2023-07-14T07:49:21-05:00 2022-09-30 111986323 MARCUM LLP 555 LONG WHARF DRIVE NEW HAVEN CT 06511 990 2021-10-01 060646718 MIDDLESEX HOSPITAL MIDD 8603586395 28 CRESCENT STREET MIDDLETOWN CT 06457 SUSAN MARTIN VP FINANCE & TREASURER 8603586395 2023-07-12 1 SUSAN MARTIN 999009999 MARY ANTONETTI P00431862 2037819600 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z VINCENT CAPECE JR 28 CRESCENT STREET MIDDLETOWN CT 06457 492619264 0 X WWW.MIDDLESEXHOSPITAL.ORG X 1895 CT A NON-PROFIT, ACUTE CARE, COMMUNITY HOSPITAL IN MIDDLETOWN, CT. (SEE SCHEDULE O)MIDDLESEX HOSPITAL IS COMMITTED TO PROVIDING HIGH QUALITY INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. THE HOSPITAL RECOGNIZES COMMUNITY TRANSPARENCY AND INTEGRITY AS FUNDAMENTAL RESPONSIBILITIES. 13 11 3566 308 2829920 0 7719795 14664845 431695661 451862643 16852994 7895630 9755684 10048100 466024134 484471218 85000 144225 0 0 251211773 256723633 0 0 972284 189071954 198914614 440368727 455782472 25655407 28688746 628027463 546749767 208628151 151860206 419399312 394889561 X MIDDLESEX HOSPITAL EXISTS TO PROVIDE THE SAFEST, HIGHEST-QUALITY HEALTH CARE AND THE BEST EXPERIENCE POSSIBLE FOR OUR COMMUNITY. (CONTINUED ON SCHEDULE O) 0 0 405105668 144225 457749517 IN MARCH OF 2020, MIDDLESEX HOSPITAL AS PART OF MIDDLESEX HEALTH'S COMMUNITY HEALTH AND WELL-BEING BASED WORK SHIFTED DRAMATICALLY TO ADDRESS THE COVID-19 PANDEMIC AND RESPOND TO COMMUNITY LEVEL NEEDS. MIDDLESEX HOSPITAL CONTINUES TO GO ABOVE AND BEYOND TO PROVIDE THE SAFEST POSSIBLE CARE TO ALL PATIENTS, WHETHER OR NOT THEIR ILLNESS IS RELATED TO THE CORONAVIRUS. MIDDLESEX HOSPITAL CONTINUES TO PROVIDE UPDATES AND ACCESS TO RESOURCES TO HELP MEMBERS OF THE COMMUNITY STAY SAFE AND HEALTHY DURING THESE CHALLENGING TIMES. 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. (CONTINUED ON SCHEDULE O)IN THE FISCAL YEAR ENDING 9/30/22, INPATIENT CARE REPRESENTED 11,902 DISCHARGES AND 54,020 PATIENT CARE DAYS. 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. 405105668 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 1 255 0 1 3566 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X X SHANNON ST HILAIRE 8603586000 28 CRESCENT STREET MIDDLETOWN CT 06457 VINCENT CAPECE JR PRESIDENT/CEO 40.00 4.00 X X 1339056 0 303449 DAVID C BENOIT DIRECTOR 1.00 3.00 X 0 0 0 JEAN M D'AQUILA DIRECTOR 1.00 4.00 X 0 0 0 JOHN J GAUTHIER DIRECTOR 1.00 3.00 X 0 0 0 ROBERT C HINTON DIRECTOR 1.00 3.00 X 0 0 0 CHANDLER J HOWARD VICE CHAIRMAN 1.00 3.00 X X 0 0 0 JONATHAN D LEVINE MD SECRETARY 1.00 4.00 X X 0 0 0 MARK D LORENZE MD ASST SECRETARY 1.00 3.00 X X 0 0 0 BRUCE S MACMILLIAN DIRECTOR 1.00 4.00 X 0 0 0 DARRELL G PATASKA CHAIRMAN 1.00 3.00 X X 0 0 0 SABRA R PURTILL DIRECTOR (LEFT 4/2022) 1.00 3.00 X 0 0 0 CHRISTINE H REPASY DIRECTOR 1.00 3.00 X 0 0 0 GARY M WALLACE DIRECTOR 1.00 3.00 X 0 0 0 MARK BERTOLAMI DIRECTOR (JOINED 6/2021) 1.00 3.00 X 0 0 0 SUSAN MARTIN VP FINANCE/TREASURER 40.00 4.00 X 568647 0 66930 JONATHAN BANKOFF CHAIRMAN EMERGENCY MEDICIN 40.00 0.00 X 469303 0 51359 TODD BISHOP CHIEF DEPT OF MED 40.00 0.00 X 411999 0 19922 DAVID GIUFFRIDA VP FACILITIES AND SUPPORT 40.00 0.00 X 441488 0 72239 EVAN JACKSON VP STRATEGIC PLANNING 40.00 0.00 X 492961 0 92263 DONNA STRONESKI VP HUMAN RESOURCES 40.00 0.00 X 383203 0 57709 DAVID COSENTINO VP QUALITY & PATIENT SAFETY 40.00 0.00 X 490080 0 94731 KELLY HAECKEL VP PATIENT CARE SERVICES/CNO 40.00 0.00 X 320293 0 76140 LAURA MARTINO VP MARKETING & DEVELOPMENT 30.00 10.00 X 0 400851 47130 JEFFREY SHELTON CHAIRMAN DEPT PSYCH 40.00 0.00 X 447264 0 39840 THEODORE HARTENSTEIN MED DIRECTOR, UTILIZATION 40.00 0.00 X 513124 0 50738 JUSTIN GORALNIK PULMONOLOGIST 40.00 0.00 X 438569 0 28589 RICARDO PEREZ PULMONOLOGIST 40.00 0.00 X 429146 0 42659 BRIAN MCGUIRE MEDICAL DIRECTOR ED 40.00 0.00 X 425308 0 54109 JESSE WAGNER MD HOSPITALIST 40.00 0.00 X 388533 0 25458 7558974 400851 1123265 559 1 1 0 EPIC SYSTEMS 1979 MILKY WAY VERONA WI 53593 TECHNOLOGY SERVICES 4387512 MEDICAL SOLUTIONS PO BOX 310737 DES MOINES IA 50331 TEMPORARY LABOR SERVICES 2875235 MEDIATELY LLC 525 S FLAGLER DRIVE SUITE 300 WEST PALM BEACH FL 33401 MARKETING 2407737 ARAMARK CORPORATION 66 OXFORD DRIVE FRANKLIN MA 02038 DIETARY / HOUSEKEEPING SERVICES 2229338 QUEST DIAGNOSTICS INC PO BOX 844217 BOSTON MA 02284 LABORATORY SERVICES 2189774 110 211 225801 12928115 1510718 63911 14664845 NET PATIENT SERVICE REVENUE 621400 446910507 446910507 SPECIMEN LAB 621500 2810510 2810510 NET INCOME FROM JOINT VENTURES 900003 2141626 2141626 451862643 3469849 3469849 1321 1321 1164493 802118 362375 362375 362375 11669495 7245035 4424460 4424460 4424460 103444 225801 98793 4651 4651 16630 2100 14530 14530 PURCHASE DISCOUNTS 900003 1924578 1924578 CAFETERIA REVENUE 722514 852528 852528 BILLING MANAGEMENT FEES 900003 648738 648738 6240700 6124068 19410 97222 9666544 484471218 457749517 2829920 9226936 144225 144225 6267228 5013782 1253446 312209 312209 207218858 188546357 18672501 10619485 9849688 769797 17288978 15926373 1362605 15016875 13815525 1201350 1999410 1015623 11503 972284 392089 392089 210620 210620 134683 134683 138295 138295 41279676 34543581 6736095 3444703 78952 3365751 7181185 5400532 1780653 10878489 6525395 4353094 9742106 5739362 4002744 1063802 930416 133386 457359 392922 64437 1185486 1185486 28628839 25305216 3323623 5569768 5569752 16 MEDICAL SUPPLIES 52045421 52042679 2742 STATE HOSPITAL TAX 30132931 30132931 FOOD 1447354 1446379 975 DUES & LICENSES 689456 0 689456 2292942 1188283 1104659 455782472 405105668 49704520 972284 2647764 1469491 94350554 59909758 611199 983766 49378240 52748169 257309 290449 2228173 2214886 4832950 5053112 681260725 457768481 227957883 223492244 219174793 176083352 431000 373533 26157598 24131007 628027463 546749767 65044555 62331084 866760 214483 31081346 28318221 25376327 3539332 86259163 57457086 208628151 151860206 X 398511116 376762460 20888196 18127101 419399312 394889561 628027463 546749767 X 28688746 -37456209 -15742288 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 134683 134683 0 PART II-B, LINE 1: 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 $13,153 AND THE PORTION OF CHA DUES TOTALED $49,029. IN ADDITION, MIDDLESEX HOSPITAL CONTRACTED WITH TWO CONSULTANTS WHO PERFORMED LOBBYING ACTIVITIES. THOSE EXPENSES TOTALED $72,500. 167025000 99000 -28415000 502000 138207000 139852000 140000 27444000 411000 167025000 128949000 11014000 111000 139852000 124738999 67000 3977000 -166001 128949000 118528000 505000 5702999 -3000 124738999 0.92000 0.00000 0.08000 0 0 15529008 15529008 356149195 229578911 126570284 5967613 3780830 2186783 293358278 220250451 73107827 10256631 4158289 6098342 223492244 EST. SELF-INSURANCE LIABILITIES 27523284 ACCRUED RETIREMENT LIABILITIES 3656271 ASSET RETIREMENT OBLIGATION 633750 THIRD-PARTY SETTLEMENTS 11907933 OTHER LIABILITIES 298314 SECURITY DEPOSITS 4172 DUE TO RELATED PARTIES 7600 HOME CARE 1512 OPERATING LEASE LIABILITIES 13424250 57457086 X PART V, LINE 4: THE WITHOUT DONOR RESTRICTIONS RECORDED IN THE 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. THESE ARE NOT IDENTIFIED ON THE AUDIT STATEMENTS IN THIS FASHION FOR FY2022. THEY ARE IN AS EITHER WITH OR WITHOUT DONOR RESTRICTIONS. 