2020-08-13T16:53:03-05:00 2019-09-30 346565596 Ernst & Young US LLP 55 Ivan Allen Blvd Suite 1000 Atlanta GA 30308 990 2018-10-01 060646715 Midstate Medical Center MIDS 8602245272 435 Lewis Avenue Meriden CT 06451 Mark Keise VP Finance 8602245272 2020-08-13 1 Aerrial M Orr P01598400 4048748300 199.231.27.235 2020-08-13 16:52:54 ED P B1F6754162BA34960FF6E5961467431CD3790A95 B528C7C86D3B360A0A6E3BCE3B7EF14312B9CEBE 2018 2020-09-23 17:36:50Z Gary Havican 435 Lewis Ave Meriden CT 06451 323303617 0 X https://midstatemedical.org X 1885 CT The mission of Midstate Medical Center is to improve the health and healing of the people and communities we serve. 12 9 1395 203 661013 251538 421341 430059 274221655 315795762 8726970 3519090 20766 314156 283390732 320059067 5000 3500 0 0 87122481 90202742 0 0 305026 178151597 201037348 265279078 291243590 18111654 28815477 304607474 331693554 150735240 174104612 153872234 157588942 X The mission of MidState Medical Center is to improve the health and healing of the people and communities we serve. 0 0 48441866 59582699 Orthopedics:In partnership with Hartford HealthCare Corporation, the System launched the Connecticut Orthopaedic Institute at Midstate Medical Center. Designed and managed by our renowned orthopaedic specialists, the professionals at the Institute plan every detail to give patients the best possible experience for treatment and recovery.At 14,000 square feet, the Institute spans an entire pavilion at MidState Medical Center that's been completely renovated and repurposed for orthopaedic patients and their guests. The 21, all-private patient rooms were designed to be calming and healing to feel more like a high-end hotel than a hospital. The Institute includes 11 operating rooms, a new orthopaedic rehabilitation space, separate kitchen facilities, and other convenient amenities to make the patient experience seamless, comforting, and safe.The Institute offers the latest treatments and techniques for bone, muscle, and joint problems to patients a faster path to recovery. Our orthopaedic specialists are fellowship-trained in their area of expertise, so patients can take comfort knowing that their doctor are wholly focused on treating their injury and helping them move forward.The Institute is a dedicated orthopaedic hospital that offers a full continuum of care from first diagnosis through rehabilitation in areas including: Joint Reconstruction (Knee, Hip, Shoulder, and Elbow)*Foot and Ankle Surgery*Podiatric Care*Hand Surgery*Spine Services*Artificial Disc Replacements*Arthroscopic Procedures*Fracture CareFor FY19, the Institute had 3,252 cases and treated 2,988 patients. The Institute employed 34 surgeons during FY19. 38277224 38724380 Oncology/Cancer Institute:Hartford 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 six hospitals across Connecticut - Hartford Hospital, The Hospital of Central Connecticut, Backus Hospital, Midstate Medical Center, Windham Hospital and Charlotte Hungerford Hospital. 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. Now, 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 FY19, the Institute had approximately 5,871 new cases across the system were as follows:Hartford Hospital - 3,187Hospital of Central Connecticut - 1,082Backus Hospital - 748Midstate Medical Center - 483Windham Hospital -163Charlotte Hungerford Hospital - 208The 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 1,158 Breast Cancer cases were treated across the system as follows:Hartford Hospital - 613Hospital of Central Connecticut - 217Backus Hospital - 127Midstate Medical Center - 120Windham Hospital - 10Charlotte Hungerford Hospital - 71Approximately 709 Lung Cancer cases were treated across the system as follows:Hartford Hospital - 438Hospital of Central Connecticut - 115Backus Hospital - 75Midstate Medical Center - 56Windham Hospital - 12Charlotte Hungerford Hospital -13Approximately 876 Prostate Cancer cases were treated across the system as follows:Hartford Hospital - 349Hospital of Central Connecticut - 90Backus Hospital - 121Midstate Medical Center - 88Windham Hospital - 20Charlotte Hungerford Hospital - 208Approximately 367 Bladder Cancer cases were treated across the system as follows:Hartford Hospital - 139Hospital of Central Connecticut - 54Backus Hospital - 94Midstate Medical Center - 55 Windham Hospital - 9Charlotte Hungerford Hospital - 16Approximately 331 Colon Cancer cases were treated across the system as follows:Hartford Hospital - 159Hospital of Central Connecticut - 51Backus Hospital - 14Midstate Medical Center - 28Windham Hospital - 8Charlotte Hungerford Hospital - 71Today, 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. 