2017-08-15T17:43:52-05:00 2016-09-30 111986323 Marcum LLP 53 State Street Boston MA 02109 990 2015-10-01 060653151 ROCKVILLE GENERAL HOSPITAL ROCK 8606461222 31 UNION STREET ROCKVILLE CT 06066 robert a schwartz md president 8606461222 2017-08-15 1 DOUGLAS FARRINGTON P00370668 6178075000 2017-08-15 2015 2021-01-29 14:40:06Z ROBERT A SCHWARTZ MD 31 UNION STREET ROCKVILLE CT 06066 61630475 0 X WWW.ECHN.ORG X 1921 CT Rockville General Hospital is a 102 bed hospital offering various healthcare services to all members of the community, including the indigent and underserved. 11 6 563 74 478318 221614 318405 444134 64638857 60462114 26701 63211 272326 120727 65256289 61090186 0 0 0 0 40377767 38022202 0 0 0 0 35015401 40377767 73037603 24878522 -11947417 66202995 53299734 47324085 36568559 18878910 16731175 X Rockville General Hospital is a 102 bed hospital offering various healthcare services to all members of the community, including the indigent and underserved. 0 0 13685290 7518617 Inpatient Services - Rockville General Hospital offers comprehensive medical services in a 102 bed acute care community hospital with a total of 2,052 inpatients treated in fiscal year 2016. Services are offered to the community, regardless of any individual's ability to pay. 6748055 18811316 Emergency Department - Emergency care is offered 24 hours per day, and provides needed emergency medical care to the community, regardless of any individual's ability to pay. 6026478 6818788 Radiology - A wide range of imaging, diagnostic and treatment services are offered, including X-rays, CT Scans, MRI, PET, ultrasound, nuclear medicine and mammography. 29016683 26835076 SEE SCHEDULE H, PART VI 29016683 26835076 55476506 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 118 0 1 563 1 1 1 0 0 0 0 0 0 0 0 0 X 11 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X NICHOLAS JAMIESON 8606461222 320 MAIN STREET MANCHESTER CT 06040 Dennis O'Neill MD Chairman 1.00 4.00 X X 0 0 0 Joy Dorin Vice Chair 1.00 2.00 X X 0 0 0 Michele Conlon MD Secretary 1.00 2.00 X X 0 0 0 Donald Genovesi Treasurer 1.00 2.00 X X 0 0 0 Thomasina Clemons Trustee 1.00 2.00 X 0 0 0 Anthony DiStefano MD Trustee 1.00 2.00 X 0 0 0 David Gonci Trustee 1.00 2.00 X 0 0 0 Eric Kloter Trustee 1.00 4.00 X 0 0 0 Kathleen A O'Neill Trustee 1.00 4.00 X 0 0 0 Maher Suede Trustee 1.00 2.00 X 0 0 0 Peter J Karl President and CEO 13.00 48.00 X X 0 866048 23743 Michael D Veillette Senior Vice President, Chief Financial Officer 13.00 48.00 X 0 495281 23743 Dennis McConville Senior Vice President, Strategic Planning 13.00 48.00 X 0 357372 9272 Joel Reich MD Senior Vice President, Medical Affairs 13.00 48.00 X 0 487147 17694 Mary Powers SVP, PATIENT CARE SERVICES 60.00 0.00 X 259352 0 9316 Robert Carroll MD Medical Director, Emergency Department 13.00 48.00 X 0 557457 23743 Joyce Tichy General Counsel 13.00 48.00 X 0 423800 23743 David Neuhaus MD Medical Director, Emergency Department 55.00 5.00 X 376136 0 1129 Ellen G Neuhaus MD Medical Director, Emergency Department 60.00 X 227011 0 23300 Alexis Cordiano Urgent Care Physician 60.00 X 225927 0 20594 Mariela Podolski Urgent Care Physician 60.00 X 149607 0 19215 Sue Cavaliere nursing supervisor 60.00 X 163488 0 9070 Deborah Gogliettino Senior Vice President, Human Resouces 13.00 48.00 X 0 141600 1159 Deborah Parker Executive Vice President, Chief Clinical Officer 13.00 48.00 X 0 226407 1655 1401521 3555112 207376 27 1 1 0 SOUND PHYSICIANS PO BOX 742936 LOS ANGELES CA 900742936 Physician Services 1898971 ALL-PHASE ENTERPRISES INC 72 W STAFFORD RD SUITE C3 STAFFORD SPRINGS CT 06076 Construction 534552 CONNECTICUT HOSPITAL ASSOCIATION PO BOX 90 110 BARNES ROAD WALLINGFORD CT 06492 various services 373476 RINALDI LINEN SERVICE 47 COMMONS COURT WATERBURY CT 06704 Linen/Laundry Services 220319 SODEXO OPERATIONS LLC BOX 360170 PITTSBURGH PA 152516170 Food/Dietary Services 210002 14 200208 243926 444134 PATIENT SERVICE REVENUE 622110 59971941 59971941 OTHER HEALTHCARE REVENUE 621500 490173 11855 478318 60462114 63211 63211 510426 534509 -24083 -24083 -24083 -9069 5780 -14849 -14849 Cafeteria Revenue 722210 159659 159659 159659 61090186 59983796 478318 183938 1571113 1571113 26474670 22781703 3692967 1107359 941255 166104 7370745 6265133 1105612 1498315 1273568 224747 93155 93155 1754625 1052775 701850 27233 27233 186310 93155 93155 102706 51353 51353 1837722 1562064 275658 6801 5781 1020 11884 10101 1783 678065 678065 3257240 2612421 644819 2938820 2497997 440823 Medical Supplies 9049593 9049593 ECHN Allocation 5636773 3382064 2254709 Physician Fees 4367419 4367419 bad debts expense 1985773 1985773 3081282 1233705 1847577 73037603 55476506 17561097 0 2130527 299533 8279947 6032974 1266636 1197642 209438 284163 91780999 67516163 23002822 24264836 14583455 2808042 3132869 2090244 7286539 3709765 6310762 12612535 66202995 53299734 5623272 4934063 22342472 0 1044272 829132 18314069 30805364 47324085 36568559 X 14969087 11556416 537851 582 3371972 5174177 18878910 16731175 66202995 53299734 X -11947417 9799682 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20213 20213 0 Part II-B, Line 1: The Connecticut Hospital Association (CHA) has determined for its fiscal year that $15,911 of its membership dues from Rockville General Hospital were used for lobbying purposes. The American Hospital Association (AHA) has determined for its fiscal year that $4,302 of its membership dues from Rockville General Hospital were used for lobbying purposes. 