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. PART X, LINE 2: BELOW IS AN EXCERPT FROM FOOTNOTE 2 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR MIDDLESEX HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE SYSTEM ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FASB ASC 740, "INCOME TAXES," WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE SYSTEM DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2022 AND 2021. IT IS THE SYSTEM'S POLICY TO RECORD PENALTIES AND INTEREST ASSOCIATED WITH UNCERTAIN TAX PROVISIONS AS A COMPONENT OF OPERATING EXPENSES. AS OF SEPTEMBER 30, 2022 AND 2021, THE SYSTEM DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE SYSTEM'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. TPC GOLF 176440 116600 59840 34755 14716 11089 HOSPICE GOLF 93234 68734 24500 3258 8288 12054 1143 2 59571 40467 19104 1037 1800 10653 329245 225801 103444 3258 44080 28570 22885 98793 4651 16630 1670 430 0 16630 1670 430 2100 14530 CT 1 0 0 0 0 0 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 1096 5774885 4173522 1601363 0.00350 21702 98171723 67139346 31032377 0.06810 22798 103946608 71312868 32633740 0.07160 20035 8822595 147963 8674632 0.01900 865 13383782 2737241 10646541 0.02340 24775 58948399 38905855 20042544 0.04400 66 282922 0 282922 0.00060 3626 331314 5350 325964 0.00070 49367 81769012 41796409 39972603 0.08770 72165 185715620 113109277 72606343 0.15930 25748 25748 0.00010 12 135641 135641 0.00030 34 19432 19432 0.00000 46 180821 180821 0.00040 0 20768625 2076863 44150026 46679121 -2529095 X 1 1 1 1 MIDDLESEX HOSPITAL 28 CRESCENT STREET MIDDLETOWN CT 06457 WWW.MIDDLESEXHEALTH.ORG 000069 X X X X MIDDLESEX HOSPITAL 1 1 0 1 X X X X X X X X X X 22 1 0 0 1 X SEE STATEMENT X X 0 0 1 X 200.000000000000 500.000000000000 X X 1 1 X X X 1 X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X X 1 X 0 X X X 1 X 0 0 MIDDLESEX HOSPITAL PART V, SECTION B, LINE 3J: IN ADDITION TO THE ELEMENTS SELECTED IN PART V, LINE 3, MIDDLESEX HOSPITAL'S MOST RECENTLY COMPLETED (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EXAMINED HOW SOCIAL DETERMINANTS OF HEALTH AND HEALTH DISPARITIES IMPACT HEALTH OUTCOMES. THE REPORT CONTINUED TO RAISE AWARENESS ABOUT HEALTH-RELATED SOCIAL NEEDS, WELL-BEING AND QUALITY OF LIFE; HEALTH DISPARITIES; AND, VULNERABLE POPULATIONS. ACHIEVING HEALTH EQUITY THE ATTAINMENT OF THE HIGHEST LEVEL OF HEALTH FOR ALL PEOPLE STARTS WITH ASKING THE APPROPRIATE QUESTIONS RELATIVE TO DETERMINANTS OF HEALTH AND HOW THEY DISPROPORTIONATELY AFFECT CERTAIN GROUPS OF PEOPLE; NEXT STEPS INVOLVE ADDRESSING THE CONDITIONS THAT PREVENT THE REALIZATION OF GOOD HEALTH FOR THESE VULNERABLE OR MARGINALIZED GROUPS. THROUGH EXAMINATION OF THE INFLUENCE OF DETERMINANTS OF HEALTH, IT IS POSSIBLE TO DEVELOP STRATEGIES THAT ELIMINATE PERSISTENT AND PERVASIVE HEALTH DISPARITIES, PROMOTE HEALTH EQUITY, IMPROVE HEALTH OUTCOMES AND REDUCE FINANCIAL COST. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 5: IN COMPLETING ITS MOST RECENT (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), MIDDLESEX HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF ITS COMMUNITY SERVED, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. A COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE WAS FORMED TO PROVIDE INPUT AND GUIDANCE, INCLUDING REVIEW OF THE STUDY'S DATA COMPONENTS; REVIEW AND INPUT ON THE MIDDLESEX HEALTH CHNA COMMUNITY SURVEY; ASSISTANCE WITH SERVICE AREA-WIDE COMMUNITY SURVEY DISSEMINATION; AND REVIEW AND INPUT ON COMMUNITY RESOURCES AND ASSETS. THE ADVISORY COMMITTEE WAS COMPRISED OF STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING LOCAL HEALTH DEPARTMENTS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), COMMUNITY-BASED ORGANIZATIONS, FAITH-BASED ORGANIZATIONS, ADVOCACY GROUPS, SUPPORT PROFESSIONALS EMBEDDED IN THE COMMUNITY (I.E., COMMUNITY HEALTH WORKERS, DOULAS, RECOVERY COACHES, ETC.) AND COMMUNITY MEMBERS TO ENSURE COMMUNITY VOICE WAS REPRESENTED. TO CAPTURE BROAD COMMUNITY INPUT ON HEALTH NEEDS, SOCIAL DETERMINANTS OF HEALTH AND HEALTH EQUITY, MIDDLESEX HOSPITAL ADMINISTERED A COMMUNITY SURVEY FOR ITS CHNA. SURVEY TOPIC AREAS INCLUDED KEY HEALTH ISSUES AND HEALTH BEHAVIORS, HEALTH CARE ACCESS, AND SOCIAL DETERMINANTS OF HEALTH. QUESTIONS RELATED TO COVID-19 WERE ADDED. ALL THE SURVEY RESPONSE OPTIONS WERE POSED IN QUANTITATIVE FORM THROUGH LIKERT SCALES. A QUALITATIVE OPEN-ENDED TEXT BOX WAS PROVIDED AT THE END OF THE SURVEY TO ALLOW FOR COMMENTS. THE EIGHT-QUESTION SURVEY (FIVE FOCUSED QUESTIONS, TWO DEMOGRAPHIC QUESTIONS AND AN OPTION TO ADD COMMENTS) WAS ADMINISTERED ELECTRONICALLY THROUGH THE ONLINE SURVEYMONKEY FORMAT. TO ENSURE RESPONSES FROM A WIDE RANGE OF REPRESENTATIVE COMMUNITY MEMBERS AND LEADERS WITH DIVERSE BACKGROUNDS, PERSPECTIVES AND FIRST-HAND KNOWLEDGE ABOUT THEIR COMMUNITIES, THE SURVEY WAS EXTENSIVELY DISSEMINATED TO AN ARRAY OF SECTOR CONTACTS; FORWARDED TO MULTIPLE COLLABORATIVE E-DISTRIBUTION LISTS; POSTED ON WEBSITES AND SOCIAL MEDIA PLATFORMS; AND INCLUDED IN E-NEWSLETTERS THROUGHOUT MIDDLETOWN, MIDDLESEX COUNTY AND THE PERIPHERY TOWNS OF MIDDLESEX HEALTH'S SERVICE AREA. SECTORS INCLUDED ADVOCACY GROUPS, ALLIANCES/COALITIONS, THE BUSINESS COMMUNITY, EDUCATIONAL INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS, COMMUNITY RESIDENTS, ELECTED OFFICIALS, MUNICIPAL STAFF, FAITH-BASED ORGANIZATIONS, FOUNDATIONS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), LOCAL HEALTH DEPARTMENTS, MENTAL HEALTH ORGANIZATIONS, SUBSTANCE TREATMENT FACILITIES, AND YOUTH AND FAMILY SERVICES. COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE MEMBERS WERE ASKED TO BROADLY SHARE THE COMMUNITY SURVEY LINK, AND ALL SURVEY RECIPIENTS WERE INVITED TO SHARE THE LINK WITH COWORKERS, FRIENDS AND FAMILY OR ANYONE WHO LIVES OR WORKS IN MIDDLESEX COUNTY. A TOTAL OF 204 SURVEYS WERE COMPLETED AND RESPONSE RESULTS ARE INCLUDED IN THE MIDDLESEX HEALTH CHNA COMMUNITY SURVEY SECTION OF THE CHNA. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 7D: MIDDLESEX HOSPITAL POSTED ITS MOST RECENTLY COMPLETED CHNA (2022) ON ITS WEB-SITE (HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT) AND ELECTRONICALLY DISTRIBUTED IT THROUGH THE FOLLOWING DISSEMINATION CHANNELS: THE CHNA ADVISORY COMMITTEE; COMMUNITY MEMBERS; AND EXISTING HOSPITAL-COMMUNITY BASED PARTNERSHIP DISTRIBUTION LISTS. RECIPIENTS WERE ENCOURAGED TO WIDELY SHARE THE ASSESSMENT. HARD COPIES OF THE CHNA WERE AND WILL CONTINUE TO BE PROVIDED UPON REQUEST. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 11: MIDDLESEX HOSPITAL COMPLETED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2022, AND ITS CHNA IMPLEMENTATION STRATEGY WAS APPROVED BY MIDDLESEX HEALTH'S GOVERNING BODY IN FEBRUARY 2023. A FACILITATED COMMUNITY CONVERSATION WAS HELD TO REVIEW, PRIORITIZE, AND DISCUSS STRATEGIES AND SOLUTIONS FOR THE SIGNIFICANT HEALTH AND HEALTH-RELATED NEEDS IDENTIFIED IN MIDDLESEX HEALTH'S 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THEREBY INFORMING MIDDLESEX HEALTH'S CHNA IMPLEMENTATION STRATEGY. A FLIER AND INVITATION TO THE EVENT WAS WIDELY DISSEMINATED TO AN ARRAY OF CONTACTS IN MIDDLETOWN, MIDDLESEX COUNTY AND THE PERIPHERY TOWNS OF MIDDLESEX HEALTH'S PRIMARY SERVICE AREA TO ENSURE PARTICIPATION BY COMMUNITY LEADERS, STAKEHOLDERS AND COMMUNITY MEMBERS WITH DIVERSE BACKGROUNDS, PERSPECTIVES AND FIRST-HAND KNOWLEDGE ABOUT THEIR COMMUNITIES. THE COMMUNITY CONVERSATION FORMAT WAS SELECTED AS IT PROVIDES A PRACTICAL, PURPOSEFUL AND INTERACTIVE APPROACH FOR 1) EXPLORING THE CAUSES AND UNDERLYING ISSUES BEHIND SPECIFIC HEALTH PROBLEMS; 2) ADDRESSING CONCERNS; 3) DISCUSSING DESIRED FUTURE STATE; 4) DESIGNING STRATEGIES BASED ON DATA AND INDIVIDUAL KNOWLEDGE, PERSPECTIVE AND EXPERIENCE; AND, 5) SERVING AS A FOUNDATION TO ENCOURAGE SUSTAINED