2022-08-12T07:42:19-05:00 2021-09-30 440160260 FORVIS 1201 Walnut Suite 1700 Kansas City MO 64106 990 2020-10-01 060250773 The William W Backus Hospital WILL 8608898331 326 Washington Street Norwich CT 06360 Mark Keise VP, Finance 8608898331 2022-08-12 0 Mark Keise 999009999 P00482834 8162216300 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Donna Handley 326 Washington Street Norwich CT 06360 500957269 0 X www.Backushospital.org X 1891 CT The William W. Backus Hospital delivers and coordinates a continuum of high-quality health care that is sensitive to the needs of individuals in Eastern Connecticut. The Hospital is committed to being responsive and accountable to those for whose benefit it exists, and to improving the health of its communities. 9 5 2064 105 0 0 1006722 835698 409055991 467917459 16591056 29151486 -796368 -1839472 425857401 496065171 10084 49000 0 0 152009748 155341528 0 0 233598 257379435 279161242 409399267 434551770 16458134 61513401 729174132 858731409 256353625 201920527 472820507 656810882 X To improve the health and healing of the people and communities we serve. 0 0 48859114 56336429 Hartford HealthCare Cancer CenterHartford HealthCare is Connecticut's most comprehensive healthcare network. Our fully integrated health system includes a tertiary-care teaching hospital, an acute-care community teaching hospital, an acute-care hospital and trauma center, two community hospitals. The Hartford HealthCare Cancer Institute encompasses comprehensive cancer centers at seven hospitals across Connecticut; Hartford Hospital, The Hospital of Central Connecticut, William W. Backus Hospital, Midstate Medical Center, The Windham Community Memorial Hospital, Charlotte Hungerford Hospital and St Vincent's Medical Center. Collectively, the cancer programs within the Cancer Institute treat more than 5,000 new cancer patients per year while caring for tens of thousands of existing patients, offering a full range of innovative, evidence-based and personalized treatments designed to meet the needs of each individual patient. Our innovative Institute approach is unlike any other in the state and is among the most highly regarded in the nation. Through our Institute, which is organized around a specific disease and not necessarily location, we can apply best practices throughout our system so that patients receive the same high standards of care no matter where they live or which Hartford HealthCare cancer center they choose. For all of our patients, a dedicated team of oncologists, surgeons, radiologists, pathologists, nurses, clinical researchers, technicians and others collaborate to provide the exact course of care they need. The Institute's multidisciplinary disease management teams meet and collaborate regularly to lend expertise and insight on numerous cancer types, translating into exceptional coordinated care. The Institute's accomplished, fellowship-trained physicians are nationally recognized for their level of sophisticated care in areas such as radiation oncology, medical oncology and surgical oncology. Patients are also cared for in an environment that emphasizes compassion and personal connections, with a team of trained nurse navigators who provide guidance and support to patients and families, from diagnosis to recovery. The Institute also boasts a thriving survivorship program. In 2013, the Hartford HealthCare Cancer Institute became the first community-based cancer program to become a member of the Memorial Sloan Kettering Cancer Alliance, establishing a relationship with one of the world's premier cancer centers. The Institute's membership in the Alliance provides patients in Connecticut access to the most advanced, leading-edge treatments available anywhere. In 2017, the Institute was accredited as a network by the American College of Surgeons Commission on Cancer, one of a select few institutes nationwide to be recognized as a system, rather than individual cancer centers. For patients coming through our doors with a cancer diagnosis, that means three things: standardized care, more options and more hope.More than four years after the Hartford HealthCare Cancer Institute became the charter member of the Memorial Sloan Kettering (MSK) Cancer Alliance, cancer patients now have unprecedented access to the world's most advanced clinical trials. And more than ever before, physicians, nurses, pharmacists and researchers are working collaboratively to implement cancer treatment standards and protocols developed at MSK, the premier cancer treatment center in the country. This distinctive cancer care and clinical research partnership means the Hartford HealthCare Cancer Institute brings the most innovative, evidence-based cancer care directly into community settings.During FY21, the Institute was again impacted by COVID-19 and that had an impact on the number of patients treated. For FY21, the approximate number of cases was as follows:Hartford Hospital - 2,964The Hospital of Central Connecticut - 1,190The William W. Backus Hospital - 834Midstate Medical Center - 594Windham Community Memorial Hospital - 147Charlotte Hungerford Hospital - 314St. Vincent's Medical Center - 645The five most common types of cancer diagnosed by teams of specialists at the Hartford HealthCare Cancer Institute are cancers of the bladder, breast, colon, lung and prostate. Each patient has a unique scenario requiring a personalized plan.Approximately 1,641 Breast Cancer cases were treated across the system as follows:Hartford Hospital - 625The Hospital of Central Connecticut - 294William W. Backus Hospital - 226Midstate Medical Center - 199Windham Community Memorial Hospital - 54Charlotte Hungerford Hospital - 61St. Vincent's Medical Center - 182Approximately 836 Lung Cancer cases were treated across the system as follows:Hartford Hospital - 341The Hospital of Central Connecticut - 184William W. Backus Hospital - 127Midstate Medical Center - 65Windham Community Memorial Hospital - 17Charlotte Hungerford Hospital - 25St. Vincent's Medical Center - 77Approximately 837 Prostate Cancer cases were treated across the system as follows:Hartford Hospital - 395The Hospital of Central Connecticut - 119William