2019-08-13T09:43:19-05:00 2018-09-30 440160260 BKD 1201 Walnut Suite 1700 Kansas City MO 64106 990 2017-10-01 060966963 Natchaug Hospital Inc NATC 8604561311 189 Storrs Road Mansfield Center CT 06226 Paul V Maloney VP of Finance 8604561311 2019-08-13 0 Mike Engle P00482834 8162216300 199.231.28.240 2019-08-13 09:42:56 ED P D6D028B83EC7BAE48696A0FE418AC7215527A94E CD71869BFC494223FABD92E93AB0669CE7B22062 2017 2019-02-21 02:37:17Z Patricia Rehmer 189 Storrs Road Mansfield Center CT 06226 52836588 0 X WWW.NATCHAUG.ORG X 1954 CT The mission of Natchaug Hospital is to provide a continuum of accessible, community-based services for those living with psychiatric illness and chemical dependency or emotional and related educational disabilities, with a commitment to the dignity and privacy of those needing service, empowering them to participate in their own care, education and recovery. 11 6 609 23 0 22174 117000 149482 51782498 52609728 12428 43856 39109 33522 51951035 52836588 0 0 0 0 38151135 38056575 0 0 18354 13819638 14927823 51970773 52984398 -19738 -147810 30036519 27593035 15861884 8485392 14174635 19107643 X The mission of Natchaug Hospital is to provide a continuum of accessible, community-based services for those living with psychiatric illness and chemical dependency or emotional and related educational disabilities, with a commitment to the dignity and privacy of those needing service, empowering them to participate in their own care, education and recovery. 0 0 21519343 22327025 Inpatient Treatment:Natchaug Hospital provides a full range of inpatient psychiatric and substance-abuse treatment for children, adolescents and adults at our 57-bed Mansfield Center facility. The highly qualified, experienced and dedicated professional staff of Natchaug Hospital provides expert care in a supportive, therapeutic setting - helping people regain their stability and return as soon as possible to their own homes. The hospital serves Medicare and Medicaid subscribers and provides care without regard to ability to pay.Intermediate Care (ICC):This is an acute level of care for a longer length of stay for persons living with prolonged and severe mental illness. Historically, people from Eastern Connecticut who were in need of an extended length of stay were referred to Cedarcrest Hospital in Newington. Natchaug Hospital ICC provides this much-needed care for persons from the Eastern Region, closer to the communities where they live and work.United Services and the Southeastern Mental Health Authority are the Local Mental Health Authorities (LMHA's) responsible for authorizing admission to the Intermediate Care Program. The above includes the authorization of Department of Mental Health and Addiction Services (DMHAS) funds to pay for care in the event the patient is medically indigent, has exhausted his/her Medicare benefit, or has no Medicare hospitalization coverage. Patients are most likely to be referred from Eastern Region hospital inpatient units when it becomes clear that the patient will not be able to safely return to the community following an acute care stay. Upon admission, each patient is assessed by a psychiatrist, a registered nurse and a primary therapist. A treatment plan is developed for each patient. The treatment team works closely with the patient, their family and community providers to develop a discharge plan and ensure that community supports are in place.In-Patient Treatment Programs:* Treats approximately 60 patients on a daily basis at the Mansfield locationInpatient Treatment includes:* Comprehensive bio-psycho-social assessment* Formulation of a treatment plan developed with the patient/family which may include the use of medications * Group therapy (a primary treatment approach)* Family therapy and individual therapy* Formulation of a discharge/aftercare plan* Case management servicesTypical patient experience: The majority of our patients arrive via ambulance through the ambulance entrance. All patients receive an initial assessment by a registered nurse and psychiatrist which is completed within 8 hours of admission. Patients are oriented to the unit, the milieu, and the schedule. Our patients are closely monitored for the first 24-48 hours, depending on presentation and symptoms. 