2014-08-14T13:58:48-05:00 2013-09-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2012-10-01 060646718 MIDDLESEX HOSPITAL % DONALD LUDWIG CPA MIDD 8603586395 28 CRESCENT STREET Suite MIDDLETOWN CT 06457 VIN CAPECE 2014-08-14 3176817000 2012 2015-11-30 17:44:51Z VINCENT CAPECE - PRESIDENTCEO 28 Crescent Street Middletown CT 06457 378930100 false X WWW.MIDDLESEXHOSPITAL.ORG X 1895 CT MIDDLESEX HOSPITAL EXISTS TO PROVIDE THE SAFEST, HIGHEST-QUALITY HEALTH CARE AND THE BEST EXPERIENCE POSSIBLE FOR OUR COMMUNITY. 11 8 3224 612 4410512 5380626 5032550 348999762 348379202 2997354 6856293 9976768 9320271 367354510 369588316 0 0 0 0 199306965 201505574 0 0 900861 138777708 144283780 338084673 345789354 29269837 23798962 440085000 460311000 279080000 196145000 161005000 264166000 X MIDDLESEX HOSPITAL EXISTS TO PROVIDE THE SAFEST, HIGHEST-QUALITY HEALTH CARE AND THE BEST EXPERIENCE POSSIBLE FOR OUR COMMUNITY. false false 139147876 0 159829791 IN THE FISCAL YEAR ENDING 9/30/2013, INPATIENT CARE REPRESENTED 15,162 DISCHARGES AND 62,546 PATIENT CARE DAYS. ARMED WITH SKILLED STAFF, PROGRESSIVE DIAGNOSTIC TOOLS AND ADVANCED SURGICAL TECHNIQUES, THE HOSPITAL WAS WELL POSITIONED TO ENSURE A COMFORTABLE, SAFE ENVIRONMENT FOR EXCEPTIONAL MEDICAL TREATMENT AND RECOVERY. SEE SCHEDULE O FOR FURTHER DETAIL. 48185941 0 64796539 MIDDLESEX HOSPITAL EMERGENCY DEPARTMENT DELIVERS CARE AT THE WHALEN EMERGENCY CENTER AT THE HOSPITAL'S MAIN CAMPUS AS WELL AS TWO SATELLITE SITES LOCATED AT THE SHORELINE MEDICAL CENTER IN ESSEX AND THE MIDDLESEX HOSPITAL MEDICAL CENTER IN MARLBOROUGH. THE EMERGENCY DEPARTMENT TREAT AND RELEASE VISITS FOR THE FISCAL YEAR ENDING 9/30/2013 WERE 81,193. IN EACH, EMERGENCY CARE IS DEPLOYED BY EXPERT, BOARD-CERTIFIED EMERGENCY MEDICINE DOCTORS AND SPECIFICALLY TRAINED PHYSICIAN ASSISTANTS, NURSES, PATIENT CARE TECHNICIANS AND OTHER SUPPORT PERSONNEL. SEE SCHEDULE O FOR FURTHER DETAIL. 16510261 0 27603446 IN FISCAL YEAR ENDING 09/30/2013 THERE WERE 6,705 REVENUE GENERATING AMBULATORY SURGERY CASES FROM ENDOSCOPY/COLONOSCOPY TO ORTHOPEDIC AND OTHER OUTPATIENT PROCEDURES. SEE SCHEDULE O FOR FURTHER DETAIL. 77540092 2999000 100803253 281384170 true true false true false false false false false true true false false false true false true true false false false false false false true false true true false false true true false false false false false false false false true true true false false false false true true true false false true 172 0 true 3224 true true true false false false false true true false false false false X 11 8 false false false false true true true true true false false true true true true true true true true true true CT X X DONALD LUDWIG CPA 8603586879 28 CRESCENT STREET Middletown CT 06457 John Rafal 1.0 1.0 X 0 0 0 Eric Thornburg 1.0 1.0 X 0 0 0 Barbara Weiss 1.0 1.0 X 0 0 0 Vincent Capece Jr 40.0 1.0 X X 757217 0 362397 David Baggish MD 40.0 1.0 X X 331012 0 5037 R Christopher Seaton 1.0 1.0 X X 0 0 0 Gary Willis 1.0 1.0 X X 0 0 0 Geoffrey Herter MD 1.0 1.0 X X 0 0 0 Chandler Howard 1.0 1.0 X 0 0 0 Hugh MacKenzie 1.0 1.0 X 0 0 0 Bruce MacMillian 1.0 1.0 X 0 0 0 Susan Martin 40.0 1.0 X 1369857 0 90670 Arthur McDowell MD 40.0 0.0 X 659889 0 240208 Harry Evert 40.0 0.0 X 411866 0 58782 Jesse Wagner MD 40.0 0.0 X 411976 0 101642 Gregory Nokes 40.0 0.0 X 459586 0 148140 Jacquelyn Calamari 40.0 0.0 X 282936 0 70256 Garrett Havican 40.0 0.0 X 222278 0 63488 Michael Saxe MD 40.0 0.0 X 402948 0 6440 David Giuffrida 40.0 0.0 X 258983 0 62000 Jonathan Bankoff MD 40.0 0.0 X 352111 0 5642 Randolph Goodwin MD 40.0 0.0 X 357538 0 1225 Mario Capuzzi MD 40.0 0.0 X 319742 0 6552 David Consentino MD 40.0 0.0 X 318543 0 5147 Robert Grillo MD 40.0 0.0 X 312231 0 5525 7228713 0 1233151 259 false true false ARAMARK CORPORATION 66 OXFORD DRIVE FRANKLIN MA 02038 DIETARY/HOUSEKEEPING 1514492 QUEST DIAGNOSTICS 2025 COLLECTION CENTER DRIVE CHICAGO IL 60693 LABORATORY SERVICES 1334934 COMPANY 1 CONSULTING 6 CRAIG DRIVE MONROE CT 06468 INFORMATION SERVICES 892655 TOBIN CARBERRY O'MALLEY PO BOX 58 NEW LONDON CT 06320 LEGAL SERVICES 853202 PHILBRICK TRANSCRIPTIONS 59 CARMEL HILL ROAD BETHLEHEM CT 06751 TRANSCRIPTION SVCS 823110 70 99006 1026164 3907380 557840 5032550 Patient revenues 621110 343984296 343984296 0 0 Specimen laboratory 621500 3186704 0 3186704 0 Technical laboratory 621500 1208202 0 1208202 0 348379202 760275 760275 20018 20018 0 643540 389545 253995 0 253995 253995 14952760 8876760 6076000 6076000 6076000 77416 99006 75479 1937 1937 0 0 CAFETERIA REVENUE 722210 1245629 1245629 0 0 MEDICARE DEMONSTRATION PR 900099 1642000 1642000 0 0 EQUITY IN JOINT VENTURE INCOME 900099 2021783 2021783 0 0 4154927 4139321 15606 0 9064339 369588316 353033029 4410512 7112225 0 0 0 0 0 0 0 0 5476483 4381186 1095297 0 235005 235005 0 0 159897043 143629874 16267169 0 11159520 10070406 1089114 0 13656796 12268535 1388261 0 11080727 9941471 1139256 0 39954882 23446778 15607243 900861 447095 0 447095 0 194525 0 194525 0 51500 0 51500 0 0 0 0 0 0 0 0 0 0 0 1530208 735084 795124 0 11706022 8729379 2976643 0 0 0 0 0 0 0 0 0 6628988 3995782 2633206 0 1639800 1279087 360713 0 0 0 0 0 648989 441835 207154 0 3016511 0 3016511 0 0 0 0 0 22145057 21133028 1012029 0 5009092 0 5009092 0 MEDICAL EXPENSES 36955430 36955430 0 0 TRANS TO MHS PRIMARY CARE 2999000 2999000 0 0 STATE NET PATIENT REV TAX 9221970 0 9221970 0 ALL OTHER EXPENSES 2134711 1142290 992421 0 345789354 281384170 63504323 900861 54769000 39387000 10187000 20741000 1668000 2082000 47154000 45387000 0 0 0 0 645000 617000 1347000 1251000 3970000 4058000 416504000 230191000 179846000 186313000 138950000 151822000 0 0 0 0 0 0 1549000 8653000 440085000 460311000 53975000 50292000 0 0 671000 769000 66330000 63180000 0 0 0 0 1620000 47000 0 0 156484000 81857000 279080000 196145000 X 144992000 247940000 9049000 9250000 6964000 6976000 161005000 264166000 440085000 460311000 X 23798962 5770000 73592038 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 false 0 false 0 true 51500 51500 false LOBBYING ACTIVITY SCHEDULE C, PART II-B, LINE 1I MIDDLESEX HOSPITAL PAYS DUES TO BOTH THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE CONNECTICUT HOSPITAL ASSOCIATION (CHA). A PERCENTAGE OF THOSE DUES FUNDED LOBBYING ACTIVITIES DURING THE FISCAL YEAR. THE PORTION OF AHA DUES TOTALED $10,112 AND THE PORTION OF CHA DUES TOTALED $25,448. IN ADDITION, MIDDLESEX HOSPITAL CONTRACTED WITH A CONSULTANT WHO PERFORMED LOBBYING ACTIVITIES. THOSE EXPENSES TOTALED $15,940. 