2019-08-09T15:19:42-05:00 2018-09-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2017-10-01 060646599 DAY KIMBALL HEALTHCARE INC % PAUL A BEAUDOIN DAYK 8609286541 320 POMFRET STREET PUTNAM CT 06260 PAUL A BEAUDOIN CFO 2019-08-15 true Krystal K Creach P01248198 4178658701 167.68.126.162 43032920192215000014 2019-08-09 P 8F438207F781E16C0FE969051AA52AD6F3A8EA5F AE6E5E46D41BC60DF08B4BEE75B34EFCBA1C7A6F 2017 2019-02-21 02:37:17Z DAY KIMBALL HOSPITAL ANNE DIAMOND 320 POMFRET STREET PUTNAM CT 06260 124611903 false X WWW.DAYKIMBALL.ORG X 1894 CT DKH IS A SHORT-TERM GENERAL CARE HOSPITAL PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO NORTHEASTERN CT AND BORDER COMMUNITIES IN MA AND RI. 15 10 1031 180 0 79353 2598273 1628273 105351113 121020191 1729742 681472 39031 -351228 109718159 122978708 0 0 0 0 54954429 54799752 0 0 0 51033667 60463543 105988096 115263295 3730063 7715413 93138645 94302713 101713410 93856549 -8574765 446164 THE MISSION OF DAY KIMBALL HEALTHCARE IS TO MEET THE HEALTH NEEDS AND WELL-BEING OF OUR DIVERSE COMMUNITY THROUGH OUR CORE VALUES OF CLINICAL QUALITY, CUSTOMER SERVICE, FISCAL AND ENVIRONMENTAL RESPONSIBILITY AND LOCAL CONTROL. false false 101522995 115977588 DAY KIMBALL HEALTHCARE PROVIDES A COMPREHENSIVE HEALTHCARE SYSTEM OFFERING PRIMARY CARE AND A MULTITUDE OF MEDICAL AND SURGICAL SPECIALTIES ALONG WITH LEADING-EDGE TECHNOLOGY AND SOPHISTICATED DIAGNOSTICS. OUR SERVICE AREA INCLUDES NORTHEAST CONNECTICUT AS WELL AS NEARBY MASSACHUSETTS AND RHODE ISLAND COMMUNITIES. DAY KIMBALL HEALTHCARE'S COMPREHENSIVE NETWORK OFFERS MORE THAN 1,000 EMPLOYEES INCLUDING MORE THAN 200 HIGHLY-SKILLED PHYSICIANS, SURGEONS AND SPECIALISTS. 4414130 5042603 PHYSICIAN OFFICE PROVIDING PRIMARY CARE AND OUTPATIENT VISITS TO NORTHEASTERN CONNECTICUT COMMUNITIES. 105937125 true true false true false false false false false true true true false false true false false true false false false false false false true false true true false false true true false false false false false false false false false false false false false false true true true true false false true 90 0 true 1031 true true true false false false false true true false false false false X 15 10 false false false false false true false true true false false true true true true true true true true false X PAUL A BEAUDOIN 8609286541 320 POMFRET STREET PUTNAM CT 06260 X MICHAEL BAUM MD DIRECTOR 1.0 40.0 X 26400 310279 22429 KAREN COLE SECRETARY 1.0 0.0 X X 0 0 0 ANTHONY CHIEFFALO DIRECTOR 1.0 40.0 X 21079 280525 15629 EDWIN HIGGINS ASST. SECRETARY/TREASURER 1.0 0.0 X X 0 0 0 DR PAUL MATTY DIRECTOR 1.0 40.0 X 11000 259646 21093 JANICE THURLOW VICE CHAIRWOMAN 1.0 0.0 X X 0 0 0 STEVEN SCHIMMEL MD MEDICAL STAFF REPRESENTATIVE 1.0 0.0 X 0 0 0 PETER DEARY DIRECTOR BEG 01/18 1.0 0.0 X 0 0 0 JEFFREY PAUL TREASURER 1.0 0.0 X X 0 0 0 JOSEPH ADILETTA CHAIRMAN; INTERIM PRESIDENT 40.0 1.0 X X 201761 0 10305 KATHY ROCHA DIRECTOR BEG 01/18 1.0 0.0 X 0 0 0 SHAWN MCNERNEY DIRECTOR 1.0 1.0 X 0 0 0 NANCY WEISS DIRECTOR BEG 01/18 1.0 0.0 X 0 0 0 ANNE DIAMOND PRESIDENT AND CEO BEG 08/2017 40.0 1.0 X X 160940 0 9450 KEVIN JOHNSTON DIRECTOR 1.0 0.0 X 0 0 0 JOSEPH ALESSANDRO DO DIRECTOR END 12/17 1.0 2.0 X 