2016-08-11T07:58:03-05:00 2015-09-30 135565207 KPMG LLP ONE FINANCIAL PLAZA 755 MAIN STREET HARTFORD CT 06103 990 2014-10-01 060646554 BRIDGEPORT HOSPITAL BRID 2036889642 267 GRANT STREET BRIDGEPORT CT 06610 JOHN SKELLY SENIOR VICE PRESIDENT 2036889642 2016-08-02 0 MARY-EVELYN ANTONETTI P00431862 8602976085 2014 2016-09-27 15:27:22Z JOHN SKELLY 267 GRANT ST BRIDGEPORT CT 06610 517899260 0 X WWW.BRIDGEPORTHOSPITAL.ORG X 1878 CT TO OPERATE AN ACUTE CARE HOSPITAL IN BRIDGEPORT, CONNECTICUT. 14 9 3118 332 668671 -291452 3303523 2827511 439374962 466074249 848999 744239 19984117 28760828 463511601 498406827 55000 15000 0 0 208728562 213856545 0 0 0 221199064 232570920 429982626 446442465 33528975 51964362 472575330 532166912 316742498 363602875 155832832 168564037 X TO OPERATE AN ACUTE CARE HOSPITAL IN BRIDGEPORT, CONNECTICUT FOR THE CARE AND TREATMENT OF PERSONS SUFFERING FROM DISEASE OR OTHER PHYSICAL OR MENTAL CONDITIONS WITHOUT REGARD TO RACE, COLOR, CREED, SEX, AGE OR ABILITY TO PAY. 0 0 357988010 15000 490195539 SCHEDULE OTHE HOSPITAL ADDED A BARIATRIC SURGERY PROGRAM, IN COOPERATION WITH YALE BARIATRIC AND MINIMALLY INVASIVE SURGERY. IT BECAME THE FIRST HOSPITAL IN SOUTHERN CONNECTICUT TO ADD THE NEW-GENERATION ORBITAL ATHERECTOMY PROCEDURE TO ELIMINATE CALCIUM BLOCKAGES IN THE HEART. HOSPITAL STAFF NOW INCLUDES FELLOWSHIP TRAINED EAR, NOSE AND THROAT (ENT) SPECIALISTS WITH THYROID/ PARATHYROID, HEAD AND NECK, SKULL BASE AND MICROVASCULAR/ RECONSTRUCTIVE SURGERY EXPERTISE. THE NEW MEDICAL OFFICE BUILDING AT THE PARK AVENUE OUTPATIENT CAMPUS IN TRUMBULL, CONNECTICUT WILL HOUSE SERVICES PROVIDED BY SMILOW CANCER HOSPITAL, PRIMARY CARE CENTER, AMBULATORY SURGERY AND A FULL RANGE OF SUPPORT SERVICES.THE HOSPITAL DRAMATICALLY DECREASED ITS SERIOUS SAFETY EVENT RATE DURING THE YEAR, FROM 0.64 PER 10,000 PATIENT DAYS IN JANUARY 2013 TO 0.50 PER 10,000 DAYS IN SEPTEMBER 2015. IN 2015, THE HOSPITAL CONTINUED ITS HIGH RELIABILITY ORGANIZATION JOURNEY COMMITTING TO LEVEL 3 PARTICIPATION IN THE STATE HIGH RELIABILITY WORK WITH HEALTHCARE PERFORMANCE IMPROVEMENT. HIGH-RELIABILITY ORGANIZATION TRAINING WAS COMPLETED BY THE HOSPITAL'S STAFF AS IT CONTINUES TO ENSURE SAFE, EFFECTIVE PATIENT CARE.THE HOSPITAL WAS RECOGNIZED BY THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION (AHA/ASA) FOR THE QUALITY OF ITS STROKE CARE AND RESUSCITATION MEASURES FOR CARDIAC ARREST PATIENTS. THE HOSPITAL EARNED THE AHA/ASA "GET WITH THE GUIDELINES" STROKE GOLD PLUS QUALITY ACHIEVEMENT AWARD AFTER CONSISTENTLY MEETING QUALITY MEASURES FOR STROKE CARE. THE HOSPITAL ALSO MADE THE AHA/ASA TARGET: STROKE HONOR ROLL. THIS SIGNIFIES THAT THE HOSPITAL MET QUALITY MEASURES TO REDUCE THE TIME BETWEEN A PATIENT'S ARRIVAL AT THE HOSPITAL AND TREATMENT WITH THE CLOT-BUSTER TISSUE PLASMINOGEN ACTIVATOR (TPA), THE ONLY DRUG APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION TO TREAT ISCHEMIC STROKE.THE DEPARTMENT OF MEDICINE INTRODUCED A NEW APPROACH TO TREATING PATIENTS WITH SICKLE CELL DISEASE (SCD), RESULTING FROM ITS INTERDISCIPLINARY CLINICAL REDESIGN PROJECT. SCD PATIENTS RECEIVE AN INDIVIDUALIZED CARE PLAN THROUGH EPIC, THE HOSPITAL'S ELECTRONIC MEDICAL RECORD SYSTEM, WHICH CAN BE USED ACROSS CARE VENUES (EMERGENCY DEPARTMENT, CLINICS AND THE HOSPITAL). THE GOAL IS TO STANDARDIZE AND IMPROVE THE QUALITY OF PATIENT CARE.THE GERIATRIC INJURY INSTITUTE WAS LAUNCHED BY A MULTIDISCIPLINARY HOSPITAL TEAM LED BY THE DEPARTMENT OF SURGERY TO DECREASE TRAUMATIC INJURIES DUE TO FALLS AMONG THE ELDERLY. 357988010 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 393 0 3118 1 1 1 0 0 0 0 0 0 0 0 0 X 14 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X KEITH TANDLER 2036889642 789 HOWARD AVENUE NEW HAVEN CT 06519 NEWMAN MARSILIUS III CHAIRMAN/DIRECTOR 1.00 2.00 X X 0 0 0 PETER HURST VICE CHAIRMAN/DIRECTOR 1.00 0.00 X X 0 0 0 GEORGE CARTER VICE CHAIRMAN/DIRECTOR 1.00 0.00 X X 0 0 0 MEREDITH REUBEN VICE CHAIRMAN/DIRECTOR 1.00 1.00 X X 0 0 0 HOWARD TAUBIN VICE CHAIRMAN/DIRECTOR 1.00 0.00 X X 0 0 0 WILLIAM JENNINGS PRESIDENT & CEO/DIRECTOR 32.00 8.00 X X 983068 245767 320176 PATRICK MCCABE SR. VP, CFO & TREASURER 12.00 28.00 X 219108 511252 248759 NORMAN ROTH THRU 61615 COO & SEC. 8.00 32.00 X 728297 2913188 94724 PAMELA SCAGLIARINIEFF61615 COO & SEC. 40.00 0.00 X 459252 0 81671 MICHAEL IVY SR. VP MEDICAL AFFAIRS 38.00 2.00 X 538226 0 54513 MARYELLEN KOSTURKO SR. VP PATIENT CARE 40.00 0.00 X 375434 0 24570 CAROLYN SALSGIVER SR. VP STRATEGY & BUSINESS 39.00 1.00 X 402470 0 151431 MELISSA TURNER SR. VP HUMAN RESOURCE 20.00 20.00 X 206519 206519 140548 MARC BRUNETTI VP OF SUPPORT OPERATIONS 40.00 0.00 X 287413 0 60095 RYAN O'CONNELL VP OF PERFORMANCE & RISK 40.00 0.00 X 387424 0 57650 JOHN SKELLY VP OF FINANCE 39.00 1.00 X 593406 0 202506 JENNIFER WILLCOX ASSISTANT SECRETARY 1.00 39.00 X 0 321374 43901 GAYLE CAPOZZALO DIRECTOR 4.00 36.00 X 132393 1191536 37933 JOHN FALCONI DIRECTOR 1.00 0.00 X 0 0 0 RUSSELL FUCHS THRU 91615 DIRECTOR 1.00 0.00 X 0 0 0 RICHARD HOYT THRU 10214 DIRECTOR 1.00 0.00 X 0 0 0 THOMAS LENCI DIRECTOR 1.00 0.00 X 0 0 0 MICK MAURER DIRECTOR 1.00 0.00 X 0 0 0 STEPHEN MARSHALKO DIRECTOR 1.00 0.00 X 135068 0 0 FRED MCKINNEY DIRECTOR 1.00 0.00 X 0 0 0 RONALD NOREN DIRECTOR 1.00 0.00 X 0 0 0 DUNCAN O'BRIEN DIRECTOR 1.00 0.00 X 0 0 0 GARY ZIMMERMAN DIRECTOR 1.00 0.00 X 28200 0 0 JONATHAN MAISEL PHYSICIAN 40.00 0.00 X 423556 0 45560 THOMAS LAMONTE PHYSICIAN 40.00 0.00 X 357131 0 45560 ROCKMAN FERRIGNO PHYSICIAN 40.00 0.00 X 464515 0 34582 GUILLERMO KATIGBAK PHYSICIAN 40.00 0.00 X 366078 0 41072 FRANCISCO GARRIDO PHYSICIAN 40.00 0.00 X 364659 0 29062 PATRICK SCHMINCKE THRU 62014 FORMER OFFICER 0.00 0.00 X 168102 0 13340 ROBERT TREFRY RET 92010 FORMER OFFICER 0.00 0.00 X 0 216182 0 7620319 5605818 1727653 340 1 1 0 UNITEX TEXTILE RENTAL 155 SOUTH TERRACE AVE MOUNT VERNON NY 10550 LAUNDRY/SERVICE 2362459 NOVAMED 30 NUTMEG DRIVE TRUMBULL CT 06611 BIOMEDICAL SVC 1884567 NURSEFINDERS INC PO BOX 910738 DALLAS TX 753910738 STAFFING 1761660 SHEPLEY BULFINCH RICHARDSON 2 SEAPORT LN BOSTON MA 02210 ARCHITECTURE SERVICE 1492877 APOLLO SECURITY INTERNATIONAL 2150 BOSTON PROVIDENCE HWY WALPOLE MA 02081 SECURITY 1037803 150 2827511 2827511 INPATIENT REVENUE 621990 269879045 269879045 OUTPATIENT REVENUE 621990 195527433 195527433 LABORATORY SERVICES 621500 602211 602211 RADIOLOGY SERVICES 621500 35805 35805 RESEARCH SERVICES 541700 29755 29755 466074249 266619 900 265719 1119040 877845 241195 241195 241195 19084708 7500 18614588 0 470120 7500 477620 477620 OTHER OPERATING INCOME 900099 10653777 10653777 PEDIATRIC ANCILLARY REVENUE 900099 9000000 9000000 CAFETERIA/VENDING OTHER OPERATING 900099 2257784 2257784 6608072 5135284 1472788 28519633 498406827 490195539 668671 4715106 X 15000 15000 6182576 6182576 157432453 119585964 37846489 1360205 1143971 216234 37816994 28801873 9015121 11064317 8387061 2677256 148411 112500 35911 408000 309275 98725 149774 149774 101948291 