2017-08-14T10:01:45-05:00 2016-09-30 350921680 CROWE HORWATH LLP 175 POWDER FOREST DRIVE SIMSBURY CT 06089 990 2015-10-01 060646718 Middlesex Hospital MIDD 8603586395 28 CRESCENT STREET MIDDLETOWN CT 06457 SUSAN MARTIN VP FINANCE & TREASURER 2017-04-20 true BETH THURZ P00346435 8606789200 2015 2021-01-29 14:40:06Z VINCENT CAPECE JR 28 CRESCENT STREET MIDDLETOWN CT 06457 438480615 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 11 3286 614 2657505 169109 5636857 4369874 358596197 380845793 7154518 13159337 8689467 7393593 380077039 405768597 102500 47000 0 0 210643345 209929362 0 0 921264 160659192 163902742 371405037 373879104 8672002 31889493 470017750 457928368 208061750 189037229 261956000 268891139 X 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 143181199 164137346 IN THE FISCAL YEAR ENDING 9/30/2016, INPATIENT CARE REPRESENTED 13,338 DISCHARGES AND 54,860 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. 53073794 84000125 MIDDLESEX HOSPITAL EMERGENCY DEPARTMENT DELIVERS CARE AT THE WHALEN EMERGENCY CENTER AT THE HOSPITAL'S MAIN CAMPUS AS WELL AS TWO SATELLITE SITES LOCATED AT THE SHORELINE MEDICAL CENTER IN WESTBROOK AND THE MIDDLESEX HOSPITAL MEDICAL CENTER IN MARLBOROUGH. THE EMERGENCY DEPARTMENT TREAT AND RELEASE VISITS FOR THE FISCAL YEAR ENDING 9/30/2016 WERE 80,023. IN EACH, EMERGENCY CARE IS DEPLOYED BY EXPERT, BOARD-CERTIFIED EMERGENCY MEDICINE DOCTORS AND SPECIFICALLY TRAINED PHYSICIAN ASSISTANTS, NURSES, PATIENT CARE TECHNICIANS AND OTHER SUPPORT PERSONNEL. EMERGENCY CARE IS PROVIDED 24 HOURS A DAY, 7 DAYS A WEEK. THE DEPARTMENTS ARE SUPPORTED BY A BROAD SPECTRUM OF DIAGNOSTIC CAPABILITIES AND SOPHISTICATED INFORMATION SYSTEMS. IN ADDITION TO EMERGENCY CARE THERE ARE ALSO ISOLATION AND DECONTAMINATION AREAS IN THE EMERGENCY DEPARTMENT AND A HELIPAD ON SITE FOR LIFE STAR MEDICAL HELICOPTER TRANSPORTS. MIDDLESEX HOSPITAL IS COMMITTED TO PROVIDING THE HIGHEST STANDARD OF CARE FOR BOTH THE PHYSICAL AND BEHAVIORAL HEALTH NEEDS OF OUR PSYCHIATRIC PATIENTS. THE EMERGENCY DEPARTMENT AT THE HOSPITAL HOUSES AN EIGHT BED EMERGENCY DEPARTMENT CRISIS UNIT. TREATMENT IS PROVIDED REGARDLESS OF THE PATIENT'S BACKGROUND OR STATUS. ED SERVICES ARE STAFFED WITH CLINICAL PERSONNEL SPECIFICALLY TRAINED TO CARE FOR THE UNIQUE NEEDS OF THEIR PATIENTS (PSYCHIATRISTS, STAFF NURSES, PATIENT CARE TECHNICIANS/MENTAL HEALTH WORKERS, SECRETARIES, NURSE EDUCATOR, SOCIAL WORKERS, COTAS, OT AND OTHERS). TOGETHER THE STAFF PARTNERS WITH HOSPITAL STAFF AND COMMUNITY RESOURCES TO DEVELOP THE BEST CARE PLAN FOR PATIENTS THROUGHOUT THEIR STAY IN THE HOSPITAL AND UPON DISCHARGE. IN FY 16, THE EMERGENCY ROOM ACTIVITY ACCOUNTED FOR 80,023 EMERGENCY DEPARTMENT VISITS. DEMAND CONTINUES TO RISE AND THE SERVICES PROVIDED CONTINUE TO BE RECOGNIZED FOR CONTINUOUS PATIENT SATISFACTION IN PARTICULAR AS A RECIPIENT OF THE PRESS GANEY SUMMIT AWARD FOR ACHIEVING A 99% CUSTOMER SATISFACTION RATING FOR ELEVEN CONSECUTIVE YEARS. 23599129 13645641 THE HOSPITAL'S HOMECARE DEPARTMENT MAKES OVER 96,000 REVENUE GENERATING VISITS A YEAR TO COMMUNITY RESIDENTS. HOMECARE IS STAFFED WITH SPECIALTY NURSES, HOME HEALTH AIDES, PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS, SPEECH THERAPISTS, MEDICAL SOCIAL WORKERS AND NUTRITIONISTS TO MEET THE PHYSICAL AND BEHAVIORAL HEALTH NEEDS OF PATIENTS CARED FOR IN THEIR HOMES AND OUTSIDE THE HOSPITAL SETTING. HOMECARE SERVICES INCLUDE: SPECIALIZED CARDIAC CARE; INCLUDING TELE MONITORING AND THE HEART SMART PROGRAM (A MULTIDISCIPLINARY PROGRAM WHICH INCLUDES THE FULL SPECTRUM CARDIAC SELF MANAGEMENT SUPPORT AND CLINICAL CARE), FULL SPECTRUM GERIATRIC CARE, INFUSION THERAPIES, LIFELINE SERVICES, AND A SIGNIFICANT RANGE OF RESPIRATORY, PULMONARY AND MEDICAL REHABILITATION SERVICES AS WELL AS PROVIDING OUTPATIENT HOSPICE AND PALLIATIVE SERVICES THROUGHOUT THE COMMUNITY. THE HOMECARE DEPARTMENT GENEROUSLY PROVIDES COMMUNITY HEALTH SERVICES INCLUDING FLU SHOTS, HEALTH FAIRS, AND COORDINATION OF LINKAGES WITH MEALS ON WHEELS, TRANSPORTATION, ADULT DAY CARE AND OTHER SERVICES ON CONTRACT WITH LOCAL ORGANIZATIONS. 115938342 47000 122536474 OTHER SERVICES INCORPORATE A WIDE RANGE OF CARE PROVIDED TO PATIENTS THAT ARE NOT SPECIFICALLY CAPTURED IN THE THREE LARGEST CATEGORIES. THIS DESIGNATION ACCOUNTS FOR APPROXIMATELY 500,000 VISITS. THESE SERVICES INCLUDE CARE PROVIDED AT THE CANCER CENTER SUCH AS DIAGNOSTIC TESTING, TREATMENT AND SUCH SUPPORTS AS ALTERNATIVE MEDICINE THERAPIES/INTEGRATIVE MEDICINES, AND HEREDITARY RISK ASSESSMENTS. PHYSICAL MEDICINE AND REHABILITATION SERVICES ALSO ARE FOLDED INTO THIS GROUPING. SERVICES ARE AVAILABLE AT MULTIPLE LOCATIONS WHICH OFFER COMPREHENSIVE REHABILITATION AND OCCUPATIONAL MEDICINE AND PHYSICAL THERAPY (INCLUDING HAND THERAPY) SERVICES. CARE IS DELIVERED BY EXPERIENCED, HIGHLY-QUALIFIED STAFF, WITH ADVANCED TRAINING IN PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH LANGUAGE PATHOLOGY AND RELATED FIELDS. IN EACH CLINICAL CASE, PATIENTS ARE EVALUATED AND RECEIVE A UNIQUE TREATMENT PLAN, WHICH INCLUDES DESIRED GOALS, ANTICIPATED OUTCOMES AND THE TIME FRAME NECESSARY TO ACHIEVE CLINICALLY OPTIMAL RESULTS. ADDITIONAL SERVICES ARE AVAILABLE BY THE WOUND AND SKIN TEAM AT MIDDLESEX HOSPITAL. THE MULTIDISCIPLINARY TEAM PROVIDES TREATMENT WHICH FOCUSES ON CLINICAL WOUND, OSTOMY AND SKIN ISSUES. THE HOSPITAL HAS CAREFUL AND ONGOING SERVICES FOR INDIVIDUALS WITH CHRONIC DISEASES. A SAMPLING OF SUCH PROGRAMS INCLUDE PULMONARY REHABILITATION SERVICES WHICH PROVIDE RESPIRATORY THERAPY AND CARE FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AS WELL AS DIABETES EDUCATION AND MEDICAL NUTRITION THERAPY AT THE CENTER FOR CHRONIC CARE MANAGEMENT PROVIDED TO INDIVIDUALS WITH A NEW DIAGNOSIS AND UNCONTROLLED DIABETES. MANY BEHAVIORAL HEALTH SERVICES ARE PROVIDED TO PATIENTS IN THE OUTPATIENT SETTING IN ADDITION TO COUNSELING AND SUPPORT GROUPS. PROGRAMS INCLUDE THE DAY TREATMENT PROGRAM (INTENSIVE OUTPATIENT SERVICES FOR ADULTS, GERIATRIC PATIENTS, AND DUALLY-DIAGNOSED PATIENTS), SERVICES AT THE OUTPATIENT CENTER FOR BEHAVIORAL HEALTH (PSYCHOTHERAPY AND MEDICATION MANAGEMENT FOR ADULTS) AND THE FAMILY ADVOCACY PROGRAM (MENTAL HEALTH TREATMENT FOR PATIENTS UNDER 18 YEARS OLD AND THEIR FAMILIES). IN FISCAL YEAR ENDING 9/30/2016, THERE WERE 7,611 REVENUE GENERATING AMBULATORY SURGERY CASES FROM ENDOSCOPY/COLONOSCOPY TO ORTHOPEDIC AND OTHER OUTPATIENT PROCEDURES. AMBULATORY OR OUTPATIENT SURGERY IS PERFORMED AT MIDDLESEX HOSPITAL AND THE MIDDLESEX OUTPATIENT CENTER. 