2017-08-14T10:57:00-05:00 2016-09-30 135565207 KPMG LLP 345 PARK AVENUE NEW YORK NY 10154 990 2015-10-01 060646704 LAWRENCE & MEMORIAL HOSPITAL INC LAWR 8604420711 365 MONTAUK AVENUE NEW LONDON CT 06320 SETH VAN ESSENDELFT SR VP FINANCE 8604420711 2017-08-14 0 ROBERT ROBINSON P00741489 2127589700 2015 2021-01-29 14:40:06Z SETH VAN ESSENDELFT 365 MONTAUK AVENUE NEW LONDON CT 06320 380317629 0 X WWW.LMHOSPITAL.ORG X 1912 CT TO IMPROVE THE HEALTH OF THE REGION. 11 7 2551 367 1995154 -410314 857596 948883 352401780 341289063 11372756 2266946 2880175 2811097 367512307 347315989 0 214962 0 0 192132028 195404454 0 0 862618 157997754 149133953 350129782 344753369 17382525 2562620 368349831 350297218 239868109 237695395 128481722 112601823 X TO IMPROVE THE HEALTH OF THE REGION. 0 1 254505945 214962 341289063 SEE SCHEDULE O 254505945 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 1 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 1 339 0 2551 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 7 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DENIS DONEGAN 2036886088 789 HOWARD AVE NEW HAVEN CT 06519 X BRUCE D CUMMINGS PRESIDENT/CEO AND TRUSTEE 1.00 39.00 X X 639099 0 50765 ALAN R HUNTER CHAIRMAN AND TRUSTEE 1.00 6.00 X X 0 0 0 MARY ELLEN JUKOSKI VICE CHAIRMAN AND TRUSTEE 1.00 0.00 X X 0 0 0 JAMES MITCHELL SECRETARY AND TRUSTEE 1.00 0.00 X X 0 0 0 JOHN E ALLEN TREASURER AND TRUSTEE 1.00 0.00 X X 0 0 0 SHARON ARNOLD TRUSTEE 1.00 0.00 X 0 0 0 JOSEPH A CECERE TRUSTEE START 1/16 1.00 0.00 X 0 0 0 NIALL J DUHIG TRUSTEE 1.00 0.00 X 61800 0 0 CHRISTOPHER O'CONNOR TRUSTEE START 9/16 1.00 39.00 X 0 1210574 388215 JOSH PARSONS TRUSTEE 1.00 0.00 X 0 0 0 DAVID F REISFELD TRUSTEE 1.00 39.00 X 317862 0 63398 DONALD FELITTO TRUSTEE UNTIL 12/15 1.00 1.00 X 0 0 0 MAUREEN ANDERSON ASSISTANT SECRETARY 1.00 39.00 X 285844 0 74161 SETH VAN ESSENDELFT VP/CFO 1.00 39.00 X 374982 0 48016 DONNA EPPS VP CHIEF HR OFFICER 40.00 0.00 X 227931 0 26982 KIMBERLY KALAJAINEN VP CHIEF INFORMATION OFFICER 40.00 0.00 X 289748 0 43078 CHRISTOPHER LEHRACH CHIEF TRANSFORMATION OFFICER 40.00 0.00 X 401811 0 62721 DANIEL RISSI VP CHIEF MEDICAL OFFICER 40.00 0.00 X 474651 0 68811 WILLIAM STANLEY VP DEV & COMMUNITY RELATIONS 40.00 0.00 X 212413 0 43635 LAUREN WILLIAMS VP PATIENT CARE SERVICES 40.00 0.00 X 271773 0 50081 GERALDINE RUFFA MEDICAL DIRECTOR, PHYSICIAN 40.00 0.00 X 228915 0 22497 TINA DICIOCCIO CORPORATE CONTROLLER 40.00 0.00 X 193087 0 36901 GARY CASS DIRECTOR HR/LABOR RELATIONS 40.00 0.00 X 187049 0 33293 WARREN ROGERS PHARMACY DIRECTOR 40.00 0.00 X 177496 0 38902 GREGORY GEORGES RN, CRISIS INTERVENTION 40.00 