102354000 869000 11675000 111000 114787000 87389000 83000 14929000 47000 102354000 87748000 85000 -354000 90000 87389000 80828000 208000 6856000 144000 87748000 79900000 416000 597000 85000 80828000 0.90000 0.06000 0.04000 false false 8674000 8674000 237627000 118816000 118811000 2062000 1302000 760000 145685000 107175000 38510000 22456000 2898000 19558000 186313000 0 ACCRUED RETIREMENT LIABILITIES 49029000 SELF INSURANCE LIABILITIES 18079000 ASSET RETIREMENT OBLIGATION 1040000 LEASE INCENTIVE OBLIGATION 25000 UNALLOCATED 3RD PARTY 13680000 SECURITY DEPOSITS 4000 81857000 366407000 366407000 3181316 3181316 369588316 342279000 342279000 3510354 3510354 345789354 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 BOARD-DESIGNATED (QUASI-ENDOWMENT) FUNDS ARE ASSETS SET ASIDE BY THE BOARD FOR FUTURE UNSPECIFIED USES AND TO SUPPORT EDUCATION AND OTHER PROGRAMS OVER WHICH THE BOARD RETAINS CONTROL AND MAY, AT ITS DISCRETION, SUBSEQUENTLY USE FOR OTHER PURPOSES. PERMANENT ENDOWMENT FUNDS ARE ASSETS RECEIVED WITH THE DONOR STIPULATION THAT THE PRINCIPAL BE INVESTED IN PERPETUITY AND THAT ONLY THE INCOME EARNED THEREON IS AVAILABLE FOR SPECIFIC OR GENERAL SERVICES, SUCH AS FREE BED FUNDS AND SUPPORT OF HOSPITAL OPERATIONS. TEMPORARILY RESTRICTED ENDOWMENT FUNDS ARE ASSETS RESTRICTED BY THE DONOR EITHER AS TO PURPOSE AND/OR AS TO TIME OF EXPENDITURE, SUCH AS EDUCATION, HEALTH SERVICES AND CAPITAL PURCHASES. RECONCILIATION OF REVENUE PER AFS WITH REVENUE PER RETURN SCHEDULE D, PART XI, LINE 4B RESTRICTED CONTRIBUTIONS 2,295,000 RESTRICTED INVESTMENT INCOME 375,000 NET FUND RAISING ACTIVITIES 900,861 RENTAL EXPENSES (389,545) LINE 4B TOTAL 3,181,316 RECONCILIATION OF EXPENSES PER AFS WITH EXPENSES PER RETURN SCHEDULE D, PART XII, LINE 4B PAYMENTS TO AFFILIATES 2,999,000 NET FUND RAISING ACTIVITIES 900,861 RENTAL EXPENSES (389,545) ROUNDING 38 LINE 4B TOTAL 3,510,354 TPC Golf 114015 77200 36815 2450 36066 9356 Hospice Golf 45776 15550 30226 3044 17463 240 2 16631 6256 10375 6860 176422 99006 77416 5494 53529 16456 75479 1937 true true X true X true X 500. true true true false true true 6751 4484459 1618666 2865793 0.00830 16107 58491447 38087735 20403712 0.05900 378 744832 551750 193082 0.00060 23236 63720738 40258151 23462587 0.06790 26051 4586704 17037 4569667 0.01320 1304 8287968 2033063 6254905 0.01810 25735 43914282 26546337 17367945 0.05020 123 884550 0 884550 0.00260 5951 364882 0 364882 0.00110 59164 58038386 28596437 29441949 0.08520 82400 121759124 68854588 52904536 0.15310 12346 12346 10 193019 193019 0.00060 991 12651 12651 104 67546 67546 0.00020 1105 285562 285562 0.00080 false 11094963 1109496 85392574 102250037 -16857463 X true true 1 1 MIDDLESEX HOSPITAL

28 CRESCENT STREET MIDDLETOWN CT 06457

WWW.MIDDLESEXHOSPITAL.ORG X X X X MIDDLESEX HOSPITAL 1 true X X X X X X X 12 true false true X X X X X X X X X X false false true true 200. true 500. true X X X X true true X X X X X X true false X X X true X false false 1 MIDDLESEX HOSPITAL HOMECARE

770 SAYBROOK ROAD MIDDLETOWN CT 06457

HOMECARE SERVICES, REHAB, HEART HEALTH, OTHER SERVICES PART I, LINE 3C: IN GENERAL, MIDDLESEX HOSPITAL ("THE HOSPITAL") USES FPG TO DETERMINE ELIGIBILITY. THERE ARE, HOWEVER, SPECIAL CIRCUMSTANCES (SUCH AS A CATASTROPHIC EVENT) WHICH MAY AFFECT A PATIENT'S ABILITY TO PAY. IN THIS CASE, THE HOSPITAL EVALUATES THE APPLICATION WITH CONSIDERATION GIVEN TO THE PATIENT'S CURRENT SITUATION. WITH SPECIAL CIRCUMSTANCES THE FPG THRESHOLD MAY BE IGNORED AND THE HOSPITAL MAY USE THE PATIENT'S ASSETS AND/OR TAX RETURN ITEMIZED DEDUCTIONS TO DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE. PART I, LINE 6A: N/A PART I, LINE 7G: MIDDLESEX HOSPITAL INCLUDES ITS FAMILY MEDICINE GROUP AS A SUBSIDIZED SERVICE. FOR FY13, 9,803 UNIQUE INDIVIDUALS WERE SERVED WITH A TOTAL HOSPITAL SUBSIDY OF $1,910,055. MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDE TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS THAT MIDDLESEX COUNTY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY MEDICAL CARE. MIDDLESEX HOSPITAL'S FAMILY MEDICINE GROUP FILLS A VITAL COMMUNITY HEALTH NEED BY PROVIDING ACCESS TO PRIMARY CARE SERVICES. PART I, LINE 7, COLUMN (F): N/A PART I, LINE 7: FOR PART 1, LINE 7 SECTIONS (A) FINANCIAL ASSISTANCE AT COST, (B) MEDICAID, (C) COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS, PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, AND (G) SUBSIDIZED HEALTH SERVICES, THE COSTING METHODOLOGY USED IS A HYBRID COST ACCOUNTING/MEDICARE COST-TO-CHARGE RATIO CALCULATION. THE PERCENTAGES ARE DERIVED FROM THE MOST CURRENT MEDICARE COST REPORT AND APPLIED BY CHARGE LINE APPROPRIATELY. INDIRECT COSTS WERE APPLIED TO SUBSIDIZED HEALTH SERVICES. THE MEDICARE COST REPORT DOES NOT ADDRESS ALL AREAS OF THE HOSPITAL IN THE SAME DETAIL, BUT DOES ACCURATELY ADDRESS INPATIENT AND OUTPATIENT, HOMECARE AND TO AN EXTENT PHYSICIAN SERVICES. SECTIONS (E) COMMUNITY HEALTH IMPROVEMENT; PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, (H) RESEARCH, AND (I) CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS ARE COMPRISED (EXCEPT FOR CASH DONATIONS AND IN-KIND MATERIAL DONATIONS) OF 1) SUPPLY EXPENSES; 2) PURCHASED SERVICES; AND 3) THE DIRECT SALARY COSTS FOR HOSPITAL STAFF WHOSE TIME WAS COMPENSATED BY THE HOSPITAL FOR TIME SPENT PARTICIPATING IN ACTIVITIES THAT QUALIFY AS COMMUNITY BENEFITS PLUS THE CURRENT FISCAL YEAR FRINGE BENEFIT RATE. INDIRECT COSTS WERE APPLIED TO SUBSIDIZED SERVICES AND TO A SMALL SELECTION OF SALARIES AND SERVICES UNDER COMMUNITY HEALTH IMPROVEMENT, RESEARCH, AND COMMUNITY BENEFIT OPERATIONS, BUT NOT BROADLY ACROSS ALL COMMUNITY BENEFIT ACTIVITY ENTRIES. PART II: MIDDLESEX HOSPITAL'S PARTICIPATION IN COMMUNITY BUILDING ACTIVITIES HAS A VITAL ROLE IN CONTINUING TO PROMOTE THE HEALTH, WELL-BEING AND SAFETY FOR RESIDENTS IN ITS SERVICE AREA. THE HOSPITAL OFFERS ITS RESOURCES AND EXPERTISE TO SUPPORT AND STRENGTHEN COMMUNITY ASSETS IN A VARIETY OF PROGRAMS THAT FALL UNDER THE SCOPE OF COMMUNITY BUILDING. STAFF MEMBERS ARE HIGHLY PARTICIPATIVE IN COMMUNITY PARTNERSHIPS AND COALITIONS, THE SUCCESS OF WHICH ARE GREATLY ENHANCED BY HOSPITAL COLLABORATION - MANY COMMUNITY INITIATIVES WOULD NOT BE AS EFFECTIVE WITHOUT THE HOSPITAL'S ADMINISTRATIVE AND CLINICAL STAFF IN-KIND INVOLVEMENT, SUPPORT AND EXPERTISE. AS COMMUNITY BUILDING PARTICIPATION IS FOCUSED ON HAVING A DIRECT IMPACT ON IMPROVING THE HEALTH OF THE COMMUNITY, IT MEETS THE CRITERIA FOR INCLUSION IN COMMUNITY BENEFIT AGGREGATE TOTALS. IN FY13 THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES TOTALED $285,562 AND SERVED 1,105 INDIVIDUALS. EXAMPLES INCLUDE (BUT ARE NOT LIMITED TO): " OPPORTUNITY KNOCKS (OK): A MULTIDISCIPLINARY COMMUNITY COALITION THAT INCLUDES 70+ COLLABORATORS COMPRISED OF LOCAL HEALTH AND SOCIAL SERVICE AGENCIES, EARLY CARE AND EDUCATION PROVIDERS AND PARENTS. THE GOALS ARE TO ENSURE THAT CHILDREN ENTER KINDERGARTEN PHYSICALLY AND EMOTIONALLY HEALTHY AND READY TO SUCCEED. SINCE ITS INCEPTION IN 2003, OK HAS SERVED APPROXIMATELY 8,900 CHILDREN AGES 0-5. MIDDLESEX HOSPITAL PROVIDES: FUNDING; THE PROGRAM PLANNER, A PHYSICIAN CHAMPION, GRANT-WRITING SUPPORT, FISCAL ADMINISTRATION FOR THE FUNDING SOURCES AND PARTICIPATION FROM MULTIPLE DEPARTMENTAL STAFF MEMBERS. " DISASTER READINESS: FOR DISASTER READINESS, THE HOSPITAL PLAYS A PIVOTAL ROLE BY WORKING IN COLLABORATION WITH KEY COMMUNITY PARTNERS TO ENSURE THE SAFETY OF THE COMMUNITY AT LARGE DURING A POTENTIAL DISASTER. TO PREPARE FOR