALITION IS AVAILABLE TO EDUCATE CHILDREN AND ADULTS ON VARIETY OF HEALTH AND SAFETY PROGRAMS TO REDUCE UNINTENTIONAL INJURIES AMONG CHILDREN. WE OFFER PROGRAMS AT THE HOSPITAL OR AT YOUR FACILITY.VITAHLS VALLEY INITIATIVE TO ADVANCE HEALTH & LEARNING IN SCHOOLS GRIFFIN HOSPITAL HAS BEEN EXPANDING ITS REACH INTO THE COMMUNITY LIKE NEVER BEFORE.IN ADDITION TO PROVIDING HEALTH INFORMATION AND SERVICES TO THE PUBLIC AT THE HOSPITAL AND OTHER SATELLITE LOCATIONS, GRIFFIN TAKES THESE ACTIVITIES INTO THE COMMUNITIES WHERE PATIENTS LIVE, WORK, AND WORSHIP. BY OFFERING A VARIETY OF SUPPORT GROUPS, TRAINING SESSIONS, EDUCATIONAL PROGRAMS, AND OTHER COMMUNITY-BASED RESOURCES AND ACTIVITIES, AND COLLABORATING WITH OTHER NON-PROFIT ORGANIZATIONS AND GOVERNMENT ENTITIES, GRIFFIN HAS EXTENDED ITS MISSION "TO PROVIDE LEADERSHIP TO IMPROVE THE HEALTH OF THE COMMUNITY SERVED" FAR BEYOND THE HOSPITAL'S WALLS. SPECIAL PROGRAMS WERE HELD ON THE FOLLOWING TOPICS AT LOCAL CHURCHES, LIBRARIES, HOSPITAL, SENIOR CENTERS AND PRIVATE COMPANIES: MONTHLY ACP -ACCOUNTABLE CARE PLANNING, ACCESS HEALTH ASSISTANCE, BREAST WELLNESS, DIABETES EDUCATION FALL PREVENTION, TRANSPORTING CHILDREN WITH SPECIAL NEEDS INSTRUCTOR CLASS, AARP SAFE DRIVING, CHILD PASSENGER SAFETY CONFERENCE, LIVER DISEASE EDUCATION, VOLUNTEER PARISH NURSES FROM NUMEROUS DIFFERENT PARISHES AFFILIATED WITH THE VPNP AT GRIFFIN HOSPITAL PARTICIPATED FOR THE PROGRAM YEAR. CONTACTS INCLUDED OFFICE HOUR VISITS, HOME, HOSPITAL AND NURSING HOME VISITS, PHONE CALLS, AND BULLETIN DELIVERIES, HEALTH AND WELLNESS PROGRAMS WERE HOSTED AT THE VARIOUS CHURCHES.GRIFFIN HOSPITAL COMMUNITY VAN VISITED MANY COMMUNITY SITES CONSISTING OF LOCAL CHURCHES, FOOD BANKS, SHELTERS AND SHOPPING AREAS AND THE VALLEY PARISH NURSE PROGRAM COMPLETED A SIGNIFICANT NUMBER OF SCREENINGS THROUGHOUT THE YEAR.COMMUNITY OUTREACH MEETINGS WERE HELD WITH LOCAL BOARD OF DIRECTORS, HEALTH DEPTS., HEALTH CARE COUNCILS, PARISH NURSING, SAFE KIDS, CANCER COMMITTEES, AND WOMEN MAKING A DIFFERENCE. ACO STEERING ACP, QUARTERLY AHA, ANSONIA EARLY CHILDHOOD COUNCIL, BOYS & GIRLS CLUB BOARD- SHELTON, CANCER COMMITTEE, CHA- COMMUNITY HEALTH GROUP, CT COALITION OF DIABETES EDUCATOR, CT COUNCIL OF PARISH NURSE, KOMEN, DERBY DIABETES PREVENTION TASK FORCE, EARLY CHILDHOOD COUNCIL COORDINATOR, CT DIABETES PARTNERSHIP, PASTORAL CARE, SAFE KIDS, STATE DEPT. HEALTH IMPROVEMENT, PLAN VALLEY CARES, ALLIANCE VALLEY CARE, GIVERS VALLEY COUNCIL, HEALTH/HUMAN SERVICES, VALLEY HEALTHCARE COUNCIL, VALLEY PARISH NURSES, VALLEY COUNCIL YOUTH COMMITTEE, VITAHLS, VSAAC WOMEN HEART WELLNESS, WOMEN MAKING A DIFFERENCE, EARLY