W. Backus Hospital - 101Midstate Medical Center - 86Windham Community Memorial Hospital - 1Charlotte Hungerford Hospital - 64St. Vincent's Medical Center - 71 Approximately 387 Bladder Cancer cases were treated across the system as follows:Hartford Hospital - 131The Hospital of Central Connecticut - 66William W. Backus Hospital - 66Midstate Medical Center - 50 Windham Community Memorial Hospital - 10 Charlotte Hungerford Hospital - 30St. Vincent's Medical Center - 34Approximately 334 Colon Cancer cases were treated across the system as follows:Hartford Hospital - 148The Hospital of Central Connecticut - 53 William W. Backus Hospital - 38Midstate Medical Center - 29Windham Community Memorial Hospital - 13Charlotte Hungerford Hospital - 15St. Vincent's Medical Center - 38Today, Hartford HealthCare is creating a better future for healthcare in Connecticut and beyond. We are a community of caregivers engaged in developing a coordinated, consistent high standard of care. We use research and education as partners in care delivery. We create and engage in meaningful alliances to enhance access to services. We invest in technology and training to develop new pathways to improve the timeliness, efficiency and accuracy of our services. 31154764 33318539 Bone & Joint (Orthopedics):The Orthopedics Department at The William W. Backus Hospital (Backus) offers a full range of services to the communities it serves. As a member of Hartford HealthCare Corporation's network, the Hospital has access to the integrated health network's recognized expertise, ongoing research studies that evaluate new treatments and one of the nation's top training centers for robot-assisted surgery.Backus offers the latest robotic surgery techniques for hip and knee procedures Mako technology. Mako is a treatment option for patients that have early to mid-stage degeneration of the hip or knee. With smaller incisions, the robotic arm-assisted technology allows the surgeon to more precisely place the implant for faster recovery and more effective results. This technology is also available at Windham Community Memorial Hospital.At the completion of the FY21 the Division of Orthopedics was comprised of nine orthopedic surgeons and ten advanced practice providers. For FY21, Backus maintained its Disease Specific Certification through the Joint Commission for its Total Hip and Total Knee program. The Department completed 1,332 total orthopedic cases. Of the 1,332, 186 were Total knee Replacements and 169 of those were performed with MAKO robotic surgery. Total Hip Replacements were 123 with 92 of those being performed with MAKO robotic surgery. Backus also performed 92 Globus Robotic Spine surgeries.Backus continues to be part of the Comprehensive Joint Replacement Bundle through CMS and received NO payment for the work accomplished in the prior 3 years of the program. 30632069 34426052 Heart and Vascular:As a member of Hartford HealthCare, Cardiology services at The William W. Backus Hospital (Backus) are provided through the Hartford HealthCare Heart and Vascular Institute. While some of the symptoms of congestive heart failure (CHF) can be managed, patients often need advanced care as the disease progresses. The stress of driving long distances for care and assessment can have a serious impact on the patient's quality of life. The Hartford HealthCare Heart & Vascular Institute advanced CHF patients in the Norwich area now have the option of receiving some of their care close to home. The care provided at Backus location works seamlessly with the Heart & Vascular Institute's Center for Advanced Heart Failure at Hartford Hospital. The program enables patients who have been diagnosed with congestive heart disease to manage their health and improve the quality of their lives through early symptom recognition, continuity of care, diet planning and medication management.At the completion of the Fiscal Year FY21 the, Division of Cardiology was comprised of eight cardiologist and one Advanced Practice provider and had 21,180 visits with an average length of stay of 4.4 days. 272409669 49000 343836439 Other program services include EHR revenue, purchase discounts, contract services and other miscellaneous income. 272409669 49000 343836439 383055616 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 126 0 1 2064 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X X Anthony Mastroianni 8608898331 326 Washington Street Norwich CT 06360 Donna Handley Director, SVP, HHC & Pres. 20.00 40.00 X X 0 784677 76359 Mark Tramontozzi MD Director 1.00 59.00 X 0 300916 53096 Mary Barry MD Director & Chair 2.00 58.00 X X 0 197850 18331 Gregory Shangold MD Director (Thru 10/20) 1.00 2.00 X 0 77961 5288 Stephen Larcen PhD Director 1.00 2.00 X 0 0 0 Carmen Cid Director (Thru 6/21) 1.00 2.00 X 0 0 0 Anthony Joyce III Director 1.00 2.00 X 0 0 0 Carina Vora DDS Director 1.00 2.00 X 0 0 0 Henry Beck MD Director, Vice Chair 1.00 2.00 X X 0 0 0 Anita Lee Director 1.00 2.00 X 0 0 0 Joanne Chaurette MD Director 1.00 2.00 X 0 328842 34138 Anthony Mastroianni VP, Finance 30.00 30.00 X 0 305168 63738 Robert Sidman MD VP, Medical Affairs 30.00 30.00 X 0 559012 72376 Pam DeLise VP, Human Services 30.00 30.00 X 0 238545 39614 Laura Currie VP, Patient Care 30.00 30.00 X 0 309715 55915 Matthew Kaufman VP, Operations 30.00 30.00 X 0 287565 52706 Zhenxiang Liu MD Physician 60.00 X 595581 0 68411 Mariano Librojo MD Hospitalist 60.00 X 492944 0 48011 Kyle Mcclaine MD Chief Emergency Medicine 60.00 X 486907 0 68639 William Horgan MD Asst. Chief Emergency Svcs 60.00 X 477200 0 67695 Mohammed Ahmad Qureshi MD Physician 60.00 X 467768 0 61415 David Whitehead Former Director & Pres. 0.00 60.00 X 0 1147748 79658 Bimal Patel Former Director & Pres. 0.00 60.00 X 0 1118518 144997 Thomas Vaccarelli Former VP Facilities 0.00 60.00 X 0 436104 71557 Gregory Makowski Former VP, Clinical Lab Sv 0.00 60.00 X 0 337830 38547 Margaret Marchak Former - Secretary 0.00 60.00 X 0 923811 44292 2520400 7354262 1164783 270 1 1 0 Origin Incorporated 1800 SW 1ST Street STE 510 Portland OR 97201 Staffing Services 4973404 Morrison Management Services 400 Northridge Road Sandy Springs GA 30350 Food Services 