DISASTERS, THE HOSPITAL PARTICIPATES IN SCHOOL SAFETY COMMITTEES; COMMUNITY FLU PREPARATION COMMITTEES; STATEWIDE/REGIONAL EMERGENCY MANAGEMENT COMMITTEES; REGULAR COLLABORATIVE COMMUNITY EDUCATION AND DRILLS; AND HOSTS YEARLY RADIATION DRILLS FOR THE STAFF OF A LOCAL NUCLEAR POWER PLANT. IN ADDITION, THE HOSPITAL PURCHASES AND STOCK-PILES LARGE QUANTITIES OF EXTENSIVE PANDEMIC SUPPLIES TO BE USED SHOULD A COMMUNITY-WIDE DISASTER OCCUR. INCLUDED IN THIS STOCK-PILE ARE MEDICATIONS FOR INFECTIOUS DISEASE AND CHEMICAL EXPOSURE CURATIVES. THE MAJORITY OF THE VALUE OF THE SUPPLIES, SPACE UTILIZATION AND COSTS ASSOCIATED TO MONITOR AND REPLENISH PANDEMIC PRODUCTS (WITHIN EXPIRATION DATES) ARE ABSORBED BY THE HOSPITAL. " SHORELINE MEDICAL CENTER MENTORING FOR CAREERS IN HEALTHCARE: THE HOSPITAL'S SHORELINE MEDICAL CENTER (SMC) HAS WELL-DEVELOPED EDUCATIONAL PROGRAMS FOR LOCAL STUDENTS INTERESTED IN MEDICAL CAREERS. SHORTAGES OF CERTAIN TRAINED MEDICAL PROFESSIONALS SUCH AS NURSES AND RADIOLOGIC TECHNOLOGISTS SERVED AS THE IMPETUS FOR STARTING THESE PROGRAMS. 1) CAREER DAY IS AN EXPERIENTIAL LEARNING EVENT WHERE HIGH SCHOOL STUDENTS INTERACT WITH STAFF MEMBERS FROM A VARIETY OF CLINICAL FIELDS AND PARTICIPATE IN INTERACTIVE MOCK DEMONSTRATIONS/SIMULATIONS. 2) INTERNSHIPS: SMC PROVIDES INTERNSHIPS FOR LOCAL HIGH SCHOOL STUDENTS. AMONG MANY OTHER EXPERIENCES, STUDENTS ARE INVOLVED IN PATIENT ROUNDS AND ARE EXPOSED TO HOW DIAGNOSES ARE MADE. 3) WORLD OF WORK IS AN EDUCATIONAL EXPERIENCE FOR MIDDLE SCHOOLS STUDENTS WHERE STUDENTS LEARN ABOUT SPECIFIC HEATH CARE FIELDS AND THE EDUCATION REQUIRED FOR EACH SPECIALTY. STUDENTS ALSO RECEIVE DEMONSTRATIONS ON HEALTH CARE MODALITIES. PART III, LINE 2: THE BAD DEBT EXPENSE AMOUNT IN PART III, LINE 2 IS BASED ON CHARGES AND TIED TO THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. THE HOSPITAL ACCOUNTS FOR DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS IN DETERMINING BAD DEBT EXPENSE BY REDUCING BAD DEBT BY RECOVERIES ON THE HOSPITAL'S FINANCIALS. PART III, LINE 3: FOR PART III, LINE 3, THE HOSPITAL ESTIMATES THAT 10% OF ITS BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL HAS A WELL-ESTABLISHED PROCESS WITH ITS THIRD PARTY AGENCIES TO CAPTURE AS MANY PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE AS POSSIBLE AND AWARDS FINANCIAL ASSISTANCE TO THOSE PATIENTS IN COLLECTIONS WHO ARE KNOWN TO QUALIFY. ONCE IN COLLECTIONS, THERE ARE TWO METHODS WHICH ENABLE PATIENTS TO RECEIVE FINANCIAL ASSISTANCE AWARDS: 1) PATIENTS COMPLETE A FINANCIAL ASSISTANCE APPLICATION, MEET ELIGIBILITY CRITERIA AND ARE APPROVED; OR 2) THE THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE HOSPITAL TO COLLECT BALANCES SCREEN FOR FINANCIAL ASSISTANCE ELIGIBILITY. IN ORDER TO ENSURE THAT ALL PATIENTS IN COLLECTIONS ARE AWARE OF FINANCIAL ASSISTANCE AVAILABILITY, THE HOSPITAL REQUIRES THIRD PARTY ORGANIZATIONS TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WITHIN THE POLICY THERE IS A PROVISION WHEREBY COLLECTION AGENCIES, USING GUIDELINES SET FORTH BY THE HOSPITAL, ASSIST THE HOSPITAL IN IDENTIFYING PATIENTS WHO DO NOT HAVE A MEANS TO PAY FOR SERVICES AND THEREFORE QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM - WHILE THESE PATIENTS HAVE NOT GONE THROUGH THE FORMAL APPLICATION PROCESS, THEY MEET THE ELIGIBILITY GUIDELINES FOR FINANCIAL ASSISTANCE AS DEFINED BY THE HOSPITAL. THESE PATIENTS ARE THEN TRANSFERRED AND INCLUDED UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE UMBRELLA. WHILE THIS PROCESS CAPTURES THE MAJORITY OF THOSE WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL RECOGNIZES IT WILL STILL HAVE A POPULATION OF PATIENTS WHO COULD POTENTIALLY QUALIFY FOR FINANCIAL ASSISTANCE AND DO NOT RECEIVE AWARDS - THOSE WHO ARE UNCOOPERATIVE, UNRESPONSIVE OR HAVE MOVED AWAY. BAD DEBT DOLLARS ARE NOT INCLUDED IN ANY OF THE HOSPITAL'S PROGRAMMATIC COMMUNITY BENEFIT VALUES AND, WHILE NOTED, ARE NOT INCLUDED IN THE HOSPITAL'S COMMUNITY BENEFIT TOTALS IN ANY HOSPITAL COMMUNITY BENEFIT PUBLICATION. PART III, LINE 4: THE HOSPITAL ESTIMATES A RESERVE FOR UNCOLLECTIBLE ACCOUNTS AGAINST ITS PATIENT ACCOUNTS RECEIVABLES. WHEN BAD DEBTS ARE IDENTIFIED, THEY ARE ACCOUNTED FOR AS A COMPONENT OF THE OPERATING EXPENSE PROVISION FOR BAD DEBTS NET OF RECOVERIES. PAGE 15 OF THE MIDDLESEX HOSPITAL'S FY13 AUDITED FINANCIAL STATEMENT STATES: FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT B PART III, LINE 9B: MIDDLESEX HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY STATES THAT PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE WILL BE RESPONSIBLE FOR PAYING ANY BALANCE REMAINING AFTER THE FINANCIAL ASSISTANCE ALLOWANCE HAS BEEN APPLIED (THAT IS, IF 100% FINANCIAL ASSISTANCE HAS NOT BEEN AWARDED). THE POLICY ALSO OUTLINES THE PROCESS FOR PAYING OUTSTANDING BALANCES SHOULD THE PATIENT BE FOUND TO HAVE THE MEANS TO PAY A PARTIAL AMOUNT AFTER THE HOSPITAL'S FINANCIAL ASSISTANCE DETERMINATION CRITERIA HAS BEEN APPLIED. FOR SUCH BALANCES, THE HOSPITAL WILL NOTIFY THE PATIENT OF HIS/HER LIABILITY. IF PAYMENT IS NOT MADE, THE POLICY STATES THAT THE HOSPITAL WILL USE APPROPRIATE METHODS TO PURSUE COLLECTION, WHICH MAY INCLUDE COLLECTIONS AGENCIES AND ATTORNEYS. THIS PRACTICE IS BROADLY UTILIZED FOR ALL PATIENTS WITH OUTSTANDING BALANCES. THE HOSPITAL MAKES EVERY EFFORT TO ENSURE THAT ALL PATIENTS KNOW PAYMENT PLANS ARE AVAILABLE FOR ANY BALANCE, INCLUDING THOSE PATIENTS WHO HAVE A BALANCE LEFT OVER AFTER A FINANCIAL ASSISTANCE AWARD HAS BEEN APPLIED. IN ORDER TO CAPTURE THE PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE HOSPITAL HAS PROVISIONS IN ITS COLLECTION POLICY. IN THE CASE WHERE PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE DO NOT COMPLETE A FINANCIAL ASSISTANCE APPLICATION AND ARE PLACED INTO COLLECTIONS, THE THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE HOSPITAL TO COLLECT BALANCES SCREEN FOR FINANCIAL ASSISTANCE ELIGIBILITY. THE THIRD PARTY ORGANIZATIONS FOLLOW HOSPITAL POLICY BY ALERTING ALL PATIENTS IN COLLECTIONS TO THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WITHIN THE HOSPITAL'S COLLECTION POLICY THERE IS A PROVISION WHEREBY COLLECTION AGENCIES, USING GUIDELINES SET FORTH BY THE HOSPITAL, ASSIST THE HOSPITAL IN IDENTIFYING PATIENTS WHO DO NOT HAVE A MEANS TO PAY FOR SERVICES AND THEREFORE QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM - WHILE THESE PATIENTS HAVE NOT GONE THROUGH THE FORMAL APPLICATION PROCESS, THEY MEET THE ELIGIBILITY GUIDELINES FOR FINANCIAL ASSISTANCE AS DEFINED BY THE HOSPITAL. THESE PATIENTS ARE THEN TRANSFERRED AND INCLUDED UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE UMBRELLA. THIS PROCESS WAS PUT IN PLACE BY THE HOSPITAL IN ORDER TO CAPTURE AS MANY PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE AS POSSIBLE. PART V, SECTION B, LINE 1J: N/A PART V, SECTION B, LINE 3: MIDDLESEX HOSPITAL WAS INVITED TO JOIN THE MIDDLESEX COUNTY COALITION ON COMMUNITY WELLNESS (MCCOCW), AN INCLUSIVE AND REPRESENTATIVE PARTNERSHIP