12526596 30131 9737092 11593 2808042 12538092 5697 17193 12526596 11605016 939011 5935 12538092 10707116 1197900 300000 11605016 9113580 1593536 10707116 0.00230 0.99770 0 1 1 644006 644006 50974604 32233051 18741553 1440025 703499 736526 38128625 34078239 4050386 593739 501374 92365 24264836 INTEREST IN NET ASSETS OF ECHN COMMUNITY HEALTHCARE FOUNDATION, INC. 282871 F INVESTMENTS IN JOINT VENTURES 3426894 C 3709765 DUE FROM AFFILIATES 11126106 OTHER ASSETS 18779 ESTIMATED SETTLEMENTS DUE FROM THIRD PARTY PAYERS 1308852 REINSURANCE RECOVERABLE 158798 12612535 ESTIMATED SELF INSURANCE LIABILITIES 4488643 ACCRUED PENSION AND POST RETIREMENT BENEFITS 14677465 CONDITIONAL RETIREMENT ASSET OBLIGATIONS 132211 ESTIMATED SETTLEMENTS DUE TO THIRD-PARTY PAYERS 3469683 OTHER CURRENT LIABILITIES 252586 DUE TO AFFILIATES 6504197 ADVANCE ON SALE 1280579 30805364 X 61266478 164451 164451 61102027 -11841 -11841 61090186 73067466 5780 5780 73061686 -24083 -24083 73037603 Part V, Line 4: THE PRINCIPAL AND INCOME FROM THE UNRESTRICTED ENDOWMENT FUNDS AND THE INCOME FROM THE TERM ENDOWMENTS ARE FOR CAPITAL AND OPERATING NEEDS OF MANCHESTER MEMORIAL HOSPITAL. THE INCOME FROM THE PERMANENT ENDOWMENTS AND PRINCIPAL FROM THE TERM ENDOWMENTS ARE FOR THE USE OF MANCHESTER MEMORIAL HOSPITAL AS RESTRICTED BY THE DONORS. Part X, Line 2: THE NETWORK ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH PROVISIONS OF FASB ASC 740, "INCOME TAXES," WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR CONSOLIDATED FINANCIAL STATEMENTS. THE NETWORK MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE NETWORK DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2016 AND 2015. THE NETWORK'S POLICY IS TO INCLUDE PENALTIES AND INTEREST AS A COMPONENT OF INCOME TAX EXPENSE, WHEN APPLICABLE. AS OF SEPTEMBER 30, 2016 AND 2015, THE NETWORK DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. GENERALLY, THE NETWORK'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. Part XI, Line 2d - Other Adjustments: COST OF GOODS SOLD - GIFT SHOP 5,780. NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 158,671. Part XI, Line 4b - Other Adjustments: TEMPORARILY RESTRICTED CONTRIBUTIONS AND INVESTMENT income 12,242. NET RENTAL LOSS -24,083. Part XII, Line 2d - Other Adjustments: COST OF GOODS SOLD - GIFT SHOP 5,780. Part XII, Line 4b - Other Adjustments: NET RENTAL LOSS -24,083. 1 1 X 1 X 125.000000000000 1 X 1 1 0 1 1 529 452861 70395 382466 0.00520 16057 14252671 7446951 6805720 0.09320 16586 14705532 7517346 7188186 0.09840 11 41754 155360 1439 153921 0.00210 9 275 387019 78294 308725 0.00420 4 1258 941510 331001 610509 0.00840 1 14859 14859 0.00020 3 447 16933 16933 0.00020 28 43734 1515681 410734 1104947 0.01510 28 60320 16221213 7928080 8293133 0.11350 3 0 41983 26510 15473 0.00020 1 6 79 79 0.00000 4 6 42062 26510 15552 0.00020 1 1985773 1504520 15368482 20398087 -5029605 X 1 1 1 1 ROCKVILLE GENERAL HOSPITAL 31 union street vernon CT 06066 WWW.ECHN.ORG LICENSE NO: 00036 X X X X ROCKVILLE GENERAL HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X http://www.echn.org/community-benefit-reporting X 1 15 1 http://www.echn.org/community-benefit-reporting 0 0 1 X 125.000000000000 400.000000000000 X X 1 1 X X X X 1 X www.echn.org X www.echn.org X www.echn.org X X X X X 1 0 X X X X 1 X 0 0 ROCKVILLE GENERAL HOSPITAL Part V, Section B, Line 5: The assessments incorporate data from both quantitative and qualitative sources. Quantitative data input includes primary research (phone surveys) and secondary research (vital statistics and other existing health-related data); these quantitative components allow for comparison to benchmark data at the state and national levels. Qualitative data input includes primary research gathered through an online key informant survey (OKIS).The Community Health Needs Assessment was sponsored by a collaboration of community partners and relied on information provided by: public health and vital statistics data a variety of existing (secondary) data data representing the most recent BRFSS (Behavioral Risk Factor Surveillance System) prevalence and trends data (published online by the Centers for Disease Control and Prevention) state-wide risk factor data nationwide risk factor data Healthy People 2020 which provides science-based, 10-year national objectives for improving the health of all Americans phone surveys (based on the Centers for Disease Control Behavioral Risk Factor Surveillance Survey) And online key informant surveys.The participants for the online surveys included input from physicians and other health providers, public health experts, social service representatives, and community leaders. For a full listing of participating agencies, please reference the 2016 CHNA for Rockville General Hospital. ROCKVILLE GENERAL HOSPITAL Part V, Section B, Line 6a: FACILITY NAME:ROCKVILE GENERAL HOSPITALDESCRIPTION:THE CHNA WAS CONDUCTED BY EASTERN CONNECTICUT HEALTH NETWORK,WHICH INCLUDES MANCHESTER MEMORIAL HOSPITAL AND ROCKVILLEGENERAL HOSPITAL. ROCKVILLE GENERAL HOSPITAL Part V, Section B, Line 11: FACILITY NAME:ROCKVILLE GENERAL HOSPITALDESCRIPTION:I. Access to Healthcare Services:Strategy #1: Build the capacity of ECMPF primary care offices to provide primary and preventive healthcare services with at least 2 providers.Strategy #2: Expand the number of Family Practice Residents trained at ECHN from 25 residents per year to 33 and actively recruit graduates to practice locally. Strategy #3: Ensure that ECHN's hospital and home health care management programs as well as the ECHN hospitalist practitioners provide effective transitions of care for patients treated at ECHN facilities with an emphasis on communication with primary care physicians. II. Cancer Strategy 1: Colon Cancer - Colorectal screening and education Develop a marketing campaign for Colon Cancer Awareness Month each year to create awareness Hold a colonoscopy screening event to promote screenings, educate the community Promote the Open Access Program offered by local physicians at Evergreen Endoscopy Center that makes convenient appointments easier to obtain for screeningsStrategy 2: Lung Cancer - Promote and educate community on ECHN's Low Dose CT Screening Program Maintain ECHN's ACR accreditation as a Designated Cancer Screening Center Develop marketing and promotional material to create awareness of the need for screening and the community resources available Provide education to community and physicians through presence at