2138722 North American Partners in Anesthesia 68 South Service Road Melville NY 11747 Medical Services 1257392 Quest Diagnostics Nichols Inst Inc PO Box 912512 Pasadena CA 91110 Medical Services 1120318 Pulmonary Physicians of Norwich PC 330 Washington Street Norwich CT 06360 Medical Services 971020 37 113750 721948 835698 Net Patient Revenue 624100 467917459 467917459 467917459 2367232 2367232 3025828 4826508 -1800680 -1800680 -1800680 26791052 2000 0 8798 26791052 -6798 26784254 26784254 18000 113750 56792 -38792 -38792 496065171 467917459 0 27312014 X 49000 49000 130585759 124264543 6203704 117512 4430638 4216166 210485 3987 12133292 11545960 576413 10919 8191839 7708266 474583 8990 148424 148424 56378 56378 398626 398626 58431647 58431647 17924 17924 2897373 1828636 1003828 64909 22809148 13913580 8895568 6551439 5943354 608085 20007 9453 10554 337986 186988 150998 4420288 3889853 530435 39952843 10670238 29282605 12381865 12124971 256894 2627040 2627040 Medical Supplies 63481765 63481765 Hospital Provider Tax 27455941 27455941 Purchased Services 17558372 15674795 1874616 8961 Miscellaneous Expenses 11191082 11191082 8423094 7842338 580360 396 434551770 383055616 51262556 233598 19176388 23608445 200 200 43530690 48418655 6124004 6973330 2235079 2605546 337625051 217575464 122009462 120049587 373584 457282 413356124 529981586 14919217 17190952 107449384 109445826 729174132 858731409 27673125 22316363 393161 403164 882846 6392865 227404493 172808135 256353625 201920527 X 459971560 640519465 12848947 16291417 472820507 656810882 729174132 858731409 X 61513401 87093329 35383645 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 56378 0 0 56378 0 Part II-B, Line 1: The Backus Hospital paid annual dues to Connecticut Hospital Association (CHA). CHA conducts lobbying activities on behalf of its members. CHA allocates a portion of their dues as lobbying expenses. The portion of dues allocated as lobbying expenses is calculated under current Medicare rules. CHA conducts lobbying activities under current Medicare rules. The total amount of all dues allocated for lobbying expenses for FY21 was $56,378. 6856072 1354000 8210072 6405072 451000 6856072 6212072 193000 6405072 8405072 757000 2950000 6212072 7849631 555441 8405072 0.78000 0.22000 0 1 1 5124999 5124999 187282835 114330476 72952359 18826265 14770354 4055911 114570794 88474634 26096160 11820158 11820158 120049587 Investment In Endowment LLC 526727245 F Assets Held In Trust By Others 3254341 F 529981586 Due From Affiliates 76425270 Other Assets 15122483 Malpractice Claims 11726686 SERP Asset 5360802 Workers Comp 757856 Patient Refunds 52729 109445826 Tax Exempt Bonds 75864761 Other Liabilities 59067844 Accrued Post Retirement Expenses 14141100 Accrued Malpractice 11726686 Hospital Provider User Fee 6646941 SERP Liability 5360803 172808135 Part V, Line 4: The Hospital has adopted investment and spending policies for Endowment assets that attempt to provide a predictable stream of funding to mission related programs such as those described in Part III, lines 4a-d while seeking to maintain purchasing power of the endowment assets. Endowment assets include those assets of donor-restricted funds that the Hospital must hold in perpetuity or for a donor-specific period(s). Under this policy, as approved by the Board of Directors, the Endowment assets are invested in a manner that is intended to produce a real return, net of inflation and investment management costs, of a least 4% over the long term. Actual returns in any given year may vary from this amount. The Hospital's Endowment consists of hundreds of individual funds established for a variety of purposes. Net assets associated with Endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions. The income generated by the funds are used mainly for capital expenses. Golf Tournament 131750 113750 18000 7106 22957 25344 500 885 131750 113750 18000 7106 22957 25344 500 885 56792 -38792 1 1 X 1 X 250.000000000000 1 X 1 1 0 0 1495808 1495808 0.00340 102390307 68000331 34389976 0.07910 103886115 68000331 35885784 0.08250 155402 155402 0.00040 135540 135540 0.00030 564560 298787 265773 0.00060 49000 49000 0.00010 904502 298787 605715 0.00140 104790617 68299118 36491499 0.08390 0 12945709 68909651 81311085 -12401434 X 1 1 1 1 The William W Backus Hospital 326 Washington Street Norwich CT 06360 Backushospital.org 0037 X X X The William W Backus Hospital 1 0 0 1 X X X X X X X X 20 1 1 0 1 X See Part V, Page 8 X X 1 20 0 1 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 The William W. Backus Hospital Part V, Section B, Line 5: Community health needs were identified by collecting and analyzing data from multiple sources. Statistics for numerous community health status, health care access, and related indicators were analyzed, including data provided by local, state, and federal government agencies, local community service organizations, and Hartford HealthCare. Comparisons to benchmarks were made where possible. Input from persons representing the broad interests of the community was taken into account through key informant interviews with thirteen (13) individuals. Stakeholders included: individuals with special knowledge of or expertise in public health; local public health departments; hospital staff and providers; representatives of social service organizations; and leaders, representatives, and members of medically underserved, low-income, and minority populations.Data from multiple sources were gathered and assessed, including secondary data published by others and primary data obtained through community input. Input from the community was received through key stakeholder interviews. Interviewees (listed below) represented the broad interests of the community and included individuals with special knowledge of or expertise in public health:Backus Hospital Emergency DepartmentCenter for Healthy AgingConnecticut Alliance for Basic Human NeedsFoodShare/CT Food BankMadonna PlaceMashantucket Pequot Tribal Nation Health ServicesMohegan Tribal Nation Health DepartmentReliance Health, Inc.Thames Valley Council for Community Action, Inc.The Health Education CenterUncas Health DistrictUnited Way of Central