46130 0 0 WILLIAM ST ONGE DIRECTOR END 12/17 1.0 1.0 X 0 0 0 JOSEPH BOTTA DIRECTOR END 12/17 1.0 0.0 X 0 0 0 JACK BURKE DIRECTOR END 12/17 1.0 1.0 X 0 0 0 MARK SHAMBER DIRECTOR END 12/17 1.0 0.0 X 0 0 0 PAUL BEAUDOIN CFO 40.0 1.0 X 299277 0 8964 JOHN GRAHAM V.P. MEDICAL AFFAIRS, CMO 40.0 1.0 X 274101 0 8307 JOHN O'KEEFE V.P. OF NURSING, CNO 40.0 0.0 X 166309 0 5179 SARAH JANE DEASIS PHYSICIAN 40.0 0.0 X 301390 0 18619 JOHN MODICA PHYSICIAN 40.0 0.0 X 232409 0 14140 KRISTEN LESCAULT O.R. COORDINATOR 60.0 0.0 X 168467 0 27549 ODILE ROMANICK DIRECTOR OF I.T. 40.0 0.0 X 145579 0 26630 RENEE SMITH ADMINISTRATOR 30.0 10.0 X 119438 33254 8342 ROBERT SMANIK FORMER PRESIDENT AND DIRECTOR, 40.0 1.0 X 443064 0 4794 2617344 883704 201430 44 true true false DOWNES CONSTRUCTION CO LLC 200 STANLEY STREET NEW BRITIAN CT 06051 CONSTRUCTION SVCS. 1819950 EASTERN CT HEMATOLOGY AND ONCOLOGY 330 WASHINGTON ST STE 230 NORWICH CT 06360 ONCOLOGY SVCS. 794873 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 303845547 TEMP PLACEMENT 522128 RDW GROUP 125 HOLDEN STREET PROVIDENCE RI 02908 MARKETING/COMM. 509847 ORTHOPEDIC ASSOCIATES OF WINDHAM CO 255 POMFRET STREET PUTNAM CT 06260 PHYSICIAN SVCS. 502295 24 175400 805121 647752 1628273 NET PATIENT SERVICE REVENUE 621110 115977588 115977588 OTHER 900099 4078205 4078205 CAFETERIA 722514 567943 567943 AFFILIATED ORGANIZATION RENT 900099 316211 316211 PHARMACY 446110 80244 80244 121020191 571278 571278 0 0 183629 173921 9708 0 9708 9708 1520816 10000 1379472 41150 141344 -31150 110194 110194 31770 175400 38652 -6882 -6882 0 0 0 0 0 0 LOSS ON DEBT EXTINGUISHMENT 900099 -354054 -354054 -354054 122978708 121020191 330244 0 0 0 0 1650930 371172 1279758 0 40939198 37760443 3178755 1693334 1521512 171822 7299496 6569615 729881 3216794 2882523 334271 0 355137 355137 163930 163930 0 0 89917 89917 9267420 8304401 963019 402768 360915 41853 4322376 3873219 449157 3020809 2706903 313906 0 2164666 1939726 224940 175787 157520 18267 0 23594 21142 2452 1841040 1649729 191311 0 4975451 4458430 517021 1433294 1284354 148940 PROVIDER TAX 13810397 13810397 MEDICAL SUPPLIES & DRUGS 13759197 13759197 BAD DEBT 3196626 3196626 REPAIRS & MAINTENANCE 1198642 1074086 124556 262492 235215 27277 115263295 105937125 9326170 0 282640 243493 15082286 15272529 45722 205888 9645362 10307569 0 0 0 0 0 0 2341451 2472900 318844 1362611 131610875 86551373 46965736 45059502 2438919 64002 15588299 18500983 0 0 0 0 429386 813236 93138645 94302713 15601716 22839585 0 0 0 0 25617185 21853272 0 0 0 0 11291122 10493552 201208 124192 49002179 38545948 101713410 93856549 X -14575043 -5767874 1572296 1708308 4427982 4505730 -8574765 446164 93138645 94302713 X 7715413 527120 778396 X false true X true true true X false false false false false false false false true 19919 19919 false SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: DAY KIMBALL HOSPITAL PAID DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION DURING THE FISCAL YEAR. A PORTION OF THESE DUES MAY BE ATTRIBUTABLE TO LOBBYING EXPENSES. 