health fairs and by hosting community education lecturesStrategy 3: Prostate Cancer - Host a Prostate Screening Event Determine eligibility and process to adhere to national standard of prostate screenings Collaborate with local physicians and health care workers to hold event Market and promote a prostate cancer screening eventStrategy #1: Educate women about the importance of preventative and screening services and lifestyle changes: Develop and coordinate educational lectures and seminars which will be offered to the community Publish information in ECHN's Better Being newsletter regarding health screenings, educational programs and lectures Participate in health fairs and community events Coordinate with ECHN providers to present educational programs and lectures related to women's health, diabetes and heart diseaseStrategy #2: Build community relationships to increase awareness of the ECHN Early Detection Program: The Community Health Navigator will engage and collaborate with community partners in order to provide education on program benefits and services available The Community Health Navigator will provide written material, in both English and Spanish, to community partners and providers detailing services available, and contact information for eligibilityStrategy 1: Freedom From Smoking: Provide program at least 3 times a year Advertise program through Better Being and with community partners Increase number of facilitators to 2 Provide program at multiple locationsStrategy 2: Offer smoking prevention presentation to public and private schools: Contact schools with 6th grade classes offering presentations Participate in health fairs at high schools and vocational schoolsStrategy 3: Provide CEU program to community primary care physicians: Provide education regarding available smoking prevention and cessation programsStrategy 4: Participate in health fairs: Provide material on nicotine addiction Provide material on Freedom From SmokingStrategy 1: Offer support to cancer survivors Established process to identify patients who have completed cancer therapy and provide patients with summary care plan which includes cancer diagnosis, stage and treatment receivedStrategy 2: Educate cancer survivors on managing lifestyle behaviors after treatment completion Survivorship care plan will also include road map for recommended follow up care Educate and encourage lifestyle changes to reduce cancer recurrence and/or improve quality of lifeIII. Heart Disease & StrokeStrategy #1: Provide education for cardiovascular disease risk factors and behavior modification Produce multi-year plan to improve health and reduce risky behaviors of our ECHN employees and families Provide community education lecture(s) on the signs and symptoms of stroke and heart attack, the early recognition of symptoms and importance of seeking immediate medical care Promote nutrition counseling services offered by local supermarkets and community centers to promote healthy diets Promote physical fitness activities/programs available in the community including fitness centers, cardiac rehabilitation programs, schools, parks and recreation programs Participate in community health fairs throughout service area where blood pressure, cholesterol, body fat composition analysis and education resources will be offeredStrategy #2: Promote the Freedom From Smoking cessation program Offer behavioral counseling on the short and long term physiologic benefits and quality of life benefits from smoking cessation Provide education about FDA approved smoking cessation medications Promote available smoking cessation programs to physicians in the community and hospitals as an option for patients who smokeStrategy #3: Promote cardiac rehabilitation Promote cardiac rehabilitation services to restore people who have had a heart condition or heart surgery to the highest possible physiological, emotional, social, and vocational levelIV. Infant Health & Family PlanningThis strategy will focus on the service areas of Manchester and Vernon Strategy #1: Improve access to care and education Continue family planning education sessions/tours Encourage the use of the Maternity Care Center (MCC) at Rockville General Hospital Provide information through ECHN digital boards, Readiness Committees, ECHN social media and ECHN Website Continue to publicize educational opportunities through Better Being magazine Continue the distribution of ECHN prenatal folders through the community practices that contain comprehensive topical informationStrategy #2: Increase preconception and first trimester pregnancy education Encourage regular ECHN birth class attendance Provide information through ECHN digital boards, Readiness Committees, ECHN social media and Website Pursue the development of a preconception and an early pregnancy class offering ROCKVILLE GENERAL HOSPITAL Part V, Section B, Line 13h: DESCRIPTION:FAMILY SIZE IS USED WITH INCOME LEVEL. ROCKVILLE GENERAL HOSPITAL Part V, Section B, Line 16i: DESCRIPTION:THE HOSPITAL COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH NOTICES POSTED IN PUBLIC AREAS AROUND THE HOSPITAL, ON THE PATIENT BILLS, ON OUR WEBSITE, AND FOR SELECTED PRE-SCHEDULED SERVICES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE. ROCKVILLE GENERAL HOSPITAL Part V, Section B, Line 22d: DESCRIPTION:PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORETHAN THE AMOUNT GENERALLY BILLED TO PATIENTS WITH INSURANCE FOREMERGENCY OR OTHER MEDICALLY NECESSARY CARE. Part II, Community Building Activities: ROCKVILLE GENERAL HOSPITAL (RGH), AS PART OF EASTERN CONNECTICUT HEALTH NETWORK (ECHN), PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY COMMITTING THE EXPERTISE AND RESOURCES OF THE ORGANIZATION TO A NUMBER OF COMMUNITY BUILDING ACTIVITIES THAT SUPPORT ASSOCIATIONS, BUSINESSES, PROGRAMS, INITIATIVES AND OTHER VALUABLE LOCAL COMMUNITY ASSETS. COMMUNITY BUILDING ACTIVITIES INCLUDE SERVING ON THE BOARD AND EXECUTIVE COMMITTEE OF REGIONAL