ENGAGEMENT AND TO CREATE OPPORTUNITIES FOR COOPERATIVE ACTION. GIVEN COVID-19 CONCERNS, THE COMMUNITY CONVERSATION WAS HELD VIA A VIRTUAL FORMAT. A TOTAL OF 65 PEOPLE PARTICIPATED, REPRESENTING VARIOUS SECTORS INCLUDING ADVOCACY GROUPS, ALLIANCES / COALITIONS, EDUCATIONAL INSTITUTIONS, COMMUNITY BASED ORGANIZATIONS, COMMUNITY RESIDENTS, ELECTED OFFICIALS, FAITH-BASED ORGANIZATIONS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), LOCAL HEALTH DEPARTMENTS, MUNICIPAL AGENCIES, SCHOOLS, SOCIAL SERVICES, STATE AGENCIES AND YOUTH AND FAMILY SERVICES. PRIOR TO THE PRIORITIZATION AND STRATEGY EXERCISES, AN OVERVIEW OF MIDDLESEX HEALTH'S 2022 CHNA WAS GIVEN, INCLUDING BACKGROUND ON THE PROCESS; KEY DEMOGRAPHIC DATA; DATA LIMITATIONS; DEFINITIONS OF HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH; DATA ON AN ARRAY OF HEALTH INDICATORS; SOCIAL AND HEALTH DISPARITY DATA, WHEN AVAILABLE; AND AN OVERVIEW OF THE TOP HEALTH NEEDS IDENTIFIED IN MIDDLESEX HEALTH'S 2022 CHNA. FACILITATORS WITH EXPERTISE IN COMMUNITY CONVERSATIONS LED THE ATTENDEES IN A PRIORITIZATION EXERCISE AND A DISCUSSION OF POTENTIAL STRATEGIES AND SOLUTIONS. PARTICIPANTS WERE ASKED TO CONSIDER THE IMPACTS OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH DISPARITIES WHEN REVIEWING EACH HEALTH ISSUE. ONCE THE RANKING PROCESS WAS COMPLETED, THE RESULTS WERE TALLIED AND FIVE PRIORITY AREAS WERE DETERMINED. THE RESULTS OF THE COMMUNITY CONVERSATION SERVED AS A GUIDE FOR MIDDLESEX HEALTH'S SELECTION OF PRIORITY AREAS FOR ITS CHNA IMPLEMENTATION STRATEGY. THROUGH THIS PROCESS, THE FOLLOWING HEALTH TOPICS WERE SELECTED AS AREAS OF FOCUS FOR THE IMPLEMENTATION STRATEGY: 1) MENTAL HEALTH ALL AGES; 2) SUBSTANCE USE ISSUES; 3) HEALTHY AGING; 4) MATERNAL CHILD HEALTH; AND 5) CHRONIC DISEASES, WITH SOCIAL DETERMINANTS OF HEALTH, HEALTH EQUITY AND THE IMPACTS OF COVID-19 AS ESSENTIAL COMPONENTS FOR EACH HEALTH AREA. WHILE MIDDLESEX HEALTH'S CHNA WAS COMPLETED IN 2022, ITS CHNA IMPLEMENTATION STRATEGY WAS COMPLETED AND APPROVED BY ITS GOVERNING BODY IN FEBRUARY 2023; THEREFORE, IN FISCAL YEAR 2022, MIDDLESEX HEALTH CONTINUED TO FOCUS ON THE HEALTH AND WELL-BIENG NEEDS IDENTIFIED IN ITS PREVIOUS CHNA. WITH REGARD TO NEEDS THAT ARE NOT BEING ADDRESSED, MIDDLESEX HOSPITAL RECOGNIZES THAT IT CANNOT FOCUS ON EVERY HEALTH AND SOCIAL NEED IDENTIFIED IN ITS PREVIOUSLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND IS THEREFORE COMMITTED TO ALLOCATING RESOURCES AND IN-KIND TIME TO THE HIGHEST AREAS OF IDENTIFIED NEED AND/OR AREAS WITH GREATEST POTENTIAL FOR IMPACT AND FEASIBILITY (THE SELECTED PRIORITY AREAS). RESOURCE CONSTRAINTS PREVENT THE HOSPITAL FROM ADDRESSING EVERY NEED, AND IN MANY CASES, OTHER LOCAL COMMUNITY BASED ORGANIZATIONS MAY BE BETTER SUITED TO TAKE A LEADERSHIP ROLE IN IMPROVING CERTAIN HEALTH OUTCOMES. AS WITH OUR PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENTS, THE HOSPITAL WILL CONTINUE TO BE A WILLING PARTNER, WHEN ABLE, FOR INITIATIVES NOT RELATED TO ITS SELECTED CHNA IMPLEMENTATION STRATEGY PRIORITY AREAS.TO ALIGN WITH ITS COMMUNITY HEALTH NEEDS ASSESSMENT FOCUS ON ADVANCING HEALTH EQUITY BY ADDRESSING THE ROOT CAUSES OF HEALTH DISPARITIES, MIDDLESEX HOSPITAL HAS ADOPTED A COLLABORATIVE PHILOSOPHY FOR ITS COMMUNITY HEALTH AND WELL-BEING VISION. IN FY22 MIDDLESEX HOSPITAL SECURED $1,521,120 IN GRANT FUNDING AND CONTINUATION FUNDING FOR COMMUNITY-LED PROGRAMS DEVELOPED TO SUPPORT STRATEGIC, PLACE-BASED PARTNERSHIPS. MIDDLESEX HEALTH WROTE THE GRANTS THAT SECURED FUNDING FROM MULTIPLE ORGANIZATIONS AND PROVIDED ASSISTANCE WITH BUDGET PREPARATION; THIS SUPPORT WAS PROVIDED IN-KIND AND 100% OF THE FUNDS WENT TO COMMUNITY-BASED ORGANIZATIONS AND CREATED JOBS. HEALTH SYSTEMS ARE ANCHOR INSTITUTIONS IN THEIR SERVICE AREAS. BY SUPPORTING ONGOING COMMUNITY INITIATIVES, MIDDLESEX HOSPITAL IS ENSURING THAT ITS COMMUNITY BENEFIT PROGRAMS MEET COMMUNITY NEEDS, AS DEFINED BY COMMUNITY INPUT AND VOICE. BY INFUSING 100% OF THIS GRANT MONEY INTO THE COMMUNITY AND CREATING COMMUNITY-BASED JOBS, MIDDLESEX HOSPITAL IS HELPING TO ADVANCE EQUITABLE AND INCLUSIVE ECONOMIC DEVELOPMENT STRATEGIES IN MEANINGFUL WAYS; THIS IS IMPORTANT BECAUSE SOCIOECONOMIC STATUS AND RELATED FACTORS, SUCH AS EMPLOYMENT, ARE DRIVERS OF HEALTH. THESE GRANTS, WRITTEN BY MIDDLESEX HOSPITAL AND SECURED IN PARTNERSHIP, HAVE UNDERWRITTEN MULTIPLE COMMUNITY-BASED PROGRAMS THAT FOCUS ON ADDRESSING SYSTEMIC BARRIERS THAT BLACK, INDIGENOUS, LATINO/A INDIVIDUALS EXPERIENCE WITH ACCESS TO QUALITY HEALTH CARE SERVICES. EACH PROGRAM HAS BEEN DESIGNED, IMPLEMENTED AND LED BY COMMUNITY LEADERS OR COLOR AND COMMUNITY MEMBERS OF COLOR WHO KNOW THE NEEDS OF AND SOLUTIONS FOR THEIR COMMUNITIES BEST. IN ADDITION TO PROVIDING SUPPORT FOR GRANT WRITING, BUDGET PREPARATION, PROGRAM DESIGN, PROGRAM IMPLEMENTATION, PROGRAM EVALUATION AND GRANT REPORTING, MIDDLESEX HEALTH IS AN ACTIVE PARTNER WITH THE ORGANIZATIONS OVERSEEING THE PROGRAMS. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 13H: MIDDLESEX HOSPITAL'S SLIDING SCALE OUTLINES THE FACTORS THAT IT USES TO DETERMINE FINANCIAL ASSISTANCE DETERMINATIONS: THE FEDERAL POVERTY INCOME GUIDELINES AND NUMBER OF PERSONS IN HOUSEHOLD. PART V, SECTION B, LINE 7A: HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 10A: HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 16A, FAP WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART V, SECTION B, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART V, SECTION B, LINE 16C, FAP PLAIN LANGUANCE SUMMARY WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART VI, QUESTION 4 - COMMUNITY INFORMATION (CONTINUED): WHILE THE MAJORITY OF TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA EXPERIENCE A LOWER HOUSING COST-BURDEN RATE (HOUSEHOLDS THAT SPEND AT LEAST 30% OF THEIR ANNUAL HOUSEHOLD INCOME ON HOUSING COSTS) WHEN COMPARED TO CONNECTICUT (39.6%), FOR THIS COHORT, THE PERCENTAGE OF HOUSEHOLDS IN THE TOWNS THAT ARE COST-BURDENED IS HIGH, RANGING FROM 22% - 37.8%. THE TOWNS OF CLINTON, LYME, AND MIDDLETOWN COMPARE TO CONNECTICUT, WHILE CHESTER, OLD SAYBROOK, AND WESTBROOK EXCEED THE STATE AVERAGE WITH A RANGE OF 41.2% - 43.6% EXPERIENCING HOUSING COST-BURDEN (CONNECTICUT DATA COLLABORATIVE, 2015-2019).FOR HEALTH INSURANCE STATUS, UNDER AGE 18, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (3.0%), EXCEPT CLINTON (3.4%), ESSEX (4.9%) AND OLD LYME (4.7%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. FOR HEALTH INSURANCE STATUS, AGES 18-64, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (7.5%), EXCEPT DEEP RIVER (12.8%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. FOR HEALTH INSURANCE STATUS, AGES 65+, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (0.6%), EXCEPT DEEP RIVER (1.0%) AND KILLINGWORTH (2.9%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. IN 2022, THE PERCENT OF HOSPITAL DISCHARGES FOR MEDICAID/SAGA/UNINSURED COMBINED WERE: 21% INPATIENT; 15% OUTPATIENT; 29% EMERGENCY DEPARTMENT NON-ADMISSION; AND, FOR THE FOLLOWING SERVICES: 37% NEWBORN; 50% INPATIENT PSYCHIATRY; 14% OUTPATIENT SURGERY AND 15% OTHER OUTPATIENT SERVICES. 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 A LACK OF ACCESS TO PRIMARY CARE SERVICES. PART V, SECTION B, LINE 20A: WRITTEN NOTICE ABOUT UPCOMING ECAS WAS NOT REQUIRED BECAUSE THE ORGANIZATION DID NOT PURSUE ANY EXTRAORDINARY COLLECTION ACTION'S DURING THE YEAR. IF AN ECA WAS PURSUED IN THE FUTURE, PROPER NOTICE WOULD BE GIVEN. 