2015-08-14T09:15:10-05:00 2014-09-30 350921680 CROWE HORWATH LLP 175 POWDER FOREST DRIVE SIMSBURY CT 06089 990 2013-10-01 060647014 GRIFFIN HOSPITAL GRIF 2037327528 130 DIVISION STREET DERBY CT 06418 MARK O'NEILL VP FINANCE/ CFO 2037327528 2015-08-11 1 BETH THURZ P00346435 8606789200 2013 2016-04-25 22:37:26Z PATRICK S CHARMEL 130 DIVISION STREET DERBY CT 06418 141539678 0 X GRIFFINHEALTH.ORG X 1908 CT GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT. 18 15 1461 450 3664269 -596810 2231692 1883920 128990660 138777765 320617 323608 452490 554385 131995459 141539678 0 0 0 0 72402078 72464593 0 0 0 57266011 59780750 129668089 132245343 2327370 9294335 119856922 119095066 133564097 135761625 -13707175 -16666559 X GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT; TO EMPOWERING INDIVIDUALS TO BE ACTIVELY INVOLVED IN DECISIONS AFFECTING THEIR CARE AND WELL-BEING THROUGH ACCESS TO INFORMATION AND EDUCATION; AND TO PROVIDING LEADERSHIP TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE. 0 0 114783740 122796073 GRIFFIN HOSPITAL IS AN ACUTE CARE HOSPITAL PROVIDING MEDICAL CARE TO PATIENTS IN COMMUNITIES SERVED, INCLUDING SUBSIDIZED CARE, CHARITY CARE, AND EDUCATIONAL SERVICES TO HEALTH PROFESSIONALS TO HELP PREPARE THE NEXT GENERATION OF CAREGIVERS. 3630422 8957280 PROVIDE CANCER RELATED RADIOLOGY SERVICES TO THE COMMUNITY. 2079957 2193968 PROVIDE PSYCHIATRIC SERVICES TO THE COMMUNITY ON AN OUTPATIENT BASIS. 649588 1329708 PROVIDE HOSPICE SERVICES TO THE COMMUNITY. 649588 1329708 121143707 1 1 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 203 0 1 1461 1 1 1 0 0 0 0 0 0 0 0 0 X 18 15 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 CT X JAMES DOWNEY 2037327528 130 DIVISION STREET DERBY CT 06418 HENDRICKS DAVID MD/BOARD MEMBER 1.00 X 0 0 0 CHARMEL PATRICK PRESIDENT/CEO/SEC/TREASURER 40.00 5.00 X X 457568 0 61107 BORIS GREGORY MD/BOARD MEMBER 1.00 X 0 0 0 DOBULER KENNETH MD/BOARD MEMBER 14.00 X 234903 0 47152 SCHWARTZ KENNETH MD/BOARD MEMBER 16.00 X 173967 0 64324 ANDREANA JOSEPH TRUSTEE 1.00 X 0 0 0 BALDYGA KENNETH TRUSTEE 1.00 X 0 0 0 BETKOSKI JOHN W III TRUSTEE 1.00 X 0 0 0 DINARDO NANCY TRUSTEE 1.00 X 0 0 0 JONES JEAN CRUM TRUSTEE 1.00 X 0 0 0 KLARIDES THEMIS TRUSTEE 1.00 X 0 0 0 LOGAN GEORGE S TRUSTEE 1.00 X 0 0 0 OSAK FRANK M TRUSTEE 1.00 X 0 0 0 REISS ROBERT G TRUSTEE 1.00 X 0 0 0 WEINER GERALD T CHAIRMAN 1.00 X X 0 0 0 ZAPRZALKA JOHN J TRUSTEE 1.00 X 0 0 0 BINGAMAN LARRY TRUSTEE 1.00 X 0 0 0 PEARSON WM NEIL MD/TRUSTEE 1.00 X 0 0 0 POWANDA WILLIAM VICE PRESIDENT 40.00 X 129095 0 42672 STUMPO BARBARA J V.P. 40.00 X 171849 0 43838 BERNS EDWARD VICE PRESIDENT 40.00 X 136945 0 30335 MARTIN KATHLEEN VICE PRESIDENT 40.00 X 140345 0 30958 DEEGAN MARGARET VICE PRESIDENT 40.00 X 184438 0 34538 SHEPARD SETH VICE PRESIDENT 40.00 X 164097 0 23008 O'NEILL MARK V.P./CFO 40.00 X 245070 0 10480 D'SOUSA SEEMA MD 30.00 X 287181 0 18980 HALSTEAD EDWARD MD 40.00 X 225150 0 36627 NAWAZ HAQ MD 40.00 X 329925 0 34172 SALABARRIA JAVIER MD 40.00 X 292547 0 17172 PAXTON HEATHER MD 40.00 X 175063 0 23387 3348143 0 518750 67 0 1 0 HURON CONSULTING SERVICE 4795 PAYSPHERE CIRCLE CHICAGO IL 60674 CONSULTING SERVICE 3104216 CONNECTICUT EMERGENCY MEDICINE SPECIALIS PO BOX 271618 WEST HARTFORD CT 06127 E.R. PHYSICIAN SERVICES 1673090 UNIDINE CORPORATION 75 REMITTANCE DRIVE CHICAGO IL 60675 FOOD SERVICE 1529480 GRIFFIN PATHOLOGY 1140 FAIRFIELD AVENUE BRIDGEPORT CT 06605 PHYSICIAN SERVICES 458963 QUEST DIAGNOSTICS 2025 COLLECTION CENTER CHICAGO IL 60693 MEDICAL SERVICES 353946 22 1661116 222804 1883920 PATIENT SERVICE REVENUE 622110 135897993 132397257 3500736 OTHER PROGRAM SERVICES 621500 2879772 2879772 138777765 269076 269076 390852 0 390852 390852 390852 54532 0 54532 54532 54532 PARTNERSHIP INCOME 900099 163533 163533 163533 141539678 135277029 3664269 714460 1916339 1638470 277869 53786635 50320751 3465884 2972123 2772362 199761 9554311 8902794 651517 4235185 3950532 284653 3506241 2360214 1146027 169634 169634 269004 269004 10725776 9783028 942748 432860 432860 353575 313387 40188 383317 159324 223993 348388 288697 59691 235950 205496 30454 386004 105180 280824 3531137 2401173 1129964 5750660 4767227 983433 2235254 1609383 625871 MEDICAL & DRUG SUPPLIES 19889030 19889030 RESEARCH GRANT EXPENSES 1969557 1649436 320121 DIETARY 1237808 1237808 8356555 8356555 132245343 121143707 11101636 0 5178405 7492599 14419423 12651193 804168 940022 2669266 2653216 152106216 98968474 55610873 53137742 10227164 9337106 16149279 18270288 14798344 14612900 119856922 119095066 25957546 24399592 194930 39289 48355712 46974634 59055909 64348110 133564097 135761625 X -22179759 -26106535 2641381 3519544 5831203 5920432 -13707175 -16666559 119856922 119095066 X 9294335 263170 -12516889 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23941 23941 0 PART II-B, LINE 1: THE GRIFFIN HOSPITAL PAID FOR MEMBERSHIP DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION FOR THE FISCAL YEAR ENDED 9/30/2014. $23,941 OF THE MEMBERSHIP DUES PAID WAS USED FOR LOBBYING ON ISSUES RELEVANT TO THE ORGANIZATION'S EXEMPT PURPOSE. 