and Northeastern ConnecticutSignificant Community Health Needs were determined by analyzing secondary community health data and gathering input provided by community stakeholders.In addition, data were gathered to evaluate the impact of various services and programs identified in the hospital's previous CHNA process.Individual key informant interviews were conducted from 3/26/21 thru 5/21/21 with representatives from Hartford HealthCare, the Hospital and numerous community-based organizations and social services agencies. The William W. Backus Hospital Part V, Section B, Line 6a: For this community health assessment, Backus Hospital collaborated with the following Hartford Healthcare hospitals: Charlotte Hungerford Hospital, Hartford Hospital, The Hospital of Central Connecticut, Midstate Medical Center, Natchaug Hospital, and Windham Community Memorial Hospital. These facilities collaborated by gathering and assessing secondary data together, scheduling and conducting interviews together, and by relying on shared methodologies, report formats, and staff to manage the CHNA process.Part V, Section B, Line 7ahttps://backushospital.org/about-us/community-health-needs-assessment The William W. Backus Hospital Part V, Section B, Line 7d: The needs assessment was published in September 2021 and is available on the Hospitals website. In addition, electronic copies are available upon request. The William W. Backus Hospital Part V, Section B, Line 11: As determined by analyses of secondary community health data and of input provided by community stakeholders, significant health needs in the community served by William W. Backus Hospital (Backus) are as follows:Access to health care services, which has been affected by:*Community members experiencing difficulties navigating the health care system and connecting to needed services.*Transportation challenges (particularly for low-income and elderly populations).*A comparatively low per-capita supply of primary care physicians and dentists.*Gaps in health insurance - particularly for mental health services.*Systemic racism and a lack of trust in the healthcare system among minority populations.*Linguistic isolation for Latinos and Asians.Mental health status:*In Norwich and for racial and ethnic minorities across Connecticut; made worse by the COVID-19 pandemic.*A comparatively high age-adjusted suicide rate in New London County.*Social Determinants of Health, which are most problematic in Norwich and for Black and Latino populations in the *Backus Service Area, including:*Poverty rates*Levels of educational achievement*Access to affordable housing*Food insecurity*Comparatively high rates of smoking in Norwich*Comparatively high rates of obesity in Norwich and in New London County*Substance abuse (particularly opioids including fentanyl)*The COVID-19 pandemic, which has caused virus-related illness and death, increased isolation and mental health problems, and economic challenges.This CHIP is organized across four focus areas that are intended to address root causes of community health issues while recognizing where the East Region in partnership with the community can be most effective in impacting change. The plan for each of these areas is outlined on the following pages. The driving rationale for each of these can be summarized as follows:1. Promote Healthy Behaviors and Lifestyles.Research has repeatedly shown that good eating and exercise choices are critical to averting lost or unproductive time at school or work, growing and maintaining cognitive and physical functioning, promoting mental health, and preventing and managing many chronic diseases such as heart disease, cancer, stroke, diabetes, and osteoporosis.Rationale for Action - *Self-rated health "Excellent or "Very Good" is 46% in Norwich compared to 60% in Connecticut.*Comparatively Short life expectancy (years) Norwich 77.4 compared to 80.3 Connecticut.*Food Insecurity Backus Service Area: Black 25%, Latino 36%, White 14% compared to 13% Connecticut .CHIP addressed this need in the following manner: *Provide fresh fruits and vegetables to low-income individuals and families via RX for Health Program.*Educate food pantry staff and volunteers about strategic food choices for medical conditions. *Reduce tobacco use by increasing participation in evidence-based tobacco cessation treatments. 2. Reduce the Burden of Chronic Disease.Proven interventions can prevent and reduce the effects of chronic and infectious diseases and are aimed at the six most common and costly health conditions - tobacco use, high blood pressure, healthcare-associated infections, asthma, unintended pregnancies, and diabetes - these conditions can be countered by proven specific interventions as highlighted by the CDC.Rationale for Action - *Adults with diabetes (Age Adjusted Rate) New London County 8.4% as compared to 7.4% in Connecticut. *Smoking 18% in Norwich as compared to 14% in Connecticut.*Obesity 35% in Norwich as compared to 33% in Backus Service Area. CHIP addressed this need in the following manner: *Educate and teach individuals on how best to prepare food for themselves and their families while keeping in mind their medical conditions.*Provide testing and resources to assist individuals who remain undiagnosed due to lack of regular medical care in places like soup kitchens, mobile health fairs, mobile food pantries, homeless shelters, and brick and mortar food pantries.3. Improve Health Equity, Social Determinants of Health, and Access to and Coordination of Care and Services. There are many factors that shape and confine health outcomes including obstacles related to accessing care and services, awareness of available resources, and tracking patients as they move to and from points of care. More systemically, racial and economic inequities and other unfavorable environmental conditions provide powerful influencers in limiting individuals and communities from reaching their health potential. Rationale for Action - *Poverty Rate Black in Backus HSA 18% as compared to the poverty rate white in the Backus Service Area 7%.*Poverty Rate Latino in Backus HSA 14% as compared to the poverty rate white in the Backus Service Area 7%.