86724306 15223985 6934138 5257570 1676568 20336682 15488491 4848191 676834 527931 148903 3048075 2310526 737549 31147692 23610819 7536873 6856795 6703960 152835 MEDICAL SUPPLIES 52564036 52564036 YNHHS SYSTEM SUPPORT FE 5461092 4139660 1321432 OTHER MISC EXPENSES 809721 577550 232171 DUES, FEES AND MEMBERSH 762800 578224 184576 1318579 999519 319060 446442465 357988010 88454455 0 8000 8000 28518791 25960053 49731677 54662116 4338167 4348501 35269493 30123344 500211923 289390883 165140207 210821040 31752120 47488705 35342449 37554124 17217110 17217110 105257316 103983919 472575330 532166912 43752248 49162515 35022422 32238597 33855563 68525740 204112265 213676023 316742498 363602875 X 100810892 110842796 33279300 34845554 21742640 22875687 155832832 168564037 472575330 532166912 X 51964362 676032 -39909189 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 1 500 0 0 0 0 1 71898 0 1 77376 149774 0 PART II-B, LINE 1: THE AMOUNT REPORTED IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING DURING 2015. ALSO, THE HEALTH SYSTEM OFFICIALS HAD MEETINGS AND CONTACTS WITH STATE GOVERNMENT OFFICIALS, INCLUDING STATE LEGISLATORS AND THEIR STAFF TO DISCUSS VARIOUS HEALTH CARE REFORM PROPOSALS. BRIDGEPORT HOSPITAL HAS CERTAIN STAFF MEMBERS THAT LOBBY ON BEHALF OF THE HOSPITAL ON VARIOUS HEALTHCARE ISSUES. BRIDGEPORT HOSPITAL IS PART OF A CONTROLLED GROUP WITH THE FOLLOWING LOBBYING EXPENSES: YALE NEW HAVEN HOSPITAL EIN 06-0646652 $ 771,458 GREENWICH HOSPITAL EIN 06-0646659 $ 116,429 NORTHEAST MEDICAL GROUP INC. EIN 06-1330992 $ 51,985 23470000 0 634000 878000 23226000 41860000 2176000 2969000 4297000 42708000 37606000 3504000 2097000 -1347000 41860000 34442000 874000 2394000 -104000 37606000 32083000 1805000 1209000 -655000 34442000 0.55000 0.45000 0 0 703591 703591 128223826 104058156 24165670 20500665 2249466 18251199 280998799 183083261 97915538 69785042 69785042 210821040 HEDGE FUNDS 365550 F YALE ENDOWMENT POOL 37188574 F 37554124 OTHER RECEIVABLES 1102600 INTEREST IN FOUNDATION,INC. 69267171 INTEREST IN BRIDGEPORT HOSPITAL AUXILIARY 633100 INTEREST IN CENTURY FINANCIAL SERVICES 1095751 DUE FROM AFFILIATES 5015351 DEFERRED ISSUANCE COSTS 1196193 THIRD PARTY RECEIVABLES 1503753 PROFESSIONAL LIABILITIES INSURANCE RECOVERIES RECEIVABLES 24170000 103983919 SELF INSURANCE 21073148 ASSET RETIREMENT OBLIGATIONS 11026920 PENSION OBLIGATION 68303593 THIRD PARTY PAYABLE 29646448 DUE TO AFFILIATES 59455914 MALPRACTICE GROSS LIABILITY 24170000 213676023 X 499073754 676032 2977227 3653259 495420495 2986332 2986332 498406827 443456133 0 443456133 2986332 2986332 446442465 PART V, LINE 4: INTENDED USES FOR ENDOWMENT FUNDS THE ENDOWED FUNDS' INTENDED USE IS TO GENERATE INCOME TO SUPPORT BRIDGEPORT HOSPITAL PROGRAM SERVICE FUNCTIONS AND OTHER OPERATIONS IN ACCORDANCE WITH THE BRIDGEPORT HOSPITAL POOLED INVESTMENT POLICY, TO PROVIDE FREE CARE BASED ON DONORS WISHES. PART X, LINE 2: THE CONSOLIDATED FINANCIAL STATEMENTS OF BRIDGEPORT HOSPITAL AND SUBSIDIARIES INCLUDE THE FOOTNOTE AS FOLLOWS: THE HOSPITAL AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. PROPERTIES IS A TAX-EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(2) OF THE CODE AND ALSO IS NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED "UNRELATED BUSINESS INCOME AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: ASSETS RELEASE FROM OTHER OPERATING RESTRICTION 750,000. RECLASS BHF INVESTMENT INCOME TO CHANGE IN NET ASSETS 20,165. RECLASS OTHER NON-OPERATING INCOME TO CHANGE IN NET ASSETS 1,353. RECLASS SERP ASSET GAIN/LOSS TO CHANGE IN NET ASSETS -119. RECLASS BHF FROM RESTRICTED 2,910,465. RECLASS INVESTMENT INCOME FROM TEMP RESTRICTED FUNDS -489,743. RECLASS SABA SURGERY FUND TRANSFER -214,894. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS CONTRIBUTION 2,827,511. RECLASS NET RENTAL INCOME AND EXPENSE 158,821. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS CONTRIBUTION 2,827,511. RECLASS NET RENTAL INCOME AND EXPENSE 158,821. PART V, LINE 1A - THE BEGINNING OF YEAR BALANCE: THE BEGINNING OF YEAR BALANCE HAS BEEN ADJUSTED TO REFLECT THE AMOUNT REPORTED SEPARATELY IN BRIDGEPORT HOSPITAL FOUNDATION (EIN# 22-2908698). 1 1 X 1 X 250.000000000000 0 1 1 1 0 1 1 18251 36354487 4946591 31407896 0.07040 119898 121742056 91053803 30688253 0.06870 138149 158096543 96000394 62096149 0.13910 10 1955 748845 15000 733845 0.00160 4 166 22609123 8338658 14270465 0.03200 1 1912 11435084 9905280 1529804 0.00340 0 0 2 27740 92909 0 92909 0.00020 17 31773 34885961 18258938 16627023 0.03720 17 169922 192982504 114259332 78723172 0.17630 1 0 12500 0 12500 0.00000 1 0 7265 0 7265 0.00000 3 30 29199 0 29199 0.00010 1 0 700 0 700 0.00000 6 30 49664 49664 0.00010 1 15417028 0 171741184 165376479 6364705 X 1 1 1 NONE NONE 1 1 BRIDGEPORT HOSPITAL 267 GRANT STREET BRIDGEPORT CT 06610 WWW.BRIDGEPORTHOSPITAL.ORG 0040 X X X X X BRIDGEPORT HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X SEE PART V SUPPLEMENTAL INFORMATION X SEE PART V SUPPLEMENTAL INFORMATION X 1 13 1 SEE PART V SUPPLEMENTAL INFORMATION 0 0 1 X 250.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.BRIDGEPORTHOSPITAL.ORG/YNHHS/BILLING-INSURANCE.ASPX X HTTPS://WWW.YNHHS.ORG/FORMS.ASPX X HTTPS://WWW.YNHHS.ORG/FORMS.ASPX X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION A: THIS STATE LICENSE FOR THE HOSPITAL LOCATION LISTED IN SCHEDULE H, PART V, SECTION A, ALSO COVERS VARIOUS SATELLITE LOCATIONS OPERATED UNDER AND EXPRESSLY LISTED ON THE SAME STATE HOSPITAL LICENSE. BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY ENGAGEMENT AND FEEDBACK WERE AN INTEGRAL PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. BRIDGEPORT HOSPITAL, THROUGH THE PRIMARY CARE ACTION GROUP, SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL THROUGH FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS AND COMMUNITY STAKEHOLDERS, AS WELL AS INCLUSION OF AT LEAST EIGHTY COMMUNITY PARTNERS AND RESIDENTS IN THE PRIORITIZATION AND IMPLEMENTATION PLANNING PROCESS. PUBLIC HEALTH AND HEALTH CARE PROFESSIONALS SHARED KNOWLEDGE AND EXPERTISE ABOUT HEALTH ISSUES, WHILE LEADERS AND REPRESENTATIVES OF NON-PROFIT AND COMMUNITY-BASED ORGANIZATIONS PROVIDED INSIGHT ON THE COMMUNITY SERVED BY BRIDGEPORT HOSPITAL, INCLUDING MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 6A: ST. VINCENT'S MEDICAL CENTER, A MEMBER OF ASCENSION HEALTH SYSTEM, ALSO LOCATED IN BRIDGEPORT, IS PART OF THE PRIMARY CARE ACTION GROUP, WHICH CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT. BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 6B: THE CHNA FOR THE GREATER BRIDGEPORT REGION, WHICH SERVES AS THE CHNA FOR BRIDGEPORT HOSPITAL, WAS CONDUCTED IN COLLABORATION WITH THE PRIMARY CARE ACTION GROUP. PRIMARY CARE ACTION GROUP MEMBERS IN ADDITION TO BRIDGEPORT HOSPITAL AND ST. VINCENT'S MEDICAL CENTER INCLUDE: OPTIMUS HEALTHCARE, SOUTHWEST COMMUNITY HEALTH CENTER, CITY OF BRIDGEPORT DEPARTMENT OF HEALTH AND SOCIAL SERVICES, STRATFORD