30238420 33427755 Gastroenterology:The Digestive Health Center of Midstate Medical Center (The Center) is a dedicated hospital center by board certified gastroenterologists and is located on the Hospital's main campus. For patients in central Connecticut, The Center is a comprehensive resource for the prevention, diagnosis and treatment of a full range of gastrointestinal disorders that affect the stomach, colon and digestive tract.The staff provides expert care to all of our patients and work together to provide a seamless transition from pre-procedure to procedure and room to home. Our staff ensures that each patient has a visit that is as pleasant and comfortable as possible. We care for inpatients as well as an outpatient population.The Center provides upper services such endoscopies and colonoscopies as well as radiofrequency ablation for patients with high grade Barrett's Esophagus, and ERCP (Endoscopic Retrograde Cholangiopancreatogram). Pulmonologist's frequent our department as we continue to care for patients having Bronchoscope procedures.Some other conditions treated at the Center include: Ulcerative Colitis; GERD (Heartburn); Diverticulitis; Irritable Bowel Syndrome; Crohn's Disease; Barrett's Esophagus; and Colon Cancer.For FY19, the Center had 5,566 cases and treated 4,857 patients. The Center had 34 surgeons during FY19. 143820361 3500 184060928 Midstate Medical Center is a 156-bed acute care hospital located in Meriden, Connecticut, with satellite offices in Cheshire, Wallingford and Southington. Midstate Medical Center provides a broad spectrum of services that meets the needs of the community it serves. In towns across Central Connecticut, Midstate Medical Center is committed and focused on efforts to promote health and wellness. In addition to the programs referred to above, the Hospital provides services/programs including but not limited to the following:*Behavioral Health*Cancer Care*Cardiology & Heart Care*Cosmetic & Reconstructive Surgery*Diabetes & Endocrinology*Digestive Health*Emergency Services*Headache Center*Imaging Services*Mako System*Maternity*Medical Weight Loss*MediQuick*Movement Disorders Center*Neuroscience Institute*Neurosciences*Neurosurgery*Orthopaedics*Pain Treatment*Physical Rehabilitation*Podiatry*Primary Care & Family Medicine*Sleep Care*Spine Care*Stroke*Surgical Services*Surgical Weight Loss*Travel Clinic & Infectious Diseases*Urgent / Walk-in Care*Urology & Kidney*Women's Health*Wound Care 143820361 3500 184060928 260777871 1 1 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 121 0 1 1395 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CT X Carol Wardell 8606966200 181 Patricia M Genova Drive Newington CT 06111 Letterio Asciuto MD Director 1.00 2.00 X 0 62670 0 Irfan Chughtai MD Director 1.00 2.00 X 0 0 0 Nadine Francis-West Director 1.00 2.00 X 0 0 0 Paul Czepiga Thru 11718 Director 1.00 2.00 X 0 0 0 Carl Grant Thru 12918 Director 1.00 2.00 X 0 0 0 Joseph Harrison MD Director 1.00 60.00 X 0 115398 19214 Bruce Koeppen MD Director 1.00 2.00 X 0 0 0 Denise McNair Director 1.00 2.00 X 0 0 0 George Springer Jr Esq Director 1.00 2.00 X 0 0 0 David Hyman DDS Director 1.00 2.00 X 0 0 0 Ming Jung Kim Director 1.00 2.00 X 0 0 0 Gary Havican Director/President 30.00 30.00 X X 0 489143 100907 Jason Howey Chair 2.00 4.00 X X 0 0 0 John Rathgeber Director/Vice Chair 2.00 4.00 X X 0 0 0 Margaret Marchak Secretary 2.00 58.00 X 0 1116829 82271 Sean Curtin VP, Finance 30.00 30.00 X 0 237207 54425 Elizabeth Ciotti VP, Care Logistics 30.00 30.00 X 0 246146 39157 Karen Fasano VP, Patient Care 30.00 30.00 X 0 221686 33400 Jeff Finkelstein VP, Medical Affairs 30.00 30.00 X 0 522939 77789 Janette Edwards VP, Operations 30.00 30.00 X 0 301893 55016 Andrew Metzger Medical Director 60.00 X 455425 0 60263 Timothy Pratt MD Hospitalist 60.00 X 463666 0 43101 Adwoa Nyanin Hospitalist 60.00 X 364967 0 41865 Mohammed Shams MD Hospitalist 60.00 X 377746 0 62089 Amir Ahmad MD Hospitalist 60.00 X 382021 0 58997 2043825 3313911 728494 141 0 1 0 Radiology Services LLC 101 N Plains Industrial Road Wallingford CT 06492 Medical Services 7200000 Origin Incorporated 1800 SW 1st St STE 510 Portland OR 97201 Staffing Services 2801089 Morrison Management SP Inc 400 Northbridge Road Sandy Springs GA 30350 Food Services 1240917 Vista Staffing Solutions Inc 189 Redstone Hill Road Bristol CT 06010 Staffing Services 990490 Midstate Radiology Associates LLC 101 No Plains Indust Road Wallingford CT 06492 Medical Services 941502 43 