3409062 242728 25358 3626432 3249540 183001 23479 3409062 2932333 322207 5000 3249540 2953261 -1478 19450 2932333 2773278 124305 1337 2896246 0.59600 0.40400 1 0 4015091 4015091 73363740 38051000 35312740 74378178 60672419 13705759 349207 245055 104152 53137742 FIXED INCOME SECURITIES 4284319 F MARKETABLE EQUITY SECURITIES 5052787 F 9337106 LIMITED USE ASSETS - CURRENT 718521 F BOARD DESIGNATED INVESTMENTS 30866 F BENEFICIAL INTEREST IN TRUSTS 3760171 F UNDER INDENTURE AGREEMENT 4289408 F INVESTMENTS IN NET ASSETS OF AFFILIATES 9471322 C 18270288 OTHER RECEIVABLES 1443122 DUE FROM AFFILIATES 6230012 OTHER ASSETS & INSURANCE RECOVERABLE 6137382 THIRD PARTY 765159 DEFERRED REVENUE 37225 14612900 ACCRUED POST RETIREMENT - CURRENT 447000 ACCRUED POST RETIREMENT - NONCURRENT 8517526 PROFESSIONAL AND GENERAL LIABILITY 842593 MINIMUM PENSION LIABILITY 35030915 WORKERS COMPENSATION - LONG TERM 2178810 ACCRUED INTEREST PAYABLE 295828 OTHER LIABILITIES 2229003 RETIREMENT OBLIGATION 109412 CAPITAL LEASE - NET OF CURRENT 1720364 SWAP OBLIGATION 6436499 CLAIM RESERVE 842593 DUE TO THIRD PARTY 5697567 64348110 141802848 263170 263170 141539678 0 141539678 132245343 0 132245343 0 132245343 PART V, LINE 4: THE HOSPITAL'S ENDOWMENT FUNDS CONSIST OF DONOR RESTRICTED FUNDS TO BE INVESTED IN PERPETUITY TO PROVIDE A PERMANENT SOURCE OF INCOME. 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 278 1077837 0 1077837 0.00820 13928 14980475 11687429 3293046 0.02490 85 77853 72569 5284 0.00000 14291 16136165 11759998 4376167 0.03310 16 44311 881535 54896 826639 0.00630 2 212 7300952 5938278 1362674 0.01030 3 39626 7723089 6645147 1077942 0.00820 0 0 1137037 1130680 6357 0.00000 2 1623 32184 18917 13267 0.00010 23 85772 17074797 13787918 3286879 0.02490 23 100063 33210962 25547916 7663046 0.05800 1 175 1010 1010 0.00000 1 175 1010 1010 1 300338 45782394 49493109 -3710715 X 1 1 1 1 GRIFFIN HOSPITAL 130 DIVISION STREET DERBY CT 06418 GRIFFINHEALTH.ORG 00034 X X X X X GRIFFIN HOSPITAL 1 1 X X X X X X X 12 1 0 1 X HTTP://WWW.GRIFFINHEALTH.ORG X HTTP://WWW.CT.GOV/DPH/CWP/VIEW X X X X X X X X X 0 0 1 1 250.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 GRIFFIN HOSPITAL PART V, SECTION B, LINE 3: REGIONAL COOPERATION ON HEALTH ISSUES - REGIONAL COOPERATION, THE LEADERSHIP OF GRIFFIN HOSPITAL ON COMMUNITY HEALTH IMPROVEMENT AND THE EFFECTIVENESS OF EFFORTS WAS POSITIVELY NOTED IN FOCUS GROUPS, FORUMS AND SURVEYS. OF PARTICULAR NOTE WAS THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS (VCHHSO). GRIFFIN HOSPITAL WAS A LEADER IN ESTABLISHING THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS WHICH HAS BECOME A MODEL FOR OTHER COMMUNITIES. THE VALLEY COUNCIL IS A COOPERATIVE VENTURE FOUNDED OVER TWENTY YEARS AGO LINKING APPROXIMATELY 50 NON-PROFIT HEALTH & HUMAN SERVICE PROVIDERS THROUGHOUT THE VALLEY. ITS MISSION IS TO IDENTIFY, PLAN, IMPLEMENT, AND COORDINATE A COMPREHENSIVE SYSTEM OF HUMAN SERVICE DELIVERY AND TO ADVOCATE FOR COMMUNITY-WIDE AND CULTURALLY DIVERSE PLANNING APPROACHES IN THE LARGER VALLEY COMMUNITY. DECISION MAKERS FROM EACH OF THE ACTIVE MEMBERS MEET MONTHLY. THE COUNCIL'S OBJECTIVES ARE TO: 1. ENGAGE IN PERIODIC ASSESSMENT AND IDENTIFICATION OF LOCAL SERVICE NEEDS, INCLUDING CLIENT INPUT. 2. COLLABORATIVELY EVALUATE CURRENT SERVICES, IDENTIFY GAPS, AND STRATEGIZE ON HOW TO FILL GAPS IN SERVICES. 3. SERVE AS THE PRIMARY PLANNING AND COORDINATING BODY FOR THE REGIONS' SERVICE PROVISION SYSTEM. 4. PROVIDE A PLACE FOR SUPPORT AND NETWORKING AMONG THE VALLEY HUMAN SERVICES COMMUNITY. 5. ADVOCATE FOR THE NEEDS OF LOCAL RESIDENTS AND FOR RESOURCES TO MEET THOSE NEEDS ON A LOCAL, STATE, AND FEDERAL LEVEL. 6. SEEK TO DEVELOP PARTNERSHIPS WITH OTHER COMMUNITY SYSTEMS (I.E. SCHOOLS, BUSINESSES, STATE AND LOCAL GOVERNMENTS, PUBLIC SAFETY) TO ENHANCE SERVICE DELIVERY. GRIFFIN REMAINS AN ACTIVE MEMBER OF THE COUNCIL. NOT ONLY IS GRIFFIN HOSPITAL A CONTINUING MEMBER, THE VALLEY PARISH NURSE PROGRAM AND THE YALE-GRIFFIN PREVENTION RESEARCH CENTER ALSO ARE MEMBERS. THE COMMUNITY ADVISORY COUNCIL ENGAGED THE PATIENTS AND THE COMMUNITY TO GET MEANINGFUL FEEDBACK ABOUT THE HOSPITAL'S SERVICES. THROUGHOUT ITS HISTORY, GRIFFIN'S MOST INNOVATIVE PROGRAMS HAVE BEEN DEVELOPED USING INSIGHTS GLEANED FROM PATIENTS AND FAMILY MEMBER FOCUS GROUPS. THE COMMUNITY ADVISORY COUNCIL WAS A NATURAL NEXT STEP FOR GRIFFIN AS A WAY TO SOLICIT THE PATIENT'S PERSPECTIVE OF CARE, PROGRAMS AND SERVICES AND TO IDENTIFY COMMUNITY NEEDS ON AN ONGOING BASIS.THE VALLEY CARES TASKFORCE BETH PATTON COMERFORD, MS, YALE-GRIFFIN PREVENTION RESEARCH CENTER (TASKFORCE CO-CHAIR) MARY S. NESCOTT, MPH, BIRMINGHAM GROUP HEALTH SERVICES, INC. (TASKFORCE CO-CHAIR) HEIDI ZAVATONE-VETH, PHD, VALLEY COUNCIL FOR HEALTH & HUMAN SERVICES (VALLEY COUNCIL COORDINATOR) KAREN N. SPARGO, MA, MPH, NAUGATUCK VALLEY HEALTH DISTRICT JESSE REYNOLDS, MS, (CURRENTLY YALE UNIVERSITY) ANN HARRISON, THE WORKPLACE, INC. (CURRENTLY WORKFORCE