2016-08-05T10:00:10-05:00 2015-09-30 350921680 CROWE HORWATH LLP 175 Powder Forest Drive Simsbury CT 060897902 990 2014-10-01 060646678 The Charlotte Hungerford Hospital CHAR 8604966728 540 LITCHFIELD STREET PO BOX 988 TORRINGTON CT 067900988 SUSAN M SCHAPP VP FINANCE/TREASURER 2016-08-05 true KRISTIN ANDERSON P01231300 8606789200 2014 2016-12-15 16:53:06Z SUSAN M SCHAPP 540 LITCHFIELD STREET PO BOX 988 TORRINGTON CT 067900988 128622190 false X WWW.CHARLOTTEHUNGERFORD.ORG X 1917 CT TO PROVIDE QUALITY, COMPASSIONATE AND COST EFFECTIVE HEALTHCARE TO THE COMMUNITY OF NORTHWESTERN CONNECTICUT. 16 14 1254 159 1130944 -158020 3170907 3042196 118627892 117560638 3182192 3147645 479250 457183 125460241 124207662 12000 12000 0 0 73040987 71960031 0 0 386360 49026972 50378090 122079959 122350121 3380282 1857541 137043425 133432509 52361370 62057302 84682055 71375207 THE CHARLOTTE HUNGERFORD HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY COEXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGAMS FOR THE ELDERLY, HANDICAPPED, THE MEDICALLY UNDERSERVED AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. false false 107785563 12000 116691901 DURING FY 2015 THE HOSPITAL CONTRIBUTED OVER 14,000 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTHCARE NEEDS OF THE COMMUNITY. THE VALUE OF THIS CONTRIBUTION IS APPROXIMATELY $115,000, WHICH IS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS IN BOTH PATIENT SERVICES AND OTHER "WELLNESS" PROGRAMS. IN ADDITION THE HOSPITAL GRANTED CHARITY CARE IN THE AMOUNT OF $695,328 DURING FISCAL YEAR 2015. THE CHARLOTTE HUNGERFORD HOSPITAL RENDERED THE FOLLOWING SERVICES DURING FY 2015: INPATIENT SERVICES: DISCHARGES 6,030 PATIENT DAYS 26,064 SPECIAL SERVICES: OPERATING ROOM CASES 3,741 AMBULATORY SURGERY CASES 3,031 ENDOSCOPY CASES 964 AMBULATORY MEDICAL CASES 2,494 WOUND CARE CASES 6,445 POST ANESTHESIA CARE UNIT CASES 2,180 DELIVERY ROOM DELIVERIES 447 RESPIRATORY THERAPY TREATMENTS 36,758 PULMONARY REHAB TESTS 5,114 PULMONARY FUNCTION LAB TESTS 1,710 CARDIO DIAGNOSTIC EXAMS 12,660 EEG EXAMS 232 PHYSICAL THERAPY TREATMENTS 37,027 CARDIAC REHAB TREATMENTS 3,570 SPEECH THERAPY TREATMENTS 759 OCCUPATIONAL THERAPY TREATMENTS 3,803 SLEEP STUDY TESTS 548 DIAGNOSTIC RADIOLOGY EXAMS 25,830 MAMMOGRAPHY EXAMS 9,185 NUCLEAR MEDICINE EXAMS 762 ULTRASOUND EXAMS 9,325 C.A.T. SCAN EXAMS 14,035 P.E.T. SCAN EXAMS 211 M.R.I. EXAMS 1,279 SPECIAL PROCEDURES (RADIOLOGY) EXAMS 1,232 RADIATION THERAPY TREATMENTS 6,766 LABORATORY TESTS 545,137 PSYCHIATRIC CLINIC VISITS 37,118 PHP-ADULT/ADOLESCENT VISITS 4,833 RENAL DIALYSIS VISITS 274 EMERGENCY DEPARTMENT VISITS 35,607 OUTPATIENT DIABETES PROGRAM VISITS 6,699 WALK IN CENTER VISITS 13,558 PROFESSIONAL SERVICE CONSULTS 122,425 HUNGERFORD EMERGENCY MEDICAL CENTER: CARDIAC REHAB TREATMENTS 1,513 DIAGNOSTIC RADIOLOGY EXAMS 3,669 LABORATORY TESTS 16,827 EMERGENCY DEPARTMENT VISITS 6,823 PULMONARY REHAB TESTS 1,728 107785563 true true false true false false false false false true true false false false true true true false false false false false false false true false true true false true true false false false false false false false true false false false false false true false true false true 216 0 true 