2013-08-11T09:26:45-05:00 2012-09-30 061533253 SASLOW LUFKIN & BUGGY LLP TEN TOWER LANE AVON CT 06001 990 2011-10-01 060647014 GRIFFIN HOSPITAL GRIF 2037327528 130 DIVISION STREET DERBY CT 06418 PATRICK S CHARMEL 2037327528 2013-08-08 1 BETH THURZ P00346435 8606789200 2011 2016-02-24 21:20:13Z PATRICK S CHARMEL 130 DIVISION STREET DERBY CT 06418 129508601 0 X GRIFFINHEALTH.ORG X 1908 CT GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT. 22 18 1531 486 3663683 -1442351 2414954 2234902 127604535 126387570 456315 464000 421266 422129 130897070 129508601 0 0 0 0 70585160 72639965 0 0 0 60252685 61258997 130837845 133898962 59225 -4390361 122634410 129920217 157297042 159955862 -34662632 -30035645 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 116126636 109680301 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. 3754826 8911560 PROVIDE CANCER RELATED RADIOLOGY SERVICES TO THE COMMUNITY. 2018059 2791088 PROVIDE PSYCHIATRIC SERVICES TO THE COMMUNITY ON AN OUTPATIENT BASIS. 483799 1340938 PROVIDE HOSPICE SERVICES TO THE COMMUNITY. 483799 1340938 122383320 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 1 0 1 183 0 1 1531 1 1 1 0 0 0 0 0 0 0 0 0 X 22 18 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 1.00 X 0 0 0 CHARMEL PATRICK 40.00 X X 413379 0 58191 BORIS GREGORY 1.00 X 0 0 0 DOBULER KENNETH 14.00 X 226511 0 47152 SCHWARTZ KENNETH 16.00 X 190532 0 67325 STUMPO BARBARA J 40.00 X X 169709 0 40922 ANDREANA JOSEPH 1.00 X 0 0 0 BALDYGA KENNETH 1.00 X 0 0 0 BETKOSKI JOHN W III 1.00 X X 0 0 0 DINARDO NANCY 1.00 X 0 0 0 FOX ROBERT A 1.00 X 0 0 0 JONES JEAN CRUM 1.00 X 0 0 0 KLARIDES THEMIS 1.00 X 0 0 0 LOGAN GEORGE S 1.00 X 0 0 0 OSAK FRANK M 1.00 X 0 0 0 MEZZO ROBERT 1.00 X 0 0 0 REISS ROBERT G 1.00 X 0 0 0 WEINER GERALD T 1.00 X 0 0 0 ZAPRZALKA JOHN J 1.00 X 0 0 0 SACZYNSKI SHELLY 1.00 X 0 0 0 BINGAMAN LARRY 1.00 X 0 0 0 PEARSON WM NEIL 1.00 X 0 0 0 MOYLAN JAMES J 40.00 X 249920 0 39027 POWANDA WILLIAM 40.00 X 181708 0 48142 BERNS EDWARD 40.00 X 152735 0 36514 MARTIN KATHLEEN 40.00 X 149614 0 37662 DEEGAN MARGARET 40.00 X 204758 0 31516 SHEPARD SETH 40.00 X 183468 0 21483 FRAMPTON SUSAN 40.00 X 0 274324 28232 D'SOUSA SEEMA 30.00 X 179424 0 21635 HALSTEAD EDWARD 40.00 X 199780 0 68082 NAWAZ HAQ 40.00 X 240796 0 27500 SALABARRIA JAVIER 40.00 X 266555 0 21604 HURIBAL MARSEL 40.00 X 175011 0 0 3183900 274324 594987 76 0 1 0 UNIDINE CORPORATION 75 REMITTANCE DRIVE CHICAGO IL 60675 FOOD SERVICE 1478271 F & F MECHANICAL ENTERPRISES 2 DWIGHT STREET NORTH HAVEN CT 06473 CONSTRUCTION 418396 CONNECTICUT EMERGENCY MEDICINE SPECIALIS PO BOX 271618 WEST HARTFORD CT 06127 E.R. PHYSICIAN SERVICES 411762 CARDIOLOGY ASSOC OF DERBY 130 DIVISION STREET DERBY CT 06418 PHYSICIAN SERVICES 399621 NEW MILFORD LAUNDRY 47 COMMONS COURT WATERBURY CT 06704 LAUNDRY SERVICE 384115 20 1908138 326764 2234902 PATIENT REVENUE 621500 121066315 117402632 3663683 OTHER PROGRAM SERVICES 621500 5321255 5321255 126387570 351715 351715 422129 0 422129 422129 422129 