COMPRISED OF CONSTITUENTS FROM THE SECTORS OF PUBLIC HEALTH, HEALTH CARE, SOCIAL SERVICES, COMMUNITY SERVICES AND EDUCATION. MCCOCW'S PURPOSE IS TO WORK COLLABORATIVELY, THROUGH A MULTI-SECTORIAL EFFORT, AS AGENTS OF CHANGE TO IMPROVE THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. GOALS INCLUDE: 1) WORKING TOGETHER TO CONDUCT A MIDDLESEX COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA); 2) IDENTIFYING KEY ISSUES THAT IMPACT HEALTH AND WELLBEING; AND 3) DEVELOPING COLLABORATIVE PROGRAMS TO MEET IDENTIFIED NEED. MCCOCW'S CHNA WAS COMPLETED IN 2013. MIDDLESEX COUNTY WAS A RECIPIENT OF CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) COMMUNITY TRANSFORMATION GRANT (CTG) FUNDING FOR PROJECTS THAT IMPROVE THE HEALTH AND WELLBEING OF COMMUNITIES, REDUCE CHRONIC DISEASE RATES AND REDUCE HEALTH DISPARITIES. THE CT DEPARTMENT OF PUBLIC HEALTH (DPH) WAS ONE OF 61 CTG NATIONAL RECIPIENTS AND SECURED FUNDING FOR CAPACITY BUILDING TO IMPROVE COMMUNITY HEALTH BY LAYING A SOLID FOUNDATION FOR COMMUNITY PREVENTION EFFORTS. CONNECTICUT DPH IDENTIFIED 5 OF THE 8 COUNTIES WITH POPULATIONS OF LESS THAN 500,000 TO RECEIVE FUNDING, ONE OF WHICH WAS MIDDLESEX COUNTY. CTG DELIVERABLES INCLUDED: THE STRENGTHENING OF MULTI-SECTORIAL, COUNTY-WIDE COALITIONS; THE COMPLETION OF POLICY SCANS TO IDENTIFY BEST PRACTICES AND GAPS (I.E. POLICIES, PROGRAMS, INFRASTRUCTURE); AND THE COMPLETION OF A COUNTY-WIDE HEALTH NEEDS ASSESSMENT. THE CHATHAM HEALTH DISTRICT PROVIDED THE OVERSIGHT FOR THE ADMINISTRATION OF THE CTG CAPACITY-BUILDING DELIVERABLES IN MIDDLESEX COUNTY IN PARTNERSHIP WITH THE CT RIVER AREA HEALTH DISTRICT, ESSEX HEALTH DEPARTMENT, THE MIDDLETOWN, DURHAM AND CROMWELL HEALTH DEPARTMENTS, MIDDLESEX HOSPITAL AND A WIDE ARRAY OF COMMUNITY PARTNERS REPRESENTING THE BROAD INTERESTS OF MIDDLESEX COUNTY. THE CHATHAM HEALTH DISTRICT DIRECTOR OF HEALTH AND THE MIDDLESEX HOSPITAL MANAGER OF COMMUNITY BENEFIT SERVE AS CO-CHAIRS OF THE COALITION. THE COALITION IS MADE UP OF 75+ MEMBERS FROM MIDDLESEX COUNTY, INCLUDING THOSE WHO HAVE SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH AND PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY(IES) SERVED BY MIDDLESEX HOSPITAL. COALITION MEMBERS INCLUDE: THE CHATHAM HEALTH DISTRICT; MIDDLESEX HOSPITAL; CT RIVER AREA HEALTH DISTRICT; ESSEX HEALTH DEPARTMENT; THE MIDDLETOWN, DURHAM AND CROMWELL HEALTH DEPARTMENTS; THE COMMUNITY HEALTH CENTER, MIDDLETOWN; MIDDLESEX COUNTY CHAMBER OF COMMERCE HEALTH CARE COUNCIL; MIDDLESEX COUNTY SUBSTANCE ABUSE ACTION COUNCIL; DURHAM MIDDLEFIELD YOUTH AND FAMILY SERVICES; MIDDLESEX COALITION FOR CHILDREN; NORTH END ACTION TEAM; MIDDLETOWN YOUTH SERVICES; YOUTH AND FAMILY SERVICES OF HADDAM-KILLINGWORTH; TOWN OF PORTLAND; ACES MIDDLESEX COUNTY EARLY HEADSTART PARTNERSHIP; MIDDLETOWN SCHOOLS; ST. LUKE'S ELDERCARE SERVICES; MIDDLESEX UNITED WAY; DURHAM MIDDLEFIELD YOUTH AND FAMILY SERVICES; OLD SAYBROOK YOUTH AND FAMILY SERVICES; PORTLAND LIBRARY; CONNECTICUT DENTAL HEALTH PARTNERSHIP; WESLEYAN UNIVERSITY; MIDDLETOWN YOUTH SERVICES BUREAU; CHESTER HEALTH DEPARTMENT; CONNECTICUT DEPARTMENT OF CHILDREN AND FAMILIES; LILY'S KIDS, INC.; ST. VINCENT DE PAUL, MIDDLETOWN; HADDAM SENIOR CENTER; PORTLAND SENIOR CENTER; PORTLAND YOUTH SERVICES; KILLINGWORTH HEALTH DEPARTMENT; OLD SAYBROOK PUBLIC SCHOOLS; EAST HADDAM FREE PUBLIC LIBRARY; MIDDLESEX YMCA; UCHC CENTER FOR PUBLIC HEALTH AND HEALTH POLICY; UNIVERSITY OF CONNECTICUT HEALTH CENTER; MIDDLETOWN CITIZEN'S ADVISORY COMMITTEE; SHORELINE SOUP KITCHEN AND PANTRIES; CLINTON YOUTH AND FAMILY SERVICES; CONNECTICUT GENERAL ASSEMBLY; MIDDLETOWN MINISTERIAL ALLIANCE; MIDDLESEX COUNTY NAACP; PORTLAND PARKS AND RECREATION; EAST HAMPTON PUBLIC LIBRARY; OLD SAYBROOK SOCIAL SERVICES; COMMUNITY FOUNDATION OF MIDDLESEX COUNTY; CROMWELL SENIOR AND HUMAN SERVICES; CONNECTICUT HOUSE OF REPRESENTATIVES; EAST HAMPTON HUMAN SERVICES. AS COMPLETING A COMMUNITY HEALTH NEEDS ASSESSMENT WAS A GOAL FOR THE MIDDLESEX COUNTY COALITION ON COMMUNITY WELLNESS, IT WAS A STANDING AGENDA ITEM FOR THE MONTHLY COALITION MEETINGS. THOSE WHO WERE UNABLE TO ATTEND THE MONTHLY MEETINGS WERE KEPT INFORMED AND ENGAGED VIA E-MAIL COMMUNICATIONS AS WELL AS MEETING MINUTES, AGENDAS AND PERTINENT DOCUMENTS. FOR CHNA PRIMARY DATA COLLECTION, THE COALITION CONDUCTED MULTIPLE KEY INFORMANT SURVEYS AND FOCUS GROUPS. THE MIDDLESEX HOSPITAL BOARD OF DIRECTORS REVIEWED THE HOSPITAL'S COMMUNITY BENEFIT COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGY FOR ADDRESSING FIVE PRIORITY AREAS IDENTIFIED IN THE MCCOCW 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND APPROVED THE STRATEGY ON SEPTEMBER 20, 2013. PART V, SECTION B, LINE 4: N/A PART V, SECTION B, LINE 5A: THE MIDDLESEX COUNTY COALITION ON COMMUNITY WELLNESS COMMUNITY HEALTH NEEDS ASSESSMENT 2013 (OF WHICH THE HOSPITAL WAS A COLLABORATIVE PARTNER), ALONG WITH THE MIDDLESEX HOSPITAL CHNA IMPLEMENTATION STRATEGY 2013 ARE LOCATED ON MIDDLESEX HOSPITAL'S WEB-SITE AT THE FOLLOWING URL: HTTP://MIDDLESEXHOSPITAL.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMU NITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. THE MCCOCW CHNA IS ALSO LOCATED ON THE CHATHAM HEALTH DISTRICT WEB-SITE AT THE FOLLOWING URL: HTTP://WWW.CHATHAMHEALTH.ORG/PDF/SUPPORTINGDOCUMENTS/COMMUNITYHEALTHNEEDSA SSESSMENTEVERSION.PDF PART V, SECTION B, LINE 5C: IN ADDITION TO POSTING ON THE MIDDLESEX HOSPITAL'S WEB-SITE AND MAKING THE CHNA AVAILABLE UPON REQUEST, THE MIDDLESEX COUNTY COALITION ON COMMUNITY WELLNESS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (IN WHICH THE HOSPITAL WAS A COLLABORATIVE PARTNER), WAS DISTRIBUTED TO THE ENTIRE MIDDLESEX COUNTY COALITION ON COMMUNITY WELLNESS; THOSE WHO PARTICIPATED IN THE KEY INFORMANT SURVEYS AND FOCUS GROUPS; COMMUNITY MEMBERS; THE MIDDLESEX HOSPITAL MEDICAL STAFF VIA E-MAIL; THE MIDDLESEX HOSPITAL EXECUTIVE STAFF, MANAGERS AND SUPERVISORS VIA E-MAIL; AND THE MIDDLESEX HOSPITAL EMPLOYEE BASE THROUGH POSTING IN THE HOSPITAL'S WEEKLY NEWSLETTER. MIDDLESEX HOSPITAL STAFF WAS ASKED TO FREELY SHARE THE CHNA WITH COMMUNITY COLLEAGUES. IN ADDITION, COMMUNITY PRESENTATIONS WERE GIVEN ON THE RESULTS OF THE CHNA. PART V, SECTION B, LINE 6I: N/A PART V, SECTION B, LINE 7: MIDDLESEX HOSPITAL RECOGNIZES THAT IT CANNOT FOCUS ON ALL THE HEALTH NEEDS IDENTIFIED IN THE MCCOCW 2013 COMMUNITY HEALTH NEEDS ASSESSMENT. GIVEN THE SIGNIFICANT RESOURCES AND IN-KIND TIME NEEDED TO ADDRESS HEALTH PRIORITY AREAS UNCOVERED BY A COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL ENGAGED IN A THOROUGH PROCESS OF DATA REVIEW AND DISCUSSION TO IDENT Q4 - COMMUNITY INFORMATION: MIDDLESEX HOSPITAL IS THE SOLE HOSPITAL PROVIDER IN ITS SERVICE AREA, WHICH INCLUDES THE LARGE GEOGRAPHIC AREA OF MIDDLESEX COUNTY AND SURROUNDING TOWNS. IT ENCOMPASSES 24 MUNICIPALITIES, INCLUDING THE 15 TOWNS OF MIDDLESEX COUNTY (MIDDLETOWN, CROMWELL, PORTLAND, EAST HAMPTON, EAST HADDAM, HADDAM, MIDDLEFIELD, DURHAM, KILLINGWORTH, CHESTER, DEEP RIVER, ESSEX, OLD