*Linguistically Isolated Latino 25%, Asian 44% as compared to linguistically isolated white 1%.CHIP addressed this need in the following manner: *Create a community benefit infrastructure within Backus hospital for greater knowledge of hospital based community services.*To provide information and services that are linguistically responsive and culturally relevant in order to facilitate access to health related services.4. Enhance Community-Based Behavioral Health Services.Mental health and substance abuse were also consistently identified as a top issue by the community and a root cause impacting all aspects of health. These services and interventions include more accessible screening, improved and timelier referrals, expanded programming and public awareness and empowerment.Rationale for Action - *Share of drug overdose deaths involving fentanyl, 2019-2020 in Backus HSA 87% as compared to Share of drug overdose deaths involving fentanyl, 2015-2016 in Backus Service Area 59%.*Bothered by depression in Norwich 12% as compared to 9% in Connecticut.*Experiencing Anxiety in Norwich 13% as compared to 12% in Connecticut.CHIP addressed this need in the following manner: *Maintain a tertiary prevention program to identify at risk patients, implement interventions, and establish triple aim goals for experience of care, cost, and population health.*Investigate and document that effectiveness of the Recovery Coach program through partnership with CCAR.Provide support groups at Backus hospital.Significant needs that are not currently been addressed are Support Groups and Tobacco Cessation Programs. The Hospital has not opened up to hosting events for the public due to Covid precautions and the most recent surge. Zoom support groups have technological challenges for participants many of whom are elderly. The Hospital did put together a bereavement support group and created fliers, a zoom platform and have advertised on social media, with providers and staff, in the community and most recently in hospital internal communications. However, so far no one signed up. As for tobacco cessation programs, the hospital partnered with the local health district to provide training booklets as well as cessation medication alongside with respiratory therapists that would provide the class instructions. The hospital was using the Freedom from Smoking program which is a nationally recognized program. The space within the Outpatient care center was secured for meeting purposes, fliers were created and distributed via marketing and media channels as well as through community contacts and partners. Unfortunately no one signed up for the classes, therefore, they were cancelled. This has been a historically low attended initiative. The William W. Backus Hospital Part V, Section B, Line 13h: Family eligibility criteria for financial assistance also include family size, employment status, financial obligations, and amount and frequency of the health care expenses. The William W. Backus Hospital Part V, Section B, Line 15e: In addition, patients may ask a nurse, physician, chaplain, or staff member from Patient Registration, Patient Financial Services, Case Coordination, or Social Services about initiating the Financial Assistance Application process. Part V, Section B, Line 16a: FAP Website:https://backushospital.org/patients-visitors/patients/billing-insurance/financial-assistancePart V, Section B, Line 16b: FAP Application Website:https://backushospital.org/patients-visitors/patients/billing-insurance/financial-assistancePart V, Section B, Line 16c: FAP Plain Language Summary:https://backushospital.org/patients-visitors/patients/billing-insurance/financial-assistance The William W. Backus Hospital Part V, Section B, Line 16j: Patients are informed directly by staff of the availability of the Financial Assistance Policy. 10 1 - Backus Outpatient Care Center 111 Salem Turnpike Norwich CT 06360 Outpatient Services 2 - Medical Office Building 330 Washington Street Norwich CT 06360 Medical Office 3 - Colchester Backus Health Center 163 Broadway Colchester CT 06415 Primary Care 4 - Harford HealthCare Health Center 350 Liberty Street Pawcatuck CT 06379 Primary Care 5 - Backus Outpatient Care Center 42 Town Street Norwich CT 06360 Outpatient Services 6 - Family Health Center at Crossroads 196 Parkway South Waterford CT 06385 Primary Care/Rehab/Outpatient 7 - Infectious Disease Clinic 107 Lafayette Street Norwich CT 06360 Outpatient Services 8 - Plainfield Medical Office 584 Norwich Road Plainfield CT 06374 Medical Office 9 - Plainfield Emergency Center 582 Norwich Road Plainfield CT 06374 Emergency Services 10 - Hartford HealthCare Health Center 100 Perkins Farm Drive Mystic CT 06355 Rehabilitation Services Part I, Line 3c: The Organization uses Federal Poverty Guidelines (FPG) to determine eligibility. In addition, the Hospital takes into consideration, medical indigency, insurance status, underinsurance status, and other family eligibility criteria such as family size, employment and financial obligations. Part I, Line 6a:Although the Organization does not prepare a formal Community Benefits Reports, it does submit a quarterly report to The Connecticut Hospital Association and Form 990 is submitted to the Connecticut Office of Health Strategy (OHS) annually. Part I, Line 7: The Organization utilized an overall Cost to Charge Ratio (RCC), developed from the Medicare Cost Report. Total expense was adjusted for: Medicaid provider taxes, directly identified community benefit expense and community building expenses. This Cost to Charge Ratio was used to calculate costs for Part I, Line 7a & b. The costs associated with the activities reported on Part I, Line 7e were captured using actual time multiplied by an average salary rate. The costs associated with Line 7h, were the actual costs reported in the organization's general ledger less any industry funded studies. These costs were removed from the calculations to avoid duplication. Costs reported in Part III, Section B6, were calculated from the Medicare cost report and reduced for Medicare costs previously reported in Part I, Lines 7f &g. Part I, Line 7g: No physician clinic