11812302 863836 500000 74586 12101552 9884933 16104 2005447 94182 11812302 9568620 548627 753291 878996 106609 9884933 13426179 187403 3920227 124735 9568620 15007697 1543560 452041 3449846 127273 13426179 0.86000 0.14000 false false 3378743 3378743 84348421 54252489 30095932 41115121 32298884 8816237 2768590 2768590 45059502 INV IN VHA COALITION 80000 C FUNDS HEAD IN TRUST BY OTHERS 3507452 F INVESTMENT IN REAL ESTATE 159723 C BOARD RESTRICTED ENDOW FUNDS 13624330 F DONOR RESTRICTED ENDOW FUNDS 1129478 F 18500983 0 PENSION LIABILITIES 34195825 EST AMT DUE TO THIRD PARTIES 2744999 DEFERRED GAIN ON LIABILITIES 1605124 38545948 119899171 527120 -3331064 -2803944 122703115 275593 275593 122978708 111092002 212573 212573 110879429 4383866 4383866 115263295 SCHEDULE D, PART X, LINE 4 ENDOWMENT FUND: THE HOSPITAL'S ENDOWMENT CONSISTS OF MULTIPLE FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES INCLUDING CAPITAL EXPENDITURES, OPERATIONS, AND OTHER DONOR-SPECIFIED RESTRICTIONS. SCHEDULE D, PART V, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $(6,198,590) TRANSFER TO AFFILIATE (3,196,626) BAD DEBT (1,097,323) PENSION EXPENSE ( 89,917) INVESTMENT MANAGEMENT FEES 213,802 NET ASSETS RELEASED FROM RESTRICTION 7,037,590 CHANGE IN DEFINED BENEFIT PLAN ------------ $(3,331,064) SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $( 173,921) RENT EXPENSE ( 38,652) FUNDRAISING EXPENSE 488,166 TEMPORARILY RESTRICTED CONTRIBUTIONS ------------ 275,593 SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ 173,921 RENT EXPENSE 38,652 FUNDRAISING EXPENSE ------------ $ 212,573 SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 3,196,626 BAD DEBT 1,097,323 PENSION EXPENSE 89,917 INVESTMENT MANAGEMENT FEES ------------ $ 4,383,866 GOLF CLASSIC 103422 78462 24960 1250 3571 18481 645 1050 279 TREE OF LIFE 32285 32285 3623 6 71463 64653 6810 1960 705 3430 775 2883 207170 175400 31770 1250 5531 19186 4075 1825 6785 38652 -6882 true true X true X 250. true X true true true false true true 117368 117368 0.00100 33215581 25141489 8074092 0.07200 3878 3878 33336827 25141489 8195338 0.07300 4903 4903 140540 140540 0.00130 8430126 5567318 2862807 0.02560 8575569 5567318 3008250 0.02690 41912396 30708807 11203588 0.09990 true 3196626 283124 28776876 35148210 -6371334 X true true 1 1 DAY KIMBALL HEALTHCARE 320 POMFRET STREET PUTNAM CT 06260 WWW.DAYKIMBALL.ORG 0043 X X X DAY KIMBALL HEALTHCARE 1 false false true X X X X X X X X 17 true true false true X SEE PART V, SECTION C X true 17 true SEE PART V, SECTION C false true X 250. 250. X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X true X false false SCHEDULE H, PART V, LINE 5 COMMUNITY INPUT: DAY KIMBALL HOSPITAL ALONG WITH THE OTHER MEMBERS OF THE WINDHAM COUNTY HEALTHCARE CONSORTIUM (WINDHAM HOSPITAL, DAY KIMBALL HOSPITAL, NATCHAUG HOSPITAL, GENERATIONS FAMILY HEALTH CENTER, UNITED SERVICES, VNA EAST, NORTHEAST DISTRICT DEPARTMENT OF HEALTH AND COMMUNITY HEALTH RESOURCES (CHR)) UTILIZED THE CENTER FOR RESEARCH AND PUBLIC POLICY (CRPP), AN INDEPENDENT RESEARCH FIRM, TO CONDUCT A COMPREHENSIVE NEEDS ASSESSMENT UTILIZING FOCUS GROUPS AND PHONE SURVEYS OF COUNTY RESIDENTS ALONG WITH STATE AND FEDERAL DATA TO IDENTIFY AND PRIORITIZE THE HEALTHCARE NEEDS IN WINDHAM COUNTY. COUNTY RESIDENTS ALONG WITH STATE AND FEDERAL DATA TO IDENTIFY AND PRIORITIZE THE HEALTHCARE NEEDS IN WINDHAM