CHILDHOOD COUNCIL.GRIFFIN HELD CHILDREN'S PROGRAMS THROUGHOUT THE YEAR. CHILDREN'S EDUCATION PROGRAMS INCLUDED CPR EDUCATION, POISON EDUCATION, HALLOWEEN HOME, FIRE.911,GERMS, WINTER, PETS, NUTRITION, EXERCISE, SPORTS, SUMMER, WATER AND PEDESTRIAN CROSSING.SUPPORT GROUPS OFFERED THROUGH GRIFFIN HOSPITAL VALLEY PARISH NURSE, CANCER CENTER AND PASTORAL CARE WERE HELD. SUPPORT GROUPS INCLUDED ALZHEIMER CAREGIVERS, DIABETES, HEAL, MULTIPLE SCLEROSIS, FIBROMYALGIA, VALLEY HEART CLUB, PASTORAL CARE BEREAVEMENT GROUP, VOICES OF HOPE, LOOK GOODFEEL BETTER, AND CIRCLE OF FRIENDS.GRIFFIN HOSPITAL SUPPLIED COMMUNITY ASSISTANCE THROUGH THE WALK RUN 5K FUNDRAISING EVENT THAT SUPPLIED THE FUNDS TO ASSIST OUR COMMUNITY CANCER PROGRAMS SUCH AS LOOK GOODFEEL BETTER, VOICES OF HOPE AND ASSISTANCE FOR WIGS AND SUPPLIES, TREATMENT, TRANSPORTATION, SEYMOUR PINK EXERCISE TRAINOR, AFTER THE STORM MASSAGE THERAPY SERVICES AND CIRCLE OF FRIENDSGRIFFIN HOSPITAL HOSTS WONDERLAND OF TREES PROGRAM WHICH SUPPORTS EMPLOYEES TIME TO RAISE MONEY IN THE HOSPITAL WITH A CHRISTMAS TREE RAFFLES AND EASTER RAFFLES WERE THE MONEY IS DONATED TO SPOONER HOUSE FOOD SHELTER IN SHELTON, CT. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES CT X X X X 0 0 0 0 0 0 0 0 0 FREDERICK BROWNE MD TRUSTEE 0 335583 0 58391 0 1722 0 8100 0 20652 0 424448 0 0 PATRICK A CHARMEL CEO/PRESIDENT, BOD SECRETARY/TREASUR 505820 0 130125 0 1722 0 12668 0 20652 0 670987 0 0 0 KENNETH J DOBULER MD TRUSTEE/PHYSICIAN 326654 0 7246 0 0 0 9083 0 23873 0 366856 0 0 0 MARK O'NEILL CFO/VP FINANCE 268239 0 45058 0 1722 0 7404 0 2145 0 324568 0 0 0 MARGARET DEEGAN VP 202299 0 34742 0 1536 0 6200 0 20652 0 265429 0 0 0 TODD LIU VP 185635 0 31242 0 1423 0 5453 0 20652 0 244405 0 0 0 BARBARA STUMPO VP 195391 0 32721 0 1484 0 5972 0 20652 0 256220 0 0 0 KATHLEEN MARTIN VP 178416 0 30347 0 1353 0 5333 0 20652 0 236101 0 0 0 BENJAMIN ZIGUN PHYSICIAN 264765 0 0 0 1722 0 7946 0 20652 0 295085 0 0 0 EDWARD HALSTEAD PHYSICIAN 185590 0 0 0 872 0 5425 0 15919 0 207806 0 0 0 MIHAELA BORAN PHYSICIAN 176333 0 0 0 1321 0 5519 0 19266 0 202439 0 0 0 NUMAN GHARAIBEH PHYSICIAN 168562 0 0 0 1099 0 4693 0 18023 0 192377 0 0 0 ADAM DWORKIN VP 166590 0 3148 0 1282 0 5125 0 20652 0 196797 0 0 0 A CHEFA SERIES E 060806186 2017-01-20 40652000 RETIREMENT OF EXISTING DEBT 0 0 0 A 40652000 3957357 36768665 739692 2500000 4601000 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 GREGORY BORIS DO TRUSTEE 462833 GRIFFIN HOSPITAL RETAINED THE SERVICES OF CONNECTICUT EMERGENCY MEDICINE SPECIALISTS TO OVERSEE THE EMERGENCY DEPARTMENT. GREGORY BORIS IS THE DIRECTOR OF THE EMERGENCY DEPARTMENT. 