0.00 X 167560 0 28647 HENRY AMDUR FORMER OFFICER 0.00 0.00 X 302897 0 51545 4814918 1210574 1131648 269 1 1 0 BERKELEY RESEARCH GROUP LLC 2200 POWELL STREET SUITE 1200 EMERYVILLE CA 94608 CONSULTING 4061282 IPC HOSPITALISTS PO BOX 844929 LOS ANGELES CA 900844929 HOSPITALISTS 3006802 PRESIDIO NETWORKED SOLUTIONS PO BOX 677638 DALLAS TX 752677638 IT SERVICES 1804873 TOTAL LAUNDRY COLLABORATIVE LLC 114 WOODLAND ST HARTFORD CT 06105 LAUNDRY SERVICE 885534 QUEST DIAGNOSTICS 2025 COLLECTION CENTER DR CHICAGO IL 60693 DIAGNOSTIC SERVICE 823182 74 181630 737343 29910 48210 948883 NET PATIENT SERVICES 900099 312684018 312684018 OTHER PATIENT RELATED REVENUE 900099 23248634 23248634 PARAMEDIC SERVICES 900099 3389977 3389977 LAB TESTING 900099 1966434 1966434 341289063 1806949 28720 1778229 1921694 0 1921694 1921694 1921694 33364362 9770 32914135 0 450227 9770 459997 459997 38335 181630 87505 -49170 -49170 DINING ROOM SERVICES 900099 938573 938573 938573 347315989 339322629 1995154 5049323 166912 166912 48050 48050 4080384 3832577 247807 138758625 106132684 32322999 302942 4472951 3329282 1134166 9503 37902476 28211358 9610592 80526 10190018 7584577 2583792 21649 2318903 64161 2254742 1085126 67250 1017876 97147 97147 482801 482801 10479786 10051812 427974 6015190 4397999 1558256 58935 6325653 1692768 4619211 13674 5775277 1633589 4141688 312697 101734 210963 3520300 3520300 23211689 11511914 11699388 387 5984632 5984632 MEDICAL & SURGICAL 52704308 52399075 300511 4722 PURCHASED SVCS 22433685 11943309 10483682 6694 EQUIP RENTAL & MAINTENA 6771736 4964806 1806930 0 TELEPHONE 906797 64327 842470 0 708226 538259 54188 115779 344753369 254505945 89384806 862618 13532578 4150271 20366 20366 35571826 33342997 29011 19685 6194355 6339039 3125348 2228771 450435446 307044724 150976973 143390722 126094405 111310322 3584118 3664330 29220851 45830715 368349831 350297218 45529044 41891240 106006013 100443141 88333052 95361014 239868109 237695395 X 103558083 86150494 18960042 20326874 5963597 6124455 128481722 112601823 368349831 350297218 X 2562620 5585471 -24027990 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 97147 97147 0 PART II-B, LINE 1: THE AMOUNT REPORTED IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING DURING FY 2016. ALSO, THE HEALTH SYSTEM OFFICIALS HAD MEETINGS AND CONTACTS WITH STATE GOVERNMENT OFFICIALS, INCLUDING STATE LEGISLATORS AND THEIR STAFF TO DISCUSS VARIOUS HEALTH CARE REFORM PROPOSALS. LAWRENCE & MEMORIAL HOSPITAL IS PART OF A CONTROLLED GROUP WITH THE FOLLOWING LOBBYING EXPENSES: YALE-NEW HAVEN HOSPITAL EIN 06-0646652 $1,099,541 BRIDGEPORT HOSPITAL EIN 06-0646554 $ 