HEALTH DEPARTMENT, FAIRFIELD HEALTH DEPARTMENT, TRUMBULL HEALTH DEPARTMENT, MONROE HEALTH DEPARTMENT, EASTON HEALTH DEPARTMENT, AMERICARES FREE CLINIC OF BRIDGEPORT, LLC, CONNECTICUT DEPARTMENT OF SOCIAL SERVICES, CONNECTICUT DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES, GREATER BRIDGEPORT MEDICAL ASSOCIATION, SOUTHWESTERN AREA HEALTH EDUCATION CENTER, AND THE BRIDGEPORT CHILD ADVOCACY COALITION. PART V, SECTION B, LINE 7A - HOSPITAL FACILITY'S WEBSITE URL: HTTPS://WWW.BRIDGEPORTHOSPITAL.ORG/ABOUTUS/CHNA/DEFAULT.ASPXPART V, SECTION B, LINE 7B - OTHER WEBSITES (LIST URL):CT.GOV/DPH/LIB/DPH/OHCA/COMMUNITY_NEEDS_ASSESSMENT/CHNA/2014/GREATER_BRIDGEPORT.PDF; HTTP://WWW.TOWNOFSTRATFORD.COM/CONTENT/39832/39846/39915/40728/54513.ASPX; HTTP://WWW.BRIDGEPORTCT.GOV/HEALTH; HTTP://WWW.STVINCENTS.ORG/SEARCH-RESULTS?QUERY=COMMUNITY+HEALTH+NEEDS;PART V, SECTION B, LINE 10A:HTTPS://WWW.BRIDGEPORTHOSPITAL.ORG/ABOUT/COMMUNITY/HEALTH-NEEDS-ASSESSMENT.ASPX BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 11: BASED ON THE FEEDBACK FROM COMMUNITY PARTNERS INCLUDING HEALTH PROVIDERS, PUBLIC HEALTH EXPERTS, HEALTH AND HUMAN SERVICE AGENCIES, AND OTHER COMMUNITY REPRESENTATIVES, FOUR HEALTH ISSUES WERE PRIORITIZED: CARDIOVASCULAR DISEASE AND DIABETES, OBESITY, MENTAL HEALTH AND SUBSTANCE ABUSE AND ACCESS TO CARE. BRIDGEPORT HOSPITAL PLANS TO FOCUS ITS COMMUNITY HEALTH IMPROVEMENT EFFORTS ON ALL FOUR OF THESE AREAS. TO LEARN MORE ABOUT HOW BRIDGEPORT HOSPITAL AND ITS COMMUNITY PARTNERS ARE MEETING THESE NEEDS PLEASE REVIEW THE GREATER BRIDGEPORT REGION'S COMMUNITY HEALTH IMPROVEMENT PLAN. AREAS IDENTIFIED AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT NOT BEING ADDRESSED AS A RESULT OF A PRIORITIZATION PROCESS INCLUDE ABILITY TO CARE FOR THE ELDERLY, ASTHMA, CANCER, DENTAL / ORAL HEALTH, ENVIRONMENTAL ISSUES / CONTAMINATED LANDS, PRENATAL CARE, SEXUAL HEALTH, TOBACCO, TRANSPORTATION AND VIOLENCE.BRIDGEPORT HOSPITAL RECOGNIZES THAT PARTNERSHIPS WITH COMMUNITY AGENCIES HAVE THE BROADEST REACH TO IMPROVE COMMUNITY HEALTH ISSUES. AS SUCH, THE HOSPITAL IS PROVIDING FACILITATION SUPPORT FOR THE IMPLEMENTATION OF THE COMMUNITY-WIDE HEALTH IMPROVEMENT PLAN THAT WILL FOCUS ON ALL FOUR AREAS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 13H: THESE PROGRAMS COVER MEDICALLY NECESSARY CARE ONLY. BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 22D: PRIOR TO BECOMING FAP-ELIGIBLE, ALL INDIVIDUALS ARE CHARGED STANDARD GROSS CHARGES. AFTER AN INDIVIDUAL IS DEEMED TO BE FAP-ELIGIBLE, ANY DISCOUNTS OR FREE CARE ASSISTANCE DISCOUNTS ARE APPLIED IN ACCORDANCE WITH THE FAP PROGRAM THE INDIVIDUAL QUALIFIES FOR. THE DISCOUNTS ARE ADJUSTED OFF THE PATIENT'S ACCOUNT WHICH IS ALSO REFLECTED IN THE INDIVIDUAL'S BILLING. SCHEDULE H, PART V, SECTION D THE FACILITY LOCATIONS LISTED IN SCHEDULE H, PART V, SECTION D, INCLUDE OFF-CAMPUS OUTPATIENT HEALTH CARE FACILITIES THAT BRIDGEPORT HOSPITAL OPERATED DURING THE TAX YEAR UNDER ITS STATE HOSPITAL LICENSE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: HTTPS://WWW.BRIDGEPORTHOSPITAL.ORG/YNHHS/BILLING-INSURANCE.ASPX BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTPS://WWW.YNHHS.ORG/FORMS.ASPX BRIDGEPORT HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: HTTPS://WWW.YNHHS.ORG/FORMS.ASPX 27 NORMA F PFRIEM CANCER INSTITUTE 5520 PARK AVENUE TRUMBULL CT 06611 ONCOLOGY RADIOLOGY; LAB; PERINATAL/ATU CARDIAC DIAGNOSTIC TESTING 1305 POST ROAD FAIRFIELD CT 06824 CARDIAC SERVICES; DIAGNOSTIC TESTING OUTPATIENT RADIOLOGY 4699 MAIN STREET BRIDGEPORT CT 06610 RADIOLOGY; OUTPATIENT BRIDGEPORT HOSPITAL REHABILITATION 226 MILL HILL AVENUE BRIDGEPORT CT 06610 REHABILITATION CARDIAC DIAGNOSTIC TESTING 999 SILVER LANE TRUMBULL CT 06611 CARDIAC SERVICES OUTPATIENT RADIOLOGY 425 POST ROAD FAIRFIELD CT 06824 RADIOLOGY CARDIAC DIAGNOSTIC TESTING 25 GERMANTOWN ROAD DANBURY CT 06810 CARDIAC SERVICES FAIRFIELD URGENT CARE CENTER 309 STILLSON ROAD FAIRFIELD CT 06824 MEDICAL OFFICE OUTPATIENT RADIOLOGY 2909 MAIN STREET STRATFORD CT 06614 RADIOLOGY REACH AT BH 305 BOSTON AVENUE STRATFORD CT 06614 VARIOUS MEDICAL SERVICES CARDIAC DIAGNOSTIC TESTING 20 COMMERCE PARK MILFORD CT 06460 CARDIAC SERVICES; DIAGNOSTIC TESTING AHLBIN REHAB CENTER-STRATFORD 3585 MAIN STREET STRATFORD CT 06614 PHYSICAL THERAPY OUTPATIENT RADIOLOGY 2595 MAIN STREET STRATFORD CT 06614 RADIOLOGY; OUTPATIENT BRIDGEPORT HOSPITAL LAB 4 CORPORATE DRIVE SHELTON CT 06484 BLOOD DRAW CENTER AHLBIN REHAB CENTER-SOUTHPORT 2600 POST ROAD SOUTHPORT CT 06890 PHYSICAL THERAPY; DRAW STATION CARDIAC DIAGNOSTIC TESTING 30 PROSPECT STREET RIDGEFIELD CT 06877 CARDIAC SERVICES; DIAGNOSTIC TESTING BRIDGEPORT HOSPITAL LAB 40 COMMERCE PARK MILFORD CT 06460 BLOOD DRAW CENTER BLOOD DRAW STATION 887 BRIDGEPORT AVENUE SHELTON CT 06484 BLOOD DRAW CENTER AHLBIN PHYSICAL THERAPY 2750 RESERVOIR AVE TRUMBULL CT 06611 REHABILITATION IVY BROOK MEDICAL CENTER 2 IVY BROOK ROAD SHELTON CT 06484 CARDIAC SERVICES; DIAGNOSTIC TESTING BRIDGEPORT HOSPITAL LAB 15 CORPORATE DRIVE TRUMBULL CT 06611 BLOOD DRAW CENTER BRIDGEPORT HOSPITAL LAB 3115 MAIN STREET STRATFORD CT 06614 BLOOD DRAW CENTER NORMA PFRIEM BREAST CENTER 111 BEACH ROAD FAIRFIELD CT 06824 CANCER CENTER SLEEP STUDY CENTER 1070 MAIN STREET BRIDGEPORT CT 06610 SLEEP CENTER OUTPATIENT RADIOLOGY 2660 MAIN STREET BRIDGEPORT CT 06606 OUTPATIENT RADIOLOGY CENTER FOR GERIATRICS 95 ARMORY ROAD STRATFORD CT 06614 ELDER CARE CARDIAC DIAGNOSTIC TESTING 300 SEYMOUR AVENUE DERBY CT 06418 CARDIAC SERVICES; DIAGNOSTIC TESTING PART I, LINE 3C: THE FINANCIAL ASSISTANCE POLICY PROVIDES THAT THE PATIENT MUST SUBMIT A FINANCIAL ASSISTANCE APPLICATION. THE FINANCIAL ASSISTANCE POLICY PROVIDES FOR ELIGIBILITY OF DISCOUNTED CARE REGARDLESS OF INCOME. PART I, LINE 7: THE HOSPITAL USES A COST ACCOUNTING SYSTEM, STRATAJAZZ, TO CALCULATE THE AMOUNTS PRESENTED IN PART I, LINE 7. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS.PART I, LINE 7 CONTINUED-DESCRIPTION OF INCONSISTENCIES FROM REPORTING IN PRIOR YEARS:THE CATHOLIC HOSPITAL ASSOCIATION'S WHAT COUNTS TASK FORCE DISCUSSED WHETHER THE COSTS FOR CANCER REGISTRIES SHOULD BE REPORTED AS COMMUNITY BENEFIT. THE TASK FORCE WAS ASKED TO REVIEW ITS RECOMMENDATION THAT CANCER REGISTRIES NOT BE REPORTED AS COMMUNITY BENEFIT. THE TASK FORCE CONCLUDED THAT SINCE REGISTRIES ARE REQUIRED FOR ACCREDITATION AS A CANCER HOSPITAL, IT SHOULD AFFIRM ITS GUIDANCE THAT THEIR COST NOT BE REPORTED AS COMMUNITY BENEFIT. IN 2014, BRIDGEPORT HOSPITAL ATTRIBUTED $190,932 IN TOTAL COSTS TO ITS CANCER REGISTRY. PART II, COMMUNITY BUILDING ACTIVITIES: BRIDGEPORT HOSPITAL, ALONG WITH MANY OTHER HOSPITALS ACROSS THE COUNTRY, UTILIZES THE COMMUNITY BENEFITS INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA) DATABASE DEVELOPED BY LYON SOFTWARE TO CATALOG ITS COMMUNITY BENEFIT AND COMMUNITY BUILDING ACTIVITIES AND THE GUIDELINES DEVELOPED BY THE CATHOLIC HOSPITAL ASSOCIATION (CHA) IN ORDER TO CATALOG THESE BENEFITS. THESE