2017-08-15T08:50:07-05:00 2016-09-30 111986323 MARCUM LLP CITY PLACE II 185 ASYLUM STREET HARTFORD CT 06103 990 2015-10-01 060647014 GRIFFIN HOSPITAL GRIF 2037327528 130 DIVISION STREET DERBY CT 06418 JAMES DOWNEY CONTROLLER 2037327528 2017-08-14 1 DOUGLAS FARRINGTON P00370668 8607600600 2015 2021-01-29 14:40:06Z PATRICK CHARMEL 130 DIVISION STREET DERBY CT 06418 171966646 0 X GRIFFINHEALTH.ORG X 1908 CT GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT. 20 14 1577 340 655328 -35750 2304322 2104693 147861773 167363786 390781 349434 2517335 2148733 153074211 171966646 0 0 0 0 77228070 83138243 0 0 0 67748671 73706348 144976741 156844591 8097470 15122055 115933017 117119256 145509400 147254744 -29576383 -30135488 X GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT, TO EMPOWERING INDIVIDUALS TO BE ACTIVELY INVOLVED IN DECISIONS AFFECTING THEIR CARE AND WELL-BEING THROUGH ACCESS TO INFORMATION AND EDUCATION, AND TO PROVIDING LEADERSHIP TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE. 0 0 119219198 149246444 GRIFFIN HOSPITAL IS AN ACUTE CARE HOSPITAL PROVIDING MEDICAL CARE TO PATIENTS IN COMMUNITIES SERVED, INCLUDING SUBSIDIZED CARE, CHARITY CARE, AND EDUCATIONAL SERVICES TO HEALTH PROFESSIONALS TO HELP PREPARE THE NEXT GENERATION OF CAREGIVERS. 3858009 13618961 PROVIDE CANCER RELATED RADIOLOGY SERVICES TO THE COMMUNITY. 1492468 3974581 PROVIDE PSYCHIATRIC SERVICES TO THE COMMUNITY ON AN OUTPATIENT BASIS. 664525 1301423 PROVIDE HOSPICE SERVICES TO THE COMMUNITY. 664525 1301423 125234200 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 158 0 1 1577 1 1 1 0 0 0 0 0 0 0 0 0 X 20 14 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 CT X JAMES DOWNEY 2037327528 130 DIVISION STREET DERBY CT 06418 JOSEPH ANDREANA TRUSTEE 0.23 0.23 X 0 0 0 JOHN AVERSA JR DO TRUSTEE 0.23 0.23 X 0 0 0 FREDERICK BROWNE MD TRUSTEE 0.23 40.23 X 0 328315 13026 KENNETH BALDYGA CHAIRMAN 0.23 0.46 X X 0 0 0 JOHN W BETKOWSKI III TRUSTEE 0.23 0.62 X 0 0 0 GREGORY BORIS DO TRUSTEE 0.23 0.15 X 0 0 0 PATRICK A CHARMEL CEO/PRESIDENT 45.00 5.15 X X 537613 0 25950 DONNA DIGIANVITTORIO TRUSTEE 0.23 0.23 X 0 0 0 NANCY DINARDO TRUSTEE 0.23 0.38 X 0 0 0 KENNETH J DOBULER MD TRUSTEE/PHYSICIAN 40.00 0.23 X 258340 0 8438 DAVID J HENDRICKS MD TRUSTEE (RESIGNED 3/29/16) 0.23 0.23 X 0 0 0 JEAN CRUM JONES MPH RD TRUSTEE 0.23 0.46 X 0 0 0 THEMIS KLARIDES TRUSTEE 0.23 0.23 X 0 0 0 MICHAEL LAW TRUSTEE 0.23 0.23 X 0 0 0 GEORGE S LOGAN TRUSTEE 0.23 0.46 X 0 0 0 WM NEIL PEARSON MD TRUSTEE 0.23 0.23 X 44128 0 0 MARK PETERSON TRUSTEE 0.23 0.23 X 0 0 0 ROBERT G REISS TRUSTEE 0.23 0.46 X 0 0 0 GERALD T WEINER ESQ TRUSTEE 0.23 0.62 X 0 0 0 PHILLIP WHITE TRUSTEE 0.23 0.23 X 0 0 0 JOHN J ZAPRZALKA TRUSTEE 0.23 0.46 X 0 0 0 MARK O'NEILL CFO/VP FINANCE 40.00 X 304966 0 9096 MARGARET DEEGAN VP 40.00 X 230756 0 26418 TODD LIU VP 40.00 X 201795 0 21302 BARBARA STUMPO VP 40.00 X 222218 0 26542 KATHLEEN MARTIN VP 40.00 X 181380 0 26528 BENJAMIN ZIGUN MD 40.00 X 258185 0 21784 EDWARD HALSTEAD MD 40.00 X 236224 0 26146 MIHAELA BORAN MD 40.00 X 211548 0 23630 SUSAN BOUTON RN 40.00 X 154901 0 21270 STEPHEN MORDECAI DIRECTOR OF HR 40.00 X 154476 0 24448 2996530 328315 274578 94 0 1 0 UNIDINE CORPORATION 75 REMITTANCE DRIVE CHICAGO IL 60675 DINING SERVICES 1906907 CONNECTICUT EMERGENCY MEDICINE PO BOX 271618 WEST HARTFORD CT 06127 MEDICAL SERVICES 1479509 QUEST DIAGNOSTICS 2025 COLLECTION CENTER CHICAGO IL 60693 LABORATORY SERVICES 557934 GRIFFIN PATHOLOGY CONSULTANTS 1140 FAIRFIELD AVENUE BRIDGEPORT CT 06605 MEDICAL SERVICES 459522 H & H LINEN SERVICES INC 60 BELAMOSE AVE STE 2 ROCKY HILL CT 06067 LAUNDRY SERVICES 380476 29 1770261 334432 2104693 PATIENT SERVICE REVENUE 622110 160938256 160333412 604844 STATE SUPPLEMENTAL REVENUE 900099 4948647 4948647 OTHER PROGRAM SERVICES 621500 1242924 1242924 TUITION/EDUCATION REVENUE 900099 233959 233959 167363786 335251 335251 331408 0 331408 331408 331408 11483 2700 0 0 11483 2700 14183 14183 CAFETERIA INCOME 900099 989218 989218 OTHER INCOME 900099 828107 777623 50484 1817325 171966646 167536565 655328 1670060 2225699 356940 1868759 60024317 51071477 8952840 174923 169467 5456 15932521 13267381 2665140 4780783 3957591 823192 306858 306858 244331 244331 21223 21223 8095913 5990742 2105171 327622 327622 3389448 2573188 816260 905516 319644 585872 3499643 2641297 858346 318159 91759 226400 2128918 1885480 243438 4253884 3305311 948573 1770484 1362304 408180 MEDICAL & DRUG SUPPLIES 26421609 26394255 27354 STATE HOSPITAL TAX EXP 7583772 7583772 PHYSICIAN FEES 5113922 4378831 735091 GRANT EXPENSES 2103848 2103848 7221198 5037063 2184135 156844591 125234200 31610391 0 962 962 6771172 8451571 13268952 13410622 938379 993432 2650944 1400243 154614919 102648545 51622810 51966374 14161460 14189308 3450227 3581854 23068111 23124890 115933017 117119256 24726374 22968934 157449 430074 44033321 41741449 2140557 1563518 74451699 80550769 145509400 147254744 X -39254442 -38610232 4067571 2732629 5610488 5742115 -29576383 -30135488 115933017 117119256 X 15122055 469115 -16150275 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21223 21223 0 PART II-B, LINE 1: THE GRIFFIN HOSPITAL PAID FOR MEMBERSHIP DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION. FOR THE FISCAL YEAR ENDED 9/30/2016, $21,223 OF THE MEMBERSHIP DUES PAID WAS USED FOR LOBBYING ON ISSUES RELEVANT TO THE ORGANIZATION'S EXEMPT PURPOSE. 