130750 29337 269972 430059 Patient Care 624100 313838917 313838917 Income-Pass Thru Entity 900003 1956845 1295832 661013 315795762 3519090 3519090 2884652 3244550 -359898 -359898 -359898 Cafeteria Income 722210 674054 674054 674054 320059067 315134749 661013 3833246 X 3500 3500 75983996 70196986 5578884 208126 2681338 2477125 196869 7344 6410446 5922220 470667 17559 5126962 4736488 376431 14043 3742 3742 33249 33249 150035 150035 41641526 41641526 35905 35905 2290010 1613119 656089 20802 15396793 9084108 6312685 4309351 2190837 2118514 59389 55954 3391 44 147160 129333 17577 250 3476275 695255 2781020 22297201 19621536 2675665 9998981 4400811 5594221 3949 3603937 3603937 Medical Supplies 66515446 66515446 Hospital Provider Tax 22040478 22040478 Repairs & Maintenance 4597891 3067839 1513744 16308 Purchased Services 3751094 2485359 1250857 14878 688885 260109 427053 1723 291243590 260777871 30160693 305026 8430286 11922315 6498 10334 29054710 32312716 4830454 5283543 1887820 1913555 276904783 168144842 99756436 108759941 18870810 16604791 94303464 120134355 47466996 34752004 304607474 331693554 13092588 18711133 137642652 155393479 150735240 174104612 X 135536576 139474208 2240516 2341936 16095142 15772798 153872234 157588942 304607474 331693554 X 28815477 1000672 -26099441 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 33249 0 0 33249 0 Part II-B, Line 1: Midstate Medical Center is a member of Connecticut Hospital Association (CHA). CHA engages in lobbying activities on behalf of all their members. Efforts mainly include lobbying activities that are directly related to communications with legislators or actions on specific legislative bills on healthcare matters. CHA allocates portion of its dues as lobbying expenses. The total amount of dues allocated for lobbying purpose in FY19 was $33,249. 21835639 802000 15000 22622639 20216639 1623000 4000 21835639 17241639 2975000 20216639 16445639 796000 17241639 16586328 -140689 16445639 0.92000 0.05000 0.03000 0 1 1 1250000 1250000 125051898 60176453 64875445 8341655 6973179 1368476 127605490 100995210 26610280 14655740 14655740 108759941 Other Investments 1612047 F Funds Held in Trust by Others 14992744 F 16604791 Investment in Endowment LLC 120134355 F 120134355 Security Deposits 9000 Insurance Receivable 13650146 Other Non Current Assets 386553 Due from Affiliates 20706305 34752004 Accrued Post Retirement Expenses 49930299 IBNR Malpractice Reserve 2346258 Other Liabilities 3261347 Long Term Debt - Intercompany 80343465 Accrued Malpractice Claims 13351917 Hospital Provider Tax 5454193 General Reserve 706000 155393479 Part V, Line 4: Midstate Medical Center has adopted investment and spending policies for endowment assets that attempt to provide a predictable stream of funding to programs supported by its endowment while seeking to maintain purchasing power of the endowment assets. Midstate Medical Center's spending policy is that investment income and realized gains and losses associated with the endowments are appropriated for spending every year, and unrealized gains and losses are reinvested back in to the endowment as accumulated earnings. Endowment assets include those assets of donor-restricted funds as well as board designated funds that the Midstate Medical Center must hold in perpetuity or for donor-specific period(s). Midstate Medical Center's endowment consists of approximately 100 individual funds established for a variety of purposes. The endowment includes both donor-restricted endowment funds and funds designated by the Board of Directors to function as endowments. Net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments, 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 purchases. 1 1 X 1 X 250.000000000000 1 X 1 0 1 0 0 1381694 1381694 0.00470 69888618 40105140 29783478 0.10230 71270312 40105140 31165172 0.10700 188742 5900 182842 0.00060 401177 143542 257635 0.00090 589919 149442 440477 0.00150 71860231 40254582 31605649 0.10850 0 3763659 65035514 71481150 -6445636 X 1 1 1 1 Midstate Medical Center 435 Lewis Avenue Meriden CT 06451 midstatemedical.org 0070 X X Midstate Medical Center 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X See Part V, Page 8 X X 1 17 1 See Part V, Page 8 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 Midstate Medical Center Part V, Section B, Line 5: To solicit input from key informants and individuals who have broad interest in the health of the community, the hospital performed surveys, community forums, focus groups and interviews with key informants. The key informants were selected by community leader(s) or