112285 0 112285 112285 112285 129508601 122723887 3663683 886129 3183757 2101280 1082477 49478334 44530501 4947833 5288072 4759265 528807 10586624 9527962 1058662 4103178 3692860 410318 6491127 5842014 649113 237404 237404 255252 255252 10081414 9073273 1008141 478606 478606 358359 322523 35836 427133 427133 313890 313890 348787 348787 5233260 5233260 5913219 5913219 945756 851180 94576 MEDICAL & DRUG SUPPLIES 15930763 15930763 RESEARCH GRANT EXPENSES 2259698 2033728 225970 FOOD 1186176 1186176 BAD DEBT 985616 985616 9812537 8831284 981253 133898962 122383320 11515642 0 5513612 8071213 17025431 12754987 794648 852072 1810064 2258893 148245027 88278309 62082187 59966718 8656773 6519819 14181684 15213004 12570011 24283511 122634410 129920217 26635850 28300556 33048 40179 53037112 51432599 77591032 80182528 157297042 159955862 X -42070163 -38049002 1880150 2203003 5527381 5810354 -34662632 -30035645 122634410 129920217 X -4390361 9017348 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 0 0 0 0 0 0 1 11700 11700 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE GRIFFIN HOSPITAL PAID FOR MEMBERSHIP DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION FOR THE FISCAL YEAR ENDED 9/30/2012. $11,699.62 OF THE MEMBERSHIP DUES PAID WAS USED FOR LOBBYING ON ISSUES RELEVANT TO THE ORGANIZATION'S EXEMPT PURPOSE. 2932333 322207 5000 3249540 2953261 -1478 19450 2932333 2773278 124305 1337 2896246 2677652 97031 1405 2773278 0.66500 0.33500 1 0 4015091 4015091 72926054 34898661 38027393 70963696 53127705 17835991 340186 251943 88243 59966718 FIXED INCOME SECURITIES 3611174 F MARKETABLE EQUITY SECURITIES 2908645 F 6519819 LIMITED USE ASSETS - CURRENT 700398 F BOARD DESIGNATED INVESTMENTS 10001 F BENEFICIAL INTEREST IN TRUSTS 3650093 F UNDER INDENTURE AGREEMENT 4288627 F INVESTMENTS OF NET ASSETS OF AFFILIATES 6563885 C 15213004 OTHER RECEIVABLES 2405920 DUE FROM AFFILIATES 7998375 OTHER ASSETS & INSURANCE RECOVERABLE 12635039 THIRD PARTY 1203411 DEFERRED REVENUE 40766 24283511 ACCRUED POST RETIREMENT - CURRENT 435000 ACCRUED POST RETIREMENT - NONCURRENT 8484801 PROFESSIONAL AND GENERAL LIABILITY 876637 MINIMUM PENSION LIABILITY 42429930 WORKERS COMPENSATION - LONG TERM 2108091 ACCRUED INTEREST PAYABLE 347111 OTHER LIABILITIES 22138767 RETIREMENT OBLIGATION 119709 CAPITAL LEASE - NET OF CURRENT 1299057 L.T. - CURRENT PORTION 1943425 80182528 129508601 133898962 -4390361 534665 8482683 9017348 4626987 130043266 534665 534665 129508601 0 129508601 133898962 0 133898962 0 133898962 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THERE IS NO FIN 48 (ASC 740) FOOTNOTE IN THE GRIFFIN HOSPITAL AUDITED FINANCIAL STATEMENTS. PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFERS BETWEEN AFFILIATES -2,731,233. MINIMUM PENSION LIABILITY ADJUSTMENT 10,040,391. CHANGE IN NET ASSETS OF AFFILIATE 567,699. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 322,853. CHANGE IN BENEFICIAL INTEREST IN TRUSTS 282,973. TOTAL TO SCHEDULE D, PART XI, LINE 8: 8,482,683. 