CHAMBERS OF COMMERCE IN SUPPORT OF THE LOCAL BUSINESS INDUSTRY; PARTNERING WITH THE LOCAL SCHOOL SYSTEMS AND COLLEGES IN VARIOUS WORKFORCE DEVELOPMENT PROGRAMS; SERVING ON THE VERNON SCHOOL READINESS COUNCIL, THE CANCER COMMUNITY OUTREACH COMMITTEE AND THE AMERICAN HOSPITAL ASSOCIATION'S REGIONAL POLICY BOARD; AND NUMEROUS COMMUNITY COALITIONS THAT ADDRESS ADOLESCENT BEHAVIORAL HEALTH CONCERNS. AS A RESULT OF THESE ACTIVITIES, THERE HAS BEEN IMPROVED COLLABORATION AMONG COMMUNITY PROVIDERS ANDOTHERS INVOLVED IN PROVIDING SERVICES TO CHILDREN, ADOLESCENTS AND THEIR FAMILIES AND OTHER ADULTS. Part III, Line 2: METHODOLOGY USED TO ESTIMATE BAD DEBT:THE NETWORK PROVIDES FOR A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE NETWORK ANALYZES CONTRACTUALLY DUEAMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITHDEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE NETWORK RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THEBASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE NETWORK OFFERS A DISCOUNT OFF ITS STANDARD RATES FOR SERVICES PROVIDED. THE DIFFERENCE BETWEEN THE DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED UNCOLLECTIBLE. Part III, Line 4: FOOTNOTE IN ORGANIZATION'S FINANCIAL STATEMENTS DESCRIBING BAD DEBT:the Network provided for a provision for bad debts. For receivables associated with services provided to patients who have third-party coverage, the Network analyzed contractually due amounts and provided an allowance for doubtful accounts (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who were known to be having financial difficulties that makethe realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and co-payment balances due for which third-party coverage existed for part of the bill), the Network recorded a significant provision for bad debts in the period of service on the basis of its past experience, which indicated that many patients were unable or unwilling to pay the portion of their bill for which they were financially responsible. For uninsured patients that did not qualify for financial assistance, the Network offered a discount off its standard rates for services provided. The difference between the discounted rates and the amounts actually collected after all reasonable collection efforts have been exhausted is written off against the allowance for doubtful accounts in the period they were determined uncollectible. Part III, Line 8: DESCRIBE EXTENT ANY SHORTFALL FROM LINE 7 TREATED AS COMMUNITY BENEFIT AND COSTING METFIOD USED:THE HOSPITAL PROVIDES QUALITY HEALTH CARE TO ALL, REGARDLESS OF THEIR ABILITY TO PAY, CHARITY CARE IS PROVIDED TO THOSE WHO ARE ELIGIBLE BASED ON RGH'S POLICY. RGH ALSO INCURS UNPAID COSTS FORGOVERNMENT PROGRAMS BECAUSE REIMBURSEMENT IS NOT SUFFICIENT TO COVER COSTS ASSOCIATED WITH MEDICARE AND MEDICAID PATIENTS. THE ORGANIZATION'S MEDICARE COST REPORT WAS USED TO CALCULATE ACTUAL COSTS REPORTED ON PART III, LINE 6. THE ACCESS TO HEALTHCARE BY PATIENTS COVERED BY MEDICARE IS A FUNDAMENTAL PART OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM. Part III, Line 9b: DID COLLECTION POLICY CONTAIN PROVISIONS ON COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR ASSISTANCE:INTERNAL AND EXTERNAL COLLECTION POLICIES AND PROCEDURES TAKE INTO ACCOUNT THE EXTENT TO WHICH A PATIENT IS QUALIFIED FOR CHARITY CARE OR DISCOUNTS. IN ADDITION, PATIENTS WHO QUALIFY FOR PARTIAL DISCOUNTS ARE REQUIRED TO MAKE A GOOD FAITH EFFORT TO HONOR PAYMENT AGREEMENTS WITH THE HOSPITAL, INCLUDING PAYMENT PLANS AND DISCOUNTED HOSPITAL BILLS. RGH IS COMMITTED TO WORKING WITH PATIENTS TO RESOLVE THEIR ACCOUNTS, AND AT ITS DISCRETION, MAY PROVIDE EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS. RGH WILL NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF BILLS AGAINST CHARITY CARE PATIENTS WHO HAVE COOPERATED WITH THE HOSPITAL TO RESOLVE THEIR ACCOUNTS AND HAVE DEMONSTRATED THEIR INCOME AND/OR ASSETS ARE INSUFFICIENT TO PAY MEDICAL BILLS. Part VI, Line 2: In 2016, RGH collaborated with Manchester Memorial Hospital, also an affiliate of ECHN, to conduct a comprehensive community health needs assessment (CHNA). The CHNA was a systematic, data-driven approach to determining the health status, behaviors and needs of residents in the service area of Rockville General Hospital. Subsequently, this information was used to inform decisions and guide efforts to improve community health and wellness.A CHNA provides information so that communities may identify issues of greatest concern and decide to commit resources to those areas, thereby making the greatest possible impact on community health status. This CHNA will serve as a tool toward reaching three basic goals: To improve residents' health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life. To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors which have historically had a negative impact on residents' health. To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care.This assessment was conducted on behalf of the Eastern Connecticut Health Network and Rockville General Hospital by Professional Research Consultants, Inc. (PRC). PRC is a nationally recognized healthcare consulting firm with extensive experience conducting Community Health Needs Assessments such as this in hundreds of communities across the United States since 1994. Part VI, Line 3: THE HOSPITAL COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH NOTICES POSTED IN PUBLIC AREAS AROUND THE HOSPITAL, ON THE PATIENT BILLS, ON OUR WEBSITE, AND SELECTED PRE-SCHEDULED SERVICES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTHCARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE. Part VI, Line 4: ECHN's community, as defined for the purposes of the Community Health Needs Assessment, included each of the residential Zip Codes that comprise the hospital's town location including 06040 and 06042 for Manchester Memorial Hospital and 06066 for Rockville General Hospital. This community definition was