COUNTY. SCHEDULE H, PART V, LINE 6A CHNA CONDUCTED WITH OTHER HOSPITALS: DAY KIMBALL HOSPITAL CONDUCTED ITS NEEDS ASSESSMENT IN CONJUNCTION WITH THE WINDHAM COUNTY HEALTHCARE CONSORTIUM. THE MEMBERS OF THIS CONSORTIUM INCLUDE WINDHAM HOSPITAL, DAY KIMBALL HOSPITAL, NATCHAUG HOSPITAL, GENERATIONS FAMILY HEALTH CENTER, UNITED SERVICES, VNA EAST, NORTHEAST DISTRICT DEPARTMENT OF HEALTH AND COMMUNITY HELATH RESOURCES (CHR). SCHEDULE H, PART V, LINE 7A CHNA AVAILABILITY: THE ORGANIZATION'S CHNA REPORT WAS MADE AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/ABOUT-DAY-KIMBALL-HEALTHCARE/IN-THE-COMMUNITY/ COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, LINE 10A IMPLEMENTATION STRATEGY AVAILABILITY: THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/ABOUT-DAY-KIMBALL-HEALTHCARE/IN-THE/COMMUNITY/ COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART V, LINE 11 ADDRESSING IDENTIFIED NEEDS: MOST OF THE HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT ARE ALREADY ADDRESSED BY DAY KIMBALL HOSPITAL, EITHER BY DIRECT DELIVERY OF SERVICE TO THE COMMUNITY OR THROUGH OUR COLLABORATIONS WITH SUCH ORGANIZATIONS AS HEALTHQUEST. THESE INCLUDE SERVICES AND PROGRAMS SUCH AS: - EXPANDING OUR INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES - PARTNERING WITH WHOLESOME WAVE, WIC, AND THE LOCAL FARMER'S MARKET TO SUBSIDIZE MARKET COUPONS, DOUBLING THEIR VALUE, FOR FAMILIES WITH CHILDREN - WORKING WITH HEALTHQUEST AS AN ACTIVE MEMBER AND FUNDER ON SUCH PROGRAMS AS FOLLOW THE FIFTY, HEART HEALTH, PROGRAM FOR WOMEN AND WRITE STEPS, AN ELEMENTARY SCHOOL-BASED WALKING AND WRITING PROGRAM TO IMPROVE HEALTH (IN PARTICULAR OBESITY IN CHILDREN) AND EDUCATION - BECOMING A SMOKE-FREE ORGANIZATION AND OFFERING SMOKING CESSATION CLASSES TO OUR EMPLOYEES AND CONTINUING TO OFFER CLASSES TO THE COMMUNITY - OFFERING DIABETES CARE MANAGEMENT SERVICES IN ALL OUR PRIMARY CARE OFFICES - IMPLEMENTING A SERIES OF COMMUNITY-BASED FLU SHOT CLINICS TO IMPROVE ACCESS - EXPANDING OUR SLEEP LAB WITH IN-HOME TESTING NOW AVAILABLE - CONDUCTING EDUCATIONAL SEMINARS ON COLON CANCER AND COLONOSCOPIES HOSTED BY OUR SPECIALTY TEAM OF PROVIDERS SCHEDULE H, PART V, LINES 16A, 16B, & 16C FINANCIAL ASSISTANCE POLICY AVAILABILITY: THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE POLICY APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT THE FOLLOWING URL: https://www.daykimball.org/resources/financial-services/ 11 PLAINFIELD HEALTHCARE CENTER 31 DOW ROAD/12 LATHROP ROAD PLAINFIELD CT 06374 PRIMARY CARE; PEDIATRICS DANIELSON HEALTHCARE CENTER 55 GREEN HOLLOW ROAD DANIELSON CT 06239 DIAGNOSTIC IMAGING DANIELSON MEDICAL ASSOCIATES 45 GREEN HOLLOW ROAD DANIELSON CT 06239 PRIMARY CARE SERVICES PUTNAM SURGICAL ASSOCIATES 346 POMFRET STREET PUTNAM CT 06260 CONSULTATIVE AND SURGICAL SERVICES WOODSTOCK MEDICAL ASSOCIATES 168 ROUTE 171 SOUTH WOODSTOCK CT 06267 INTERNAL MEDICINE NORTHEAST CONNECTICUT DERMATOLOGY 55 GREEN HOLLOW ROAD DANIELSON CT 06239 DERMATOLOGY SERVICES MEDICAL CENTER OF NORTHEAST CONNECTICUT 612 HARTFORD DRIVE DAYVILLE CT 06241 INTERNAL MEDICINE POMFRET STREET FAMILY MEDICAL ASSOCIATES 235 POMFRET STREET PUTNAM CT 06260 PRIMARY CARE SERVICES PUTNAM HEALTHCARE