1 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, IN ORDER TO MAXIMIZE THE AMOUNT OF FINANCIAL ASSISTANCE DISCOUNT, 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 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. IN ADDITION TO SUBSIDIZED SERVICES, INDIRECT COSTS WERE APPLIED 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 I, LINE 7G: MIDDLESEX HOSPITAL INCLUDES ITS FAMILY MEDICINE GROUP AS A SUBSIDIZED SERVICE. FOR FY22, 7,778 UNIQUE INDIVIDUALS WERE SERVED WITH A TOTAL HOSPITAL SUBSIDY OF $509,742. 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 HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS) FOR PRIMARY CARE (MIDDLETOWN SERVICE AREA; LOW INCOME POPULATION), MENTAL HEALTH (MIDDLESEX COUNTY; HIGH NEED GEOGRAPHIC) AND DENTAL HEALTH (CENTRAL MIDDLETOWN; LOW INCOME POPULATION). MIDDLESEX HOSPITAL'S FAMILY MEDICINE GROUP FILLS A VITAL COMMUNITY HEALTH NEED BY PROVIDING ACCESS TO PRIMARY CARE SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: THE MAJORITY OF MIDDLESEX HOSPITAL'S COMMUNITY BASED HEALTH IMPROVEMENT WORK IS CAPTURED UNDER COMMUNITY BENEFIT CATEGORIES. THE HOSPITAL'S PARTICIPATION IN COMMUNITY BUILDING ACTIVITIES, HOWEVER, 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 WAYS THAT FALL UNDER THE SCOPE OF COMMUNITY BUILDING. STAFF MEMBERS PARTICIPATE IN MULTIPLE 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.THE CRITICAL ROLE OF THE NOT-FOR-PROFIT HOSPITAL AS A SAFETY NET AND ANCHOR HEALTHCARE INSTITUTION HAS NEVER BEEN MORE APPARENT THAN DURING THE COVID-19 PANDEMIC THAT COMMENCED IN THE UNITED STATES IN THE EARLY MONTHS OF 2020 AND HAS CONTINUED THROUGH 2022 WITH NEW COVID-19 VARIANTS EMERGING AND CONTINUING TO CAUSE SURGES IN THE HEALTHCARE SYSTEM. CONTINUING TO RESPOND TO THE COVID-19 PANDEMIC IN ORDER TO TREAT ITS COVID-19 PATIENTS AND ALL ITS OTHER PATIENTS NEEDING MEDICAL CARE CONTINUED TO BE AN EXTENSIVE UNDERTAKING FOR HOSPITALS AND HEALTHCARE SYSTEMS, AND WAS NO DIFFERENT FOR MIDDLESEX HOSPITAL IN FY22.TO FURTHER ITS COMMITMENT TO DIVERSITY, EQUITY AND INCLUSION TO ADDRESS DISPARITIES IN HEALTH CARE, MIDDLESEX HEALTH OFFERS THE MIDDLESEX HEALTH MEDICAL EXPLORERS PROGRAM (WORKFORCE DEVELOPMENT). BLACK, INDIGENOUS AND LATINO/A INDIVIDUALS ARE EXTREMELY UNDERREPRESENTED IN HEALTHCARE PROFESSIONS IN THE UNITED STATES, WHICH CONTRIBUTES TO HEALTH DISPARITIES FOR PEOPLE OF COLOR. IT IS WELL DOCUMENTED THAT THE LACK OF DIVERSITY IN THE HEALTHCARE WORKFORCE HAS A NEGATIVE EFFECT ON PATIENTS OF COLOR. FOSTERING A DIVERSE AND INCLUSIVE WORKFORCE IS CRITICAL TO IMPROVING TRUST AMONG PATIENT-PROVIDER RELATIONSHIPS, INCREASING ACCESS TO CARE AND IMPROVING HEALTHCARE QUALITY AND OUTCOMES AMONG PEOPLE OF COLOR. TO ADDRESS THE LACK OF RACIAL AND ETHNIC REPRESENTATION IN HEALTHCARE, MIDDLESEX HEALTH HAS RE-LAUNCHED ITS MEDICAL EXPLORERS PROGRAM, WHICH WAS ORIGINALLY PILOTED IN 2016-2017. THE PROGRAM'S OBJECTIVE IS TO CREATE A HEALTHCARE EDUCATIONAL PIPELINE BY INTRODUCING BLACK, INDIGENOUS, AND LATINO/A STUDENTS TO A VARIETY OF HEALTH CARE PROFESSIONS THROUGH AN ENGAGED INTERACTIVE LEARNING EXPERIENCE. THE MEDICAL EXPLORERS PROGRAM OCCURS ONCE A YEAR FROM JANUARY - MAY. THE MONTHLY SESSIONS ARE VIRTUAL TO ALLOW FOR MAXIMUM STUDENT PARTICIPATION AND GEOGRAPHIC REACH BY REDUCING TRAVEL TIME AND THE NEED FOR TRANSPORTATION. TO BE ELIGIBLE FOR THE PROGRAM, STUDENTS MUST BE IN GRADES 7 - 12 OR RECENT HIGH SCHOOL GRADUATES AND IDENTIFY AS BLACK, INDIGENOUS AND LATINO/A. THE MEDICAL EXPLORERS ARE GUIDED THROUGH A SIMULATED PATIENT CASE AS IT MOVES ALONG THE HOSPITAL SYSTEM. TO MODEL A VARIETY OF PROFESSIONS, MIDDLESEX HEALTH STAFF IDENTIFYING AS PEOPLE OF COLOR ARE THE FEATURED SPEAKERS. STUDENTS LEARN ABOUT THE SPECIFICS OF EACH HIGHLIGHTED PROFESSION, THE SPEAKER'S PATHWAY TO THAT PROFESSION, AND THE SPEAKER'S CLINICAL EXPERTISE REGARDING THE CASE. ON-SITE EXPERIENCES INCLUDE A TOUR OF THE HOSPITAL WHERE MEDICAL EXPLORERS WILL GET TO MEET STAFF AND EXPERIENCE VARIOUS CLINICAL DEPARTMENTS; A PARTICIPATORY SIM LAB EXPERIENCE, ONE-ON-ONE INTERACTIONS IN AREAS OF INTEREST, AND A CELEBRATION WHERE CERTIFICATES OF COMPLETION ARE AWARDED. PART III, LINE 2: DUE TO THE ADOPTION OF ASC NO 2014-09 CONTRACTS WITH CUSTOMERS (TOPIC 606) BAD DEBT EXPENSE IS NO LONGER REPORTED ON THE AUDITED FINANCIAL STATEMENT. RATHER IT IS TREATED AS A PRICE CONCESSION. THE BAD DEBT EXPENSE FOR FY2022 WAS $20,768,625. 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 EITHER 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 NET PATIENT REVENUE PROVISION FOR BAD DEBTS NET OF RECOVERIES. PAGE 15 OF THE MIDDLESEX HEALTH SYSTEM'S CONSOLIDATED FY22 AUDITED FINANCIAL STATEMENT STATES: THE SYSTEM DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE FROM THAT CATEGORY OF PAYOR. PART III, LINE 8: THE MEDICARE COST REPORT IS THE COSTING METHODOLOGY SYSTEM USED TO DETERMINE THE AMOUNT REPORTED ON PART III, LINES 5 AND 6. THE HOSPITAL UTILIZES WORKSHEET 6 FOUND IN THE FORM 990 INSTRUCTIONS FOR SCHEDULE H TO CALCULATE ITS SUBSIDIZED SERVICES. THE INSTRUCTIONS STATE THAT "THE FINANCIAL LOSS IS MEASURED AFTER REMOVING LOSSES, MEASURED BY COST, ASSOCIATED WITH BAD DEBT, CHARITY CARE, MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS". GIVEN THAT WORKSHEET 6 DOESN'T SUGGEST REMOVING LOSSES ASSOCIATED WITH MEDICARE, A PORTION OF MEDICARE IS INCLUDED IN THE HOSPITAL'S SUBSIDIZED SERVICE CALCULATIONS. SO AS NOT TO DOUBLE COUNT MEDICARE VALUES IN PART III, SECTION B, LINES 5 AND 6, THE PORTION OF MEDICARE SHORTFALL INCLUDED IN OUR SUBSIDIZED SERVICES CALCULATIONS HAS BEEN SUBTRACTED FROM THE MEDICARE REVENUE AND COSTS DERIVED FROM THE MEDICARE COST REPORT. THE VALUES INDICATED IN PART III, LINES 5 AND 6 ARE THEREFORE WHAT REMAINS AFTER THE MEDICARE REVENUE AND COSTS INCLUDED IN THE SUBSIDIZED SERVICES CALCULATIONS HAS BEEN SUBTRACTED OUT. GIVEN THIS, THE RESULTING VALUES (PART III, LINES 5, 6 AND 7) WOULD NEED TO BE COMBINED WITH THE MEDICARE REVENUE/COSTS INCLUDED IN OUR SUBSIDIZED SERVICES TO GET THE FULL OVERVIEW OF MEDICARE REVENUE, COSTS AND ANY REMAINING SHORTFALL OR SURPLUS. WE AGREE WITH THE CURRENT SUBSIDIZED SERVICES CALCULATION METHODOLOGY THAT ALLOWS THE INCLUSION OF MEDICARE DOLLARS AS THE MEDICARE POPULATION COMPRISES AN IMPORTANT SEGMENT OF THOSE RECEIVING SUBSIDIZED SERVICES CARE. THE HOSPITAL TREATS ALL MEDICARE PATIENTS EQUALLY AND DOES NOT DISCRIMINATE AGAINST LOWER-MARGIN YIELDING SERVICES. AS A NOT-FOR-PROFIT HOSPITAL, MIDDLESEX HOSPITAL IS THE SAFETY-NET IN THE COMMUNITY FOR ALL MEDICARE PATIENTS, REGARDLESS OF LEVEL OF MEDICARE COVERAGE AND REGARDLESS IF A SURPLUS OR DEFICIT RESULTS. THIS OPEN ACCESS FOR MEDICARE PATIENTS PROMOTES ACCESS TO CARE, A FUNDAMENTAL TENET OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM.THERE REMAINS A DISPROPORTIONATE PERCENTAGE OF OLDER ADULTS IN MIDDLESEX COUNTY WHEN COMPARED TO STATE AVERAGES. MIDDLESEX HOSPITAL'S MOST RECENTLY COMPLETED (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOUND THAT, WHEN EXTRACTING THE AGE 65+ POPULATION, MIDDLESEX COUNTY (19.0%) EXCEEDS CONNECTICUT (17.2%), AND THE MAJORITY OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA CONTINUE TO HAVE A GREATER CONCENTRATION OF OLDER ADULTS WHEN COMPARED TO CONNECTICUT. THE TOWNS OF COLCHESTER, MARLBOROUGH AND MIDDLETOWN FALL BELOW THE STATE AVERAGE OF 17.2%. PORTLAND IS ON PAR WITH THE STATE AVERAGE, WHILE CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, HADDAM, KILLINGWORTH, AND MIDDLEFIELD EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 19.1%-24.8%, AND