SAYBROOK, WESTBROOK, CLINTON) AND 9 TOWNS ON MIDDLESEX COUNTY'S PERIPHERY (ROCKY HILL, GLASTONBURY, HEBRON, MARLBOROUGH, COLCHESTER, SALEM, LYME/OLD LYME, MADISON, GUILFORD). THE MIX OF SUBURBAN AND RURAL TOWNS EXIST WITHIN A LAND MASS OF APPROXIMATELY 623 SQUARE MILES AND HAS A POPULATION OF APPROXIMATELY 250,000 [WITH A POPULATION OF 165,676 (2010 CENSUS) IN MIDDLESEX COUNTY PROPER]. MIDDLESEX COUNTY IS LOCATED IN SOUTHEASTERN CONNECTICUT AND RANKS 3RD OF THE EIGHT CT COUNTIES IN POPULATION SIZE. 72% OF THE COUNTY'S RESIDENTS LIVE IN URBAN AREAS WITH 28% LIVING IN RURAL ENVIRONMENTS. THE MAIN INDUSTRY INCLUDES: MIDDLESEX HOSPITAL, WESLEYAN UNIVERSITY, PRATT & WHITNEY AND THE SMALL BUSINESS COMMUNITY. THE COUNTY'S RACIAL COMPOSITION IS 89.2% WHITE, 4.6% BLACK OR AFRICAN AMERICAN, 2.6% ASIAN PACIFIC, 0.2% NATIVE AMERICAN AND 3.4% OTHER/MULTI-RACE, WITH AN ETHNIC MAKE-UP OF 5.1% HISPANIC OR LATINO (2011). MIDDLETOWN IS THE LARGEST MUNICIPALITY IN THE COUNTY, WITH A POPULATION OF 47,648 (2010 CENSUS) AND DEMOGRAPHICALLY STANDS ALONE FROM THE OTHER TOWNS WITHIN MIDDLESEX COUNTY. MIDDLETOWN'S RACIAL COMPOSITION IS 76% WHITE, 12% BLACK OR AFRICAN AMERICAN, 4% ASIAN PACIFIC, 0.1% NATIVE AMERICAN AND 7.5% OTHER/MULTI-RACE, WITH AN ETHNIC MAKE-UP OF 6.8% HISPANIC OR LATINO (2010). REGARDING THE SOCIOECONOMIC MEASURES OF INCOME LEVEL, POVERTY RATE, AND EDUCATION ATTAINMENT: 1) THE AVERAGE ANNUAL HOUSEHOLD INCOME IS $61,791 IN MIDDLETOWN AND $74,627 IN MIDDLESEX COUNTY (2010); 2) THE POVERTY RATE IS 11.8% IN MIDDLETOWN AND 5.8% IN MIDDLESEX COUNTY (2009); AND 3) 10.3% OF ADULTS AGE 25 OR OLDER IN MIDDLETOWN DON'T HAVE A HIGH SCHOOL DIPLOMA COMPARED TO 7% IN MIDDLESEX COUNTY (2007-2011). IN 2013, THE PERCENT OF HOSPITAL DISCHARGES FOR MEDICAID/SAGA/UNINSURED COMBINED FOR THE FOLLOWING SERVICE LINES WERE: 14.8% INPATIENT; 37.6% NEWBORN; 12.3% OUTPATIENT SURGERY; 31.4% EMERGENCY DEPARTMENT NON-ADMISSION AND 14.7% OUTPATIENT OBSERVATION. Q5 - PROMOTION OF COMMUNITY HEALTH: AS MIDDLESEX HOSPITAL IS A COMMUNITY HOSPITAL, INVOLVING COMMUNITY MEMBERS IN KEY FUNCTIONS HAS ALWAYS BEEN A PRIORITY. THE HOSPITAL'S BOARD IS COMPRISED MAINLY OF COMMUNITY MEMBERS WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS NOR CONTRACTORS OF THE ORGANIZATION, BUT ARE LONG-TERM RESIDENTS WHOSE PRIMARY INTEREST IS THE HEALTH AND WELL-BEING OF THE COMMUNITY AT LARGE. MIDDLESEX HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY BASED ON THE HOSPITAL'S CURRENT AND PROJECTED PATIENT CARE, TEACHING AND RESEARCH NEEDS, AND OVERALL COMMUNITY NEED. MEDICAL STAFF INPUT AND PARTICIPATION IS HIGHLY VALUED BY THE HOSPITAL AS EVIDENCED BY INCLUSION IN THE HOSPITAL'S MEDICAL EXECUTIVE COMMITTEE, THE MEDICAL STAFF COUNCIL AND COUNTLESS OTHER WORKING COMMITTEES. THE HOSPITAL HAS A FORMAL PROCESS FOR ALLOCATION OF SURPLUS FUNDS; A MULTIDISCIPLINARY CAPITAL BUDGETING COMMITTEE MEETS AND SETS PRIORITIES FOR INVESTMENTS IN PATIENT CARE, EDUCATION AND RESEARCH, AND PHYSICAL STRUCTURE. THE APPROACH TAKES INTO CONSIDERATION PATIENT, COMMUNITY AND STAFF NEEDS. EACH YEAR THE HOSPITAL ALLOCATES A PORTION OF SURPLUS FUNDING TO A WIDE ARRAY OF COMMUNITY BENEFIT PROGRAMS AND SERVICE LINES, INCLUDING SUBSTANTIAL HEALTH AND WELLNESS ACTIVITIES AND INITIATIVES, SUBSIDIZED SERVICES, MEDICAL EDUCATION, RESEARCH AND HEALTH ASSESSMENT COSTS. CONTINUOUS DEDICATION TO THE COMMUNITIES IT SERVES REMAINS THE HALLMARK OF MIDDLESEX HOSPITAL'S VISION, MISSION, AND STRATEGIC PLANNING. AMBITIOUS COMMUNITY BENEFIT GOALS, THE INCORPORATION OF COMMUNITY BENEFIT INTO ANNUAL ORGANIZATIONAL PLANNING, AND THE PROVISION OF COMMUNITY BENEFIT PROGRAMS THAT TARGET THE COMMUNITY'S MOST VULNERABLE AND AT-RISK POPULATIONS HAS ALLOWED THE HOSPITAL TO PUT A FORMAL STRUCTURE AROUND ITS FUNDAMENTAL PURPOSE. THE HOSPITAL'S COMMUNITY BENEFIT TOTAL FOR FY13 WAS $52,904,536 (EXCLUDING COMMUNITY BUILDING) WITH 82,400 SERVED (EXCLUDING COMMUNITY BUILDING). THE FOLLOWING IS AN OVERVIEW OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM: COMMUNITY HEALTH IMPROVEMENT SERVICES: THE HOSPITAL UNDERWRITES A VAST RANGE OF COMMUNITY HEALTH EDUCATION AND HEALTH IMPROVEMENT PROGRAMS, NONE OF WHICH ARE DEVELOPED FOR MARKETING PURPOSES, ALL OF WHICH ARE SUPPORTED AS A MEANS OF FULFILLING THE HOSPITAL'S MISSION TO SERVE ITS COMMUNITY. ALMOST 100% OF THE TIME THESE SERVICES ARE OFFERED FREE OF CHARGE; IN THE RARE INSTANCE WHERE A NOMINAL FEE IS ASSESSED THE COST OF PROVIDING THE SERVICE IS NOT COVERED. COMMUNITY HEALTH EDUCATION IS PROVIDED TO THE COMMUNITY AT LARGE. SOME OF THE PROGRAMS REPRESENT ONE TIME EVENTS, HOWEVER MOST ARE ONGOING AND OVER THE YEARS HAVE BECOME ENTRENCHED IN THE COMMUNITY AS A SOURCE OF SUPPORT AND CONTINUED EDUCATION FOR A HEALTHFUL FUTURE. EXAMPLES OF COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE (BUT ARE NOT LIMITED TO): 1) HEALTH EDUCATION (COMMUNITY EDUCATION PRESENTATIONS; HEALTH AND WELLNESS EVENTS/HEALTH FAIRS; SUPPORT GROUPS; LARGE SCALE CANCER AWARENESS AND EDUCATIONAL EVENTS; AND THE AVAILABILITY OF HEALTH LITERATURE); 2) COMMUNITY-BASED CLINICAL SERVICES (CLINICS AND SCREENINGS; ANNUAL FLU SHOTS; BLOOD PRESSURE CLINICS); AND 3) HEALTHCARE SUPPORT SERVICES OFFERED TO INCREASE ACCESS AND QUALITY OF CARE TO INDIVIDUALS, ESPECIALLY THOSE LIVING IN POVERTY AND/OR OTHER VULNERABLE POPULATIONS (CENTER FOR CHRONIC CARE MANAGEMENT DISEASE MANAGEMENT OUTPATIENT PROGRAMS FOR ADULT ASTHMA; CHILD ASTHMA; DIABETES EDUCATION AND DISEASE MANAGEMENT; MEDICAL NUTRITION THERAPY; SMOKING CESSATION; CHRONIC HEART FAILURE; AND CHILDHOOD WEIGHT MANAGEMENT). IN FY13, THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT SERVICES SERVED 26,051 INDIVIDUALS AT A TOTAL COST OF $4,165,765 TO THE HOSPITAL. HEALTH PROFESSIONS EDUCATION: HELPING TO PREPARE FUTURE HEALTH CARE PROFESSIONALS IS A LONG-STANDING COMMITMENT OF MIDDLESEX HOSPITAL AND DISTINGUISHING CHARACTERISTIC THAT CONSTITUTES A SIGNIFICANT COMMUNITY BENEFIT. THE HOSPITAL'S FAMILY MEDICINE RESIDENCY PROGRAM GRADUATES FAMILY PRACTICE PHYSICIANS, MANY OF WHOM CONTINUE TO PRACTICE IN THE MIDDLESEX COUNTY AREA AFTER THEIR TRAINING IS COMPLETE. THIS IS ESPECIALLY IMPORTANT GIVEN THAT MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDE TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS THAT MIDDLESEX COUNTY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY MEDICAL CARE. THE HOSPITAL ALSO WELCOMES MEDICAL AND NURSING STUDENT INTERNS AND PROVIDES ON-SITE TRAINING DURING CLINICAL ROTATIONS. NURSING STUDENTS FROM LOCAL COLLEGES AND PROGRAMS RECEIVE HANDS-ON MENTORSHIP IN THE MAJORITY OF CLINICAL SERVICE LINES YEAR-ROUND. OTHER HEALTHCARE PROFESSIONAL EDUCATION INCLUDES THE HOSPITAL'S RADIOLOGY SCHOOL (WHICH OPERATES AT A LOSS FOR THE HOSPITAL) AND CLINICAL/NON-CLINICAL EDUCATIONAL STUDENT TRAINING IN MULTIPLE FIELDS. IN FY13, THE HOSPITAL'S HEALTH PROFESSIONS EDUCATION CATEGORY SERVED 1,304 INDIVIDUALS AT A TOTAL COST OF $6,254,905 TO THE HOSPITAL. SUBSIDIZED HEALTH SERVICES: THE HOSPITAL'S SUBSIDIZED HEALTH