ALLIANCE). THE MATERIAL IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT WILL DOCUMENT GRIFFIN'S COMMITMENT TO THE SIX TOWN VALLEY COMMUNITIES THAT HAS BEEN ITS PRIMARY SERVICE AREA FOR OVER A CENTURY. MUCH OF THE RESEARCH REFERENCED AND USED IN THE CHNA HAS BEEN DONE OVER A TWO DECADE PERIOD OF TIME AND HAS BEEN A COLLABORATIVE EFFORT BETWEEN THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS, GRIFFIN HOSPITAL AND THE YALE-GRIFFIN PREVENTION RESEARCH CENTER. GRIFFIN HOSPITAL PART V, SECTION B, LINE 4: CHNA WAS NOT CONDUCTED WITH ANY OTHER HOSPITAL. GRIFFIN HOSPITAL PART V, SECTION B, LINE 5D: HTTP://WWW.GRIFFINHEALTH.ORG/PORTALS/0/CHNA/CHIP.PDFHTTP://WWW.GUIDESTAR.ORG/FINDOCUMENTS/2013 - GUIDESTAR GRIFFIN HOSPITAL PART V, SECTION B, LINE 7: GRIFFIN'S CHNA IDENTIFIED OUR COMMUNITY NEEDS AS AWARENESS OF HEALTH AND HUMAN SERVICES, TRANSPORTATION, OBESITY, PRIMARY CARE ACCESS, COMMUNITY POPULATION BASED MEDICAL ISSUES, CLINICAL SERVICES, SUBSTANCE ABUSE, PRE-NATAL CARE AND REGIONAL COOPERATION ON HEALTH ISSUES. GRIFFIN PLANS TO ADDRESS PRIORITY AREAS WITH IMPLEMENTATION PLANS ON ALL BUT ONE OF THE SUGGESTED NEEDS. THERE WAS A PERCEPTION THAT PRE-NATAL CARE WAS LOW AND THAT AN INTERVENTION WAS NEEDED. RESEARCH, HOWEVER, REVEALED THAT PRENATAL CARE FOR MOTHERS-TO-BE IN THE VALLEY WAS SIGNIFICANTLY BETTER WHEN COMPARED TO THE STATE AND NEW HAVEN COUNTY AS REPORTED BY THE CONNECTICUT DEPARTMENT OF PUBLIC HEALTH. BASED ON THE ACTUAL DATA THERE IS NO ACTION REQUIRED RELATED TO PRE-NATAL CARE. THE INFORMATION WILL BE WIDELY SHARED WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS AND OTHER COMMUNITY LEADERS TO ENSURE THAT THERE IS INCREASED KNOWLEDGE OF THE VALLEY DATA AS COMPARED TO NEW HAVEN COUNTY AND THE STATE OF CONNECTICUT. GRIFFIN HOSPITAL PART V, SECTION B, LINE 20D: THE UNINSURED RATES ARE ESTABLISHED BASED ON THE AVERAGE PAYMENTS RECEIVED FROM OUR LARGEST PARTICIPATING HMO. PART I, LINE 3C: GRIFFIN HOSPITAL CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE CARE OR DISCOUNTED CARE INCLUDE ELIGIBILITY REQUIREMENTS. ALL GUARANTORS WITH FAMILY INCOME EQUAL TO OR BELOW TWO HUNDRED PERCENT OF THE FEDERAL POVERTY STANDARD ADJUSTED FOR FAMILY SIZE SHALL BE DETERMINED TO BE INDIGENT PERSONS QUALIFYING FOR CHARITY SPONSORSHIP FOR THE FULL AMOUNT OF HOSPITAL CHARGES RELATED TO APPROPRIATE HOSPITAL-BASED MEDICAL SERVICES THAT ARE NOT COVERED BY PRIVATE OR PUBLIC THIRD-PARTY SPONSORSHIP. ALL GUARANTORS WITH FAMILY INCOME BETWEEN TWO HUNDRED AND FIFTY PERCENT (250%) AND FOUR HUNDRED PERCENT (400%) OF THE FEDERAL POVERTY STANDARD ADJUSTED FOR FAMILY SIZE SHALL BE DETERMINED TO BE INDIGENT PERSONS QUALIFYING FOR DISCOUNTS FROM CHARGES RELATED TO APPROPRIATE HOSPITAL BASED MEDICAL SERVICES IN ACCORDANCE WITH THE SLIDING FEE SCHEDULE AND POLICIES REGARDING INDIVIDUAL FINANCIAL CIRCUMSTANCES BASED ON THE BELOW CRITERIA: A. ELIGIBILITY SHALL BE BASED ON FINANCIAL NEED AT THE TIME OF APPLICATION BY COMPARING TOTAL FAMILY INCOME WITH THE CURRENT FEDERAL POVERTY GUIDELINES. IF A FAMILY'S TOTAL INCOME IS GREATER THAN 100% OF THE FEDERAL POVERTY GUIDELINE FAMILY ASSETS, OTHER THAN EXEMPT ASSETS LISTED BELOW, MAY BE CONSIDERED AS A SOURCE OF PAYMENT. B. EXEMPT ASSETS (BASED ON MEDICARE EXEMPTED ASSETS) LISTED BELOW SHOULD NOT BE ADDED TO FAMILY WORTH FOR CHARITY REVIEW: I. FAMILY PRINCIPAL RESIDENCE, II. NECESSARY MOTOR VEHICLES REQUIRED FOR EMPLOYMENT, REQUIRED FOR ACCESS TO TREATMENT, OR MODIFIED FOR OPERATION FOR TRANSPORT OF A DISABLED PERSON, III. PERSONAL EFFECTS AND HOUSEHOLD GOODS, IV. RESOURCES NECESSARY FOR SELF-SUPPORT. ALL RESOURCES OF BOTH SPOUSES ARE CONSIDERED TOGETHER. C. CHARITY WILL BE ASSIGNED USING THE MOST RECENTLY PUBLISHED FEDERAL POVERTY STANDARDS AND EVALUATED ON THE ADJUSTED FAMILY INCOME AS EXPLAINED ABOVE FOR THOSE ABOVE 250% OF SUCH STANDARDS. D. DOCUMENTATION WILL BE REQUESTED AND IN MOST CASES WILL BE REQUIRED TO ESTABLISH ELIGIBILITY FOR CHARITY CARE. IN THE EVENT THAT THE GUARANTOR IS NOT ABLE TO PROVIDE THE DOCUMENTATION DESCRIBED ABOVE, THE HOSPITAL SHALL RELY UPON WRITTEN AND SIGNED STATEMENTS FROM THE GUARANTOR TO MAKE A FINAL DETERMINATION OF ELIGIBILITY FOR CLASSIFICATION AS AN INDIGENT PERSON. PART I, LINE 6A: GRIFFIN HOSPITAL DID PREPARE A COMMUNITY BENEFIT REPORT FOR THE YEAR ENDING 2014. IT WAS PART OF OUR ANNUAL REPORT. PART I, LINE 6B: GRIFFIN HOSPITAL POSTS ITS COMMUNITY BENEFIT REPORT AND INFORMATION ON THE HOSPITAL WEBSITE GRIFFINHEALTH.ORG. PART I, LINE 7: CHARITY CARE AND OTHER COMMUNITY BENEFITS TABLES WERE CALCULATED USING A COST ACCOUNTING SYSTEM OR COST TO CHARGE RATIO. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND ASSIGNS COST TO INDIVIDUAL SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: EXPOSING STUDENTS AND ADULTS TO THE POSSIBILITIES OF A HEALTH CAREER PROFESSION IS A COMMUNITY BUILDING ACTIVITY THAT PROMOTES THE HEALTH OF THE COMMUNITY IT SERVES. EDUCATING AND POTENTIALLY EMPLOYING INDIVIDUALS WOULD LEAD TO FAMILY SUPPORT AND ECONOMIC STABILITY. GRIFFIN HOSPITAL SPONSORED PROGRAMS TO INTRODUCE STUDENTS TO HEALTHCARE CAREERS. THESE PROGRAMS WERE HELD AT VARIOUS CAREER FAIRS AND INFORMATIONAL SESSIONS. FOLLOWING IS A PARTIAL LIST OF THE SCHOOLS INVOLVED. CAREER FAIR DERBY HIGH SCHOOL, INFORMATION SESSION, EMMITT O'BRIEN TECH, INFORMATION SESSION NAUGATUCK, VALLEY PROJECT, CAREER FAIR ANSONIA HIGH SCHOOL, INFORMATION SESSION SHELTON HIGH SCHOOL, CAREER FAIR JONATHAN LAW HIGH SCHOOL, NAUGATUCK VALLEY PROJECT COMMUNITY OUTREACH, VALLEY REGIONAL ADULT ED INFORMATIONAL SESSION, NAUGATUCK VALLEY PROJECT COMMUNITY OUTREACH, NAUGATUCK HIGH SCHOOL CAREER FAIR, JONATHAN LAW HIGH CAREER FAIR, EMMITT O'BRIEN SHADOW PROGRAM, CAREER FAIR EMMITT O'BRIEN TECH, HOSPITAL TOUR EMMITT O'BRIEN TECH, HEALTH FAIR VPN. PART III, LINE 2: GRIFFIN HOSPITAL BAD DEBT EXPENSE IS DETERMINED USING UNCOLLECTED ACCOUNTS NET OF ANY BAD DEBT RECOVERY MULTIPLIED BY THE COST TO CHARGE RATIO. GRIFFIN HOSPITAL HAS A WRITTEN POLICY ABOUT WHEN AND UNDER WHOSE AUTHORITY PATIENT DEBT IS ADVANCED FOR COLLECTION AND SHALL USE ITS BEST EFFORTS TO ENSURE THAT THE PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. CHARITY APPROVAL WILL AFFECT ALL ACCOUNTS FOR WHICH THE APPROVED GUARANTOR IS RESPONSIBLE. THE APPROVED CHARITY PERCENTAGE WILL BE APPLIED TO ALL EXISTING ACCOUNTS WITH DEBIT BALANCES. ACCOUNTS MAY ALSO BE RETURNED FROM BAD DEBT STATUS IF FINANCIAL CIRCUMSTANCES WARRANT AND CHARITY MAY BE APPLIED. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FREE CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN IT'S ESTABLISHED AND CONTRACTUAL RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FREE CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. PART III, LINE 3: GRIFFIN HOSPITAL DOES NOT ATTRIBUTE ANY BAD DEBT TO COMMUNITY BENEFIT EXPENSE. UNCOLLECTED BALANCES ARE REVIEWED AT MANY STAGES TO DETERMINE IF THEY FALL UNDER UNINSURED OR FREE CARE ASSISTANCE. PART III, LINE 4: GRIFFIN HOSPITAL AND SUBSIDIARY NOTES TO CONSOLIDATED FINANCIAL STATEMENTS SEPTEMBER 30, 2014, PAGE 11.NEW ACCOUNTING PRONOUNCEMENT:THE CORPORATION ADOPTED ACCOUNTING STANDARD UPDATE ("ASU") NO. 2011-7, WHICH REQUIRES HEALTH CARE ENTITIES TO CHANGE THE PRESENTATION OF THEIR STATEMENT OF OPERATIONS BY RECLASSIFYING THE PROVISION FOR BAD DEBTS ASSOCIATED WITH PATIENT SERVICE REVENUE FROM AN OPERATING EXPENSE TO A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS). ADDITIONALLY THOSE HEALTH CARE ENTITIES ARE REQUIRED TO PROVIDE ENHANCED DISCLOSURES ABOUT THEIR POLICIES FOR RECOGNIZING REVENUE, ASSESSING BAD DEBTS, AND DISCLOSURES OF PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS). PART III, LINE 8: GRIFFIN HOSPITAL BELIEVES THAT ALL OF THE $3.710 MILLION SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THIS YEAR MEDICARE ACCOUNTED FOR 2.8 % OF HOSPITAL EXPENSES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. PART III, LINE 9B: GRIFFIN HOSPITAL HAS A WRITTEN POLICY ABOUT WHEN AND UNDER WHOSE AUTHORITY PATIENT DEBT IS ADVANCED FOR COLLECTION AND SHALL USE ITS BEST EFFORTS TO ENSURE THE PATIENT AMOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. GRIFFIN WILL ENSURE THAT PRACTICES TO BE USED BY THEIR OUTSIDE COLLECTION AGENCIES WILL CONFORM TO THE STANDARDS SET FORTH IN THIS POLICY AND SHALL OBTAIN WRITTEN COMMITMENTS FROM SUCH AGENCIES AT TIME OF BILLING. GRIFFIN WILL PROVIDE TO ALL LOW INCOME UNINSURED PATIENTS THE SAME INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED TO ALL OTHER PATIENTS WHO RECEIVE CARE AT THE HOSPITAL. FOR PATIENTS WHO HAVE AN APPLICATION PENDING DETERMINATION FOR EITHER GOVERNMENT SPONSORED COVERAGE OR FOR THE HOSPITAL'S OWN FINANCIAL ASSISTANCE PROGRAM, GRIFFIN WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO A COLLECTION AGENCY. IF A PATIENT DOES NOT MAINTAIN THE AGREED UPON PAYMENT SCHEDULE THE AMOUNT WILL BE FORWARDED TO AN OUTSIDE COLLECTION AGENCY AT THE FULL REMAINING BALANCE. IF IT IS LATER DETERMINED BY THE GRIFFIN HOSPITAL OR OR A COLLECTION AGENCY ACTING ON BEHALF OF GRIFFIN HOSPITAL THAT THE PATIENT FINANCIAL CONDITIONS HAVE CHANGED AND THE PATIENT WAS UNABLE TO PAY THE OUTSTANDING ACCOUNT BALANCES AN OVERRIDE MAY BE APPLIED BY THE BUSINESS SERVICES DIRECTOR. THE UNCOLLECTED DEBT WILL BE TRANSFERRED TO UNINSURED OR FREE CARE ASSISTANCE BY THE SUPERVISOR AFTER REVIEW.THE MEDICARE COSTS WERE OBTAINED FROM THE HOSPITAL'S INTERNAL COST ACCOUNTING SYSTEM. PART VI, LINE 2: GRIFFIN HAS A HISTORY OF COMMUNITY SERVICE AND SOCIAL RESPONSIBILITY DATING BACK TO ITS FOUNDING 100 YEARS AGO, AND OF PROVIDING EDUCATIONAL, PREVENTION AND SCREENING PROGRAMS AND SERVICES. IN 1970, FUNDED BY A GRANT FROM THE KELLOGG FOUNDATION, GRIFFIN ESTABLISHED ONE OF THE FIRST HOSPITAL DEPARTMENTS OF COMMUNITY HEALTH IN THE COUNTRY TO FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE COMMUNITY IT SERVES. OVER THE PAST FIFTEEN YEARS, GRIFFIN'S REACH HAS BEEN EXPANDING INTO THE COMMUNITY. IN ADDITION TO PROVIDING HEALTH INFORMATION AND SERVICES TO THE PUBLIC AT THE HOSPITAL AND OTHER SATELLITE