2017-08-10T15:25:39-05:00 2016-09-30 440160260 BKD LLP 1201 WALNUT SUITE 1700 KANSAS CITY MO 64106 990 2015-10-01 060250773 THE WILLIAM W BACKUS HOSPITAL WILL 8608898331 326 WASHINGTON STREET NORWICH CT 06360 ANTHONY MASTROIANNI REGIONAL VP FINANCE 8608898331 2017-08-10 1 MICHAEL J ENGLE P00482834 8162216300 2015 2021-01-29 14:40:06Z BIMAL PATEL 326 WASHINGTON STREET NORWICH CT 06360 389400558 0 X WWW.BACKUSHOSPITAL.ORG X 1891 CT THE WILLIAM W.BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH-QUALITY HEALTH CARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT. THE HOSPITAL IS COMMITTED TO BEING RESPONSIVE AND ACCOUNTABLE TO THOSE FOR WHOSE BENEFIT IT EXISTS, AND TO IMPROVING THE HEALTH OF ITS COMMUNITIES. 12 8 2010 485 2413551 -48595 1626345 512743 294807000 308726062 7159759 8686222 2525641 1672123 306118745 319597150 178641 149587 0 0 133334931 139755080 0 0 690298 124142781 135932582 257656353 275837249 48462392 43759901 533869094 589761844 166315438 172757813 367553656 417004031 X THE WILLIAM W BACKUS HOSPITAL DELIVERS AND COORDINATES A CONTINUUM OF HIGH QUALITY HEALTH CARE THAT IS SENSITIVE TO THE NEEDS OF INDIVIDUALS IN EASTERN CONNECTICUT. THE HOSPITAL IS COMMITTED TO BEING RESPONSIVE AND ACCOUNTABLE TO THOSE FOR WHOSE BENEFIT IT EXISTS, AND TO IMPROVING THE HEALTH OF ITS COMMUNITIES. 0 0 108913167 117201207 INPATIENT-THE HOSPITAL HAS 233 LICENSED BEDS. DISCHARGES FOR FY 16 WERE 10,607 OF WHICH 7,943 MED/SURG AND ICU, 1,943 MATERNITY/NEWBORN AND 721 PSYCH. PATIENT DAYS TOTALED 46,555 OF WHICH 36,062 MED/SURG AND ICU, 4,687 MATERNITY/NEWBORN AND 5,806 PSYCH. OBSERVATION DISCHARGES WERE 2,528 AND OBSERVATION DAYS WERE 4,996. THE AVERAGE LENGTH OF STAY IS 4.39 DAYS. THERE WERE 2,214 INPATIENT SURGERIES PERFORMED. 88655473 149587 126816749 OUTPATIENT-FOR FISCAL 16, THE HOSPITAL HAD 433,273 OUTPATIENT VISITS. INCLUDED IN THOSE VISITS ARE 144,276 IMAGING EXAMS, 7,337 MRI EXAMINATIONS, 6,334 SAME DAY SURGICAL PROCEDURES, 7,354 PSYCHIATRIC CLINICAL VISITS, 6,475 PSYCHIATRIC PARTIAL HOSPITAL VISITS, 26,643 REHAB VISITS, 3,568 CARDIAC VISITS, 2,822 CHEMO VISITS, AND 2,925 GASTROINTESTINAL VISITS. 33216731 64668888 EMERGENCY DEPARTMENT-THE HOSPITAL HAS EMERGENCY DEPARTMENTS LOCATED IN NORWICH AND PLAINFIELD. FOR FISCAL 16, VISITS TOTALED 78,199 OF WHICH 6,342 WERE TRANSITIONED TO INPATIENT CARE. 1211594 OTHER PROGRAM SERVICES INCLUDE EHR REVENUE, PURCHASE DISCOUNTS, CONTRACT SERVICES AND OTHER MISCELLANEOUS INCOME. 1211594 230785371 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 174 0 1 2010 1 1 1 0 0 0 0 1 1 0 0 0 0 X 12 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X X ANTHONY MASTROIANNI 8608898331 326 WASHINGTON STREET NORWICH CT 06360 ELIZABETH CONWAY DIRECTOR (THRU 3/16) 2.00 2.00 X 0 0 0 DEBORAH MONAHAN DIRECTOR 2.00 2.00 X 0 0 0 STEPHEN LARCEN DIRECTOR 2.00 2.00 X 0 724236 99900 REGINA CUSSON DIRECTOR (THRU 8/16) 2.00 2.00 X 0 0 0 LYNNE QUINTAL-HILL DIRECTOR 2.00 2.00 X 0 0 0 MARK TRAMONTOZZI DIRECTOR 2.00 2.00 X 0 0 0 JAMES WATSON MD DIRECTOR 2.00 2.00 X 0 0 0 CAROLYN DRESCHER DIRECTOR 2.00 2.00 X 0 0 0 MARY BARRY MD DIRECTOR 2.00 2.00 X 0 48374 1721 CATINA CABAN-OWEN DIRECTOR (THRU 9/16) 2.00 2.00 X 0 0 0 DIANE WISHNAFSKI DIRECTOR 2.00 2.00 X 0 0 0 CARMEN CID DIRECTOR 2.00 2.00 X 0 0 0 KARLA FOX DIRECTOR/CHAIR 3.00 3.00 X X 0 0 0 ANTHONY JOYCE DIRECTOR/VICE CHAIRMAN 3.00 3.00 X X 0 0 0 DAVID WHITEHEAD FORMER DIRECTOR/PRESIDENT/EVP 0.00 60.00 X 0 969377 71418 BIMAL PATEL DIRECTOR/PRESIDENT 20.00 40.00 X X 0 476135 95399 MARGARET MARCHAK SECRETARY/CLO 3.00 60.00 X 0 660302 141415 DANIEL LOHR SENIOR VP/CFO 30.00 30.00 X 0 576066 64342 CAROLYN TRANTALIS VP OPERATIONS EAST REGION 30.00 30.00 X 0 288714 50224 ROBERT SIDMAN MD VP MEDICAL AFFAIRS EAST REGION 40.00 X 476272 0 41235 KAREN JAMES VP HUMAN RESOURCES EAST REGION 30.00 30.00 X 0 150219 35596 SERGIO CASILLA MD PHYSICIAN 40.00 X 659293 0 55946 ZHENXIANG LIU MD PHYSICIAN 40.00 X 499301 0 51677 RICHARD GOULDING MD PHYSICIAN 40.00 X 400039 0 54383 WILLIAM HORGAN MD PHYSICIAN 