CENTER 6-12 SOUTH MAIN STREET PUTNAM CT 06260 LAB AND THERAPY SERVICES DAY KIMBALL HOMEMAKERS 24-32 SOUTH MAIN STREET PUTNAM CT 06260 UNSKILLED HOMECARE SERVICES ST LUKE'S FAMILY PRACTICE 7 KENNEDY DRIVE PUTNAM CT 06260 PRIMARY CARE SERVICES SCHEDULE H, PART I, LINES 3A, 3B, & 3C DETERMINING ELIGIBILITY FOR FREE & DISCOUNTED CARE: TO QUALIFY FOR FREE CARE, AN INDIVIDUAL MUST MEET ALL OF THE CRITERIA: - SINGLE ACCOUNT BALANCE OF $250 OR GREATER OR ACCOUNTS SPANNING SIX MONTHS TOTALING $500 OR GREATER (INDIVIDUAL) OR ACCOUNTS SPANNING SIX MONTHS TOTALING $1000 OR GREATER FOR 2 OR MORE FAMILY MEMBERS (UNDER SAME GUARANTOR). - ANNUAL INCOME IS LESS THAN 250% OF THE CURRENT FEDERAL INCOME POVERTY LEVEL (FPL). - LIQUID ASSETS MUST NOT EXCEED $100,000 (INCLUDES STOCKS, BONDS, CASH, 401K, IRA, CD, PROPERTY AND BUSINESS VALUE, AND RECREATIONAL VEHICLES). TO QUALIFY FOR A 75% CHARITY CARE DISCOUNT, AN INDIVIDUAL MUST MEET ALL OF THE FOLLOWING CRITERIA: - SINGLE ACCOUNT BALANCE OF $250 OR GREATER OR ACCOUNTS SPANNING SIX MONTHS TOTALING $500 OR GREATER (INDIVIDUAL) OR ACCOUNTS SPANNING SIX MONTHS TOTALING $1000 OR GREATER FOR 2 OR MORE FAMILY MEMBERS (UNDER SAME GUARANTOR). - ANNUAL INCOME IS LESS THAN 250% OF THE CURRENT FEDERAL INCOME POVERTY LEVEL (FPL). - LIQUID ASSETS MUST NOT EXCEED $100,000 INCLUDING (STOCKS, BONDS, CASH, 401, IRA, CD, PROPERTY AND BUSINESS VALUE AND RECREATIONAL VEHICLES). - INSURED PATIENTS WHO HAVE NO ADDITIONAL COVERAGE (AND HAVE DOCUMENTATION THAT THEY HAVE EXHAUSTED THEIR INSURANCE) FOR THE REMAINDER OF THEIR PLAN YEAR WILL BE DEEMED "UNINSURED" UNDER SECTION A OF THIS POLICY. IF GRANTED CHARITY CARE, IT WILL BE ONE-TIME GRANTING. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COSTING METHODOLOGY THAT WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS DAY KIMBALL HOSPITAL'S COST-TO-CHARGE RATIO THAT WAS REPORTED IN THE FY2018 MEDICARE COST REPORT. SCHEDULE H, PART I, LINE 7G SUBSIDIZED SERVICES: DAY KIMBALL HOSPITAL PARTNERS WITH NORTHEASTERN CONNECTICUT COUNCIL OF GOVERNMENTS (NECCOG) TO PROVIDE LOCAL PARAMEDIC INTERCEPT SERVICES. DAY KIMBALL HOSPITAL AND NECCOG AGREED THAT THE ABSENCE OF PARAMEDIC INTERCEPT SERVICES IN NORTHEASTERN CONNECTICUT, COMPRISED OF MANY RURAL TOWNS, WOULD CREATE A SIGNIFICANT DEFICIENCY IN THE AVAILABILITY AND ACCESSIBILITY OF MEDICAL SERVICES IN THE COMMUNITY. THE HOSPITAL PROVIDES CERTAIN MONETARY AND IN-KIND SERVICES FOR THE PROVISION OF PARAMEDIC INTERCEPT SERVICES. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF FORM 990 WAS REDUCED BY BAD DEBT EXPENSE OF $3,196,626. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE ORGANIZATION CALCULATED BAD DEBT EXPENSE USING THE AMOUNTS CALCULATED IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS ESTIMATED USING THE PERCENTAGE OF THE POPULATION THAT IS BELOW THE POVERTY LINE IN THE HOSPITAL'S SERVICE AREA. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: PLEASE REFER TO THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR NOTE 1 - PATIENT ACCOUNTS RECEIVABLE AND CHARITY CARE. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT RATIONALE: THE SHORTFALLS BETWEEN DAY KIMBALL HOSPITAL'S MEDICARE COSTS AND PAYMENTS ARE CONSIDERED COMMUNITY BENEFIT BECAUSE THE SERVICES WERE PROVIDED BY DAY KIMBALL HOSPITAL EVEN THOUGH THE COSTS WERE NOT COVERED OR REIMBURSED. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 WAS GROSS CHARGES REDUCED BY THE COST TO CHARGE RATIO THAT WAS REPORTED IN THE FY2018 MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION B, LINE 9B COLLECTION POLICY: IT IS THE PHILOSOPHY AND POLICY OF DAY KIMBALL HOSPITAL THAT MEDICALLY NECESSARY HEALTH CARE SERVICES SHOULD BE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE POLICY WAS BEEN WRITTEN IN ACCORDANCE WITH SECTION 9007 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACT), SIGNED INTO LAW ON MARCH 23, 2010, WHICH ADDS NEW SECTIONS 501(R) AND 4959 TO THE INTERNAL REVENUE CODE. SECTION 510(R) INCLUDES A SERIES OF SPECIFIC REQUIREMENTS FOR HOSPITALS TO RECEIVE AND MAINTAIN SECTION 501(C)(3) "TAX EXEMPT" STATUS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: DAY KIMBALL HOSPITAL HAS RECENTLY COMPLETED A COMMUNITY NEEDS ASSESSMENT IN CONJUNCTION WITH THE WINDHAM COUNTY HEALTHCARE CONSORTIUM. THE CONSORTIUM UTILIZED A NATIONAL CONSULTING FIRM TO ASSIST IN THE PROCESS OF IDENTIFYING SPECIFIC HEALTH CARE NEEDS IN WINDHAM COUNTY. FOCUS GROUPS, TELEPHONE SURVEYS AND STATE AND FEDERAL DATA WAS USED TO IDENTIFY THE SPECIFIC HEALTH CARE NEEDS DURING THIS ASSESSMENT. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ALL PATIENTS WHO ARE UNINSURED ARE REFERRED TO THE FINANCIAL COUNSELING DEPARTMENT; INPATIENTS ARE ALL VISITED BY A FINANCIAL COUNSELOR (OR GIVEN A FINANCIAL COUNSELING PACKET) PRIOR TO DISCHARGE WITH ALL OF THE AVAILABLE PROGRAMS THAT ARE AVAILABLE THROUGH OUR FINANCIAL ASSISTANCE (CHARITY CARE) POLICY. ANY SCHEDULED PATIENTS WHO ARE UNINSURED ARE CALLED BY THE FINANCIAL COUNSELORS IN ADVANCE TO PROVIDE ALL OF THE OPTIONS INCLUDING SCREENING FOR MEDICAID ASSISTANCE, CHARITY CARE, AS WELL AS SEVERAL OTHER LOCAL FUNDING SOURCES THAT THEY MAY QUALIFY FOR. ALL PATIENT STATEMENTS HAVE INFORMATION ABOUT OUR CHARITY CARE POLICY AS WELL AS DOWNLOADABLE CHARITY CARE APPLICATION. ALL OF OUR THIRD PARTY VENDORS, INCLUDING OUR BAD DEBT AGENCIES AND OUR LONG TERM PATIENT FINANCING PROGRAM THROUGH CAREPAYMENT ALSO PROVIDE OUR CHARITY CARE POLICY TO PATIENTS UPON REQUEST. OUR FINANCIAL ASSISTANCE GUIDELINES ARE ALSO POSTED IN ALL PATIENT REGISTRATION AREAS OF THE HOSPITAL. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: DAY KIMBALL HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF 13 TOWNS IN THE NORTHEASTERN CORNER OF CONNECTICUT AS WELL AS BORDERING MASSACHUSETTS AND RHODE ISLAND TOWNS. DAY KIMBALL'S SERVICE AREA IS OVER 438 SQUARE MILES AND CONTAINS APPROXIMATELY 116,192 IN WINDHAM COUNTY. THE POPULATION RANGES FROM LONG-TERM, MULTI-GENERATIONAL FAMILIES TO NEWLY IMMIGRATED RESIDENTS FROM URBAN AREAS. ACCORDING TO THE 2010 CENSUS, 11.7% OF THE POPULATION IS UNDER POVERTY LEVEL AND 14.3% ARE OVER AGE 65. THERE IS A WIDE RANGE OF SOCIO-ECONOMIC FACTORS INCLUDING VERY HIGH INCOME TO POVERTY; ADVANCED EDUCATION TO INCOMPLETE HIGH SCHOOL. THE MEDIAN HOUSEHOLD INCOME IN 2010 IN WINDHAM COUNTY WAS $58,489 (THE LOWEST INCOME OF ANY COUNTY IN THE STATE OF CONNECTICUT), WHILE THE STATE MEDIAN WAS $69,519. ACCORDING TO THE HEALTHY CONNECTICUT 2020 STATE HEALTH ASSESSMENT THAT WAS RELEASED IN MARCH 2014 THE LEADING CAUSE OF DEATH IN CONNECTICUT ARE HEART DISEASE AND CANCER. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: THE MISSION OF DAY KIMBALL HOSPITAL IS TO MEET THE HEALTH NEEDS OF OUR COMMUNITY THROUGH OUR CORE VALUES OF CLINICAL QUALITY, CUSTOMER SERVICE, FISCAL RESPONSIBILITY AND LOCAL CONTROL. DAY KIMBALL HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND PHYSICIANS. THE MEDICAL STAFF IS OPEN TO ALL PHYSICIANS IN THE COMMUNITY WHO MEET MEMBERSHIP AND CLINICAL PRIVILEGE REQUIREMENTS. INPATIENT, OUTPATIENT AND EMERGENCY SERVICES THAT ARE MEDICALLY NECESSARY ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. SCHEDULE H, PART VI, LINE 6 AFFILIATE STRUCTURE: DAY KIMBALL HOSPITAL HAS A RELATIONSHIP WITH UMASS MEMORIAL MEDICAL CENTER AS ITS TERTIARY CARE SITE. WHEN PATIENTS' CARE REQUIRES SPECIALIZED TREATMENTS, DAY KIMBALL COLLABORATES WITH PROMINENT MEDICAL CENTERS TO PROVIDE THE CARE THEY NEED. FOR INSTANCE, DAY KIMBALL PARTNERS WITH UMASS MEMORIAL MEDICAL CENTER IN WORCESTER, MA, FOR CARDIAC CARE AND HAS DEVELOPED A SYSTEMATIC APPROACH TO STABILIZING AND TRANSPORTING HEART ATTACK PATIENTS TO UMASS FOR FURTHER TREATMENT. X X X X true false false false false false false false false MICHAEL BAUM MD DIRECTOR 26400 287893 0 20929 0 1457 0 7830 0 14599 26400 332708 0 0 ANTHONY CHIEFFALO DIRECTOR 21079 223493 0 39583 0 17449 0 0 0 15629 21079 296154 0 0 DR PAUL MATTY DIRECTOR 11000 258395 0 0 0 1251 0 6564 0 14529 11000 280739 0 0 JOSEPH ADILETTA CHAIRMAN; INTERIM PRESIDENT 190269 0 0 0 11492 0 0 0 10305 0 212066 0 0 0 PAUL BEAUDOIN CFO 297987 0 0 0 1290 0 1684 0 7280 0 308241 0 0 0 ANNE DIAMOND PRESIDENT AND CEO BEG 08/2017 150940 0 10000 0 0 0 0 0 9450 0 170390 0 0 0 ROBERT SMANIK FORMER PRESIDENT AND DIRECTOR, 51087 0 0 0 391977 0 0 0 4794 0 447858 0 0 0 SARAH JANE DEASIS PHYSICIAN 288599 0 12350 0 441 0 2977 0 15642 0 320009 0 0 0 JOHN MODICA PHYSICIAN 150267 0 81302 0 840 0 7120 0 7020 0 246549 0 0 0 KRISTEN LESCAULT O.R. COORDINATOR 167169 0 0 0 1298 0 5296 0 22253 0 196016 0 0 0 ODILE ROMANICK DIRECTOR OF I.T. 142637 0 0 0 2942 0 4520 0 22110 0 172209 0 0 0 RENEE SMITH ADMINISTRATOR 119058 33254 0 0 380 0 1300 0 7042 0 127780 33254 0 0 JOHN GRAHAM V.P. MEDICAL AFFAIRS, CMO 272335 0 0 0 1766 0 7950 0 357 0 282408 0 0 0 JOHN O'KEEFE V.P. OF NURSING, CNO 165012 0 0 0 1297 0 4989 0 190 0 171488 0 0 0 SCHEDULE J, PART I, LINE 1A HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: ANNE DIAMOND, PRESIDENT, RECEIVED A HOUSING ALLOWANCE. THE ALLOWANCE WAS TAXABLE IN THE YEAR RECEIVED. SCHEDULE J, PART I, LINE 4C SEVERANCE PAYMENTS: ROBERT SMANIK, RESIGNED ON 11/23/16, RECEIVED A SEVERANCE PACKAGE IN THE AMOUNT OF $305,888 WHICH INCLUDED EQUAL WEEKLY PAYMENTS OVER A 52 WEEK PERIOD. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: BONUSES AWARDED DURING THE YEAR WERE EITHER STIPENDS FOR AN INDIVIDUAL SERVING AS A DEPARTMENT OR COMMITTEE CHAIRPERSON OR INCENTIVE PAYMENTS FOR RVU'S WORKED. A STATE OF CONNECTICUT HEALTH AND 060806186 20774YPC5 2013-06-06 30330000 EMERGENCY DEPARTMENT EXPANSION false false false A 0 0 30330000 2340522 1170295 15485409 606600 0 0 10723350 3824 0 2014 true false true true A false false false false 0 false false false true A false true false false false false 0 false 0 false true A true SCHEDULE K, PART I(F) DESCRIPTION OF PURPOSE: CURRENT REFUNDING AND EMERGENCY DEPARTMENT EXPANSION AND RENOVATION. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT THE GOVERNING BODY: THE HOSPITAL HAS MORE THAN 400 CORPORATORS WHO ARE DEDICATED TO THE HOSPITALS MISSION. CORPORATORS ARE INDIVIDUALS INTERESTED IN THE PURPOSES OF THE HOSPITAL AND REPRESENT THE COMMUNITIES SERVED. CORPORATORS HAVE THE RIGHT TO PARTICIPATE IN THE ELECTION OF DIRECTORS AND OFFICERS. FORM 990, VI, SECTION B, LINE 11B REVIEW OF FORM 990: FORM 990 IS REVIEWED BY PAUL A. BEAUDOIN, CFO, PRIOR TO FILING. A COPY OF THE 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING BOARD MEMBERS, ADMINISTRATION, THE MEDICAL STAFF, AND ALL OTHER EMPLOYEES TO FILL OUT A CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. IF ANY CHANGE IN THE FORM ARISES THROUGHOUT THE YEAR, IT IS REQUIRED TO BE REPORTED PROMPTLY TO THE CHAIR OF THE BOARD OF DIRECTORS OR THE PRESIDENT OF DAY KIMBALL HOSPITAL. IN THE EVENT A POTENTIAL CONFLICT OF INTEREST HAS A DIRECT IMPLICATION FOR PATIENT CARE, THE INSTITUTION MAY CONVENE AN ETHICS COMMITTEE MEETING TO ASSIST IN THE RESOLUTION OF THE ISSUE. IF AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE AFFECTED EMPLOYEE WILL REFRAIN FROM FURTHER PARTICIPATION IN MATTERS TO WHICH THE CONFLICT RELATES UNTIL THE QUESTION OF CONFLICT HAS BEEN RESOLVED. FORM 990, PART VI, SECTION C, LINE 15A & 15B COMPENSATION OF TOP MANAGEMENT: DAY KIMBALL HEALTHCARE PARTNERS WITH AN EXTERNAL CONSULTANT TO ANALYZE ALL LEVELS OF COMPENSATION WITHIN THE ORGANIZATION. THIS ENABLES US TO ENSURE THAT THERE IS A SOLID FRAMEWORK TO MAKE EFFECTIVE, CONSISTENT, STRATEGIC AND OPERATIONAL COMPENSATION DECISIONS THAT IMPACT OUR EMPLOYEES FOR THE SUPPORT THEY PROVIDE TO THE OVERALL MISSION AND STRATEGY OF THE HOSPITAL. ANY CHANGES THAT INVOLVE SIGNIFICANT FINANCIAL ADJUSTMENTS ARE PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A COMPENSATION OF BOARD OF DIRECTORS: NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. DIRECTORS WITH COMPENSATION LISTED ON PART VII ARE EITHER EMPLOYEES OF THE FILING ORGANIZATION, OR EMPLOYEES AND/OR INDEPENDENT CONTRACTORS FOR A RELATED ORGANIZATION, DAY KIMBALL MEDICAL GROUP. THEY ARE COMPENSATED FOR THEIR DUTIES IN THAT CAPACITY. FORM 990, PART XI, LINE 9 CHANGES IN NET ASSETS: $(6,198,590) TRANSFER TO AFFILIATE ( 60,604) CHANGE IN INTEREST IN BENEFICIAL TRUST 7,037,590 CHANGE IN DEFINED BENEFIT PENSION PLAN ------------ $ 778,396 PHYSICIAN SERVICES OF NORTHEAST CT 45 GREEN HOLLOW ROAD DANIELSON CT 06239 262565797 PHYSICIAN SVC CT DK HLTHCR DAY KIMBALL HOMEMAKERS 320 POMFRET STREET PUTNAM CT 06260 061136893 HOMEMAKERS CT 501(C)(3) 10 DK HLTHCR true DAY KIMBALL MEDICAL GROUP INC 320 POMFRET STREET PUTNAM CT 06260 454077626 PHYS SERVICES CT 501(C)(3) 10 DK HLTHCR true false false false false false false false false false true false false false false false true true true false DAY KIMBALL MEDICAL GROUP INC R 6198590 COST DAY KIMBALL MEDICAL GROUP INC J 316211 COST