0 FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES MAKES RECOMMENDATIONS TO THE INCORPORATORS OF THE HOSPITAL REGARDING NOMINATIONS OF MEMBERS OF THE COMMUNITY TO SERVE AS TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR ALL MEMBERS OF THE HOSPITAL BOARD, OFFICERS, DIRECTORS, AND KEY EMPLOYEES RECEIVE, SIGN, AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE. THE DISCLOSURES ARE REVIEWED BY THE HOSPITAL BOARD AND DOCUMENTED IN THE MINUTES. ANY DISCLOSURE OF A CONFLICT PREVENTS THE INDIVIDUAL FROM INVOLVEMENT WITH OR PARTICIPATION IN SUBJECT MATTER THAN MIGHT AFFECT THE DISCLOSED CONFLICT. ALL CONFLICTS ARE DISCLOSED AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS AND KEY EMPLOYEES ARE REVIEWED ANNUALLY BY THE COMPENSATION COMMITTEE WHICH IS A SUBCOMMITTEE OF THE HOSPITAL BOARD. THIS COMMITTEE SETS THE COMPENSATION FOR THE CEO BASED ON INDUSTRY DATA. COMPENSATION OF OTHER OFFICERS AND DIRECTORS IS SET BY THE CEO BASED ON INDUSTRY DATA. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS ARE FILED WITH THE OFFICE OF HEALTH CARE ACCESS AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFERS BETWEEN AFFILIATES -6,358,361. MINIMUM PENSION LIABILITY ADJUSTMENT 9,954,568. CHANGE IN NET ASSETS OF AFFILIATE 1,588,353. CHANGE IN BENEFICIAL INTEREST IN TRUSTS 45,949. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS 1,073,692. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES OF GRIFFIN HOSPITAL IS RESPONSIBLE FOR SELECTING AN INDEPENDENT AUDIT FIRM AND FOR OVERSEEING THE FINANCIAL STATEMENT PREPARATION PROCESS. THERE HAVE BEEN NO CHANGES IN THESE PROCEDURES SINCE THE PRIOR YEAR. GRIFFIN HEALTH SERVICES CORPORATION 130 DIVISION STREET DERBY CT 06418 222560257 HOLDING COMPANY CT 501(C)(3) LINE 12B, II N/A 0 GRIFFIN FACULTY PHYSICIANS INC 130 DIVISION STREET DERBY CT 06418 061463147 MEDICAL/EDUCATION CT 501(C)(3) LINE 11 GRIFFIN HOSPITAL 1 GRIFFIN HOSPITAL DEVELOPMENT FUND 130 DIVISION STREET DERBY CT 06418 222560254 FUNDRAISING CT 501(C)(3) LINE 12B, II GRIFFIN HEALTH SERVICES CORPORATION 0 PLANETREE INTERNATIONAL INC 130 DIVISION STREET DERBY CT 06418 061505284 EDUCATION CT 501(C)(3) LINE 11 GRIFFIN HEALTH SERVICES CORPORATION 0 GH VENTURES INC 130 DIVISION STREET DERBY CT 06418 222560247 RENTAL REAL ESTATE CT N/A C 0 HEALTHCARE ALLIANCE INSURANCE CO LTD 171 ELGIN AVENUE GEORGETOWN GRAND CAYMAN CJ OFFSHORE CAPTIVE INSURANCE CJ N/A C 0 CT PRACTICE MANAGEMENT INC 130 DIVISION STREET DERBY CT 06418 061152819 INACTIVE CT N/A C 0 0 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 GRIFFIN FACULTY PHYSICIANS INC R 5843292 GRIFFIN FACULTY PHYSICIANS INC M 2029202