TWO ORGANIZATIONS HAVE WORKED TOGETHER FOR OVER TWENTY YEARS TO PROVIDE SUPPORT TO NON-FOR-PROFIT HOSPITALS TO DEVELOP AND SUSTAIN EFFECTIVE COMMUNITY BENEFIT PROGRAMS.THE MOST RECENT VERSION OF THE CHA GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT DEFINES COMMUNITY BUILDING ACTIVITIES AS PROGRAMS THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS AND ENVIRONMENTAL PROBLEMS. THESE ACTIVITIES ARE CATEGORIZED INTO EIGHT DISTINCT AREAS INCLUDING PHYSICAL IMPROVEMENT AND HOUSING, ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT ENVIRONMENTAL IMPROVEMENTS, LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, COALITION BUILDING, ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENTS, AND WORKFORCE DEVELOPMENT. BRIDGEPORT HOSPITAL IS INCREASINGLY AWARE OF HOW SOCIAL DETERMINANTS IMPACT THE HEALTH OF INDIVIDUALS AND COMMUNITIES. A PERSON'S HEALTH AND CHANCES OF BECOMING SICK AND DYING EARLY ARE GREATLY INFLUENCED BY POWERFUL SOCIAL FACTORS SUCH AS EDUCATION, INCOME, NUTRITION, HOUSING AND NEIGHBORHOODS. DURING FISCAL YEAR 2015, BRIDGEPORT HOSPITAL PROVIDED $49,664 IN FINANCIAL AND IN-KIND DONATIONS TO SUPPORT JOB TRAINING, ECONOMIC DEVELOPMENT AND OTHER ESSENTIAL SERVICES. THE HOSPITAL CONSIDERS THESE INVESTMENTS PART OF ITS OVERALL COMMITMENT OF BUILDING STRONGER NEIGHBORHOODS. EXAMPLES BELOW FOCUS ON THE AREAS OF REVITALIZING OUR NEIGHBORHOODS AND CREATING EDUCATIONAL OPPORTUNITIES.REVITALIZING OUR NEIGHBORHOODSSEVERAL YEARS AGO, THE CITY OF BRIDGEPORT ORGANIZED NEIGHBORHOOD REVITALIZATION ZONES (NRZS) IN ORDER TO EXPAND AND IMPROVE BUSINESS AND HOUSING IN LOW-TO-MODERATE INCOME NEIGHBORHOODS OR AREAS WITHIN NEIGHBORHOODS. THE NRZS RECEIVE TECHNICAL ASSISTANCE FROM THE CITY AND OUTSIDE CONSULTANTS, AND ENGAGE NEIGHBORHOOD RESIDENTS, NON-PROFITS, BUSINESSES AND FAITH-BASED ORGANIZATIONS TO MEET AND FORM STAKEHOLDER GROUPS. THESE GROUPS IDENTIFY THE PRIORITIES AND NEEDS OF THE NEIGHBORHOODS AND ARE ELIGIBLE TO BORROW STATE MONEY TO PURCHASE BLIGHTED PROPERTIES OR OFFER LOW-INTEREST LOANS TO QUALIFYING BUSINESSES FOR FACADE IMPROVEMENTS. HOSPITAL LEADERSHIP HAS BEEN ACTIVELY ENGAGED IN THE NRZ PROCESS FROM THE ONSET WITH REPRESENTATIVES SERVING ON COMMITTEES ORGANIZED IN THE CITY'S EAST END, EAST SIDE AND MILL HILL NEIGHBORHOODS, WHICH ARE LOCATED NEAR THE HOSPITAL. THE HOSPITAL PROVIDES ANNUAL OPERATIONAL SUPPORT TO THE EAST END COMMUNITY COUNCIL, A GROUP OF COMMUNITY RESIDENTS, BUSINESS, CIVIC, RELIGIOUS LEADERS AND COMMUNITY POLICE OFFICERS. THE EAST END COMMUNITY COUNCIL WORKS COLLABORATIVELY TO ENHANCE THE QUALITY OF LIFE IN THE NEIGHBORHOOD THROUGH VARIOUS INITIATIVES INCLUDING SAFE STREETS, FOOD PANTRIES, ANNUAL TOY DRIVES AND A LITTLE LEAGUE TEAM.AS PART OF A SUSTAINABILITY PROGRAM AIMED AT ADDRESSING FOOD INSECURITY WITHIN THE CITY OF BRIDGEPORT, BRIDGEPORT HOSPITAL AND ROCK AND WRAP IT UP! TEAMED UP TO RECOVER FOOD THAT HAS BEEN PREPARED BUT NOT SERVED FROM THE HOSPITAL AND DONATE IT TO THE BRIDGEPORT RESCUE MISSION. OVER 500 POUNDS OF FOOD WAS DONATED IN 2015. BRIDGEPORT HOSPITAL, ALONG WITH OTHER AREA BUSINESSES, IS A FOUNDING MEMBER OF THE SEAVIEW AVENUE BUSINESS ALLIANCE. THE SEAVIEW AVENUE BUSINESS ALLIANCE IS A NON-PROFIT ORGANIZATION DEDICATED TO IMPROVING STREETSCAPES AND IMPROVING THE AREA ALONG THE SEAVIEW AVENUE CORRIDOR. THE ORGANIZATION ALSO PROVIDES ANNUAL SCHOLARSHIPS TO STUDENTS GRADUATING FROM HARDING HIGH SCHOOL WHO PLAN TO ATTEND COLLEGE. IN 2015, THE HOSPITAL PROVIDED FINANCIAL AND IN-KIND SUPPORT FOR THESE EFFORTS.CREATING EDUCATIONAL OPPORTUNITIESBRIDGEPORT HOSPITAL, THROUGH THE SEAVIEW AVENUE BUSINESS ALLIANCE, PROVIDED SCHOLARSHIPS TO SENIORS FROM HARDING HIGH SCHOOL WHO WILL BE ATTENDING COLLEGE. THE HOSPITAL IS ALSO A MEMBER OF THE BRIDGEPORT CHILD ADVOCACY COALITION, WHICH IS A COALITION OF ORGANIZATIONS, PARENTS AND OTHER CONCERNED INDIVIDUALS COMMITTED TO IMPROVING THE WELL-BEING OF BRIDGEPORT'S CHILDREN THROUGH RESEARCH, ADVOCACY, COMMUNITY EDUCATION AND MOBILIZATION. PART III, LINE 2: IN ACCORDANCE WITH THE ESTABLISHED POLICIES OF THE HOSPITAL, DURING THE REGISTRATION, BILLING AND COLLECTION PROCESS A PATIENT'S ELIGIBILITY FOR FREE CARE FUNDS IS DETERMINED. FOR PATIENTS WHO WERE DETERMINED BY THE HOSPITAL TO HAVE THE ABILITY TO PAY BUT DID NOT, THE UNCOLLECTED AMOUNTS ARE BAD DEBT EXPENSE. THE HOSPITAL'S COST ACCOUNTING SYSTEM UTILIZES PATIENT-SPECIFIC DATA TO ACCUMULATE AND DERIVE COSTS RELATED TO THESE BAD DEBT ACCOUNTS. PART III, LINE 3: THE ORGANIZATION DOES NOT CURRENTLY HAVE A METHODOLOGY TO ACCURATELY QUANTIFY OR ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE THAT WOULD BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: THE HOSPITAL'S COMMITMENT TO COMMUNITY SERVICE IS EVIDENCED BY SERVICES PROVIDED TO THE POOR AND BENEFITS PROVIDED TO THE BROADER COMMUNITY. SERVICES PROVIDED TO THE POOR INCLUDE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED.THE HOSPITAL MAKES AVAILABLE FREE CARE PROGRAMS FOR QUALIFYING PATIENTS. IN ACCORDANCE WITH THE ESTABLISHED POLICIES OF THE HOSPITAL, DURING THE REGISTRATION, BILLING, AND COLLECTION PROCESS A PATIENT'S ELIGIBILITY FOR FREE CARE FUNDS IS DETERMINED. FOR PATIENTS WHO WERE DETERMINED BY THE HOSPITAL TO HAVE THE ABILITY TO PAY BUT DID NOT, THE UNCOLLECTED AMOUNTS ARE BAD DEBT EXPENSE. FOR PATIENTS WHO DO NOT AVAIL THEMSELVES OF ANY FREE CARE PROGRAM AND WHOSE ABILITY TO PAY CANNOT BE DETERMINED BY THE HOSPITAL, CARE GIVEN BUT NOT PAID FOR IS CLASSIFIED AS CHARITY CARE. TOGETHER, CHARITY CARE AND THE PROVISION FOR BAD DEBTS REPRESENT UNCOMPENSATED CARE. THE ESTIMATED COST OF TOTAL UNCOMPENSATED CARE IS APPROXIMATELY $24.8 MILLION AND $31.2 MILLION FOR THE YEARS ENDED SEPTEMBER 30, 2015 AND 2014, RESPECTIVELY. THE ESTIMATED COST OF UNCOMPENSATED CARE IS BASED ON THE RATIO OF COST TO CHARGES, AS DETERMINED BY CLAIMS ACTIVITY. THE ESTIMATED COST OF CHARITY CARE IS BASED ON THE RATIO OF COST TO CHARGES. THE ALLOCATION BETWEEN BAD DEBT AND CHARITY CARE IS DETERMINED BASED ON MANAGEMENT'S ANALYSIS ON THE PREVIOUS 12 MONTHS OF HOSPITAL DATA. THIS ANALYSIS CALCULATES THE ACTUAL PERCENTAGE OF ACCOUNTS WRITTEN OFF OR DESIGNATED AS BAD DEBT VERSUS CHARITY CARE WHILE TAKING INTO ACCOUNT THE TOTAL COSTS INCURRED BY THE HOSPITAL FOR EACH ACCOUNT ANALYZED.THE ESTIMATED COST OF CHARITY CARE AND FREE CARE PROVIDED WAS APPROXIMATELY $17.3 MILLION AND $22.1 MILLION FOR THE YEARS ENDED SEPTEMBER 30, 2015 AND 2014, RESPECTIVELY. THE ESTIMATED COST OF CHARITY CARE IS BASED ON THE RATIO OF COST TO CHARGES, AS DETERMINED BY HOSPITAL SPECIFIC DATA.FOR THE YEARS ENDED SEPTEMBER 30, 2015 AND 2014, THE PROVISION FOR BAD DEBTS, AT CHARGES, WAS APPROXIMATELY $15.4 MILLION AND $20.3 MILLION, RESPECTIVELY. FOR THE YEARS ENDED SEPTEMBER 30, 2015 AND 2014,THE PROVISION FOR BAD DEBTS, AT COST, WAS APPROXIMATELY $7.5 MILLION AND $9.1 MILLION, RESPECTIVELY. THE BAD DEBT EXPENSE IS MULTIPLIED BY THE RATIO OF COST TO CHARGES FOR PURPOSES OF