596,691 GREENWICH HOSPITAL EIN 06-0646659 $ 120,642 NORTHEAST MEDICAL GROUP EIN 06-1330992 $ 42,892 LMW HEALTHCARE, INC. EIN 46-0543230 $ 66,063 17802690 1586788 77634 53322 19258522 18987367 -944846 194153 45678 17802690 17922953 1382314 269234 48666 18987367 16251377 1952978 239701 41701 17922953 14398889 2146447 266733 27226 16251377 0.16000 0.84000 0 0 1464979 1464979 146232746 83713789 62518957 14219342 10787995 3431347 278800243 212542940 66257303 9718136 9718136 143390722 OTHER RECEIVABLES 25568590 DEBT SERVICE FUND 1306653 DEFERRED FINANCING COSTS 2058260 DUE FROM AFFILIATES 16897212 45830715 DUE TO L&M CORPORATION 2860337 DEFERRED FINANCING COST 2312832 MALPRACTICE INSURANCE 22155848 DUE TO THIRD PARTY AGENCIES 7944521 SELF ASSURANCE RESERVES 3635721 ASSET RETIREMENT OBLIGATION 976570 ACCRUED PENSION AND OTHER POST RETIREMENT 55475185 95361014 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNCTIONS TO SUPPORT AND PROVIDE INCOME FOR THE FURTHERANCE OF THE HEALTHCARE MISSION OF LAWRENCE & MEMORIAL HOSPITAL. CENTRAL AMERICA/CARIBBEAN INVESTMENTS 29524838 0 0 0 0 0 0 29524838 0 29524838 0 0 1 0 0 0 GALA 219965 181630 38335 13178 71727 2600 219965 181630 38335 13178 71727 2600 87505 -49170 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 1795 19462066 5731639 13730427 0.03980 26683 57231990 40491363 16740627 0.04860 0 0 0 28478 76694056 46223002 30471054 0.08840 44 13711 1906668 508065 1398603 0.00410 9 9465 2148661 19600 2129061 0.00620 9 6283 8097085 3628288 4468797 0.01300 0 0 0 0 11 721 157518 0 157518 0.00050 73 30180 12309932 4155953 8153979 0.02380 73 58658 89003988 50378955 38625033 0.11220 0 0 0 0 1 0 910 0 910 0.00000 2 883 54593 0 54593 0.00020 0 0 0 0 0 0 0 0 2 0 5884 0 5884 0.00000 0 0 0 0 0 0 0 0 0 0 0 0 5 883 61387 61387 0.00020 1 9904254 131536088 155295024 -23758936 X 1 1 1 1 LAWRENCE & MEMORIAL HOSPITAL 365 MONTAUK AVE NEW LONDON CT 06320 WWW.LMHOSPITAL.ORG 0047 X X X X LAWRENCE & MEMORIAL HOSPITAL 0 0 1 X X X X X X X X X X 15 1 0 1 1 X SEE PART V X WWW.LEDGELIGHTHD.ORG/ASSESSMENT X X 1 15 1 SEE PART V 0 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X 1 X 0 X 1 X 0 0 LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 3J: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COMPONENTS LISTED, THE LMH CHNA REPORT INCLUDED ANALYSIS OF THE DATA IN TERMS OF STRENGTHS AND OPPORTUNITIES FOR ACTION. THIS ANALYSIS INFORMED THE CREATION OF THE COMMUNITY HEALTH IMPLEMENTATION PLAN. LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY ENGAGEMENT AND FEEDBACK WERE AN INTEGRAL PART OF THE CHNA PROCESS WHICH WAS CO-LED BY LMH AND LEDGE LIGHT HEALTH DISTRICT, THE