ESSEX, LYME, OLD LYME, OLD SAYBROOK, AND WESTBROOK CONSIDERABLY EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 26.2%-30.9% (CT DATA COLLABORATIVE, 2016-2020). THE TREND OF A DISPROPORTIONATELY HIGHER 65+ OLDER ADULT POPULATION IN THE MAJORITY OF TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA WHEN COMPARED TO THE STATE AVERAGE CONTINUES TO BE EVIDENT FOR POPULATION PROJECTIONS FOR 2030. EXCLUDING MIDDLETOWN (AT 14.9%), THE EXPECTED GROWTH FOR AGE 65+ BY 2030 RANGES FROM 19.5% TO 34.9% IN THE REMAINING 18 TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA COMPARED TO 17.9% FOR CONNECTICUT (CT DATA COLLABORATIVE, AGE 65+ POPULATION PROJECTIONS, 2030). AS MIDDLESEX COUNTY HAS A DISPROPORTIONATE LEVEL OF COMMUNITY MEMBERS AGE 65+ WHEN COMPARED TO STATE AVERAGES, THE SHORTFALL THAT THE HOSPITAL EXPERIENCES IN PROVIDING CRITICAL HEALTHCARE SERVICES TO THE MEDICARE POPULATION SHOULD BE CONSIDERED A COMMUNITY BENEFIT WITHIN THE HOSPITAL'S SUBSIDIZED SERVICES, WHICH THOSE AGE 65+ ALSO RELY HEAVILY ON FOR CARE. THE HOSPITAL FILLS A HEALTHCARE DELIVERY GAP FOR MEDICARE PATIENTS, ONE WHICH WOULD BE DETRIMENTAL TO THE COMMUNITY IF THE HOSPITAL WAS NOT PRESENT. PART III, LINE 9B: MIDDLESEX HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. THE 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. 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 VI, LINE 2: SINCE THE INCEPTION OF MIDDLESEX HEALTH'S COMMUNITY BENEFIT POLICY IN 2007, AND PRIOR TO THE MANDATE OF THE AFFORDABLE CARE ACT, CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ORDER TO PRIORITIZE SPECIFIC COMMUNITY BENEFIT INITIATIVES HAS BEEN A CORE ELEMENT OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM. IN ADDITION TO COMPLETING A CHNA, THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVICES ON AN ON-GOING BASIS THROUGH A VARIETY OF METHODS. EXAMPLES INCLUDE UNDERSTANDING THE LOCAL AND STATE-WIDE NEEDS DERIVED FROM: 1) PARTICIPATION IN COMMUNITY HEALTHCARE COALITIONS AND BOARDS, WHICH INCLUDE STRATEGIC PLANNING THAT IS RESPONSIVE TO COMMUNITY NEED; 2) PARTICIPATION IN THE LEADERSHIP TEAM OF THE GREATER MIDDLETOWN HEALTH ENHANCEMENT COMMUNITY (GMHEC), A PLACE-BASED INITIATIVE THAT SUPPORTS LONG-TERM, COLLABORATIVE, AND CROSS-SECTOR EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELL-BEING THROUGH BROAD, SYSTEMIC CHANGE BY BUILDING HEALTHY AND EQUITABLE COMMUNITIES THAT ACTIVELY WORK TOGETHER TO PREVENT THE DEVELOPMENT OF DISEASE; 3) PARTICIPATION IN THE STATE'S HOSPITAL ASSOCIATION POPULATION AND COMMUNITY HEALTH INITIATIVES BASED ON STATE-WIDE AND LOCAL COMMUNITY HEALTH ISSUES; 4) ANY REAL-TIME COMMUNITY BASED INPUT, FEED-BACK, RECOMMENDATIONS AND SUGGESTIONS; AND 5) CONTINUOUS ASSESSMENT AND ADJUSTMENTS, WHEN NECESSARY, OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAMS THROUGH SURVEYS AND PATIENT/PARTICIPANT FEED-BACK. HAVING A STRONG PRESENCE IN COMMUNITY COALITIONS AND PARTNERSHIPS, IN ADDITION TO BEING RESPONSIVE TO THE NEEDS EXPRESSED BY OUR COMMUNITY RESIDENTS, ALLOWS MIDDLESEX HOSPITAL TO CONTINUALLY ASSESS THE HEALTHCARE NEEDS OF OUR COMMUNITY IN BETWEEN COMMUNITY HEALTH NEEDS ASSESSMENT CYCLES. PART VI, LINE 3: GREAT CONCERN IS TAKEN TO ENSURE THAT PATIENTS ARE APPRISED OF THE AVAILABILITY OF FEDERAL/STATE/LOCAL GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE PLAN. NOTICE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS DISPLAYED CONSPICUOUSLY IN ENGLISH AND SPANISH AT THE ENTRY OF EACH FACILITY AND AT ALL PATIENT REGISTRATION POINTS. THE NOTIFICATION INCLUDES AN OVERVIEW OF THE HOSPITAL'S FINANCIAL AID PROGRAM; THE AVAILABILITY OF FREE BED FUNDS AND OTHER FINANCIAL ASSISTANCE; SLIDING SCALE; AND FINANCIAL COUNSELOR CONTACT INFORMATION. AT THE TIME OF REGISTRATION, HOSPITAL ACCESS STAFF REVIEWS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND ASKS THE PATIENT IF HE/SHE WOULD LIKE A FINANCIAL ASSISTANCE PACKAGE. BUILT INTO THE REGISTRATION DATABASE IS A REQUIRED FINANCIAL ASSISTANCE FIELD WHICH MUST BE COMPLETED AS PART OF THE ADMISSIONS PROCESS. ONCE THE PATIENT EXPRESSES THE DESIRE TO RECEIVE A FINANCIAL ASSISTANCE PACKAGE, PAPERWORK WITH PATIENT NAME AND MEDICAL RECORD IS AUTOMATICALLY PRINTED AT THE REGISTRATION STATION AND HANDED TO THE PATIENT. OTHER METHODS OF COMMUNICATION TO INCREASE AWARENESS REGARDING THE FINANCIAL ASSISTANCE AND FREE BED FUND PROGRAM INCLUDE 1) A FINANCIAL ASSISTANCE BROCHURE THAT AIDS PATIENTS IN THE PROCESS, ANSWERS KEY QUESTIONS AND PROVIDES EASY ACCESS FOR HELP (AVAILABLE AT MULTIPLE HOSPITAL DEPARTMENTS AND LOCATIONS, INCLUDING KIOSKS AT EVERY HOSPITAL ENTRY POINT); 2) A SEPARATE AND DISTINCT FINANCIAL ASSISTANCE SERVICES SECTION ON THE HOSPITAL'S WEB-SITE (HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES) WHICH INCLUDES APPLICATION, INSTRUCTIONS, AND SLIDING SCALE; 3) INCLUSION OF FINANCIAL ASSISTANCE INFORMATION IN THE HOSPITAL'S INPATIENT ADMISSIONS BOOKLET; 4) NOTICE OF THE PROGRAM AND FINANCIAL COUNSELOR CONTACT INFORMATION ON EVERY BILLING STATEMENT; 5) NOTIFICATION AT DISCHARGE; AND 6) A LETTER OUTLINING THE PROGRAM SENT TO EVERY SELF-PAY PATIENT FOLLOWING DISCHARGE. THE HOSPITAL HAS A TEAM OF FINANCIAL COUNSELORS WHO ARE AVAILABLE TO ASSIST THE PATIENT THROUGH THE APPLICATION PROCESS EITHER BY PHONE OR VISIT. THE ROLE OF THE COUNSELORS IS TO HELP PATIENTS NAVIGATE THE HOSPITAL'S FINANCIAL ASSISTANCE PROCESS AND TO AID IN APPLICATION FOR MEDICAID/STATE PROGRAMS. ALL COUNSELORS RECEIVE DEPARTMENTAL TRAINING ON THE IMPORTANCE OF ASSISTING PATIENTS IN NEED OF STATE/GOVERNMENTAL OR HOSPITAL FINANCIAL ASSISTANCE, THE HOSPITAL'S FINANCIAL ASSISTANCE PROTOCOLS, SYSTEMS, NEW PROGRAM ENHANCEMENTS, AND HOW TO PROVIDE SUPPORT AND FOLLOW-UP FOR MEDICAID/STATE ENROLLMENT. THE HOSPITAL'S SOCIAL WORKERS ALSO ASSIST PATIENTS WITH COMPLETION OF HOSPITAL FINANCIAL ASSISTANCE APPLICATIONS AS WELL AS MEDICAID/STATE APPLICATIONS. AN IMPORTANT ADDITION TO MIDDLESEX HOSPITAL'S FINANCIAL ASSISTANCE PROCESS HAS BEEN THE DEVELOPMENT OF THE FINANCIAL ASSISTANCE WORKGROUP SEVERAL YEARS AGO. WORKGROUP TASKS INCLUDE: INCREASING AWARENESS REGARDING FINANCIAL ASSISTANCE AVAILABILITY; CONTINUOUS MONITORING OF APPROPRIATENESS, FEASIBILITY AND ACCESSIBILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PRACTICES; AND A COMPREHENSIVE COMMUNICATIONS STRATEGY FOR INCREASING AWARENESS FOR FINANCIAL ASSISTANCE. IN FY21, MIDDLESEX HOSPITAL GRANTED $2,301,326 IN FINANCIAL ASSISTANCE TO 1,276 UNIQUE RECIPIENTS AND ABSORBED $29,755,083 IN UNPAID COSTS OF MEDICAID (TOTAL OF MEDICAID INCLUDING MANAGED CARE AND LIA), SERVING 20,745 INDIVIDUALS. PART VI, LINE 4: 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. MIDDLESEX HOSPITAL HEALTH'S SERVICE AREA. THERE ARE NINETEEN TOWNS IN ITS PRIMARY SERVICE AREA: CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, ESSEX, HADDAM, KILLINGWORTH, MIDDLEFIELD, MIDDLETOWN, OLD SAYBROOK, PORTLAND, AND WESTBROOK (THE FIFTEEN TOWNS OF MIDDLESEX COUNTY) AND COLCHESTER, LYME, MARLBOROUGH AND OLD LYME; AND, FIVE TOWNS IN ITS SECONDARY SERVICE AREA: GUILFORD, HEBRON, MADISON, MERIDEN, AND ROCKY HILL. BY LAND AREA, MIDDLESEX COUNTY (369.3 SQUARE MILES) IS THE SMALLEST COUNTY OF THE EIGHT COUNTIES IN CONNECTICUT AND IS THE SIXTH IN POPULATION SIZE (U.S. CENSUS, 2020). MUNICIPALITY SIZES BY LAND MASS VARY THROUGHOUT THE COUNTY, FROM 10.40 SQUARE MILES (ESSEX) TO 54.25 SQUARE MILES (EAST HADDAM) WITH MIDDLETOWN HAVING 41.02 SQUARE MILES OF LAND AREA. THE CITY OF MIDDLETOWN (ZIP CODE 06457) IS CENTRALLY