1 1 1 X 250.000000000000 1 X 1 1 1 0 1 1 275 2150116 0 2150116 0.01610 10197 10577781 7060403 3517378 0.02630 145 310135 241706 68429 0.00050 10617 13038032 7302109 5735923 0.04290 46175 896911 6830 890081 0.00660 140 5850061 4797952 1052109 0.00790 42141 21661980 20149686 1512294 0.01130 1183995 0 1183995 0.00880 2133 38051 0 38051 0.00030 90589 29630998 24954468 4676530 0.03490 101206 42669030 32256577 10412453 0.07780 2878 34180 34180 0.00030 2878 34180 34180 0.00030 1 312439 41800233 49286120 -7485887 X 1 1 1 1 GRIFFIN HOSPITAL

130 DIVISION STREET DERBY CT 06418

X X X X X X X GRIFFIN HOSPITAL 1 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 1 X X X X X X X X 1 X 0 0 PART I, LINE 3C: N/A PART II: THE DEPARTMENT OF COMMUNITY OUTREACH AND PARISH NURSING HAS PROMOTED THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH ITS COMMUNITY BUILDING ACTIVITIES. GRIFFIN HOSPITAL SPONSORS AND PROVIDES OPERATIONAL LEADERSHIP FOR THE VALLEY PARISH NURSE PROGRAM THROUGH COMMUNITY HEALTH IMPROVEMENT ADVOCACY. THE DEPT. OF COMMUNITY OUTREACH HAS MADE A SUBSTANTIAL IMPACT ON THE GREATER NAUGATUCK VALLEY. COMMUNITY HEALTH IMPROVEMENT ADVOCACY ACTIVITIES COLLABORATE WITH THE COMMUNITY ON VARIOUS OUTREACH NEEDS. SOME EXAMPLES OF THE GROUPS AND BOARDS THAT ARE INVOLVED ARE: BOYS & GIRLS CLUB BOARD, CT COUNCIL OF PARISH NURSE COORDINATORS, VALLEY COUNCIL FOR HEALTH & HUMAN SERVICES, WOMEN MAKING A DIFFERENCE, VITALS, VALLEY UNITED WAY, KOMEN FOUNDATION GRANT EXPLORATION, ANSONIA COMMUNITY ACTION ADVISORY BOARD, BIRTH TO 9, CT HOSPITAL ASSOCIATION, VNA ANNUAL MEETING , NEW HAVEN BUSINESS ASSOCIATION, SPOONER HOUSE FOOD DRIVE, VALLEY SUBSTANCE ABUSE ACTION COUNCIL, AMERICAN HEART ASSOCIATION, ECC/CPR BOARD, COMMUNITY FOUNDATION FOR GREATER NEW HAVEN, CT HOSPITAL ASSOCIATION AND SUB COMMITTEE. PART III, LINE 4: GRIFFIN HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT HAVE A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. BAD DEBT EXPENSE IS REPORTED ON LINE 2 PER GRIFFIN HOSPITAL'S AUDITED FINANCIAL STATEMENTS, NET OF ANY BAD DEBT RECOVERY, MULTIPLIED BY THE COST TO CHARGE RATIO. GRIFFIN HOSPITAL REQUIRES OUR COLLECTION AGENCIES TO FOLLOW THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THEREFORE THE HOSPITAL DID NOT ATTRIBUTE ANY BAD DEBT EXPENSE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART III, LINE 8: GRIFFIN HOSPITAL BELIEVES THAT ALL OF THE $7.486 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 5.9% 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 ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. GRIFFIN HOSPITAL WILL ENSURE THAT PRACTICES TO BE USED BY THEIR OUTSIDE (NON HOSPITAL) 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 HOSPITAL 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 HOSPITAL WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO A COLLECTION AGENCY. PART VI, LINE 2: THE GRIFFIN HOSPITAL IS CURRENTLY DEVELOPING AN ACTION PLAN TO ADDRESS IDENTIFIED NEEDS, WHICH WILL