REGIONAL LOCAL PUBLIC HEALTH ENTITY. THROUGHOUT, PARTNERS SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL THROUGH COMMUNITY MEETINGS AND INCLUSION OF RESIDENTS AND COMMUNITY PARTNERS IN THE PRIORITIZATION AND IMPLEMENTATION PLANNING PROCESS. PUBLIC HEALTH AND HEALTH CARE PROFESSIONALS SHARED KNOWLEDGE AND EXPERTISE ABOUT HEALTH ISSUES, WHILE LEADERS AND REPRESENTATIVES OF NON-PROFIT AND COMMUNITY-BASED ORGANIZATIONS PROVIDED INSIGHT ON THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. SCHEDULE H, PART V, SEC B, LINE 7A AND 10A:WWW.LMHOSPITAL.ORG/ABOUT/COMMUNITY-INVOLVEMENT/COMMUNITY-PARTNERSHIPS.ASPX LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: THE CHNA WAS GUIDED BY THE SOUTHEASTERN CT HEALTH IMPROVEMENT COLLABORATIVE, A COALITION OF HEALTH CARE PROVIDERS, LOCAL PUBLIC HEALTH, FEDERALLY QUALIFIED HEALTH CENTERS, TRIBAL REPRESENTATIVES, HIGHER EDUCATION, RESIDENTS, AND NUMEROUS NON-PROFIT ORGANIZATIONS SERVING THE REGION. PARTNERS INCLUDED:NEW LONDON HOUSING AUTHORITYSOUTHEASTERN MENTAL HEALTH AUTHORITYTHAMES VALLEY COUNCIL FOR COMMUNITY ACTIONSE REGIONAL ACTION COUNCILTOWN OF GROTON, PARKS AND RECEASTERN AREA HEALTH EDUCATION CENTERNEW LONDON PARKS AND RECREATIONUNITED COMMUNITY AND FAMILY SERVICESNEW LONDON POLICE DEPARTMENTTHAMES VALLEY COUNCIL FOR COMMUNITY ACTIONCHILD AND FAMILY AGENCYAFRICAN AMERICAN HEALTH COUNCILMINISTERIAL ALLIANCE OF SECTUNITED COMMUNITY AND FAMILY SERVICESL+M HEALTHCARECITY OF NEW LONDONCONNECTICUT COLLEGESPARK MAKERSPACECT LEGAL SERVICESVISITING NURSE ASSOCIATION OF SE CTCOMMUNITY HEALTH CENTER, INC.SE CT ENTERPRISE REGIONALLIANCE FOR LIVINGSOUND COMMUNITY SERVICESSE CT COUNCIL OF GOVERNMENTSFRESH NLGROTON PARKS AND RECSE CT ENTERPRISE REGIONLEDGE LIGHT HEALTH DISTRICTUNCAS HEALTH DISTRICTHOLLERAN CENTER CONNECTICUT COLLEGEHISPANIC ALLIANCENEW LONDON SOCIAL SERVICESCOMMUNITY FOUNDATION OF E CTGROTON TOWN MANAGERMAYOR, CITY OF NEW LONDONTOWN OF WATERFORD DEPARTMENT OF PLANNINGTOWN OF GROTON DEPARTMENT OF PLANNINGCONNECTICUT COLLEGECHILD AND FAMILY AGENCYMASHANTUCKET PEQUOT TRIBAL NATIONUNITED WAYMOHEGAN TRIBAL HEALTH DEPARTMENTHIGHER EDGE LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA REPORT WAS RELEASED AT A PRESENTATION OPEN TO THE PUBLIC ON MARCH 23, 2016. IN ATTENDANCE WERE COMMUNITY PARTNERS REPRESENTING OTHER NON-PROFIT ORGANIZATIONS, BUSINESS LEADERS, INDIVIDUALS REPRESENTING THE EDUCATION SECTOR, HOSPITAL STAFF, MEMBERS OF THE MEDIA, AND COMMUNITY MEMBERS. LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: FOLLOWING THE COMPLETION OF THE CHNA, THE COLLABORATIVE ENGAGED IN A PROCESS TO PRIORITIZE ISSUES