LOCATED 16 MILES SOUTH OF HARTFORD. THE POPULATION IN MIDDLETOWN IS ECONOMICALLY AND RACIALLY / ETHNICALLY MORE DIVERSE WHEN COMPARED TO OTHER MUNICIPALITIES IN MIDDLESEX COUNTY AND IS ONE OF THE FEW COMMUNITIES IN CONNECTICUT TO INCLUDE URBAN, SUBURBAN, AND RURAL CHARACTERISTICS. THE DATA THAT FOLLOWS IS PER MIDDLESEX HEALTH'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT (2022).OF THE TOTAL STATE OF CONNECTICUT POPULATION (3,605,597), 4.6% (164,759) RESIDE IN MIDDLESEX COUNTY (U.S. CENSUS, 2021). WITH A POPULATION OF 47,108 (U.S. CENSUS, 2021), MIDDLETOWN IS THE LARGEST MUNICIPALITY IN MIDDLESEX COUNTY. THE REMAINING TOWNS IN MIDDLESEX HEALTH'S PRIMARY SERVICE AREA FALL INTO THREE POPULATION RANGES. COLCHESTER, CROMWELL, CLINTON, EAST HAMPTON AND OLD SAYBROOK HAVE POPULATIONS BETWEEN 10,000 AND 15,600. PORTLAND, EAST HADDAM, HADDAM, OLD LYME, DURHAM, WESTBROOK, ESSEX, KILLINGWORTH AND MARLBOROUGH HAVE POPULATIONS BETWEEN 5,000 AND 9,999. DEEP RIVER, MIDDLEFIELD, CHESTER AND LYME HAVE POPULATIONS LESS THAN 5,000. THE CONNECTICUT OFFICE OF RURAL HEALTH (CT-ORH) DEFINES RURAL AS ALL TOWNS WITH A POPULATION CENSUS OF 10,000 OR LESS AND A POPULATION DENSITY OF 500 OR LESS PEOPLE PER SQUARE MILE. BASED ON THIS METRIC, THE TOWNS OF CHESTER, DEEP RIVER, DURHAM, EAST HADDAM, HADDAM, KILLINGWORTH, LYME, MARLBOROUGH, MIDDLEFIELD, OLD LYME AND WESTBROOK ARE CONSIDERED RURAL. FOR THE AGE DISTRIBUTIONS, MIDDLESEX COUNTY IS LOWER THAN THE STATE AVERAGE IN THE 0-19 AND 20-44 AGE GROUPS AND EXCEEDS THE STATE AVERAGE IN THE 45-64 AND 65+ AGE GROUPS. MIDDLETOWN IS LOWER THAN THE STATE AVERAGE IN THE 0-19 AGE GROUP, IS SIGNIFICANTLY HIGHER THAN THE STATE AVERAGE IN THE 20-44 AGE GROUP AND LOWER THAN THE STATE AVERAGE IN THE 45-64 AND 65+ AGE GROUPS. WHEN EXTRACTING AGE 65+, MIDDLESEX COUNTY (19.0%) EXCEEDS CONNECTICUT (17.2%), AND THE MAJORITY OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA CONTINUE TO HAVE A GREATER CONCENTRATION OF OLDER ADULTS WHEN COMPARED TO CONNECTICUT. THE TOWNS OF COLCHESTER, MARLBOROUGH AND MIDDLETOWN FALL BELOW THE STATE AVERAGE OF 17.2%. PORTLAND IS ON PAR WITH THE STATE AVERAGE, WHILE CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, HADDAM, KILLINGWORTH, AND MIDDLEFIELD EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 19.1%-24.8%, AND ESSEX, LYME, OLD LYME, OLD SAYBROOK, AND WESTBROOK CONSIDERABLY EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 26.2%-30.9% (CT DATA COLLABORATIVE, 2016-2020).MIDDLETOWN HAS A MORE DIVERSE RACIAL / ETHNIC DEMOGRAPHIC RELATIVE TO THE OTHER TOWNS IN MIDDLESEX COUNTY AND RESEMBLES CONNECTICUT EXCEPT IN THE HISPANIC OR LATINO CATEGORY, WHERE MIDDLETOWN HAS A SMALLER POPULATION. MIDDLESEX COUNTY'S RACE AND HISPANIC OR LATINO ORIGIN COMPOSITION IS 82.4% WHITE, NON-HISPANIC OF LATINO; 6% BLACK OR AFRICAN AMERICAN, NON-HISPANIC; 7.1% HISPANIC OR LATINO; 3.3% ASIAN, NON-HISPANIC; 2.2% TWO OR MORE RACES, NON-HISPANIC (U.S. CENSUS QUICK FACTS 2021). MIDDLETOWN'S RACE AND HISPANIC OR LATINO ORIGIN COMPOSITION IS 66.8% WHITE, NON-HISPANIC OR LATINO; 15.8% BLACK OR AFRICAN AMERICAN, NON-HISPANIC; 10.3% HISPANIC OR LATINO; 6% ASIAN, NON-HISPANIC; 4.2% TWO OR MORE RACES, NON-HISPANIC (U.S. CENSUS QUICK FACTS 2021).THE MEDIAN HOUSEHOLD INCOME PER TOWN IN MIDDLESEX HEALTH'S SERVICE AREA RANGES FROM $62,022 (MIDDLETOWN) TO $130,635 (DURHAM) AND ALL TOWNS EXCEPT MIDDLETOWN, MIDDLEFIELD AND WESTBROOK EXCEED CONNECTICUT'S MEDIAN INCOME OF $79,855 (CONNECTICUT DATA COLLABORATIVE, 2016-2020). THERE ARE SIGNIFICANT MEDIAN HOUSEHOLD INCOME DISPARITIES WHEN DATA POINTS ARE DISAGGREGATED BY RACE AND ETHNICITY AND COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO. IN MIDDLETOWN, WHITE HOUSEHOLDS EARN 1.6 TIMES MORE THAN BLACK HOUSEHOLDS AND 1.8 TIMES MORE THAN HISPANIC OR LATINO HOUSEHOLDS. IN MIDDLESEX COUNTY, WHITE HOUSEHOLDS EARN 1.8 TIMES MORE THAN BLACK HOUSEHOLDS AND 1.6 TIMES MORE THAN HISPANIC OR LATINO HOUSEHOLDS. WHILE THE GAP IS NARROWER, WHITE HOUSEHOLDS EARN 1.1 TIMES MORE (MIDDLETOWN) AND 1.4 TIMES MORE (MIDDLESEX COUNTY) THAN ASIAN HOUSEHOLDS. FOR POVERTY STATUS, THE TOTAL POVERTY RATE FOR MIDDLETOWN AT 12.3% EXCEEDS THE STATE OF CONNECTICUT AT 9.8%. THE TOTAL POVERTY RATES FOR MIDDLEFIELD (8.5%) AND MARLBOROUGH (8.4%) EXCEED THE MIDDLESEX COUNTY TOTAL POVERTY RATE OF 7.1%. THE UNDER 18 POVERTY RATE FOR MIDDLETOWN AT 16.1% EXCEEDS THE STATE OF CONNECTICUT AT 13.0%. THE UNDER 18 POVERTY RATES FOR THE TOWNS OF COLCHESTER (11.6%), PORTLAND (10.9%), MIDDLEFIELD (9.3%) AND EAST HAMPTON (8.7%) EXCEED THE MIDDLESEX COUNTY UNDER 18 POVERTY RATE OF 8.3% (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2016-2020).POVERTY RATES ARE SIGNIFICANTLY MORE PRONOUNCED AMONG BLACK OR AFRICAN AMERICAN ALONE, HISPANIC OR LATINO, AND TWO OR MORE RACES POPULATIONS IN MIDDLETOWN AND MIDDLESEX COUNTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO FOR THE TOTAL AND UNDER 18 CATEGORIES. BLACK OR AFRICAN AMERICAN ALONE RESIDENTS ARE 2.5 TIMES MORE LIKELY (MIDDLETOWN) AND 3.2 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. HISPANIC OR LATINO RESIDENTS ARE 4.1 TIMES MORE LIKELY (MIDDLETOWN) AND 3.8 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. ASIAN ALONE RESIDENTS ARE 1.2 TIMES MORE LIKELY (MIDDLETOWN) AND 2 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. RESIDENTS WITH TWO OR MORE RACES ARE 2.7 TIMES MORE LIKELY (MIDDLETOWN) AND 3.1 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: CONNECTICUT DATA COLLABORATIVE, 2015-2019). UNDER AGE 18 BLACK OR AFRICAN AMERICAN ALONE YOUTH ARE 2.9 TIMES MORE LIKELY (MIDDLETOWN) AND 5.5 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER 18 AGE WHITE ALONE NOT HISPANIC OR LATINO YOUTH. UNDER AGE 18 HISPANIC OR LATINO YOUTH ARE 5.1 TIMES MORE LIKELY (MIDDLETOWN) AND 5.8 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER AGE 18 WHITE ALONE NOT HISPANIC OR LATINO YOUTH. UNDER AGE 18 YOUTH WITH TWO OR MORE RACES ARE 2.1 TIMES MORE LIKELY (MIDDLETOWN) AND 2.3 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER AGE 18 YOUTH WHITE ALONE NOT HISPANIC OR LATINO YOUTH (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: CONNECTICUT DATA COLLABORATIVE, 2015-2019).THE COVID-19 PANDEMIC HAD A PROFOUND IMPACT ON THE UNEMPLOYMENT RATE IN CONNECTICUT. IN FEBRUARY 2020, JUST PRIOR TO THE COVID-19 LOCKDOWN, THE UNEMPLOYMENT RATE IN CONNECTICUT WAS 3.4%. BY JUNE 2020, IT HAD MORE THAN TRIPLED TO 11.1%. AS OF JUNE 2021, THE UNEMPLOYMENT RATE IN CONNECTICUT WAS STILL HIGH AT 6.7% AND EXPERIENCED A DOWNWARD TREND AS OF JUNE 2022 AT 4% (CT DEPARTMENT OF LABOR, 2022). CONNECTICUT'S OVERALL UNEMPLOYMENT RATES WERE 3.7% IN 2019 AND 7.9% IN 2020. THE UNEMPLOYMENT RATES IN THE TOWNS IN MIDDLESEX COUNTY'S SERVICE AREA INCREASED SUBSTANTIALLY WHEN COMPARING 2019 TO 2020, DEMONSTRATING THE IMPACT OF THE COVID-19 PANDEMIC. WHILE ALL TOWNS EXPERIENCED A SIGNIFICANT INCREASE IN 2020, MIDDLETOWN HAD THE HIGHEST UNEMPLOYMENT RATE AT 7.3%. (CONTINUED AT END OF SECTION) PART VI, LINE 5: AS MIDDLESEX HOSPITAL IS A COMMUNITY HOSPITAL, INVOLVING COMMUNITY MEMBERS IN KEY FUNCTIONS HAS ALWAYS BEEN A PRIORITY. MIDDLESEX 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. MIDDLESEX 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 FY21 WAS $67,067,572 (EXCLUDING COMMUNITY BUILDING) WITH 65,214 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. IN FY21, THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT SERVICES SERVED 15,222 INDIVIDUALS AT A TOTAL COST OF $2,531,038 