SERVICES REPRESENT A SIGNIFICANT PORTION OF MIDDLESEX HOSPITAL'S ANNUAL COMMUNITY BENEFIT AGGREGATE FINANCIALS AND NUMBERS SERVED. SUBSIDIZED SERVICES ARE PARTICULAR CLINICAL PROGRAMS PROVIDED TO THE COMMUNITY DESPITE A FINANCIAL LOSS, WITH NEGATIVE MARGINS REMAINING AFTER SPECIFIC DOLLARS (FINANCIAL ASSISTANCE AND BAD DEBT) AND SHORTFALLS (MEDICAID) ARE REMOVED. IN ORDER TO QUALIFY AS A SUBSIDIZED SERVICE, THE PROGRAM MUST MEET CERTAIN HEALTH DELIVERY CRITERIA; MEET AN IDENTIFIED NEED IN THE COMMUNITY; AND WOULD BECOME UNAVAILABLE OR THE RESPONSIBILITY OF A GOVERNMENTAL OR ANOTHER NOT-FOR-PROFIT AGENCY TO PROVIDE IF THE HOSPITAL DISCONTINUED THE SERVICE. MIDDLESEX HOSPITAL'S SUBSIDIZED SERVICES FOR FY13 INCLUDE FAMILY PRACTICE SERVICES, BEHAVIORAL HEALTH (INPATIENT AND OUTPATIENT), HOMECARE, CARDIAC REHABILITATION, PARAMEDICS, HOSPICE, DIABETES EDUCATION, WOUND CARE AND PULMONARY REHABILITATION. IN FY13 THE HOSPITAL'S SUBSIDIZED SERVICES SERVED 25,735 PEOPLE WITH A TOTAL COST OF $17,367,945 TO THE HOSPITAL. RESEARCH: MIDDLESEX HOSPITAL CONDUCTS RESEARCH IN THE DOMAINS OF CLINICAL AND COMMUNITY HEALTH. CLINICAL EXAMPLES INCLUDE NATIONAL TRIALS BY THE HOSPITAL'S CANCER CENTER FOR BREAST, LUNG, PROSTATE, COLORECTAL, AMONG OTHERS. FOR FY13, THE HOSPITAL'S ASSOCIATED COSTS FOR ALL RESEARCH PROJECTS TOTALED $884,550 AND SERVED 123 INDIVIDUALS. FINANCIAL AND IN-KIND CONTRIBUTIONS: MIDDLESEX HOSPITAL SUPPORTS THE COMMUNITY IN THE FORM OF FINANCIAL AND IN-KIND CONTRIBUTIONS. THE HOSPITAL'S IN-KIND CONTRIBUTIONS X X X X X true true X X X X X false true false false false true false false false Susan Martin 332712 0 141500 0 895645 0 87440 0 3230 0 1460527 0 958020 0 Arthur McDowell MD 381737 0 150500 0 127652 0 232720 0 7488 0 900097 0 340109 0 Harry Evert 272492 0 99500 0 39874 0 55000 0 3782 0 470648 0 44500 0 Jesse Wagner MD 407756 0 0 0 4220 0 95500 0 6142 0 513618 0 15000 0 Gregory Nokes 275712 0 108000 0 75874 0 143300 0 4840 0 607726 0 193215 0 Jacquelyn Calamari 210180 0 69500 0 3256 0 68200 0 2056 0 353192 0 32500 0 Garrett Havican 220397 0 0 0 1881 0 56000 0 7488 0 285766 0 13000 0 Michael Saxe MD 359372 0 38118 0 5458 0 0 0 6440 0 409388 0 15000 0 Jonathan Bankoff MD 266690 0 85421 0 0 0 0 0 5642 0 357753 0 77565 0 Randolph Goodwin MD 306920 0 23225 0 27393 0 0 0 1225 0 358763 0 5767 0 Mario Capuzzi MD 249132 0 70610 0 0 0 0 0 6552 0 326294 0 0 0 David Giuffrida 216025 0 40000 0 2958 0 62000 0 0 0 320983 0 0 0 David Consentino MD 253378 0 64922 0 243 0 0 0 5147 0 323690 0 66224 0 Robert Grillo MD 258840 0 33610 0 19781 0 0 0 5525 0 317756 0 0 0 Vincent Capece Jr 564719 0 176500 0 15998 0 354750 0 7647 0 1119614 0 334028 0 David Baggish MD 322215 0 8554 0 243 0 0 0 5037 0 336049 0 0 0 SUPPLEMENTAL COMPENSATION INFORMATION BENEFITS SCHEDULE J, PART I, LINE 1A FIRST CLASS TRAVEL - THE HOSPITAL'S POLICY AUTHORIZES FIRST CLASS TRAVEL FOR THE CHIEF EXECUTIVE OFFICER ON TRIPS EXCEEDING FOUR HOURS IN DURATION. NONE WAS USED DURING THE REPORTING PERIOD. TRAVEL FOR COMPANIONS - THE HOSPITAL'S POLICY PROVIDES FOR SPOUSAL OR "SIGNIFICANT OTHER" TRAVEL IN CERTAIN INSTANCES RELATED TO BUSINESS ACTIVITIES AND PRESCRIBES THE PROPER TAX TREATMENT OF THAT BENEFIT. THIS BENEFIT WAS TREATED AS TAXABLE COMPENSATION. SOCIAL CLUB DUES - REPRESENTS A CORPORATE MEMBERSHIP AT A GOLF CLUB USED FOR VARIOUS BUSINESS PURPOSES. TO THE EXTENT THIS MEMBERSHIP IS USED FOR PERSONAL REASONS THE ASSOCIATED COST IS INCLUDED IN THE TAXABLE INCOME OF THE EXECUTIVE STAFF MEMBER ACCORDING TO IRS RULES AND REGULATIONS. THIS BENEFIT WAS TREATED AS TAXABLE COMPENSATION. PERSONAL SERVICES - REPRESENTS TAX PLANNING AND/OR TAX PREPARATION FEES FOR TWO (2) MEMBERS OF THE EXECUTIVE STAFF. THIS BENEFIT WAS TREATED AS TAXABLE COMPENSATION. SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B NONQUALIFIED RETIREMENT BENEFITS ARE PROVIDED AS PART OF A COMPETITIVE TOTAL COMPENSATION PROGRAM AND TO ENCOURAGE RETENTION OF KEY EXECUTIVES. THE NONQUALIFIED RETIREMENT PLAN BENEFIT ACCRUES ANNUALLY AND THE PLAN PROVIDES THAT A PARTICIPANT VESTS AFTER THREE (3) YEARS OF SERVICE. THE AMOUNT OF THE VESTED BENEFITS IS CONSIDERED "INCOME" TO THE EXECUTIVE'S W-2 FORM AND IS TAXABLE. CERTAIN EXECUTIVES ALSO PARTICIPATE IN A FORMER PLAN, WHERE ACCRUALS CEASED IN 2010 AND THE VESTED BENEFITS WILL BE DISTRIBUTED ON TERMINATION OF EMPLOYMENT. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NONQUALIFIED RETIREMENT PLAN. THE AMOUNTS REPORTED BELOW REPRESENT BENEFITS ACCRUED DURING CALENDAR YEAR 2012, NOT PAYABLE UNTIL RETIREMENT. SUSAN MARTIN $890,245 ARTHUR MCDOWELL, MD $118,818 GREGORY NOKES $70,486 HARRY EVERT $27,700 THE FOLLOWING PARTICIPANTS HAD FUNDS CONTRIBUTED TO THEIR SERP ACCOUNT IN 2012: ARTHUR MCDOWELL, MD $155,720 DAVID GIUFFRIDA $22,000 GREGORY NOKES $84,300 VINCENT CAPECE $171,750 SUSAN MARTIN $13,440 GARY HAVICAN $20,000 JESSE WAGNER, MD $34,000 JACQUELYN CALAMARI $21,200 COMPENSATION CONTINGENT ON NET REVENUE SCHEDULE J, PART I, LINE 6A THERE ARE FOUR (4) BROAD CATEGORIES OF EXECUTIVE INCENTIVE GOALS: CLINICAL QUALITY AND PATIENT SATISFACTION (40%), FINANCIAL STRENGTH (30%), WORKPLACE ENVIRONMENT (20%), AND COMMUNITY BENEFIT/CHARITABLE MISSION EFFECTIVENESS (10%). WITHIN EACH CATEGORY ARE MORE SPECIFIC GOALS WHICH ARE DETERMINED FROM OUR OWN PAST EXPERIENCE AS WELL AS STATE AND NATIONAL BENCHMARK DATA. THE INCENTIVE COMPENSATION OF THE EXECUTIVE STAFF IS DETERMINED WITH REFERENCE TO PERFORMANCE RELATIVE TO THESE GOALS. BONUS & INCENTIVE COMPENSATION - COLUMN B(II) SCHEDULE J, PART II THE AMOUNTS REPRESENT INCENTIVE COMPENSATION PAYMENTS MADE IN CALENDAR YEAR 2012. PAYMENTS INCLUDE AMOUNTS EARNED IN 2011 AND DEFERRED, WHERE APPLICABLE. A STATE OF CT HEALTH & EDUCATIONAL FACILITIES AUTH 060806186 20774UGQ2 2006-12-07 23613507 CONSTRUCTION OF NEW EMERGENCY ROOM false false false B STATE OF CT HEALTH & EDUCATIONAL FACILITIES AUTH 060806186 20774UGR0 2006-12-07 16620000 REFINANCE 11/15/2002 (SERIES K) false false false C STATE OF CT HEALTH & EDUCATIONAL FACILITIES AUTH 060806186 20774YAW7 2011-07-26 33803383 REFINANCE 10/9/1997 (SERIES H) false false false A 2250000 0 24649762 1625617 0 0 392822 720290 0 21821549 89483 0 2008 false false true true B 3890000 0 16775130 1219669 0 0 256847 429253 0 14869361 0 0 2007 true false true true C 3775000 0 33803651 0 0 0 537961 0 0 33265690 0 0 2011 true false true true A false false false false 0 B 0 C 0 A false false false 0 false 0 false B false false false 0 false 0 false C false false false 0 false 0 false A true B true C true TOTAL PROCEEDS OF ISSUE SCHEDULE K, PART II, LINE 3 (ALL BONDS): THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS IS INTEREST IN THE AMOUNT OF: $1,036,255 FOR COLUMN A BOND, $155,130 FOR COLUMN B BOND AND $268 FOR COLUMN C BOND. ISSUANCE COSTS FROM PROCEEDS SCHEDULE K, PART II, LINE 7 (COLUMN C BOND): THIS AMOUNT WILL NOT TIE TO 8038 DUE TO ALLOCATION TO OBLIGATED GROUP. Anne Calamari-LCSW Coordinator Family member-J. Calamari 63312 Receipt of