AND DEVELOP STRATEGIES TO IMPROVE HEALTH AND WELL-BEING IN THE REGION. THE PRIORITIZATION PROCESS INCLUDED SEVERAL ROUNDS OF REVIEW, DISCUSSION AND GROUP PRIORITIZATION EXERCISES. PRIORITY AREAS SELECTED WERE: 1. IMPROVE THE CONDITIONS THAT SUPPORT MENTAL WELLBEING AND REDUCE SUBSTANCE USE. INDICATORS: OPIOID USE AND ANXIETY/DEPRESSION AMONG MINORITIES2. SUPPORT AND NURTURE HEALTHY LIFESTYLES. INDICATOR: CONTRIBUTING FACTORS TO DIABETES3. ENSURE ACCESS TO CARE. INDICATORS: PRENATAL CARE AND RELATED BIRTH OUTCOMES AND ACCESS TO CARE FOR THE LOW-INCOME POPULATION. ALL TOLD, OVER 65 INDIVIDUALS, PRESENTING A BROAD RANGE OF PERSPECTIVES, PARTICIPATED IN THE PRIORITIZATION WORK.TO LEARN MORE ABOUT HOW LMH AND ITS COMMUNITY PARTNERS ARE MEETING THESE NEEDS PLEASE REVIEW THE COMMUNITY HEALTH IMPROVEMENT PLAN ATTACHED TO THIS FILING. IN ADDITION, LMH WILL CONTINUE EXISTING PROGRAMS, SERVICES AND INITIATIVES IN THE AREAS OF ASTHMA, HIV OUTREACH, MATERNAL AND CHILD HEALTH, AND BREAST AND CERVICAL CANCER AND CARDIOVASCULAR DISEASE PREVENTION AND EARLY DETECTION.IN PARTNERSHIP WITH OTHER ORGANIZATIONS, ALL OF THE AREAS PRIORITIZED AREA BEING ADDRESSED. A DRIVING PHILOSOPHY OF LMH'S COMMUNITY BENEFIT EFFORTS IS TO BUILD ON COMMUNITY RESOURCES, PROGRAMS AND SERVICES AND TO NOT DUPLICATE THEM. AS SUCH, IN EXAMINING EACH OF THE PRIORITIZED COMMUNITY HEALTH NEEDS, EXISTING COMMUNITY ASSETS WERE IDENTIFIED BEFORE CONSIDERING ANY NEW STRATEGIES THAT LMH MIGHT INITIATE AND/OR THOSE TO BE CONTINUED. WHERE THERE IS AN EXISTING COMMUNITY-BASED PROGRAM ADDRESSING ANY OF THE PRIORITIZED NEEDS, OR DUE TO RESOURCE LIMITATIONS, LMH WILL WORK TO SUPPORT AND BUILD CAPACITY OF THOSE PROGRAMS RATHER THAN TO CREATE SOMETHING NEW. LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 13B: HOSPITAL SHALL PROVIDE DISCOUNTED CARE ON A SLIDING SCALE FOR SELF-PAY PATIENTS IF THE PATIENT'S: (A) ANNUAL INCOME IS BETWEEN 251% AND UP TO 400% OF THE FEDERAL POVERTY LEVELS, TAKING INTO CONSIDERATION FAMILY UNIT SIZE; AND (B) ASSETS DO NOT EXCEED $50,000 WHICH EXCEEDS THE ASSET THRESHOLD (AS DEFINED IN THE RHODE ISLAND STATEWIDE STANDARDS FOR THE PROVISION OF CHARITY CARE; SEE R23-17.14-HCA). LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: THESE PROGRAMS COVER MEDICALLY NECESSARY CARE ONLY. LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 16I: WEBSITE PROVIDES DIRECT EMAIL LINK TO FINANCIAL COUNSELORS. LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 20E: PRIOR TO INITIATION ANY COLLECTION ACTION, THE HOSPITAL DOCUMENTED ITS DETERMINATION OF WHETHER INDIVIDUALS WHO SUPPLIED A COMPLETED FINANCIAL ASSISTANCE