2023-08-15T10:50:52-05:00 2022-09-30 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2021-10-01 060646599 DAY KIMBALL HEALTHCARE INC % PAUL A BEAUDOIN DAYK 8609286541 320 POMFRET STREET PUTNAM CT 06260 PAUL BEAUDOIN CFO 4178317283 2023-08-15 true PAUL BEAUDOIN XXX-XX-XXXX Brian D Todd P00422601 4178658701 2 2021 2023-04-26 12:10:37Z DAY KIMBALL HOSPITAL KYLE KRAMER 320 POMFRET STREET PUTNAM CT 06260 139761697 false X WWW.DAYKIMBALL.ORG X 1894 CT DKH IS A SHORT-TERM GENERAL CARE HOSPITAL PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO NORTHEASTERN CT AND BORDER COMMUNITIES IN MA AND RI. 18 14 1042 39 0 0 7622084 7941179 120053667 118250256 2064614 1119765 -3203 -18179 129737162 127293021 0 0 0 0 56837790 53693251 0 0 0 62544720 66219538 119382510 119912789 10354652 7380232 92896606 78766295 113028483 94464307 -20131877 -15698012 THE MISSION OF DAY KIMBALL HEALTHCARE IS TO IMPROVE THE HEALTH AND WELLBEING OF OUR COMMUNITY BY PROVIDING THE BEST MEDICAL CARE. false false 99687932 106572940 DAY KIMBALL HEALTHCARE PROVIDES A COMPREHENSIVE HEALTHCARE SYSTEM OFFERING PRIMARY CARE AND A MULTITUDE OF MEDICAL AND SURGICAL SPECIALTIES ALONG WITH LEADING-EDGE TECHNOLOGY AND SOPHISTICATED DIAGNOSTICS. OUR SERVICE AREA INCLUDES NORTHEAST CONNECTICUT AS WELL AS NEARBY MASSACHUSETTS AND RHODE ISLAND COMMUNITIES. DAY KIMBALL HEALTHCARE'S COMPREHENSIVE NETWORK OFFERS MORE THAN 1,000 EMPLOYEES INCLUDING MORE THAN 200 HIGHLY SKILLED PHYSICIANS, SURGEONS AND SPECIALISTS. 10922918 11677316 PHYSICIAN OFFICE PROVIDING PRIMARY CARE AND OUTPATIENT VISITS TO NORTHEASTERN CONNECTICUT COMMUNITIES. 110610850 true true false true false false false false false true true true false true true false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false true true true true false false true 98 0 true 1042 true false false false false false false false false false false false false X 18 14 false true false false false true false true true false false true true true true true true true true false X PAUL A BEAUDOIN 8609286541 320 POMFRET STREET PUTNAM CT 06260 X RICHARD WILCON PRESIDENT, MED STAFF BEG 07/22 1.0 40.0 X X 24000 528582 34043 CARMEN PISC PHYSICIAN 40.0 0.0 X 504452 0 1370 PAUL BEAUDOIN CFO 40.0 3.0 X 492311 0 458 MICHAEL BAUM DIRECTOR 1.0 41.0 X 28800 437132 26324 ALEJANDO CARVAJAL PHYSICIAN 40.0 0.0 X 428254 0 10918 ALEXANDRE CARRE PHYSICIAN 40.0 0.0 X 384550 0 370 ANTHONY CHIEFFALO DIRECTOR END 02/22 1.0 40.0 X 14200 284055 17600 PAUL MATTY DIRECTOR 1.0 40.0 X 12000 279242 8377 JOHN GRAHAM MD VP MEDICAL AFFAIRS/CMO 40.0 0.0 X 245858 0 272 JOHN O'KEEFE CNO 40.0 0.0 X 227473 0 17562 JOHN MODICA PHYSICIAN 40.0 0.0 X 229217 0 14814 KRISTA MATSEN DIRECTOR 1.0 40.0 X 12000 192362 5771 JANICE THURLOW CHAIRWOMAN 1.0 2.0 X X 0 0 0 PETER DEARY VICE CHAIR 1.0 1.0 X X 0 0 0 KATHY ROCHA SECRETARY 1.0 1.0 X X 0 0 0 EDWIN HIGGINS ASST SECRETARY / TREASURER 1.0 0.0 X X 0 0 0 KYLE KRAMER CEO/DIRECTOR 40.0 3.0 X X 0 0 0 KAREN COLE DIRECTOR BEG 02/22 1.0 0.0 X 0 0 0 JAY CYR DIRECTOR BEG 02/22 1.0 0.0 X 0 0 0 MATTHEW DESAULNIER DIRECTOR BEG 02/22 1.0 0.0 X 0 0 0 ANNE LAMODY DIRECTOR BEG 02/22 1.0 0.0 X 0 0 0 DANIEL SULLIVAN DIRECTOR BEG 02/22 1.0 0.0 X 0 0 0 NANCY WEISS DIRECTOR 1.0 1.0 X 0 0 0 STEVEN WEXLER DIRECTOR 1.0 0.0 X 0 0 0 JAMES ZAHANSKY DIRECTOR BEG 02/22 1.0 0.0 X 0 0 0 KEVIN P JOHNSTON DIRECTOR 1.0 0.0 X 0 0 