3400689 252030 373002 3279717 3517730 -117041 3400689 3409062 134026 25358 3517730 3249540 183001 23479 3409062 2932333 322207 5000 3249540 0.00000 0.65870 0.34130 1 0 4002889 4002889 75816672 40067137 35749535 73367215 61516530 11850685 1428143 1064878 363265 51966374 OTHER RECEIVABLES 507066 DUE FROM AFFILIATES 7841990 OTHER ASSETS & INSURANCE RECOVERABLE 5046027 INTEREST IN NET ASSETS OF AFFILIATES 7834670 INVESTMENT IN AFFILIATE 1895137 23124890 ACCRUED POSTRETIREMENT BENEFIT LIABILITY 10366769 PROFESSIONAL AND GENERAL LIABILITY LOSS RESERVES 2927302 ACCRUED PENSION LIABILITY 49234443 WORKERS COMPENSATION LOSS RESERVES 1906731 ACCRUED INTEREST PAYABLE 266810 CONDITIONAL ASSET RETIREMENT OBLIGATIONS 95831 INTEREST RATE SWAP AGREEMENTS 9122953 ESTIMATED THIRD-PARTY SETTLEMENTS 6353296 DUE TO AFFILIATES 276634 80550769 X 172408892 469115 469115 171939777 26869 26869 171966646 154305703 -2538888 -2538888 156844591 0 156844591 PART V, LINE 4: THE HOSPITAL'S ENDOWMENT FUNDS CONSIST OF DONOR RESTRICTED FUNDS TO BE INVESTED IN PERPETUITY TO PROVIDE A PERMANENT SOURCE OF INCOME. PART X, LINE 2: THE HOSPITAL AND GFP ARE NOT-FOR-PROFIT ORGANIZATIONS, EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL AND GFP ACCOUNT FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2016, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL AND GFP ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: TEMPORARILY RESTRICTED INVESTMENT INCOME 26,869. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET PENSION CREDIT -2,538,888. 1 1 1 X 250.000000000000 1 X 1 1 1 0 1 1 139 1018499 0 1018499 0.00660 4500 18474558 13579977 4894581 0.03160 0 0 0 4639 19493057 13579977 5913080 0.03820 84147 870301 133446 736855 0.00480 0 7649564 6245558 1404006 0.00910 38453 8739904 6734252 2005652 0.01290 0 956988 898470 58518 0.00040 1269 90614 0 90614 0.00060 123869 18307371 14011726 4295645 0.02780 128508 37800428 27591703 10208725 0.06600 1 524574 0 53794180 56381057 -2586877 X 1 1 1 1 GRIFFIN HOSPITAL 130 DIVISION STREET DERBY CT 06418 WWW.GRIFFINHEALTH.ORG X X X X X GRIFFIN HOSPITAL 1 1 0 1 X X X X X X X X 15 1 0 1 1 X WWW.GRIFFINHEALTH.ORG X WWW.CT.GOV/DPH/CWP/VIEW X X 1 15 1 WWW.GRIFFINHEALTH.ORG/PORTALS/0/DOCUMENTS/CHNA/NAUGATUCK-VALLEY-COMM 0 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X WWW.GRIFFINHEALTH.ORG/PATIENT-INFORMATION/BILLING-INSURANCE/UNINSURED X WWW.GRIFFINHEALTH.ORG/PATIENT-INFORMATION/BILLING-INSURANCE X X X X X 1 0 X X X 1 X 0 0 GRIFFIN HOSPITAL PART V, SECTION B, LINE 5: THE 2016 VALLEY COMMUNITY INDEX WAS CREATED IN PARTNERSHIP WITH DATAHAVEN, THIS 2016 VALLEY COMMUNITY INDEX IS THE FIRST SINGLE-SOURCE REPORT OF ITS KIND THAT PROVIDES TIMELY, COMPREHENSIVE SOCIOECONOMIC, EDUCATION, HEALTH, AND WELL-BEING DATA SHAPING OUR REGION. COMMUNITY LEADERS WHO HAVE A FIRM PULSE ON THE NEEDS AND OPPORTUNITIES OF THE VALLEY CAME TOGETHER AS AN ADVISORY COMMITTEE SHARING A COMMON AGENDA TO PROVIDE THE DIRECTION FOR DATA RESEARCH, WHICH WILL ULTIMATELY LEAD TO MEASURABLE OUTCOMES. THIS REPORT IS ALSO COMPLETED TO MEET GRIFFIN HOSPITAL'S IRS REQUIREMENTS IN FORM 990 SCHEDULE H AND NOTICE 2011-52 THAT DISCUSS THE CREATION OF A COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH ALL TAX-EXEMPT HOSPITALS COMPLETE AS A RESULT OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. THIS INDEX WILL BE USED TO CONVENE COMMUNITY CONVERSATIONS, FOSTER ENGAGEMENT, ALIGN CURRENT EFFORTS AND INVESTMENTS, AND COLLABORATE ON STRATEGIC ENDEAVORS TO BUILD, SUSTAIN, AND ENHANCE THE QUALITY OF LIFE IN THE VALLEY. -VALLEY COMMUNITY FOUNDATIONTHE INDEX ALSO WENT INTO THE COMMUNITY MEASURING DIFFERENCES IN PERSONAL WELL-BEING IN THE VALLEY. THE UNITED NATIONS HAS IDENTIFIED MEASURING LOCAL WELL-BEING AS A GLOBAL PRIORITY. 4 THE 2015 DATAHAVEN COMMUNITY WELLBEING SURVEY (CWS) REPRESENTED A FIRST STEP TOWARD ACHIEVING THAT GOAL IN CONNECTICUT. MORE THAN 16,000 RANDOMLY-SELECTED ADULTS LIVING THROUGHOUT THE STATE, INCLUDING 1,051 IN THE VALLEY REGION, PARTICIPATED IN LIVE, IN-DEPTH INTERVIEWS. DESIGNED BY A PANEL OF LOCAL AND NATIONAL EXPERTS AND DRAWN FROM WELL-KNOWN SURVEYS IN THE UNITED STATES AND UNITED KINGDOM, THE CWS INCLUDED A SERIES OF QUESTIONS THAT ARE REGULARLY USED TO EVALUATE PERSONAL WELL-BEING:UNDERSTANDING THE VALLEY REGION: 2016 VALLEY COMMUNITY INDEXPRODUCED BY THE VALLEY COMMUNITY FOUNDATION AND DATAHAVEN, SEPTEMBER 2016LEAD AUTHORS MARY BUCHANAN, PROJECT MANAGER, DATAHAVEN, MARK ABRAHAM, EXECUTIVE DIRECTOR, DATAHAVEN, VALLEY COMMUNITY FOUNDATION STAFF SHARON CLOSIUS, PRESIDENT AND CEO, BETH COLETTE, VALERIE KNIGHT-DIGANGI, JOHN READY, LAURA DOWNS, MORRISON DOWNS ASSOCIATES, PROJECT CONSULTANTLEAD SPONSORS VALLEY COMMUNITY FOUNDATION, INC., BASSETT FAMILY FUND, GRIFFIN HEALTH SERVICES, INC., KATHARINE MATTHIES FOUNDATION, BANK OF AMERICA, N.A., TRUSTEE, VALLEY UNITED WAY CONTRIBUTING SPONSORS CONNECTICUT COMMUNITY FOUNDATION, LIBERTY BANK FOUNDATIONSPECIAL THANKS THE COMMUNITY FOUNDATION FOR GREATER NEW HAVEN, OUR PARTNER IN PHILANTHROPY, NAUGATUCK VALLEY COUNCIL OF GOVERNMENTS, VALLEY COMMUNITY INDEX ADVISORY COMMITTEE, ALLIANCE FOR PREVENTION & WELLNESS (FORMERLY VSAAC), ANSONIA SCHOOL READINESS, BH CARE, BOYS & GIRLS CLUB OF THE LOWER NAUGATUCK VALLEY, CELEBRATE SHELTON, CENTER STAGE THEATRE, THE COMMUNITY FOUNDATION FOR GREATER NEW HAVEN, CONNECTICUT COMMUNITY FOUNDATION, DERBY EARLY CHILDHOOD COUNCIL, DERBY NECK LIBRARY, DERBY YOUTH SERVICES BUREAU, DOWN TO EARTH CONSULTING SOLUTIONS, GREATER VALLEY CHAMBER OF COMMERCE, GRIFFIN HOSPITAL, HOUSATONIC COUNCIL, BSA, LITERACY VOLUNTEERS OF GREATER NEW HAVEN, MIECHV/TEAM EARLY HEAD START, NAUGATUCK VALLEY COUNCIL OF GOVERNMENTS, NAUGATUCK VALLEY HEALTH DISTRICT, NAUGATUCK YMCA, PARENT CHILD RESOURCE CENTER, SHELTON ECONOMIC DEVELOPMENT CORPORATION, TEAM, INC., VALLEY PARISH NURSE PROGRAM, VALLEY REGIONAL ADULT EDUCATION, VALLEY SHAKESPEARE FESTIVAL, VALLEY UNITED WAY, THE VALLEY VOICE, VALLEY YMCA, VNA OF SOUTH CENTRAL CT, THE WORKPLACE, INC., HOWARD WHITTEMORE MEMORIAL LIBRARY, YALE-GRIFFIN PREVENTION RESEARCH CENTERCOMMUNITY VOLUNTEERS MARILYN CORMACK, ED KISLUK, AND RICHARD KNOLLREPRESENTATIVES FROM THE VALLEY COUNCIL FOR HEALTH & HUMAN SERVICES, WITH SPECIAL THANKS TO THE MEMBERS OF THE SENIOR SERVICES SUBCOMMITTEEREPRESENTATIVES FROM EACH OF THE MUNICIPAL GOVERNMENTS AND SCHOOL DISTRICTS IN THE VALLEYUNDERSTANDING THE VALLEY REGION: 2016 VALLEY COMMUNITY INDEXPRODUCED BY THE VALLEY COMMUNITY FOUNDATION AND DATAHAVEN, SEPTEMBER 2016VALLEY COMMUNITY INDEX ADVISORY COMMITTEE:BUCHANAN, MARY, AND MARK ABRAHAM. (2016). UNDERSTANDING THE VALLEY REGION: 2016 VALLEY COMMUNITY INDEX.DERBY, CT: VALLEY COMMUNITY FOUNDATION AND DATAHAVEN. GRIFFIN HOSPITAL PART V, SECTION B, LINE 6A: CHNA WAS NOT CONDUCTED WITH ANY OTHER HOSPITAL. GRIFFIN HOSPITAL PART V, SECTION B, LINE 6B: - NAUGATUCK VALLEY HEALTH DISTRICT- VALLEY COMMUNITY FOUNDATION- DATA HAVEN- VALLEY COMMUNITY INDEX ADVISORY COMMITTEE- GRIFFIN HEALTH SERVICES, INC.