10035066 8942475 Joshua Centers: The Joshua Centers provides various treatment programs including:Partial Hospital Program (PHP): The Partial Hospital Program provides four hours of intensive psychiatric support daily for up to five days per week. This is a morning program for adults and an after-school program for children and adolescents. The program can eliminate the need for a hospital stay, and/or help with the transition back to home and regular school after a period of inpatient care.Intensive Outpatient Program (IOP): The Intensive Outpatient Program is somewhat less intense than the PHP, providing three hours of intensive treatment each day for up to five days each week. This program is offered both in the morning and during the evening for adults and after-school for children and adolescents. The IOP program is designed to help continue progress with behavioral health stabilization and recovery.Extended Day Treatment (EDT):This special program, partially funded by the Connecticut Department of Children, supports children and adolescents who have emotional or behavioral health issues that put them at risk of needing psychiatric residential or inpatient care. The Extended Day Treatment program is particularly helpful for children with special needs who are in foster care.Child & Adolescent Treatment Programs:* Treat about 250 children and adolescents daily in all programs/locations* May prevent hospitalization* Aids in transition back to the community following hospitalization* Transportation to Partial Hospital Program, Intensive Outpatient Program and Extended Day Program: Most of this transportation is provided by Natchaug Hospital staff, driving the Hospital vans that pick up patients from their school or home. * Average length of stay in PHP/IOP program, 6 - 8 weeks; EDT and Intensive In-Home Child & Adolescent Psychiatric Services, 6 months.Joshua Program treatment services include: * Comprehensive bio-psycho-social assessment* Group Therapy (the primary treatment approach)* Family and individual therapy* Medication management* Occupational and creative rehabilitation therapy* Comprehensive aftercare/discharge planningPartial Hospital Program (PHP): four hours of treatment for up to five days per week Intensive Outpatient program (IOP): three hours of treatment up to five days per week Extended Day Treatment (EDT) is a specialized therapeutic after-school support program that provides structured groups for three hours a day up to five days per week to learn and practice social skills such as group interaction, listening, cooperative leisure activities. Intensive In-Home Child & Adolescent Psychiatric Services(IICAPS): developed and monitored by the Yale University Child Study Center, provides in home services 2-3 times per week to help meet the needs of families with children with persistent psychiatric disorders. Client referral to a Child/Adolescent Treatment Program:* Referred from an inpatient program in Connecticut* Community providers (Child & Family Services; United Children & Families; Emergency Rooms)* School systems* Private providers (community psychiatrists or therapists)* Family and friendsIn a treatment day, clients arrive after being picked up from their school (or home) in one of Natchaug Hospital vans and will attend four groups in PHP and three groups in IOP. Groups include a psychotherapy group, educational groups and an activity group. The activity group is led by a Mental Health Worker or a CRS Staff member; all other groups are led by a masters level clinician. Education groups might include managing emotions, dangers of substance abuse, handling relationships, etc. 7939610 8461126 Education: Natchaug provides various educational programs such as:Clinical Day Treatment School Programs (CDT):Natchaug's clinical day treatment programs, which are approved by the Connecticut Department of Education, offer special education services to students in grades 1 - 12, whose social, emotional or behavioral health problems prevent them from functioning successfully in a regular school environment. Each student's individual academic and clinical treatment plan is designed to address their special needs and return them to their regular schools as soon as possible. Natchaug Hospital schools operate in Enfield, Danielson, Mansfield, Norwich, and Windham. Natchaug is also the contracted operator of a school for the Town of Norwich. Natchaug Hospital's Board of Directors serves a number of functions similar to a Board of Education, with responsibilities for the oversight and the implementation of certain State statutes and Federal legislation.Natchaug Hospital School Programs:* Each school day, an average of 200 students attend Natchaug Hospital's school programs* Approved by the Connecticut Department of Education * Inpatient School, Journey House School, Clinical Day Treatment School in six sites Students come to the Inpatient School on an emergency basis, and for non-educational reasons; school staff determines if the student receives special education services, and if there is an Individual Education Plan (IEP) to be implemented. Students come to the Journey House School on a planned basis and for non-educational reasons. Each student's school files are evaluated for proper placement in school. Girls who receive special education, Section 504, and regular education all are educated at the Journey School. Students come to the six CDT sites via a Planning and Placement Team (PPT) Meeting from their home school district. They may be placed on a diagnostic basis with PPT meetings every