0 SHAWN MCNERNEY DIRECTOR END 12/21 1.0 0.0 X 0 0 0 JEFFREY PAUL TREASURER END 12/21 1.0 0.0 X X 0 0 0 2603115 1721373 137879 76 false true false SODEXO 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 NUTRITIONAL 2013149 ENSEMBLE PO BOX 639076 CINCINNATI OH 45263 BILLING 867255 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 554850737 HEALTHCARE SRVCS 1690984 NORTH AMERICAN PARTNERS IN ANESTHES 68 SOUTH SERVICE ROAD STE 350 MELVILLE NY 11747 MGMT SRVCS 963456 ALLIANCE HEALTHCARE PO BOX 735714 DALLAS TX 753735714 HEALTHCARE SVC 919876 96 7905803 35376 7941179 NET PATIENT SERVICE REVENUE 621110 106572940 106572940 OTHER 900099 8927972 8927972 PHARMACY 446110 2035037 2035037 CAFETERIA 722514 412111 412111 AFFILIATED ORGANIZATION RENT 531120 302196 302196 118250256 359436 359436 0 0 160799 178978 -18179 0 -18179 -18179 13048027 2000 12289698 758329 2000 760329 760329 0 0 0 0 0 0 0 0 0 0 127293021 118250256 1101586 X 0 0 0 0 828804 336035 492769 0 43405998 40091051 3314947 874138 798871 75267 5217921 4767542 450379 3366390 3076529 289861 0 986349 986349 242707 242707 56250 56250 0 75452 75452 18953528 17321547 1631981 204898 187255 17643 4551891 4159954 391937 3362620 3073084 289536 0 2106337 1924972 181365 170237 155579 14658 0 2474 2261 213 1694080 1548212 145868 0 4063010 3713167 349843 2310518 2111572 198946 MEDICAL SUPPLIES & DRUGS 16191526 16191526 PROVIDER TAX 10133103 10133103 REPAIRS & MAINTENANCE 815396 745187 70209 LICENSES, DUES, SUBSCRIPTIONS 299162 273403 25759 119912789 110610850 9301939 0 0 6666 11211339 8889876 76449 0 13243482 12986456 0 0 0 0 0 0 2932701 3182101 364289 413811 142465869 103711594 38239837 38754275 698209 0 20399676 10421053 0 0 0 0 5730624 4112057 92896606 78766295 26483377 29934245 0 0 0 0 18272094 16946852 0 0 0 0 8879518 10223672 385539 330140 59007955 37029398 113028483 94464307 X -27297367 -21892384 7165490 6194372 -20131877 -15698012 92896606 78766295 X 7380232 -2630607 -315760 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 56250 56250 false SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: DAY KIMBALL HOSPITAL PAID DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION DURING THE FISCAL YEAR. A PORTION OF THESE DUES MAY BE ATTRIBUTABLE TO LOBBYING EXPENSES. 13303764 -1726549 4250000 75452 7251763 11737989 2076148 430000 80373 13303764 11512363 672481 375000 71856 11737988 12101552 233920 750000 73109 11512363 11812302 863836 500000 74586 12101552 0.86000 0.14000 false false 1276668 1276668 88350477 62357568 25992909 49091040 39263025 9828015 3747684 2091001 1656683 38754275 INV IN VHA COALITION 80000 C INVESTMENTS IN REAL ESTATE 104779 C FUNDS HELD IN TRUST BY OTHERS 3154812 F BOARD RESTRICTED ENDOWMNT FUND 7081462 F 10421053 DUE FROM AFFILIATE 90156 EST AMT DUE FROM THIRD PARTY 100639 INSURANCE CLAIMS 1212403 RIGHT OF USE OF ASSETS 2708859 4112057 0 PENSION LIABILITIES 28614117 EST AMT DUE TO THIRD PARTIES 1700000 DEFERRED GAIN ON LIABILITIES 1146517 OTHER LIABILITIES 2860000 RIGHT OF USE LIABILITY 2708764 37029398 124390968 -2630607 -429523 -3060130 127451098 -158077 -158077 127293021 119662207 178978 178978 119483229 429560 429560 119912789 SCHEDULE D, PART X, LINE 4 ENDOWMENT FUND: THE HOSPITAL'S ENDOWMENT CONSISTS OF MULTIPLE FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES INCLUDING CAPITAL EXPENDITURES, OPERATIONS, AND OTHER DONOR-SPECIFIED RESTRICTIONS. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $( 354,108) PENSION/PROFESSIONAL LIABILITY EXPENSE ( 75,452) INVESTMENT MANAGEMENT FEES 37 NET ASSETS RELEASED FROM RESTRICTION ------------- $( 429,523) SCHEDULE D, PART XI, LINE 4B SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VII, LINE 12, BUT NOT ON LINE 1: $(178,978) RENT EXPENSE 20,901 CONTRIBUTIONS WITH DONOR RESTRICTIONS ------------- $(158,077) SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ 178,556 RENT EXPENSE SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 354,108 PENSION/PROFESSIONAL LIABILITY EXPENSE 75,452 INVESTMENT MANAGEMENT FEES ------------- $ 429,560 true true X true X 250. true X true true true false true true 93862 93862 0.00080 32734849 25368652 7366197 0.06160 30137 30137 32858848 25368652 7490196 0.06240 93144 93144 0.00080 8921841 7059882 1861959 0.01560 9014985 7059882 1955103 0.01640 41873833 32428534 9445299 0.07880 true 4960324 159094 24124640 27462204 -3337564 X true true 1 1 DAY KIMBALL HEALTHCARE 320 POMFRET STREET PUTNAM CT 06260 WWW.DAYKIMBALL.ORG 0043 X X X DAY KIMBALL HEALTHCARE false false true X X X X X X X X X 20 true true false true X SEE PART V, SECTION C X true 21 true SEE PART V, SECTION C false true X 250. 250. X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X true X false false SCHEDULE H, PART V, LINE 5 COMMUNITY INPUT: DAY KIMBALL HOSPITAL CONDUCTED A COMPREHENSIVE NEEDS ASSESSMENT UTILIZING FOCUS GROUPS AND PHONE SURVEYS OF COUNTY RESIDENTS ALONG WITH STATE AND FEDERAL DATA TO IDENTIFY AND PRIORITIZE THE HEALTHCARE NEEDS IN WINDHAM COUNTY. A BROAD RANGE OF INFORMATION WAS COLLECTED FROM THE FOLLOWING SOURCES: - ANONYMOUS PAPER AND ELECTRONIC SURVEYS TO EMPLOYEES AND DKH CORPORATORS FOCUSING ON ACCESS, QUALITY, AND SERVICES NEEDED. - INTERVIEWS WITH MORE THAN 50 COMMUNITY LEADERS. - DAY KIMBALL HEALTHCARE BOARD OF DIRECTORS. - DATA REVIEW FROM MULTIPLE PUBLICLY REPORTED RESOURCES SCHEDULE H, PART V, LINE 6A CHNA CONDUCTED WITH OTHER HOSPITALS: DAY KIMBALL HOSPITAL CONDUCTED ITS NEEDS ASSESSMENT IN CONJUNCTION WITH THE WINDHAM COUNTY HEALTHCARE CONSORTIUM. THE MEMBERS OF THIS CONSORTIUM INCLUDE WINDHAM HOSPITAL, DAY KIMBALL HOSPITAL, NATCHAUG HOSPITAL, GENERATIONS FAMILY HEALTH CENTER, UNITED SERVICES, VNA EAST, NORTHEAST DISTRICT DEPARTMENT OF HEALTH AND COMMUNITY HEALTH RESOURCES (CHR). SCHEDULE H, PART V, LINE 7A CHNA AVAILABILITY: THE ORGANIZATION'S CHNA REPORT WAS MADE AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/ABOUT-DAY-KIMBALL-HEALTHCARE/IN-THE-COMMUNITY/C OMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, LINE 10A IMPLEMENTATION STRATEGY AVAILABILITY: THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/ABOUT-DAY-KIMBALL-HEALTHCARE/IN-THE-COMMUNITY/C OMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, LINE 11 ADDRESSING IDENTIFIED NEEDS: DAY KIMBALL LEADERS CONTINUE TO HAVE ACTIVE DISCUSSIONS WITH REGIONAL OFFICIALS, SCHOOL ADMINISTRATORS, AND OTHER MEMBERS OF THE COMMUNITY REGARDING OVERARCHING HEALTH CARE RELATED ISSUES ACROSS THE REGION. THROUGH THESE ONGOING DISCUSSIONS, DAY KIMBALL HAVE IDENTIFIED THOSE NEEDS, GOALS TO CLOSE THE GAPS, AND IMPLEMENTATION STRATEGY FOR DOING SO OVER THE NEXT SEVERAL YEARS. DAY KIMBALL HOSPITAL WILL CONTINUE TO WORK WITH COMMUNITY PARTNERS AND ADVOCATES TOWARDS