- KATHARINE MATTHIES FOUNDATION- CONNECTICUT COMMUNITY FOUNDATION- THE COMMUNITY FOUNDATION FOR GREATER NEW HAVEN- NAUGATUCK VALLEY COUNCIL OF GOVERNMENTS- VALLEY COMMUNITY INDEX ADVISORY COMMITTEE ALLIANCE FOR PREVENTION & WELLNESS (FORMERLY VSAAC)- ANSONIA SCHOOL READINESS- BH CARE- BOYS & GIRLS CLUB OF THE LOWER NAUGATUCK VALLEY- CELEBRATE SHELTON- CONNECTICUT COMMUNITY FOUNDATION DERBY EARLY CHILDHOOD COUNCIL- DERBY NECK LIBRARY- DERBY YOUTH SERVICES BUREAU DOWN TO EARTH CONSULTING SOLUTIONS- GREATER VALLEY CHAMBER OF COMMERCE- GRIFFIN HOSPITAL HOUSATONIC COUNCIL, BSA- LITERACY VOLUNTEERS OF GREATER NEW HAVEN- MIECHV/TEAM EARLY HEAD START NAUGATUCK VALLEY COUNCIL OF GOVERNMENTS- NAUGATUCK VALLEY HEALTH DISTRICT- NAUGATUCK YMCA PARENT CHILD RESOURCE CENTER- SHELTON ECONOMIC DEVELOPMENT CORPORATION- TEAM, INC.- GRIFFIN HOSPITAL VALLEY PARISH NURSE PROGRAM- VALLEY REGIONAL ADULT EDUCATION- VALLEY SHAKESPEARE FESTIVAL VALLEY UNITED WAY- THE VALLEY VOICE- VALLEY YMCA- VNA OF SOUTH CENTRAL CT- THE WORKPLACE, INC.- HOWARD WHITMORE MEMORIAL LIBRARY- YALE-GRIFFIN PREVENTION RESEARCH CENTER COMMUNITY- VALLEY COUNCIL FOR HEALTH & HUMAN SERVICES GRIFFIN HOSPITAL PART V, SECTION B, LINE 7D: WWW.GUIDESTAR.ORG/PROFILE/06-0647014 GRIFFIN HOSPITAL PART V, SECTION B, LINE 11: COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) PRIMARY FOCUS AREASTO BE FINALIZED WITH GOALS, OBJECTIVES AND STRATEGIES DEVELOPED FOR EACH IN CONJUNCTION WITH NAUGATUCK VALLEY HEALTH DISTRICT AND OTHER COMMUNITY PARTNERS:CREATION OF BEHAVIORAL HEALTH/SUBSTANCE ABUSE COMMUNITY ACTION TEAM CHRONIC DISEASE MANAGEMENT (DIABETES, CHF, COPD, ETC.) OPIATE/ADDICTION PREVENTION & TREATMENTCHILDHOOD OBESITY PREVENTION (VITAHLS PROGRAM)EARLY DETECTION OF LUNG CANCER & SMOKING CESSATIONASTHMA PREVENTION & SELF-MANAGEMENT (PART OF STATEWIDE CHA ASTHMA INITIATIVE) GRIFFIN HOSPITAL PART V, SECTION B, LINE 13B: INVESTMENT, IRA, CHECKING ACCT, REAL ESTATE GRIFFIN HOSPITAL PART V, SECTION B, LINE 16I: FINANCIAL ASSISTANCE INFORMATION FOR GRIFFIN HOSPITAL IS POSTED THROUGHOUT THE HOSPITAL'S MAIN REGISTRATION AREA AND IS ATTACHED TO THE BILLING INVOICES. GRIFFIN HOSPITAL PART V, SECTION B, LINE 22D: THE UNINSURED RATES ARE ESTABLISHED BASED ON THE AVERAGE PAYMENTS RECEIVED FROM OUR LARGEST PARTICIPATING HMO. PART I, LINE 3C: GRIFFIN HOSPITAL CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE CARE OR DISCOUNTED CARE INCLUDE ELIGIBILITY REQUIREMENTS ALL GUARANTORS WITH FAMILY INCOME EQUAL TO OR BELOW TWO HUNDRED PERCENT OF THE FEDERAL POVERTY STANDARD ADJUSTED FOR FAMILY SIZE SHALL BE DETERMINED TO BE INDIGENT PERSONS QUALIFYING FOR CHARITY SPONSORSHIP FOR THE FULL AMOUNT OF HOSPITAL CHARGES RELATED TO APPROPRIATE HOSPITAL-BASED MEDICAL SERVICES THAT ARE NOT COVERED BY PRIVATE OR PUBLIC THIRD-PARTY SPONSORSHIP. ALL GUARANTORS WITH FAMILY INCOME BETWEEN TWO HUNDRED ONE (250%) AND FOUR HUNDRED PERCENT (400%) OF THE FEDERAL POVERTY STANDARD ADJUSTED FOR FAMILY SIZE SHALL BE DETERMINED TO BE INDIGENT PERSONS QUALIFYING FOR DISCOUNTS FROM CHARGES RELATED TO APPROPRIATE HOSPITAL BASED MEDICAL SERVICES IN ACCORDANCE WITH THE SLIDING FEE SCHEDULE IN ATTACHMENT A AND POLICIES REGARDING INDIVIDUAL FINANCIAL CIRCUMSTANCES BASED ON THE BELOW CRITERIA: A. ELIGIBILITY SHALL BE BASED ON FINANCIAL NEED AT THE TIME OF APPLICATION BY COMPARING TOTAL FAMILY INCOME WITH THE CURRENT FEDERAL POVERTY GUIDELINES. IF A FAMILY'S TOTAL INCOME IS GREATER THAN 100% OF THE FEDERAL POVERTY GUIDELINE FAMILY ASSETS OTHER THAN EXEMPT ASSETS LISTED BELOW MAY BE CONSIDERED AS A SOURCE OF PAYMENT. B. EXEMPT ASSETS (BASED ON MEDICARE EXEMPTED ASSETS) LISTED BELOW SHOULD NOT BE ADDED TO FAMILY WORTH FOR CHARITY REVIEW: I. FAMILY PRINCIPAL RESIDENCE II. NECESSARY MOTOR VEHICLES REQUIRED FOR EMPLOYMENT, REQUIRED FOR ACCESS TO TREATMENT, OR MODIFIED FOR OPERATION OR TRANSPORT OF A DISABLED PERSON III. PERSONAL EFFECTS AND HOUSEHOLD GOODS IV. RESOURCES NECESSARY FOR SELF-SUPPORT. ALL RESOURCES OF BOTH SPOUSES ARE CONSIDERED TOGETHER. 3. CHARITY WILL BE ASSIGNED USING THE MOST RECENTLY PUBLISHED FEDERAL POVERTY STANDARDS AND EVALUATED ON THE ADJUSTED FAMILY INCOME AS EXPLAINED ABOVE FOR THOSE ABOVE 250% OF SUCH STANDARDS. 4. DOCUMENTATION WILL BE REQUESTED AND IN MOST CASES WILL BE REQUIRED TO ESTABLISH ELIGIBILITY FOR CHARITY CARE. IN THE EVENT THAT THE GUARANTOR IS NOT ABLE TO PROVIDE THE DOCUMENTATION DESCRIED ABOVE, THE HOSPITAL SHALL RELY UPON WRITTEN AND SIGNED STATEMENTS FORM THE GUARANTOR TO MAKE A FINAL DETERMINATION OF ELIGIBILITY FOR CLASSIFICATION AS AN INDIGENT PERSON. PART I, LINE 7: CHARITY CARE AND OTHER COMMUNITY BENEFITS TABLE WERE CALCULATED USING A COST ACCOUNTING SYSTEM OR COST TO CHARGE RATIO. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND ASSIGNS COST TO INDIVIDUAL SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,923,632. PART I, LINE 6A: GRIFFIN HOSPITAL DID PREPARE A COMMUNITY BENEFIT REPORT FOR YEAR ENDING 2016. IT IS POSTED ON THE GRIFFIN HOSPITAL WEBSITE. PART I, LINE 6B: GRIFFIN HOSPITAL POSTS ITS COMMUNITY BENEFIT REPORT AND INFORMATION ON THE HOSPITAL WEBSITE GRIFFINHEALTH.ORG. PART III, LINE 4: GRIFFIN HOSPITAL AND SUBSIDIARY NOTES TO CONSOLIDATED FINANCIAL STATEMENTS SEPTEMBER 30, 2016ALLOWANCE FOR DOUBTFUL ACCOUNTS - PAGE 16THE HOSPITAL'S ESTIMATION OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED PRIMARILY UPON THE TYPE AND AGE OF THE PATIENT ACCOUNTS RECEIVABLE AND THE EFFECTIVENESS OF THE HOSPITAL'S COLLECTION EFFORTS. THE HOSPITAL'S POLICY IS TO RESERVE A PORTION OF ALL SELF-PAY RECEIVABLES, INCLUDING AMOUNTS DUE FROM THE UNINSURED AND AMOUNTS RELATED TO CO-PAYMENTS AND DEDUCTIBLES, AS THE CHARGES ARE RECORDED. ON A MONTHLY BASIS, THE HOSPITAL REVIEWS ITS ACCOUNTS RECEIVABLE BALANCES, THE EFFECTIVENESS OF THE HOSPITAL'S RESERVE POLICIES AND VARIOUS ANALYTICS TO SUPPORT THE BASIS FOR ITS ESTIMATES. THESE EFFORTS PRIMARILY CONSIST OF REVIEWING THE FOLLOWING: REVENUE AND VOLUME TRENDS BY PAYOR, PARTICULARLY THE SELF-PAY COMPONENTS; CHANGES IN THE AGING AND PAYOR MIX OF ACCOUNTS RECEIVABLE, INCLUDING INCREASED FOCUS ON ACCOUNTS DUE FROM THE UNINSURED AND ACCOUNTS THAT REPRESENT CO-PAYMENTS AND DEDUCTIBLES DUE FROM PATIENTS; VARIOUS ALLOWANCE COVERAGE STATISTICS. THE HOSPITAL REGULARLY PERFORMS HINDSIGHT PROCEDURES TO EVALUATE HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE THROUGHOUT THE YEAR TO ASSIST IN DETERMINING THE REASONABLENESS OF ITS PROCESS FOR ESTIMATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.GRIFFIN HOSPITAL AND SUBSIDIARY NOTES TO CONSOLIDATED FINANCIAL STATEMENTS SEPTEMBER 30, 2016MEASURING CHARITY CARE - PAGE 17THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FREE CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED AND CONTRACTUAL RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FREE CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS POSSIBLE. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED FEDERAL POVERTY INCOME LEVELS, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES AND ASSETS. SELF-PAY REVENUES ARE DERIVED PRIMARILY FROM PATIENTS WHO DO NOT HAVE ANY FORM OF HEALTH CARE COVERAGE. THE HOSPITAL EVALUATES THESE PATIENTS, AFTER THE PATIENT'S MEDICAL CONDITION IS DETERMINED TO BE STABLE, FOR THEIR ABILITY TO PAY BASED UPON FEDERAL AND STATE POVERTY GUIDELINES, QUALIFICATIONS FOR MEDICAID OR OTHER GOVERNMENTAL ASSISTANCE PROGRAMS, AS WELL AS THE HOSPITAL'S POLICY FOR CHARITY CARE. FOR THE YEARS ENDED SEPTEMBER 30, 2016 AND 2015, THE HOSPITAL ESTIMATES THAT ITS COSTS OF CARE PROVIDED UNDER ITS CHARITY CARE PROGRAMS APPROXIMATED $1,016,129 AND $822,647, RESPECTIVELY. THE HOSPITAL'S MANAGEMENT ESTIMATES ITS COSTS OF CARE PROVIDED UNDER ITS CHARITY CARE PROGRAMS UTILIZING A CALCULATED RATIO OF COSTS TO GROSS CHARGES MULTIPLIED BY THE HOSPITAL'S GROSS CHARITY CARE CHARGES PROVIDED. THE HOSPITAL'S GROSS CHARITY CARE CHARGES INCLUDE ONLY SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE TO PAY AND QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. TO THE EXTENT THE HOSPITAL RECEIVES REIMBURSEMENT THROUGH THE VARIOUS GOVERNMENTAL ASSISTANCE PROGRAMS IN WHICH IT PARTICIPATES TO SUBSIDIZE ITS CARE OF INDIGENT PATIENTS, THE HOSPITAL DOES NOT INCLUDE THESE PATIENTS' CHARGES IN ITS COST OF CARE PROVIDED UNDER ITS CHARITY CARE PROGRAM. ADDITIONALLY, THE HOSPITAL DOES NOT REPORT A CHARITY CARE PATIENT'S CHARGES IN REVENUES OR IN THE PROVISION FOR DOUBTFUL ACCOUNTS AS IT IS THE HOSPITAL'S POLICY NOT TO PURSUE COLLECTION OF AMOUNTS RELATED TO THESE PATIENTS. PART III, LINE 8: GRIFFIN HOSPITAL BELIEVES THAT ALL OF THE $2.587 MILLION SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THIS YEAR MEDICARE ACCOUNTED FOR 1.7% OF HOSPITAL EXPENSES THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. PART III, LINE 9B: GRIFFIN HOSPITAL HAS A WRITTEN POLICY ABOUT WHEN AND UNDER WHOSE AUTHORITY PATIENT DEBT IS ADVANCED FOR COLLECTION AND SHALL USE ITS BEST EFFORTS TO ENSURE THE PATIENT AMOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. GRIFFIN WILL ENSURE THAT PRACTICES TO BE USED BY THEIR OUTSIDE COLLECTION AGENCIES WILL CONFORM TO THE STANDARDS SET FORTH IN THIS POLICY AND SHALL OBTAIN WRITTEN COMMITMENTS FROM SUCH AGENCIES AT TIME OF BILLING. GRIFFIN WILL PROVIDE TO ALL LOW INCOME UNINSURED PATIENTS THE SAME INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED TO ALL OTHER PATIENTS WHO RECEIVE CARE AT THE HOSPITAL FOR PATIENTS WHO HAVE AN APPLICATION PENDING DETERMINATION FOR EITHER GOVERNMENT SPONSORED COVERAGE OR FOR THE HOSPITAL OWN FINANCIAL ASSISTANCE PROGRAM GRIFFIN WILL NOT KNOWINGLY SEND THAT PATIENT BILL TO A COLLECTION AGENCY. IF A PATIENT DOES NOT MAINTAIN THE AGREED UPON PAYMENT SCHEDULE THE AMOUNT WILL BE FORWARDED TO AN OUTSIDE COLLECTION AGENCY AT THE FULL REMAINING BALANCE. IF IT IS LATER DETERMINED BY THE GRIFFIN HOSPITAL OR A COLLECTION AGENCY ACTING ON BEHALF OF GRIFFIN HOSPITAL THAT THE PATIENT FINANCIAL CONDITIONS HAVE CHANGED AND THE PATIENT WAS UNABLE TO PAY THE OUTSTANDING ACCOUNT BALANCES AN OVERRIDE MAY BE APPLIED BY THE BUSINESS SERVICES DIRECTOR. THE UNCOLLECTED DEBT WILL BE TRANSFERRED TO UNINSURED OR FREE CARE ASSISTANCE BY THE SUPERVISOR AFTER REVIEW. THE MEDICARE COSTS WERE OBTAINED FROM THE HOSPITAL'S INTERNAL COST ACCOUNTING SYSTEM. PART III, LINE 2: GRIFFIN HOSPITAL BAD DEBT EXPENSE IS DETERMINED USING UNCOLLECTED ACCOUNTS NET OF ANY BAD DEBT RECOVERY MULTIPLIED BY THE COST TO CHARGE RATIO. GRIFFIN HOSPITAL HAS A WRITTEN POLICY ABOUT WHEN AND UNDER WHOSE AUTHORITY PATIENT DEBT IS ADVANCED FOR COLLECTION AND SHALL USE ITS BEST EFFORTS TO ENSURE THAT THE PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. CHARITY APPROVAL WILL AFFECT ALL ACCOUNTS FOR WHICH THE APPROVED GUARANTOR IS RESPONSIBLE. THE APPROVED CHARITY PERCENTAGE WILL BE APPLIED TO ALL EXISTING ACCOUNTS WITH DEBIT BALANCES. ACCOUNTS MAY ALSO BE RETURNED FROM BAD DEBT STATUS IF FINANCIAL CIRCUMSTANCES WARRANT AND CHARITY MAY BE APPLIED. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FREE CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAT IT'S ESTABLISHED AND CONTRACTUAL RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FREE CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. PART III, LINE 3: GRIFFIN HOSPITAL DOES NOT ATTRIBUTE ANY BAD DEBT TO COMMUNITY BENEFIT EXPENSE. UNCOLLECTED BALANCES ARE REVIEWED AT MANY STAGES TO DETERMINE IF THEY FALL UNDER UNINSURED OR FREE CARE ASSISTANCE. PART VI, LINE 2: THE TRADITIONAL APPROACH OF REACTING TO ILLNESSES IS SHIFTING TOWARDS A PROACTIVE APPROACH TO OVERALL WELLNESS AND GENERAL WELL-BEING. INCREASINGLY, HOSPITALS, PHYSICIANS, AND OTHER HEALTHCARE PROVIDERS ARE BEING REWARDED FOR KEEPING PEOPLE--AND IN SOME CASES, ENTIRE POPULATIONS--HEALTHY. WHAT IS NEW IS THAT THE INCENTIVES ARE BEING ALIGNED TO HELP ACHIEVE THE PROMOTION OF TRUE POPULATION HEALTH. FOR MANY YEARS, GRIFFIN HOSPITAL AND OTHER FORWARD-THINKING HEALTHCARE PROVIDERS HAVE FOCUSED EFFORTS ON PREVENTION AND WELLNESS BECAUSE, QUITE FRANKLY, IT WAS THE RIGHT THING TO DO FOR THOSE WE SERVE. NOW, WE ARE SEEING THE STATE AND FEDERAL GOVERNMENTS (MEDICAID AND MEDICARE), AS WELL AS PRIVATE INSURERS AND EMPLOYERS THAT PAY FOR HEALTH COVERAGE, RECOGNIZE THE COST-EFFECTIVE VALUE OF THOSE EFFORTS. AN INDIVIDUAL'S GOOD HEALTH AND WELL-BEING HAS A POSITIVE RIPPLE EFFECT ON HIS/HER FAMILY, COMMUNITY, AND WORKPLACE. FACING HEALTH CHALLENGES, HOWEVER, CAN HAVE QUITE THE OPPOSITE EFFECT. FOR EXAMPLE, THE COST OF MISSING WORK OR MISSING SCHOOL FOR BOTH THE PATIENT AND THE CAREGIVER CAN BE A TREMENDOUS PHYSICAL AND ECONOMIC BURDEN. PREVENTION IS NO LONGER JUST THE RIGHT THING TO DO MORALLY AND ETHICALLY FOR OUR CITIZENS, IT IS ALSO THE RIGHT THING TO DO TO PRESERVE THE COMMUNITY'S ECONOMIC VIABILITY. GRIFFIN HOSPITAL, AS THE HUB OF THE VALLEY'S HEALTH CARE SYSTEM, LONG AGO REALIZED THAT THERE ARE MANY SPOKES THAT REACH OUT TO WHERE, FROM A POPULATION HEALTH STANDPOINT, THE RUBBER HITS THE ROAD. WE HAVE A LONG AND PROUD HISTORY OF HELPING ORGANIZE AND COORDINATE COMMUNITY RESOURCES THAT IDENTIFY AND ADDRESS INDIVIDUAL AND REGIONAL HEALTH NEEDS AND PROVIDE SUPPORT FOR OUR MOST VULNERABLE RESIDENTS. WORKING COLLABORATIVELY WITH THE NAUGATUCK VALLEY HEALTH DISTRICT, THE VALLEY COUNCIL FOR HEALTH AND HUMAN SERVICES, THE ALLIANCE FOR PREVENTION & WELLNESS (FORMERLY VSAAC), AND OUR VALLEY PARISH NURSES COMMUNITY OUTREACH PROGRAM, WE PROACTIVELY ADDRESS ISSUE AREAS SUCH AS CHILDHOOD OBESITY, EARLY DETECTION SCREENING FOR CANCER, CHILDHOOD ASTHMA, AND SUBSTANCE ABUSE PREVENTION. TO PARAPHRASE DR. DAVID KATZ, DIRECTOR OF THE YALE-GRIFFIN PREVENTION RESEARCH CENTER, WHAT WE DO WITH OUR FEET (ACTIVITY/EXERCISE), OUR FORKS (WHAT AND HOW MUCH WE EAT), AND OUR FINGERS (SMOKING AND DRINKING, FOR EXAMPLE) GREATLY INFLUENCES OUR LIKELIHOOD TO DEVELOP PREVENTABLE CHRONIC DISEASE. THESE ARE THE DISEASES THAT ROB NOT ONLY YEARS OF LIFE, BUT LIFE FROM OUR YEARS. AS A VALLEY COMMUNITY, WE HAVE ALWAYS BEEN UNIQUELY CONNECTED, WITH A SPIRIT OF COOPERATION AND COLLECTIVE WILL TO MAKE THINGS BETTER. NOW, BY LOOKING AT OUR SEVEN VALLEY TOWNS THROUGH THE LENS OF THIS REPORT, TAKING INTO CONSIDERATION EDUCATION, HOUSING, EMPLOYMENT, RECREATION, EARLY CHILDHOOD DEVELOPMENT, AND AGING ISSUES IN ADDITION TO HEALTH AND HEALTHIER LIFESTYLES, WE ARE SEEING A MUCH BROADER AND MORE COMPREHENSIVE PICTURE THAN EVER BEFORE. THIS INDEX SERVES AS THE AERIAL VIEW FROM WHICH WE CAN ZOOM IN ON THE CHALLENGES WE FACE, THE ISSUES WE HOPE TO ADDRESS, AND THE MANY OPPORTUNITIES WE HAVE TO LEVERAGE OUR CONSIDERABLE RESOURCES OVER THE NEXT THREE YEARS TO EFFECT CHANGE AND IMPROVE THE HEALTH OF OUR COMMUNITY. PART VI, LINE 3: A FINANCIAL ASSISTANCE BROCHURE IS POSTED THROUGHOUT THE HOSPITAL (CHILDBIRTH AREA, ER AREA, AND CUSTOMER SERVICE AREA) IN ENGLISH AND SPANISH EXPLAINING THE FINANCIAL ASSISTANCE POLICY AND HOW TO CONTACT THE FINANCIAL COUNSELORS. THE FOLLOWING POLICY REPRESENTS GRIFFIN HOSPITAL'S PROCEDURES FOR THE UNINSURED PATIENT, FREE CARE ASSISTANCE, AND FREE BED FUNDS AVAILABLE FOR PATIENTS WHO DO NOT HAVE MEDICAL INSURANCE.POLICY: 2013UNINSURED PATIENT PROCEDUREPATIENTS THAT ARE EITHER SCHEDULED OR REGISTERED WITH NO ACTIVE INSURANCE WILL IMPORT ONTO THE THREE FINANCIAL ADVISORS ONTRAC WORKLIST. PATIENTS THAT ARE REGISTERED WILL RECEIVE A STATE APPLICATION PACKET FROM THE PATIENT ACCESS STAFF. THIS CONSISTS OF THE FINANCIAL ADVISOR'S BUSINESS CARD, STATE APPLICATION, AND LIST OF DOCUMENTS NEEDED TO COMPLETE THE STATE APPLICATION. A LISTING OF THE DSS OFFICES IS INCLUDED IN THE PACKET. ALL PATIENTS IDENTIFIED WILL RECEIVE A CALL OR A DIRECT VISIT, IF ADMITTED TO THE HOSPITAL, BY A FINANCIAL ADVISOR. THE FINANCIAL ADVISOR WILL SCREEN THE PATIENT FOR ANY CURRENT SPONSORSHIP AND DISCUSS ALL ELIGIBILITY OPTIONS WITH THE PATIENT. IF THE PATIENT MEETS CRITERIA, THE FINANCIAL ADVISORS WILL BEGIN THE HUSKY APPLICATION PROCESS WITH THE PATIENT. A DUE DILIGENCE PROCESS WILL BE FOLLOWED BY THE FINANCIAL ADVISORS TO ENSURE THAT THE PATIENTS ARE PURSUING ACTIVE COVERAGE. THE FINANCIAL ADVISORS WILL MONITOR THE DSS WEBSITE TO TRACK THE PROGRESS OF THE APPLICATION WITH THE STATE. ONCE ELIGIBILITY HAS BEEN DETERMINED, ALL APPROPRIATE ACCOUNTS WILL BE UPDATED TO THE HUSKY INSURANCE AND BILLED ACCORDINGLY. ALL UNINSURED PATIENTS NOT GRANTED STATE/HUSKY COVERAGE WILL HAVE THE CHA UNINSURED RATE APPLIED TO THEIR ACCOUNT. THE UNINSURED RATE WAS DETERMINED BY THE HOSPITAL TO REPRESENT THE CONNECTICUT NOT-FOR-PROFIT HOSPITAL DISCOUNT POLICY AS ADOPTED BY THE CONNECTICUT HOSPITAL ASSOCIATION 4/10/2006. FREE CARE ASSISTANCE ANY PATIENT REQUESTING CONSIDERATION FOR FREE CARE ASSISTANCE IN PAYING THEIR GRIFFIN HOSPITAL BILLS OR FINANCIAL RESPONSIBILITY AFTER INSURANCE PAYMENT SHOULD CONTACT THE HOSPITAL'S FINANCIAL ADVISORY STAFF. THE FINANCIAL ADVISOR WILL OBTAIN THE FOLLOWING INFORMATION FROM THE PATIENT IN ORDER TO COMPLETE THE FREE CARE APPLICATION. THE INFORMATION REQUIRED FROM THE PATIENT TO COMPLETE THE FREE CARE APPLICATION IS AS FOLLOWS: - PATIENT W-2 FORM OR MOST CURRENT AND COMPLETED TAX RETURN. - OR