costs were included in the Subsidized Health Services cost calculations. Part III, Line 3: A pre bad debt financial assistance screening is in place to identify patients that may be eligible for financial assistance. Pre bad debt accounts that are identified as meeting the requirements are adjusted prior to being sent to bad debt. Therefore, any bad debt expense that could have been attributable to charity care at the end of FY 2021 would be immaterial. Part III, Line 4: Please see the text of the footnote that describes bad debt expense beginning on page 28 of the Audited Financial Statement. This note also relates to Part III, Line 2. Part III, Line 8: Cost Reports were used to report Medicare allowable costs. Medicare defines allowable costs as those appropriate and helpful in developing and maintaining the operation of patient care facilities and activities. It specifically excludes certain costs that are not directly related to patient care. The hospital incurs additional expense related to the provision of care to Medicare patients that Medicare has deemed non-allowable. This additional expense includes costs of physician services (emergency on-call fees, Hospitalist Programs, recruitment, etc.), advertising costs, cafeteria costs for meals sold to visitors, etc. The Hospital attempts to collect coinsurance and deductibles from Medicare beneficiaries. To the extent collection efforts are unsuccessful; Medicare reimburses the hospital at 65% of unpaid amounts. The table reconciles the shortfall or surplus from Line 7 to the actual surplus or shortfall. The additional costs were allocated to Medicare based upon Medicare's percentage of total allowable costs. The unpaid coinsurance/deductibles were estimated using historical collection results. Any shortfall amounts have not been treated as Community Benefits. Part III, Line 9b: The William W. Backus Hospital has adopted the Financial Assistance Policy of its Parent Company, Hartford HealthCare Corporation. The following is included in the Financial Assistance Policy: Patients who are deemed ineligible for financial assistance or who receive a partial discount and do not pay their bills may be subject to the following Extraordinary Collection Action (ECAs):*Wage Garnishments*Liens on primary and secondary residences, bank or investment accounts, or other assets*Legal actions and reporting the matter to one or more credit rating agencies*Other ECAs not listed aboveIf an individual has not submitted an application within the first 120 days from the date on which Hartford HealthCare first issues its first, post-discharge billing statement, then Hartford HealthCare may begin engaging in the ECAs described above.ECAs may begin after the first 120 days from the date on which Hartford HealthCare issues its first, post-discharge billing statement. If the patient applies for assistance within 240 days from the first notification of the self-pay balance, and is granted assistance, Hartford HealthCare will take all reasonable available measures to remove any collection actions such as negative reporting to a credit bureau or liens that have been filed.Before Hartford HealthCare initiates any collection actions, it will issue a written notice to the last known address of record for the patient (or his/her family) that describes the specific collection activities it intends to initiate (or resume), provides a deadline after which such action(s) will be initiated (or resumed), and includes a plain language summary of this Policy. ECAs can begin no sooner than 30 days from the date written notice is transmitted. Patients who are ineligible for financial assistance, or qualify for partial financial assistance and who are cooperating in good faith to resolve the outstanding accounts, may be offered extended payment plans. No further collection action will be taken as long as the patient continues to meet the terms of the payment plan. Part VI, Line 2: Backus Hospital uses Emergency Room data to track medical conditions such as falls, flu, drug overdoses, etc. and the same approach is taken in our outpatient clinics. Periodically information is surveyed to determine additional patient needs. Information is also tracked from other entities such as area non profits, governmental agencies and public schools. Part VI, Line 3: Backus Hospital provides information about its financial assistance policy as follows: (1) Provides signage, brochures and/or a written plain language summary describing the policy along with financial assistance contact information in the emergency department, labor and delivery areas, discharge paperwork, other patient registration/admission areas, as well as in billing and collection communication.(2) Makes paper copies of the policy, financial assistance application, and plain language summary of the policy available upon request and without charge, by mail.(3) Posts the policy, plain language summary and financial assistance application on the website with clear linkage to such documents on the Hartford HealthCare and each affiliated hospital's home page.(4) Educates all admission and registration personnel, financial counselors, billing and collection specialists and social workers regarding the policy so that they can serve as an informational resource to patients.