determined because the majority of ECHN's patients originate from these areas for use of our hospital services.Demographics of the CommunityThe population of Rockville General Hospital's service area is estimated at 29,179 people. It is predominantly non-Hispanic White (85.1%), but also has substantial African America (5.8%) and Hispanic (6.5%) populations. Part VI, Line 5: Community health education initiatives and programs are offered to the community and include free community health educational programs, development and distribution of a wellness magazine to more than 150,000 households in the service area, demonstrations, and health fair participation. For example, the hospital hosted a series of Heart Talk education programs for people living with heart failure, to help people learn how to proactively manage heart disease and improve quality of life. Other presentations were made to the community about breast cancer, preventative/screening recommendations, and free screening programs. These presentations were made at the Greater Hartford Women's Conference, Town of Ellington Senior Health Fair, 4th District Health Fair, Mobile Food Share, Town of Vernon "Seniorhood" Fair, Woodlake at Tolland Health Center Fair, A Conversation: Women to Women presentation, and the Crestfield Manor Health Fair. Other areas of particular focus include: access to healthcare services, cancer, heart disease and stroke, infant health, mental health, nutrition/physical activity/weight, substance abuse, diabetes, and tobacco use, which were identified as areas of need in the community health needs assessment conducted in 2016. More than 40,000 people benefitted from these initiatives and programs in FY 16. Free health screenings including diabetic foot checks, mammograms, heart disease screenings, glucose readings, injury screenings, blood pressure, vital sign checks and medical exams are offered in the community. For example, risk factor screenings were done at the Wear Red Day. Blood Pressure screenings were done at the Women's Center for Wellness. Three diabetic foot screenings were done during the year. Targeting uninsured/underinsured populations, 33 people benefitted from these services in FY 16. Healthcare support services are provided by the hospital to increase access and quality of care to individuals in need. Efforts include assistance to enroll in public programs, referrals to social services, and help in finding physicians who accept Medicaid or other government programs. Fifteen (15) people benefitted from these efforts in FY 16. Partnering with local educational institutions, Rockville General Hospital provides a clinical setting for medical students, nursing students, radiologic technicians, phlebotomy students, respiratory technicians, dietetic interns, pharmacy students, physical therapists and others from the University of New England College of Osteopathic Medicine, University of Connecticut, Manchester Community College, Central Connecticut State University, Goodwin College, Capital Community College, American International College, Springfield Technical Community College, Asnuntuck Community College, Stone Academy, University of Saint Joseph's, and the University of Hartford. For example, the RGH pharmacy rotated 2nd and 4th year pharmacy students through the pharmacy. Health services which are subsidized by the hospital include the Early Detection Program, the Maternity Care Center, dialysis services, and the Ryan White Part A program. Specific research initiatives conducted by the hospital include an Institutional Review Committee, which has the primary responsibility to protect the rights and welfare of research subjects and to approve all research studies in accordance with federal regulations. The hospital also maintains a cancer registry database. Financial and in-kind services and goods are donated to community groups and other not for profit organizations, including local fundraisers, facility space to host blood drives, and conference rooms for health support groups organizations' meetings. For example, the hospital provides free meeting space for the ECHN Prostate Cancer Support Group, the Breast Cancer Network of Strength, and Overeaters Anonymous. The expertise and resources of the organization are dedicated to a number of community building activities that support associations, businesses, programs, initiatives and other valuable local community assets. For example, the hospital and its employees participate in regional exercises to evaluate the readiness of the hospital's emergency preparedness capabilities, partner with the local school systems and colleges in various workforce development programs, serve on the Vernon School Readiness Council, and the Cancer Community Outreach Committee. Part VI, Line 6: ROCKVILLE GENERAL HOSPITAL (RGH) IS AN AFFILIATE OF EASTERN CONNECTICUT HEALTH NETWORK (ECHN), A HEALTH CARE SYSTEM SERVING 19 TOWNS IN EASTERN CONNECTICUT.THE ECHN NETWORK OF AFFILIATES INCLUDES: MANCHESTER MEMORIAL HOSPITAL, A COMMUNITY HOSPITAL LICENSED FOR 249 BEDS AND 34 BASSINETS, THAT OFFERS MEDICAL AND SURGICAL SERVICES, 24-HOUR EMERGENCY CARE, MEDICAL IMAGING, A MODERN FAMILY BIRTHING CENTER AND NEONATOLOGY SERVICES, REHABILITATION SERVICES, A CERTIFIED SLEEP DISORDERS CENTER, INTENSIVE CARE SUITES, A WOUND HEALING CENTER WITH HYPERBARIC THERAPY, HOSPICE CARE, DIABETES SELF-MANAGEMENTPROGRAM, CARDIAC &PULMONARY REHABILITATION, ACOMPREHENSIVE RANGE OF ADOLESCENT AND ADULT INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES, NUTRITION COUNSELING, LABORATORY SERVICES, AND THE EASTERN CONNECTICUT CANCER INSTITUTE AT THE JOHN A. DEQUATTROCANCER CENTER.ROCKVILLE GENERAL HOSPITAL, A COMMUNITY HOSPITAL LICENSED FOR 102 BEDS, THAT OFFERS MEDICAL AND SURGICAL SERVICES, 24-HOUR EMERGENCY CARE, MEDICAL IMAGING, CARDIAC 8 PULMONARY REHABILITATION, PHYSICAL REHABILITATION, HOSPICE CARE, A MATERNITY CARE CENTER FOR UNINSUREDWOMEN, OUTPATIENT ADOLESCENT BEHAVIORAL HEALTH