115938342 47000 122536474 335792464 true true false true false 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 181 0 true 3286 true true true false false false false true true false false false false X 14 11 true false false false true true true true true false false true true true true true true true true true true CT X X THE ORGANIZATION 8603586000 28 CRESCENT STREET MIDDLETOWN CT 06457 DAVID BAGGISH MD SECRETARY & CHIEF DEPT OF MEDICINE 40.0 3.0 X X 342375 0 41898 VINCENT CAPECE JR PRESIDENT/CEO 40.0 4.0 X X 1100034 0 422632 BRUCE S MACMILLIAN ASSISTANT SECRETARY 1.0 3.0 X X 0 0 0 ERIC W THORNBURG VICE CHAIRMAN 1.0 2.0 X X 0 0 0 GARY K WILLIS CHAIRMAN 1.0 2.0 X X 0 0 0 GREGORY B BUTLER DIRECTOR 1.0 2.0 X 0 0 0 JEAN M D'AQUILA DIRECTOR 1.0 2.0 X 0 0 0 CHANDLER J HOWARD DIRECTOR 1.0 2.0 X 0 0 0 JONATHAN D LEVINE MD DIRECTOR 1.0 2.0 X 0 0 0 GERALD P MIGLIACCIO DIRECTOR 1.0 3.0 X 0 0 0 DARRELL G PATASKA DIRECTOR 1.0 2.0 X 0 0 0 R CHRISTOPHER SEATON DIRECTOR 1.0 2.0 X 0 0 0 CAROL P WALLACE DIRECTOR 1.0 3.0 X 0 0 0 SUSAN MARTIN VP FINANCE/TREASURER 40.0 4.0 X 464642 0 123201 JACQUELYN CALAMARI VP NURSING 40.0 0 X 314797 0 64800 DAVID GIUFFRIDA VP FACILITIES AND SUPPORT SERVICES 40.0 0 X 302618 0 43291 GARRETT HAVICAN VP OPERATIONS 40.0 0 X 289057 0 77034 ARTHUR MCDOWELL VP CLINICAL AFFAIRS 40.0 1.0 X 532131 0 154505 GREGORY NOKES VP HUMAN RESOURCES 40.0 0 X 392743 0 119050 MICHAEL SAXE CHAIRMAN EMERGENCY MEDICINE 40.0 0 X 413170 0 49310 JESSE WAGNER MD VP QUALITY AND PATIENT SAFETY 40.0 0 X 502452 0 186626 JONATHAN BANKOFF MD PHYSICIAN EMERGENCY DEPARTMENT 40.0 0 X 365060 0 35496 MARIO CAPUZZI MD MEDICAL DIRECTOR ED 40.0 0 X 346773 0 44090 DAVID COSENTINO PHYSICIAN EMERGENCY DEPARTMENT 40.0 0 X 355052 0 40622 MICHAEL KAZAKOFF MD ASSOC DIRECTOR FAMILY PRACTICE 40.0 0 X 330705 0 36078 BENJAMIN SIGAL MD PHYSICIAN EMERGENCY DEPARTMENT 40.0 0 X 352684 0 34882 HARRY EVERT SR. VP STRATEGIC PLANNING AND OPS 0 X 388929 0 196901 6793222 0 1670416 271 true true true ACSYS INTERACTIVE 1577 NEW BRITAIN AVENUE FARMINGTON CT 06032 MARKETING 3485810 ARAMARK CORPORATION 66 OXFORD DRIVE FRANKLIN MA 02038 DIETARY / HOUSEKEEPING 1561812 COMPANY 1 CONSULTING 6 CRAIG DRIVE MONROE CT 06468 INFORMATION SERVICES 1142230 QUEST DIAGNOSTICS INC 2025 COLLECTION CENTER DRIVE CHICAGO IL 60693 LABORATORY SERVICES 886613 CT Pathology Group PC 28 Crescent Street Middletown CT 06457 Pathology Services 616647 70 X 186405 1771014 2412455 337691 4369874 PATIENT SERVICES 621110 378212953 378212953 0 0 SPECIMEN LAB 621500 1894047 0 1894047 0 TECHNICAL LAB 621500 738793 0 738793 0 0 0 0 0 0 0 0 0 0 0 0 0 380845793 924368 0 0 924368 22969 0 0 22969 0 0 0 0 616033 0 680558 0 -64525 0 -64525 0 0 -64525 44163072 0 31951072 0 12212000 0 12212000 0 0 12212000 71216 186405 80388 -9172 0 -9172 0 0 0 0 0 0 0 0 0 0 0 0 EQUITY JOINT VENTURE INCOME 900099 1774000 1774000 0 0 CAFETERIA REVENUE 722210 1335992 0 0 1335992 LOSS ON EXTINGUISHMENT OF DEBT 900099 -994698 -994698 0 0 5351996 5327331 24665 0 7467290 405768597 384319586 2657505 14421632 47000 47000 5811375 4649100 1162275 328595 328595 169086051 155399057 13686994 7997861 7325187 672674 15228294 14059078 1169216 11477186 10511878 965308 5680999 4662922 96813 921264 560109 560109 191009 191009 123585 123585 911365 440243 471122 0 2510472 51655 2458817 6388606 4399442 1989164 6926788 4156073 2770715 7848654 4304008 3544646 1112487 991649 120838 456111 374491 81620 2323206 2323206 24047594 21697890 2349704 3312603 3312603 MEDICAL EXPENSES 44774551 44673271 101280 STATE NET PATIENT REVENUE TAX 21095400 21095400 TRANSFER TO AFFILIATES 6933000 6933000 28706203 24056716 4649487 0 373879104 335792464 37165376 921264 47854000 22406000 10160000 30358000 1688843 1361355 44026399 41619922 0 0 0 1591934 2063703 1190149 1091607 3952556 4573363 495365457 299995075 188201265 195370382 157754000 144923999 0 0 891654 810024 12706950 13350013 470017750 457928368 48434000 49019671 1897910 870927 56003000 51839307 5245 0 101721595 87307324 208061750 189037229 X 245191000 251796436 9787000 10115458 6978000 6979245 261956000 268891139 470017750 457928368 X 31889493 -1352000 0 0 0 -23602354 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 123585 123585 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 $9,811 AND THE PORTION OF CHA DUES TOTALED $37,334. IN ADDITION, MIDDLESEX HOSPITAL CONTRACTED WITH TWO CONSULTANTS WHO PERFORMED LOBBYING ACTIVITIES. THOSE EXPENSES TOTALLED $76,440. 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 $9,811 AND THE PORTION OF CHA DUES TOTALED $37,334. IN ADDITION, MIDDLESEX HOSPITAL CONTRACTED WITH TWO CONSULTANTS WHO PERFORMED LOBBYING ACTIVITIES. THOSE EXPENSES TOTALLED $76,440. 122014000 10726000 29414000 103326000 126387000 2000 -2106000 0 2269000 122014000 114787000 229000 11527000 0 156000 0 126387000 102354000 869000 11675000 0 111000 0 114787000 87389000 83000 14929000 0 47000 0 102354000 0.9036 0.0424 0.054 false false 8727212 8727212 283386836 150636096 132750740 2061978 1543638 518340 182264682 143176921 39087761 18924749 4638420 14286329 195370382 ACCRUED RETIREMENT LIABILITIES 48697915 SELF INSURANCE LIABILITIES 25960905 ASSET RETIREMENT OBLIGATION 984770 LEASE INCENTIVE OBLIGATION 17600 UNALLOCATED 3RD PARTY 11366576 SECURITY DEPOSITS 4172 OTHER 275386 87307324 X 403673000 680667 680667 402992333 2776264 2776264 405768597 366706000 681160 681160 366024840 7854264 7854264 373879104 Schedule D, Part V, Line 4 Intended uses of endowment funds 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. 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, 2016 AND 2015. 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, 2016 AND 2015, 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. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 RENTAL EXPENSES - 680558 ROUNDING - 109 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements RESTRICTED CONTRIBUTIONS - 1855000 NET FUNDRAISING ACTIVITIES - 921264 Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990 RENTAL EXPENSES - 680558 ROUNDING - 602 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements PAYMENTS TO AFFILIATES - 6933000 NET FUNDRAISING ACTIVITIES - 921264 TPC Golf 131435 93660 37775 0 0 41413 0 0 8052 Hospice Golf 64856 31415 33441 0 1400 8060 10265 0 3487 2 61330 61330 0 0 0 0 0 0 7711 257621 186405 71216 0 1400 49473 10265 0 19250 80388 -9172 true true X true X true X 500 true true false true true 0 5066 3902163 509404 3392759 0.0091 19698 71303522 35551350 35752172 0.0956 0 396 735262 488397 246865 0.0007 0 25160 75940947 36549151 39391796 0.1054 0 20063 4360455 359533 4000922 0.0107 0 3868 14915071 2071629 12843442 0.0344 0 29401 49524712 33869338 15655374 0.0419 55 342627 15466 327161 0.0009 0 3647 319170 0 319170 0.0009 0 57034 69462035 36315966 33146069 0.0887 0 82194 145402982 72865117 72537865 0.1940 0 0.0 0 0.0 10 144279 59850 84429 0.0002 0 0.0 0 0.0 10613 10613 0.0000 0 0.0 32 110919 110919 0.0003 0 0.0 0 42 265811 59850 205961 0.0006 false 10993577 1099358 52066803 63904743 -11837940 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 15 true false false true X https://middlesexhospital.org/middlesex-and-the-community/serving-our-community/community-health-nee X X true 16 true https://middlesexhospital.org/middlesex-and-the-community/serving-our-community/community-health-nee false false true X 200.0 500.0 X X true true X X X true X https://middlesexhospital.org/files/dmfile/FinancialAssistancePacketRev2016.pdf X https://middlesexhospital.org/files/dmfile/FinancialAssistancePacketRev2016.pdf X https://middlesexhospital.org/files/dmfile/FinancialAssistancePacketRev2016.pdf X X X X X true X false X X X X true X false false 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 Hospital 2016 Community Health Needs Assessment (CHNA) examined how social determinants of health and health disparities impact health outcomes. The report was used to raise awareness regarding how critical determinants influence health, 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 2016 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 participatory approach was utilized to create the 2016 CHNA through the following activities: 1) development of a CHNA Advisory Committee to provide guidance and insight; and 2) use of key informant surveys to promote diverse perspectives through community and clinical engagement. In addition to Hospital staff, CHNA Advisory Committee member organizations included: Middletown Health Department; Essex Health Department; Chatham Health District; Town of Killingworth Health Department; Durham Health Department; Connecticut River Area Health District; Middlesex County Branch of the NAACP; (FQHC) Community Health Center, Inc., Middletown; and the Middlesex County Substance Abuse Action Council. Advisory Committee development purposefully included organizations that represented low-income, medically underserved and minority populations. Advisory Committee participants provided key input and integral guidance to Middlesex Hospital throughout the CHNA process; members were engaged in a formal meeting during the assessment planning phase to review the study's overarching framework, planned data sources, list of potential stakeholders for key informant survey distribution, and to give suggestions and feedback on the key informant survey content and structure. In order to achieve county-based representation for the key informant survey, committee members provided additional contacts for the survey distribution list. Advisory Committee Members were given updates and kept informed by email regarding assessment status. Prior to finalization, the Advisory Committee was convened to review the CHNA draft and to offer comments and suggestions. To capture broad community input on health needs, social determinants of health and health equity, the Hospital administered its key informant survey through the online SurveyMonkey format. A total of 2,886 surveys were sent with a total of 438 completed for an overall response rate of 15.2%. Three discrete distribution channels were utilized: 1) Community: an extensive community contact list was developed, including representation from Middletown, Middlesex County and the periphery towns in the Middlesex Hospital service area. Sectors included elected officials (mayors, selectpersons, state legislators, etc.); local health departments; health care services (medical, dental, behavioral health, etc.); schools (public, private); colleges and universities; public safety (police, fire, emergency management); social services; youth and family services; other community services (senior care, veterans representation, etc.); faith-based organizations; community organizations and coalitions; the business community; and residents; Development of the community outreach distribution list included organizations that represented low-income, medically underserved and minority populations. 2) Middlesex Hospital/System Staff: the survey was sent to the Hospital's 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; and 3) Middlesex Hospital Medical Staff: surveys were sent to active medical staff and allied health professional staff through the Hospital's Medical Staff Office. In addition, through the prioritization process, the Hospital hosted a community forum to review the summary findings and themes of the assessment and to facilitate a prioritization dialogue. Participants included representatives from key community sectors and hospital departmental leadership; a total of 47 stakeholders attended. Presentation of the findings included primary and secondary data based on the following categories: demographic data; social determinants of health; health equity; health indicators; behavioral health indicators; key informant survey results; United Way 2-1-1 Connecticut system utilization; and a selection of DataHaven 2016 Wellbeing Survey results. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - MIDDLESEX HOSPITAL. In addition to posting Middlesex Hospital's 2016 community health needs assessment (CHNA) on its web-site and making it available upon request, the Hospital electronically distributed its 2016 CHNA through the following dissemination channels: the CHNA Advisory Committee; key informant community partners; community members; the Middlesex Hospital medical staff; Hospital leadership, management staff, and board of directors; and, existing Hospital-community based partnership distribution lists. Other dissemination mechanisms included: a press release; the Hospital's weekly electronic newsletter Stat; a feature in the Hospital's community electronic newsletter, eVita; and presentations. Recipients were encouraged to widely share the assessment. During the dissemination process, CHNA hard copies were provided and will continue to be provided upon request. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - MIDDLESEX HOSPITAL. Based on the findings of the Middlesex Hospital's 2016 community health needs assessment (CHNA) and the CHNA community forum prioritization discussion hosted by the Hospital, the Hospital has selected four priority areas. Each priority has associated Goals, Actions, Anticipated Impact of Actions; Plans to Evaluate Actions; and Community Partners, as well as a focus on social determinants of health and health equity. The priority areas are as follows: 1a) Mental Health 1.1: Goal - Improve access to mental health services through interprofessional collaborative practice; Actions - Implement an evidence-based integrated model for mental health treatment within the primary care setting, including a focus on social determinants of health and health equity. 1b) Mental Health 1.2: Goal - Provide specialized mental health treatment for high risk populations; Actions - Plan, develop, and implement an early treatment intervention program for young adults with emerging mental illness and/or substance use disorders, including a focus on social determinants of health and health equity. 2a) Substance Abuse 2.1: Goal - Develop a treatment program for high-risk patients experiencing severe alcohol use disorders; Actions - Plan, develop, and implement targeted treatments to support patients gaining and sustaining sobriety utilizing evidence-based interventions, including a focus on social determinants of health and health equity; 2b) Substance Abuse 2.1: Goal - Develop and launch an opioid awareness campaign & increase access of naloxone to patients at high risk for opioid overdose; Actions - Provide education to key community stakeholders & provide patients brought to the emergency department following opioid overdose with naloxone. 3) Aging Population: Goal - Design and implement interventions to promote healthy aging in place and improve outcomes for the aging population; Actions - Develop an in-home comprehensive geriatric assessment and management service line using the HRSA funded GOT Care! (Geriatrics Outreach and Training with Care) program as a template. Coordinate care through an integrated and collaborative approach including a focus on social determinants of health and health equity. 4) Asthma: Goal - Improve asthma outcomes by meeting the Connecticut Asthma Initiative goals. Actions - Improve access and appropriate asthma care by partnering with the community; Enhance patient education techniques for asthma management; Advance progress toward health equity for asthma care and outcomes by focusing on social determinants of health; Develop a pediatric asthma pathway; and, increase utilization of asthma action plans and enhance asthma action plan handoffs. Oversight of Middlesex Hospital's 2016 CHNA Implementation Strategy resides under Community Benefit, where Hospital staff collaborate with community agencies on the priority areas whenever possible and build evidence-based programs, where needed, with measurable, benchmarked results and the goal of achieving positive outcomes. In addition, the CHNA priority areas become the foundation for the Hospital's community benefit organizational goals. Middlesex Hospital recognizes that it cannot focus on all the health needs identified in its 2016 CHNA. Given the significant resources and in-kind time needed to address health priority areas uncovered by a community health needs assessment, the Hospital engaged in a thorough process of data review and discussion to identify the areas of greatest need, impact potential and feasibility. For those areas of identified needs not addressed by the Hospital, its 2016 CHNA was widely disseminated to Middlesex County community agencies with the hope that the study would be used to initiate focus on CHNA findings that are outside the scope of the Hospital's selected priority areas. As many local community-based organizations are dedicated to meeting the needs of county residents, the Hospital realizes that these organizations may be better suited to take a leadership role in improving certain health outcomes. As with our previous community health needs assessment, the Hospital will continue to be a willing partner, when able, for initiatives not related to its selected CHNA 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. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - MIDDLESEX HOSPITAL. The hospital used the average of its Medicare and commercial rates when calculating the maximum amounts that can be charged. 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 the Healthcare Advocate. 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 the Healthcare Advocate. Schedule H, Part I, Line 7g Subsidized Health Services Middlesex Hospital includes its Family Medicine Group as a subsidized service. For FY16, 9,968 unique individuals were served with a total Hospital subsidy of $239,082. 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 that Middlesex County is a Health Professional Shortage Area (HPSA) for primary medical care. 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 Middlesex Hospital's participation in Community Building activities 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 FY16 the Hospital's Community Building Activities totaled $205,961 and served 42 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. a) SMC Career Day is an experiential learning event where high school students interact with staff members from a variety of clinical fields and participate in interactive mock demonstrations/simulations. b) SMC Internships: SMC provides internships for local high school students. Among many other experiences, students are involved in patient rounds and are exposed to how diagnoses are made. c) SMC World of Work is 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. On the main Hospital campus, the Middlesex Medical Explorers Program teaches critical thinking and medical problem solving while exposing high school students to various medical professions and furthering their understanding of the health care system. The target population is under-represented populations in healthcare. During each session, guest speakers describe their professions and the students review a singular, medical case study that travels month to month through each discipline. 