(5) Includes the tag line 'Please ask about our Financial Assistance Policy" in applicable Hartford HealthCare written publications. Part VI, Line 4: As of 2019, the population of the Backus Hospital HSA is 115,760, including 9,057 residents (8%) who are foreign-born. 24% of the Backus Hospital Service Area residents are people of color.20% of Backus Hospital Service Area residents are children under age 18, and 17% are adults ages 65 and up. As Connecticut's predominantly white Baby Boomers age, younger generations are driving the state's increased racial and ethnic diversity. Black and Latino populations in particular skew much younger than white populations. In Backus Hospital Service Area, 27% of Black and Latino residents are children, compared to 18% of white residents.Linguistic isolation is characterized as speaking English less than "very well." People who struggle with English proficiency may have difficulty in school, seeking health care, accessing social services, or finding work in a largely English-speaking community. In the Backus Hospital Service Area, 5,783 residents, or 5% of the population age 5 and older, are linguistically isolated. Latinos and Asian Americans are more likely to be linguistically isolated than other racial/ethnic groups.The region is a federally designated medically underserved area. Part VI, Line 5: A Regional Board governs Backus, Windham and Natchaug Hospitals. The board is responsible for maintaining outstanding quality services and credentials its medical staff. All of the directors either reside or work in our service area. Part VI, Line 6: Hartford Healthcare Corporation (HHC) is organized as a support organization to govern, manage and provide support services to its affiliates. HHC, through its affiliates including The William W Backus Hospital, strives to improve health using the "Triple Aim" model: improving quality and experience of care; improving health of the population (population health) and reducing costs. HHC and it's affiliates including all supported organizations, develop and implement programs to improve the health care in our Southern New England region. This includes initiatives to improve the quality and accessibility of health care, create efficiency on both our internal operations and the utilization of health care, and provide patients with the most technically advanced and compassionate coordinated care. In addition, HHC continues to take important steps toward achieving its vision of being "nationally respected for excellence in patient care and most trusted for personalized, coordinated care."The affiliation with HHC creates a strong, integrated health care delivery system with a full continuum of care across a broader geographic area. This allows the small communities easy and expedient access to the more extensive and specialized services the hospital is able to offer. This includes continuing education of health care professionals at all the affiliated institutions through the Center of Education, Simulation and Innovation located at Hartford Hospital. The affiliation further enhances the hospitals' abilities to support their missions, identity, and respective community roles. This is achieved through integrated planning and communication to meet the changing needs of the region. This includes responsible decision making and appropriate sharing of services, resources and technologies, as well as containment strategies. Part VI, Line 7, Reports Filed With States CT 1 American Heart Association 5 Brookside Drive Wallingford CT 06492 135613797 501(c)(3) 25000 To support the The American Heart Associations mission committed to fighting heart disease and stroke and helping families and communities thrive. Diocese of Norwich 201 Broadway Norwich CT 06360 060687373 501(c)(3) 24000 To support mission of The Diocese of Norwich and its parishes, schools, and other affiliated institutions in providing safe environments for children, young people, and adults. 2 Part I, Line 2: Upon issuing the grant, the hospital attaches a letter that restricts the use of the funds for a specific purpose. All of the grants are made to public charities to assist in funding their exempt programs. Therefore, extensive monitoring of the use of these funds by these entities is not warranted. X X X X 1 1 0 0 0 0 0 1 0 Bimal Patel Former Director & Pres. 0 731746 0 358360 0 28412 0 113175 0 31822 0 1263515 0 0 David Whitehead Former Director & Pres. 0 656733 0 364451 0 126564 0 19950 0 59708 0 1227406 0 0 Margaret Marchak Former - Secretary 0 156673 0 152082 0 615056 0 10053 0 34239 0 968103 0 18671 Donna Handley Director, SVP, HHC & Pres. 0 493765 0 214681 0 76231 0 19950 0 56409 0 861036 0 0 Zhenxiang Liu MD Physician 550769 0 43886 0 926 0 19950 0 48461 0 663992 0 0 0 Robert Sidman MD VP, Medical Affairs 0 409322 0 145613 0 4077 0 19950 0 52426 0 631388 0 0 Kyle Mcclaine MD Chief Emergency Medicine 329910 0 156445 0 552 0 19950 0 48689 0 555546 0 0 0 William Horgan MD Asst. Chief Emergency Svcs 313099 0 163549 0 552 0 19950 0 47745 0 544895 0 0 0 Mariano Librojo MD Hospitalist 447691 0 45037 0 216 0 19950 0 28061 0 540955 0 0 0 Mohammed Ahmad Qureshi MD Physician 350616 0 116600 0 552 0 19950 0 41465 0 529183 0 0 0 Thomas Vaccarelli Former VP Facilities 0 272362 0 141605 0 22137 0 25650 0 45907 0 507661 0 19500 Anthony Mastroianni VP, Finance 0 220737 0 82270 0 2161 0 19950 0 43788 0 368906 0 0 Laura Currie VP, Patient Care 0 229304 0 79250 0 1161 0 19950 0 35965 0 365630 0 0 Joanne Chaurette MD Director 0 312424 0 15200 0 1218 0 19950 0 14188 0 362980 0 0 Mark Tramontozzi MD Director 0 285353 0 13979 0 1584 0 17573 0 35523 0 354012 0 0 Matthew Kaufman VP, Operations 0 220270 0 66862 0 433 0 19458 0 33248 0 340271 0 0 Pam DeLise VP, Human Services 0 210779 0 27312 0 454 0 16907 0 22707 0 278159 0 0 Mary Barry MD Director & Chair 0 197700 0 150 0 0 0 6925 0 11406 0 216181 0 0 Part I, Line 3 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of The William W. Backus Hospital, hires an outside consultant, Human Resources and Compensation Consulting Practice of Gallagher, to determine best practices in governing executive compensation. Please refer to compensation narrative reported on Schedule O. Part I, Lines 4a-b Hartford HealthCare Corporation, a related organization, maintains a 457(f) Supplemental Executive Retirement Plan (SERP). Participants include certain officers and key employees at the President & CEO, Executive Vice President and Senior Vice President levels that are reported by The William W. Backus Hospital on its Form 990, Part VII. Contributions are made by Hartford HealthCare Corporation to the plan based on a percentage of the participant's compensation. Participants vest in the plan at the earlier of reaching age 55 and having 5 years of service, death, disability, involuntary separation without reasonable cause, upon reaching age 65 or the occurence of a change in control. Each participant ceases to be eligible for further contributions by Hartford HealthCare Corporation on the date of the participant's separation from service. Participants receive a one-time lump sum payment of the accumulated amount during the 30-day period following the participant's separation from service. In 2020, Margaret Marchack, Former Secretary, received a lump sum severance payment of $583,803. 