APPLICATION WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY. LAWRENCE & MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: THE HOSPITAL PROVIDES FULL CHARITY CARE TO PATIENTS WITH ANNUAL INCOME UP TO AND INCLUDING 250% OF THE FEDERAL POVERTY GUIDELINES (FPG). HOSPITAL PROVIDES DISCOUNTED CARE ON A SLIDING SCALE FOR SELF-PAY PATIENTS IF THE PATIENT'S: (A) ANNUAL INCOME IS BETWEEN 251% AND UP TO 400% OF THE FEDERAL POVERTY LEVELS, TAKING INTO CONSIDERATION FAMILY UNIT SIZE; AND(B) ASSETS DO NOT EXCEED $50,000 WHICH EXCEEDS THE ASSET THRESHOLD.DISCOUNTS ARE BASED ON THE GROSS AMOUNTS CHARGED UNIFORMLY ACCORDING TO THE PUBLISHED CHARGEMASTER AND WILL BE AUTHORIZED AS FOLLOWS:251% - 300% = 50%301% - 350% = 40%351% - 400% = 30% SCHEDULE H, PART V, SECTION B, LINE 16A, 16B AND 16C: WWW.LMHOSPITAL.ORG/PATIENTS-VISITORS/PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE.ASPX PART I, LINE 3C: IT IS THE PHILOSOPHY AND POLICY OF LAWRENCE & MEMORIAL HOSPITAL THAT MEDICALLY NECESSARY HEALTH CARE SERVICES SHOULD BE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY.CHARITY CARE APPLIES TO ALL UNINSURED PATIENTS (DEFINED AS EARNING LESS THAN 250% OF THE POVERTY GUIDELINES). CARE WILL BE PROVIDED FREE FOR THOSE UNINSURED PATIENTS WHO REQUEST ASSISTANCE AND VERIFY THEIR ANNUAL INCOME IS LESS THAN 250% OF THE FEDERAL INCOME POVERTY LEVEL ("FPL").LIQUID ASSETS MUST NOT EXCEED $50,000 (STOCKS, BONDS, CASH, IRA, CD, ETC.) EXCLUDING PRIMARY RESIDENCE AND PRIMARY MOTOR VEHICLE, BUSINESS ASSETS, RENTAL PROPERTY, SECONDARY RESIDENCES, RECREATIONAL VEHICLES AND OTHER SUCH LUXURY ITEMS WILL BE APPLIED TO THE LIQUID ASSETS. CARE WILL BE DISCOUNTED ON A SLIDING SCALE FOR SELF PAY PATIENTS WHO HAVE NO THIRD PARTY INSURANCE TO COVER SERVICES WITH AN ANNUAL INCOME THAT IS BETWEEN 250% AND 400% OF THE FPL AND HAVE ASSETS LESS THAN $50,000, IN ACCORDANCE WITH THE FOLLOWING:251%-300%= COST OF CHARGE301%-350%= 40%351%-400%= 30% PART I, LINE 7: THE AMOUNTS REPORTED ON PART I, LINE 7 WERE CALCULATED AS DIRECT, SEPARATELY IDENTIFIABLE COSTS INCURRED BY THE HOSPITAL PLUS AN ALLOCATION OF OVERHEAD. PART II, COMMUNITY BUILDING ACTIVITIES: LMH, ALONG WITH MANY OTHER HOSPITALS ACROSS THE COUNTRY, UTILIZES THE COMMUNITY BENEFITS INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA) DATABASE DEVELOPED BY LYON SOFTWARE TO CATALOG ITS COMMUNITY BENEFIT AND COMMUNITY BUILDING ACTIVITIES AND THE GUIDELINES DEVELOPED BY THE CATHOLIC HOSPITAL ASSOCIATION (CHA) IN ORDER TO CATALOG THESE BENEFITS. THESE TWO ORGANIZATIONS HAVE WORKED TOGETHER FOR OVER 20 YEARS TO PROVIDE SUPPORT TO NOT-FOR-PROFIT HOSPITALS TO DEVELOP AND