BE COMPLETED, FILED AND PUBLISHED ON THE GRIFFIN HOSPITAL WEB SITE.GRIFFIN HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES IN A VARIETY OF WAYS. THE HOSPITAL USES RESOURCES THAT ARE CONNECTED AND AFFILIATED WITH THE HOSPITAL OR THE COMMUNITY IT SERVES. EXAMPLES OF THESE ARE: COMMUNITY HEALTH PROFILE DONE BY THE YALE-GRIFFIN PRC AT LEAST BI-ANNUALLY THAT TRACKS MORTALITY AND OTHER DATA BY DISEASE, WHICH PROMPTED LAUNCHING OF THE HIM PROJECT TO ADDRESS MALE PROSTATE AND COLON CANCER RATES. VALLEY COUNCIL'S QUALITY OF LIFE REPORT PUBLISHED LAST YEAR FOR THE FIRST TIME (WWW.VALLEYCOUNCIL.ORG). THE INITIATIVE OF THE VALLEY COUNCIL IS DESIGNED TO TRACK KEY INDICATORS OF QUALITY OF LIFE IN THE VALLEY OVER TIME. OUR GOAL IS TO SEE WHAT ASPECTS OF COMMUNITY LIFE HAVE GOTTEN BETTER OVER TIME AND WHAT AREAS MAY NEED IMPROVEMENT. PRODUCTION OF THE VALLEY CARES REPORT WAS MADE POSSIBLE BY GENEROUS GRANTS FROM: THE COMMUNITY FOUNDATION FOR GREATER NEW HAVEN, THE VALLEY COMMUNITY FOUNDATION, THE VALLEY UNITED WAY, AND THE KATHARINE MATTHIES FOUNDATION. ADDITIONAL SUPPORT PROVIDED BY: YALE-GRIFFIN PREVENTION RESEARCH CENTER, NAUGATUCK VALLEY HEALTH DISTRICT, GRIFFIN HOSPITAL, BIRMINGHAM GROUP HEALTH SERVICES, INC., THE WORKPLACE, INC. AND THE MEMBER AGENCIES OF THE VALLEY COUNCIL. CLARITAS - DEMOGRAPHIC PROFILE OF THE HOSPITAL'S PRIMARY SERVICE AREA. COMMUNITY PERCEPTION TELEPHONE SURVEY DONE EVERY TWO OR THREE YEARS OF 400 PRIMARY SERVICE AREA RESIDENTS. VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS WHICH IS A COOPERATIVE VENTURE 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. STRATEGIC PLAN - GREATER VALLEY CHAMBER OF COMMERCE'S HEALTHCARE COUNCIL. THE HEALTHCARE COUNCIL WAS CREATED BASED ON THE PREMISE THAT HEALTH AND WELLNESS ARE INCREASINGLY IMPORTANT ISSUES TO AREA BUSINESSES. FROM PROVIDING INSIGHTS INTO CHRONIC DISEASES TO THE EFFECTS POOR HEALTH HAS ON PRODUCTIVITY AND EMPLOYEE ATTENDANCE, THE COUNCIL IS AN EDUCATIONAL RESOURCE ON HEALTH AND WELLNESS FOR BUSINESSES THROUGHOUT THE GREATER VALLEY REGION. VALLEY UNITED WAY SENIOR NEEDS ASSESSMENT - 2007, VALLEY NEEDS AND OPPORTUNITIES PROJECT - REPORT ON PROGRESS, MOUNT AUBURN ASSOCIATES - 2005, YALE-GRIFFIN PREVENTION RESEARCH CENTER CORPORATE SOCIAL RESPONSIBILITY SECTION OF THE FORTUNE APPLICATION Q.16 GRIFFIN HOSPITAL'S SCHOOL-BASED CHILDHOOD AND ADOLESCENT OBESITY PREVENTION PROJECT, OUR DEPARTMENT OF COMMUNITY OUTREACH AND PARISH NURSING WHICH FOCUSES ON THE UNDERSERVED POPULATIONS. THE PARISH NURSE PROGRAM ITSELF. PART VI, LINE 3: GRIFFIN HOSPITAL SHALL COMMUNICATE TO THE PUBLIC THROUGH APPROPRIATE MEANS REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE TO LOW-INCOME UNINSURED PATIENTS. NOTICES ARE POSTED IN VISIBLE LOCATIONS THROUGHOUT THE HOSPITAL SUCH AS ADMITTING, REGISTRATION, BILLING OFFICE, EMERGENCY DEPARTMENT AND OTHER OUTPATIENT SETTINGS. EVERY POSTED NOTICE REGARDING FINANCIAL ASSISTANCE POLICIES SHALL CONTAIN BRIEF INSTRUCTIONS ON HOW TO APPLY FOR