two weeks while psychiatric, psychological and educational assessments are performed. Students also may enter the program already receiving special education services with an IEP (Individualized Education Plan) in place. Students at the Hickory Street School are placed by the Norwich Board of Education. All students are identified as special education and have an IEP in place. Transportation to all day school programs is provided by the Local Education Authority (LEA) that placed the student; however, transportation during the school day for field trips is often provided using Natchaug vans with school staff driving; sometimes school field trips are transported by outside vendors. Description of typical day:A typical day in the Inpatient and Journey House School is a five-hour day that covers all academic areas, including electives of Art and PE. A typical day in the CDT schools is similar to any traditional school day, with academic subjects in addition to psycho-educational groups led by school clinicians. 5760273 12879102 Natchaug Hospital is eastern Connecticut's leading provider of mental health and addiction services for children, adolescents and adults. Founded in 1954, Natchaug Hospital provides a wide range of mental health and addiction treatment services for children, adolescents and adults in eastern Connecticut. Natchaug offers inpatient services, including one of only six pediatric inpatient units in the state of Connecticut, residential treatment for court-involved teenage girls, clinical day treatment schools, and ambulatory services through its 10-site network of care.In addition to above, Natchaug provides the following services/programs:Child Services Adolescent ServicesYoung Adult ServicesAdult ServicesAlcohol AbuseOlder Adults ProgramAttention Deficit Hyperactivity Disorder Evaluations Autism Spectrum Disorder EvaluationsPsychological ServicesSchoolsExtended Day TreatmentInpatient TreatmentIntensive In-Home Child and Adolescent Psychiatric Services (IICAPS)Intensive Outpatient TreatmentJoshua Center ProgramsJourney House ProgramPartial HospitalizationResidential Treatment ProgramMedication Assisted Treatment Close to Home (MATCH) 5760273 12879102 45254292 1 1 0 1 0 0 0 0 0 0 1 0 0 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 49 0 1 609 1 1 1 0 0 0 0 0 0 0 0 0 X 11 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CT X Paul V Maloney VP Finance Behavioral Health Network 8604561311 189 Storrs Road Mansfield Center CT 06226 Mary Barry MD Director 1.00 2.00 X 0 64068 2641 Henry Beck Director 1.00 2.00 X 0 0 0 Carmen Cid Director 1.00 2.00 X 0 0 0 Carolyn Drescher Director 1.00 2.00 X 0 0 0 Stephen Larcen Director 2.00 1.00 X 0 5976 0 Steve Lee MD Thru Dec 2017 Director 1.00 2.00 X 0 0 0 Lynne Quintal-Hill Director 1.00 2.00 X 0 0 0 Mark Tramontozzi Director 1.00 2.00 X 0 67297 0 James Watson MD Director 1.00 2.00 X 0 0 0 Diane Wishnafski Director & Chair 3.00 6.00 X X 0 0 0 Deborah Monahan Director & Vice Chair 3.00 6.00 X X 0 0 0 Donna Handley Director 1.00 2.00 X 0 399296 62413 Paul Weigle Associate Medical Director 60.00 0.00 X 262026 0 60022 Margaret Marchak Secretary 1.00 59.00 X 0 691694 136350 Patricia Rehmer President BHN 30.00 30.00 X 0 466644 84063 Paul Maloney VP, Finance 30.00 30.00 X 0 288773 51274 Harold Schwartz MD VP, Psychiatrist in Chief 30.00 30.00 X 0 640664 76070 Deborah Weidner MD VP, Safety and Quality 30.00 30.00 X 476551 0 55686 James O'Dea VP, Operations 30.00 30.00 X 0 288270 49994 Pamela Shuman Associate Medical Director 60.00 0.00 X 272794 0 50599 Jonathan Raub Associate Medical Director 60.00 0.00 X 269018 0 60482 Gengyun Wen Psychiatric Attending 60.00 0.00 X 252789 0 51065 Tiwalola Kolawole Psychiatric Attending 60.00 0.00 X 248725 0 40621 Judah David Weathers Psychiatric In House 60.00 0.00 X 230668 0 27703 David Whitehead Former President 0.00 60.00 X 0 1005456 74886 2012571 3918138 883869 37 1 1 0 Morrison Mgmt Specialists Inc 2655 Northwinds Parkway Alpharetta GA 30009 Food and Nutrition Services 545123 Locumtenens Holdings LLC 5801 Peachtree Dunwoody Rd Atlanta GA 30342 Staffing Services 525279 Barton Associates Inc PO Box 417844 Boston MA 02241 Staffing Services 327049 J E R & L Corporation 348 Orchard Hill Road Pomfret Center CT 06259 Construction Services 246300 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Staffing Services 212792 11 149482 149482 Net Patient Revenue 624100 52609728 52609728 52609728 43856 43856 33522 0 33522 33522 33522 52836588 52609728 0 77378 466312 466312 28681167 26500754 2180413 1771197 1638700 132497 4846780 4484211 362569 2291119 2124317 166802 1685 1685 5931 5931 2162493 2162493 22768 22684 84 459122 250972 206102 2048 3614148 1991920 1622228 1509764 1491994 17770 78216 65519 12526 171 49504 25079 24226 199 99184 99184 3203841 2062623 1141218 791270 114482 676788 378860 378860 Purchased Services 1408499 1006834 387257 14408 Medical Supplies 556304 