liaison(s). Additionally, focus groups were used to identify any other resource.Focus groups, community forums, and individual key informant interviews were conducted from February to June 2018 with representatives from Hartford HealthCare, the Hospital and numerous community-based organizations and social services agencies.Participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the overall community. They were asked to rate the degrees to which various health issues were a problem in the Midstate Region. Follow-up questions asked them to describe why they identified areas as such, and how these might be better addressed. These participants included physicians, public health representatives, health professionals, social service providers and a variety of other community leaders including the following:Adelbrook American School for the DeafARC of Meriden and WallingfordBeat the Street Community Center Boy Scouts of America Bradley Home Casa Boricua Catholic Charities Child Guidance Clinic Choate School Chrysalis Center City of Meriden - Senior Center Coalition on Housing & Homelessness Columbus House Community Foundation for Greater New Haven Community Health Network of CT Community Health Center (FQHC) Concepts for Adaptive Learning (CfAL) Connecticut Legal Services Conservation Commission Connecticut Community Foundation Connecticut Food Bank Connecticut Legal Services Cuno Foundation FoodCorps Franciscan Home Gaylord Hospital Girl Scouts of Connecticut Girls Inc. Good News Christian Church Hartford HealthCare Behavioral Health Healthy Wallingford 2020 ION Bank Foundation James H. Napier Foundation Liberty Bank Foundation Literacy Volunteers of Greater New Haven Maloney High School Band Boosters Masonic Home & Hospital Master's Manna Meriden Arts Trust Meriden Boys & Girls Club Meriden Boys & Girls Club Meriden Children First Meriden Clergy Association Meriden City Council Meriden Department of Health and Human Services Meriden Foundation Meriden Parks Department Meriden Public Schools Meriden Senior Center Meriden Soup Kitchen Meriden Wallingford Collaborative MidState Chamber of Commerce MidState Medical Center My City Kitchen New Opportunities of Greater Meriden Nutmeg Big Brothers Big Sisters Prepare Tomorrow's Parents Quinnipiac Chamber of Commerce Rushford SCOW Senior Transportation Services, Inc. Soul Friends South Central Connecticut Substance Abuse Action Council Spanish Community of Wallingford St. Vincent DePaul Middletown State House of Representatives, Meriden The Grace Place Town of Wallingford Ulbrich Boys & Girls Club United Way of Meriden and Wallingford Wallingford Boys & Girls Club Wallingford Daycare Wallingford Health Department Wallingford Housing Authority Wallingford School District Wallingford Senior Center Wallingford YMCA Women & Families CenterPart V, Section B, 7a:https://midstatemedical.org/about/community-outreach/community-health-needs-assessment Midstate Medical Center Part V, Section B, Line 7d: The needs assessment was published in June 2018 and is available on the hospital's website. In addition, electronic copies are available upon request.Part V, Section B, Line 10a:https://midstatemedical.org/community-health-needs-assessment Midstate Medical Center Part V, Section B, Line 11: After reviewing the Community Health Needs Assessment findings, the community representatives met on May 11, 2018 to determine the health needs to be prioritized for action. There was a review of the identified needs followed by a wide-ranging discussion. After which the participants were asked to rank each of the needs. Based on data analysis, surveys, focus groups, and interviews, these are the top community health needs and priorities identified for the Midstate Medical Center focus area: - Common themes surfaced around access to housing and transportation. When the lack of access to transportation impact the ability to access healthcare, the population usually foregoes healthcare services. Transportation schedules and routes do not service many outpatient or urgent care clinics; however, they do service the hospital, leading to overutilization of the ED. *Lack of affordable, secure, and stable housing *Access to care *Emergency departments often used for primary care *Patient hand-offs between caregivers are not well coordinated or followed-up on *Underutilized preventative care - Availability of healthy foods, especially fruits and vegetables, with a significant impact on seniors and children outside school-based programs - Childhood obesity including a lack of resources/facilities to safely exercise