INCLUSION IN THE TOTAL UNCOMPENSATED CARE AMOUNT IDENTIFIED ABOVE.THE CONNECTICUT DISPROPORTIONATE SHARE HOSPITAL PROGRAM (CDSHP) WAS ESTABLISHED TO PROVIDE FUNDS TO HOSPITALS FOR THE PROVISION OF UNCOMPENSATED CARE AND IS FUNDED, IN PART, BY A 1% ASSESSMENT ON HOSPITAL NET INPATIENT SERVICE REVENUE. DURING THE YEARS ENDED SEPTEMBER 30, 2015 AND 2014, THE HOSPITAL RECEIVED APPROXIMATELY $4.9 MILLION AND $14.4 MILLION, RESPECTIVELY, IN CDSHP DISTRIBUTIONS, OF WHICH APPROXIMATELY $3.4 MILLION AND $10.2 MILLION, RESPECTIVELY, RELATED TO CHARITY CARE. THE HOSPITAL MADE PAYMENTS INTO CDSHP OF APPROXIMATELY $19.1 MILLION AND $16.9 MILLION FOR THE YEARS ENDED SEPTEMBER 30, 2015 AND 2014, RESPECTIVELY, FOR THE 1% ASSESSMENT.THE STATE OF CONNECTICUT IMPLEMENTED CHANGES TO THE HOSPITAL FUNDING LEVELS FOR THE CDSHP IN THEIR FISCAL 2016 BIENNIUM BUDGET. AS A RESULT OF THESE BUDGET CHANGES, THE FUNDING FOR THIS PROGRAM WAS REDUCED EFFECTIVE JULY 1, 2015. THE REDUCTION IN FUNDING WAS APPROXIMATELY $6.1 MILLION FOR THE PERIOD JULY 1, 2015 TO SEPTEMBER 30, 2015 AND THE FUNDING HAS BEEN ELIMINATED FOR THE STATE FISCAL YEAR 2016 IN THE AMOUNT OF $24.2 MILLION.ADDITIONALLY, THE HOSPITAL PROVIDES BENEFITS FOR THE BROADER COMMUNITY, WHICH INCLUDES SERVICES PROVIDED TO OTHER NEEDY POPULATIONS THAT MAY NOT QUALIFY AS POOR BUT NEED SPECIAL SERVICES AND SUPPORT. BENEFITS INCLUDE THE COST OF HEALTH PROMOTION AND EDUCATION OF THE GENERAL COMMUNITY, INTERNS AND RESIDENTS, HEALTH SCREENINGS, AND MEDICAL RESEARCH. THE BENEFITS ARE PROVIDED THROUGH THE COMMUNITY HEALTH CENTERS, SOME OF WHICH SERVICE NON ENGLISH SPEAKING RESIDENTS, DISABLED CHILDREN, AND VARIOUS COMMUNITY SUPPORT GROUPS. THE HOSPITAL VOLUNTARILY ASSISTS WITH THE DIRECT FUNDING OF SEVERAL CITY OF BRIDGEPORT PROGRAMS, INCLUDING AN ECONOMIC DEVELOPMENT PROGRAM AND A YOUTH INITIATIVE PROGRAM.IN ADDITION TO THE QUANTIFIABLE SERVICES DEFINED ABOVE, THE HOSPITAL PROVIDES ADDITIONAL BENEFITS TO THE COMMUNITY THROUGH ITS ADVOCACY OF COMMUNITY SERVICE BY EMPLOYEES. THE HOSPITAL'S EMPLOYEES SERVE NUMEROUS ORGANIZATIONS THROUGH BOARD REPRESENTATION, MEMBERSHIP IN ASSOCIATIONS, AND OTHER RELATED ACTIVITIES. THE HOSPITAL ALSO SOLICITS THE ASSISTANCE OF OTHER HEALTH CARE PROFESSIONALS TO PROVIDE THEIR SERVICES AT NO CHARGE THROUGH PARTICIPATION IN VARIOUS COMMUNITY SEMINARS AND TRAINING PROGRAMS. PART III, LINE 9B: IT IS THE HOSPITAL'S POLICY TO TREAT ALL PATIENTS EQUITABLY WITH RESPECT AND COMPASSION, FROM THE BEDSIDE TO THE BILLING OFFICE. THE HOSPITAL WILL PURSUE PATIENT ACCOUNTS, DIRECTLY AND THROUGH ITS COLLECTION AGENTS, FAIRLY AND CONSISTENTLY TAKING INTO CONSIDERATION DEMONSTRATED FINANCIAL NEED. AS PART OF ITS COLLECTION PROCESS, THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO DETERMINE IF AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER ITS FINANCIAL ASSISTANCE POLICY. IN THE EVENT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL WILL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTION AS DEFINED BY LAW AND HOSPITAL POLICY. PART VI, LINE 2: COMMUNITY NEEDS ARE ROUTINELY REVIEWED AND ADDRESSED AS PART OF THE OPERATIONS AND SERVICE LINE TEAMS AT BRIDGEPORT HOSPITAL. THESE MULTI-DISCIPLINARY GROUPS PROVIDE ANALYSIS AND INSIGHT INTO PATIENT UTILIZATION TRENDS ACROSS OUR DELIVERY OF CARE AND ARE REVIEWED IN TANDEM WITH CARE MANAGEMENT AND PATIENT SATISFACTION RESULTS AND OTHER COMMUNITY FEEDBACK. COUPLED WITH THE RECENTLY COMPLETED COMMUNITY NEEDS ASSESSMENT, THIS INFORMATION ASSISTS WITH THE DEVELOPMENT OF NEW INITIATIVES, PARTNERSHIPS, PROGRAMS AND SERVICES TO BENEFIT OUR COMMUNITY. PART VI, LINE 3: BRIDGEPORT HOSPITAL INFORMS INDIVIDUALS ABOUT ITS FINANCIAL ASSISTANCE PROGRAMS ON ITS WEBSITE, THROUGH VISIBLE POSTINGS AND COMMUNICATIONS AT POINTS OF REGISTRATION AND FRONT LINE ACCESS. THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND SUMMARY ARE AVAILABLE ON REQUEST WITHOUT CHARGE BY MAIL, INCLUDING AT ADMITTING DEPARTMENT. FURTHER, PATIENTS RECEIVE A SUMMARY OF FINANCIAL ASSISTANCE PROGRAMS, INCLUDING ELIGIBILITY REQUIREMENTS THROUGH A FIRST STATEMENT MAILER AS PART OF THE BILLING PROVES. THESE COMMUNICATIONS INCLUDE TELEPHONE NUMBERS AND POINT OF CONTACT FOR INDIVIDUALS TO VISIT OR CALL. THE HOSPITAL HAS RESOURCES TO ASSIST PATIENTS WITH STATE OF CONNECTICUT MEDICAID APPLICATIONS. PART VI, LINE 4: BRIDGEPORT HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT EFFORTS ARE SPECIFICALLY FOCUSED IN TOWNS WHERE THE HOSPITAL IS ENGAGED WITH COMMUNITY PARTNERS THROUGH THE PRIMARY CARE ACTION GROUP. THIS GEOGRAPHIC AREA INCLUDES BRIDGEPORT, EASTON, FAIRFIELD, MONROE, STRATFORD, AND TRUMBULL. OVER 323,900 PEOPLE LIVE IN THESE TOWNS INCLUDING 75,369 UNDER THE AGE OF 18, 73,111 BETWEEN THE AGES OF 18 AND 128,251 BETWEEN THE AGES OF 35 AND 64, AND 47,202 OVER THE AGE OF 65. APPROXIMATELY 12% OF HOUSEHOLDS HAVE INCOMES LESS THAN $15,000, 29% OF HOUSEHOLDS HAVE INCOMES BETWEEN $15,000 AND $50,000, 40% OF HOUSEHOLDS HAVE INCOMES BETWEEN $50,000 AND $150,000 AND THE REMAINING 19% OF HOUSEHOLDS HAVE INCOMES GREATER THAN $150,000 PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH AS A COMMUNITY HEALTH CARE SERVICES PROVIDER, BRIDGEPORT HOSPITAL REMAINS ATTENTIVE TO HEALTH AND WELL-BEING THROUGH EDUCATION, OUTREACH AND OTHER INNOVATIVE SERVICES. DURING FISCAL YEAR 2015, BRIDGEPORT HOSPITAL PROVIDED $78.7 MILLION IN COMMUNITY BENEFITS THROUGH FINANCIAL AND IN-KIND CONTRIBUTIONS IN FIVE WIDE-RANGING PROGRAMS - GUARANTEEING ACCESS TO CARE; PROMOTING HEALTH AND WELLNESS; ADVANCING CAREERS IN HEALTH CARE; RESEARCH; AND CREATING HEALTHIER COMMUNITIES. BRIDGEPORT HOSPITAL ALSO CONTRIBUTES TO THE COMMUNITY IN WAYS THAT ARE NOT QUANTIFIED AS PART OF COMMUNITY BENEFITS AND SERVES AS AN IMPORTANT COMMUNITY RESOURCE. THIS INCLUDES HAVING A COMMUNITY-BASED BOARD OF TRUSTEES WITH MANY MEMBERS RESIDING OR WORKING IN THE AREA SERVED BY THE HOSPITAL. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. IN FISCAL YEAR 2015 THERE WERE A TOTAL OF 828 MEMBERS OF THE BRIDGEPORT HOSPITAL MEDICAL STAFF. BRIDGEPORT HOSPITAL, FOUNDED IN 1878, IS A 383-BED URBAN TEACHING HOSPITAL SERVING 19,815 INPATIENTS AND MORE THAN 287,660 OUTPATIENT ENCOUNTERS IN 2015. BRIDGEPORT HOSPITAL IS THE LARGEST PRIVATE EMPLOYER IN BRIDGEPORT WITH MORE THAN 2,600 EMPLOYEES IN 2015. PART VI, LINE 6 - AFFILIATED HEALTH CARE INFORMATION THE YALE NEW HAVEN HEALTH SYSTEM'S FUNDAMENTAL MISSION IS TO ENSURE THAT THE DELIVERY NETWORKS ASSOCIATED WITH THE SYSTEM PROMOTE THE HEALTH OF THE COMMUNITIES THEY SERVE AND ENSURE THAT ALL PATIENTS HAVE ACCESS TO APPROPRIATE HEALTHCARE SERVICES. THE YALE NEW HAVEN HEALTH SYSTEM REQUIRES ITS HOSPITALS TO INCORPORATE PLANS TO PROMOTE HEALTHY COMMUNITIES WITHIN THE HOSPITAL'S EXISTING BUSINESS PLANS FOR WHICH THEY ARE HELD ACCOUNTABLE. IN ADDITION, REGULAR REPORTING ON COMMUNITY BENEFITS IS REQUIRED ON A QUARTERLY BASIS. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT:CONNECTICUT 1 WITNESS PROJECT OF CT INC 2470 FAIRFIELD AVE BRIDGEPORT CT 06605 010668736 501(C)(3) 10000 SUPPORT MISSION P T BARNUM FOUNDATION INC 1070 MAIN ST BRIDGEPORT CT 06604 222655681 501(C)(3) 5000 SUPPORT MISSION SUPPORT MISSION 2 0 PART I, LINE 2: BRIDGEPORT HOSPITAL ("BH") CARRIES OUT DUE DILIGENCE IN PROVIDING MONETARY ASSISTANCE ONLY TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT COMPLEMENT ITS MISSION OR SUPPORT THE GREATER GOOD IN THE COMMUNITIES SERVES. NONE OF THE AMOUNTS REPORTED ON SCHEDULE I, PART II ARE GRANTS. THESE AMOUNTS ARE DONATIONS AND SPONSORSHIPS GIVEN TO ORGANIZATIONS TO ASSIST IN THE FURTHERANCE OF THEIR CHARITABLE MISSION. BH VERIFIES EACH ORGANIZATION'S EIN AS LISTED ON IRS FORM W-9 THAT HAS BEEN SUBMITTED TO BH. ASSISTANCE DONATED BY BH TO THESE QUALIFYING ORGANIZATIONS IS NOT OUTCOMES-BASED AND IS GIVEN IN SUPPORT OF AN INDIVIDUAL ORGANIZATION'S FUNDRAISING EVENTS OR IN SUPPORT OF DIRECT SERVICES. BH MAINTAINS FULL AND COMPLETE RECORDS OF ALL MONETARY ASSISTANCE PROVIDED, HOWEVER DOES NOT MONITOR SPECIFIC FUNDS. X X X X X 0 1 0 0 0 0 0 1 0 WILLIAM JENNINGS PRESIDENT & CEO/DIRECTOR 681337 170334 199267 49817 102464 25616 240589 60147 15552 3888 1239209 309802 71636 17909 PATRICK MCCABE SR. VP, CFO & TREASURER 153581 358356 45360 105839 20167 47057 69309 161720 5319 12411 293736 685383 5428 12665 NORMAN ROTH THRU 61615 COO & SEC. 103713 414852 29192 116769 595392 2381567 15982 63929 2963 11850 747242 2988967 202611 810445 PAMELA SCAGLIARINIEFF61615 COO & SEC. 332588 0 74850 0 51814 0 60593 0 21078 0 540923 0 10126 0 MICHAEL IVY SR. VP MEDICAL AFFAIRS 410414 0 99204 0 28608 0 15600 0 38913 0 592739 0 0 0 MARYELLEN KOSTURKO SR. VP PATIENT CARE 285769 0 66557 0 23108 0 23689 0 881 0 400004 0 9006 0 CAROLYN SALSGIVER SR. VP STRATEGY & BUSINESS 286275 0 68423 0 47772 0 132822 0 18609 0 553901 0 17335 0 MELISSA TURNER SR. VP HUMAN RESOURCE 144380 144380 38305 38305 23834 23834 59090 59090 11184 11184 276793 276793 0 0 MARC BRUNETTI VP OF SUPPORT OPERATIONS 231809 0 38104 0 17500 0 25029 0 35066 0 347508 0 0 0 RYAN O'CONNELL VP OF PERFORMANCE & RISK 315268 0 50294 0 21862 0 17719 0 39931 0 445074 0 0 0 JOHN SKELLY VP OF FINANCE 419203 0 103072 0 71131 0 180809 0 21697 0 795912 0 7891 0 JENNIFER WILLCOX ASSISTANT SECRETARY 0 254882 0 29871 0 36621 0 17667 0 26234 0 365275 0 0 GAYLE CAPOZZALO DIRECTOR 79650 716846 26292 236632 26451 238058 2310 20790 1483 13350 136186 1225676 7627 68639 JONATHAN MAISEL PHYSICIAN 390683 0 9873 0 23000 0 25711 0 19849 0 469116 0 0 0 THOMAS LAMONTE PHYSICIAN 325967 0 8164 0 23000 0 25711 0 19849 0 402691 0 0 0 ROCKMAN FERRIGNO PHYSICIAN 436567 0 10448 0 17500 0 14733 0 19849 0 499097 0 0 0 GUILLERMO KATIGBAK PHYSICIAN 339207 0 8202 0 18669 0 26000 0 15072 0 407150 0 0 0 FRANCISCO GARRIDO PHYSICIAN 347265 0 0 0 17394 0 12504 0 16558 0 393721 0 0 0 PATRICK SCHMINCKE THRU 62014 FORMER OFFICER 123144 0 36016 0 8942 0 3523 0 9817 0 181442 0 18564 0 ROBERT TREFRY RET 92010 FORMER OFFICER 0 0 0 0 0 216182 0 0 0 0 0 216182 0 216182 PART I, LINE 4B THE INDIVIDUALS LISTED BELOW ARE PARTICIPANTS IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THESE ACCRUALS ARE INCLUDED IN THE AMOUNTS REPORTED IN PART II, COLUMN C (DEFERRED COMPENSATION) AND REPRESENTS BOTH THE REPORTING ENTITY'S AND RELATED ENTITY'S COMBINED AMOUNTS CONSISTENT WITH THE COMPENSATION REPORTING PER IRS INSTRUCTIONS. SEVERANCE NONQUALIFIED EQUITY-BASED WILLIAM M. JENNINGS $0 $182,736 $0 PATRICK MCCABE $0 $124,768 $0 JOHN SKELLY $0 $102,215 $0 MELLISSA TURNER $0 $70,493 $0 CAROLYN SALSGIVER $0 $67,220 $0 INDIVIDUALS LISTED BELOW BECAME VESTED IN BENEFITS VALUED AT THE AMOUNTS RESPECTIVELY REPORTED DURING THE REPORTING YEAR. INCLUDED IN SECTION II, COLUMN B (III) ARE AMOUNTS VESTED DURING THE 2014 CALENDAR YEAR THAT WERE RECOGNIZED AS TAXABLE EVENTS AND REPORTED IN THE INDIVIDUALS' 2014 CALENDAR YEAR FORM W-2S. NORMAN ROTH $2,901,058 GAYLE CAPOZZALO $ 171,683 ONE FORMER OFFICER RECEIVED PAYMENTS FROM THE NONQUALIFIED PLAN. THE AMOUNT IS INCLUDED IN SECTION II, COLUMN B (III). THE FOLLOWING PAYMENT WERE MADE DIRECTLY TO HIM FROM THE RABBI TRUST: ROBERT TREFRY $216,182 THE SUPPLEMENTAL RETIREMENT PLAN IS DESIGNED TO ENSURE THE PAYMENT OF A COMPETITIVE LEVEL OF RETIREMENT INCOME WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME IN ORDER TO ATTRACT AND RETAIN KEY MANAGEMENT EMPLOYEES SERVING AS CORPORATE OFFICERS. THE PLAN PROVIDES SUPPLEMENTAL RETIREMENT INCOME THROUGH AN UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION ARRANGEMENT UNDER SECTION 457(F) AND THROUGH A DEFERRED COMPENSATION PLAN UNDER SECTION 409A OF THE INTERNAL REVENUE CODE AND A MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES' PLAN UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). PART I, LINE 7 NON-FIXED PAYMENTS PROVIDED THE SHORT TERM INCENTIVE PLAN IS A VARIABLE COMPENSATION PLAN WHICH PROVIDES ONE-TIME PAYMENTS TO ELIGIBLE MEMBERS OF MANAGEMENT IN RECOGNITION OF THE ACCOMPLISHMENT OF KEY ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE OBJECTIVES. PERFORMANCE LEVELS ARE ESTABLISHED AND REVIEWED ANNUALLY AT THRESHOLD, TARGET AND MAXIMUM LEVELS, ACCORDING TO PLANNED "STRETCH" GOALS AND OBJECTIVES. INCENTIVE AWARD OPPORTUNITIES ARE ESTABLISHED ACCORDING TO MARKET PRACTICES BASED ON EACH ELIGIBLE POSITION'S RESPONSIBILITIES, PERFORMANCE AND LEVEL OF AUTHORITY. PERFORMANCE RELATIVE TO STIP AWARD OPPORTUNITIES INCORPORATES A BROAD SPECTRUM OF PRE-DEFINED FINANCIAL AND NON-FINANCIAL METRICS THAT ARE ALIGNED WITH ORGANIZATIONAL MISSION AND VALUES. A CHEFA- SERIES D 060806186 20774YJE8 2012-05-31 40467946 REFINANCING A & C ISSUED 92 & 95 0 0 0 A 5485724 40467946 781263 39686683 2012 1 0 1 1 A 0 1 1 0 0 0 0 0 1 A 0 PART III - PRIVATE BUSINESS USE THIS SECTION IS NOT REQUIRED TO BE COMPLETED AS THE BOND REFUNDED PRE-2003 BOND ISSUANCES. CONNECTICUT NEUROSURGICAL SPECIALISTS PC SEE SCHEDULE O 310986 SEE PART V 0 EBP SUPPLY SOLUTIONS SEE SCHEDULE O 125655 SEE PART V 0 PART IV, COLUMN D NAME OF INTERESTED PERSON: CONNECTICUT NEUROSURGICAL SPECIALISTS, P.C.TRUSTEE GARY ZIMMERMAN, M.D. IS A GREATER THAN 35% OWNER OF CONNECTICUT NEUROSURGICAL SPECIALISTS, P.C. CONNECTICUT NEUROSURGICAL SPECIALISTS, P.C. PROVIDES MEDICAL SERVICES TO THE HOSPITAL.AMOUNT OF TRANSACTION: $310,986NAME OF INTERESTED PERSON: EBP SUPPLY SOLUTIONSTRUSTEE MEREDITH REUBEN IS THE SOLE STOCKHOLDER AND CHIEF EXECUTIVE OFFICER OF EBP SUPPLY SOLUTIONS. AFTER PERFORMING AN OBJECTIVE REVIEW PROCESS, WHICH INCLUDED A COMPARISON TO COMPETITIVE ALTERNATIVES AVAILABLE IN THE MARKETPLACE AND IN WHICH MS. REUBEN WAS NOT INVOLVED, THE HOSPITAL PURCHASED JANITORIAL AND FOOD SERVICE SUPPLIES AND SERVICES FROM EBP SUPPLY SOLUTIONS.AMOUNT OF TRANSACTION: $125,655 FORM 990, PART VI PART I, LINE 4 & PART VI, LINE 1B NUMBER OF INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY THE ORGANIZATION SOUGHT TO CONFIRM THE INDEPENDENCE OF EACH VOTING MEMBER OF ITS GOVERNING BODY BY REQUESTING THAT EACH SUCH VOTING MEMBER RESPOND TO A QUESTIONNAIRE CONTAINING THE PERTINENT INSTRUCTIONS AND DEFINITIONS AND DESIGNED TO ELICIT THE INFORMATION NECESSARY TO DETERMINE INDEPENDENCE. BASED ON RESPONSES TO THE QUESTIONNAIRES RECEIVED BY THE ORGANIZATION AND ANNUAL CONFLICTS OF INTEREST DISCLOSURES, THE ORGANIZATION WAS ABLE TO CONFIRM THAT NINE (9) VOTING MEMBERS ARE INDEPENDENT. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS BETWEEN OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES: THE ORGANIZATION'S CURRENT OFFICERS AND/OR TRUSTEES SERVE AS OFFICERS AND/OR DIRECTORS OF TAXABLE AFFILIATES WITHIN THE ORGANIZATION'S CORPORATE SYSTEM OR JOINT VENTURES IN WHICH THE ORGANIZATION'S CORPORATE SYSTEM HAS AN OWNERSHIP INTEREST. THE INDIVIDUAL OFFICERS DO NOT HAVE PERSONAL FINANCIAL INTERESTS IN THE TAXABLE AFFILIATE AND SERVE ONLY AS A FUNCTION OF THEIR ROLES WITH THE ORGANIZATION OR WITHIN THE ORGANIZATION'S CORPORATE SYSTEM. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF BRIDGEPORT HOSPITAL IS YALE-NEW HAVEN HEALTH SERVICES CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE HOSPITAL IS GOVERNED BY ITS BOARD OF DIRECTORS, WHICH ELECTS THE PERSONS TO SERVE ON SUCH BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER, YALE-NEW HAVEN HEALTH SERVICES CORPORATION, HAS THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF THE ORGANIZATION, AND (ON THE RECOMMENDATION OF THE BOARD OF DIRECTORS) THE FOLLOWING ADDITIONAL RIGHTS: TO APPROVE OPERATING, CASH FLOW AND CAPITAL BUDGETS; TO APPROVE GRADUATE AND UNDERGRADUATE MEDICAL EDUCATION ARRANGEMENTS; TO APPROVE MAJOR NEW CLINICAL PROGRAMS AND SERVICES AND CONTINUATION OF SAME; APPROVAL OF STRATEGIC PLANS; AND ADOPTION OF SAFETY AND QUALITY ASSESSMENT POLICIES; TO APPROVE THE MERGER, CONSOLIDATION, DISSOLUTION OR THE SALE OF ALL OR SUBSTANTIALLY ALL THE ORGANIZATION'S ASSETS; TO AMEND THE CERTIFICATE OF INCORPORATION AND BYLAWS OF THE ORGANIZATION, TO APPROVE THE EXECUTION OF LONG-TERM OR MATERIAL AGREEMENTS, TO APPROVE THE APPOINTMENT OF AN INDEPENDENT AUDITOR AND THE HIRING OF INDEPENDENT COUNSEL, TO AUTHORIZE THE EXECUTION OF CONTRACTS WITH AN UNRELATED THIRD PARTY FOR MANAGEMENT OF THE ASSETS OR OPERATIONS OF THE ORGANIZATION, AND TO APPROVE COMPENSATION OF EMPLOYED PHYSICIANS. YALE-NEW HAVEN HEALTH SERVICES CORPORATION RETAINS THE FOLLOWING AUTHORITY: ADOPTION OF BUDGETARY TARGETS, INDEBTEDNESS, MANAGEMENT AND CONTROL OF LIQUID ASSETS, APPOINTMENT OF THE INDEPENDENT AUDITOR AND APPOINTMENT OF THE CEO. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 TAX RETURN AND ATTACHED SCHEDULES WERE PREPARED BY EMPLOYEES OF THE SYSTEM TAX DEPARTMENT. THE RETURN IS INITIALLY REVIEWED BY THE EXECUTIVE DIRECTOR/DIRECTOR OF FINANCE. SUBSEQUENTLY IT IS SENT TO KPMG LLP FOR THEIR INITIAL REVIEW. AFTER ALL COMMENTS FROM THE ABOVE GROUP ARE CLEARED, THE RETURN IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER OF THE ENTITY AND A FINAL VERSION OF THE RETURN IS SENT BACK TO KPMG LLP FOR FINAL REVIEW. PRIOR TO FILING, THE ORGANIZATION MADE AVAILABLE A COMPLETE COPY OF THE RETURN TO THE BOARD OF DIRECTORS VIA A WEB PORTAL. FORM 990, PART VI, SECTION B, LINE 12C BRIDGEPORT HOSPITAL IS COVERED UNDER THE YALE-NEW HAVEN HEALTH SERVICES CORP. CONFLICT OF INTEREST POLICY. THE YALE NEW HAVEN HEALTH SYSTEM CONFLICT OF INTEREST POLICY (CC:R-7) AND INDIVIDUAL ANNUAL DISCLOSURE FORM APPLIES TO A POOL OF EMPLOYEES, BOARD MEMBERS AND NON-BOARD MEMBERS SERVING ON BOARD COMMITTEES. THESE "COVERED INDIVIDUALS" ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT, UPON BEGINNING EMPLOYMENT OR OTHERWISE BECOMING A COVERED INDIVIDUAL AND ANNUALLY THEREAFTER. COVERED INDIVIDUALS ARE ALSO REQUIRED TO IMMEDIATELY REPORT MATERIAL CHANGES TO THEIR MOST RECENTLY COMPLETED DISCLOSURE STATEMENT. THESE DISCLOSURE STATEMENTS AND REPORTS ARE REVIEWED BY THE OFFICE OF PRIVACY AND CORPORATE COMPLIANCE AND/OR THE LEGAL AND RISK SERVICES DEPARTMENT TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF A POTENTIAL CONFLICT ARISES, THE PRESIDENT AND CEO WOULD CONSULT WITH THE BOARD CHAIRPERSON AND THE LEGAL AND RISK SERVICES DEPARTMENT AND TAKE ANY ACTIONS THAT SHE DEEMS REQUIRED OR APPROPRIATE TO MANAGE OR RESOLVE A POTENTIAL CONFLICT OF INTEREST. FOR EXAMPLE, A VOTING BOARD OR COMMITTEE MEMBER WOULD BE REQUIRED TO RECUSE HIMSELF OR HERSELF FROM VOTING ON MATTERS RELATED TO THE POTENTIAL CONFLICT AND THE POTENTIAL CONFLICT WOULD BE DISCLOSED TO OTHER VOTING MEMBERS. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A - COMPENSATION PROCESS FOR TOP OFFICIAL: THE MANAGEMENT AFFAIRS COMMITTEE OF BRIDGEPORT HOSPITAL STRIVES TO TAKE THE STEPS NECESSARY TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER FEDERAL TAX LAW. THE MANAGEMENT AFFAIRS COMMITTEE IS AUTHORIZED UNDER THE BRIDGEPORT HOSPITAL BYLAWS AND IS RESPONSIBLE FOR (1) DETERMINING THE OVERALL TOTAL COMPENSATION STRATEGY FOR ALL CORPORATE OFFICERS, (2) APPROVING ALL COMPENSATION AND BENEFITS DECISIONS FOR CORPORATE OFFICERS, AND (3) REPORTING SUCH ACTIONS TO THE FULL BRIDGEPORT HOSPITAL BOARD ON AN ANNUAL BASIS. IN ADDITION, THE MANAGEMENT AFFAIRS COMMITTEE EXPRESSLY DETERMINES THE REASONABLENESS OF TOTAL COMPENSATION AND BENEFITS FOR ALL CORPORATE OFFICERS, AND ASSURES THAT ALL OFFICER COMPENSATION DECISIONS ARE MADE AFTER THOROUGH CONSIDERATION OF AND COMPARISON TO THE MARKET PRACTICES OF OTHER SIMILARLY SITUATED NOT-FOR-PROFIT HEALTHCARE EXECUTIVES IN COMPARABLE ORGANIZATIONS. THE MANAGEMENT AFFAIRS COMMITTEE CONSISTS OF BOARD MEMBERS WHO DO NOT HAVE MATERIAL FINANCIAL INTERESTS THAT COULD BE AFFECTED BY THE OFFICER COMPENSATION DECISIONS MADE BY THE COMMITTEE. THE COMPARABILITY DATA USED TO ASSIST THE MANAGEMENT AFFAIRS COMMITTEE IN ITS COMPENSATION DELIBERATIONS ARE COMPILED BY AN INDEPENDENT, NATIONAL COMPENSATION CONSULTING FIRM THAT IS RETAINED BY AND REPORTS DIRECTLY TO THE MANAGEMENT AFFAIRS COMMITTEE. THE DATA COLLECTED BY THE CONSULTANT CONSISTS OF MARKET INFORMATION FOR EXECUTIVES IN FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS. THE DELIBERATIONS AND DECISIONS OF THE MANAGEMENT AFFAIRS COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED, REVIEWED AND APPROVED BY THE MANAGEMENT AFFAIRS COMMITTEE, AND PROVIDED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 15: LINE 15B - COMPENSATION PROCESS FOR OTHER OFFICERS OR KEY EMPLOYEES: THE MANAGEMENT AFFAIRS COMMITTEE OF BRIDGEPORT HOSPITAL STRIVES TO TAKE THE STEPS NECESSARY TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER FEDERAL TAX LAW. THE MANAGEMENT AFFAIRS COMMITTEE IS AUTHORIZED UNDER THE BRIDGEPORT HOSPITAL BYLAWS AND IS RESPONSIBLE FOR (1) DETERMINING THE OVERALL TOTAL COMPENSATION STRATEGY FOR ALL CORPORATE OFFICERS, (2) APPROVING ALL COMPENSATION AND BENEFITS DECISIONS FOR CORPORATE OFFICERS, AND (3) REPORTING SUCH ACTIONS TO THE FULL BRIDGEPORT HOSPITAL BOARD ON AN ANNUAL BASIS. IN ADDITION, THE MANAGEMENT AFFAIRS COMMITTEE EXPRESSLY DETERMINES