1254 true true true false false false false false false false false false X 16 14 false false false false false false false true true false false true true true true true true true true true true CT X SUSAN M SCHAPP 8604966728 540 LITCHFIELD STREET TORRINGTON CT 06790 DAVID J FRAUENHOFER SECRETARY 8.00 X X 0 0 0 JOHN JANCO CHAIRMAN 8.00 X X 0 0 0 EDWARD ARUM GOVERNOR 8.00 X 0 0 0 RICHARD DUTTON MD GOVERNOR 8.00 X 0 0 0 GLADYS CERRUTO GOVERNOR 8.00 X 0 0 0 JAMIE GREG GOVERNOR 8.00 X 0 0 0 KENDRICK HOM MD GOVERNOR 40.00 X 290110 0 36960 JOHN LAVIERI GOVERNOR 8.00 X 0 0 0 DIANE LIBBY CPA VICE CHAIRMAN 8.00 X 0 0 0 JAMES O' LEARY GOVERNOR 8.00 X 0 0 0 EDWIN G BOOTH JR GOVERNOR 8.00 X 0 0 0 FRANK BUONOCORE JR GOVERNOR 8.00 X 0 0 0 STEPHANIE FOWLER MD GOVERNOR 8.00 X 0 0 0 MICHAEL PATTERSON GOVERNOR 8.00 X 0 0 0 CHARLES W RORABACK GOVERNOR 8.00 X 0 0 0 ANDREW SZCZEPENSKI MD GOVERNOR 8.00 X 3591 0 363 DANIEL J MCINTYRE CEO/PRESIDENT 60.00 X 491615 0 92994 SUSAN M SCHAPP VP FINANCE/ TREASURER 60.00 X 311491 0 56463 JOHN J CAPOBIANCO VP OPERATIONS 60.00 X 273477 0 50725 MARK PRETE MD VP MEDICAL AFFAIRS 60.00 X 324503 0 63352 BRIAN MATTIELLO VP ORGANIZATIONAL DEVELOPMENT / HR 60.00 X 216450 0 29120 MUSTAFA UGURLU PHYSICIAN 60.00 X 500389 0 59272 TIMOTHY GOSTKOWSKI MD PHYSICIAN 60.00 X 576785 0 68107 WILLIAM MCGEEHIN MD PHYSICIAN 60.00 X 556387 0 66483 DAVID FRECCERO MD PHYSICIAN 60.00 X 589870 0 63358 Robert Kahan MD Physician 60.00 X 355266 0 43543 4489934 0 630740 86 false true false Quest Diagnostics Inc 12436 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LABORATORY SERVICES / TESTS 3830198 Morrison Health Care Inc PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 2042897 ADULT & PEDIATRIC UROLOGY OF NW CONNECTICUT 538 LITCHFIELD STREET TORRINGTON CT 06790 UROLOGY SERVICES 1624749 BUILDING ONE FACILITY SERVICES 57 OZICK DRIVE SUITE A DURHAM CT 06422 CLEANING SERVICES 1293292 NWCT EMERGENCY SERVICES 80 SOUTH MAIN STREET WEST HARTFORD CT 06107 MEDICAL 642837 29 2410 1861466 1178320 3042196 NET PATIENT REVENUE 900099 104548663 104548663 LABORATORY SERVICES 621500 9187067 8036840 1150227 OTHER HOSPITAL SERVICES 900099 3824908 3824908 0 0 0 0 117560638 1683390 1683390 612356 330866 281490 0 281490 281490 5347812 42298 3887757 38098 1460055 4200 1464255 1464255 125805 47625 78180 78180 195865 110182 85683 85683 INCOME FROM JOINT VENTURES 900001 31113 31113 MEDCONN 561499 -19283 -19283 0 0 0 0 11830 124207662 116691901 1130944 3342621 12000 12000 2203345 1652509 550836 55752044 49710128 5850409 191507 3316027 2938811 366259 10957 6898071 6113377 761900 22794 3790544 3359349 418670 12525 9056832 8026567 1000338 29927 238878 211705 26384 789 122246 108340 13502 404 5972213 5292841 659638 19734 417593 370089 46124 1380 353218 313038 39013 1167 1642115 1455315 181374 5426 3466839 3072466 382917 11456 29281 25950 3234 97 5917387 5244251 653583 19553 2407852 2133946 265950 7956 SUPPLIES 15339604 13594638 1694278 50688 PHYSICIAN FEES 5055157 3791368 1263789 HOSPITAL AUXILIARY EXPENSE 69005 69005 289870 289870 0 0 122350121 107785563 14178198 386360 110649 124676 7236836 5611256 14891 0 13152579 13732468 0 0 0 1999800 2017265 1264076 1057686 160783226 120950456 39240101 39832770 