SUSTAIN EFFECTIVE COMMUNITY BENEFIT PROGRAMS.THE MOST RECENT VERSION OF THE CHA GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT DEFINES COMMUNITY BUILDING ACTIVITIES AS PROGRAMS THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS AND ENVIRONMENTAL PROBLEMS. THESE ACTIVITIES ARE CATEGORIZED INTO EIGHT DISTINCT AREAS INCLUDING PHYSICAL IMPROVEMENT AND HOUSING, ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT, ENVIRONMENTAL IMPROVEMENTS, LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, COALITION BUILDING, ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENTS, AND WORKFORCE DEVELOPMENT. LMH ENHANCES THE LIVES OF THOSE WE SERVE BY PROVIDING ACCESS TO INTEGRATED, HIGH-VALUE, PATIENT-CENTERED CARE IN COLLABORATION WITH OTHERS WHO SHARE OUR VALUES. AS SUCH, LMH IS INCREASINGLY AWARE OF HOW SOCIAL DETERMINANTS IMPACT THE HEALTH OF INDIVIDUALS AND COMMUNITIES. A PERSON'S HEALTH AND CHANCES OF BECOMING SICK AND DYING EARLY ARE GREATLY INFLUENCED BY POWERFUL SOCIAL FACTORS SUCH AS EDUCATION, INCOME, NUTRITION, HOUSING AND NEIGHBORHOODS. DURING FISCAL YEAR 2016, LMH INVESTED IN COMMUNITY BUILDING EFFORTS THAT PROMOTE THRIVING AND HEALTHY COMMUNITIES IN OUR REGION. PART III, LINE 2: LAWRENCE & MEMORIAL HOSPITAL USES A COST REPORTING SYSTEM TO DETERMINE THE BAD DEBT EXPENSE. THE AMOUNT OF BAD DEBT EXPENSE (AT COST) REPORTED ON PART III, LINE 2 IS TAKEN DIRECTLY FROM THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 3: THE ORGANIZATION DOES NOT CURRENTLY HAVE A METHODOLOGY TO ACCURATELY QUANTIFY OR ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE THAT WOULD BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A BAD DEBT FOOTNOTE. PART III, LINE 8: THE MEDICARE SHORTFALL REPORTED IN PART III, LINE 7 WAS CALCULATED BASED ON COST REPORTING. THE COSTING METHOD WAS FROM THE MEDICARE COST REPORT'S OWN METHODOLOGY OF ALLOCATING COST BY DEPARTMENT AND DERIVING A RATIO OF COST TO CHARGES. THIS AMOUNT SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE THE RATES PAID BY MEDICARE DO NOT ACCURATELY REFLECT THE COST OF CARE PROVIDED BY LAWRENCE & MEMORIAL HOSPITAL. ACCORDINGLY, LAWRENCE & MEMORIAL HOSPITAL MUST SUBSIDIZE THE COST OF CARE PROVIDED TO MEDICARE BENEFICIARIES WITH OTHER REVENUES. PART III, LINE 9B: IN ACCORDANCE WITH ITS WRITTEN CREDIT AND COLLECTION POLICY, LAWRENCE & MEMORIAL HOSPITAL WILL NOT PURSUE COLLECTION EFFORTS, DIRECTLY OR THROUGH COLLECTION AGENCIES, ON THE PORTION OF A PATIENT'S BILL FOR WHICH THAT PATIENT HAS ESTABLISHED ELIGIBILITY FOR CHARITY CARE. PART VI, LINE 2: LAWRENCE & MEMORIAL HOSPITAL ("LMH") EMPLOYS A VARIETY OF STRATEGIES IN