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 14 of the Middlesex Health System's Consolidated FY16 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 is a disproportionate percentage of older adults in Middlesex County when compared to state averages. The Hospital's most recent (2016) community health needs assessment (CHNA) found that, when comparing state and national growth projections for persons age 65+ to local growth, every town in Middlesex County, except Middletown, considerably exceeds Connecticut and U.S. projections for 2020 and 2025 (Administration on Aging; Administration for Community Living; The Connecticut Data Collaborative and Connecticut's Legislative Commission on Aging). For 2020, excluding Middletown (at 16.4%), expected growth for age 65 and older ranges from 18.8% to 34.1% in the towns of Middlesex County compared to 17.5% for Connecticut and 16.3% for the U.S. For 2025, excluding Middletown (at 18.8%), expected growth for age 65 and older ranges from 22.6% to 38.9% in the towns of Middlesex County compared to 19.6% for Connecticut and 18.2% for the U.S. In Addition, the 2008, 2013 and 2016 Middlesex County CHNAs found older adults to be a priority area (access to care, health service utilization, lack of services, etc.). 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 and attorneys. 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/files/dmfile/FinancialAssistancePacketRev2016.pdf; Schedule H, Part V, Section B, Line 16b FAP Application website - MIDDLESEX HOSPITAL: Line 16b URL: https://middlesexhospital.org/files/dmfile/FinancialAssistancePacketRev2016.pdf; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - MIDDLESEX HOSPITAL: Line 16c URL: https://middlesexhospital.org/files/dmfile/FinancialAssistancePacketRev2016.pdf; Schedule H, Part VI, Line 2 Needs assessment Since the inception of Middlesex Hospital'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 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 the 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 data base 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 (www.midhosp.org) 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 FY16, Middlesex Hospital granted $3,392,759 of financial assistance to 5,066 unique recipients and absorbed $35,999,037 in unpaid costs of Medicaid (total of Medicaid including managed care and LIA), serving 20,094 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 (Middletown, Cromwell, Portland, East Hampton, East Haddam, Haddam, Middlefield, Durham, Killingworth, Chester, Deep River, Essex, Old Saybrook, Westbrook, Clinton) and 9 towns on Middlesex County's periphery (Rocky Hill, Glastonbury, Hebron, Marlborough, Colchester, Salem, Lyme/Old Lyme, Madison, Guilford). Middlesex County is 369 square miles, making it the smallest county by land area in Connecticut, and is the fifth in population size out of the eight Connecticut counties (TownCharts 2014). Municipality sizes vary throughout the county, from 10 square miles (Essex) to 54 square miles (East Haddam). Middletown has a geographic area of 41 square miles by land area. The periphery towns cover an additional 340 square miles. 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 2010 U.S. Census Data, the Middlesex County towns of Chester, Deep River, Durham, East Haddam, Haddam, Killingworth, Middlefield, Portland, Westbrook are considered rural, as well as the periphery town of Marlborough. Major employers include Middlesex Hospital, Wesleyan University, Middlesex Community College, Connecticut Valley Hospital, Pratt & Whitney, and the small business community. 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. Middletown is the largest municipality (47,424 persons) in Middlesex County (165,534 persons) [2014; CERC Town Profiles 2016]. Chester, Deep River and Middlefield have populations less than 5,000; Durham, East Haddam, Essex, Haddam, Killingworth, Portland, and Westbrook have populations between 5,000 and 9,999; Clinton, Cromwell, East Hampton and Old Saybrook have populations between 10,000 and 14,999 (2014; CERC Town Profiles 2016). The periphery towns in Middlesex Hospital's service area have a combined population of 141,516. Lyme and Salem have populations less than 5,000; Hebron, Old Lyme, and Marlborough have populations between 5,000 and 9,999; Colchester, Glastonbury, Guilford, Madison, and Rocky Hill have populations between 15,000 and 35,000 (2014; CERC Town Profiles 2016). Foreign born persons comprise 11% of the population in Middletown and 7.3% of Middlesex County compared to 13.7% of the state (2010-2014; U.S. Census Bureau QuickFacts). The median age in the towns in Middlesex County range from ages 37-53, with median age 37 in Middletown, 44 in Middlesex County, and 40 in the state of CT (2010-2014; CERC Town Profiles 2016). When comparing state and national growth projections for persons age 65+ to local growth every town in Middlesex County, except Middletown, considerably exceeds Connecticut and U.S. projections for 2020 and 2025 (Administration on Aging; Administration for Community Living; The Connecticut Data Collaborative and Connecticut's Legislative Commission on Aging). For 2020, excluding Middletown (at 16.4%), expected growth for age 65 and older ranges from 18.8% to 34.1% in the towns of Middlesex County compared to 17.5% for Connecticut and 16.3% for the U.S. For 2025, excluding Middletown (at 18.8%), expected growth for age 65 and older ranges from 22.6% to 38.9% in the towns of Middlesex County compared to 19.6% for Connecticut and 18.2% for the U.S. Middlesex County's race and Hispanic Origin composition is 85.3% white, non-Hispanic; 4.9% Black or African American; 5.3% Hispanic or Latino; 2.7% Asian; 2.2% two or more races; 1.2% other (U.S. Census 2010- 2014). Middletown's race and Hispanic Origin composition is 70.3% white, non-Hispanic; 