40.00 X 390483 0 52048 NADER BAHADORY MD PHYSICIAN 40.00 X 393615 0 59472 MARY BYLONE FORMER VP PATIENT CARE EAST REGIO 40.00 X 0 350170 24332 PETER SHEA FORMER MEDICAL DIRECTOR 40.00 X 0 197152 29825 2819003 4440745 928933 196 1 1 0 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 60693 MEDICAL SERVICES 2806438 HARTFORD HEALTHCARE LABORATORIES 80 SEYMOUR STREET HARTFORD CT 06102 LAB SERVICES 1091730 NORTH AMERICAN PARTNERS IN ANESTHESIA 68 SOUTH SERVICE RD MELVILLE NY 11747 MEDICAL SERVICES 862008 LOCUMTENES PO BOX 405547 ATLANTA GA 30384 MEDICAL SERVICES 712551 DVA HEALTHCARE OF NORWICH LLC PO BOX 781607 PHILADELPHIA PA 19178 MEDICAL SERVICES 546908 30 95410 87 417246 13239 512743 OUTPATIENT 900099 124404721 124404721 INPATIENT 900099 117201207 117201207 EMERGENCY DEPT 900099 64668888 64668888 LAB COURIER SERVICE 621500 2412028 2412028 EHR REVENUE 900099 39218 39218 308726062 831985 831985 1731711 2475866 -744155 -744155 -744155 74748467 57100 66909675 41655 7838792 15445 7854237 7854237 28080 95410 52640 -24560 -24560 428555 323572 104983 104983 CAFETERIA 722320 1163479 1163479 PURCHASE DISCOUNTS 900099 409840 409840 CONTRACT SERVICES 621400 385653 385653 376883 375360 1523 2335855 319597150 307484887 2413551 9185969 139537 139537 10050 10050 517507 517507 110203665 102979500 7083897 140268 4635955 4311807 318275 5873 16611120 15449663 1140413 21044 7786833 7242374 534594 9865 31476 31476 1282702 1282702 17111241 14899675 2211566 22104 7809 14295 4132875 3181022 950036 1817 14397431 7061323 7336108 5758651 513148 5245503 232706 120730 111976 14493 14493 3144871 3144871 10920911 7177855 3743056 13228471 5454203 7774268 2996067 2185052 811015 MEDICAL EXPENSES 40625083 40625083 BAD DEBT 8148518 8148518 MAINT/SERVICE CONTRACTS 5340571 4067378 1273193 LAB EXPENSES 4915923 4915923 3628488 2294721 836631 497136 275837249 230785371 44361580 690298 3266435 2302732 189891820 46966017 142 64 36077266 37772680 8773 7885 3679710 3822252 3850954 4061424 314440561 200112441 119579223 114328120 69130964 27637016 92436024 340919004 15947783 11944650 533869094 589761844 18341304 15572886 1395217 1322594 146578917 155862333 166315438 172757813 X 355541298 404269648 3907265 4543173 8105093 8191210 367553656 417004031 533869094 589761844 X 43759901 25299227 -19608753 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 31476 0 0 0 31476 0 PART II-B, LINE 1: LOBBYING ACTIVITIES ARE PRIMARILY COMPRISED OF THE PORTION OF DUES PAID TO THE CONNECTICUT HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT THOSE INSTITUTIONS DEEM LOBBYING BASED ON THE MEDICARE DEFINITION. 7465627 384004 7849631 7558064 -92437 7465627 7100798 459483 2217 7558064 6513852 591457 4511 7100798 5813863 705215 5226 6513852 0.73000 0.27000 0 1 1 5011878 5011878 10381267 119378436 75859976 53899727 65481009 35698812 29782197 109693345 88553653 21139692 4494626 4494626 114328120 CT HOSP LAB 12632 C ENDOWMENT LLC 340906372 F 340919004 DUE TO 3RD PARTIES 6879937 EMPLOYEE RELATED OBLIGATIONS 62840113 SELF-INSURED PROF LIABILITY 8932886 CAPITAL LEASE OBLIGATIONS 6938228 OTHER LIABILITIES 4571139 DUE TO AFFILIATES 5661723 TAX EXEMPT SERIES E BOND PREMIUM 1338239 LT INTERCOMPANY DEBT SERIES E 58700068 155862333 PART V, LINE 4: THE PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE MEANT TO PROVIDE LONG TERM SUPPORT FOR CAPITAL AND OPERATING PROGRAMS FOR THE HOSPITAL IN ACCORDANCE WITH THE DONOR'S WISHES. GOLF TOURNAMENT 77005 57805 19200 9180 10820 9778 3625 SEDER GOLF TOURNAMENT 46485 37605 8880 1115 6142 9904 2076 123490 95410 28080 10295 16962 19682 5701 52640 -24560 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 1514083 1514083 0.00570 61534651 38672617 22862034 0.08540 63048734 38672617 24376117 0.09110 549220 549220 0.00210 150114 150114 0.00060 3160177 3160177 0.01180 55500 55500 0.00020 3915011 3915011 0.01470 66963745 38672617 28291128 0.10580 93793 93793 0.00040 400 400 0.00000 94193 94193 0.00040 0 8148488 2184007 72046496 88168329 -16121833 X 1 1 1 1 THE WILLIAM W BACKUS HOSPITAL 326 WASHINGTON STREET NORWICH CT 06360 X X X THE WILLIAM W BACKUS HOSPITAL 1 0 0 1 X X X X X X X X X 14 1 0 0 1 X SEE PART V X X 1 15 0 1 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X X X 1 X SEE PART V, PAGE 7 X SEE PART V, PAGE 7 X SEE PART V, PAGE 7 X X X X X 1 X 0 X X X X 1 X 0 0 THE WILLIAM W BACKUS HOSPITAL PART V, SECTION B, LINE 5: TO SOLICIT INPUT FROM KEY INFORMANTS AND INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS ALSO IMPLEMENTED AS PART OF THIS PROCESS. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS AND A VARIETY OF OTHER COMMUNITY LEADERS INCLUDING THE FOLLOWING: AMERICAN AMBULANCE SERVICE, INC. AMERICAN RED CROSS BLOOD SERVICES BACKUS HOSPITAL CATHOLIC CHARITIES GENERATIONS FAMILY HEALTH CENTER, INC. MOHEGAN TRIBE NORWICH ADULT EDUCATION / RELIANCE HOUSE, INC. ROSE CITY SENIOR CENTER SOUTHEASTERN REGIONAL ACTION COUNCIL ST. VINCENT DE PAUL PLACE NORWICH THREE RIVERS COMMUNITY COLLEGE NURSING PROGRAM TOWN OF WINDHAM TVCCA UNCAS HEALTH DISTRICT UNITED COMMUNITY AND FAMILY SERVICES WINDHAM HOSPITAL WINDHAM REGION NO FREEZE PROJECTPARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE OVERALL COMMUNITY. KEY INFORMANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE. KEY INFORMANTS WERE ASKED TO RATE THE DEGREES TO WHICH VARIOUS HEALTH ISSUES WERE A PROBLEM IN THE HARTFORD REGION. FOLLOW-UP QUESTIONS ASKED THEM TO DESCRIBE WHY THEY IDENTIFIED AREAS AS SUCH, AND HOW THESE MIGHT BE BETTER ADDRESSED.AFTER REVIEWING THE COMMUNITY HEALTH NEEDS ASSESSMENT FINDINGS, THE COMMUNITY REPRESENTATIVES MET ON JUNE 11, 2015 TO DETERMINE THE HEALTH NEEDS TO BE PRIORITIZED FOR ACTION. DURING A DETAILED PRESENTATION OF THE CHNA FINDINGS, THE HOSPITAL USED AUDIENCE RESPONSE SYSTEM (ARS) TECHNOLOGIES TO LEAD STEERING COMMITTEE MEMBERS THROUGH A PROCESS OF UNDERSTANDING KEY LOCAL DATA FINDINGS (AREAS OF OPPORTUNITY) AND RANKING IDENTIFIED HEALTH ISSUES AGAINST THE FOLLOWING ESTABLISHED, UNIFORM CRITERIA: MAGNITUDE, IMPACT/SERIOUSNESS/FEASIBILITY, CONSEQUENCES OF INACTION. FROM THIS EXERCISE, THE AREAS OF OPPORTUNITY WERE PRIORITIZED AS FOLLOWS BY THE COMMITTEE: MENTAL HEALTH, NUTRITION, PHYSICAL ACTIVITY & WEIGHT STATUS, DIABETES, SUBSTANCE ABUSE, CANCER, HEART DISEASE AND STROKE.PART V, SECTION B, LINE 7AWWW.BACKUSHOSPITAL.ORG/ABOUT-US/COMMUNITY-OUTREACH/HEALTH-NEEDS-ASSESSMENT THE WILLIAM W BACKUS HOSPITAL PART V, SECTION B, LINE 7D: THE NEEDS ASSESSMENT WAS PUBLISHED IN MARCH 2015 AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE. IN ADDITION, COPIES WERE MADE AVAILABLE TO OUR COMMUNITY PARTNERS. THE WILLIAM W BACKUS HOSPITAL PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, BACKUS HOSPITAL DETERMINED THAT IT COULD ONLY EFFECTIVELY FOCUS ON THOSE WHICH IT DEEMED MOST PRESSING, MOST UNDER-ADDRESSED, AND MOST WITHIN ITS ABILITY TO INFLUENCE:* NUTRITION* PHYSICAL ACTIVITY & WEIGHT (OBESITY)* CANCER* DIABETES* HEART DISEASE & STROKE* RESPIRATORY DISEASES* ACCESS TO CARE* ORAL HEALTH* DEMENTIA* ALZHEIMER'S DISEASE* MENTAL HEALTH & SUBSTANCE USE (INCLUDING TOBACCO USE).BACKUS HOSPITAL IS IMPLEMENTING INITIATIVES THAT WILL RESPOND TO THESE NEEDS. ADDITIONAL NEEDS IDENTIFIED AS "AREAS OF OPPORTUNITIES" WERE NOT DEEMED AS SIGNIFICANT NEEDS AND DID NOT RANK HIGHLY ENOUGH TO EARN A PRIORITIZED RANKING. AREAS OF OPPORTUNITY, IDENTIFIED BUT NOT PRIORITIZED: * INFANT HEALTH AND FAMILY PLANNING * INJURY & VIOLENCE* POTENTIALLY DISABLING CONDITIONSINFANT HEALTH AND FAMILY PLANNING: BACKUS HOSPITAL HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS FAMILY PLANNING AND INFANT HEALTH. OTHER COMMUNITY PARTNERS SUCH AS UCFS AND MADONNA PLACE HAVE INFRASTUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED.INJURY & VIOLENCE: BACKUS HOSPITAL BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF SAFE FUTURES, THE FORMER WOMEN'S SHELTER. BACKUS IS A COMMUNITY PARTNER AND HAS ARRANGED FOR SAFE FUTURES TO OPEN AN OFFICE IN THE MEDICAL OFFICE BUILDING, ADJOINING THE HOSPITAL. BACKUS HOSPITAL HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS INJURY PREVENTION.POTENTIALLY DISABLING CONDITIONS: BACKUS HOSPITAL HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS POTENTIALLY DISABLING CONDITIONS. THE WILLIAM W BACKUS HOSPITAL PART V, SECTION B, LINE 13H: FAMILY ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE ALSO INCLUDE FAMILY SIZE, EMPLOYMENT STATUS, FINANCIAL OBLIGATIONS, AND AMOUNT AND FREQUENCY OF HEALTH CARE EXPENSES. THE WILLIAM W BACKUS HOSPITAL PART V, SECTION B, LINE 15E: IN ADDITION, PATIENT MAY ASK A NURSE, PHYSICIAN, CHAPLAIN, OR STAFF MEMBER FROM PATIENT REGISTRATION, PATIENT FINANCIAL SERVICES, CASE COORDINATION, OR SOCIAL SERVICES ABOUT INITIATING THE FINANCIAL ASSISTANCE APPLICATION PROCESS.THE WILLIAM W BACKUS HOSPITAL:PART V, LINE 16A, FAP WEBSITE: HTTPS://BACKUSHOSPITAL.ORG/FOR-PATIENTS-FAMILIES/FINANCIAL- INSURANCE-INFO/FINANCIAL-COVERAGE/THE WILLIAM W BACKUS HOSPITAL:PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://BACKUSHOSPITAL.ORG/FOR-PATIENTS- FAMILIES/FINANCIAL-INSURANCE-INFO/FINANCIAL-COVERAGE/THE WILLIAM W BACKUS HOSPITAL:PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://BACKUSHOSPITAL.ORG/FOR-PATIENTS -FAMILIES/FINANCIAL-INSURANCE-INFO/FINANCIAL-COVERAGE/ THE WILLIAM W BACKUS HOSPITAL PART V, SECTION B, LINE 16I: PATIENTS ARE INFORMED DIRECTLY BY STAFF OF THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY. THE WILLIAM W BACKUS HOSPITAL PART V, SECTION B, LINE 22D: FOR UNINSURED PATIENTS, PUBLISHED RATES ARE REDUCED BY THE PERCENTAGE DEFINED BY THE IRS AS THE AMOUNTS GENERALLY BILLED USING A "LOOK BACK" RETROSPECTIVE CALULATION TO CALCULATE THE AMOUNT ALLOWED BY GOVERNMENTAL (MEDICARE AND MEDICAID) AND COMMERCIALLY INSURED PATIENTS. THIS PERCENTAGE IS UPDATED ON AN ANNUAL BASIS. THE ANNUAL CALCULATION METHODOLOGY AND THE PERCENTAGES ARE LOCATED IN APPENDIX A OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. UNDERINSURED PATIENTS WILL NOT BE BILLED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) TO INSURED PATIENTS. 11 1 - BACKUS OUTPATIENT CARE CENTER 111 SALEM TURNPIKE NORWICH CT 06360 OUTPATIENT SERVICES 2 - MEDICAL OFFICE BUILDING 330 WASHINGTON STREET NORWICH CT 06360 RADIATION THERAPY/LAB 3 - COLCHESTER BACKUS HEALTH CENTER 163 BROADWAY COLCHESTER CT 06415 RADIOLOGY/LAB/PRIMARY CARE 4 - MONTVILLE BACKUS HEALTH CARE 80 NORWICH/NEW LONDON TURNPIKE UNCASVILLE CT 06382 RADIOLOGY/LAB/PRIMARY CARE 5 - LEDYARD BACKUS HEALTH CENTER 2 LORENZ PARKWAY LEDYARD CT 06339 LAB/PRIMARY CARE 6 - FAMILY HEALTH CENTER AT CROSSROADS 196 PARKWAY SOUTH WATERFORD CT 06385 PRIMARY CARE/REHAB/ORTHOPEDICS 7 - INFECTIOUS DISEASE CLINIC 107 LAFAYETTE STREET NORWICH CT 06360 CLINIC 8 - NORTH STONINGTON BACKUS HEALTH CENTER 82 NORWICH-WESTERLY ROAD NORTH STONINGTON CT 06359 PRIMARY CARE 9 - NORWICHTOWN BACKUS PATIENT SERVICE CTR 55 TOWN STREET NORWICH CT 06360 LAB 10 - PLAINFIELD EMERGENCY CENTER 582 NORWICH ROAD PLAINFIELD CT 06374 LAB/RADIOLOGY/EMERGENCY SERVICES 11 - JEWETT CITY PATIENT SERVICE CENTER 70 MAIN STREET JEWETT CITY CT 06351 LAB PART I, LINE 3C: BACKUS HOSPITAL USED FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. IN ADDITION, THE HOSPITAL TAKES INTO CONSIDERATION, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND OTHER FAMILY ELIGIBILITY CRITERIA SUCH AS FAMILY SIZE, EMPLOYMENT AND FINANCIAL OBLIGATIONS. PART I, LINE 7: THE ORGANIZATION UTILIZED THE RATIO OF COST TO CHARGE (RCC), DERIVED FROM THE FY2016 MEDICARE COST REPORT WHICH ALREADY INCORPORATES OR IS NET OF NON-PATIENT CARE COSTS (I.E. BAD DEBT, NON-PATIENT CARE, ETC). THE RATIO WAS FURTHER REDUCED TO INCORPORATE THE DIRECTLY INDENTIFIED COMMUNTIY EXPENSES. THIS COST TO CHARGE RATIO WAS USED TO CALCULATE COSTS FOR PART I LINES 7A & B. THE COSTS ASSOCIATED WITH THE ACTIVITIES REPORTED ON PART I, LINE 7E WERE CAPTURED USING ACTUAL TIME MULTIPLIED BY AN AVERAGE SALARY RATE. COSTS REPORTED IN PART III, SECTION B 6, WERE CALCULATED FROM THE MEDICARE COST REPORT AND REDUCED FOR MEDICARE COSTS PREVIOUSLY REPORTED ON PART I, LINES 7 F & G. 