and cost of food - Mental health issues including substance abuse and addiction *Shortage of providers or Lack of affordable treatment options *Limited comprehensive outpatient care *Lack of insurance coverage for behavioral health *No same-day access - Stressing of social networks - Meriden scored significantly worse in physical and mental health indicators (including healthy weight, cigarette smoking, asthma, and depression) relative to the rest of the focus area and the state of Connecticut - Despite a significant number of outstanding ongoing community health initiatives, the majority of stakeholders who participated in focus groups and interviews said that a lack of coordination among and between providers and community-based organizations limits the overall effectiveness of the programs and the funding that is going to help serve the populations most in need. The results were then grouped into 3 Areas of Concern that were addressed in Community Health Improvement Plan (CHIP):1. Enhance Coordination of Services: this category includes Access to Care and TransportationCHIP addressed this need in the following manner:a. Evaluate and use information exchange portal resources, linking healthcare providers with community-based organizations.b. Improve IT resources to enable community focus and better measurement of outcomes.c. Develop a playbook for infrastructure, dashboard of health, governance, and community workflows.d. Enable dynamic and up-to-date asset mapping.e. Develop innovation network for learning, research, co-creation, and rapid knowledge dissemination (bi-directional communication platform).f. Implement new or increased use of Community Health Workers (CHW).g. Evaluate and use adaptive technology (e.g., geo-fencing, GIS mapping, artificial intelligence, biometric risk assessment, Epic tie-ins).2. Promote Healthy Behaviors and Lifestyle: this category includes Access to Healthy Food and Poor Physical and Mental Health. CHIP addresses this need in the following manner:a. Screen for healthy food need identification in community population and provide assessment at points of care. b. Enhance Promotion and Marketing, including adopting 5-2-1-0 initiative, at schools, workplaces, public spaces, faith communities, and healthcare events. c. Provide voucher/prescription programs for fruits and vegetables.d. Promote and improve healthy food donation. e. Further partnerships with food pantries/banks and food providers and suppliers.f. Create more access points for healthy foods.g. Develop urban gardens, community gardens, hospital campus gardens, farmer's markets (fresh food).h. Evaluate and use mobile food programs.i. Create and support food policy councils.3. Improve community Behavioral Health: this category includes Mental Health and Substance Abuse. CHIP addresses this need in the following manner: a. Embed behavioral health services in primary care (ongoing).b. Recruit more mental health providers, with focus on community outpatient services (e.g., family therapists).c. Implement Recovery Coach program in ED.d. Provide more depression screening growth and at more points of care with referrals.(including at public schools) and integrate into Epic.e. Further Mental Health First Aid training and grow community behavioral health training at the local level.f. Enhance services in virtual mental health, including tele-psychiatry.Areas of Opportunity, identified but not prioritized were housing and safety issues including a lack of affordable housing, neighborhood safety, and housing conditions. It was determined that Midstate Medical Center does not have the resources or expertise to address these issues but will certainly support the efforts of other city and community agencies and organizations. Midstate Medical Center 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 health care expenses. Midstate Medical Center Part V, Section B, Line 15e: In addition, patient may ask 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://midstatemedical.org/patients-visitors/financial-assistancePart V,Section B, Line 16b, FAP Application website:https://midstatemedical.org/patients-visitors/financial-assistancePart V,Section B, Line 16c, FAP Plain Language Summary website:https://midstatemedical.org/patients-visitors/financial-assistance Midstate Medical Center Part V, Section B, Line 16j: Patients are informed directly by staff of the availability of the Financial Assistance Policy. 