THE REASONABLENESS OF TOTAL COMPENSATION AND BENEFITS FOR ALL CORPORATE OFFICERS, AND ASSURES THAT ALL OFFICER COMPENSATION DECISIONS ARE MADE AFTER THOROUGH CONSIDERATION OF AND COMPARISON TO THE MARKET PRACTICES OF OTHER SIMILARLY SITUATED NOT-FOR-PROFIT HEALTHCARE EXECUTIVES IN COMPARABLE ORGANIZATIONS. THE MANAGEMENT AFFAIRS COMMITTEE CONSISTS OF BOARD MEMBERS WHO DO NOT HAVE MATERIAL FINANCIAL INTERESTS THAT COULD BE AFFECTED BY THE OFFICER COMPENSATION DECISIONS MADE BY THE COMMITTEE. THE COMPARABILITY DATA USED TO ASSIST THE MANAGEMENT AFFAIRS COMMITTEE IN ITS COMPENSATION DELIBERATIONS ARE COMPILED BY AN INDEPENDENT, NATIONAL COMPENSATION CONSULTING FIRM THAT IS RETAINED BY AND REPORTS DIRECTLY TO THE MANAGEMENT AFFAIRS COMMITTEE. THE DATA COLLECTED BY THE CONSULTANT CONSISTS OF MARKET INFORMATION FOR EXECUTIVES IN FUNCTIONALLY SIMILAR POSITIONS IN SIMILARLY SITUATED NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS. THE DELIBERATIONS AND DECISIONS OF THE MANAGEMENT AFFAIRS COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED, REVIEWED AND APPROVED BY THE MANAGEMENT AFFAIRS COMMITTEE, AND PROVIDED TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF FORM 990, FORM 1023 (IF AVAILABLE) AND AUDITED FINANCIAL STATEMENTS ARE MAINTAINED IN THE SYSTEM TAX DEPARTMENT. OTHER CORPORATE GOVERNING DOCUMENTS ARE MAINTAINED BY THE LEGAL AND RISK SERVICES DEPARTMENT. THE CONFLICT OF INTEREST POLICY, WHISTLEBLOWER POLICY, AND DOCUMENT RETENTION POLICY ARE AVAILABLE TO ALL EMPLOYEES ON THE CORPORATE INTERNAL WEBSITE. COPIES OF ALL DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 50,434,002. MANAGEMENT AND GENERAL EXPENSES 12,423,050. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,857,052. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 27,530,794. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,530,794. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 8,759,510. MANAGEMENT AND GENERAL EXPENSES 2,800,935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,560,445. FORM 990, PART XI, LINE 9: INCREASE IN TEMP RESTRICTED NET ASSETS 1,565,537. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS 3,660,512. TEMPORARILY RESTRICTED INCOME -489,743. SABA SURGERY FUND TRANSFER TO BRIDGEPORT HOSPITAL FOUNDATION -214,894. INCREASE IN PERM RESTRICTED NET ASSETS 1,133,000. DECREASE IN UNRESTRICTED RESTRICTED NET ASSETS -45,585,000. RECLASS OPERATING INCOME TO CHANGE IN NET ASSETS 20,165. RECLASS SERP ASSETS G/L -119. OTHER-NON-OPERATING INCOME ADJUSTMENT 1,353. GREENWICH HOSPITAL 5 PERRYRIDGE ROAD GREENWICH CT 06830 060646659 HEALTHCARE SERVICES CT 501C3 LINE 3 GREENWICH HEALTH CARE SERVICES INC 1 GREENWICH HEALTH CARE SERVICES INC 5 PERRYRIDGE ROAD GREENWICH CT 06830 222593399 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II YALE-NEW HAVEN HEALTH SERVICES CORP 0 THE GREENWICH HOSPITAL ENDOWMENT FUND INC 5 PERRYRIDGE ROAD GREENWICH CT 06830 061526642 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II GREENWICH HEALTH CARE SERVICES INC 1 SOUTHERN CONNECTICUT HEALTH SYSTEM PROPERTIES INC 267 GRANT STREET BRIDGEPORT CT 06610 061297708 TITLE HOLDING CT 501C2 BRIDGEPORT HOSPITAL 1 BRIDGEPORT HOSPITAL AUXILIARY INC 267 GRANT STREET BRIDGEPORT CT 06610 066042500 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11A, I BRIDGEPORT HOSPITAL 1 BRIDGEPORT HOSPITAL FOUNDATION INC 267 GRANT STREET BRIDGEPORT CT 06610 222908698 SYSTEM SUPPORT SERVICES CT 501C3 LINE 7 BRIDGEPORT HOSPITAL 1 NORTHEAST MEDICAL GROUP INC 99 HAWLEY LANE STRSTFORD CT 06614 061330992 HEALTHCARE SERVICES CT 501C3 LINE 9 YALE-NEW HAVEN HEALTH SERVICES CORP 1 NORTHEAST MEDICAL GROUP PLLC 99 HAWLEY LANE STRSTFORD CT 06614 352380180 HEALTHCARE SERVICES CT 501C3 LINE 11A, I NORTHEAST MEDICAL GROUP INC 1 YALE-NEW HAVEN HOSPITAL 20 YORK STREET NEW HAVEN CT 06504 060646652 HEALTHCARE SERVICES CT 501C3 LINE 3 YALE-NEW HAVEN HEALTH SERVICES CORP 1 YALE-NEW HAVEN CARE CONTINUUM CORP 789 HOWARD AVE NEW HAVEN CT 06519 455235566 NURSING HOME CT 501C3 LINE 3 YALE-NEW HAVEN HOSPITAL 1 CARITAS INSURANCE - TERMINATED 121514 40 MAIN STREET BURLINGTON VT 05401 030322238 INSURANCE SERVICES VT 501C3 LINE 11A, I YALE-NEW HAVEN HOSPITAL 1 YALE-NEW HAVEN HEALTH SERVICES CORP 789 HOWARD AVE NEW HAVEN CT 06519 222529464 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11A, I N/A 0 PERRYRIDGE CORPORATION 5 PERRYRIDGE ROAD GREENWICH CT 06830 061207316 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11B, II GREENWICH HEALTH CARE SERVICES INC 1 BRIDGEPORT HOSPITAL FRIENDS OF PEDIATRICS INC 120 COLUMBINE DRIVE TRUMBULL CT 06611 066048427 SYSTEM SUPPORT SERVICES CT 501C3 LINE 11A, I YALE-NEW HAVEN HOSPITAL 1 SHORELINE SURGERY CENTER LLC 60 TEMPLE STREET NEW HAVEN CT 06510 900110459 HEALTHCARE SERVICES CT N/A SSC II LLC 111 GOOSE LANE GUILFORD CT 06437 261709382 HEALTHCARE SERVICES CT N/A ORTHOPAEDIC & NEUROSURGERY CENTER 55 HOLLY HILL LANE GREENWICH CT 06830 273477197 HEALTHCARE SERVICES CT N/A TOTAL HEALTH CONNECTICUT LLC 789 HOWARD AVENUE NEW HAVEN CT 06519 474070024 HEALTHCARE SERVICES CT N/A YNHHS-MSO INC 789 HOWARD AVE NEW HAVEN CT 06519 061467717 MANAGEMENT SERVICES CT N/A C 1 YALE NEW HAVEN AMBULATORY SERVICES 40 TEMPLE STREET NEW HAVEN CT 06510 061398526 HEALTHCARE SERVICES CT N/A C 1 MEDICAL CENTER REALTY INC 50 YORK STREET NEW HAVEN CT 06511 061110858 RENTAL SERVICES CT N/A C 1 GREENWICH HEALTH SERVICES INC - TERMINATED 63015 5 PERRYRIDGE ROAD GREENWICH CT 06830 061233643 HEALTHCARE SERVICES CT N/A C 1 GREENWICH FERTILITY & IVF PC 5 PERRYRIDGE ROAD GREENWICH CT 06830 300145464 HEALTHCARE SERVICES CT N/A C 1 YORK ENTERPRISES INC 50 YORK STREET NEW HAVEN CT 06511 061110937 TITLE HOLDING CT N/A C 1 YNHH-PHYSICIANS CORP 789 HOWARD AVE NEW HAVEN CT 06519 061202305 ADMINISTRATIVE SERVICES CT N/A C 1 MEDICAL CENTER PHARMACY INC 50 YORK STREET NEW HAVEN CT 06511 061087673 PHARMACY CT N/A C 1 GREENWICH OCCUPATIONAL HEALTH SERVICES OF NY PC 5 PERRYRIDGE ROAD GREENWICH CT 06830 061540101 HEALTHCARE SERVICES NY N/A C 1 LUKAN INDEMNITY COMPANY - TERMINATED 3312015 58 PAR-LA-VALLIS RD HAMILTON BD 981072793 INSURANCE SERVICES BD N/A C 1 GREENWICH OCCUPATIONAL HEALTH SERVICES OF NEW JERSEY 5 PERRYRIDGE ROAD GREENWICH CT 06830 453833883 HEALTHCARE SERVICES NJ N/A C 1 PRIMARYNET OF CONNECTICUT INC 789 HOWARD AVE NEW HAVEN CT 06519 061463534 HEALTHCARE SERVICES CT N/A C 1 CENTURY FINANCIAL SERVICES INC 23 MAIDEN LANE NORTH HAVEN CT 06473 061110797 DEBT COLLECTION SERVICES CT N/A C 1 CENTURY MANAGEMENT SERVICES INC 23 MAIDEN LANE NORTH HAVEN CT 06473 061303173 RECEIVABLE MANAGEMENT SERVICES CT N/A C 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 YALE NEW HAVEN SERVICES CORPORATION P 5555029 TRANSACTION REVIEW YALE NEW HAVEN SERVICES CORPORATION M 58571666 COMPARABLE MARKET VALUE BRIDGEPORT HOSPITAL FOUNDATION INC Q 3124421 TRANSACTION REVIEW BRIDGEPORT HOSPITAL FOUNDATION INC L 3941042 TRANSACTION REVIEW BRIDGEPORT HOSPITAL FOUNDATION INC A 4200 TRANSACTION REVIEW