SERVICES, AND LABORATORY SERVICES. WOODLAKE AT TOLLAND IS A SKILLED NURSING &REHABILITATION CENTER, A 130-BED LONG-TERM SKILLED NURSING CARE AND SHORT-TERM REHABILITATION FACILITY. CUSTOMIZED REHABILITATION TREATMENTSERVICES INCLUDE JOINT REPLACEMENT REHABILITATION, ORTHOPEDIC POSTHOSPITAL CARE, STROKE/NEUROLOGICAL REHAB, POST MEDICAUSURGICAL RECONDITIONING, AND PERSONALIZED, PROGRESSIVE, AND INTERDISCIPLINARY CARE SERVICES.EASTERN CONNECTICUT MEDICAL PROFESSIONALS FOUNDATION, INC. (ECMPF), A MULTI-SPECIALTY PHYSICIAN GROUP PRACTICE THAT OFFERS A FULL RANGE OF HEALTHCARE SERVICES, INCLUDING PRIMARY AND SPECIALTY CARE IN THE TOWNS OF EAST HARTFORD, ELLINGTON, MANCHESTER, SOUTH WINDSOR,TOLLAND AND VERNON/ROCKVILLE. GLASTONBURY WELLNESS CENTER COMBINES FITNESS AND MEDICAL SERVICES UNDER ONE ROOF, INCLUDING PHYSICIAN PRACTICES, LABORATORY DRAW SERVICES, MEDICAL IMAGING DIAGNOSTIC SERVICES, AND REHABILITATION SERVICES.ECHN MEDICAL BUILDINGS AT EVERGREEN WALK (SOUTH WINDSOR): 2400 TAMARACK AVENUE OCCUPANTS INCLUDE EVERGREEN ENDOSCOPY CENTER, CENTRAL CONNECTICUT GASTROENTEROLOGY, THE COLON & RECTAL SURGEONS OF GREATER HARTFORD, ECMPF PRIMARY CARE PHYSICIANS, RHEUMATOLOGY PHYSICIANS, WALDEN BEHAVIORAL CARE EATING DISORDERS CLINIC, ACCLAIM BEHAVIORAL SERVICES, LLC, AND LABORATORY SERVICES.2600 TAMARACK AVENUE INCLUDES THE WOMEN'S CENTER FOR WELLNESS, ECHN BREAST CARE COLLABORATIVE, AND THE OB/GYN GROUP OF EASTERN CONNECTICUT. THE CONFERENCE ROOM IS USED FOR COMMUNITY PROGRAMS.2800 TAMARACK AVENUE HOUSES EVERGREEN IMAGING CENTER, ECHN REHABILITATION SERVICES, A LABORATORY DRAW STATION, AND A SERIES OF MEDICAL PRACTICES (INCLUDING ORTHOPEDIC SURGERY, OPHTHALMOLOGY, AND OTOLARYNGOLOGY), CORPCARE, AND SOUTH WINDSOR URGENT CARE.ECHN MANCHESTER MEDICAL OFFICE BUILDINGS: 150 NORTH MAIN STREET OFFERS A VARIETY OF ADULT BEHAVIORAL HEALTH SERVICES. 130 HARTFORD ROAD, OFFERING PRIMARY CARE AND LABORATORY SERVICES. 353 Main Street, Manchester houses Digestive Heath Specialists of Eastern CT, LLC and a gastroenterologist. 945 Main Street, Manchester houses digestive health physicians. 460 Hartford Turnpike, Vernon, includes an endocrinologist and Davita Dialysis. VISITING NURSE &HEALTH SERVICES OF CONNECTICUT, PROVIDES AT-HOME NURSING CARE AND HOSPICE CARE.ECHN HAS 388 PHYSICIANS (305 ACTIVE, 34 COURTESY, 16 CONSULTING, 33 PART-TIME), 105 ALLIED HEALTH PROFESSIONALS, 10 MEDICAL DEPARTMENTS AND 16 SERVICES AS WELL AS 18 UNIVERSITY OF NEW ENGLAND COLLEGE OF OSTEOPATHIC MEDICINE THIRD-YEAR MEDICAL STUDENTS AVAILABLE TO CAREFOR THE COMMUNITY. IN ADDITION, ECHN HAS 87 ELECTIVE STUDENTS FROM VARIOUS UNIVERSITIES WHO COME FOR ONE ROTATION PER YEAR. SCHEDULE H, PART VI - ADDITIONAL INFORMATION THE ROCKVILLE GENERAL HOSPITAL, INC. IS A NOT-FOR-PROFIT 102-BED ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF VERNON-ROCKVILLE, CT AND SURROUNDING TOWNS. THE HOSPITAL IS A SUBSIDIARY OF THE EASTERN CONNECTICUT HEALTH NETWORK, INC., WHICH WAS FORMED IN 1995 BY A MERGER OF MMH CORP. AND ROCKVILLE AREA HEALTH SERVICES, INC. ECHN WAS ORGANIZED TO PROVIDE A BROADER HEALTH CARE SYSTEM FOR THESURROUNDING COMMUNITIES WITH QUALITY MEDICAL CARE AT A REASONABLE COST AND TO FOSTER AN ENVIRONMENT CONDUCIVE TO HEALTH AND WELL BEING WHETHER IN THE HOME OR IN THE COMMUNITY.ROCKVILLE GENERAL HOSPITAL PATIENTS NOT HAVING INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY QUALIFIED CARE (UNINSURED PATIENTS), AS WELL AS UNDERINSURED PATIENTS, SUBJECT TO INCOME LIMITS AND FAMILY SIZE RECEIVE FREE OR DISCOUNTED CARE. ROCKVILLE GENERAL HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. CHARGES FOR CARE PROVIDED TO PATIENTS ARE DETERMINED BY ESTABLISHED RATES, SUBJECT TO POSSIBLE ADJUSTMENTS OR DISCOUNTS FOR LOW INCOME PATIENTS; CONTRACTUAL DISCOUNTS, OR DISCOUNTS FOR PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES. CHARITY CARE FOR FY 2016 WAS $1,504,520 FOR 529 APPROVED APPLICANTS.EXPENSES RELATED TO SERVICES PERFORMED FOR PATIENTS OF ROCKVILLE GENERAL HOSPITAL CONTRIBUTE IMPORTANTLY TO ITS EXEMPT PURPOSE BECAUSE THE EXPENSES ARE INCURRED IN THE DIAGNOSIS, CURE,MITIGATION, TREATMENT AND PREVENTION OF DISEASE, AND FOR MEDICAL PURPOSES AFFECTING THE STRUCTURE OR FUNCTION OF THE HUMAN BODY. ROCKVILLE GENERAL HOSPITAL PROVIDED NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY. TWO THOUSAND ONE HUNDRED TWELVE (2,052) INPATIENTS WERE CARED FOR IN FY16 REPRESENTING 10,022 PATIENT DAYS. 67,723 OUTPATIENT VISITS WERE RECORDED.INCLUDED IN THE 2,052 INPATIENTS WERE 1,610 GOVERNMENT RELATEDPATIENTS. THE GOVERNMENT INPATIENTS FALL INTO THE FOLLOWING GROUPS.MEDICARE...928MEDICARE MANAGED CARE... 382MEDICAID... 295CHAMPUS... 5TOTAL GOV PATIENTS...1,610INCLUDED IN THE 67,723 OUTPATIENT VISITS WERE 35,475 GOVERNMENTRELATED VISITS. THE VISITS ARE A PRODUCT OF GROSS REVENUERELATIONSHIP TO TOTAL VISITS. THE GOVERNMENT VISITS FALL INTO THEFOLLOWING GROUPS.MEDICARE... 16,469MEDICARE MANAGED CARE... 7,675MEDICAID... 11,150CHAMPUS... 181TOTAL GOV PATIENTS... 35,475THE HOSPITAL PROVIDED UNCOMPENSATED CARE TO 16,057 MEDICAIDPATIENTS FOR A NET COMMUNITY BENEFIT AMOUNT OF $6,805,721 AFTERMEDICAID REIMBURSEMENT. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: CT X X X X X 0 1 0 0 0 0 0 0 0 Peter J Karl President and CEO 0 607548 0 258500 0 0 0 0 0 23743 0 889791 0 0 Michael D Veillette Senior Vice President, Chief Financi 0 364031 0 131250 0 0 0 0 0 23743 0 519024 0 0 Dennis McConville Senior Vice President, Strategic Pla 0 226122 0 131250 0 0 0 0 0 9272 0 366644 0 0 Joel Reich MD Senior Vice President, Medical Affai 0 355897 0 131250 0 0 0 0 0 17694 0 504841 0 0 Mary Powers SVP, PATIENT CARE SERVICES 244352 0 15000 0 0 0 0 0 9316 0 268668 0 0 0 Robert Carroll MD Medical Director, Emergency Departme 0 410665 0 146792 0 0 0 0 0 23743 0 581200 0 0 Joyce Tichy General Counsel 0 292550 0 131250 0 0 0 0 0 23743 0 447543 0 0 David Neuhaus MD Medical Director, Emergency Departme 306136 0 70000 0 0 0 0 0 1129 0 377265 0 0 0 Ellen G Neuhaus MD Medical Director, Emergency Departme 227011 0 0 0 0 0 0 0 23300 0 250311 0 0 0 Alexis Cordiano Urgent Care Physician 225927 0 0 0 0 0 0 0 20594 0 246521 0 0 0 Mariela Podolski Urgent Care Physician 131657 0 17950 0 0 0 0 0 19215 0 168822 0 0 0 Sue Cavaliere nursing supervisor 161988 0 1500 0 0 0 0 0 9070 0 172558 0 0 0 Deborah Gogliettino Senior Vice President, Human Resouce 0 141600 0 0 0 0 0 0 0 1159 0 142759 0 0 Deborah Parker Executive Vice President, Chief Clin 0 126407 0 100000 0 0 0 0 0 1655 0 228062 0 0 Part I, Line 3 ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION THE BOARD OF TRUSTEES (THE "BOARD") APPOINTS AN EXECUTIVE COMPENSATION COMMITTEE (THE "COMMITTEE") AND HAS DELEGATED THE RESPONSIBILITY OF COMPLETING AN ANNUAL MARKET ANALYSIS OF THE CEO'S COMPENSATION AND OTHER SENIOR EXECUTIVES AND COMPLETION OF THE CEO'S ANNUAL PERFORMANCE REVIEW. THE EVALUATION OF THE CEO IS AN IMPORTANT RESPONSIBILITY OF THE BOARD AND IS CRITICAL TO THE GOVERNANCE RESPONSIBILITIES OF THE BOARD. THE EXECUTIVE COMPENSATION COMMITTEE SOLICITS FEEDBACK ABOUT THE PERFORMANCE OF THE CEO FROM EVERY ACTIVE BOARD MEMBER WHICH WHEN RECEIVED IS ANALYZED AND REVIEWED BY THE MEMBERS OF THE COMMITTEE. THE CEO COMPLETES A SELF EVALUATION AND AN EVALUATION FOR ALL ELIGIBLE MEMBERS OF THE SENIOR LEADERSHIP TEAM, WHO COMPLETE BOTH ASELF-EVALUATION AND A PEER EVALUATION. THE RESULTS OF THE ASSESSMENTS COMPLETED BY THE MEMBERS OF THE SENIOR LEADERSHIP TEAM ARE REVIEWED BY THE CEO WHO DISCUSSES THE RESULTS WITH THE MEMBERS OF THE COMMITTEE ON AN ANNUAL BASIS. THE EXECUTIVE COMPENSATION COMMITTEE IN COLLABORATION WITH THE CEO EVALUATES AND APPROVES ORGANIZATIONAL PERFORMANCE OBJECTIVES BOTH ON AN ANNUAL AND LONG TERM BASIS AND FOCUSES ON THOSE GOALS WITH THE GREATEST IMPACT TO THE ORGANIZATION'S STRATEGY AND MISSION. THE COMMITTEE ENSURES AN ANNUAL REVIEW OF THE CEO'S PERFORMANCE IN RELATION TO THESE GOALS; REVIEWS THE TALLY SHEETS TO UNDERSTAND THE ECONOMICS OF THE EMPLOYEE BENEFITS; RETAINS AND ENSURES THE INDEPENDENCE OF ITS EXTERNAL CONSULTANTS AND ADVISORS AND INVOLVES RELEVANT ORGANIZATIONAL RESOURCES AS APPROPRIATE TO CARRY OUT ITS RESPONSIBILITIES. THE COMMITTEE ENSURES TRANSPARENCY AND DISCLOSURE TO THE BOARD BY PRESENTING THE RESULTS OF THE ANNUAL PERFORMANCE AND MARKET REVIEWS PROVIDING THE BOARD WITH THE OPPORTUNITY FOR FURTHER INPUT AND CONSIDERATION AND ASKING THAT THE BOARD TAKE ACTION ON THE RECOMMENDATION OF THE COMMITTEE IF THE RECOMMENDATION IS APPROPRIATE. THE BOARD HAS THE OPPORTUNITY TO CHANGE ANY RECOMMENDATIONS OF THE COMMITTEE IF IT SO DESIRES. MEMBERS OF THE BOARD AND OF THE COMMITTEE WHO MAY BE INTERESTED PARTIES ARE ASKED TO RECUSE THEMSELVES FROM ANY REQUIRED VOTES TO AVOID CONFLICTS OF INTEREST. THE COMMITTEE ENSURES THAT THE PROCESS MEETS COMPLIANCE STANDARDS. SCHEDULE J, PART I, LINE 5 THE ECHN EXECUTIVE INCENTIVE COMPENSATION PLAN IS A PLAN THAT HAS BEEN DEVELOPED, REVIEWED AND IS ANNUALLY APPROVED BY MEMBERS OF THE BOARD EXECUTIVE COMPENSATION COMMITTEE WITH CONSULTANT THIRD PARTY OVERSIGHT. THE PLAN ESTABLISHES GOALS IN 4 AREAS OF PERFORMANCE: SYSTEM-WIDE FINANCIAL PERFORMANCE BASED ON PROFIT FROM OPERATIONS, TWO QUALITY OUTCOMES IN CLINICAL CORE MEASURES AND PATIENT SATISFACTION AND AN INDIVIDUAL GOAL (WHICH HAS A SEPARATE MEASUREMENT FOR TEAM ASSESSMENT) FOR EACH MEMBER OF THE INCENTIVE PROGRAM. THERE IS NO EXECUTIVE COMPENSATION TIED TO THE REVENUES OF THE REPORTING ORGANIZATION OR OTHER RELATED ENTITIES. THERE IS EXECUTIVE COMPENSATION TIED TO THE NET EARNINGS (INCOME FROM OPERATIONS), AS NOTED IN THE PRIOR PARAGRAPH, HOWEVER IT IS ONE OF FOUR PERFORMANCE LEVERS THAT DETERMINE THE LEVEL OF COMPENSATION. THE AGGREGATE NET EARNINGS OF THE ECHN "SYSTEM NOT ANY ONE REPORTING ORGANIZATION OR RELATED ENTITIES OF ECHN DETERMINE THIS COMPENSATION. SO TO CONCLUDE, THE ANSWER TO THESE 4 QUESTIONS IS "NO" WITH THE CLARIFICATION THAT IT IS THE PERFORMANCE OF THE ENTIRE SYSTEM AS A WHOLE THAT DETERMINES EXECUTIVE COMPENSATION, NOT ONE REPORTING ORGANIZATION OR A RELATED ENTITY. MEMBERS OF THE INCENTIVE PROGRAM INCLUDE THE FOLLOWING: POSITION TITLE -KEY EMPLOYEE NAME PRESIDENT AND CEO -PETER J. KARL SVP, CHIEF FINANCIAL OFFICER -MICHAEL D. VEILLETTE SVP, HUMAN RESOURCES -DEBORAH GOGLIETTINO SVP, STRATEGIC PLANNING - DENNIS MCCONVILLE SVP, CHIEF CLINICAL OFFICER -DEBORAH PARKER SVP, MEDICAL AFFAIRS -JOEL REICH, M.D. SVP, GENERAL COUNSEL -JOYCE TICHY Addendum for calendar year 2015: The ECHN Board of Trustees and the Board Compensation Committee replaced the executive short term incentive compensation program with a retention (or "stay") program pertaining to key senior ECHN executives. The purpose of this change was to ensure that the Prospect Medical Holdings (PMH) acquisition process be successfully executed through the closing date, and help provide a smooth transition of ownership. The move to this program and away from the short term incentive compensation structure was approved by the ECHN Board, as recommended by the Compensation Committee in the latter part of calendar year 2013. This decision was driven by the acquisition process and the Board's concern around executive departure. SCHEDULE J, PART II THE SALARY INFORMATION PROVIDED WITHIN SCHEDULE J REPRESENTS CALENDAR YEAR 2015 WAGES AND BENEFITS. Dr Dennis O'Neill Dr Michele Co Drs. O'Neill & Conlon RGH TRUSTEES, EACH OWN MORE THAN 5% OF ECPC. 214646 ECHN, INC. CONTRACTS WITH EASTERN CONNECTICUT PATHOLOGY CONSULTANTS, PC (ECPC), TO PROVIDE PATHOLOGY SERVICES AND LAB MANAGEMENT SERVICES TO MMH AND RGH. ALL PAYMENTS MADE TO ECPC ARE FOR PURPOSES OF OPERATING THE BUSINESS AND MAINTAINING OPERATING CASHFLOW. PAYMENTS ARE NOT DIRECTLY TO ANY OF THE OWNERS. 0 Kathleen O'Neill RGH TRUSTEE AND wife OF DR. DENNIS O'NEILL, TRUSTEE FOR ALL AFFILIates ECHN TRUSTEE AND THE WIFE OF DR. DENNIS O'NEILL, TRUSTEE FOR ALL AFFILIATES, WHO HAS A REPORTABLE TRANSACTION AS NOTED ABOVE. 