FINANCIAL ASSISTANCE OR A DISCOUNTED PAYMENT. THE NOTICES WILL INCLUDE A CONTACT TELEPHONE NUMBER THAT A PATIENT OR FAMILY MEMBER CAN CALL TO OBTAIN MORE INFORMATION. GRIFFIN HOSPITAL SHALL ENSURE THAT APPROPRIATE STAFF MEMBERS ARE KNOWLEDGEABLE ABOUT THE EXISTENCE OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES. TRAINING WILL BE PROVIDED TO STAFF MEMBERS WHO DIRECTLY INTERACT WITH PATIENTS REGARDING THEIR HOSPITAL BILLS. WHEN COMMUNICATING TO PATIENTS REGARDING THEIR FINANCIAL ASSISTANCE POLICIES GRIFFIN HOSPITAL SHALL ATTEMPT TO DO SO IN THE PRIMARY LANGUAGE OF THE PATIENT OR HIS /HER FAMILY, IF REASONABLY POSSIBLE, AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. GRIFFIN HOSPITAL SHALL SHARE ITS FINANCIAL ASSISTANCE POLICIES WITH APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST SUCH PATIENTS. PART VI, LINE 4: THE COMBINED POPULATION OF GRIFFIN'S SIX TOWN PRIMARY SERVICE AREA (THE VALLEY) IS 107,269. THE SIX SUBURBAN TOWNS THAT MAKE UP THE HOSPITAL'S PRIMARY SERVICE AREA ARE:ANSONIA - POPULATION 19,219, SIZE 6.2 SQ. MILES, BEACON FALLS - POPULATION 6,038, SIZE 9.9 SQ. MILES, DERBY - POPULATION 12,882, SIZE 5.4 SQ. MILES, OXFORD - POPULATION 12,662, SIZE 33 SQ. MILES, SEYMOUR - POPULATION 16,514, 15 SQ. MILES, SHELTON - POPULATION 39,954, SIZE 32 SQ. MILES. THE COMBINED SIZE OF THE SIX TOWN VALLEY REGIONS IS 101.5 SQUARE MILES.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 ABOUT 15 MILES FROM GRIFFIN HOSPITAL. THERE ARE TWO TERTIARY CARE HOSPITALS IN EACH OF THE CITIES AND 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.THE VALLEY'S POPULATION IS PRIMARILY WHITE AT 91.1%. THE BLACK OR AFRICAN AMERICAN POPULATION IS 2.9% AND THE ASIAN POPULATION IS 2.3%. THE HISPANIC OR LATINO POPULATION IS 5.9%. THE AGE 65 AND OVER POPULATION IS 14% COMPARED TO THE STATE OF CONNECTICUT ALSO AT 14% IN 2010. ENGLISH IS THE PRIMARY LANGUAGE SPOKEN IN 86% OF HOMES. THE ESTIMATED AVERAGE FAMILY HOUSEHOLD INCOME FOR VALLEY RESIDENTS IS $95,592 AND THE MEDIAN FAMILY HOUSEHOLD INCOME IS $83,335. IT IS ESTIMATED THAT 1,149 FAMILIES (3.9%) OF VALLEY FAMILIES HAVE INCOMES BELOW THE POVERTY LEVEL. GRIFFIN HOSPITAL IS A NON-PROFIT, 160 BED, 20 BASSINETTE ACUTE CARE HOSPITAL WITH 6,904 DISCHARGES AND 196,386 OUTPATIENT VISITS IN FISCAL YEAR 2012. WITH 1,325 FULL TIME, PART TIME AND PER DIEM EMPLOYEES IT IS THE VALLEY'S LARGEST EMPLOYER WITH EMPLOYEE COMPENSATION AND BENEFITS LAST YEAR TOTALING $72.6 MILLION, SIXTY-ONE PERCENT OF GRIFFIN'S EXPENSE BUDGET OF $120 MILLION. OVER $46 MILLION IS SPENT ON SUPPLIES AND SERVICES MUCH OF WHICH IS TO AREA VENDORS. WITH 70% OF THE HOSPITAL'S EMPLOYEES RESIDING IN THE HOSPITAL PRIMARY SERVICE AREA, GRIFFIN HOSPITAL IS AN ECONOMIC ENGINE FOR THE COMMUNITY IT SERVES. PART VI, LINE 5: GRIFFIN HOSPITAL IS AN ACUTE CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT MEDICAL CARE AND RELATED SERVICES FOR OBSTETRICS, SURGERY AND ACUTE MEDICAL CONDITIONS OR INJURIES USUALLY FOR A SHORT DURATION. GRIFFIN