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 $ 8,148,488. PART III, LINE 4: PLEASE SEE THE TEXT OF THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE BEGINNING ON PAGE 20 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: PROVIDING FOR THOSE IN NEED, INCLUDING MEDICARE PATIENTS AND SERVING ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY IS AN ESSENTIAL PART OF THE ORGANIZATION'S MISSION. THE HOSPITAL SERVES ALL PATIENTS WITHOUT REGARD TO ANY PAYMENT SHORTFALL. THEREFORE THE MEDICARE SHORTFALL SHOULD BE CONSIDERED TO BE A COMMUNITY BENEFIT. THE ORGANIZATION'S MEDICARE COST REPORT WAS USED TO ACCUMULATE ACTUAL COSTS RELATED TO PART III, SECTION B, LINE 6. PART III, LINE 9B: THE FINANCIAL ASSISTANCE POLICY STATES:IN THE EVENT A PATIENT FAILS TO QUALIFY FOR FINANCIAL ASSISTANCE OR FAILS TO PAY THEIR PORTION OF DISCOUNTED CHARGES PURSUANT TO THIS POLICY, AND THE PATIENT DOES NOT PAY TIMELY THEIR OBLIGATIONS TO THE HOSPITAL, THE HOSPITAL RESERVES THE RIGHT TO BEGIN COLLECTION ACTIONS, INCLUDING BUT NOT LIMITED TO, IMPOSING WAGE GARNISHMENTS OR LEINS ON PRIMARY RESIDENCES, INSTITUTING LEGAL ACTION AND REPORTING THE MATTER TO ONE OR MORE CREDIT RATING AGENCIES. FOR THOSE PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THE HOSPITAL'S OUTSTANDING ACCOUNTS, THE HOSPITAL MAY OFFER EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS, WILL NOT IMPOSE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES AND WILL CEASE ALL COLLECTION EFFORTS.NO EXTRAORDINARY COLLECTION ACTIONS (ECA) WILL BE INITIATED DURING THE FIRST 120 DAYS FOLLOWING THE FIRST POST-DISCHARGE BILLING STATEMENT TO A VALID ADDRESS OR DURING THE TIME THAT PATIENT'S FINANCIAL ASSISTANCE APPLICATION IS PROCESSING. BEFORE INITIATING ANY ECA, A NOTICE WILL BE PROVIDED TO THE PATIENT 30 DAYS PRIOR TO INITIATING SUCH AN EVENT.IF THE PATIENT APPLIES FOR ASSISTANCE WITHIN 240 DAYS FROM THE FIRST NOTIFICATION OF THE SELF-PAY BALANCE, AND IS GRANTED ASSISTANCE, ANY ECA'S SUCH AS NEGATIVE REPORTING TO A CREDIT BUREAU OR LIENS THAT HAVE BEEN FILED WILL BE REMOVED. PART VI, LINE 2: BACKUS HOSPITAL USES EMERGENCY ROOM DATA TO TRACK INCREASES IN MEDICAL CONDITIONS SUCH AS FALLS, FLU, DRUG OVERDOSES, ETC. THE SAME APPROACH IS TAKEN IN OUR OUTPATIENT CLINICS. WE PERIODICALLY CANVAS OUR SOCIAL WORK/CASE MANAGEMENT STAFF AS TO WHAT THEY ARE SEEING AND HEARING ABOUT AS THEY WORK WITH PATIENTS. WE ALSO TRACK REQUESTS FROM OTHER ENTITIES SUCH AS AREA NON-PROFITS, LOCAL GOVERNMENTAL AGENCIES AND PUBLIC SCHOOLS. THESE REQUESTS OFTEN REFLECT GROWING NEEDS AND ISSUES IN OUR COMMUNITY. PART VI, LINE 3: BACKUS HOSPITAL WILL PROVIDE INFORMATION ABOUT ITS FINANCIAL ASSISTANCE POLICY AS FOLLOWS:(1) PROVIDE SIGNS REGARDING THIS POLICY AND WRITTEN PLAIN LANGUAGE SUMMARY INFORMATION DESCRIBING THE POLICY ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION IN THE EMERGENCY DEPARTMENT, LABOR AND DELIVERY AREAS AND OTHER PATIENT REGISTRATION AREAS;(2) PROVIDE TO EACH PATIENT WRITTEN PLAIN LANGUAGE SUMMARY INFORMATION DESCRIBING THE POLICY ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSION, PATIENT REGISTRATION, DISCHARGE, BILLING AND COLLECTION WRITTEN COMMUNICATIONS;(3)MAKE PAPER COPIES OF THE POLICY, FINANCIAL ASSISTANCE APPLICATION, AND PLAIN LANGUAGE SUMMARY OF THE POLICY AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH BY MAIL AND IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY, INCLUDING THE EMERGENCY ROOM AND ADMISSION AREAS;(4) POST THE POLICY, PLAIN LANGUAGE SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ON THE WEBSITE WITH CLEAR LINKAGE TO SUCH DOCUMENTS ON THE HOSPITAL'S HOME PAGE;(5) EDUCATE ALL ADMISSION AND REGISTRATION PERSONNEL REGARDING THE POLICY SO THAT THEY CAN SERVE AS AN INFORMATIONAL RESOURCE TO PATIENTS REGARDING THE POLICY AND (6) INCLUDE THE TAG LINE "PLEASE ASK ABOUT OUR FINANCIAL ASSISTANCE POLICY" IN BACKUS WRITTEN PUBLICATIONS. PART VI, LINE 4: THE TOTAL POPULATION OF THE BACKUS HOSPITAL PRIMARY SERVICE AREA IS 391,769. 