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 (MUA) EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDES 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 FY21, THE HOSPITAL'S HEALTH PROFESSIONS EDUCATION CATEGORY SERVED 1,080 INDIVIDUALS AT A TOTAL COST OF $11,624,148 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 INCLUDE FAMILY PRACTICE SERVICES, BEHAVIORAL HEALTH (INPATIENT AND OUTPATIENT), HOMECARE, PARAMEDICS, HOSPICE, CENTER FOR CHRONIC CARE MANAGEMENT DISEASE MANAGEMENT OUTPATIENT PROGRAMS (ADULT ASTHMA; CHILD ASTHMA; DIABETES EDUCATION AND DISEASE MANAGEMENT; MEDICAL NUTRITION THERAPY; SMOKING CESSATION; CHRONIC HEART FAILURE; AND CHILDHOOD WEIGHT MANAGEMENT); AMBULATORY INFUSION, CARDIAC REHAB, AND WOUND CARE. IN FY21 THE HOSPITAL'S SUBSIDIZED SERVICES SERVED 25,392 PEOPLE WITH A TOTAL COST OF $20,023,422 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 FY21, THE HOSPITAL'S ASSOCIATED COSTS FOR ALL (NON-INDUSTRY) RESEARCH PROJECTS TOTALED $294,902 AND SERVED 160 INDIVIDUALS. FINANCIAL AND IN-KIND CONTRIBUTIONS: MIDDLESEX HOSPITAL SUPPORTS THE COMMUNITY IN THE FORM OF FINANCIAL AND IN-KIND CONTRIBUTIONS. THE HOSPITAL'S MAIN CAMPUS AND SATELLITE LOCATIONS MAKE MEETING SPACE AVAILABLE, FREE-OF-CHARGE AND ON AN ON-GOING BASIS, FOR MANY COMMUNITY GROUPS THAT WOULD OTHERWISE STRUGGLE TO PAY FOR SPACE. IN ADDITION, EACH YEAR THE HOSPITAL MAKES SUBSTANTIAL CASH DONATIONS TO CAREFULLY SELECTED MISSION-DRIVEN COMMUNITY ORGANIZATIONS THROUGHOUT ITS SERVICE AREA. THE HOSPITAL'S FY21 SUPPORT FOR FINANCIAL AND IN-KIND CONTRIBUTIONS TOTALED $404,622, SERVING 1,339 INDIVIDUALS. COMMUNITY BENEFIT OPERATIONS: COMMUNITY BENEFIT OPERATIONS INCLUDE ACTIVITIES AND COSTS ASSOCIATED WITH COMMUNITY BENEFIT STRATEGIC PLANNING, ADMINISTRATION, ANNUAL GOAL ATTAINMENT, AND COMMUNITY HEALTH NEEDS ASSESSMENT PRODUCTION AND IMPLEMENTATION. MIDDLESEX HOSPITAL HAS A DEDICATED DIRECTOR OF COMMUNITY BENEFIT AND A REPORTING STRUCTURE THAT OVERSEES COMMUNITY BENEFIT PLANNING AND OPERATIONS. OUTSIDE OF ON-GOING COMMUNITY BENEFIT ACTIVITIES, KEY COMPONENTS OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM IS CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOPING A CHNA IMPLEMENTATION STRATEGY EVERY THREE TAXABLE YEARS, ENSURING THAT THE CHNA IMPLEMENTATION STRATEGY GOALS ARE ADDRESSED THROUGH COLLABORATION WITH COMMUNITY PARTNERS, AND FOCUSING ON HEALTH EQUITY AND HEALTH-RELATED SOCIAL NEEDS. THE HOSPITAL'S FY21 COMMUNITY BENEFIT OPERATIONS EXPENSE TOTALED $133,031. PART VI, LINE 6: THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. MIDDLESEX HEALTH IS A FULLY COMPREHENSIVE NETWORK OF EXPERT HEALTH CARE PROVIDERS THAT HAS CONVENIENT LOCATIONS THROUGHOUT CENTRAL CONNECTICUT AND THE SHORELINE. MEMBERS OF THE COMMUNITY ARE ALWAYS CLOSE TO CARE FOR EVERY FAMILY MEMBER AT EVERY AGE. MIDDLESEX HEALTH PROVIDES THE BEST CARE POSSIBLE FOR JUST ABOUT ALL YOUR HEALTH AND WELLNESS NEEDS.THE ORGANIZATIONS INCLUDED IN THE AFFILIATED HEALTH CARE SYSTEM ARE AS FOLLOWS:MIDDLESEX HOSPITAL - A NON-PROFIT, ACUTE CARE, COMMUNITY HOSPITAL IN MIDDLETOWN, CT.MIDDLESEX HEALTH SERVICES PROVIDING INTEGRATIVE MEDICINE SERVICES TO THE COMMUNITY.MHS PRIMARY CARE - PROVIDES PATIENT-CENTERED COMPASSIONATE CARE TO ALL MEMBERS OF THE COMMUNITY.MIDDLESEX HOSPITAL FOUNDATION - SUPPORTS MIDDLESEX HOSPITAL.MIDDLESEX HEALTH SYSTEM - PARENT OF AND PROVIDES FUNDRAISING SERVICES FOR MIDDLESEX HOSPITAL. PART VI, LINE 7, REPORTS FILED WITH STATES CT PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT: UNDER THE CONNECTICUT GENERAL STATUTES 19A-127K, HOSPITALS THAT HAVE A COMMUNITY BENEFIT PROGRAM IN PLACE, AS SPECIFIED BY THE STATUTE, ARE REQUIRED TO REPORT BIENNIALLY TO THE STATE OF CT. THIS BIENNIAL COMMUNITY BENEFIT REPORTING IS CURRENTLY UNDER THE AUSPICES OF THE STATE OF CONNECTICUT'S OFFICE OF HEALTH STRATEGY. AS MIDDLESEX HOSPITAL MEETS THE STATUTE AS HAVING A COMMUNITY BENEFIT PROGRAM IN PLACE, IT REPORTS BIENNIALLY TO THE STATE OF CT'S OFFICE OF HEALTH STRATEGY. EFFECTIVE JANUARY 1, 2023, SECTION 19A-127K OF THE GENERAL STATUTES WAS REPEALED AND WAS REPLACED BY PUBLIC ACT NO. 22-58 (AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS REGARDING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES). SECTION 50 OF PUBLIC ACT NO. 22-58 OUTLINES THE COMMUNITY BENEFIT REPORTING REQUIREMENTS. ON OR BEFORE OCTOBER 1, 2023, AND ANNUALLY THEREAFTER, EACH HOSPITAL SHALL SUBMIT TO THE OFFICE OF HEALTH STRATEGY A STATUS REPORT ON SUCH HOSPITAL'S COMMUNITY BENEFIT PROGRAM. 1 MIDDLESEX CHAMBER OF COMMERCE 393 MAIN STREET MIDDLETOWN CT 06457 060452410 501(C)(6) 61735 0 GENERAL SUPPORT COMMUNITY FOUNDATION OF MIDDLESEX COUNTY 211 SOUTH MAIN STREET MIDDLETOWN CT 06457 061477711 501(C)(3) 25000 0 GENERAL SUPPORT THE BUSHNELL 166 CAPITOL AVE HARTFORD CT 06106 060662112 501(C)(3) 6990 0 GENERAL SUPPORT VARSITY COMMUNICATIONS INC 5720 204TH ST SUITE 100 LYNNWOOD WA 98036 911430177 15500 0 2022 CT GOLF SHOW SPONSOR SEASONS PUBLICATIONS 821 SAWGRASS LANE NEW SMYRNA BEACH FL 32168 205146106 15000 0 GENERAL SUPPORT MAIDEN UNITED INC PO BOX 290276 WETHERSFIELD CT 06129 465046996 501(C)(3) 10000 0 GENERAL SUPPORT 3 3 PART I, LINE 2: THE PUBLIC RELATIONS DEPARTMENT HAS A POLICY REGARDING WHICH ORGANIZATIONS THEY ARE WILLING TO PARTNER WITH AND GIVE GRANTS OR ASSISTANCE. THEN ONCE THE GRANT OR ASSISTANCE IS AWARDED THE PUBLIC RELATIONS DEPARTMENT WORKS CLOSELY WITH EACH OF THE ORGANIZATIONS TO ENSURE THAT THE GRANT OR ASSISTANCE IS USED FOR THE INTENDED PURPOSES. THIS IS DONE BY CONTACT AND ATTENDANCE AT THE SPONSORED EVENTS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 VINCENT CAPECE JR PRESIDENT/CEO 815772 0 216000 0 307284 0 270400 0 33049 0 1642505 0 283258 0 SUSAN MARTIN VP FINANCE/TREASURER 466481 0 71000 0 31166 0 42112 0 24818 0 635577 0 22033 0 EVAN JACKSON VP STRATEGIC PLANNING 381005 0 68500 0 43456 0 59140 0 33123 0 585224 0 40173 0 DAVID COSENTINO VP QUALITY & PATIENT SAFETY 426208 0 60898 0 2974 0 63717 0 31014 0 584811 0 0 0 THEODORE HARTENSTEIN MED DIRECTOR, UTILIZATION 493574 0 19250 0 300 0 17400 0 33338 0 563862 0 0 0 JONATHAN BANKOFF CHAIRMAN EMERGENCY MEDICIN 448053 0 20800 0 450 0 20300 0 31059 0 520662 0 0 0 DAVID GIUFFRIDA VP FACILITIES AND SUPPORT 346270 0 52300 0 42918 0 58030 0 14209 0 513727 0 38018 0 JEFFREY SHELTON CHAIRMAN DEPT PSYCH 427564 0 19250 0 450 0 17400 0 22440 0 487104 0 0 0 BRIAN MCGUIRE MEDICAL DIRECTOR ED 321805 0 103053 0 450 0 20300 0 33809 0 479417 0 0 0 RICARDO PEREZ PULMONOLOGIST 298479 0 130427 0 240 0 11600 0 31059 0 471805 0 0 0 JUSTIN GORALNIK PULMONOLOGIST 322200 0 116099 0 270 0 14500 0 14089 0 467158 0 0 0 LAURA MARTINO VP MARKETING & DEVELOPMENT 0 334337 0 59400 0 7114 0 23200 0 23930 0 447981 0 0 DONNA STRONESKI VP HUMAN RESOURCES 299507 0 45200 0 38496 0 53320 0 4389 0 440912 0 33670 0 TODD BISHOP CHIEF DEPT OF MED 374401 0 37148 0 450 0 17400 0 2522 0 431921 0 0 0 JESSE WAGNER MD HOSPITALIST 218800 0 112431 0 57302 0 18196 0 7262 0 413991 0 56109 0 KELLY HAECKEL VP PATIENT CARE SERVICES/CNO 279880 0 39000 0 1413 0 45840 0 30300 0 396433 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES - REPRESENTS A CORPORATE MEMBERSHIP AT A GOLF CLUB USED FOR VARIOUS BUSINESS PURPOSES. THE ASSOCIATED COST IS INCLUDED IN THE TAXABLE COMPENSATION OF THE EXECUTIVE STAFF MEMBER ACCORDING TO IRS RULES AND REGULATIONS. THIS BENEFIT WAS PROVIDED TO THE FOLLOWING INDIVIDUAL: VINCENT CAPECE PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED COMPENSATION FROM A SERP, WHICH WAS