13.1% Black or African American; 9.1% Hispanic or Latino; 4.4% Asian; 4.2% two or more races; 1.6% other (U.S. Census 2010- 2014). The median household income in Middlesex County ($77,931) is higher than the state of Connecticut average ($69,899) [2010-2014; CERC Town Profile 2016 Report]. There is a significant range between the towns in Middlesex County, with Middletown at the lower bound ($61,373) and Durham at the highest level ($117,328) [2010-2014; CERC Town Profiles 2016]. Similar to the range of median household income in the towns throughout Middlesex County, there is a significant difference in poverty rate in Middletown (12.5%) when compared to the rest of the county (6.9%) [2010-2014; CERC Town Profile 2016 Report]. Educational attainment in Middlesex County is: less than high school diploma - 7.9%; high school diploma, General Educational Development (GED) or equivalent: 21.4%; some college - 13.3%; associate's degree - 6.1%; bachelor's degree or higher: 39.8% (U.S. Census Bureau, American Community Survey 5-Year, 2010-2014). Unemployment in Middlesex County is 6.6% (U.S. Census Bureau, American Community Survey 5-Year, 2010-2014). Health insurance status (all income levels) in Middlesex County is: insured, ages <19: 97.2%; insured, ages 18 to 64 years: 93.6%; insured, ages 40 to 64 years: 94.8%; insured, ages 50 to 64 years: 95.1% (U.S. Census Bureau and the Small Area Health Insurance Estimates, 2014). In 2016, the percent of Hospital discharges for Medicaid/SAGA/Uninsured combined were: 17% inpatient; 14% outpatient; 28% Emergency Department non-admission; and, for the following services: 37% newborn; 40% 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 too few primary care providers, high infant mortality, high poverty or a high elderly population. The Index of Medical Underservice includes the four variables of: ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population age 65 or over. 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. The 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. The 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 FY16 was $72,537,865 (excluding Community Building) with 82,194 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 FY16, the Hospital's Community Health Improvement Services served 20,063 individuals at a total cost of $3,754,797 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 FY16, the Hospital's Health Professions Education category served 3,868 individuals at a total cost of $12,843,442 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, Cardiac Rehabilitation, Paramedics, Hospice, Diabetes Education, Wound Care and Pulmonary Rehabilitation. In FY16 the Hospital's subsidized services served 29,401 people with a total cost of $15,655,374 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 FY16, the Hospital's associated costs for all research projects totaled $327,161 and served 55 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 FY16 support for financial and in-kind contributions totaled $319,170, serving 3,647 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, the main goals of the Hospital's community benefit program in FY16 were completion of the community health needs assessment, continued to focus on on-going priority areas and collaborating with community partners. The Hospital's FY16 Community Benefit Operations expense totaled $246,125. Schedule H, Part VI, Line 7 State filing of community benefit report CT true FRIENDS OF LONG HILL 421 WADSWORTH STREET MIDDLETOWN CT 06457 061546991 501(C)(3) 5000 Donation MIDDLESEX UNITED WAY 100 RIVERVIEW CENTER SUITE 230 MIDDLETOWN CT 06457 060665170 501(C)(3) 10000 Corporate Gift MIDDLESEX CHAMBER OF COMMERCE 393 MAIN STREET MIDDLETOWN CT 06457 060452410 501(C)(6) 27000 Corporate Donation HEALTH ASSISTANCE INTERVENTION EDUCATION NETWORK 835 Queen Stret 2nd Floor Southington CT 06489 510642913 501(C)(3) 5000 Donation 4 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. EACH OF THE ORGANIZATIONS HAS A FORMAL PROCESS FOR ENSURING THE GRANT MONEY RECEIVED IS USED FOR APPROPRIATE PURPOSES VIA GRANT COMMITTEES. X X X true true X X X X X false true false false false true false false false DAVID BAGGISH MD SECRETARY & CHIEF DEPT OF MEDICINE 341675 0 700 0 0 0 21200 0 20698 0 384273 0 0 0 VINCENT CAPECE JR PRESIDENT/CEO 682074 0 184000 0 233960 0 385700 0 36932 0 1522666 0 417960 0 SUSAN MARTIN VP FINANCE/TREASURER 374417 0 73000 0 17226 0 100114 0 23087 0 587844 0 90226 0 HARRY EVERT SR. VP STRATEGIC PLANNING AND OPS 302929 0 86000 0 0 0 174498 0 22403 0 585830 0 53000 0 JACQUELYN CALAMARI VP NURSING 245558 0 43000 0 26239 0 44592 0 20208 0 379596 0 26239 0 DAVID GIUFFRIDA VP FACILITIES AND SUPPORT SERVICES 234889 0 37000 0 30729 0 38295 0 4996 0 345909 0 30729 0 GARRETT HAVICAN VP OPERATIONS 216446 0 44000 0 28611 0 57048 0 19986 0 366090 0 68611 0 ARTHUR MCDOWELL VP CLINICAL AFFAIRS 459013 0 73000 0 118 0 116836 0 37669 0 686636 0 73118 0 GREGORY NOKES VP HUMAN RESOURCES 335743 0 57000 0 0 0 97544 0 21506 0 511794 0 57000 0 MICHAEL SAXE CHAIRMAN EMERGENCY MEDICINE 391840 0 1500 0 19830 0 21200 0 28110 0 462480 0 19830 0 JESSE WAGNER MD VP QUALITY AND PATIENT SAFETY 402149 0 64000 0 36303 0 159766 0 26860 0 689079 0 100303 0 JONATHAN BANKOFF MD PHYSICIAN EMERGENCY DEPARTMENT 294573 0 70487 0 0 0 13250 0 22246 0 400556 0 0 0 MARIO CAPUZZI MD MEDICAL DIRECTOR ED 273355 0 73418 0 0 0 15761 0 28329 0 390863 0 0 0 DAVID COSENTINO PHYSICIAN EMERGENCY DEPARTMENT 312396 0 42656 0 0 0 18550 0 22072 0 395674 0 0 0 MICHAEL KAZAKOFF MD ASSOC DIRECTOR FAMILY PRACTICE 330505 0 200 0 0 0 21083 0 14995 0 366783 0 0 0 BENJAMIN SIGAL MD PHYSICIAN EMERGENCY DEPARTMENT 273817 0 78868 0 0 0 13116 0 21766 0 387566 0 0 0 Schedule J, Part II, Column (B)(ii) BONUS & INCENTIVE COMPENSATION THE AMOUNTS REPRESENT INCENTIVE COMPENSATION PAYMENTS MADE IN CALENDAR YEAR 2015. PAYMENTS INCLUDE AMOUNTS EARNED IN 2014 AND DEFERRED, WHERE APPLICABLE. 