wages/compensation false Steve McDowell-Purchasing Manager Family member-A. McDowell 100027 Receipt of wages/compensation false Victoria McDowell-Registered Nurse Family member-A. McDowell 71666 Receipt of wages/compensation false Essex Financial Services John W. Rafal/Director 626850 Entity more than 35% owned false BUSINESS TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV ANNE CALAMARI, LCSW COORDINATOR, IS THE DAUGHTER OF JACQUELYN CALAMARI, VP NURSING. ANNE CALAMARI'S WAGES FOR 10/01/12 TO 09/30/13 TOTALED $63,312. STEVE MCDOWELL, PURCHASING MANAGER, IS THE BROTHER OF ARTHUR MCDOWELL, VICE PRESIDENT OF CLINICAL AFFAIRS. STEVE MCDOWELL'S WAGES FOR 10/01/12 TO 09/30/13 TOTALED $100,027. VICTORIA MCDOWELL, REGISTERED NURSE, IS THE SISTER-IN-LAW OF ARTHUR MCDOWELL, VICE PRESIDENT OF CLINICAL AFFAIRS. VICTORIA MCDOWELL'S WAGES FOR 10/01/12 TO 09/30/13 TOTALED $71,666. JOHN W. RAFAL, DIRECTOR, IS 40% OWNER OF ESSEX FINANCIAL SERVICES. DURING THE REPORTING PERIOD, $626,850 OF MIDDLESEX HOSPITAL EMPLOYER CONTRIBUTIONS WERE TRANSFERRED TO ESSEX FINANCIAL SERVICES FOR MANAGEMENT IN 403(B) PLANS. X 8 557840 SELLING PRICE false true true USE OF THIRD PARTIES TO SELL NONCASH CONTRIBUTIONS SCHEDULE M, PART I, LINE 32B DONORS OF STOCK ARE INSTRUCTED TO TRANSFER TO MERRILL LYNCH, IN WHICH MERRILL LYNCH IS INSTRUCTED TO SELL STOCK IMMEDIATELY. PROGRAM SERVICES PROGRAM SERVICE #1, INPATIENT CARE FORM 990, PART III, LINE 4A INPATIENT CARE FROM REGISTRATION THROUGH DISCHARGE IS CAREFULLY MANAGED TO EXCEED REGULATORY REQUIREMENTS AND ENSURE QUALITY, PATIENT SATISFACTION, AND BEST PRACTICE WITH EACH ASPECT OF THE INPATIENT EXPERIENCE, INCLUDING ALL ELEMENTS OF CARE FROM NURSING COMPETENCY AND COMPASSION, TO MEAL QUALITY, LAB AND DIAGNOSTIC TESTING, SAFE AND SECURE PHYSICAL SURROUNDINGS TO PATIENT EDUCATION. MIDDLESEX HOSPITAL, LICENSED FOR 275 BEDS AND 22 BASSINETS, PROVIDES ACUTE CARE FROM DEDICATED HEALTH CARE TEAMS WHICH INCLUDE SURGEONS, HOSPITALISTS, FAMILY PRACTITIONERS AND RESIDENTS, MEDICAL STAFF PHYSICIANS, MAGNET NURSES, PHYSICIAN ASSISTANTS, PATIENT CARE TECHNOLOGISTS, DIAGNOSTIC TECHNICIANS, PATHOLOGISTS, ADMINISTRATORS, ENVIRONMENTAL SERVICES, SECURITY, ENGINEERING AND A HOST OF OTHERS WORKING TOGETHER TO ENABLE THE ORGANIZATION'S SUCCESS. THE HOSPITAL UNITS INCLUDING INTENSIVE AND CRITICAL CARE, MEDICAL SURGICAL, ONCOLOGY, ORTHOPEDIC, PULMONOLOGY, VASCULAR AND CARDIOLOGY, GASTROINTESTINAL, MATERNITY, A 20 BED PSYCHIATRIC FLOOR, AND HOSPICE SERVICES SPECIALIZE IN THE SPECIFIC NEEDS OF THEIR PATIENTS AND ARE STAFFED TO ACCOMMODATE THE UNIQUE TREATMENT REQUIREMENTS OF EACH. ALL ANCILLARY SERVICES INCLUDING LABS, RADIOLOGY, FOOD SERVICES, PATHOLOGY, PHARMACY, MEDICAL TRANSCRIPTION AND INFORMATION SERVICES TOO ARE A PART OF THE HOSPITAL TEAM. PATIENT CARE IS DEVELOPED WITH FULL CONSIDERATION OF THE WHOLE INDIVIDUAL, AS THEY ARE ASSIGNED TO CONDITION SPECIFIC CARE PATHWAYS AND SERVICES TO SECURE BEST TREATMENT AND RECOVERY. PROGRAM SERVICE #2, MIDDLESEX HOSPITAL EMERGENCY DEPARTMENT FORM 990, PART III, LINE 4B EMERGENCY CARE IS PROVIDED 24 HOURS A DAY, 7 DAYS A WEEK. THE DEPARTMENTS ARE SUPPORTED BY A BROAD SPECTRUM OF DIAGNOSTIC CAPABILITIES AND SOPHISTICATED INFORMATION SYSTEMS. IN ADDITION TO EMERGENCY CARE THERE ARE ALSO ISOLATION AND DECONTAMINATION AREAS IN THE EMERGENCY DEPARTMENT AND A HELIPAD ON SITE FOR LIFE STAR MEDICAL HELICOPTER TRANSPORTS. MIDDLESEX HOSPITAL IS COMMITTED TO PROVIDING THE HIGHEST STANDARD OF CARE FOR BOTH THE PHYSICAL AND BEHAVIORAL HEALTH NEEDS OF OUR PSYCHIATRIC PATIENTS. THE EMERGENCY DEPARTMENT AT THE HOSPITAL HOUSES AN EIGHT BED EMERGENCY DEPARTMENT CRISIS UNIT. TREATMENT IS PROVIDED REGARDLESS OF THE PATIENT'S BACKGROUND OR STATUS. ED SERVICES ARE STAFFED WITH CLINICAL PERSONNEL SPECIFICALLY TRAINED TO CARE FOR THE UNIQUE NEEDS OF THEIR PATIENTS (PSYCHIATRISTS, STAFF NURSES, PATIENT CARE TECHNICIANS/MENTAL HEALTH WORKERS, SECRETARIES, NURSE EDUCATOR, SOCIAL WORKERS, COTAS, OT AND OTHERS). TOGETHER THE STAFF PARTNERS WITH HOSPITAL STAFF AND COMMUNITY RESOURCES TO DEVELOP THE BEST CARE PLAN FOR PATIENTS THROUGHOUT THEIR STAY IN THE HOSPITAL AND UPON DISCHARGE. IN FYE 13, THE EMERGENCY ROOM ACTIVITY ACCOUNTED FOR 81,193 EMERGENCY DEPARTMENT VISITS. DEMAND CONTINUES TO RISE AND THE SERVICES PROVIDED CONTINUE TO BE RECOGNIZED FOR CONTINUOUS PATIENT SATISFACTION IN PARTICULAR AS A RECIPIENT OF THE PRESS GANEY SUMMIT AWARD FOR ACHIEVING A 99% CUSTOMER SATISFACTION RATING FOR THREE CONSECUTIVE YEARS. PROGRAM SERVICE #3, AMBULATORY OR OUTPATIENT SURGERY FORM 990, PART III, LINE 4C AMBULATORY OR OUTPATIENT SURGERY IS PERFORMED AT MIDDLESEX HOSPITAL AND THE MIDDLESEX OUTPATIENT CENTER. OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D OTHER SERVICES INCORPORATE A WIDE RANGE OF CARE PROVIDED TO PATIENTS THAT ARE NOT SPECIFICALLY CAPTURED IN THE OTHER CARE CATEGORIES. THIS DESIGNATION ACCOUNTS FOR 498,611 VISITS. THESE SERVICES INCLUDE CARE PROVIDED AT THE CANCER CENTER SUCH AS DIAGNOSTIC TESTING, TREATMENT AND SUCH SUPPORTS AS ALTERNATIVE MEDICINE THERAPIES/INTEGRATIVE MEDICINES, AND HEREDITARY RISK ASSESSMENTS. PHYSICAL MEDICINE AND REHABILITATION SERVICES ALSO ARE FOLDED INTO THIS GROUPING. SERVICES ARE AVAILABLE AT MULTIPLE LOCATIONS WHICH OFFER COMPREHENSIVE REHABILITATION AND OCCUPATIONAL MEDICINE AND PHYSICAL THERAPY (INCLUDING HAND THERAPY) SERVICES. CARE IS DELIVERED BY EXPERIENCED, HIGHLY-QUALIFIED STAFF, WITH ADVANCED TRAINING IN PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH LANGUAGE PATHOLOGY AND RELATED FIELDS. IN EACH CLINICAL CASE, PATIENTS ARE EVALUATED AND RECEIVE A UNIQUE TREATMENT PLAN, WHICH INCLUDES DESIRED GOALS, ANTICIPATED OUTCOMES AND THE TIME FRAME NECESSARY TO ACHIEVE CLINICALLY OPTIMAL RESULTS. ADDITIONAL SERVICES ARE AVAILABLE BY THE WOUND AND SKIN TEAM AT MIDDLESEX HOSPITAL. THE MULTIDISCIPLINARY TEAM PROVIDES TREATMENT WHICH FOCUSES ON CLINICAL WOUND, OSTOMY AND SKIN ISSUES. THE HOSPITAL HAS CAREFUL AND ONGOING SERVICES FOR INDIVIDUALS WITH CHRONIC DISEASES. A SAMPLING OF SUCH PROGRAMS INCLUDE PULMONARY REHABILITATION SERVICES WHICH PROVIDE RESPIRATORY THERAPY AND CARE FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AS WELL AS DIABETES EDUCATION AND MEDICAL NUTRITION THERAPY AT THE CENTER FOR CHRONIC CARE MANAGEMENT PROVIDED TO INDIVIDUALS WITH A NEW DIAGNOSIS AND UNCONTROLLED DIABETES. MANY BEHAVIORAL HEALTH SERVICES ARE PROVIDED TO PATIENTS IN THE OUTPATIENT SETTING IN ADDITION TO COUNSELING AND SUPPORT GROUPS. PROGRAMS INCLUDE THE DAY TREATMENT PROGRAM (INTENSIVE OUTPATIENT SERVICES FOR ADULTS, GERIATRIC PATIENTS, AND DUALLY-DIAGNOSED PATIENTS), SERVICES AT THE OUTPATIENT CENTER FOR BEHAVIORAL HEALTH (PSYCHOTHERAPY AND MEDICATION MANAGEMENT FOR ADULTS) AND THE FAMILY ADVOCACY PROGRAM (MENTAL HEALTH TREATMENT FOR PATIENTS UNDER 18 YEARS OLD AND THEIR FAMILIES). THE HOSPITAL'S HOMECARE DEPARTMENT MAKES OVER 98,000 REVENUE GENERATING VISITS A YEAR TO COMMUNITY RESIDENTS. HOMECARE IS STAFFED WITH SPECIALTY NURSES, HOME HEALTH AIDES, PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS, SPEECH THERAPISTS, MEDICAL SOCIAL WORKERS AND NUTRITIONISTS TO MEET THE PHYSICAL AND BEHAVIORAL HEALTH NEEDS OF PATIENTS CARED FOR IN THEIR HOMES AND OUTSIDE THE HOSPITAL SETTING. HOMECARE SERVICES INCLUDE: SPECIALIZED CARDIAC CARE; INCLUDING TELE MONITORING AND THE HEART SMART PROGRAM (A MULTIDISCIPLINARY PROGRAM WHICH INCLUDES THE FULL SPECTRUM CARDIAC SELF MANAGEMENT SUPPORT AND CLINICAL CARE), FULL SPECTRUM GERIATRIC CARE, INFUSION THERAPIES, LIFELINE SERVICES, AND A SIGNIFICANT RANGE OF RESPIRATORY, PULMONARY AND MEDICAL REHABILITATION SERVICES AS WELL AS PROVIDING OUTPATIENT HOSPICE AND PALLIATIVE SERVICES THROUGHOUT THE COMMUNITY. THE HOMECARE DEPARTMENT GENEROUSLY PROVIDES COMMUNITY HEALTH SERVICES INCLUDING FLU SHOTS, HEALTH FAIRS, AND COORDINATION OF LINKAGES WITH MEALS ON WHEELS, TRANSPORTATION, ADULT DAY CARE AND OTHER SERVICES ON CONTRACT WITH LOCAL ORGANIZATIONS. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B THE SOLE MEMBER OF THE HOSPITAL SHALL BE MIDDLESEX HEALTH SYSTEM, INC., A CONNECTICUT NON-STOCK CORPORATION, OR ITS SUCCESSOR IN INTEREST ("SOLE MEMBER"), WHICH SHALL HAVE ALL OF THE MEMBERSHIP RIGHTS CONFERRED BY LAW, THE CERTIFICATE OF INCORPORATION OR THE MIDDLESEX HOSPITAL BY-LAWS, BY VOTE OF ITS BOARD OF DIRECTORS, ITS PRESIDENT, OR BY OR THROUGH ANY OTHER PERSON(S) DESIGNATED BY ITS BOARD OF DIRECTORS ON ITS BEHALF. ANY SUCH ACTION MAY ALSO BE TAKEN WITHOUT A MEMBERSHIP MEETING IF CONSENT THERETO IS CONFIRMED THROUGH A WRITTEN COMMUNICATION OF A DULY AUTHORIZED REPRESENTATIVE OF THE SOLE MEMBER ACTING WITHIN THE LIMITS OF SUCH REPRESENTATIVE'S AUTHORITY. ANY SUCH ACTION BY THE SOLE MEMBER OR ITS DULY AUTHORIZED REPRESENTATIVE SHALL BE FILED WITH THE SECRETARY OF THE HOSPITAL. THE ANNUAL ELECTION OF THE BOARD OF DIRECTORS OF THE HOSPITAL BY THE DULY AUTHORIZED REPRESENTATIVE OF THE SOLE MEMBER SHALL BE DEEMED THE ANNUAL MEETING OF THE MEMBERSHIP OF THE HOSPITAL FOR ALL PURPOSES. THE SECRETARY OF THE HOSPITAL SHALL PROVIDE APPROPRIATE NOTICES TO THE SOLE MEMBER AS REQUIRED BY LAW IN ADVANCE OF ACTIONS BEING REQUESTED OF THE SOLE MEMBER BY THE BOARD OF DIRECTORS OF THE HOSPITAL. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11A DRAFT FORMS OF THE 990, INCLUDING REQUIRED SCHEDULES, ARE PROVIDED TO EACH BOARD MEMBER FOR REVIEW. MEMBERS REVIEW THE DOCUMENTS, HIGHLIGHT ANY SIGNIFICANT CHANGES AND ATTEST THEIR APPROVAL. ANY QUESTIONS OR COMMENTS ARE PRESENTED TO EXECUTIVE MANAGEMENT PRIOR TO FILING. A COPY OF THE FINAL FORM 990 WILL BE PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS VIA A WEB BASED COMMUNICATION PORTAL. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST FORMS ARE DISTRIBUTED ANNUALLY TO KEY EMPLOYEES, OFFICERS AND THE BOARD OF DIRECTORS. RESPONSES ARE RETURNED TO, TRACKED, AND REVIEWED BY THE COMPLIANCE OFFICER. INFORMATION REPORTED IS CONSIDERED PERSONAL AND CONFIDENTIAL AND ONLY DISCLOSED WHEN DEEMED NECESSARY TO PROTECT THE HOSPITAL AGAINST THE EFFECTS OF CONFLICTS OF INTEREST AND ONLY AFTER ADVISING THE REPORTING PERSON OF THE PROPOSED DISCLOSURE AND OF ITS EXTENT. MATERIAL CONFLICTS ARE REPORTED TO THE BOARDS AUDIT COMMITTEE FOR REVIEW AND DETERMINATION. IN ADDITION TO COMPLETING THE ANNUAL CONFLICT OF INTEREST FORM, BOARD MEMBERS MUST IMMEDIATELY DISCLOSE ANY INTEREST AND ALL MATERIAL FACTS TO THE BOARD OF DIRECTORS. THE BOARD THEN REVIEWS THE FACTS AND MAKES THE DETERMINATION AS TO WHETHER A SIGNIFICANT CONFLICT OF INTEREST EXISTS. IF SO, THE BOARD FOLLOWS DISABLING GUIDELINES TO DETERMINE IF THE BOARD MEMBER SHOULD BE ASKED TO RESIGN OR BE REMOVED. COMPENSATION POLICY FORM 990, PART VI, SECTION B, LINES 15A & 15B EXECUTIVE TEAM COMPENSATION IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. THE COMMITTEE HAS A CHARTER AND A POLICY STATEMENT SETTING FORTH A PROCESS AND CERTAIN GUIDELINES FOR DETERMINING COMPENSATION. EXECUTIVES RECEIVE A BASE SALARY AND HAVE THE OPPORTUNITY FOR INCENTIVE COMPENSATION WITHIN A RANGE SET BY THE POLICY. FOLLOWING THE CLOSE OF EACH FISCAL YEAR, THE COMMITTEE RECEIVES A MARKET ANALYSIS FROM INDEPENDENT CONSULTANTS REGARDING COMPENSATION AT PEER GROUPS OF COMPARABLE HOSPITALS AND HEALTH SYSTEMS. POSITIONS WITHIN THE EXECUTIVE TEAM ARE COMPARED TO BENCHMARK POSITIONS WITHIN THIS MARKET DATA AND THEIR COMPENSATION IS COMPARED TO THE DATA BOTH WITH RESPECT TO CASH COMPENSATION AND TOTAL COMPENSATION INCLUDING FRINGE BENEFITS. THE CEO RECOMMENDS THE INCENTIVE AWARDS AND BASE SALARY ADJUSTMENTS TO THE COMPENSATION OF THE EXECUTIVES WHO REPORT TO HIM, AND THE COMMITTEE REVIEWS THOSE RECOMMENDATIONS, APPROVES OR MODIFIES THEM, AND ALSO DETERMINES ANY INCENTIVE AWARD AND BASE SALARY ADJUSTMENT FOR THE CEO. THE CONSULTANTS PROVIDE A WRITTEN OPINION ANNUALLY CONFIRMING THAT THE COMPENSATION OF THE EXECUTIVES, AS ADJUSTED BY THIS PROCESS, IS "REASONABLE" WITHIN APPLICABLE IRS GUIDELINES. KEY EMPLOYEE COMPENSATION IS SET FOLLOWING THE GUIDELINES SET FORTH IN THE HOSPITAL COMPENSATION POLICY. THE OBJECTIVE OF THIS POLICY IS TO PAY EMPLOYEES BASED UPON HOSPITAL NEED, THE PROPER EXTERNAL LABOR MARKET AND PERFORMANCE. PUBLIC DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 MIDDLESEX HOSPITAL MAINTAINS A QUALITY AND COMPLIANCE SECTION ON ITS WEBSITE, MIDDLESEXHOSPITAL.ORG. THE HOSPITAL POSTS THE MOST CURRENT AUDITED FINANCIAL STATEMENTS THERE AS THEY BECOME AVAILABLE, AS WELL AS STATEMENTS FROM AT LEAST TWO PREVIOUS FISCAL YEARS. THE HOSPITAL'S CONFLICT OF INTEREST POLICY IS ALSO POSTED ON THE WEBSITE IN THE VENDORS AND SUPPLIERS SECTION. IN ADDITION, THE ORGANIZATION'S FORM 990 IS AVAILABLE AT WWW.GUIDESTAR.ORG AND UPON REQUEST. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 CHANGE IN ACCUMULATED PENSION CHARGES $74,406,000 EXPENDITURES FOR INTENDED PURPOSES (814,000) ROUNDING 38 TOTAL $73,592,038 MIDDLESEX HEALTH SYSTEM INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676137 SUPPORT CT 501(c)(3) 11, Type II NA false MIDDLESEX HEALTH SERVICES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676140 ASST. LIVING CT 501(c)(3) 9 MSX HLTH SYS true MIDDLESEX HOSPITAL FOUNDATION 28 CRESCENT STREET MIDDLETOWN CT 06457 273720822 SUPPORT CT 501(c)(3) 11, Type II MSX HOSP true MIDDLESEX HEALTH RESOURCES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061089925 HEALTHCARE CT MSX HEALTH SYS C Corp INTEGRATED RESOURCES FOR THE MIDDLESEX 28 CRESCENT STREET MIDDLETOWN CT 06457 061462230 OUTPATIENT CARE CT MSX HEALTH SYS C Corp MHS PRIMARY CARE INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061472743 HEALTHCARE CT MSX HEALTH SYS C Corp false true false true false false false false false false true false false false true true true false false Middlesex Health System Inc b 2999000 Middlesex Health Resources Inc k 507536 Middlesex Health Services Inc o 136203 Middlesex Health Services Inc d 4905000 Middlesex Health Services Inc q 2254245 MHS Primary Care Inc q 2332000 Middlesex Health System Inc p 976340