556304 Repairs & Maintenance 387497 369391 18106 Dues & Licenses 102547 22773 79229 545 96190 7066 88225 899 52984398 45254292 7711752 18354 6983142 5408622 188949 10729712 8544215 135350 145162 203761 167339 22716381 11758061 11144843 10958320 61155 61155 589607 2308222 30036519 27593035 3135111 3177769 1789589 1758 10937184 5305865 15861884 8485392 X 13604783 18478846 519830 578775 50022 50022 14174635 19107643 30036519 27593035 X -147810 5080818 X X 0 1 X 1 1 1 X 0 0 0 0 0 0 1 5931 0 0 5931 0 Part II-B, Line 1: Natchaug 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 Organization occasionally asks its employees to volunteer their time to contact state legislators in an effort to lobby on its behalf. The total amount of dues allocated for lobbying expenses for FY18 was $5,931. 520357 520357 14768237 6747142 8021095 2346435 1109073 1237362 4592374 3901846 690528 488978 488978 10958320 Security Deposits 49576 Patient Refunds 186586 Other Assets 584590 Due From Affiliates 1487470 2308222 Professional Liability 2872805 Accrued Post Retirement Expenses 1963186 Accrued Malpractice 469874 5305865 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 364539 364539 0.00690 18631760 14652913 3978847 0.07510 18996299 14652913 4343386 0.08200 592195 125675 466520 0.00880 607818 2000 605818 0.01140 60427 60427 0.00110 19551 19551 0.00040 1279991 127675 1152316 0.02170 20276290 14780588 5495702 0.10370 12469 12469 0.00020 12469 12469 0.00020 0 1690560 0 3343421 3915046 -571625 X 1 1 1 1 Natchaug Hospital 189 Storrs Rd PO Box 260 Mansfield Center CT 06250 www.natchaug.org H0003 X Natchaug Hospital Inc 1 0 0 1 X X X X X X X X X 17 1 1 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 Natchaug Hospital, Inc. 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 group was conducted on February 14, 2018. Community forums, and individual key informant interviews were conducted between February and May 2018.Key informants 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 of concern in the Central Region. Follow-up questions were asked to describe why they identified areas as such, and how these might be better addressed. The key informants included Physicians, public health representatives, health professionals, social service providers and a variety of other community leaders including the following:Center for Healthy Aging Connecticut Legal Services Eastern Connecticut Health Insurance Program (ECHIP)Eastern Connecticut Workforce BoardEastern Highlands Health DistrictGenerationsMansfield Youth ServicesNCDHD Natchaug HospitalNortheast District Department of HealthSt. Joseph's Living Town of MansfieldUConn Student Health ServicesUnited Services, IncWillimantic DCF officeWillimantic Fire DepartmentWillimantic PoliceWindham HospitalWindham Public SchoolsWindham Region Transit DistrictThe 2018 CHNA took a close look at social determinants of health such as poverty, housing, transportation, education, fresh food availability, and neighborhood safety. Social determinants of health have become a national priority for identifying and addressing health disparities, and Natchaug Hospital is committed to addressing these disparities through the Community Health Improvement Plan that will follow this Assessment. Thru this process, input was gathered from individuals whose organizations can provide information for the following data elements:- Medically Underserved Areas- Health Professional Shortage Areas- Demographics- Ethnicity Distributions- Median Household Incomes- Homeownership Rates- Poverty Metrics- Unemployment Rates- Educational Metrics- Children in Poverty and Single-Parent Households Natchaug Hospital, Inc. Part V, Section B, Line 6a: The hospital facility's CHNA was conducted with Windham Community Memorial Hospital.Part V, Section B, Line 7a:https://natchaug.org/health-wellness/community-health-needs-assessment Natchaug Hospital, Inc. 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://natchaug.org/health-wellness/community-health-needs-assessment Natchaug Hospital, Inc. Part V, Section B, Line 11: In acknowledging the wide range of priority health issues that emerged from the 2018 CHNA process, the community representatives met on May 16, 2018 to determine the health needs that will be prioritized for action. The review of the identified needs were followed by a wide-ranging discussion, after which the representatives were asked to rank each of the needs.Based on data analysis, surveys, focus groups, and interviews performed, the top community health needs and priorities for the Natchaug Hospital focus area are listed below: Mental Health:Mental health issues were identified as a top area need. - Undocumented citizens not seeking or accepting care for fear of losing other services - The stigma of mental health difficult to overcome - Availability of services for children - Home behavioral health services can be 6-8 weeks on the waiting list - Need