LOCATIONS, GRIFFIN TAKES THESE ACTIVITIES INTO THE COMMUNITIES WHERE PATIENTS LIVE AND WORK. BY OFFERING A VARIETY OF SUPPORT GROUPS, TRAINING SESSIONS, EDUCATIONAL PROGRAMS, AND OTHER COMMUNITY-BASED RESOUCES AND ACTIVITIES, AND COLLABORATING WITH OTHER NON-PROFIT ORGANIZATIONS AND GOVERNMENT ENTITIES, GRIFFIN HAS EXTENDED ITS MISSION FAR BEYOND THE HOSPITAL'S WALLS TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF PEOPLE OF ALL AGES. COMMUNITY LEADERSHIP RECOGNIZED THE NEED TO RESPOND TO THE CHANGING COMMUNITY DEMOGRAPHICS AND THE DIFFERENT SOCIOECONOMIC AND HEALTH NEEDS AND EXPECTATIONS OF THE MORE DIVERSE POPULATION. THREE MAJOR NEW STRUCTURES WERE CREATED. IN 1993, THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATION (VCHHSO) WAS FOUNDED. MORE THAN 55 ORGANIZATIONS THAT PROVIDE MOST OF THE HEALTH AND HUMAN SERVICES ARE MEMBERS. VCHHSO'S VISION IS A PROVIDER NETWORK THAT WORKS COLLABORATIVELY TO CREATE AN INTEGRATED HUMAN SERVICES DELIVERY SYSTEM THAT MEETS THE NEEDS OF ALL RESIDENTS. "HEALTHY VALLEY 2000", THE STATE'S FIRST HEALTHY COMMUNITY EFFORT, WAS LAUNCHED IN 1994. WITH FOUNDATION GRANT SUPPORT, THE NATIONAL CIVIC LEAGUE WAS ENGAGED TO GUIDE STAKEHOLDERS THROUGH THE PROCESS. THE VISION OF THE BROAD-BASED, VOLUNTEER INSPIRED AND MANAGED EFFORT WAS TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITY AND ITS RESIDENTS BY MAKING THE COMMUNITY A BETTER PLACE IN WHICH TO LIVE, WORK, SHOP, RAISE A FAMILY AND ENJOY LIFE. BASED ON RESEARCH, INCLUDING USE OF THE NATIONAL CIVIC LEAGUE INDEX, A S.W.O.T ANALYSIS, AND BRAINSTORMING, 175 STAKEHOLDERS IDENTIFIED ARTS & RECREATION, COMMUNITY INVOLVEMENT, ECONOMIC DEVELOPENT, EDUCATION AND HEALTH AS PRIORITIES. A TASK FORCE DEVELOPED A WORK PLAN FOR EACH OF THE PRIORITIES AND AN HONOR ROLE WAS DEVELOPED TO RECOGNIZE INITIATIVES UNDERTAKEN INDEPENDENTLY BY INDIVIDUALS OR ORGANIZATIONS RELATED TO THE IDENTIFIED PRIORITIES.THE PATIENT PROTECTION AND AFFORDABLE CARE ACT REQUIRES NON-PROFIT HOSPITALS TO PERFORM A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS AND TO ADOPT AN IMPLEMENTATION STRATEGY TO MEET OUTSTANDING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT AS A CONDITION OF MAINTAINING THE INSTITUTION'S FEDERAL TAX EXEMPTION. GRIFFIN HOSPITAL'S FIRST CHNA WAS REQUIRED TO BE SUBMITTED NOT LATER THAN SEPTEMBER 30, 2013. IN PREPARING THE GRIFFIN HOSPITAL CHNA, THE HOSPITAL COLLABORATED WITH THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS, THE LOWER NAUGATUCK VALLEY HEALTH DISTRICT, THE CONNECTICUT HOSPITAL ASSOCIATION AND THE CONNECTICUT ASSOCIATION OF DIRECTORS OF HEALTH AND NUMEROUS LOCAL COMMUNITY HEALTH AND HUMAN SERVICE ORGANIZATIONS THAT PARTICIPATED IN FOCUS GROUPS AND REVIEW OF THE CHNA DOCUMENT. GRIFFIN'S CHNA WAS SHARED WITH THE LOWER NAUGATUCK VALLEY HEALTH DISTRICT FOR USE IN PREPARING ITS COMMUNITY HEALTH IMPROVEMENT PLAN. PART VI, LINE 3: A FINANCIAL ASSISTANCE BROCHURE IS POSTED THROUGHOUT THE HOSPITAL (CHILDBIRTH AREA, ER AREA, AND CUSTOMER SERVICE AREA) IN ENGLISH AND SPANISH EXPLAINING THE FINANCIAL ASSISTANCE POLICY AND HOW TO CONTACT THE FINANCIAL COUNSELORS. THE FOLLOWING POLICY REPRESENTS GRIFFIN HOSPITAL'S PROCEDURES FOR THE UNINSURED PATIENT, FREE CARE ASSISTANCE, AND FREE BED FUNDS AVAILABLE FOR PATIENTS WHO DO NOT HAVE MEDICAL INSURANCE:1. UNINSURED PATIENT PROCEDUREA. PATIENTS THAT ARE EITHER SCHEDULED OR REGISTERED WITH NO ACTIVE INSURANCE WILL IMPORT ONTO THE THREE FINANCIAL ADVISORS ONTRAC WORK LIST.B. PATIENTS THAT ARE REGISTERED WILL RECEIVE A STATE APPLICATION PACKET FROM THE PATIENT ACCESS STAFF. THIS CONSISTS OF THE FINANCIAL ADVISOR'S BUSINESS CARD, STATE APPLICATION, AND LIST OF DOCUMENTS NEEDED TO COMPLETE THE STATE APPLICATION. A LISTING OF THE DSS OFFICES IS INCLUDED IN THE PACKET.C. ALL PATIENTS IDENTIFIED WILL RECEIVE A CALL OR A DIRECT VISIT, IF ADMITTED TO THE HOSPITAL, BY A FINANCIAL ADVISOR.D. THE FINANCIAL ADVISOR WILL SCREEN THE PATIENT FOR ANY CURRENT SPONSORSHIP AND DISCUSS ALL ELIGIBILITY OPTIONS WITH THE PATIENT.E. IF THE PATIENT MEETS CRITERIA, THE FINANCIAL ADVISORS WILL BEGIN THE HUSKY APPLICATION PROCESS WITH THE PATIENT.F. A DUE DILIGENCE PROCESS WILL BE FOLLOWED BY THE FINANCIAL ADVISORS TO ENSURE THAT THE PATIENTS ARE PURSUING ACTIVE COVERAGE. THE FINANCIAL ADVISORS WILL MONITOR THE DSS WEBSITE TO TRACK THE PROGRESS OF THE APPLICATION WITH THE STATE.G. ONCE ELIGIBILITY HAS BEEN DETERMINED, ALL APPROPRIATE ACCOUNTS WILL BE UPDATED TO THE HUSKY INSURANCE AND BILLED ACCORDINGLY.H. ALL UNINSURED PATIENTS NOT GRANTED STATE/HUSKY COVERAGE WILL HAVE THE CHA UNINSURED RATE APPLIED TO THEIR ACCOUNT. THE UNINSURED RATE WAS DETERMINED BY THE HOSPITAL TO REPRESENT THE CONNECTICUT NOT-FOR-PROFIT HOSPITAL DISCOUNT POLICY AS ADOPTED BY THE CONNECTICUT HOSPITAL ASSOCIATION 4/10/2006.2. FREE CARE ASSISTANCEA. ANY PATIENT REQUESTING CONSIDERATION FOR FREE CARE ASSISTANCE IN PAYING THEIR GRIFFIN HOSPITAL BILLS OR FINANCIAL RESPONSIBILITY AFTER INSURANCE PAYMENT SHOULD CONTACT THE HOSPITAL'S FINANCIAL ADVISORY STAFF.B. THE FINANCIAL ADVISOR WILL OBTAIN THE FOLLOWING INFORMATION FROM THE PATIENT IN ORDER TO COMPLETE THE FREE CARE APPLICATION. THE INFORMATION REQUIRED FROM THE PATIENT TO COMPLETE THE FREE CARE APPLICATION IS AS FOLLOWS:- PATIENT W-2 FORM OR MOST CURRENT AND COMPLETED TAX RETURN.