2020 SERP accrual was made on behalf of the following individual: Bimal Patel $93,225 2020 SERP Payouts were made on behalf of the following individuals: Margaret Marchak $18,671 Thomas Vaccarelli $19,500 David Whitehead $27,270* Donna Handley $19,577* *For these individuals, vesting occurred, causing taxable income. This portion of the vested amount was used to pay the associated tax liability. The remaining balance was deposited into the employee SERP account. Part I, Line 7 Hartford HealthCare Corporation, a related organization, has a Compensation At Risk Plan that encourages and rewards achievements of significant functional goals. These goals contribute to the organization's strategic and financial direction. The plan utilizes market practice alignment to ensure competitive recruitment and retention. Awards are based on President & CEO and/or Hartford HealthCare Corporation's Compensation Committee discretionary assessment of overall organization performance and individual contribution to results. Form 990, Part VI, Section A, line 6 Backus Hospital is organized as a non-stock not for profit entity. Hartford HealthCare Corporation is the sole member. Form 990, Part VI, Section A, line 7a The sole member of the organization has the authority to approve/remove members of the governing body. Form 990, Part VI, Section A, line 7b The sole member of the organization has the right to review, approve, disapprove and deny significant transactions such as mergers, acquisitions, dissolutions, etc. Form 990, Part VI, Section B, line 11b The Form 990 was prepared by Hartford HealthCare's Tax Department. It was then reviewed by an independent accounting firm and forwarded to the VP of Finance for review. The final Form was provided to the entire Board prior to submission to the Internal Revenue Services (IRS). Once the entire review process was completed, the Form was signed by the VP, Finance and then filed with the IRS. Form 990, Part VI, Section B, line 12c The hospital's board has adopted the policy of the member, Hartford HealthCare Corporation (HHC). HHC's Conflict of Interest Policy (Policy) requires all covered individuals, including board members and officers, to provide a disclosure of relationships that create or have the appearance of creating a conflict of interest or commitment. The Policy requires updates if changes in circumstances arise during the year that either (a) create a new potential conflict of interest or commitment or (b) change or eliminate a conflict of interest or commitment previously disclosed. Conflict of interest disclosure statements are maintained by the HHC Office of Compliance and Integrity (OCI). Employee disclosures are reviewed by OCI in collaboration with the Covered Individuals' supervisor when deemed appropriate, to determine if there is a potential conflict. Oversight review of employee disclosures is provided by the HHC Conflict of Interest Committee. The Conflict of Interest Committee assesses and may recommend the conflicting interest either be (a) eliminated for continued relationship with HHC/HHC Affiliate, or, (b) managed through a management plan. Oversight review of physician disclosures is provided by the HHC Physician Conflict Resolution Committee. The Physician Conflict Resolution Committee assesses and may recommend the conflicting interest either be (a) eliminated for continued relationship with HHC/HHC Affiliate, or, (b) managed through a management plan. Board member disclosures are reported to the HHC Nominating and Governance Committee for determinations of conflicts and the management of them, where applicable. Form 990, Part VI, Section B, line 15 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of The William W. Backus Hospital, hires an outside consultant, Human Resources and Compensation Consulting Practice of Gallagher, to determine best practices in governing executive compensation. The following steps were taken: - The use of an Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of The William W. Backus Hospital, established and regularly reviews Executive Compensation Philosophy; - The Committee regularly reviews scope and depth of positions taking into account complexity and the financial impact and accountability of all "disqualified persons; - National peer groups are selected for comparative purposes based on organizational size, operating revenue, geography and other relevant factors; - Analysis of current total compensation versus market is performed by independent third party compensation consulting firm and is then reviewed by the committee; - Recommendations are made based on market data analysis to ensure appropriate competitive positioning within parameters of compensation philosophy; - The President & CEO compensation is reviewed by the Committee and is based on comparative market information and organizational performance; - All changes are reviewed and approved by the Executive Compensation Committee; The compensation determination process for the President & CEO is reviewed on an annual basis. All other executive compensation is regularly reviewed for scope and depth of positions taking into account complexity and the financial impact and accountability. Form 990, Part VI, Section C, line 18 The Hospital's Form 990, 990T and form 1023 and its attachments are available upon request. Form 990, Part VI, Section C, line 19 The Hospital's Financial Statements, Governing Documents and the Conflict of Interest Policy are available for inspection upon request at the Organization's address. Form 990, Part IX, line 11g Medical Professional Fees: Program service expenses 58,431,647. Management and general expenses 0. Fundraising expenses 0. Total expenses 58,431,647. Form 990, Part XI, line 9: Change In Pension and Post-Retirement Funding Obligations 32,984,429. Transfer To/From Affiliates 2,399,216. 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