PROVIDES PSYCHIATRIC AND MENTAL HEALTH SERVICES INCLUDING AN INPATIENT UNIT. GRIFFIN OFFERS A NUMBER OF INNOVATIVE PROGRAMS DESIGNED TO PROVIDE ENHANCED COMMUNITY ACCESS TO A BROAD RANGE OF SERVICES AND MEET COMMUNITY NEEDS. THESE INCLUDE: A WOUND TREATMENT CENTER, INTEGRATIVE MEDICINE CENTER, MULTIPLE SCLEROSIS CENTER, PAIN AND HEADACHE TREATMENT CENTER, SLEEP WELLNESS CENTER, JOINT REPLACEMENT CENTER, OCCUPATIONAL MEDICINE CENTER, INPATIENT HOSPICE SERVICE, CENTER FOR CANCER CARE WITH RADIATION THERAPY SERVICE, CENTER FOR BREAST WELLNESS, BARIATRICS SERVICE, MEDI-WEIGHT LOSS SERVICE, GRIFFIN RETAIL PHARMACY, CHEMICAL DEPENDENCY AND ADDICTION SERVICE, ENHANCED EXTERNAL COUNTER PULSATION SERVICE, ANTI-COAGULATION SERVICE AND AN INFUSION CENTER. CONSISTENT WITH GRIFFIN HOSPITAL'S MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY IT SERVES, THE DEPARTMENT OF COMMUNITY OUTREACH AND VALLEY PARISH NURSE (VPN) PROGRAM CONTINUED TO EXTEND THE HOSPITAL'S REACH WELL BEYOND ITS WALLS IN 2012. ACCOUNTING FOR MORE THAN 50,000 COMMUNITY CONTACTS IN 2012, THIS OUTREACH INCLUDED EVERYTHING FROM FITTING BIKE HELMETS TO TRAINING ADULTS AND CHILDREN IN CPR TO PROVIDING HEALTH EDUCATION AND SCREENINGS AT SENIOR CENTERS, SHOPPING CENTERS, NEIGHBORHOODS, COMPANIES, AND COMMUNITY EVENTS AND HEALTH FAIRS. THESE COMMUNITY CONTACTS INCLUDED MORE THAN 8,300 HEALTH SCREENINGS - WHICH CAN HELP IDENTIFY PROBLEMS WHEN THEY ARE MOST TREATABLE - AND NEARLY 22,000 REFERRALS FOR FOLLOW UP CARE. (SOME OF GRIFFIN HOSPITAL'S COMMUNITY BENEFIT ACTIVITIES ARE SUMMARIZED ON THE OUTREACH AND SCREENING STATISTICS PAGE OF THIS REPORT.) AS PART OF THE HOSPITAL'S COMMITMENT TO PROMOTING COMMUNITY HEALTH AND WELLNESS WHILE CLOSING RACIAL, ETHNIC, GENDER, AND SOCIOECONOMIC GAPS IN HEALTH STATUS, GRIFFIN CONTINUED ITS COLLABORATION WITH COMMUNITY PARTNERS ON INITIATIVES SUCH AS THE VALLEY INITIATIVE TO ADVANCE HEALTH & LEARNING IN SCHOOLS AND THE HEALTH INITIATIVE FOR MEN.THE VALLEY INITIATIVE TO ADVANCE HEALTH & LEARNING IN SCHOOLS (VITAHLS), WHICH GRIFFIN LAUNCHED IN PARTNERSHIP WITH VALLEY SCHOOL DISTRICTS AND THE YALE-GRIFFIN PREVENTION RESEARCH CENTER (PRC) IN 2011 CONTINUED ITS EFFORTS TO REDUCE OBESITY AND PROMOTE HEALTH AND ACADEMIC READINESS IN STUDENTS. THE SCHOOL-BASED PROGRAM, WHICH HAS INTRODUCED A VARIETY OF NUTRITION AND PHYSICAL ACTIVITY PROGRAMS TO REDUCE OBESITY AND PROMOTE HEALTH AND ACADEMIC READINESS IN STUDENTS IN PRE-K TO GRADE 12, KICKED OFF ITS SECOND YEAR BY HOSTING A FAMILY FUN DAY ON SUNDAY, OCTOBER 21 AT EMMETT O'BRIEN TECHNICAL HIGH SCHOOL IN ANSONIA. THE FREE EVENT FEATURED A FESTIVAL FEEL WITH MANY BOOTHS FEATURING GAMES, NUTRITIONAL AND FITNESS ACTIVITIES, FREE HEALTHY SNACKS AND A FARMER'S MARKET.OTHER NOTABLE VITAHLS ACTIVITIES INCLUDED THE INTRODUCTION OF THE NUVAL NUTRITIONAL SCORING SYSTEM BY DERBY MIDDLE SCHOOL AND DERBY HIGH SCHOOL. BOTH SCHOOLS' CAFETERIAS AND VENDING MACHINES NOW FEATURE FOOD LABELED WITH A "NUVAL SCORE." A NUMBER BETWEEN 1-100 