2 1 - Mediquick-Midstate Medical Center 680 South Main Street Cheshire CT 06410 Urgent Care Center 2 - Mediquick-Midstate Medical Center 61 Pomeroy Avenue Meriden CT 06450 Urgent Care Center Part I, Line 3c: Midstate Medical Center used the Federal Poverty Guidelines 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 Benefit Report, quarterly reports are submitted to The Connecticut Hospital Association and Form 990 is submitted to the Connecticut Office of Health Care 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 lines 7a, b, & g. 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 above to avoid duplication. Costs reported in Part III, Section B6, were calculated from the Medicare cost report and reduced for Medicare costs previously reported on Part I Lines 7f and g. Part I, Line 7g: No physician clinic costs were included in the subsidized Health Services cost calculations. Part III, Line 2: The Hospital has established estimates based on information presently available of amounts due to or from Medicare, Medicaid, and third-party payers for adjustments to current and prior year payment rates, based on industry-wide and Hospital specific data. Such amounts are included in the accompanying consolidated balance sheets. 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 as charity care prior to being sent to bad debt. Therefore, any bad debt expense that could be attributable to charity care at the end of FY 2019 is immaterial. Part III, Line 4: Please see the text of the footnote that describes bad debt expense beginning on pages 26 of the Audited Financial Statement. The Footnote is also applicable 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: Midstate Medical Center 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: Midstate Medical Center uses Emergency Room data to track increases in medical conditions such as falls, flu, drug overdoses, etc. The same approach is taken in our outpatient clinics. We periodically canvas our Social Work/Case Management staff as to what they are seeing and hearing about as they work with patients. We also track requests from other entities such as area non profits, local government agencies and public schools. These requests often reflect growing needs and issues in our community. Part VI, Line 3: Midstate Medical Center 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: Midstate Medical Center is located in Central Connecticut. In 2018, Its primary service area has a total population of 374,591 people. Of those, 20.6% are under the age of 18, 62.4% 18 to 64 and 17% are seniors. The racial makeup is 72% White, 6.9% Black, 15.4% Hispanic and 5.6% Other. 7% of the population lives below the poverty level. The unemployment rate is 7.3%. 9.7% do not have a high school diploma and 19.2% have a Bachelor's degree or higher. Part VI, Line 5: The mission of Midstate Medical Center is to improve the health and healing of the people and communities we serve. Midstate is committed and focused on efforts to promote health and wellness.The majority of Midstate Medical Center's regional governing board is comprised of persons who either reside or work in its primary service area, and they are neither employees nor contractors of the Hospital.Midstate Medical Center extends medical staff privileges to all qualified physicians in its community. The Hospital/Medical Center has partnered with the Community Health Center to provide health services to the underserved in the community. In addition, Midstate Medical Center participates in Community Vision to improve community health and well-being.Midstate Medical Center has contracted to use the services of an organization to assist its patients in determining eligibility and applying for state and federal means tested programs such as Medicare and Medicaid, as well as for the Midstate Medical Center Financial Assistance Program. Additionally, the Midstate Emergency Department and satellite MediQuick Urgent Care facilities provide medical care regardless of patients' ability to pay for services. In towns across Central Connecticut, Midstate Medical Center is committed and focused on efforts to promote health and wellness in the communities the Hospital serves. Each year, Midstate Medical Center makes a concerted effort to go above and beyond its call to the community. Our physicians, nurses, and staff reach out to thousands of individuals every year through health-related programs and special events. Additionally, Midstate Medical Center has partnered with various community organizations to improve the quality of life of its residents. These include key opinion leaders, faith communities, business leaders, government officals, and a variety of social service