69582179 69400703 0 0 4442314 1655685 137043425 133432509 11740332 12545979 516546 126909 0 40104492 49384414 52361370 62057302 X 59513314 44714983 3526938 3263337 21641803 23396887 84682055 71375207 137043425 133432509 X 1857541 -1063899 -14100490 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 20876 20876 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY The hospital paid dues to the Connecticut Hospital Association. $20,876 represents the portion of these dues used for lobbying expenses on behalf of its' members. 21641803 0 2554961 0 799877 0 23396887 20101688 0 3608194 0 2068079 0 21641803 17620532 0 2762341 0 281185 0 20101688 16113030 0 1802455 0 294953 0 17620532 16372250 0 -259220 0 0 0 16113030 0.598 0.346 0.056 false false 155467 155467 85337412 60284949 25052463 68487363 56302784 12184579 6802984 4362723 2440261 39832770 ESTIMATED AMOUNTS DUE TO THIRD PARTY REIMBURSEMENT AGENCIES 2797659 MISCELLANEOUS CURRENT LIABILITIES 404095 ESTIMATED SELF-INSURANCE LIABILITIES 3763019 ACCRUED PENSION LIABILITY 42419641 PENSION CONTRIBUTION - CURRENT YEAR 49384414 X 124117553 0 0 124117553 90109 90109 124207662 122269116 0 0 122269116 81005 81005 122350121 Schedule D, Part V, Line 4 Intended uses of endowment funds THE ENDOWMENT FUNDS ARE USED PRIMARILY FOR CAPITAL PURCHASES, INDIGENT CARE AND OTHER USES AS APPROVED BY THE BOARD IN ACCORDANCE WITH DONOR RESTRICTIONS. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE HOSPITAL 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 FINANCIAL STATEMENTS. THE HOSPITAL 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 HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2015 AND 2014. AS OF SEPTEMBER 30, 2015 AND 2014, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE HOSPITAL WOULD RECOGNIZE INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. THE HOSPITAL'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION. Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements Auxiliary revenue - 90109 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements Auxiliary expenses - 81005 GOLF TOURNAMENT 96940 96940 6200 25259 DINNER THEATER 19299 19299 10111 4 9566 9566 6055 125805 125805 6200 25259 16166 47625 78180 true true true X true X true true false true true 1399 679802 0 679802 0.0056 50025 26635454 16668946 9966508 0.0815 520 147265 91919 55346 0.0005 0 51944 27462521 16760865 10701656 0.0875 8 2660 120576 0 120576 0.0010 2 400 2153 0 2153 0.0000 6 82974 31087251 27543411 3543840 0.0290 0 0 0 0.0 2 1570 22371 0 22371 0.0002 18 87604 31232351 27543411 3688940 0.0302 18 139548 58694872 44304276 14390596 0.1176 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 2393914 42121368 46590622 -4469254 X true true ADVANCED MEDICAL IMAGING OF NORTHWEST CT LLC IMAGING CENTER 0.5 0.5 UROLOGY CENTER OF NW CT UROLOGY CENTER 0.625 0.375 1 1 CHARLOTTE HUNGERFORD HOSPITAL WWW.CHARLOTTEHUNGERFORD.ORG 0042 X X X X CHARLOTTE HUNGERFORD HOSPITAL 1 true false true X X X X X X X X X 15 true false false true X WWW.CHARLOTTEHUNGERFORD.ORG X true 14 false true false true X 2.0 4.0 true true X X X true X www.charlottehungerford.org X www.charlottehungerford.org X www.charlottehungerford.org X X X X true true