85.4% OF THE POPULATION IS WHITE WITH 4.4% BLACK. PEOPLE OF HISPANIC ORIGIN MAKE UP 8.9%. CHILDREN AGE 0-17 MAKE UP 21.8%, 18-64 64.3% AND SENIORS ACCOUNT FOR 13.9% OF THE POPULATION. THE POPULATION LIVING IN POVERTY IS 9.2% WITH THOSE LIVING BELOW 200% FPL IS 22.5%. 10.9% HAVE NO HIGH SCHOOL DIPLOMA.THE REGION IS A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. PART VI, LINE 5: A REGIONAL BOARD GOVERNS BACKUS, WINDHAM AND NATCHAUG HOSPITALS. THE BOARD IS RESPONSIBLE FOR MAINTAINING OUTSTANDING QUALITY SERVICES AND CREDENTIALS ITS MEDICAL STAFF. ALL OF THE DIRECTORS RESIDE IN OUR SERVICE AREA AND ARE NEITHER EMPLOYEES, FAMILY MEMBERS, NOR CONTRACTORS OF THE HOSPITAL. PART VI, LINE 6: HARTFORD HEALTHCARE CORPORATION (HHC) IS ORGANIZED AS A SUPPORT ORGANIZATION TO GOVERN, MANAGE AND PROVIDE SUPPORT SERVICES TO ITS AFFILIATES. HHC, THROUGH ITS AFFILIATES INCLUDING HARTFORD HOSPITAL, STRIVES TO IMPROVE HEALTH USING THE "TRIPLE AIM" MODEL: IMPROVING QUALITY AND EXPERIENCE OF CARE; IMPROVING HEALTH OF THE POPULATION (POPULATION HEALTH) AND REDUCING COSTS. THE STRATEGIC PLANNING AND COMMUNITY BENEFIT COMMITTEE OF THE HHC BOARD OF DIRECTORS ENSURES THE OVERSIGHT FOR THESE SERVICES BY EACH HOSPITAL COMMUNITY. HHC AND ITS AFFILIATES, INCLUDING ALL SUPPORTED ORGANIZATIONS, DEVELOP AND IMPLEMENT PROGRAMS TO IMPROVE THE HEALTH CARE IN OUR SOUTHERN NEW ENGLAND REGION. THIS INCLUDES INITIATIVES TO IMPROVE THE QUALITY AND ACCESSIBILITY OF HEALTH CARE, CREATE EFFICIENCY ON BOTH OUR INTERNAL OPERATIONS AND THE UTILIZATION OF HEALTH CARE, AND PROVIDE PATIENTS WITH THE MOST TECHNICALLY ADVANCED AND COMPASSIONATE COORDINATED CARE. IN ADDITION, HHC CONTINUES TO TAKE IMPORTANT STEPS TOWARD ACHIEVING ITS VISION OF BEING "NATIONALLY RESPECTED FOR EXCELLENCE IN PATIENT CARE AND MOST TRUSTED FOR PERSONALIZED, COORDINATED CARE".THE AFFILIATION WITH HHC CREATES A STRONG, INTEGRATED HEALTH CARE DELIVERY SYSTEM WITH A FULL CONTINUUM OF CARE ACROSS A BROADER GEOGRAPHIC AREA. THIS ALLOWS THE SMALL COMMUNITIES EASY AND EXPEDIENT ACCESS TO THE MORE EXTENSIVE AND SPECIALIZED SERVICES THE HOSPITAL IS ABLE TO OFFER. THIS INCLUDES CONTINUING EDUCATION OF HEALTH CARE PROFESSIONALS AT ALL THE AFFILIATED INSTITUTIONS THROUGH THE CENTER OF EDUCATION, SIMULATION AND INNOVATION LOCATED AT HARTFORD HOSPITAL. THE AFFILIATION FURTHER ENHANCES THE AFFILIATE'S ABILITIES TO SUPPORT THEIR MISSIONS, IDENTITY, AND RESPECTIVE COMMUNITY ROLES. THIS IS ACHIEVED THROUGH INTEGRATED PLANNING AND COMMUNICATION TO MEET THE CHANGING NEEDS OF THE REGION. THIS INCLUDES RESPONSIBLE DECISION MAKING AND APPROPRIATE SHARING OF SERVICES, RESOURCES AND TECHNOLOGIES, AS WELL AS CONTAINMENT STRATEGIES. PART VI, LINE 7, REPORTS FILED WITH STATES CT 1 CHAMBER OF COMMERCE OF SE CT 914 HARTFORD TPKE WATERFORD CT 06385 060475490 501C6 11500 SPONSORSHIPSPONSORSHIP NORTHEAST CT COUNCIL OF GOVERNMENT 125 PUTNAM PIKE DAYVILLE CT 06241 060850466 DAYVILLE CT 20000 PARAMEDIC PROGRAM CT SPORTS FOUNDATION INC 445 BOSTON POST RD STE 203B OLD SAYBROOK CT 06475 061240574 501C3 6000 SPONSORSHIP SPRAGUE COMMUNITY CENTER 22 WEST MAIN STREET BALTIC CT 06330 222512537 SPRAGUE CT 10000 SPONSORSHIP CENTER FOR HOSPICE CARE 227 DUNHAM STREET NORWICH CT 06360 222667260 501C3 10000 SPONSORSHIP AMERICAN CANCER SOCIETY 825 BROOK STREET ROCKY HILL CT 06067 131788491 501C3 7100 SPONSORSHIP UNITED WAY OF SOUTHEASTERN CT RT 12 PO BOX 375 GALES FERRY CT 06335 060771393 501C3 10000 SPONSORSHIP DR MARTIN LUTHER KING SCHOLARSHIP FUND PO BOX 1308 NEW LONDON CT 06320 066107846 501C3 10000 SPONSORSHIP WINDHAM COMMUNTIY MEMORIAL HOSPITAL AUXILIARY 112 MANSFIELD AVE WILLIMANTIC CT 06226 060677728 501C3 5350 SPONSORSHIP 8 1 SCHOLARSHIP 3 10050 PART I, LINE 2: DONATIONS MADE FOR LOCAL EVENTS, SUCH AS SPONSORSHIPS ARE TYPICALLY ATTENDED BY HOSPITAL EMPLOYEES. THREE SCHOLARSHIPS IN THE AMOUNT OF $3350 EACH ARE AWARDED TO STUDENTS WHO WILL ATTEND SCHOOL EITHER FOR NURSING OR IN THE MEDICAL FIELD. THE APPLICANTS ARE REVIEWED BY THE SCHOLARSHIP COMMITTEE OF THE AUXILIARY AND WINNERS ARE BASED ON ACADEMICS AS