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. ARTHUR MCDOWELL GREGORY NOKES HARRY EVERT SUSAN MARTIN VINCENT CAPECE GARRETT HAVICAN JESSE WAGNER, MD JACQUELYN CALAMARI 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. TO THE EXTENT THIS MEMBERSHIP IS USED FOR PERSONAL REASONS THE ASSOCIATED COST IS INCLUDED IN THE TAXABLE INCOME OF THE EXECUTIVE STAFF MEMBER ACCORDING TO IRS RULES AND REGULATIONS. THIS BENEFIT WAS TREATED AS TAXABLE COMPENSATION. VINCENT CAPECE HARRY EVERT 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. GREGORY NOKES Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan NONQUALIFIED RETIREMENT BENEFITS ARE PROVIDED AS PART OF A COMPETITIVE TOTAL COMPENSATION PROGRAM AND TO ENCOURAGE RETENTION OF KEY EXECUTIVES. THE NONQUALIFIED RETIREMENT PLAN BENEFIT ACCRUES ANNUALLY AND EACH YEAR'S CONTRIBUTION VESTS AFTER THREE (3) YEARS OF SERVICE. THE AMOUNT OF THE VESTED BENEFITS IS CONSIDERED "INCOME" TO THE EXECUTIVE'S W-2 FORM AND IS TAXABLE. CERTAIN EXECUTIVES ALSO PARTICIPATE IN A FORMER PLAN, WHERE ACCRUALS CEASED IN 2010 AND THE VESTED BENEFITS WILL BE DISTRIBUTED ON TERMINATION OF EMPLOYMENT. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NONQUALIFIED RETIREMENT PLAN. THE AMOUNTS REPORTED BELOW ARE THE SERP VESTED AMOUNTS PAID TO THE EMPLOYEE DURING CALENDAR YEAR 2015: ARTHUR MCDOWELL $118 SUSAN MARTIN $17,226 VINCENT CAPECE $233,960 MICHAEL SAXE, MD $19,830 JESSE WAGNER, MD $36,303 GARRETT HAVICAN $28,611 DAVID GIUFFRIDA $30,729 JACQUELYN CALAMARI $26,239 THE AMOUNTS REPORTED BELOW ARE THE SERP AUTO-VESTED AMOUNTS MADE DIRECTLY TO THE EMPLOYEES > 62.5 YEARS OLD: HARRY EVERT $165,925 ARTHUR MCDOWELL $41,636 GREGORY NOKES $30,344 THE FOLLOWING PARTICIPANTS HAD FUNDS CONTRIBUTED TO THEIR SERP ACCOUNT IN 2015: DAVID GIUFFRIDA $23,762 VINCENT CAPECE $202,500 SUSAN MARTIN $14,914 GARRETT HAVICAN $22,048 JESSE WAGNER, MD $37,866 JACQUELYN CALAMARI $24,823 Schedule J, Part I, Line 6a Compensation contingent on net earnings of the organization THERE ARE FOUR (4) BROAD CATEGORIES OF EXECUTIVE INCENTIVE GOALS: CLINICAL QUALITY AND PATIENT SATISFACTION (40%), FINANCIAL STRENGTH (30%), WORKPLACE ENVIRONMENT (20%), AND COMMUNITY BENEFIT/CHARITABLE MISSION EFFECTIVENESS (10%). WITHIN EACH CATEGORY ARE MORE SPECIFIC GOALS WHICH ARE DETERMINED FROM OUR OWN PAST EXPERIENCE AS WELL AS STATE AND NATIONAL BENCHMARK DATA. THE INCENTIVE COMPENSATION OF THE EXECUTIVE STAFF IS DETERMINED WITH REFERENCE TO PERFORMANCE RELATIVE TO THESE GOALS. A STATE OF CT HEALTH & EDUCATIONAL FACILITIES AUTH 060806186 20774YAW7 2011-07-26 33803383 SERIES N REFINANCE 10/9/1997 (SERIES H & I) false 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 A 9790000 0 33803651 0 0 0 537971 0 0 33265690 0 0 2011 true false true true B 590000 0 19491965 0 0 0 388960 0 0 19103010 0 0 2015 false true false true C 218414 0 9683000 0 0 0 193660 0 0 9489340 0 0 2016 false true true true A 0.0 0.0 0.0 true B false false false false 0.0 0.0 0.0 false false true C false false false false 0.0 0.0 0.0 false false true 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 A true B true C true Schedule K, Part II, Line 7 COLUMN A BOND THIS AMOUNT WILL NOT TIE TO 8038 DUE TO ALLOCATION TO OBLIGATED GROUP. Schedule K, Part II, Line 3 COLUMN A BOND THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS IS INTEREST IN THE AMOUNT OF $268 FOR COLUMN A BOND. Schedule K, Part II, Line 10 COLUMN A BOND THIS AMOUNT WILL NOT TIE TO 8038 DUE TO ALLOCATION TO OBLIGATED GROUP. 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 - J. CALAMARI 83898 WAGES/COMPENSATION RECEIVED false STEVE MCDOWELL - TRANSPORTATION AND LOGISTICS SUPERVISOR FAMILY MEMBER - A. MCDOWELL 99530 WAGES/COMPENSATION RECEIVED false VICTORIA MCDOWELL - REGISTERED NURSE FAMILY MEMBER - A. MCDOWELL 65025 WAGES/COMPENSATION RECEIVED false GUIFFRIDA ELECTRIC CO FAMILY MEMBER - D. GUIFFRIDA 516567 PAYMENT FOR SERVICES RENDERED false Ruth Wagner - Registered Nurse Family Member - J Wagner 80143 WAGES/COMPENSATION RECEIVED false Schedule L, Part IV RELATED PARTIES ANNE CALAMARI, LCSW COORDINATOR, IS THE DAUGHTER OF JACQUELYN CALAMARI, VP NURSING. ANNE CALAMARI'S WAGES FOR 10/01/15 TO 09/30/16 TOTALED $83,898. STEVE MCDOWELL, TRANSPORTATION AND LOGISTICS SUPERVISOR, IS THE BROTHER OF ARTHUR MCDOWELL, VICE PRESIDENT OF CLINICAL AFFAIRS. STEVE MCDOWELL'S WAGES FOR 10/01/15 TO 09/30/16 TOTALED $99,530. VICTORIA MCDOWELL, REGISTERED NURSE, IS THE SISTER-IN-LAW OF ARTHUR MCDOWELL, VICE PRESIDENT OF CLINICAL AFFAIRS. VICTORIA MCDOWELL'S WAGES FOR 10/01/15 TO 09/30/16 TOTALED $65,025. 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 FY16 TOTALED $516,567. RUTH WAGNER, CCU REGISTERED NURSE, IS THE WIFE OF JESSE WAGNER, VP QUALITY & SAFETY. RUTH WAGNER'S WAGES FOR 10/01/15 TO 09/30/16 TOTALED $80,143. X 3 337691 Selling cost 0 false true true Schedule M, Part I, Line 32b Third parties used to solicit, process, or sell noncash contributions DONORS OF STOCK ARE INSTRUCTED TO TRANSFER TO MERRILL LYNCH, IN WHICH MERRILL LYNCH IS INSTRUCTED TO SELL THE STOCK IMMEDIATELY. 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 III, Line 4d Description of other program services (Expenses $ 115,938,342 including grants of $ 47,000)(Revenue $ 122,536,474) OTHER SERVICES INCORPORATE A WIDE RANGE OF CARE PROVIDED TO PATIENTS THAT ARE NOT SPECIFICALLY CAPTURED IN THE THREE LARGEST CATEGORIES. THIS DESIGNATION ACCOUNTS FOR APPROXIMATELY 500,000 VISITS. THESE SERVICES INCLUDE CARE PROVIDED AT THE CANCER CENTER SUCH AS DIAGNOSTIC TESTING, TREATMENT AND SUCH SUPPORTS AS ALTERNATIVE MEDICINE THERAPIES/INTEGRATIVE MEDICINES, AND HEREDITARY RISK ASSESSMENTS. PHYSICAL MEDICINE AND REHABILITATION SERVICES ALSO ARE FOLDED INTO THIS GROUPING. SERVICES ARE AVAILABLE AT MULTIPLE LOCATIONS WHICH OFFER COMPREHENSIVE REHABILITATION AND OCCUPATIONAL MEDICINE AND PHYSICAL THERAPY (INCLUDING HAND THERAPY) SERVICES. CARE IS DELIVERED BY EXPERIENCED, HIGHLY-QUALIFIED STAFF, WITH ADVANCED TRAINING IN PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH LANGUAGE PATHOLOGY AND RELATED FIELDS. IN EACH CLINICAL CASE, PATIENTS ARE EVALUATED AND RECEIVE A UNIQUE TREATMENT PLAN, WHICH INCLUDES DESIRED GOALS, ANTICIPATED OUTCOMES AND THE TIME FRAME NECESSARY TO ACHIEVE CLINICALLY OPTIMAL RESULTS. ADDITIONAL SERVICES ARE AVAILABLE BY THE WOUND AND SKIN TEAM AT MIDDLESEX HOSPITAL. THE MULTIDISCIPLINARY TEAM PROVIDES TREATMENT WHICH FOCUSES ON CLINICAL WOUND, OSTOMY AND SKIN ISSUES. THE HOSPITAL HAS CAREFUL AND ONGOING SERVICES FOR INDIVIDUALS WITH CHRONIC DISEASES. A SAMPLING OF SUCH PROGRAMS INCLUDE PULMONARY REHABILITATION SERVICES WHICH PROVIDE RESPIRATORY THERAPY AND CARE FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AS WELL AS DIABETES EDUCATION AND MEDICAL NUTRITION THERAPY AT THE CENTER FOR CHRONIC CARE MANAGEMENT PROVIDED TO INDIVIDUALS WITH A NEW DIAGNOSIS AND UNCONTROLLED DIABETES. MANY BEHAVIORAL HEALTH SERVICES ARE PROVIDED TO PATIENTS IN THE OUTPATIENT SETTING IN ADDITION TO COUNSELING AND SUPPORT GROUPS. PROGRAMS INCLUDE THE DAY TREATMENT PROGRAM (INTENSIVE OUTPATIENT SERVICES FOR ADULTS, GERIATRIC PATIENTS, AND DUALLY-DIAGNOSED PATIENTS), SERVICES AT THE OUTPATIENT CENTER FOR BEHAVIORAL HEALTH (PSYCHOTHERAPY AND MEDICATION MANAGEMENT FOR ADULTS) AND THE FAMILY ADVOCACY PROGRAM (MENTAL HEALTH TREATMENT FOR PATIENTS UNDER 18 YEARS OLD AND THEIR FAMILIES). IN FISCAL YEAR ENDING 9/30/2016, THERE WERE 7,611 REVENUE GENERATING AMBULATORY SURGERY CASES FROM ENDOSCOPY/COLONOSCOPY TO ORTHOPEDIC AND OTHER OUTPATIENT PROCEDURES. AMBULATORY OR OUTPATIENT SURGERY IS PERFORMED AT MIDDLESEX HOSPITAL AND THE MIDDLESEX OUTPATIENT CENTER. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons CAROL WALLACE & ERIC THORNBURG - Business relationship, ERIC THORNBURG & CHANDLER HOWARD - Business relationship, JEAN D'AQUILA & CHANDLER HOWARD - Business relationship, VINCENT CAPECE & CHANDLER HOWARD - Business relationship, JEAN D'AQUILA & ERIC THORNBURG - Business relationship, JEAN D'AQUILA & CAROL WALLACE - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF THE HOSPITAL SHALL BE MIDDLESEX HEALTH SYSTEM, INC., A CONNECTICUT NON-STOCK CORPORATION, OR ITS SUCCESSOR IN INTEREST ("SOLE MEMBER"). Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE ANNUAL ELECTION OF THE BOARD OF DIRECTORS OF THE HOSPITAL BY THE DULY AUTHORIZED REPRESENTATIVE OF THE SOLE MEMBER SHALL BE DEEMED THE ANNUAL MEETING OF THE MEMBERSHIP OF THE HOSPITAL FOR ALL PURPOSES. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE SOLE MEMBER, MIDDLESEX HEALTH SYSTEM, INC., SHALL HAVE ALL OF THE MEMBERSHIP RIGHTS CONFERRED BY LAW, THE CERTIFICATE OF INCORPORATION OR THE 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. THE SECRETARY OF THE HOSPITAL SHALL PROVIDE APPROPRIATE NOTICES TO THE SOLE MEMBER AS REQUIRED BY LAW IN ADVANCE OF ACTIONS BEING REQUESTED OF THE SOLE MEMBER BY THE BOARD OF DIRECTORS OF THE HOSPITAL. Form 990, Part VI, Line 11b Review of form 990 by governing body DRAFT FORMS OF THE 990, INCLUDING REQUIRED SCHEDULES, ARE PROVIDED TO EACH BOARD MEMBER FOR REVIEW. MEMBERS REVIEW THE DOCUMENTS, HIGHLIGHT ANY SIGNIFICANT CHANGES AND ATTEST THEIR APPROVAL. ANY QUESTIONS OR COMMENTS ARE PRESENTED TO EXECUTIVE MANAGEMENT PRIOR TO FILING. A COPY OF THE FINAL FORM 990 WILL BE PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS VIA A WEB BASED COMMUNICATION PORTAL. 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. INFORMATION REPORTED IS CONSIDERED PERSONAL AND CONFIDENTIAL AND ONLY DISCLOSED WHEN DEEMED NECESSARY TO PROTECT THE HOSPITAL AGAINST THE EFFECTS OF CONFLICTS OF INTEREST AND ONLY AFTER ADVISING THE REPORTING PERSON OF THE PROPOSED DISCLOSURE AND OF ITS EXTENT. MATERIAL CONFLICTS ARE REPORTED TO THE BOARD'S 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. 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 EXECUTIVE TEAM COMPENSATION IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. THE COMMITTEE HAS A CHARTER AND A POLICY STATEMENT SETTING FORTH A PROCESS AND CERTAIN GUIDELINES FOR DETERMINING COMPENSATION. EXECUTIVES RECEIVE A BASE SALARY AND HAVE THE OPPORTUNITY FOR INCENTIVE COMPENSATION WITHIN A RANGE SET BY THE POLICY. FOLLOWING THE CLOSE OF EACH FISCAL YEAR, THE COMMITTEE RECEIVES A MARKET ANALYSIS FROM INDEPENDENT CONSULTANTS REGARDING COMPENSATION AT PEER GROUPS OF COMPARABLE HOSPITALS AND HEALTH SYSTEMS. POSITIONS WITHIN THE EXECUTIVE TEAM ARE COMPARED TO BENCHMARK POSITIONS WITHIN THIS MARKET DATA AND THEIR COMPENSATION IS COMPARED TO THE DATA BOTH WITH RESPECT TO CASH COMPENSATION AND TOTAL COMPENSATION INCLUDING FRINGE BENEFITS. THE CEO RECOMMENDS THE INCENTIVE AWARDS AND BASE SALARY ADJUSTMENTS TO THE COMPENSATION OF THE EXECUTIVES WHO REPORT TO HIM, AND THE COMMITTEE REVIEWS THOSE RECOMMENDATIONS, APPROVES OR MODIFIES THEM, AND ALSO DETERMINES ANY INCENTIVE AWARD AND BASE SALARY ADJUSTMENT FOR THE CEO. THE CONSULTANTS PROVIDE A WRITTEN OPINION ANNUALLY CONFIRMING THAT THE COMPENSATION OF THE EXECUTIVES, AS ADJUSTED BY THIS PROCESS, IS "REASONABLE" WITHIN APPLICABLE IRS GUIDELINES. THE LAST COMPENSATION REVIEW OCCURRED 12/2015. Form 990, Part VI, Line 15b Process to establish compensation of other employees KEY EMPLOYEE COMPENSATION IS SET FOLLOWING THE GUIDELINES SET FORTH IN THE HOSPITAL COMPENSATION POLICY. THE OBJECTIVE OF THIS POLICY IS TO PAY EMPLOYEES BASED UPON HOSPITAL NEED, THE PROPER EXTERNAL LABOR MARKET AND PERFORMANCE. THE LAST COMPENSATION REVIEW OCCURRED 12/2015. 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 Other - Total Revenue: 5351996, Related or Exempt Function Revenue: 5327331, Unrelated Business Revenue: 24665, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Change in Accumulated Pension Charges - -22826000; Expenditures for intended purposes - -776000; Rounding - -354; 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 9 MIDDLESEX HEALTH SYSTEM true MIDDLESEX HOSPITAL FOUNDATION 28 CRESCENT STREET MIDDLETOWN CT 06457 273720822 SUPPORT CT 501(c)(3 Type II MIDDLESEX HOSPITAL true MIDDLESEX HEALTH RESOURCES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061089925 HEALTHCARE CT MIDDLESEX HEALTH SYSTEM C Corporation true INTEGRATED RESOURCES FOR THE MIDDLESEX AREA LLC 28 CRESCENT STREET MIDDLETOWN CT 06457 061462230 OUTPATIENT CARE CT MIDDLESEX HEALTH SYSTEM C Corporation true MHS PRIMARY CARE INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061472743 HEALTHCARE CT MIDDLESEX HEALTH SYSTEM C Corporation true false true true true false false false false false true true false false false true true true false false Middlesex Health System Inc B 7660000 COST Middlesex Health Resources Inc K 495775 COST Middlesex Health Services Inc O 124963 COST Middlesex Health Services Inc D 3785000 COST Middlesex Health Services Inc Q 2207394 COST MHS Primary Care Inc Q 3100000 COST Middlesex Health System Inc P 1001652 COST Middlesex Health Resources Inc C 725674 COST MHS PRIMARY CARE INC O 181726 COST MHS PRIMARY CARE INC J 134287 COST