THAT DETERMINES THE NUTRITIONAL VALUE OF THE FOOD (THE HIGHER THE SCORE, THE BETTER THE OVERALL NUTRITION). NUVAL SCORES CAN NOW BE FOUND ON A LA CARTE ITEMS IN THE CAFETERIAS AND ON FOOD IN ALL VENDING MACHINES, ENCOURAGING STUDENTS TO MAKE MORE INFORMED, AND HEALTHIER, FOOD CHOICES.AS PART OF THE HEALTH INITIATIVE FOR MEN (HIM), THE HOSPITAL ONCE AGAIN TEAMED WITH LOCAL SCHOOLS TO DISTRIBUTE FATHER'S DAY CARDS TO STUDENT'S DADS ENCOURAGING THEM TO "GET TO THE DOCTOR" FOR THEIR ANNUAL CHECK-UPS. MORE THAN 20,000 OF THESE FREE CARDS, WHICH INCLUDED MEN'S HEALTH SCREENING GUIDELINES AND CHECKLISTS, WERE DISTRIBUTED AT AREA SCHOOLS AND AT GRIFFIN HOSPITAL. THE EFFORT WAS MADE POSSIBLE BY THE "HEALTH INITIATIVE FOR MEN FUND," ESTABLISHED BY ANSONIA BUSINESSMAN FRANK MICHAUD AND HIS WIFE, JUDY, TO HELP INSPIRE MEN TO HAVE AN ANNUAL PHYSICAL AND RAISE AWARENESS ABOUT MEN'S HEALTH ISSUES, SUCH AS PROSTATE CANCER AND COLORECTAL CANCER. GRIFFIN ALSO BEGAN OFFERING FREE PROSTATE-SPECIFIC ANTIGEN (PSA) TESTS AND OTHER HEALTH SCREENINGS TO MEN AT VARIOUS COMMUNITY EVENTS. THE GRIFFIN HOSPITAL MINI MED SCHOOL CELEBRATED ITS SEVENTH YEAR IN 2012, GRADUATING MORE THAN 50 STUDENTS FROM ITS FALL SESSION. THE 10-WEEK COURSE WAS TAUGHT BY MEMBERS OF THE GRIFFIN HOSPITAL MEDICAL STAFF WHO VOLUNTEERED THEIR TIME AS FACULTY FOR THE COURSE, EXEMPLIFYING THE HOSPITAL'S COMMITMENT TO HEALTH EDUCATION AND ACCESS TO INFORMATION FOR PATIENTS, THEIR FAMILIES, AND MEMBERS OF THE COMMUNITY.ANOTHER KEY COMPONENT OF THIS COMMITMENT, GRIFFIN'S ONGOING SERIES OF FREE COMMUNITY HEALTH LECTURES, CONTINUED WITH THE INTRODUCTION OF THE "HEALTHY U" TUESDAY TALK SERIES. GRIFFIN EXPERTS PROVIDED HEALTH AND WELLNESS INFORMATION AND ENCOURAGED COMMUNITY RESIDENTS TO TAKE A MORE ACTIVE ROLE IN THEIR HEALTH AND THEIR HEALTHCARE IN A SERIES OF TALKS HELD AT GRIFFIN AND IN VARIOUS COMMUNITY SETTINGS, INCLUDING RESIDENTIAL COMMUNITIES, PUBLIC LIBRARIES, AND SENIOR AND COMMUNITY CENTERS. THE HOSPITAL'S HEALTH RESOURCE CENTER, WHICH IS OPEN SIX DAYS A WEEK AND STAFFED BY PROFESSIONAL LIBRARIANS, PROVIDED SUPPORT FOR ALL OF GRIFFIN'S HEALTH EMPOWERMENT ACTIVITIES, OFFERING RESOURCES AND ASSISTANCE TO PATIENTS, STAFF, AND COMMUNITY MEMBERS. THE CENTER FEATURES A VAST COLLECTION OF CONSUMER HEALTH BOOKS, PERIODICALS, AND VIDEO RESOURCES, AS WELL AS ACCESS TO A NUMBER OF PEER-REVIEWED ELECTRONIC DATABASES. SINCE THE CENTER OPENED IN 1994, MORE THAN 10,000 COMMUNITY MEMBERS HAVE SIGNED UP FOR LIBRARY CARDS THAT ALLOW THEM TO CHECK OUT MATERIALS AS THEY WOULD AT A PUBLIC LIBRARY.THESE ACTIVITIES AND MORE COMPRISED THE MORE THAN $18 MILLION IN COMMUNITY BENEFIT THAT GRIFFIN HOSPITAL CONTRIBUTED TO ITS COMMUNITY. THAT AMOUNT INCLUDED THE PROVISION OF NEARLY $2.8 MILLION IN CHARITY CARE, APPROXIMATELY $12.6 MILLION IN SUBSIDIZED CARE TO PATIENTS COVERED BY MEDICARE, MEDICAID, AND OTHER PUBLIC PROGRAMS, MORE THAN $1 MILLION WORTH OF HEALTH PROFESSIONS EDUCATION TO HELP PREPARE THE NEXT GENERATION OF