for more providers and more screening services - Shortage of psychiatrists, difficult to recruit based on comparatively lower pay - Need for more youth based mental health programs - Mental health patients get dropped off in hospital EDs - more and more are not able to be medically and behaviorally handled - All three counties have less primary care physicians, dentists, and mental health providers per person than the State of Connecticut. New London County has better provider ratios than Windham or Tolland counties, which are significantly worse than the State of Connecticut and the top 10th percentile of counties across the United States. - The service area has slightly better physical health metrics and comparable mental health metrics to the State of Connecticut. Tolland County has the lowest rates of poor physical and mental health. - The results of the community forum in May 2018, where participants asked to prioritize from a list of 15 top community needs, reveal mental health issues as the #1 top priority - Substance abuse was identified as a top issue:- Prevalence of smoking is a big issue - Placement after discharge and follow-up issues for patients with substance abuse- Need for a detox facility in the area- Need for prevention in opioid treatmentCHIP 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. 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 Natchaug Hospital, Inc. 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. Natchaug Hospital, Inc. Part V, Section B, Line 15e: In addition, patients may ask a nurse, physician, chaplain, or staff member from Patient Registration, Patient Financial Services, Office of Professional Services, Case Coordination, or Social Services about initiating the Financial Assistance Application process.Part V, Section B, Line 16a: FAP Website:natchaug.org/patients-caregivers/billing-insurance/financial-assistance Part V, Section B, Line 16b: FAP Application Website:natchaug.org/patients-caregivers/billing-insurance/financial-assistancePart V, Section B, Line 16c: FAP Plain Language Summary:natchaug.org/patients-caregivers/billing-insurance/financial-assistance Natchaug Hospital, Inc. Part V, Section B, Line 16j: Patients are informed directly by staff of the availability of the Financial Assistance Policy. 12 1 - Sachem House 151 Storrs Road Mansfield Center CT 06250 Day Treatment Center 2 - Joshua Center Thames Valley 11A Stott Avenue Norwich CT 06360 Day Treatment Center 3 - Joshua Center Northeast 934 North Main Street Killingly CT 06239 Day Treatment Center 4 - Joshua Center Enfield 72 Shaker Road Enfield CT 06082 Day Treatment Center 5 - Joshua Center Shoreline 5 Research Parkway Old Saybrook CT 06475 Day Treatment Center 6 - RiverEast Day Treatment Center 428 Hartford Tpke Vernon CT 06066 Day Treatment Center 7 - Joshua Center SE & Care Plus 1353 Gold Star Highway Groton CT 06340 Day Treatment Center 8 - Quinebaug Day Treatment Center 11 Dog Hill Road Killingly CT 06241 Day Treatment Center 9 - Older Adult Program Windham Hospital 112 Mansfield Avenue Willimantic CT 06226 Day Treatment Center 10 - Rushford Academy & Stonegate School 459 Wallingford Road Durham CT 06422 Day Treatment Center 11 - Green Valley School 206 Pond Road Franklin CT 06254 Day Treatment Center 12 - Backus Center for Mental Health 326 Washington Street Norwich CT 06360 Day Treatment Center Part I, Line 3c: Natchaug Hospital used 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:The Organization submits quarterly reports to Connecticut Hospital Association and Form 990 is submitted to the 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 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 II, Community Building Activities: To reduce economic impact of untreated mental illness and improve the quality of life for those living with this disease (and the communities in which they live) Natchaug Hospital pursues opportunities to increase awareness of the symptoms of mental illness, increase awareness that mental illness is a treatable disease, achieve a reduction in the stigma associated with mental illness (which is the largest barrier to treatment), and increase awareness of behavioral health treatment resources. The amount spent on Community Building activities for FY18 was $12,469. 