0 Anthony DiStefano MD MMH TRUSTEE AND SPOUSE OF LIZANNE DISTEFANO, RGH EMPLOYEE 22469 LIZANNE DISTEFANO, SPOUSE, IS EMPLOYED BY ROCKVILLE GENERAL HOSPITAL (RGH), AN AFFILIATE OF ECHN. SALARY PAID TO LIZANNE DISTEFANO AS AN EMPLOYEE OF RGH. SALARY OF $22,469 WAS PAID BY RGH. 0 Wilson Vega Former RGH trustee and president of Connecticut Business Systems (CBS) 93971 CBS contracts with ECHN, Inc. to provide copier services to MMH and RGH. Payment of $93,971 from MMH to CBS and not directly to Wilson Vega. 0 Form 990, Part V, Line 13a CT Form 990, Part VI, Section A, line 2 FAMILY/BUSINESS RELATIONSHIPS AMONGST INTERESTED PERSONS: DENNIS O'NEILL AND MICHELE CONLON -BUSINESS RELATIONSHIP KATHLEEN O'NEILL AND DENNIS O'NEILL -FAMILY RELATIONSHIP. Form 990, Part VI, Section A, line 6 CLASSES OF MEMBERS OR STOCKHOLDERS: ECHN IS THE SOLE MEMBER OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7a MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODY: ECHN HAS THE AUTHORITY TO ELECT TRUSTEES AND OFFICERS AND APPOINT COMMITTEE MEMBERS. Form 990, Part VI, Section A, line 7b DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS: ECHN HAS VARIOUS POWERS INCLUDING BUT NOT LIMITED TO: APPROVING ALL OPERATING AND CAPITAL BUDGETS, CONTROLLING THE INVESTMENT OF FUNDS, LOCATION OF SERVICES, AGREEMENTS AND TRANSACTIONS, AFFILIATIONS, CHANGES, AMENDMENTS, OR RESTATEMENTS OF CERTIFICATES OF INCORPORATION AND BYLAWS, ADOPTING A SYSTEM-WIDE VISION AND STRATEGIC PLANS, AND APPROVING DEBT BORROWINGS. Form 990, Part VI, Section B, line 11 REVIEW OF FORM 990 BY GOVERNING BODY: PRIOR TO FILING THE 990, THE FOLLOWING STEPS ARE TAKEN: 1) THE ACCOUNTING MANAGER, TOGETHER WITH OTHER MEMBERS OF THE FINANCE DEPARTMENT, CONDUCT A REVIEW OF THE 990 ALONG WITH A REVIEW AND RECONCILIATION OF THE 990 TO THE AUDITED FINANCIAL STATEMENTS; 2) THE ACCOUNTING MANAGER CONDUCTS AN EXTENSIVE REVIEW AND DISCUSSION OF THE 990 WITH THE CPA FIRM THAT PREPARES THE RETURN; 3) AN ELECTRONIC COPY OF THE 990 IS MADE AVAILABLE TO THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES (THE GOVERNING BOARD), AND SENIOR MANAGEMENT OF THE ORGANIZATION, FOR REVIEW. Form 990, Part VI, Section B, line 12c ANNUALLY, THE CORPORATE COMPLIANCE/INTERNAL AUDIT DEPARTMENT PROVIDES TO OFFICERS, DIRECTORS, OR TRUSTEES AND KEY EMPLOYEES THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND DISCLOSURE STATEMENT. EACH INDIVIDUAL IS REQUIRED TO RETURN TO THE DEPARTMENT A SIGNED DOCUMENT, ACKNOWLEDGING RECEIPT OF THE POLICY AND DISCLOSURE STATEMENT AND DISCLOSE ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. A SUMMARY OF THE DISCLOSURES IS SHARED WITH THE CHAIRMAN OF THE BOARD OF TRUSTEES AND WITH THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD. INDIVIDUALS WHO ARE IDENTIFIED AS HAVING A CONFLICT OF INTEREST ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODIES' DELIBERATIONS AND DECISIONS RELATED TO THE TRANSACTION. THE RETURNED STATEMENTS ARE RETAINED BY THE CORPORATE COMPLIANCE/INTERNAL AUDIT DEPARTMENT Form 990, Part VI, Section B, line 15 THE COMPENSATION COMMITTEE TAKES THE FOLLOWING STEPS WITH AN INDEPENDENT COMPENSATION CONSULTANT (1) REVIEWS DATA RELATED TO CURRENT MARKET VALUES CONSISTENT FOR ORGANIZATION'S EXECUTIVES BY REVIEW OF COMPENSATION LEVELS AND PLANS CONSISTENT WITH HOSPITALS AND HEALTH SYSTEMS OF COMPARABLE SIZE AND LOCATION; (2) COMPLETES A REVIEW OF DATA ON CURRENT AND FUTURE PLANS FOR THE ORGANIZATION, INCLUDING STRUCTURE AND JOB DESCRIPTIONS; (3) REVIEWS AND APPROVES AND RECOMMENDS SALARY RANGES FOR EACH POSITION, ALONG WITH RELATED BENEFITS; (4) REVIEWS AND APPROVES A TIERED EXECUTIVE STRUCTURE WITH APPROPRIATE INCENTIVE OPPORTUNITY, BENEFITS AND COMPENSATION. THE LAST COMPENSATION REVIEW OCCURRED 3/19/2015. Form 990, Part VI, Section C, line 19 THE ORGANIZATION, WILL, UPON REQUEST, ALLOW FOR REVIEW OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND MOST RECENT ANNUAL AUDITED FINANCIAL STATEMENTS AT AN OFFICE OF THE ORGANIZATION. Form 990, Part XI, line 9: Change in beneficial interest in trust assets 82,000. Pension and post retirement related adjustments -257,922. Transfers from Foundation 616,264. Transfers from VNHSC 5,310,188. Transfers from Woodlake 5,778,009. Transfers to ECHN -1,730,230. Transfers from MMH 1,373. EASTERN CONNECTICUT HEALTH NETWORK INC 71 HAYNES STREET MANCHESTER CT 06040 222546079 Integrated health care system parent Co CT 501(c)(3) 11 type iii-fi 0 Manchester Memorial Hospital 71 HAYNES STREET MANCHESTER CT 06040 060646710 HOSPITAL CT 501(c)(3) Line 3 ECHN 1 ECHN COMMUNITY HEALTHCARE FOUNDATION INC 71 HAYNES STREET MANCHESTER CT 06040 222546080 Fundraising/Support CT 501(c)(3) Line 7 ECHN 1 ECHN ELDERCARE SERVICES INC 26 SHENIPST LAKE ROAD TOLLAND CT 06084 061149193 Skilled Nursing Facility CT 501(c)(3) Line 9 ECHN 1 EASTERN CONNECTICUT MEDICAL PROFESSIONAL FOUNDATION iNc 71 HAYNES STREET MANCHESTER CT 06040 222546078 Physician Services CT 501(c)(3) Line 3 ECHN 1 VISITING NURSE & HEALTH SERVICES OF CT INC 8 KEYNOTE DRIVE VERNON CT 06066 060645795 HOME HEALTHCARE SERVICES CT 501(c)(3) Line 9 ECHN 1 MEDICAL PRACTICE PARTNERS LLC PO BOX 3830 VERNON CT 06066 271498877 CT 0 0 ECHN ENTERPRISES INC 71 HAYNES STREET MANCHESTER CT 06040 222546828 real estate holding CT N/A C 1 HAYNES STREET PROPERTY MANAGEMENT LLC 71 HAYNES STREET MANCHESTER CT 06040 222546028 REAL ESTATE PROPERTY MANAGEMENT CT N/A C 1 ECHN CORPORATE SERVICES 71 HAYNES STREET MANCHESTER CT 06040 271596320 BILLING AND OTHER PRACTICE MANAGEMENT SERVICES CT N/A C 1 CONNECTICUT HEALTHCARE INSURANCE COMPANY PO BOX 1109 cayman islands CJ 980623043 CAPTIVE INSURANCE CJ C 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 1 1 0 Eastern CT Medical Professionals Foundation J 63988 market value Eastern CT Health Network L 5272 COST Eastern CT Health Network M 9792458 COST ECHN ElderCare Services Inc Q 1638795 CASH TRANSFER ECHN Community HealthCare Foundation Inc Q 91742 CASH TRANSFER Eastern CT Medical Professionals Foundation R 1806524 CASH TRANSFER ECHN Community HealthCare Foundation Inc M 30447 cost