CAREGIVERS, AND NEARLY $1.9 MILLION WORTH OF OTHER COMMUNITY BENEFIT ACTIVITIES AND HEALTH SERVICES SUBSIDIES. PART VI, LINE 6: N/A REPORTS FILED WITH STATES PART VI, LINE 7 CT X X X 0 0 0 0 0 0 0 0 0 CHARMEL PATRICK 373073 0 39541 0 765 0 43935 0 14256 0 471570 0 0 0 DOBULER KENNETH 226511 0 0 0 0 0 47152 0 0 0 273663 0 0 0 SCHWARTZ KENNETH 166971 0 22796 0 765 0 53069 0 14256 0 257857 0 0 0 STUMPO BARBARA J 152020 0 16948 0 741 0 26666 0 14256 0 210631 0 0 0 MOYLAN JAMES J 219160 0 29995 0 765 0 37047 0 1980 0 288947 0 0 0 POWANDA WILLIAM 163711 0 17664 0 333 0 34858 0 13284 0 229850 0 0 0 BERNS EDWARD 133289 0 18768 0 678 0 22258 0 14256 0 189249 0 0 0 MARTIN KATHLEEN 130520 0 18427 0 667 0 23406 0 14256 0 187276 0 0 0 DEEGAN MARGARET 178696 0 25297 0 765 0 17260 0 14256 0 236274 0 0 0 SHEPARD SETH 160485 0 22232 0 751 0 19503 0 1980 0 204951 0 0 0 FRAMPTON SUSAN 0 235966 0 37803 0 555 0 22234 0 5998 0 302556 0 0 D'SOUSA SEEMA 179079 0 0 0 345 0 7379 0 14256 0 201059 0 0 0 HALSTEAD EDWARD 199015 0 0 0 765 0 53826 0 14256 0 267862 0 0 0 NAWAZ HAQ 240031 0 0 0 765 0 13244 0 14256 0 268296 0 0 0 SALABARRIA JAVIER 265790 0 0 0 765 0 8320 0 13284 0 288159 0 0 0 HURIBAL MARSEL 175011 0 0 0 0 0 0 0 0 0 175011 0 0 0 CHEFA SERIES B 060806186 2005-02-01 24800000 CONSTRUCTION OF NEW WING 0 0 0 CHEFA SERIES C 060806186 2007-05-01 23125000 CONSTRUCTION OF NEW CANCER CENTER & RENOVATION OF EMERGENCY DEPARTMENT 0 0 0 25769812 24573303 435721 760791 1996 1 0 1 1 22982209 1406958 234306 1133492 20207453 2010 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 534,665. TRANSFERS BETWEEN AFFILIATES -2,731,233. MINIMUM PENSION LIABILITY ADJUSTMENT 10,040,391. CHANGE IN NET ASSETS OF AFFILIATE 567,699. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 322,853. CHANGE IN BENEFICIAL INTEREST IN TRUSTS 282,973. TOTAL TO FORM 990, PART XI, LINE 5: 9,017,348. 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)(B)(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 0 THE GRIFFIN HOSPITAL DEVELOPMENT FUND 130 DIVISION STREET DERBY CT 06418 222560254 FUND RAISING CT 501(C)(3) 509(A)(1) GRIFFIN HEALTH SERVICES CORPORATION 0 PLANETREE INC 130 DIVISION STREET DERBY CT 06418 061505284 EDUCATION CT 501(C)(3) 509(A)(2) GRIFFIN HEALTH SERVICES CORPORATION 0 GH VENTURES INC 130 DIVISION STREET DERBY CT 06418 222560247 MANAGE MEDICAL BILLING CT GRIFFIN HEALTH SERVICES CORPORATION C HEALTHCARE ALLIANCE INSURANCE COMPANY LTD 171 ELGIN AVENUE GEORGETOWN CJ OFFSHORE CAPTIVE CJ GRIFFIN HEALTH SERVICES CORPORATION C CT PRACTICE MANAGEMENT INC 130 DIVISION STREET DERBY CT 06418 061152819 INACTIVE CT N/A C 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 GRIFFIN HEALTH SERVICES CORP O 387977 ACTUAL CASH GH VENTURES INC O 383280 ACTUAL CASH GRIFFIN DEVELOPMENT FUND O 546936 ACTUAL CASH PLANETREE INC O 2685450 ACTUAL CASH GRIFFIN HOSPITAL DEVELOPMENT FUND R 885000 ACTUAL CASH GRIFFIN HEALTH SERVICES CORP R 120000 ACTUAL CASH GRIFFIN FACULTY PRACTICE PLAN Q 3066634 ACTUAL CASH