WELL AS COMMUNITY SERVICE. X 0 0 X X X X 1 1 0 0 0 0 0 1 0 STEPHEN LARCEN DIRECTOR 0 434751 0 184730 0 104755 0 56425 0 43475 0 824136 0 0 DAVID WHITEHEAD FORMER DIRECTOR/PRESIDENT/EVP 0 564363 0 316867 0 88147 0 22260 0 49158 0 1040795 0 0 BIMAL PATEL DIRECTOR/PRESIDENT 0 355464 0 118896 0 1775 0 76741 0 18658 0 571534 0 0 MARGARET MARCHAK SECRETARY/CLO 0 463399 0 166749 0 30154 0 93339 0 48076 0 801717 0 0 DANIEL LOHR SENIOR VP/CFO 0 373623 0 106207 0 96236 0 22260 0 42082 0 640408 0 74000 CAROLYN TRANTALIS VP OPERATIONS EAST REGION 0 232424 0 55094 0 1196 0 15473 0 34751 0 338938 0 0 ROBERT SIDMAN MD VP MEDICAL AFFAIRS EAST REGION 372768 0 84603 0 18901 0 14310 0 26925 0 517507 0 0 0 KAREN JAMES VP HUMAN RESOURCES EAST REGION 0 133970 0 16000 0 249 0 8237 0 27359 0 185815 0 0 SERGIO CASILLA MD PHYSICIAN 518036 0 140646 0 611 0 14310 0 41636 0 715239 0 0 0 ZHENXIANG LIU MD PHYSICIAN 465945 0 32930 0 426 0 12560 0 39117 0 550978 0 0 0 RICHARD GOULDING MD PHYSICIAN 299829 0 81953 0 18257 0 14310 0 40073 0 454422 0 0 0 WILLIAM HORGAN MD PHYSICIAN 303612 0 82563 0 4308 0 14310 0 37738 0 442531 0 0 0 NADER BAHADORY MD PHYSICIAN 328715 0 64156 0 744 0 22260 0 37212 0 453087 0 0 0 MARY BYLONE FORMER VP PATIENT CARE EAST REGIO 0 116850 0 0 0 233320 0 6360 0 17972 0 374502 0 0 PETER SHEA FORMER MEDICAL DIRECTOR 0 194252 0 0 0 2900 0 6360 0 23465 0 226977 0 0 PART I, LINE 1A STARTING IN 2013, THE ORGANIZATION IMPLEMENTED A WRITTEN TAX GROSS UP POLICY WHICH RESTRICTS THE USE OF FUTURE GROSS UPS. PART I, LINES 4A-B LUMP SUM SEVERANCE PAYMENT WAS MADE TO MARY BYLONE IN THE AMOUNT OF $231,614. HARTFORD HEALTHCARE CORPORATION MAINTAINS A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). PARTICIPANTS INCLUDE CERTAIN OFFICERS AND KEY EMPLOYEES AT THE PRESIDENT, EXECUTIVE VICE PRESIDENT, SENIOR VICE PRESIDENT AND VICE PRESIDENT LEVELS. CONTRIBUTIONS ARE MADE BY HARTFORD HEALTHCARE CORPORATION TO THE PLAN BASED ON A PERCENTAGE OF THE PARTICIPANT'S COMPENSATION. PARTICIPANTS VEST IN THE PLAN AT THE EARLIER OF REACHING AGE 55 AND HAVING 5 YEARS OF SERVICE, DEATH, DISABLIITY, INVOLUNTARY SEPARATION WITHOUT REASONABLE CAUSE OR UPON REACHING AGE 65. EACH PARTICIPANT CEASES TO BE ELIGIBLE FOR FURTHER CONTRIBUTIONS BY HARTFORD HEALTHCARE CORPORATION ON THE DATE OF THE PARTICIPANT'S SEPARATION FROM SERVICE. PARTICIPANTS RECEIVE A ONE-TIME LUMP SUM PAYMENT OF THE ACCUMULATED AMOUNT DURING THE 30-DAY PERIOD FOLLOWING THE PARTICIPANT'S SEPARATION FROM SERVICE. 2015 SERP ACCRUALS MADE ON BEHALF OF THE FOLLOWING INDIVIDUALS: MR. BIMAL PATEL $44,157 MS. MARGARET MARCHAK $56,789 2015 SERP PAYMENTS WERE MADE TO THE FOLLOWING INDIVIDUALS: MR. DANIEL LOHR $74,000 MR. DAVID WHITEHEAD $69,487* MR. STEPHEN LARCEN $51,590* *FOR THESE INDIVIDUALS, VESTING OCCURRED, CAUSING TAXABLE INCOME. A PORTION OF THE VESTED AMOUNT WAS USED TO PAY THE ASSOCIATED TAX LIABILITY, THE REMAINING BALANCE STAYED IN THE SERP ACCOUNT. PART I, LINE 7 HARTFORD HEALTHCARE CORPORATION, A RELATED ORGANIZATION, HAS A COMPENSATION AT RISK PLAN THAT ENCOURAGES AND REWARDS ACHIEVEMENTS OF SIGNIFICANT FUNCTIONAL GOALS FOR MANAGEMENT THAT CONTRIBUTE TO ORGANIZATION(S) STRATEGIC AND FINANCIAL DIRECTION. THE PLAN UTILIZES MARKET PRACTICE ALIGNMENT TO ENSURE COMPETITIVE RECRUITMENT AND RETENTION. AWARDS ARE BASED ON CEO AND/OR HARTFORD HEALTHCARE CORPORATION'S COMPENSATION COMMITTEE DISCRETIONARY ASSESSMENT OF OVERALL ORGANIZATION PERFORMANCE AND INDIVIDUAL CONTRIBUTION TO RESULTS. FORM 990, PART VI, SECTION A, LINE 6 HARTFORD HEALTHCARE CORPORATION, A NOT-FOR-PROFIT 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF THE WILLIAM W BACKUS HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE ORGANIZATION HAS THE AUTHORITY TO APPROVE/REMOVE MEMBERS OF THE GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE ORGANIZATION HAS THE RIGHT TO REVIEW, APPROVE, DISAPPROVE AND DENY SIGNIFICANT TRANSACTIONS SUCH AS MERGERS, AQUISITIONS, DISSOLUTIONS, ETC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PREPARED BY HARTFORD