THREE CONSECUTIVE PAYSTUBS FROM THE PATIENT'S CURRENT EMPLOYMENT/PROOF OF SOCIAL SECURITY. - DEPENDENT INFORMATION (SPOUSE AND MINOR CHILDREN ONLY). - ANY OR ALL BANK AND CHECKING ACCOUNT STATEMENTS. THE FINANCIAL ADVISOR WILL REFER TO THE GRIFFIN HOSPITAL SLIDING SCALE. THIS IS BASED ON THE FEDERAL GOVERNMENT POVERTY INCOME GUIDELINES (SEE ATTACHED SLIDING SCALE). THE FINANCIAL ADVISOR WILL MAKE A DETERMINATION OF THE PATIENT'S FREE CARE ELIGIBILITY STATUS. IF THE PATIENT QUALIFIES FOR FREE CARE ASSISTANCE, THE APPLICABLE DISCOUNT PERCENTAGE WILL BE APPLIED TO THE PATIENT'S ACCOUNT BALANCE. THEN A LETTER (ATTACHED) WILL BE SENT OUT REFLECTING THE PATIENT'S NEW ADJUSTED BALANCE. IF A PATIENT DOES NOT QUALIFY FOR FREE CARE ASSISTANCE, THE FINANCIAL ADVISOR WILL ATTEMPT TO: - OBTAIN PAYMENT IN FULL - SEND TO AN OUTSIDE AGENCY TO SET UP A MONTHLY PAYMENT ARRANGEMENT IF THE PATIENT DOES NOT MAINTAIN THE AGREED UPON PAYMENT SCHEDULE, THE ACCOUNT WILL BE FORWARDED TO AN OUTSIDE COLLECTION AGENCY AT THE FULL REMAINING BALANCES. IF IT IS LATER DETERMINED BY THE GRIFFIN HOSPITAL OR A COLLECTION AGENCY ACTING ON BEHALF OF GRIFFIN HOSPITAL THAT THE PATIENT'S FINANCIAL CONDITIONS HAVE CHANGED AND THE PATIENT WAS UNABLE TO PAY THE OUTSTANDING ACCOUNT BALANCES, AN ADMINISTRATIVE OVERRIDE MAY BE APPLIED BY THE BUSINESS SERVICES COLLECTION SUPERVISOR OR DIRECTOR OF BUSINESS SERVICES. ALL ADMINISTRATIVE OVERRIDES WILL BE SIGNED OFF BY EACH OF THOSE PARTIES. THE BUSINESS SERVICES COLLECTION SUPERVISOR WILL MAINTAIN ALL MONTHLY SPREADSHEETS THAT WILL IDENTIFY ALL APPLIED FREE BED FUNDS, UNINSURED, AND FREE CARE ASSISTANCE ALLOCATED ON A MONTHLY BASIS.FREE BED FUNDS: THE HOSPITAL HAS THE FOLLOWING FREE BED FUNDS AVAILABLE FOR PATIENTS WHO MEET THE FOLLOWING OUTLINED CRITERIA FOR EACH FUND: THE ENO FUND: THE APPLICANT MUST BE A WORTHY PROTESTANT WOMAN, 60 YEARS OF AGE OR OLDER, AND BE A RESIDENT OF ANSONIA, DERBY OR SEYMOUR. PINE TRUST: THE FUND IS AVAILABLE TO INDIGENT PATIENTS OF GRIFFIN HOSPITAL WHO RESIDE IN THE CITY OF ANSONIA. DN CLARK: THE FUND IS AVAILABLE TO SHELTON RESIDENTS. ALL FREE BED FUNDS GRANTED ARE PROCESSED THROUGH THE HOSPITAL'S FINANCIAL ADVISOR STAFF. PART VI, LINE 4: GRIFFIN HOSPITAL SERVES THE TOWNS THAT COMPRISE THE LOWER NAUGATUCK VALLEY INCLUDING ANSONIA, DERBY, SEYMOUR, SHELTON, OXFORD, BEACON FALLS AND SURROUNDING TOWNS INCLUDING BETHANY, MIDDLEBURY, MILFORD, MONROE, NAUGATUCK, ORANGE, PROSPECT, SOUTHBURY, STRATFORD, TRUMBULL, WOODBRIDGE AND WOODBURY.THE VALLEY IS A COMMUNITY OF CONNECTICUT TOWNS LOCATED IN NEW HAVEN AND FAIRFIELD COUNTIES. IT LIES ALONG THE HOUSATONIC AND NAUGATUCK RIVERS AND IS CONNECTED TO CITY CENTERS ALONG I-95 BETWEEN NEW YORK AND NEW HAVEN, AS WELL AS ALONG ROUTE 8 TO WATERBURY. WE DEFINE THE VALLEY AS THE SEVEN TOWNS THAT COLLABORATED TO WIN THE ALL-AMERICA CITY AWARD IN THE YEAR 2000: ANSONIA, BEACON FALLS, DERBY, NAUGATUCK, OXFORD, SEYMOUR, AND SHELTON. THE TOWNS SHARE A SPIRITED COMMUNITY CULTURE AND STRONG INSTITUTIONS, WHICH COLLABORATE ON INITIATIVES IN CIVIC VITALITY, HEALTH AND HUMAN SERVICES, ECONOMIC DEVELOPMENT, AND QUALITY OF LIFE. THE COLLABORATIVE WORK IT TOOK BY MANY TO BE RECOGNIZED AS PART OF THE 20-TOWN NAUGATUCK VALLEY CORRIDOR, A FEDERALLY-DESIGNATED ECONOMIC DEVELOPMENT DISTRICT (EDD), IS A PRIME EXAMPLE OF HOW VALLEY LEADERS COME TOGETHER FOR THE GREATER GOOD. THE VALLEY HAS A COMMON HISTORY AND IDENTITY, BUT EACH OF ITS TOWNS HAS ITS OWN UNIQUE CHARACTERISTICS. THE REGION'S DEMOGRAPHICS AND ECONOMY ARE CONSTANTLY CHANGING IN RESPONSE TO OUTSIDE FORCES; THESE CHANGES AFFECT THE REGION'S NEIGHBORHOODS IN DIFFERENT WAYS. TOWN CENTERS OFFER A LARGE SHARE OF RENTAL OR AFFORDABLE HOUSING UNITS, WHICH ARE ATTRACTIVE TO YOUNGER WORKERS, SINGLE ADULTS, AND OTHER HOUSEHOLDS THAT WOULD PREFER TO RENT FOR ECONOMIC OR LIFESTYLE REASONS. IN OTHER NEIGHBORHOODS, NEWER HOMES AND LARGER LOTS CONTINUE TO ATTRACT HOMEOWNERS WITH HIGH INCOMES. THE VARIETY OF NEIGHBORHOODS AND RESIDENTS WHO CHOOSE TO LIVE THERE HELP MAKE THE VALLEY A RESILIENT COMMUNITY WITH A RICH TRADITION OF IMMIGRATION AND MIGRATION. THE VALLEY'S LEGACY OF AGRICULTURAL AND INDUSTRIAL PRODUCTION ARISES FROM ITS LOCATION ALONG TWO MAJOR RIVERS. TODAY, THE ECONOMY OF THE VALLEY COMMUNITIES IS SIGNIFICANTLY INFLUENCED BY THE CONTINUED DEVELOPMENT ALONG THE ROUTE 8 CORRIDOR, WHICH HAS RESULTED IN BOTH OPPORTUNITIES AND CHALLENGES. SHELTON, IN PARTICULAR, HAS EXPERIENCED NEW COMMERCIAL AND OFFICE DEVELOPMENT BY VIRTUE OF ITS LOCATION AND INFRASTRUCTURE. ITS STRONG FINANCIAL BASE, HOWEVER, CAN MASK THE ECONOMIC CHALLENGES THAT OTHER TOWNS FACE. LEVELS OF PERSONAL WELL-BEING ARE NOT EVENLY DISTRIBUTED ACROSS THE VALLEY'S POPULATION. AN INCREASINGLY DIVERSE POPULATION AND A GROWING NUMBER OF SENIORS PRESENT NEW NEEDS AND OPPORTUNITIES. INCOMES VARY BY TOWN, AND MORE PEOPLE, ESPECIALLY CHILDREN, LIVE IN ECONOMIC HARDSHIP. CANCER, HEART DISEASE, AND ACCIDENTS ARE LEADING CAUSES OF PREMATURE DEATHS. THE OFFICIAL 2015 UNEMPLOYMENT RATE IN THE VALLEY WAS 6.1 PERCENT, THE LOWEST SINCE 2008. CENSUS DATA SHOWS THAT 45 PERCENT OF VALLEY WORKERS EARN LESS THAN $40,000 PER YEAR, A "LIVING WAGE" THAT IS CONSIDERED NECESSARY TO COVER COSTS OF LIVING IN THE REGION. PART VI, LINE 5: AS A PATIENT-CENTERED HEALTH CARE SYSTEM, GRIFFIN HOSPITAL IS COMMITTED TO PARTNERING WITH OUR COMMUNITY TO PROMOTE WELLNESS THROUGH A WIDE VARIETY OF PROGRAMS AND SERVICES.GRIFFIN-SPONSORED EVENTS AS A PROUD MEMBER OF THE NAUGATUCK VALLEY COMMUNITY, GRIFFIN HOSPITAL WORKS IN TANDEM WITH OTHER COMMUNITY ORGANIZATIONS TO STRENGTHEN OUR CITIZENS, ENCOURAGE POSITIVE RELATIONSHIPS, FACILITATE ONGOING WELLNESS AND PROVIDE ONGOING SUPPORT TO THOSE IN NEEDS.VALLEY PARISH NURSE PROGRAM VALLEY PARISH NURSES SERVE AS COORDINATORS BETWEEN THE CLERGY, PARISH AND RESOURCES IN THE COMMUNITY, SUCH AS HOSPITALS AND OTHER SOCIAL SERVICE