ADDRESSING SOCIAL AND ECONOMIC FORCES THAT CONCURRENTLY IMPACT THE HEALTH AND WELFARE OF THOSE THEY SERVE. IDENTIFIED NEEDS THAT DAY KIMBALL HOSPITAL IS COMMITTED TO ADDRESSING INCLUDE: - MAINTAIN PARTNERSHIPS WITH STATE AND LOCAL AGENCIES TO ASSESS RISK, REDUCE TRANSMISSION AND PROMOTE PREVENTION OF COVID-19. *CONTINUE FOLLOWING EMERGING DATA, POLICIES, AND REGULATIONS. *EXPLORE ALTERNATE RECRUITING STRATEGIES TO ADDRESS DYNAMIC CHANGES IN WORKFORCE. - INCREASE AVAILABILITY OF TRANSPORTATION IN THE REGION. *INCREASE ADVOCACY FOR STATE AND FEDERAL SUPPORT OF IMPROVED TRANSPORTATION SYSTEMS. *PROVIDE ONGOING SUPPORT OF ENHANCED TRANSPORTATION SYSTEMS; I.E. RIDESHARES AND BUSSING SERVICES. *ONGOING EXPLORATION OF GRANT OPPORTUNITIES - ADDRESS NUTRITIONAL CONCERNS FOR HEMATOLOGY/ONCOLOGY PATIENTS. *ADDRESSING THE NEEDS OF CANCER PATIENTS WHO STRUGGLE WITH FOOD PROVISIONS. *PROVIDE SHELF-STABLE AND PERISHABLE FOOD TO DKH ONCOLOGY PATIENTS. *PROVIDE NUTRITION EDUCATION AND INTERVENTIONS. - REDUCE FALLS AND DECREASE UTILIZATION OF FALL RELATED SERVICES WITH THE COMMUNITY. *EXPAND FALL PREVENTION EFFORTS THROUGH THE "CONTINUUM OF HEALTHCARE" INCLUDING: DKH HOSPITAL, HOMEMAKERS, OUTPATIENT REHAB, AND BEYOND. *BOLSTER COMMUNITY PARTNERSHIPS TO PROVIDE EXPANDED PROGRAMS. - PROVIDE EDUCATION TO REDUCE MORBIDITY AND MORTALITY ASSOCIATED WITH STROKE. *EDUCATION ON STROKE INTERVENTION, DIAGNOSIS, TREATMENT, AND MANAGEMENT. *EDUCATION ON POST-STROKE CARE AND MANAGEMENT. *REDUCE POSSIBILITY OF DISABILITY ASSOCIATED WITH STROKE. - PROVIDE SERVICES TO TREAT THE INCREASED NUMBER OF LOCAL CANCER CASES IN THE COMMUNITY. *RECRUIT TWO MEDICAL ONCOLOGISTS *SUPPORT CANCER SERVICE LINE GROWTH *MAINTAIN A SUCCESSFUL ACCREDITED CANCER CARE PROGRAM AT DKH. - EFFECTIVELY OPTIMIZE SURGICAL PATIENTS TO PREVENT SURGICAL SITE INFECTIONS AND MANAGE PAIN CONTROL. *UTILIZE ENHANCED RECOVERY AFTER SURGERY (ERAS) MEASURES TO PREVENT SURGICAL SITE INFECTIONS (SSI) *DECREASE OPIOID USAGE UTILIZING ALTERNATIVE MODALITIES FOR PAIN. - MANAGE PATIENT ENDOCRINE AND METABOLIC DISORDERS WITH EXPANDED SPECIALTY CARE SERVICES. *ADDRESS THE TRANSPORTATION ISSUES OF OUR DIABETIC PATIENTS BY PROVIDING EDUCATION AND INSTRUCTION ABOUT HOW TO PERFORM DIABETIC SELF-CARE AT HOME. *PROVIDE A MORE DEFINED EDUCATIONAL PROGRAM TO PRE-DIABETIC PATIENTS. - PROVIDE COMPREHENSIVE ASSESSMENT, DIAGNOSIS, AND TREATMENT FOR A RANGE OF PSYCHIATRIC CONDITIONS FOR NORTHEASTERN CONNECTICUT COMMUNITY MEMBERS. *ADDRESS EMOTIONAL NEEDS OF SCHOOL-AGE CHILDREN AND THEIR FAMILIES. *MAKE SIGNIFICANT INVESTMENTS IN TECHNOLOGY RESOURCES TO PROTECT PATIENT PRIVACY. *IMPLEMENT NEW PROGRAMS THAT SUPPORT AND ADDRESS STIGMA. SCHEDULE H, PART V, LINES 16A, 16B, & 16C FINANCIAL ASSISTANCE POLICY AVAILABILITY: THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE POLICY APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/RESOURCES/FINANCIAL-SERVICES/ 6 PLAINFIELD HEALTHCARE CENTER 31 DOW ROAD/12 LATHROP ROAD PLAINFIELD CT 06374 PRIMARY CARE; PEDIATRICS WOMEN'S HEALTH; LABORATORY DIAGNOSTIC IMAGING DANIELSON HEALTHCARE CENTER 55 GREEN HOLLOW ROAD DANIELSON CT 06239 DIAGNOSTIC IMAGING LABORATORY; PHYSICAL MEDICINE SERVICES DANIELSON MEDICAL ASSOCIATES 45 GREEN HOLLOW ROAD DANIELSON CT 06239 PRIMARY CARE SERVICES POMFRET STREET FAMILY MEDICAL ASSOCIATES 346 POMFRET STREET PUTNAM