- OR THREE CONSECUTIVE PAYSTUBS FROM THE PATIENT'S CURRENT EMPLOYMENT/PROOF OF SOCIAL SECURITY.- DEPENDENT INFORMATION (SPOUSE AND MINOR CHILDREN ONLY).- ANY OR ALL BANK AND CHECKING ACCOUNT STATEMENTS.C. THE FINANCIAL ADVISOR WILL REFER TO THE GRIFFIN HOSPITAL SLIDING SCALE. THIS IS BASED ON THE FEDERAL GOVERNMENT POVERTY INCOME GUIDELINES. THE FINANCIAL ADVISOR WILL MAKE A DETERMINATION OF THE PATIENT'S FREE CARE ELIGIBILITY STATUS.D. IF THE PATIENT QUALIFIES FOR FREE CARE ASSISTANCE, THE APPLICABLE DISCOUNT PERCENTAGE WILL BE APPLIED TO THE PATIENT'S ACCOUNT BALANCE. THEN A LETTER WILL BE SENT OUT REFLECTING THE PATIENT'S NEW ADJUSTED BALANCE.E. IF A PATIENT DOES NOT QUALIFY FOR FREE CARE ASSISTANCE, THE FINANCIAL ADVISOR WILL ATTEMPT TO:- OBTAIN PAYMENT IN FULL.- SEND TO AN OUTSIDE AGENCY TO SET UP A MONTHLY PAYMENT ARRANGEMENT.F. IF THE PATIENT DOES NOT MAINTAIN THE AGREED UPON PAYMENT SCHEDULE, THE ACCOUNT WILL BE FORWARDED TO AN OUTSIDE COLLECTION AGENCY AT THE FULL REMAINING BALANCES.G. IF IT IS LATER DETERMINED BY THE GRIFFIN HOSPITAL OR A COLLECTION AGENCY ACTING ON BEHALF OF GRIFFIN HOSPITAL THAT THE PATIENT'S FINANCIAL CONDITIONS HAVE CHANGED AND THE PATIENT WAS UNABLE TO PAY THE OUTSTANDING ACCOUNT BALANCES, AN ADMINISTRATIVE OVERRIDE MAY BE APPLIED BY THE BUSINESS SERVICES COLLECTION SUPERVISOR OR DIRECTOR OF BUSINESS SERVICES. ALL ADMINISTRATIVE OVERRIDES WILL BE SIGNED OFF BY EACH OF THOSE PARTIES.H. THE BUSINESS SERVICES COLLECTION SUPERVISOR WILL MAINTAIN ALL MONTHLY SPREADSHEETS THAT WILL IDENTIFY ALL APPLIED FREE BED FUNDS, UNINSURED, AND FREE CARE ASSISTANCE ALLOCATED ON A MONTHLY BASIS.3. FREE BED FUNDSTHE HOSPITAL HAS THE FOLLOWING FREE BED FUNDS AVAILABLE FOR PATIENTS WHO MEET THE FOLLOWING OUTLINED CRITERIA FOR EACH FUND:A. THE ENO FUND: THE APPLICANT MUST BE A WOMAN, 60 YEARS OF AGE OR OLDER, AND BE A RESIDENT OF ANSONIA, DERBY OR SEYMOUR.B. PINE TRUST: THE FUND IS AVAILABLE TO INDIGENT PATIENTS OF GRIFFIN HOSPITAL WHO RESIDE IN THE CITY OF ANSONIA.C. DN CLARK: THE FUND IS AVAILABLE TO SHELTON RESIDENTS.ALL FREE BED FUNDS GRANTED ARE PROCESSED THROUGH THE HOSPITAL'S FINANCIAL ADVISOR STAFF. PART VI, LINE 4: GRIFFIN HOSPITAL, LICENSED BY THE STATE OF CONNECTICUT FOR 160 BEDS AND 15 BASSINETS, IS A GENERAL ACUTE CARE HOSPITAL SERVING A PRIMARY SERVICE AREA (PSA) OF SIX TOWNS: ANSONIA, BEACON FALLS, DERBY, OXFORD, SYMOUR AND SHELTON, CONNECTICUT. THE SIX TOWN REGION HAS COME TO BE KNOWN AS THE LOWER NAUGATUCK VALLEY. THE SIX TOWNS, WITH AN AREA OF A LITTLE MORE THAN 100 SQUARE MILES, HAVE A COMBINED POPULATION OF OVER 107,000 BASED ON CURRENT ESTIMATES.THE VALLEY, GEOGRAPHICALLY LOCATED IN SOUTH CENTRAL CONNECTICUT, IS SURROUNDED BY THREE OF THE STATE'S LARGEST CITIES, NEW HAVEN, TO THE SOUTH, BRIDGEPORT, TO THE SOUTHWEST, AND WATERBURY, TO THE NORTH, EACH BETWEEN 9 AND 15 MILES FROM GRIFFIN HOSPITAL. THERE ARE TWO TERTIARY CARE HOSPITALS IN BRIDGEPORT AND WATERBURY, AND WITH THE MERGER OF THE HOSPITAL OF ST. RAPHAEL WITH YALE NEW HAVEN HOSPITAL, ONE VERY LARGE HOSPITAL IN NEW HAVEN. YALE NEW HAVEN HOSPITAL IS NOW ONE OF THE TEN LARGEST HOSPITALS IN THE COUNTRY. EACH HAS VARYING DEGREES OF MARKET SHARE IN GRIFFIN'S PRIMARY SERVICE AREA TOWNS DEPENDING ON THE PROXIMITY TO THE THREE CITIES AND THE HOSPITALS LOCATED THERE. GRIFFIN'S LARGER GEOGRAPHIC REGION IS ONE OF THE MOST COMPETITIVE HOSPITAL MARKETS IN THE COUNTRY FOR BOTH PATIENTS AND STAFF.THE DEMOGRAPHICS IN TERMS OF POPULATION BY AGE GROUP MIRROR THOSE OF THE STATE OF CONNECTICUT. THE VALLEY'S AFRICAN AMERICAN POPULATION IS 4% COMPARED TO 10.1% FOR THE STATE, AND THE HISPANIC POPULATION IS 6% COMPARED TO 13.4% FOR THE STATE. THE AFRICAN AMERICAN POPULATION IS CENTERED PRIMARILY IN ANSONIA (11.6%), AND THE HISPANIC POPULUATION IS CENTERED PRIMARILY IN ANSONIA (16.7%) AND DERBY (14.2%). POPULATION BY ETHNIC BACKGROUND REMAINS PRIMARILY ITALIAN - 23%, POLISH/RUSSIAN/UKRAINIAN - 17%, AND IRISH - 11%. THE AGE 65 AND OVER POPULATION IS 14% COMPARED TO THE STATE OF CONNECTICUT ALSO AT 14% IN 2010.MEDIAN HOUSEHOLD INCOME (2007-2011) IN ALL VALLEY TOWNS HAS BEEN INCREASING, BUT ANSONIA ($55,259) AND DERBY ($55,478) REMAIN ALMOST $15,000 BELOW THE STATE MEDIAN. THE REMAINING TOWNS, SEYMOUR ($65,036), BEACON FALLS ($70,228), SHELTON ($79,176), AND OXFORD ($95,710), WERE CLOSE TO OR CONSIDERABLY ABOVE THE CONNECTICUT MEDIAN ($68,055), AN INDICATION OF THE ECONOMIC DISPARITIES WITHIN THE VALLEY. THE NUMBER OF FOOD STAMP RECIPIENTS IN ANSONIA (2,998 - 16%) AND DERBY (1,612 - 12%) WERE HIGHER THAN THE CONNECTICUT RATE (10%). ALL OTHER TOWNS WERE CONSIDERABLY BELOW THE STATE RATE. THE OVERALL POVERTY RATE WAS THE HIGHEST IN THE VALLEY (YEAR 2009) IN DERBY (11.5%) AND ANSONIA (10.7%). ALL OTHER TOWNS WERE CONSIDERABLY BELOW THE STATE RATE (11.9%) WITH OXFORD THE LOWEST (2.1%). ANSONIA AND DERBY EXPERIENCED INSIGNIFICANT POPULATION DECLINES BETWEEN THE 2000 AND 2010 CENSUS. IN ALL OTHER TOWNS THE POPULATION GREW BETWEEN 4% AND 31% IN OXFORD WHICH WAS THE FASTEST GROWING TOWN IN THE STATE PERCENTAGE WISE. THE TOTAL VALLEY POPULATION IS PROJECTED TO BE 109,510 IN 2017 UP FROM THE CURRENT 107,000.UNDER 18 YEARS OLD: 23,701 (22%)ABOVE 65 YEARS OLD: 16,353 (15%)HISPANIC OR LATINO: 9,227 (9%)NON-HISPANIC WHITE: 88,855 (83%)NON-HISPANIC BLACK: 4,412 (4%)NON-HISPANIC ASIAN: 2,834 (3%)NON-HISPANIC OTHER: 1,638 (2%)BACHELOR'S DEGREE OR HIGHER: 20,565 (28%)NUMBER OF PEOPLE IN POVERTY: 5,831 (6%) PART VI, LINE 5: GRIFFIN HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH MANY PROGRAMS AND ASSOCIATIONS INCLUDING:- DEPARTMENT OF COMMUNITY OUTREACH AND PARISH NURSING. GRIFFIN COORDINATES THE PROGRAM OUT OF ITS DEPARTMENT OF COMMUNITY OUTREACH AND PARISH NURSING. THE DEPARTMENT HAS FIVE EMPLOYEES WHO SUPPORT THE 75 VOLUNTEER PARISH NURSES AND 320 VOLUNTEERS WHO SERVE ON THE HEALTHCARE CABINETS OF THE CHURCHES. THE VALLEY PARISH NURSING PROGRAM (VPN) AT GRIFFIN HOSPITAL WILL CELEBRATE ITS 25TH YEAR WITH A CELEBRATION AT GRIFFIN HOSPITAL. IN HONOR OF THIS IMPRESSIVE MILESTONE, WE OFFER SOME OF THE PROGRAM'S GREATEST ACHIEVEMENTS IN IMPROVING THE HEALTH OF VALLEY COMMUNITIES. IN KEEPING WITH THE VALLEY PARISH NURSE PHILOSOPHY TO EMPOWER EACH AND EVERY PERSON TO CARE FOR HIS OR HER WHOLE BODY, MIND AND SPIRIT, THE VALLEY PARISH NURSES HAVE EMBARKED ON MANY NEW INITIATIVES IN ITS HISTORY. THE MOST NOTABLE ARE THE WOMEN & HEART DISEASE PROGRAM, CHILDHOOD IDENTIFICATION PROGRAM (CHIP), PUBLIC ACCESS DEFIBRILLATOR (PAD) PROGRAM, CHILDREN'S HEALTH & SAFETY FAIRS, FALLS PREVENTION PROGRAMS, AND BREAST WELLNESS OUTREACH. PERHAPS THE MOST INFLUENTIAL PROGRAM STARTED BY THE VALLEY PARISH NURSE PROGRAM IS ITS CPR INITIATIVE. BY BRINGING CPR TRAINING AND HELPING SET UP AUTOMATIC EXTERNAL DEFIBRILLATORS (AEDS) AT PLACES THROUGHOUT THE VALLEY, VPN HAS PLAYED A KEY ROLE IN INCREASING THE CARDIAC SURVIVAL RATE AT GRIFFIN HOSPITAL TO 26 PERCENT - THE NATIONAL SURVIVAL RATE IS 9%. SINCE THE INITIATIVE BEGAN, VALLEY PARISH NURSES HAVE ALSO RECEIVED MANY STORIES OF SURVIVAL RELATING TO CHOKING AND RECOGNIZING THE SIGNS OF HEART ATTACK AND CALLING 9-1-1.- THE MOBILE HEALTH RESOURCE CENTER - THE MOBILE HEALTH RESOURCE CENTER FOCUSES ON PREVENTIVE HEALTH SERVICES AND PROVIDING HEALTH EDUCATION AND SCREENING SERVICES TO NEIGHBORHOODS, COMMUNITY EVENTS, HEALTH FAIRS, SHOPPING CENTERS AND BUSINESSES/COMPANIES.- COMMUNITY OUTREACH SERVICES - IN FISCAL YEAR 2013, THE DEPARTMENT OF COMMUNITY OUTREACH AND THE VALLEY PARISH NURSE PROGRAM SERVED 39,054 PEOPLE. SERVICES INCLUDED 4,411 HEALTH SCREENING RECIPIENTS WHICH CONTRIBUTED TO 14,915 REFERRALS TO NEEDED SERVICES. IN ADDITION, 1,388 EDUCATIONAL PROGRAMS WERE PROVIDED ATTENDED BY 30,709 PEOPLE AND 3,540 PEOPLE WERE TRAINED IN CPR. THE PROGRAM ALSO PROVIDED AND PLACED AED'S (AUTOMATED EXTERNAL DEFIBRILLATORS) AT COMMUNITY SITES BRINGING THE TOTAL NUMBER OF AED'S PLACED AT COMMUNITY SITES TO 67. STARTING SIX YEARS AGO GRIFFIN HOSPITAL THROUGH ITS DEPARTMENT OF COMMUNITY OUTREACH AND PARISH NURSING, JOINED WITH ANSONIA COMMUNITY ACTION, THE NON-PROFIT AGENCY PROVIDING SERVICES TO THE AFRICAN AMERICAN COMMUNITY, FOR AN OUTREACH PROGRAM TO PROVIDE FREE CHOLESTEROL, DIABETES, AND HYPERTENSION SCREENING AND HEALTH EDUCATION FOR PEOPLE WHO ARE 60 AND OLDER. - GREATER NAUGATUCK VALLEY SAFE KIDS CHAPTER - IN MARCH 2005 THE VALLEY PARISH NURSE PROGRAM ESTABLISHED THE GREATER NAUGATUCK VALLEY SAFE KIDS CHAPTER. GRIFFIN HOSPITAL, THE VALLEY PARISH NURSE PROGRAM, THE VALLEY N.A.A.C.P., THE CITY OF ANSONIA AND THE COMMUNITY FOUNDATION OF GREATER NEW HAVEN SPONSORED THE ANNUAL COMMUNITY HEALTH AND SAFETY.- CERTIFIED CPR TRAINING CENTER - GRIFFIN HOSPITAL HAS BEEN A CERTIFIED COMMUNITY AMERICAN HEART ASSOCIATION CPR TRAINING CENTER SINCE 2006.- GRIFFIN BREAST HEALTH INITIATIVE - THE PURPOSE OF THE GRIFFIN BREAST HEALTH INITIATIVE IS TO PROVIDE OUTREACH AND EDUCATION TO WOMEN, INCLUDING THE UNINSURED OR UNDERINSURED, ABOUT THE IMPORTANCE OF BREAST WELLNESS AND EARLY BREAST CANCER DETECTION AND PROVIDE SCREENING MAMMOGRAMS TO WOMEN WHO WOULD OTHERWISE NOT BE ABLE TO AFFORD ONE. - VALLEY WOMEN'S HEALTH INITIATIVE- AED PLACEMENT AT PUBLIC SITES - THE GRIFFIN HOSPITAL VALLEY PARISH NURSE PROGRAM COORDINATED OBTAINING FUNDING FOR THE PURCHASE OF AUTOMATED EXTERNAL DEFIBRILLATORS (AEDS) AND HAS PLACED 65 AEDS AT PUBLIC NON-PROFIT PUBLIC ACCESS DEFIBRILLATOR SITES IN THE COMMUNITY. - HOMELESS SHELTER FOOD BANK DONATIONS - PATIENT AND COMMUNITY SUPPORT GROUPS AND EDUCATIONAL MEETINGS- BY YOUR SIDE - CAREGIVER SUPPORT GROUP- BEREAVEMENT SUPPORT GROUP- BEREAVEMENT SUPPORT GROUP FOR PARENTS- THE WIDOW AND WIDOWER SUPPORT GROUP PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES CT X X X 0 0 0 0 0 0 0 0 0 CHARMEL PATRICK