X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - CHARLOTTE HUNGERFORD HOSPITAL:. THE STUDY WAS CONDUCTED BY THE CENTER FOR HEALTHY SCHOOLS AND COMMUNITIES AT EDUCATION CONNECTION IN LITCHFIELD, CT. THE STEERING COMMITTEE INCLUDED THE FOLLOWING INDIVIDUALS AND ORGANIZATIONS: Joanne Borduas, BSN, MSN, MBA, Chief Executive Officer, Community Health and Wellness Center Heather Cappabianca, RN, MHA, Director, CT Office of Rural Health, Coordinator, NCCC, Allied Health Stephanie K. Fowler, M.D., Charlotte Hungerford Hospital, Board of Governors Ruthann Horvay, Director, Winsted Family Resource Center, Winchester Public Schools John N. Lavieri, President, Sterling Engineering Tim J. LeBouthillier, Director of Public Relations, Charlotte Hungerford Hospital Brian E. Mattiello, VP for Organizational Development, Charlotte Hungerford Hospital Thomas Narducci, LCSW, Administrative Director, Outpatient Behavioral Health, Charlotte Hungerford Hospital Leslie Polito, BSN, RN, Public Health Nurse, Torrington Area Health District Frank R. Vanoni, M.D., Community resident/Former member CHH staff, Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - CHARLOTTE HUNGERFORD HOSPITAL:. Charges for FAP clients are completely written off up to the cost of charges, using the appropriate cost to charge ratio. 0 NORTHWEST CONNECTICUT MEDICAL WALK IN 1598 EAST MAIN STREET TORRINGTON CT 06790 WALK IN MEDICAL CLINIC THE HUNGERFORD CENTER 780 LITCHFIELD STREET TORRINGTON CT 06790 CARDIAC AND PULMONARY REHAB SERVICES THE CENTER FOR CANCER CARE 200 KENNEDY DRIVE TORRINGTON CT 06790 CANCER TREATMENT CENTER HUNGERFORD DIAGNOSTIC CENTER 220 KENNEDY DRIVE TORRINGTON CT 06790 RADIOLOGY SERVICES THE CENTER FOR YOUTH AND FAMILIES 50 LITCHFIELD STREET TORRINGTON CT 06790 PSYCH SERVICES FOR CHILDREN AND FAMILIES WINSTED BEHAVIORAL HEALTH CENTER 294 MAIN STREET WINSTED CT 06098 PSYCH SERVICES SURGICAL ASSOCIATES OF CHH 538 LITCHFIELD STREET TORRINGTON CT 06790 SURGICAL PHYSICIANS PRACTICE NEUROLOGY PBC 780 LITCHFIELD STREET TORRINGTON CT 06790 NEUROLOGY PHYSICIANS PRACTICE CHH PRIMARY CARE 780 LITCHFIELD STREET TORRINGTON CT 06790 PRIMARY CARE PHYSICIANS PRACTICE CHH CARDIOVASCULAR MEDICINE SERVICE 1215 NEW LITCHFIELD STREET TORRINGTON CT 06790 CARDIOVASCULAR PHYSICIANS PRACTICE CHH WOUND CARE AND HYPERBARIC MEDICINE 7 FELICITY LANE TORRINGTON CT 06790 WOUND CARE PHYSICIANS PRACTICE CHH UROLOGY MEDICINE 538 LITCHFIELD STREET TORRINGTON CT 06790 ADULT AND PEDIATRIC UROLOGY PHYSICIANS PRACTICE HUNGERFORD EMERGENCY AND MEDICAL CARE 115 SPENCER STREET WINSTED CT 06098 EMERGENCY SERVICES Schedule H, Part I, Line 3c CRITERIA USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE CARE WILL BE PROVIDED FREE FOR THOSE WHO QUALIFY AS UNINSURED AND VERIFICATION HAS DETERMINED THAT THEIR ANNUAL INCOME IS LESS THAN 200% OF THE FEDERAL INCOME POVERTY LEVEL. CARE WILL BE PROVIDED AT HOSPITAL COST, AS ESTABLISHED BY THE OFFICE OF HEALTH CARE ACCESS (OCHA), FOR THOSE UNINSURED PATIENTS WHO REQUEST ASSISTANCE AND VERIFICATION HAS DETERMINED THAT THEIR ANNUAL INCOME IS BETWEEN 200% AND 250% OF THE FPL. CARE WILL BE DISCOUNTED BY 30% FOR THOSE UNISURED PATIENTS WHO REQUEST ASSISTANCE AND VERIFICATION HAS DETERMINED THAT THEIR ANNUAL INCOME IS BETWEEN 250% AND 400% OF THE FPL. THE HOSPITAL WILL ALSO CONSIDER THE TOTAL MEDICAL EXPENSES FACED BY THE FAMILY AND THE FAMILY'S ABILITY TO PAY FOR THOSE EXPENSES, AND WILL CONSIDER OFFERING GREATER ASSISTANCE WHEN POSSIBLE TO THOSE FAMILIES FACING CATASTROPHIC MEDICAL EXPENSES. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A cost to charge ratio based on charity care charges and expenses. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount COSTING METHODOLOGY USED - THE HOSPITAL USES A MODEL CONSISTING OF OUR ACCOUNTS RECEIVABLE BALANCE DIVIDED INTO EIGHT AGING CATEGORIES AS FOLLOWS: 0-30 DAYS, 31-60 DAYS, 61-90 DAYS, 91-120 DAYS, 121-210 DAYS, 211-365 DAYS, AND GREATER THAN 365 DAYS. A PERCENTAGE IS THEN ASSIGNED TO EACH AGING BUCKET BASED ON AGE, WITH A HIGHER PERCENTAGE ASSIGNED AS THE DAYS OUTSTANDING INCREASES. THE RESULTING CALCULATION IS USED TO COMPARE WITH THE RESERVE AND A MONTHLY ADJUSTMENT IS MADE TO DETERMINE THE EXPENSE. ANNUALLY, THIS CALCULATION IS COMPARED TO AN AUDIT OF THE BAD DEBT RESERVES TO DETERMINE IF ANY ADJUSTMENTS ARE REQUIRED. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS NOTE 3 ON PAGES 11 AND 12 OF THE ATTACHED FINANCIAL STATEMENTS. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs EXPLANATION: THE MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. THE MEDICARE ALLLOWABLE COSTS OF CARE ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance THE HOSPITAL ATTEMPTS TO HAVE INDIVIDUALS FILL OUT ALL PAPER WORK REQUIRED FOR CHARITY CARE. IF THE PERSON IS NOT CAPABLE OF DOING THIS OR IS KNOWN TO BE UNABLE TO DO THIS (SUCH AS A KNOWN HOMELESS PERSON), THEN THE FINANCIAL ASSISTANCE COMMITTEE WILL ADJUST THE ACCOUNT TO CHARITY CARE AND IT WILL NOT BE REPORTED AS BAD DEBT. IF THE ACCOUNT HAS BEEN REPORTED AS BAD DEBT AND INFORMATION COMES FORTH INDICATING AN INABILITY TO PAY, THEN THE ACCOUNT WOULD BE REMOVED FROM BAD DEBT AND MOVED TO CHARITY CARE. Schedule H, Part V, Section B, Line 16a FAP website - CHARLOTTE HUNGERFORD HOSPITAL: Line 16a URL: www.charlottehungerford.org; Schedule H, Part V, Section B, Line 16b FAP Application website - CHARLOTTE HUNGERFORD HOSPITAL: Line 16b URL: www.charlottehungerford.org; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - CHARLOTTE HUNGERFORD HOSPITAL: Line 16c URL: www.charlottehungerford.org; Schedule H, Part VI, Line 2 Needs assessment THE HOSPITAL OFFERS FREE HEALTH SCREENINGS, FREE HEALTH EDUCATION AND LECTURES AT VARIOUS COMMUNITY EVENTS INCLUDING FAIRS, EXPOS, PRIVATE COMPANIES, PUBLIC MUNICIPALITIES, AND PUBLIC GATHERINGS. THESE EVENTS PROVIDE A FORUM FOR RECEIVING INFORMATION AND INPUT FROM THE COMMUNITY. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance THE HOSPITAL COUNSELS ALL SELF PAY PATIENTS BY PROVIDING A MEETING WITH A FINANCIAL COUNSELOR OR SOCIAL WORKER. ALL STATEMENTS DISTRIBUTED TO PATIENTS INCLUDE FINANCIAL COUNSELING INFORMATION. SIGNS ARE POSTED THROUGHOUT THE HOSPITAL, INCLUDING THE EMERGENCY ROOM, WHICH STATE CHARITY CARE POLICIES AND FINANCIAL ASSISTANCE INFORMATION. Schedule H, Part VI, Line 4 Community information The Charlotte Hungerford Hospital (CHH) is located in the northwest part of Connecticut (Litchfield County) in the town