INCLUDED IN PART II, COLUMN B(III) AND COLUMN F: VINCENT CAPECE = $283,258 SUSAN MARTIN = $22,033 JESSE WAGNER, MD = $56,109 DAVID GIUFFRIDA = $38,028 EVAN JACKSON = $40,173 DONNA STRONESKI = $33,670 SERP CONTRIBUTIONS WERE MADE FOR THE FOLLOWING INDIVIDUALS AND ARE INCLUDED IN PART II, COLUMN C: VINCENT CAPECE = $247,200 DAVID CONSENTINO = $40,517 DAVID GIUFFRIDA = $34,830 KELLY HAECKEL = $28,600 EVAN JACKSON = $38,840 SUSAN MARTIN = $18,912 DONNA STRONESKI = $30,120 PART II, COLUMN (B)(II) - BONUS & INCENTIVE COMPENSATION: THE AMOUNTS REPRESENT INCENTIVE COMPENSATION PAYMENTS MADE IN CALENDAR YEAR 2021. PAYMENTS INCLUDE AMOUNTS EARNED IN 2020 AND DEFERRED, WHERE APPLICABLE. A CHEFA - SERIES O 060806186 20774YWD5 2015-05-19 19491965 REFINANCE L BONDS 0 0 0 B CHEFA - SERIES P 060806186 2016-06-10 9683000 REFINANCE M BONDS 0 0 0 C CHEFA - SERIES Q 060806186 2017-11-21 11599000 REFINANCE N BONDS 0 0 0 A 4500000 19491965 388960 19103010 2015 0 1 1 1 B 5460338 10347540 193660 10153880 2016 0 1 1 1 C 2049185 11599000 231980 11367020 2021 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CHEFA - SERIES O DATE THE REBATE COMPUTATION WAS PERFORMED: 05/19/2020 ISSUER NAME: CHEFA - SERIES P DATE THE REBATE COMPUTATION WAS PERFORMED: 06/10/2021 SCHEDULE K, PART II, LINE 3: SERIES P BONDS (COLUMN B) AND SERIES Q BONDS (COLUMN C) - THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS IS INVESTMENT EARNINGS. SCHEDULE K, PART II, LINE 11: THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES O BONDS (COLUMN A) WAS USED TO REFUND THE CHEFA SERIES L BONDS DATED DECEMBER 7, 2006. THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES P BONDS (COLUMN B) WAS USED TO REFUND THE CHEFA SERIES M BONDS DATED DECEMBER 7, 2006. THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES Q BONDS (COLUMN C) WAS USED TO PARTIALLY REFUND THE CHEFA SERIES N BONDS DATED JULY 26, 2011. IN ADDITION, $736 WAS A PREPAYMENT OF INTEREST. SCHEDULE K, PART III, LINE 3: SERIES O BONDS (COLUMN A) AND SERIES P BONDS (COLUMN B) - THE ORGANIZATION HAS DETERMINED THAT ALL MANAGEMENT/SERVICE CONTRACTS MEET THE SAFE HARBOR UNDER REV. PROC. 2017-13, 2017-6 I.R.B. 787. DAVID GIUFFRIDA KEY EMPLOYEE 791898 SEE PART V 0 JESSE WAGNER MD KEY EMPLOYEE 71470 SEE PART V 0 DAVID COSENTINO KEY EMPLOYEE 240739 SEE PART V 0 ROSEMARY BENOIT BOARD MEMBER 22550 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF INTERESTED PERSON: DAVID GIUFFRIDA(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN INDEPENDENT CONTRACTOR ARRANGEMENT WITH GUIFFRIDA ELECTRIC, CO., WHICH IS MORE THAN 35% OWNED BY A FAMILY MEMBER OF DAVID GIUFFRIDA.(A) NAME OF INTERESTED PERSON: JESSE WAGNER, MD(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN EMPLOYMENT ARRANGEMENT WITH RUTH WAGNER, REGISTERED NURSE, WHO IS A FAMILY MEMBER OF JESSE WAGNER, MD.(A) NAME OF INTERESTED PERSON: DAVID COSENTINO(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN EMPLOYMENT ARRANGEMENT WITH MEGAN COSENTINO, WHO IS A FAMILY MEMBER OF DAVID COSENTINO.(A) NAME OF INTERESTED PERSON: DAVID C. BENOIT(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN EMPLOYMENT ARRANGEMENT WITH ROSEMARY BENOIT, WHO IS A FAMILY MEMBER OF DAVID C. BENOIT. X 6 63911 FMV 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN B IS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: MIDDLESEX HOSPITAL IS AN ACUTE CARE GENERAL HOSPITAL SERVING THE RESIDENTS OF MIDDLESEX COUNTY AND VARIOUS SURROUNDING COMMUNITIES PROVIDING SELECTED HIGH-QUALITY INPATIENT AND OUTPATIENT HEALTH SERVICES. THE HOSPITAL MAINTAINS FORMAL RELATIONSHIPS WITH SPECIALIZED PROVIDERS TO ASSURE COORDINATION OF CARE WHEN SERVICES ARE NOT LOCALLY AVAILABLE. AN INTEGRAL PART OF THE CORE PROGRAMS, SPANNING THEIR TRADITIONAL DIAGNOSTIC AND TREATMENT SERVICES, ARE THE SCORES OF SPECIAL PROGRAMS OFFERED TO THE COMMUNITIES SERVED, MANY OF WHICH FOCUS ON THE DISADVANTAGED AND UNDERSERVED, THOSE SPECIAL POPULATIONS SUCH AS MINORITIES, OLDER PERSONS, PERSONS LIVING IN POVERTY WITH DISABILITIES, CHRONICALLY MENTALLY ILL PERSONS, AND OTHER DISENFRANCHISED PERSONS. MANY OTHER SPECIAL PROGRAMS WITH A FOCUS TO REACH OUT TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF ECONOMIC CONDITION OR SOCIAL STATUS RESPOND TO PUBLIC HEALTH NEEDS AND INVOLVE EDUCATION OR RESEARCH THAT IMPROVES OVERALL COMMUNITY HEALTH. ALL OF THESE SPECIAL PROGRAMS ARE OFFERED FREE OF CHARGE OR OFFERED AT A RATE THAT IS CONSIDERABLY LESS THAN THE COST OF PROVIDING THEM. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE HOSPITAL IS MIDDLESEX HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, MIDDLESEX HEALTH SYSTEM, INC. HAS THE RIGHT TO ANNUALLY ELECT THE BOARD OF DIRECTORS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, MIDDLESEX HEALTH SYSTEM, INC., HAS ALL RIGHTS CONFERRED BY LAW, THE CERTIFICATE OF INCORPORATION AND 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 IN ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF THE FORM 990 IS PROVIDED TO EACH BOARD MEMBER FOR THEIR REVIEW AND CHANGES FROM PRIOR YEAR ARE HIGHLIGHTED. ANY QUESTIONS OR COMMENTS THEY HAVE ARE PRESENTED TO EXECUTIVE MANAGEMENT. A COMPLETE COPY OF THE FINAL FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. 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 SYSTEM COMPLIANCE OFFICER. MATERIAL CONFLICTS ARE REPORTED TO THE 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, AS THEY OCCUR. 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. FORM 990, PART VI, SECTION B, LINE 15 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 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. THE LAST COMPENSATION REVIEW OCCURRED 12/2021. 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 AND FORM 990 WITH THOSE OF OTHER AFFILIATES AS THEY BECOME AVAILABLE, AS WELL AS STATEMENTS AND FORMS 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. FORM 990, PART XI, LINE 9: TRANSFER (TO) / FROM MIDDLESEX HEALTH SERVICES, INC. 420,158. TRANSFER (TO) / FROM MIDDLESEX HEALTH SYSTEM, INC. -626,124. TRANSFER (TO) / FROM MHS PRIMARY CARE -14,556,705. TRANSFER (TO) / FROM RESOURCES 1,147,383. CHANGE IN ASSETS HELD IN TRUST -919,000. CHANGE IN TEMP RESTRICTED NET ASSETS -1,208,000. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 3B: MIDDLESEX HOSPITAL DOES NOT HAVE A SEPARATE AUDIT PERFORMED UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. MIDDLESEX HOSPITAL IS INCLUDED IN THE A-133 AUDIT PERFORMED FOR MIDDLESEX HEALTH SYSTEM FOR PURPOSES OF THE A-133 AUDIT. THE RELEVANT ACTIVITIES AND EXPENDITURES OF MIDDLESEX HOSPITAL ARE REVIEWED AND THE RESULTS ARE INCLUDED IN THE SINGLE A-133 AUDIT REPORT FOR MIDDLESEX HEALTH SYSTEM. MIDDLESEX HEALTH SYSTEM INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676137 SUPPORT CT 501(C)(3) LINE 12B, II N/A 0 MIDDLESEX HEALTH SERVICES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676140 HEALTHCARE CT 501(C)(3) LINE 10 MIDDLESEX HEALTH SYSTEM INC 0 MIDDLESEX HOSPITAL FOUNDATION INC 28 CRESCENT STREET MIDDLETOWN CT 06457 273720822 SUPPORT CT 501(C)(3) LINE 12B, II MIDDLESEX HOSPITAL 1 MHS PRIMARY CARE INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061472743 HEALTHCARE CT 501(C)(3) LINE 10 MIDDLESEX HEALTH SYSTEM INC 0 MIDDLESEX HEALTH RESOURCES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061089925 RENTAL REAL ESTATE CT N/A C 0 INTEGRATED RESOURCES FOR THE MIDDLESEX AREA LLC 28 CRESCENT STREET MIDDLETOWN CT 06457 061462230 OUTPATIENT CARE CT N/A C 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1