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 2018 would be immaterial. Part III, Line 4: Please see the text of the footnote that describes bad debt expense beginning on page 26 of the Audited Financial Statement. The Footnote is also applicable 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: Natchaug Hospital has adopted the Financial Assistance Policy of its Parent Company, Hartford HealthCare Corporation. The following is included in the Financial Assistance Policy: In the event a patient fails to qualify for Financial Assistance or fails to pay their portion of discounted Charges pursuant to this Policy, and the patient does not pay timely their obligations to Natchaug Hospital, the Hospital reserves the right to begin collection actions, including but not limited to, imposing wage garnishments or liens on primary residences, instituting legal action and reporting the matter to one or more credit rating agencies. For those patients that qualify for Financial Assistance and who are cooperating in good faith to resolve the Hospital's outstanding accounts, the Hospital may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to outside collection agencies and will cease all collection efforts.No Extraordinary Collection Actions (ECA) will be initiated during the first 120 days following the first post-discharge billing statement to a valid address or during the time that patient's Financial Assistance Application is processing. Before initiating any ECA, a notice will be provided to the patient 30 days prior to initiating such event.If the patient applies for assistance within 240 days from the first notification of the self-pay balance, and is granted assistance, any ECA's such as negative reporting to a credit bureau or liens that have been filed will be removed. Part VI, Line 2: Natchaug Hospital periodically canvases 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. Data from health needs assessments conducted by Backus Hospital, Lawrence & Memorial Hospital, the United Way and regional health districts is also reviewed. Needs are also assessed by tracking waiting lists for admission to programs. Part VI, Line 3: Natchaug Hospital provides information about its Financial Assistance Policy as follows: (i) provide signs regarding this Policy and written plain language summary information describing the Policy along with Financial Assistance contact information in the Emergency Department, Labor and Delivery areas and other patient registration areas; (ii)provide to each patient written plain language summary information describing the Policy along with Financial Assistance contact information in admission, patient registration, discharge, billing and collection written communications; (iii) make paper copies of the Policy, financial assistance application, and plain language summary of the Policy available upon request and without charge, both by mail and in public locations in the hospital facility, including the emergency room (if any) and admissions areas; (iv) post the Policy, plain language summary and financial assistance application on the website with clear linkage to such documents on the Natchaug Hospital's home page; (v) educate all admission and registration personnel regarding the Policy so that they can serve as an informational resource to patients regarding the Policy; and (vi) include the tag line "Please ask about our Financial Assistance Policy" in Natchaug written publications. Additionally, Natchaug employs three Financial Counselors who meet with patients to review payment options or process financial assistance applications. Part VI, Line 4: Natchaug Hospital admits residents of, on average, 150 of Connecticut's 169 towns and residents of six states around the country each year. Natchaug Hospital's primary service area is comprised of 72 towns, predominantly east of the Connecticut River, which together represent approximately half the state's land area. Natchaug Hospital's clients represent urban, suburban and rural areas. The total population of the Natchaug Hospital service area is 594,576. 19.2% are age 0-17, 64% are age 18-64 and 16.8% are seniors. Whites make up 79.5%, Black 4.9%, Hispanics 8.9% and all other races combined is 6.6%.The population in poverty is 9.3%. The unemployment rate is 7.5%. Those with no High School Diploma is 8.5%. 18.4% have a Bachelor's Degree.The majority of Natchaug Hospital clients are financially stressed, as measured by the number of students meeting Federal free/reduced lunch criteria and the number of clients overall who are uninsured or participating in a public support plan such as HUSKY, Medicaid or Medicare.The region is a federally-designated medically underserved area. Part VI, Line 5: A Regional Board governs Natchaug, Windham, and Backus Hospitals. The Board is responsible for maintaining outstanding quality services and credentials its medical staff. All of the Directors reside in our service area and are neither employees, family members, nor contractors of the Hospital. Natchaug Hospital staff actively contribute to the community. For example, Natchaug Hospital's Director of Pharmacy serves on the Experiential Education Advisory Board of UConn's School of Pharmacy, staffs a Migrant Farmers Clinic, serves on the Accreditation Council for Pharmacy Education, and more; a Program Director serves on the Eastern Connecticut Chamber of Commerce's Health Advisory Committee and as a Chamber Trustee; two Natchaug staff serve on their local Boards of Education; at least three Program Directors serve