HEALTHCARE'S STAFF ACCOUNTANT. IT WAS THEN REVIEWED BY AN HHC TAX DEPARTMENT AND INDEPENDENT ACCOUNTING FIRM. THE FORM WAS THEN FORWARDED TO THE ORGANIZATION'S TOP MANAGEMENT INCLUDING THE REGIONAL VP OF FINANCE FOR REVIEW. THE FINAL FORM WAS PROVIDED TO THE ENTIRE BOARD PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE (IRS). ONCE THE ENTIRE PROCESS WAS COMPLETED, THE FORM WAS SIGNED BY THE REGIONAL VP OF FINANCE AND THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C HHC'S CONFLICT OF INTEREST POLICY (POLICY) REQUIRES ALL COVERED INDIVIDUALS, INCLUDING BOARD MEMBERS AND OFFICERS, TO PROVIDE A DISCLOSURE OF RELATIONSHIPS THAT CREATE OR HAVE THE APPEARANCE OF CREATING A CONFLICT OF INTEREST OR COMMITMENT. THE POLICY REQUIRES UPDATES IF CHANGES IN CIRCUMSTANCES ARISE DURING THE YEAR THAT EITHER (A) CREATE A NEW POTENTIAL CONFLICT OF INTEREST OR COMMITMENT OR (B) CHANGE OR ELIMINATE A CONFLICT OF INTEREST OR COMMITMENT PREVIOUSLY DISCLOSED. CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE MAINTAINED BY THE HHC OFFICE OF COMPLIANCE AND INTEGRITY (OCI). EMPLOYEE DISCLOSURES ARE REVIEWED BY OCI IN COLLABORATION WITH THE COVERED INDIVIDUALS' SUPERVISOR WHEN DEEMED APPROPRIATE, TO DETERMINE IF THERE IS A POTENTIAL CONFLICT. OVERSIGHT REVIEW OF EMPLOYEE DISCLOSURES IS PROVIDED BY THE HHC CONFLICT OF INTEREST COMMITTEE (THE COMMITTEE) WHICH INCLUDES REPRESENTATION FROM THE MEDICAL STAFF, THE LEGAL DEPARTMENT, HUMAN RESOURCES, SUPPLY CHAIN MANAGEMENT AND COMPLIANCE. THE COMMITTEE ASSESSES AND MAY RECOMMEND THE CONFLICTING INTEREST EITHER BE (A) ELIMINATED FOR A CONTINUED RELATIONSHIP WITH HHC/BACKUS, OR (B) MANAGED THROUGH A MANAGEMENT PLAN. BOARD MEMBER DISCLOSURES ARE REPORTED TO THE HHC NOMINATING AND GOVERNANCE COMMITTEE FOR DETERMINATIONS OF CONFLICTS AND THE MANAGEMENT OF THEM, WHERE APPLICABLE. FORM 990, PART VI, SECTION B, LINE 15 THE INDEPENDENT EXECUTIVE COMPENSATION COMMITTEE (COMMITTEE) OF THE BOARD OF DIRECTORS OF HARTFORD HEALTHCARE ON BEHALF OF BACKUS HOSPITAL HIRES AN OUTSIDE CONSULTANT, INTEGRATED HEALTHCARE STRATEGIES, A DIVISION OF GALLAGHER BENEFIT SERVICES, INC., TO DETERMINE BEST PRACTICES IN GOVERNING EXECUTIVE COMPENSATION. THE FOLLOWING STEPS WERE TAKEN: - INDEPENDENT EXECUTIVE COMPENSATION COMMITTEE (COMMITTEE) OF THE BOARD OF DIRECTORS OF HARTFORD HEALTHCARE, ON BEHALF OF BACKUS HOSPITAL, ESTABLISHED AND REGULARLY REVIEWS EXECUTIVE COMPENSATION PHILOSOPHY - THE COMMITTEE REGULARLY REVIEWS SCOPE AND DEPTH OF POSITIONS TAKING INTO ACCOUNT COMPLEXITY AND THE FINANCIAL IMPACT AND ACCOUNTABILITY OF ALL "DISQUALIFIED PERSONS" - NATIONAL PEER GROUPS ARE SELECTED FOR COMPARATIVE PURPOSES BASED ON ORGANIZATIONAL SIZE, OPERATING REVENUE, GEOGRAPHY AND OTHER RELEVANT FACTORS - ANALYSIS OF CURRENT TOTAL COMPENSATION VERSUS MARKET IS PERFORMED BY INDEPENDENT THIRD PARTY COMPENSATION CONSULTING FIRM, AND IS REVIEWED BY THE COMMITTEE - RECOMMENDATIONS ARE MADE BASED ON DATA ANALYSIS TO ENSURE APPROPRIATE COMPETITIVE POSITIONING WITHIN PARAMETERS OF COMPENSATION PHILOSOPHY - CEO COMPENSATION IS REVIEWED BY THE COMMITTEE BASED ON COMPARATIVE MARKET INFORMATION AND ORGANIZATIONAL PERFORMANCE - ALL CHANGES ARE REVIEWED AND APPROVED BY EXECUTIVE COMPENSATION COMMITTEE THE CEO COMPENSATION DETERMINATION PROCESS IS REVIEWED ON AN ANNUAL BASIS. ALL OTHER EXECUTIVE COMPENSATION IS REGULARLY REVIEWED FOR SCOPE AND DEPTH OF POSITIONS TAKING INTO ACCOUNT COMPLEXITY AND THE FINANCIAL IMPACT AND ACCOUNTABILITY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE FOR INSPECTION UPON REQUEST AT THE ORGANIZATION'S ADDRESS. FORM 990, PART XI, LINE 9: K-1 PASSTHROUGH -286. TRANSFER TO AFFILIATES -7,360,564. CHANGE IN ASSETS HELD IN TRUST 86,117. CHANGE IN PENSION FUNDING -12,334,020. FORM 990, PART XII, LINE 3B: ALTHOUGH THE ORGANIZATION WAS NOT REQUIRED TO UNDERGO A-133 FEDERAL AUDIT, THE RESULTS WERE INCLUDED IN A CONSOLIDATED A-133 AUDIT PERFORMED AT THE PARENT LEVEL-HARTFORD HEALTHCARE CORPORATION. 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