of Torrington. The service area of the hospital is comprised of thirteen towns with a total population of approximately 95,000 people. In recent years, the area is becoming more racially and ethnically diverse. In the past decade, the number of White residents increased at a slower rate compared to African American, Asian, and Hispanic residents. The local population is also aging, and has a lower percentage of persons under age 18 and a higher percentage of persons age 65 and older than in the state. This is evident in the high percentage of Medicare and Medicaid revenue (approximately 70%) the hospital receives as part of its operations. Of the 13 service area towns served by CHH, the towns of Torrington (11%) and Cornwall (12%) had the highest poverty levels. Both towns were above the state average of 10%. In terms of educational achievement, the overall county average for high school completion of 96% exceeded the state average of 89%. Lower levels of achievement are found in the towns of Torrington and Winchester. Both of these towns also have higher poverty rates and lower median household incomes than other towns served by the hospital. The school districts in these two towns had the highest percentage of students eligible for free or reduced meals with Torrington at 47% and Winchester at 61%.The vast majority of county residents speak English (91%) with 9% having a primary language other than English and 3% speaking English less than "very well". In terms of services provided to communities, Torrington generates 50% of hospital charges with 14% generated from Winsted. Schedule H, Part VI, Line 5 Promotion of community health All board of directors members reside in the community served by the Charlotte Hungerford Hospital. The hospital extends medical staff privileges to all providers who meet the qualification standards and requirements set forth in the Charlotte Hungerford Hospital medical staff by-laws. Schedule H, Part VI, Line 7 State filing of community benefit report CT true HEALTHCARE SCHOLARSHIPS 12 12000 Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds THE CHARLOTTE HUNGERFORD HOSPITAL AUXILIARY AWARDS SCHOLARSHIPS IN THE AMOUNT OF $1,000 EACH TO STUDENTS PURSUING HEALTHCARE EDUCATION. THE STUDENTS MUST LIVE IN THE AREA SERVED BY THE HOSPITAL. THEY MUST ALSO PROVIDE EVIDENCE OF ACCEPTANCE INTO A COLLEGE PROGRAM OR THEIR CURRENT GRADES IN COLLEGE. APPLICANTS MUST SUBMIT LETTERS OF RECOMMENDATION FROM THEIR TEACHERS AND ALSO FROM NON-FAMILY PERSONS. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. THE CHARLOTTE HUNGERFORD HOSPITAL AUXILIARY AWARDS SCHOLARSHIPS IN THE AMOUNT OF $1,000 EACH TO STUDENTS PURSUING HEALTHCARE EDUCATION. THE STUDENTS MUST LIVE IN THE AREA SERVED BY THE HOSPITAL. THEY MUST ALSO PROVIDE EVIDENCE OF ACCEPTANCE INTO A COLLEGE PROGRAM OR THEIR CURRENT GRADES IN COLLEGE. APPLICANTS MUST SUBMIT LETTERS OF RECOMMENDATION FROM THEIR TEACHERS AND ALSO FROM NON-FAMILY PERSONS. X false true X X X X false false false false false false false false false KENDRICK HOM MD GOVERNOR 290110 0 0 0 0 0 0 0 36960 0 327070 0 0 0 DANIEL J MCINTYRE CEO/PRESIDENT 491615 0 0 0 0 0 43325 0 49669 0 584609 0 0 0 SUSAN M SCHAPP VP FINANCE/ TREASURER 311491 0 0 0 0 0 24992 0 31471 0 367954 0 0 0 JOHN J CAPOBIANCO VP OPERATIONS 273477 0 0 0 0 0 23095 0 27630 0 324202 0 0 0 MARK PRETE MD VP MEDICAL AFFAIRS 324503 0 0 0 0 0 30567 0 32785 0 387855 0 0 0 BRIAN MATTIELLO VP ORGANIZATIONAL DEVELOPMENT / HR 216450 0 0 0 0 0 7252 0 21868 0 245570 0 0 0 MUSTAFA UGURLU PHYSICIAN 500389 0 0 0 0 0 8717 0 50555 0 559661 0 0 0 TIMOTHY GOSTKOWSKI MD PHYSICIAN 576785 0 0 0 0 0 9833 0 58274 0 644892 0 0 0 WILLIAM MCGEEHIN MD PHYSICIAN 556387 0 0 0 0 0 10270 0 56213 0 622870 0 0 0 DAVID FRECCERO MD PHYSICIAN 589870 0 0 0 0 0 3762 0 59596 0 653228 0 0 0 Robert Kahan MD Physician 355266 0 0 0 0 0 7650 0 35893 0 398809 0 0 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments As part of their contracts, each vice president receives a payment equal to 2.5% of their gross pay. The president receives a payment equal to 5% of his gross pay. These payments are grossed up so that the hospital pays the federal and state taxes. Schedule J, Part I, Line 1b Written policy regarding payment or reimbursement of expenses THESE BENEFITS ARE WRITTEN INTO THEIR EMPLOYMENT CONTRACTS. MARK PRETE MD KEY EMPLOYEE 696669 PARTNER IN NWCT EMERGENCY MEDICINE P.C. WHICH PROVIDES EMERGENCY ROOM SERVICES TO THE HOSPITAL. false Form 990, Part VI, Line 11b Review of form 990 by governing body A COPY OF FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS BEFORE IT IS FILED WITH THE IRS. THIS ENABLES THE BOARD TO ASK QUESTIONS, AND TO APPROVE THE DISCLOSURES MADE IN THE RETURN. Form 990, Part VI, Line 12c Conflict of interest policy THE HOSPITAL DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY TO ITS BOARD OF DIRECTORS, ALL MANAGEMENT PERSONNEL, AND PURCHASING AGENTS. Form 990, Part VI, Line 15a Process to establish compensation of top management official COMPENSATION FOR SENIOR STAFF IS DETERMINED USING THE FOLLOWING STEPS: - A MARKET SURVEY BASED ON CT HOSPITAL ASSOCIATION IS USED AS A STARTING POINT. - ADJUSTMENTS ARE THEN MADE BASED ON THE CANDIDATE'S CURRENT SALARY AND PRIOR EXPERIENCE. - THE COMPENSATION FIGURE IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. THE LAST COMPENSATION REVIEW OCCURRED IN AUGUST 2015. Form 990, Part VI, Line 15b Process to establish compensation of other employees COMPENSATION FOR SENIOR STAFF IS DETERMINED USING THE FOLLOWING STEPS: - A MARKET SURVEY BASED ON CT HOSPITAL ASSOCIATION IS USED AS A STARTING POINT. - ADJUSTMENTS ARE THEN MADE BASED ON THE CANDIDATE'S CURRENT SALARY AND PRIOR EXPERIENCE. - THE COMPENSATION FIGURE IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. THE LAST COMPENSATION REVIEW OCCURRED IN AUGUST 2015. Form 990, Part VI, Line 19 Required documents available to the public THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ANNUAL REPORT AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Pension related changes other than net periodic pension costs. - -13805331; Net assets released from restrictions. - -295159; Form 990, Part XII, Line 2c Change of oversight process or selection process THE HOSPITAL'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THESE FUNCTIONS AND PROCESSES HAVE NOT CHANGED FROM THE PRIOR YEAR. 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