PRESIDENT/CEO/SEC/TREASURER 429942 0 27038 0 588 0 43935 0 17172 0 518675 0 0 0 DOBULER KENNETH MD/BOARD MEMBER 234903 0 0 0 0 0 47152 0 0 0 282055 0 0 0 SCHWARTZ KENNETH MD/BOARD MEMBER 173379 0 0 0 588 0 47152 0 17172 0 238291 0 0 0 POWANDA WILLIAM VICE PRESIDENT 128527 0 0 0 568 0 25500 0 17172 0 171767 0 0 0 STUMPO BARBARA J V.P. 171297 0 0 0 552 0 26666 0 17172 0 215687 0 0 0 BERNS EDWARD VICE PRESIDENT 136468 0 0 0 477 0 13163 0 17172 0 167280 0 0 0 MARTIN KATHLEEN VICE PRESIDENT 139855 0 0 0 490 0 13786 0 17172 0 171303 0 0 0 DEEGAN MARGARET VICE PRESIDENT 183870 0 0 0 568 0 17366 0 17172 0 218976 0 0 0 SHEPARD SETH VICE PRESIDENT 163572 0 0 0 525 0 5836 0 17172 0 187105 0 0 0 O'NEILL MARK V.P./CFO 244482 0 0 0 588 0 8500 0 1980 0 255550 0 0 0 D'SOUSA SEEMA MD 258174 0 28419 0 588 0 17000 0 1980 0 306161 0 0 0 HALSTEAD EDWARD MD 224562 0 0 0 588 0 19455 0 17172 0 261777 0 0 0 NAWAZ HAQ MD 265200 0 64137 0 588 0 17000 0 17172 0 364097 0 0 0 SALABARRIA JAVIER MD 291979 0 0 0 568 0 0 0 17172 0 309719 0 0 0 PAXTON HEATHER MD 174516 0 0 0 547 0 6215 0 17172 0 198450 0 0 0 A CHEFA SERIES B 060806186 2005-02-01 24800000 CONSTRUCTION OF NEW WING 0 0 0 B CHEFA SERIES C & D 060806186 2007-05-01 23125000 CONSTRUCTION OF NEW CANCER CENTER & RENOVATION OF EMERGENCY DEPARTMENT 0 0 0 A 25769812 24573303 435721 760791 1996 1 0 1 1 B 22982209 1406958 234306 1133492 20207453 2010 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 1 1 WACHOVIA BANK 2037.000000000000 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 GRIFFIN HOSPITAL IS A NON-STOCK CORPORATION THAT DOES NOT HAVE STOCKHOLDERS OR MEMBERS, BUT WHICH DOES HAVE A BOARD OF INCORPORATORS WHO SERVE AS REPRESENTATIVES OF THE COMMUNITY TO CARRY OUT THE EXEMPT AND CHARITABLE PURPOSES OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES MAKES RECOMMENDATIONS TO THE INCORPORATORS OF THE HOSPITAL REGARDING NOMINATIONS OF MEMBERS OF THE COMMUNITY TO SERVE AS TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR ALL MEMBERS OF THE HOSPITAL BOARD, OFFICERS, DIRECTORS, AND KEY EMPLOYEES RECEIVE, SIGN, AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE. THE DISCLOSURES ARE REVIEWED BY THE HOSPITAL BOARD AND DOCUMENTED IN THE MINUTES. ANY DISCLOSURE OF A CONFLICT PREVENTS THE INDIVIDUAL FROM INVOLVEMENT WITH OR PARTICIPATION IN SUBJECT MATTER THAT MIGHT AFFECT THE DISCLOSED CONFLICT. SUCH ACTIONS ARE DOCUMENTED IN BOARD MINUTES. ALL CONFLICTS ARE DISCLOSED TO BOARD MEMBERS AND CORPORATORS AT THE ANNUAL MEETING OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS AND KEY EMPLOYEES ARE REVIEWED ANNUALLY BY THE COMPENSATION COMMITTEE WHICH IS A SUBCOMMITTEE OF THE HOSPITAL BOARD. THIS COMMITTEE SETS THE COMPENSATION FOR THE CEO BASED ON INDUSTRY DATA. COMPENSATION OF OTHER OFFICERS AND DIRECTORS IS SET BY THE CEO IN CONJUNCTION WITH THE HUMAN RESOURCE DEPARTMENT. AGAIN INDUSTRY COMPENSATION DATA IS THE BASIS FOR DETERMINING THE APPROPRIATENESS OF COMPENSATION. THE CEO REVIEWS WITH THE COMPENSATION COMMITTEE ALL OFFICERS AND DIRECTORS IN THE FIRST QUARTER OF THE CALENDAR YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS ARE FILED WITH THE OFFICE OF HEALTH CARE ACCESS AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFERS BETWEEN AFFILIATES -6,954,076. MINIMUM PENSION LIABILITY ADJUSTMENT -6,052,464. CHANGE IN NET ASSETS OF AFFILIATE 1,245,634. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 878,163. CHANGE IN BENEFICIAL INTEREST IN TRUSTS 89,229. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -1,723,375. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR SELECTING AN INDEPENDENT AUDIT FIRM AND FOR OVERSEEING THE FINANCIAL STATEMENT PREPARATION PROCESS. THERE HAVE BEEN NO CHANGES IN THESE PROCEDURES SINCE THE PRIOR YEAR. GRIFFIN HEALTH SERVICES CORPORATION 130 DIVISION STREET DERBY CT 06418 222560257 HOLDING COMPANY CT 501(C)(3) 509(A)(3)(I) N/A 0 GRIFFIN FACULTY PRACTICE PLAN INC 130 DIVISION STREET DERBY CT 06418 061463147 MEDICAL/EDUCATION CT 501(C)(3) 509(A)(2) GRIFFIN HOSPITAL 1 THE GRIFFIN HOSPITAL DEVELOPMENT FUND 130 DIVISION STREET DERBY CT 06418 222560254 FUND RAISING CT 501(C)(3) 509(A)(3)(I) GRIFFIN HEALTH SERVICES CORPORATION 1 PLANETREE INC 130 DIVISION STREET DERBY CT 06418 061505284 EDUCATION CT 501(C)(3) 509(A)(2) GRIFFIN HEALTH SERVICES CORPORATION 1 GH VENTURES INC 130 DIVISION STREET DERBY CT 06418 222560247 RENTAL REAL ESTATE CT N/A C 1 HEALTHCARE ALLIANCE INSURANCE COMPANY LTD 171 ELGIN AVENUE GEORGETOWN CJ OFFSHORE CAPTIVE INSURANCE CJ N/A C 0 CT PRACTICE MANAGEMENT INC 130 DIVISION STREET DERBY CT 06418 061152819 INACTIVE CT N/A C 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 GH VENTURES INC P 976444 ACTUAL CASH GRIFFIN HOSPITAL DEVELOPMENT FUND R 498897 ACTUAL CASH PLANETREE INC P 984412 ACTUAL CASH GRIFFIN HEALTH SERVICES CORPORATION P 581511 ACTUAL CASH GRIFFIN FACULTY PRACTICE PLAN R 5501071 ACTUAL CASH GRIFFIN HEALTH SERVICES CORPORATION Q 497598 ACTUAL CASH HAIC P 2235254 ACTUAL CASH PLANETREE INC Q 375766 ACTUAL CASH