CT 06260 PRIMARY CARE SERVICES PULMONOLOGY SERVICES PUTNAM HEALTHCARE CENTER 6-12 SOUTH MAIN STREET PUTNAM CT 06260 LAB AND THERAPY SERVICES DAY KIMBALL HOMEMAKERS HOMECAREHOSPICE 24-32 SOUTH MAIN STREET PUTNAM CT 06260 UNSKILLED HOMECARE SERVICES SKILLED SERVICES SCHEDULE H, PART I, LINES 3A, 3B, & 3C DETERMINING ELIGIBILITY FOR FREE & DISCOUNTED CARE: TO QUALIFY FOR FREE CARE, AN INDIVIDUAL MUST MEET ALL OF THE CRITERIA: - SINGLE ACCOUNT BALANCE OF $250 OR GREATER OR ACCOUNTS SPANNING SIX MONTHS TOTALING $500 OR GREATER (INDIVIDUAL) OR ACCOUNTS SPANNING SIX MONTHS TOTALING $1000 OR GREATER FOR 2 OR MORE FAMILY MEMBERS (UNDER SAME GUARANTOR). - ANNUAL INCOME IS LESS THAN 250% OF THE CURRENT FEDERAL INCOME POVERTY LEVEL (FPL). - LIQUID ASSETS MUST NOT EXCEED $100,000 (INCLUDES STOCKS, BONDS, CASH, 401K, IRA, CD, PROPERTY AND BUSINESS VALUE, AND RECREATIONAL VEHICLES). TO QUALIFY FOR A 75% CHARITY CARE DISCOUNT, AN INDIVIDUAL MUST MEET ALL OF THE FOLLOWING CRITERIA: - SINGLE ACCOUNT BALANCE OF $250 OR GREATER OR ACCOUNTS SPANNING SIX MONTHS TOTALING $500 OR GREATER (INDIVIDUAL) OR ACCOUNTS SPANNING SIX MONTHS TOTALING $1000 OR GREATER FOR 2 OR MORE FAMILY MEMBERS (UNDER SAME GUARANTOR). - ANNUAL INCOME IS LESS THAN 250% OF THE CURRENT FEDERAL INCOME POVERTY LEVEL (FPL). - LIQUID ASSETS MUST NOT EXCEED $100,000 INCLUDING (STOCKS, BONDS, CASH, 401, IRA, CD, PROPERTY AND BUSINESS VALUE AND RECREATIONAL VEHICLES). - INSURED PATIENTS WHO HAVE NO ADDITIONAL COVERAGE (AND HAVE DOCUMENTATION THAT THEY HAVE EXHAUSTED THEIR INSURANCE) FOR THE REMAINDER OF THEIR PLAN YEAR WILL BE DEEMED "UNINSURED" UNDER SECTION A OF THIS POLICY. IF GRANTED CHARITY CARE, IT WILL BE ONE-TIME GRANTING. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COSTING METHODOLOGY THAT WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS DAY KIMBALL HOSPITAL'S COST-TO-CHARGE RATIO THAT WAS REPORTED IN THE FY2022 MEDICARE COST REPORT. SCHEDULE H, PART I, LINE 7G SUBSIDIZED SERVICES: DAY KIMBALL HOSPITAL PARTNERS WITH NORTHEASTERN CONNECTICUT COUNCIL OF GOVERNMENTS (NECCOG) TO PROVIDE LOCAL PARAMEDIC INTERCEPT SERVICES. DAY KIMBALL HOSPITAL AND NECCOG AGREED THAT THE ABSENCE OF PARAMEDIC INTERCEPT SERVICES IN NORTHEASTERN CONNECTICUT, COMPRISED OF MANY RURAL TOWNS, WOULD CREATE A SIGNIFICANT DEFICIENCY IN THE AVAILABILITY AND ACCESSIBILITY OF MEDICAL SERVICES IN THE COMMUNITY. THE HOSPITAL PROVIDES CERTAIN MONETARY AND IN-KIND SERVICES FOR THE PROVISION OF PARAMEDIC INTERCEPT SERVICES. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR IS EQUAL TO TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF FORM 990. SCHEDULE H, PART III, LINE A, LINE 2 BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS ESTIMATED USING THE PERCENTAGE OF THE POPULATION THAT IS BELOW THE POVERTY LINE IN THE HOSPITAL'S SERVICE AREA. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT RATIONALE: THE SHORTFALLS BETWEEN DAY KIMBALL HOSPITAL'S MEDICARE COSTS AND PAYMENTS ARE CONSIDERED COMMUNITY BENEFIT BECAUSE THE SERVICES WERE PROVIDED BY DAY KIMBALL HOSPITAL EVEN THOUGH THE COSTS WERE NOT COVERED OR REIMBURSED. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 WAS GROSS CHARGES REDUCED BY THE COST TO CHARGE RATIO THAT WAS REPORTED IN THE FY2022 MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION B, LINE 9B COLLECTION POLICY: IT IS THE PHILOSOPHY AND POLICY OF DAY KIMBALL HOSPITAL THAT MEDICALLY NECESSARY HEALTH CARE SERVICES SHOULD BE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE POLICY WAS WRITTEN IN ACCORDANCE WITH SECTION 9007 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACT), SIGNED INTO LAW ON MARCH 23, 2010, WHICH ADDS NEW SECTIONS 501(R) AND 4959 TO THE INTERNAL REVENUE CODE. SECTION 510(R) INCLUDES A SERIES OF SPECIFIC REQUIREMENTS FOR HOSPITALS TO RECEIVE AND MAINTAIN SECTION 501(C)(3) "TAX EXEMPT" STATUS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: DAY KIMBALL HOSPITAL HAS RECENTLY COMPLETED A COMMUNITY NEEDS ASSESSMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS UNDERTAKEN TO IDENTIFY SPECIFIC HEALTH CARE NEEDS IN WINDHAM COUNTY. FOCUS GROUPS, TELEPHONE SURVEYS AND STATE AND FEDERAL DATA WAS USED TO IDENTIFY THE SPECIFIC HEALTH CARE NEEDS DURING THIS ASSESSMENT. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ALL PATIENTS WHO ARE UNINSURED ARE REFERRED TO THE FINANCIAL COUNSELING DEPARTMENT; INPATIENTS ARE ALL VISITED BY A FINANCIAL COUNSELOR (OR GIVEN A FINANCIAL COUNSELING PACKET) PRIOR TO DISCHARGE WITH ALL OF THE AVAILABLE PROGRAMS THAT ARE AVAILABLE THROUGH OUR FINANCIAL ASSISTANCE (CHARITY CARE) POLICY. ANY SCHEDULED PATIENTS WHO ARE UNINSURED ARE CALLED BY THE FINANCIAL COUNSELORS IN ADVANCE TO PROVIDE ALL OF THE OPTIONS INCLUDING SCREENING FOR MEDICAID ASSISTANCE, CHARITY CARE, AS WELL AS SEVERAL OTHER LOCAL FUNDING SOURCES THAT THEY MAY QUALIFY FOR. ALL PATIENT STATEMENTS HAVE INFORMATION ABOUT OUR CHARITY CARE POLICY AS WELL AS DOWNLOADABLE CHARITY CARE APPLICATION. ALL OF OUR THIRD PARTY VENDORS, INCLUDING OUR BAD DEBT AGENCIES AND OUR LONG TERM PATIENT FINANCING PROGRAM THROUGH CAREPAYMENT ALSO PROVIDE OUR CHARITY CARE POLICY TO PATIENTS UPON REQUEST. OUR FINANCIAL ASSISTANCE GUIDELINES ARE ALSO POSTED IN ALL PATIENT REGISTRATION AREAS OF THE HOSPITAL. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: DAY KIMBALL HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF 13 TOWNS IN THE NORTHEASTERN CORNER OF CONNECTICUT AS WELL AS BORDERING MASSACHUSETTS AND RHODE ISLAND TOWNS. DAY KIMBALL'S SERVICE AREA IS OVER 438 SQUARE MILES AND CONTAINS APPROXIMATELY 116,192 IN WINDHAM COUNTY. THE POPULATION RANGES FROM LONG-TERM, MULTI-GENERATIONAL FAMILIES TO NEWLY IMMIGRATED WIDE RANGE OF SOCIO-ECONOMIC FACTORS INCLUDING VERY HIGH INCOME TO POVERTY; ADVANCED EDUCATION TO INCOMPLETE HIGH SCHOOL. THE MEDIAN HOUSEHOLD INCOME IN 2010 IN WINDHAM COUNTY WAS $58,489 (THE LOWEST INCOME OF ANY COUNTY IN THE STATE OF CONNECTICUT), WHILE THE STATE MEDIAN WAS $69,519. ACCORDING TO THE HEALTHY CONNECTICUT 2020 STATE HEALTH ASSESSMENT THAT WAS RELEASED IN MARCH 2014 THE LEADING CAUSE OF DEATH IN CONNECTICUT ARE HEART DISEASE AND CANCER. RESIDENTS FROM URBAN AREAS. ACCORDING TO THE 2010 CENSUS, 11.7% OF THE POPULATION IS UNDER POVERTY LEVEL AND 14.3% ARE OVER AGE 65. THERE IS A WIDE RANGE OF SOCIO-ECONOMIC FACTORS INCLUDING VERY HIGH INCOME TO POVERTY; ADVANCED EDUCATION TO INCOMPLETE HIGH SCHOOL. THE MEDIAN HOUSEHOLD INCOME IN 2010 IN WINDHAM COUNTY WAS $58,489 (THE LOWEST INCOME OF ANY COUNTY IN THE STATE OF CONNECTICUT), WHILE THE STATE MEDIAN WAS $69,519. ACCORDING TO THE HEALTHY CONNECTICUT 2020 STATE HEALTH ASSESSMENT THAT WAS RELEASED IN MARCH 2014 THE LEADING CAUSE OF DEATH IN CONNECTICUT ARE HEART DISEASE AND CANCER. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: THE MISSION OF DAY KIMBALL HOSPITAL IS TO MEET THE HEALTH NEEDS OF OUR COMMUNITY THROUGH OUR CORE VALUES OF CLINICAL QUALITY, CUSTOMER SERVICE, FISCAL RESPONSIBILITY AND LOCAL CONTROL. DAY KIMBALL HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND PHYSICIANS. THE MEDICAL STAFF IS OPEN TO ALL PHYSICIANS IN THE COMMUNITY WHO MEET MEMBERSHIP AND CLINICAL PRIVILEGE REQUIREMENTS. INPATIENT, OUTPATIENT AND EMERGENCY SERVICES THAT ARE MEDICALLY NECESSARY ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. SCHEDULE H, PART VI, LINE 6 AFFILIATE STRUCTURE: DAY KIMBALL HOSPITAL HAS A RELATIONSHIP WITH UMASS MEMORIAL MEDICAL CENTER AS ITS TERTIARY CARE SITE. WHEN PATIENTS' CARE REQUIRES SPECIALIZED TREATMENTS, DAY KIMBALL COLLABORATES WITH PROMINENT MEDICAL CENTERS TO PROVIDE THE CARE THEY NEED. FOR INSTANCE, DAY KIMBALL PARTNERS WITH UMASS MEMORIAL MEDICAL CENTER IN WORCESTER, MA, FOR CARDIAC CARE AND HAS DEVELOPED A SYSTEMATIC APPROACH TO STABILIZING AND TRANSPORTING HEART ATTACK PATIENTS TO UMASS FOR FURTHER TREATMENT. X X X false false false false false false false true false RICHARD WILCON PRESIDENT, MED STAFF BEG 07/22 24000 482578 0 16704 0 29300 0 8700 0 25343 24000 562625 0 0 PAUL BEAUDOIN CFO 421981 0 70330 0 0 0 0 0 458 0 492769 0 0 0 MICHAEL BAUM DIRECTOR 28800 303992 0 133140 0 0 0 8700 0 17624 28800 463456 0 0 KRISTA MATSEN DIRECTOR 12000 192362 0 0 0 0 0 5771 0 0 12000 198133 0 0 PAUL MATTY DIRECTOR 12000 279242 0 0 0 0 0 8377 0 0 12000 287619 0 0 CARMEN PISC PHYSICIAN 504452 0 0 0 0 0 0 0 1370 0 505822 0 0 0 ALEJANDO CARVAJAL PHYSICIAN 368990 0 59264 0 0 0 2701 0 8217 0 439172 0 0 0 ALEXANDRE CARRE PHYSICIAN 298002 0 86548 0 0 0 0 0 370 0 384920 0 0 0 JOHN MODICA PHYSICIAN 140566 0 88651 0 0 0 6877 0 7937 0 244031 0 0 0 ANTHONY CHIEFFALO DIRECTOR END 02/22 14200 250627 0 33428 0 0 0 0 0 17600 14200 301655 0 0 JOHN GRAHAM MD VP MEDICAL AFFAIRS/CMO 231138 0 0 0 14720 0 0 0 272 0 246130 0 0 0 JOHN O'KEEFE CNO 227473 0 0 0 0 0 0 0 17562 0 245035 0 0 0 SCHEDULE J, PART I, LINE 7 NONFIXED PAYMENTS: THERE ARE THREE PROVIDERS THAT RECEIVE A BONUS WHICH ARE ALL BASED ON PRODUCTIVITY, AND ARE CALCULATED OFF OF THEIR WRVUS FOR THE CONTRACT PERIOD. A STATE OF CONNECTICUT HEALTH AND EDUCATIONAL FACILI 060806186 20774YPC5 2013-06-06 30330000 EMERGENCY DEPARTMENT EXPANSION false false false A 7760000 0 30330000 2340522 1170295 15485409 606600 0 0 10723350 3824 0 2014 true false true true A false false false false 0 false false false true A false false false true false false 0 false 0 false true A true SCHEDULE K, PART I(F) DESCRIPTION OF PURPOSE: CURRENT REFUNDING AND EMERGENCY DEPARTMENT EXPANSION AND RENOVATION. SCHEDULE K, PART IV, LINE 2C REBATE COMPUTATION: THE REBATE COMPUTATION WAS PERFORMED IN 2018. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES: DAY KIMBALL HEALTHCARE CONTRACTS WITH A MANAGEMENT COMPANY TO PROVIDE ONSITE EXECUTIVE MANAGEMENT SERVICES. CEO KYLE KRAMER WAS COMPENSATED BY THE MANAGEMENT COMPANY DURING FY22. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT THE GOVERNING BODY: THE HOSPITAL HAS MORE THAN 400 CORPORATORS WHO ARE DEDICATED TO THE HOSPITAL'S MISSION. CORPORATORS ARE INDIVIDUALS INTERESTED IN THE PURPOSES OF THE HOSPITAL AND REPRESENT THE COMMUNITIES SERVED. CORPORATORS HAVE THE RIGHT TO PARTICIPATE IN THE ELECTION OF DIRECTORS AND OFFICERS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990: FORM 990 IS REVIEWED BY PAUL A. BEAUDOIN, CFO, PRIOR TO FILING. A COPY OF THE 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING BOARD MEMBERS, ADMINISTRATION, THE MEDICAL STAFF, AND ALL OTHER EMPLOYEES TO FILL OUT A CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. IF ANY CHANGE IN THE FORM ARISES THROUGHOUT THE YEAR, IT IS REQUIRED TO BE REPORTED PROMPTLY TO THE CHAIR OF THE BOARD OF DIRECTORS OR THE PRESIDENT OF DAY KIMBALL HOSPITAL. IN THE EVENT A POTENTIAL CONFLICT OF INTEREST HAS A DIRECT IMPLICATION FOR PATIENT CARE, THE INSTITUTION MAY CONVENE AN ETHICS COMMITTEE MEETING TO ASSIST IN THE RESOLUTION OF THE ISSUE. IF AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE AFFECTED EMPLOYEE WILL REFRAIN FROM FURTHER PARTICIPATION IN MATTERS TO WHICH THE CONFLICT RELATES UNTIL THE QUESTION OF CONFLICT HAS BEEN RESOLVED. FORM 990, PART VI, SECTION C, LINE 15A & 15B COMPENSATION OF TOP MANAGEMENT: THE ORGANIZATION REVIEWS THE COMPENSATION OF THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES ON A REGULAR BASIS. COMPENSATION ADJUSTMENTS ARE SUBJECT TO BOARD APPROVAL AND THE PROCESS AND CONCLUSIONS ARE DOCUMENTED IN THE BOARD MINUTES. THE COMPENSATION REVIEW INCLUDES AN ANALYSIS OF COMPARABILITY DATA. IN APRIL 2019, GALLAGHER GROUP PREPARED AN ANNUAL HOSPITAL WAGE SURVEY FOR THE CONNECTICUT, MASSACHUSETTS AND RHODE ISLAND HOSPITAL ASSOCIATIONS AVAILABLE FOR USE BY MEMBER HOSPITALS. THIS SURVEY WAS USED BY DAY KIMBALL HEALTHCARE IN THE COMPENSATION DETERMINATION PROCESS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A COMPENSATION OF BOARD OF DIRECTORS: NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. DIRECTORS WITH COMPENSATION LISTED ON PART VII ARE EITHER EMPLOYEES OF THE FILING ORGANIZATION, OR EMPLOYEES AND/OR INDEPENDENT CONTRACTORS FOR A RELATED ORGANIZATION, DAY KIMBALL MEDICAL GROUP. THEY ARE COMPENSATED FOR THEIR DUTIES IN THAT CAPACITY. FORM 990, PART XI, LINE 9 CHANGES IN NET ASSETS: $(12,713,053) TRANSFER TO AFFILIATE (888,867) CHANGE IN INTEREST IN BENEFICIAL TRUST (103,153) NET ASSETS RELEASED FROM RESTRICTIONS 13,389,313 CHANGE IN DEFINED BENEFIT PENSION PLAN --------------- $ (315,1760) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:9386635 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:7494653 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING FEES TOTAL FEES:1555461 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:145608 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES TOTAL FEES:371171 PHYSICIAN SERVICES OF NORTHEAST CT 45 GREEN HOLLOW ROAD DANIELSON CT 06239 262565797 PHYSICIAN SVC CT DK HLTHCR DAY KIMBALL HOMEMAKERS 320 POMFRET STREET PUTNAM CT 06260 061136893 HOMEMAKERS CT 501(C)(3) 10 DKH HLTHCR true DAY KIMBALL MEDICAL GROUP INC 320 POMFRET STREET PUTNAM CT 06260 454077626 PHYS SERVICES CT 501(C)(3) 10 DKH HLTHCR true DAY KIMBALL HEALTHCARE FOUNDATION INC 309 POMFRET STREET PUTNAM CT 06260 833150493 SUPPORT CT 501(C)(3) 12A I DKH HLTHCR true false false false false false false false false false true false false false false false true false true false DAY KIMBALL MEDICAL GROUP INC J 302196 COST DAY KIMBALL MEDICAL GROUP INC R 7284005 COST DAY KIMBALL FOUNDATION R 5429048 COST