their region's Systems of Care; and the Human Services Advisory Board for the Mansfield Town Council includes a representative from Natchaug. Many professionals are continuing to benefit from Natchaug Hospital's Speaker's Bureau program which offers trainings on behavioral health topics for professionals working with school age youth (school nurses, guidance counselors, teachers, etc), for free. The goals of this community outreach are to 1) help identify treatable behavioral health conditions as early as possible and 2) to improve awareness of effective classroom. The Speakers Bureau makes Natchaug staff experts more accessible to the community. Schools, community groups, businesses and others can request a Natchaug expert to provide training, lead a school assembly or serve on a panel for free. 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 Natchaug 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 its affiliates including all supported organizations, develop and implement programs to improve the future of 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 small communities easy and expedient access to the more extensive and specialized services 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 largest of the system hospitals.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 0 1 0 0 0 0 0 1 0 Donna Handley Director 0 307528 0 70001 0 21767 0 18900 0 43513 0 461709 0 0 Paul Weigle Associate Medical Director 257561 0 4225 0 240 0 18900 0 41122 0 322048 0 0 0 Margaret Marchak Secretary 0 516132 0 151455 0 24107 0 81414 0 54936 0 828044 0 0 Patricia Rehmer President BHN 0 357611 0 104172 0 4861 0 62670 0 21393 0 550707 0 0 Paul Maloney VP, Finance 0 227931 0 57812 0 3030 0 35100 0 16174 0 340047 0 0 Harold Schwartz MD VP, Psychiatrist in Chief 0 505884 0 112940 0 21840 0 35100 0 40970 0 716734 0 0 Deborah Weidner MD VP, Safety and Quality 386929 0 83027 0 6595 0 18900 0 36786 0 532237 0 0 0 James O'Dea VP, Operations 0 233319 0 52842 0 2109 0 16893 0 33101 0 338264 0 0 Pamela Shuman Associate Medical Director 268842 0 3400 0 552 0 18900 0 31699 0 323393 0 0 0 Jonathan Raub Associate Medical Director 258707 0 7250 0 3061 0 18900 0 41582 0 329500 0 0 0 Gengyun Wen Psychiatric Attending 246425 0 3400 0 2964 0 18333 0 32732 0 303854 0 0 0 Tiwalola Kolawole Psychiatric Attending 208917 0 39650 0 158 0 17739 0 22882 0 289346 0 0 0 Judah David Weathers Psychiatric In House 230668 0 0 0 0 0 16522 0 11181 0 258371 0 0 0 David Whitehead Former President 0 665725 0 231500 0 108231 0 18900 0 55986 0 1080342 0 0 Part I, Line 3 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of Natchaug Hospital, Inc., hires an outside consultant, Integrated Healthcare Strategies, a division of Gallagher Benefit Services, Inc., to determine best practices in governing executive compensation. Please refer to compensation narrative reported on Schedule O. Part I, Line 4b Hartford Healthcare Corporation, a related organization, maintains a 457(f) Supplemental Executive Retirement Plan (SERP). Participants include certain officers and key employees at the CEO, President, Executive Vice President, Senior Vice President and Vice President levels that are reported by Natchaug Hospital, Inc., 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 chane 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. 2017 SERP Accruals were made on behalf of the following individuals: David Whitehead $75,587 Margaret Marchak $62,514 Patricia Rehmer $43,770 Donna Handley $15,077 2017 SERP Payout was made on behalf of the following individuals: David Whitehead $28,467* Donna Handley $5,162* *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 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 Natchaug 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. It was then forwarded to the organization's top management including 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 Conflict of Interest Committee ("COIC") (the Committee) which includes representation from the Medical Staff, the Legal Department, Human Services, Finance Administration, Management and Compliance. The Committee assesses and may recommend the conflicting interest either be (a) eliminated for continued relationship with HHC/Natchaug Hospital, Inc., 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 Natchaug Hospital, Inc., hires an outside consultant, Integrated Healthcare Strategies, a division of Gallagher Benefit Services, Inc., 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 Natchaug Hospital, Inc., 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, 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 XI, line 9: Change In Retirement & Pension Fund Obligation & Other 14,000. Due to Affiliates & Rounding 5,066,818. Form 990, Part XII, Line 2c: The Audit Committee reports to the parent organization, Hartford HealthCare Corporation. 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