AGENCIES.MOBILE HEALTH RESOURCE CENTER- THE GRIFFIN HOSPITAL MOBILE HEALTH RESOURCE VAN IS A CUSTOM BUILT WINNEBAGO THAT TRAVELS TO VARIOUS LOCATIONS THROUGHOUT THE LOWER NAUGATUCK VALLEY, SUCH AS SENIOR CENTERS, SHOPPING CENTERS, NEIGHBORHOODS, COMPANIES AND COMMUNITY EVENTS AND FAIRS.ADVANCE CARE PLANNING PLAN NOW TO ENSURE THAT YOUR WISHES FOR END-OF-LIFE DECISIONS ARE UNDERSTOOD, RESPECTED, AND HONORED BY LOVED ONES AND HEALTHCARE PROVIDERS. IT'S EASY AND IT'S FREE.HEALTH INITIATIVE FOR MEN (HIM)- THE GOAL OF THE HIM IS TO INFLUENCE MEN TO SEE THEIR PHYSICIAN ANNUALLY, AND TO BE SCREENED FOR VARIOUS DISEASES THAT RESPOND BETTER TO TREATMENT IF DETECTED EARLY.VALLEY WOMEN'S HEALTH INITIATIVE THE VALLEY WOMEN'S HEALTH INITIATIVE (WHI) IS COMPRISED OF MEMBERS OF THE COMMUNITY WORKING TOWARD A COMMON GOAL OF ADDRESSING AND IMPROVING WOMEN'S HEALTH ISSUES INCLUDING BREAST CANCER AWARENESS AND HEART DISEASE.WOMEN'S HEART WELLNESS COMMITTEE A COMMUNITY INITIATIVE FOCUSED ON EDUCATION, OUTREACH, AND PREVENTION.HEALTH RESOURCE CENTER THE COMMUNITY HEALTH RESOURCE CENTER (HRC) AT GRIFFIN HOSPITAL IS A TRADITIONAL FREE LENDING LIBRARY THAT PROVIDES AN ARRAY OF MEDICAL AND HEALTH INFORMATION.HEALTHY U EDUCATIONAL SERIES HEALTHY U IS A SERIES OF WELLNESS TALKS FEATURING GRIFFIN HOSPITAL MEDICAL EXPERTS AND COMMUNITY PARTNERS PROVIDING TRUSTED HEALTH INFORMATION AND ANSWERS TO QUESTIONS ON A WIDE RANGE OF TOPICS. ALL TALKS ARE FREE AND OPEN TO THE PUBLIC.MINI MED SCHOOL FREE PROGRAM FOR THE LAYPERSON WITH LITTLE OR NO MEDICAL BACKGROUND, PROVIDING A UNIQUE OPPORTUNITY TO GAIN A GREATER UNDERSTANDING OF HOW THE HUMAN BODY WORKS, INSIGHT INTO COMMON DISORDERS OF THE VARIOUS ORGAN SYSTEMS, AS WELL AS INFORMATION ABOUT DISEASE PREVENTION.PERSONAL EMERGENCY PREPAREDNESS GRIFFIN HOSPITAL DEPARTMENT OF EMERGENCY MANAGEMENT (EM) HELPS TO PREPARE THE COMMUNITY IN CASE OF A DISASTER OR EMERGENCY SITUATION. THIS PAGE PROVIDES SAFETY AND PREPAREDNESS TIPS AS WELL AS IMPORTANT LOCAL AND GOVERNMENTAL CONTACTS.PLANETREE WELLNESS EDUCATION SERIES GRIFFIN HOSPITAL'S PLANETREE EDUCATION IS PROUD TO OFFER THIS FREE HEALTH EMPOWERMENT SERIES OF FUN AND EDUCATIONAL TALKS FOR MEMBERS OF OUR COMMUNITY.SAFE KIDS GRIFFIN HOSPITAL'S SAFE KIDS GREATER NAUGATUCK VALLEY COALITION IS AVAILABLE TO EDUCATE CHILDREN AND ADULTS ON VARIETY OF HEALTH AND SAFETY PROGRAMS TO REDUCE UNINTENTIONAL INJURIES AMONG CHILDREN. WE OFFER PROGRAMS AT THE HOSPITAL OR AT YOUR FACILITY.VITAHLS VALLEY INITIATIVE TO ADVANCE HEALTH & LEARNING IN SCHOOLS GRIFFIN HOSPITAL HAS BEEN EXPANDING ITS REACH INTO THE COMMUNITY LIKE NEVER BEFORE.GRIFFIN HOSPITAL SUPPLIED COMMUNITY ASSISTANCE THRU THE WALK RUN 5K FUNDRAISING EVENT THAT SUPPLIED THE FUNDS TO ASSIST OUR COMMUNITY CANCER PROGRAMS SUCH AS LOOK GOOD FEEL BETTER, VOICES OF HOPE AND ASSISTANCE FOR WIGS AND SUPPLIES, TREATMENT, TRANSPORTATION, SEYMOUR PINK EXERCISE TRAINOR, AFTER THE STORM MASSAGE THERAPY SERVICES AND CIRCLE OF FRIENDS.SPARK PLUG PROGRAM WHICH SUPPORTS EMPLOYEES TIME TO RAISE MONEY IN THE HOSPITAL THRU CHRISTMAS TREE RAFFLES AND EASTER RAFFLES WERE THE MONEY IS DONATED TO SPOONER HOUSE FOOD SHELTER IN SHELTON CT.IN ADDITION TO PROVIDING HEALTH INFORMATION AND SERVICES TO THE PUBLIC AT THE HOSPITAL AND OTHER SATELLITE LOCATIONS, GRIFFIN TAKES THESE ACTIVITIES INTO THE COMMUNITIES WHERE PATIENTS LIVE, WORK, AND WORSHIP. BY OFFERING A VARIETY OF SUPPORT GROUPS, TRAINING SESSIONS, EDUCATIONAL PROGRAMS, AND OTHER COMMUNITY-BASED RESOURCES AND ACTIVITIES, AND COLLABORATING WITH OTHER NON-PROFIT ORGANIZATIONS AND GOVERNMENT ENTITIES, GRIFFIN HAS EXTENDED ITS MISSION "TO PROVIDE LEADERSHIP TO IMPROVE THE HEALTH OF THE COMMUNITY SERVED" FAR BEYOND THE HOSPITAL'S WALLS.367 SPECIAL PROGRAMS HELD ON THE FOLLOWING TOPICS AT LOCAL CHURCHES, LIBRARIES, HOSPITAL, SENIOR CENTERS AND PRIVATE COMPANIES: MONTHLY ACP -ACCOUNTABLE CARE PLANNING, ACCESS HEALTH ASSISTANCE, BREAST WELLNESS, DIABETES EDUCATION FALL PREVENTION, TRANSPORTING CHILDREN WITH SPECIAL NEEDS INSTRUCTOR CLASS, AARP SAFE DRIVING, CHILD PASSENGER SAFETY CONFERENCE, LIVER DISEASE EDUCATION, VOLUNTEER PARISH NURSES FROM 20 DIFFERENT PARISHES AFFILIATED WITH THE VPNP AT GRIFFIN HOSPITAL PARTICIPATED FOR THE PROGRAM YEAR. CONTACTS INCLUDED OFFICE HOUR VISITS, HOME, HOSPITAL AND NURSING HOME VISITS, PHONE CALLS, AND BULLETIN DELIVERIES, 334 HEALTH AND WELLNESS PROGRAMS WERE HOSTED AT THE VARIOUS CHURCHES WITH 8526 PARTICIPANTS, HEALTHY HINTS IN WEEKLY BULLETINS AT 3 CHURCHES. APPROXIMATELY 30,000 PEOPLE READ OVER THE YEAR, CHRONIC DISEASE SELF-MANAGEMENT PROGRAM.GRIFFIN HOSPITAL COMMUNITY VAN VISITED 223 COMMUNITY SITES CONSISTING OF LOCAL CHURCHES, FOOD BANKS, SHELTERS AND SHOPPING AREAS. THE VALLEY PARISH NURSE PROGRAM COMPLETED A TOTAL OF 7052 SCREENINGS ON INDIVIDUALS THRU PROGRAMS.162 COMMUNITY OUTREACH MEETINGS HELD WITH LOCAL BOARD OF DIRECTORS, HEALTH DEPTS., HEALTH CARE COUNCILS, PARISH NURSING, SAFE KIDS, CANCER COMMITTEES, AND WOMEN MAKING A DIFFERENCE. ACO STEERING ACP, QUARTERLY AHA, ANSONIA EARLY CHILDHOOD COUNCIL, BOYS & GIRLS CLUB BOARD- SHELTON, CANCER COMMITTEE, CHA- COMMUNITY HEALTH GROUP, CT COALITION OF DIABETES EDUCATOR, CT COUNCIL OF PARISH NURSE, KOMEN, DERBY DIABETES PREVENTION TASK FORCE, EARLY CHILDHOOD COUNCIL COORDINATOR, CT DIABETES PARTNERSHIP, PASTORAL CARE, SAFE KIDS, STATE DEPT. HEALTH IMPROVEMENT, PLAN VALLEY CARES, ALLIANCE VALLEY CARE, GIVERS VALLEY COUNCIL, HEALTH/HUMAN SERVICES, VALLEY HEALTHCARE COUNCIL, VALLEY PARISH NURSES, VALLEY COUNCIL YOUTH COMMITTEE, VITAHLS, VSAAC WOMEN HEART WELLNESS, WOMEN MAKING A DIFFERENCE, EARLY CHILDHOOD COUNCIL.320 CPR CLASSES AT VARIOUS LOCATIONS.GRIFFIN HAD 420 CHILDREN'S PROGRAMS THROUGHOUT THE YEAR. CHILDREN'S EDUCATION PROGRAMS INCLUDED CPR EDUCATION, POISON EDUCATION, HALLOWEEN HOME, FIRE.911,GERMS, WINTER, PETS, NUTRITION, EXERCISE, SPORTS, SUMMER, WATER AND PEDESTRIAN CROSSING.214 SUPPORT GROUPS OFFERED THROUGH GRIFFIN HOSPITAL VALLEY PARISH NURSE, CANCER CENTER AND PASTORAL CARE. SUPPORT GROUPS INCLUDED ALZHEIMER CAREGIVERS, DIABETES, HEAL, MULTIPLE SCLEROSIS, FIBROMYALGIA, VALLEY HEART CLUB, PASTORAL CARE BEREAVEMENT GROUP, VOICES OF HOPE, LOOK GOOD FEEL BETTER, AND CIRCLE OF FRIENDS. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES CT X X X 0 0 0 0 0 0 0 0 0 FREDERICK BROWNE MD TRUSTEE 0 328315 0 0 0 0 0 7950 0 5076 0 341341 0 0 PATRICK A CHARMEL CEO/PRESIDENT 466015 0 71598 0 0 0 8238 0 17712 0 563563 0 0 0 KENNETH J DOBULER MD TRUSTEE/PHYSICIAN 251443 0 6897 0 0 0 8438 0 0 0 266778 0 0 0 MARK O'NEILL CFO/VP FINANCE 262081 0 42885 0 0 0 7116 0 1980 0 314062 0 0 0 MARGARET DEEGAN VP 198423 0 32333 0 0 0 8706 0 17712 0 257174 0 0 0 TODD LIU VP 180170 0 21625 0 0 0 3590 0 17712 0 223097 0 0 0 BARBARA STUMPO VP 191076 0 31142 0 0 0 8830 0 17712 0 248760 0 0 0 KATHLEEN MARTIN VP 155589 0 25791 0 0 0 8816 0 17712 0 207908 0 0 0 BENJAMIN ZIGUN MD 258185 0 0 0 0 0 4072 0 17712 0 279969 0 0 0 EDWARD HALSTEAD MD 236224 0 0 0 0 0 8434 0 17712 0 262370 0 0 0 MIHAELA BORAN MD 211548 0 0 0 0 0 5918 0 17712 0 235178 0 0 0 SUSAN BOUTON RN 154901 0 0 0 0 0 3558 0 17712 0 176171 0 0 0 STEPHEN MORDECAI DIRECTOR OF HR 150997 0 3479 0 0 0 6736 0 17712 0 178924 0 0 0 A CHEFA SERIES B 060806186 2005-02-01 24800000 CONSTRUCTION OF NEW WING 0 0 0 B CHEFA SERIES C & D 060806186 2007-05-01 23125000 CONSTRUCTION OF NEW CANCER CENTER 0 0 0 A 25769812 24573303 435721 760791 1996 1 0 1 1 B 22982209 1406958 234306 1133492 20207453 2010 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 1 1 WELLS FARGO 30.000000000000 0 0 0 0 0 A 1 B 1 GREGORY BORIS DO TRUSTEE 2959019 GRIFFIN HOSPITAL RETAINED THE SERVICES OF CONNECTICUT EMERGENCY MEDICINE SPECIALISTS TO OVERSEE THE EMERGENCY DEPARTMENT. GREGORY BORIS IS THE DIRECTOR OF THE EMERGENCY DEPARTMENT. 0 DAVID J HENDRICKS MD TRUSTEE 2959019 GRIFFIN HOSPITAL RETAINED THE SERVICES OF CONNECTICUT EMERGENCY MEDICINE SPECIALISTS TO OVERSEE THE EMERGENCY DEPARTMENT. DAVID J. HENDRICKS IS A CONSULTANT FOR CONNECTICUT EMERGENCY SPECIALISTS. 0 FORM 990, PART VI, SECTION A, LINE 2 GREGORY BORIS, D.O. (TRUSTEE) IS THE DIRECTOR OF THE EMERGENCY DEPARTMENT FOR CONNECTICUT EMERGENCY MEDICINE SPECIALISTS. DAVID J. HENDRICKS, M.D. (TRUSTEE) IS A CONSULTANT FOR CONNECTICUT EMERGENCY MEDICINE SPECIALISTS. GRIFFIN HOSPITAL RETAINED THE SERVICES OF CONNECTICUT EMERGENCY MEDICINE SPECIALISTS TO OVERSEE THE EMERGENCY DEPARTMENT. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES MAKES RECOMMENDATIONS TO THE INCORPORATORS OF THE HOSPITAL REGARDING NOMINATIONS OF MEMBERS OF THE COMMUNITY TO SERVE AS TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR ALL MEMBERS OF THE HOSPITAL BOARD, OFFICERS, DIRECTORS, AND KEY EMPLOYEES RECEIVE, SIGN, AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE. THE DISCLOSURES ARE REVIEWED BY THE HOSPITAL BOARD AND DOCUMENTED IN THE MINUTES. ANY DISCLOSURE OF A CONFLICT PREVENTS THE INDIVIDUAL FROM INVOLVEMENT WITH OR PARTICIPATION IN SUBJECT MATTER THAN MIGHT AFFECT THE DISCLOSED CONFLICT. ALL CONFLICTS ARE DISCLOSED AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS AND KEY EMPLOYEES ARE REVIEWED ANNUALLY BY THE COMPENSATION COMMITTEE WHICH IS A SUBCOMMITTEE OF THE HOSPITAL BOARD. THIS COMMITTEE SETS THE COMPENSATION FOR THE CEO BASED ON INDUSTRY DATA. COMPENSATION OF OTHER OFFICERS AND DIRECTORS IS SET BY THE CEO BASED ON INDUSTRY DATA. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS ARE FILED WITH THE OFFICE OF HEALTH CARE ACCESS AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFERS BETWEEN AFFILIATES -6,839,758. MINIMUM PENSION LIABILITY ADJUSTMENT -10,758,389. CHANGE IN NET ASSETS OF AFFILIATE 1,444,294. CHANGE IN BENEFICIAL INTEREST IN TRUSTS 131,627. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -2,666,937. NET PENSION CREDIT 2,538,888. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR SELECTING AN INDEPENDENT AUDIT FIRM AND FOR OVERSEEING THE FINANCIAL STATEMENT PREPARATION PROCESS. THERE HAVE BEEN NO CHANGES IN THESE PROCEDURES SINCE THE PRIOR YEAR. FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS: NET PENSION CREDIT - THE HOSPITAL FROZE THE DEFINED BENEFIT PENSION PLAN EFFECTIVE MARCH 31, 2016 AND INTRODUCED AN EMPLOYER 403(B) MATCH AND CORE CONTRIBUTION TO THE EXISTING GRIFFIN HOSPITAL 403(B) RETIREMENT SAVINGS PLAN. EFFECTIVE WITH THE FREEZE, NO FURTHER BENEFITS WILL ACCRUE TO PLAN PARTICIPANTS. THE FREEZING OF THE PLAN CONSTITUTED A CURTAILMENT, THE RECOGNITION OF WHICH WAS REFLECTED IN THE YEAR ENDED SEPTEMBER 30, 2016. THE CURTAILMENT RESULTED IN RECOGNITION OF 100% OF THE NEGATIVE PRIOR SERVICE COST OF $5,613,532 WHICH OFFSET THE NET PERIODIC BENEFIT COST OF $3,074,644 RESULTING IN A NET PENSION CREDIT TO EXPENSE OF $2,538,888 FOR THE YEAR ENDED SEPTEMBER 30, 2016. GRIFFIN HEALTH SERVICES CORPORATION 130 DIVISION STREET DERBY CT 06418 222560257 HOLDING COMPANY CT 501(C)(3) LINE 11A, I N/A 0 GRIFFIN FACULTY PRACTICE PLAN INC 130 DIVISION STREET DERBY CT 06418 061463147 MEDICAL/EDUCATION CT 501(C)(3) LINE 9 GRIFFIN HOSPITAL 1 GRIFFIN HOSPITAL DEVELOPMENT FUND 130 DIVISION STREET DERBY CT 06418 222560254 FUNDRAISING CT 501(C)(3) LINE 11A, I GRIFFIN HEALTH SERVICES CORPORATION 0 PLANETREE INC 130 DIVISION STREET DERBY CT 06418 061505284 EDUCATION CT 501(C)(3) LINE 9 GRIFFIN HEALTH SERVICES CORPORATION 0 GH VENTURES INC 130 DIVISION STREET DERBY CT 06418 222560247 RENTAL REAL ESTATE CT N/A C 0 HEALTHCARE ALLIANCE INSURANCE CO LTD 171 ELGIN AVENUE GEORGETOWN GRAND CAYMAN CJ OFFSHORE CAPTIVE INSURANCE CJ N/A C 0 CT PRACTICE MANAGEMENT INC 130 DIVISION STREET DERBY CT 06418 061152819 INACTIVE CT N/A C 0 0 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 GRIFFIN FACULTY PRACTICE PLAN INC R 6120975 GRIFFIN HOSPITAL DEVELOPMENT FUND R 153299 GH VENTURES INC R 565484