organizations. Senior Emergency Care ServicesIn May 2013, with an eye on the health needs of our aging population, Midstate Medical Center began offering a newer, innovative approach to caring for seniors in its Emergency Department. When a patient 65+ comes to our Emergency Department, they are not just treated for the ailment that brought them to the hospital. A multi disciplinary team also performs a special assessment to guage the patient's status and whether they may have medication issues, be a fall risk or suffer from ailments like dementia and depression. The hope is to identify follow up care before the condition worsens. When patients leave our Emergency Department, we make sure they are transitioning home or to another care setting smoothly by developing individualized care plans following discharge, making follow up appointments. 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 Midstate Medical Center, 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 its affiliates, including all supporting organizations, develop and implement programs to improve the future of health care in our Central 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 small communities easy and expedient access to the more extensive and specialized services that the larger hospitals are 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 affiliates' 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 cost containment strategies. Part VI, Line 7, Reports Filed With States CT 1 1 0 0 0 0 0 1 0 Gary Havican Director/President 0 346125 0 141218 0 1800 0 66049 0 34858 0 590050 0 0 Margaret Marchak Secretary 0 492829 0 228567 0 395433 0 19250 0 63021 0 1199100 0 276628 Sean Curtin VP, Finance 0 176645 0 60241 0 321 0 17289 0 37136 0 291632 0 0 Elizabeth Ciotti VP, Care Logistics 0 183200 0 61282 0 1664 0 16524 0 22633 0 285303 0 0 Karen Fasano VP, Patient Care 0 173126 0 48071 0 489 0 11194 0 22206 0 255086 0 0 Jeff Finkelstein VP, Medical Affairs 0 390946 0 128123 0 3870 0 24750 0 53039 0 600728 0 0 Janette Edwards VP, Operations 0 223723 0 77726 0 444 0 19250 0 35766 0 356909 0 0 Andrew Metzger Medical Director 395726 0 59189 0 510 0 15781 0 44482 0 515688 0 0 0 Timothy Pratt MD Hospitalist 346410 0 116943 0 313 0 19250 0 23851 0 506767 0 0 0 Adwoa Nyanin Hospitalist 308936 0 55696 0 335 0 19250 0 22615 0 406832 0 0 0 Mohammed Shams MD Hospitalist 342129 0 35402 0 215 0 19250 0 42839 0 439835 0 0 0 Amir Ahmad MD Hospitalist 302042 0 79099 0 880 0 19250 0 39747 0 441018 0 0 0 Part I, Line 3 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of Midstate Medical Center 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 Midstate Medical Center 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 occurrence 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. 2018 SERP Accruals were made on behalf of the following individual: Gary Havican $46,999 2018 SERP Payouts were made on behalf on the following individuals: Margaret Marchack $117,856* *For this individual, vesting occured, causing taxable income. This portion of the vested amount was used to pay the 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 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 Midstate Medical Center 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 board. Form 990, Part VI, Section A, line 7b The sole member of the Organization has the right to review, approve, disapprove or deny fundamental 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. It was then 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 of 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 Respective Network or Region Executive Leadership Team (ELT). The ELT 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 Midstate Medical Center 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 Midstate Medical Center, 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 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 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 Hospital's address. Form 990, Part IX, line 11g Medical Professional Fees: Program service expenses 41,641,526. Management and general expenses 0. Fundraising expenses 0. Total expenses 41,641,526. Form 990, Part XI, line 9: Transfer to Affiliated Entity 1,585,589. Change in Pension and Post-Retirement Funding Obligation -27,685,030. Form 990 Part XII Line 3A & B Although the organization was not required to undergo A-133 Federal Audit, the results were included in a consolidated A-133 audit performed at the parent level Hartford HealthCare Corporation. 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