GAUGING THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), COVERING THE LAWRENCE & MEMORIAL PRIMARY SERVICE AREA, WAS CARRIED OUT IN PART (HOUSEHOLD SURVEY) THROUGH A PARTNERSHIP WITH DATAHAVEN. ADDITIONAL METHODS INCLUDED USING SCIENTIFICALLY VALID DATA, COMPARATIVE INFORMATION, AND INPUT FROM LOCAL RESIDENTS, PROVIDERS AND LEADERS. INDICATORS WERE COMPUTED FROM AN EXTENSIVE SET OF SECONDARY HEALTH-RELATED DATA. LMH REVIEWS DISEASE INCIDENCE AND PREVALENCE RATES FOR THE LOCAL COMMUNITY, STATE, AND NATION. RATES ARE COLLECTED FROM MEDICAL JOURNALS, THE CT DEPARTMENT OF HEALTH, OR NATIONAL HEALTH RESOURCES SUCH AS THE KAISER FAMILY FOUNDATION OR CDC. THIS ANALYSIS INFORMS LMH ON THE HEALTH STATUS OF THE COMMUNITY AND IS USED TO FOCUS PROGRAM AND SERVICE DEVELOPMENT ON AREAS OF GREATEST CONCERN. INFORMATION ON COMMUNITY NEEDS IS ALSO GATHERED THROUGH PARTNERSHIPS WITH OTHER COMMUNITY ORGANIZATIONS SUCH AS THE UNITED WAY, THE LEDGE LIGHT HEALTH DISTRICT, AND OTHER LOCAL NON-PROFITS. PERIODIC REVIEW OF DATA AND UPDATING AS APPROPRIATE IS CONDUCTED. LMH COMPLETES A PHYSICIAN MANPOWER STUDY REGULARLY. THIS STUDY, CONDUCTED BY AN OUTSIDE CONSULTANT, DOCUMENTS THE DEMAND FOR PHYSICIANS BY SPECIALTY BASED ON PHYSICIAN-TO-POPULATION RATIOS, THE SUPPLY OF PHYSICIANS IN THE COMMUNITY, AND THE RESULTANT GAPS BETWEEN DEMAND AND SUPPLY. THE ANALYSIS INFORMS LMH OF DEFICIENCIES IN PHYSICIAN SUPPLY AND HELPS FOCUS RECRUITMENT EFFORTS TO MEET THE DEMANDS OF THE COMMUNITY. ALL COMMUNITY BENEFIT ACTIVITIES ARE REGULARLY EVALUATED FOR IMPACT AND EFFECTIVENESS AND AUDITED FOR COMPLIANCE WITH THE ORGANIZATION'S COMMUNITY BENEFIT POLICY. PART VI, LINE 3: IN ACCORDANCE WITH ITS CHARITY CARE POLICY, LMH NOTIFIES PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE USING SEVERAL METHODS. 1) SIGNAGE INDICATING THE AVAILABILITY OF CHARITY CARE IS POSTED IN ENGLISH AND SPANISH IN PATIENT ACCOUNTS, HEALTH ACCESS MANAGEMENT AND CERTAIN CLINICAL AREAS. SUMMARIES OF THE PROGRAMS WILL ALSO BE AVAILABLE IN THOSE AREAS. 2) PATIENT FINANCIAL ADVISORS WILL ATTEMPT TO VISIT ALL INPATIENTS REGISTERED AS SELF-PAY PATIENTS. A SUMMARY EXPLAINING CHARITY CARE WILL BE GIVEN TO THE PATIENT OR GUARANTOR WHEN THIS VISIT OCCURS. 3) PATIENTS WITH NO INSURANCE WILL RECEIVE AN INITIAL LETTER WITHIN ONE WEEK OF DISCHARGE INFORMING THEM THAT LMH CONSIDERS THEM "INSURED" PER THE CONNECTICUT GENERAL STATUTES SECTION 19A-673. IT IS THE RESPONSIBILITY OF THE PATIENT TO ADVISE LMH IF THEY BELIEVE THEY QUALIFY AS "UNINSURED" (AT OR UNDER 250% OF THE FPG). 4) A SERIES OF MONTHLY STATEMENTS WILL BE SENT FOLLOWING DISCHARGE. EACH STATEMENT WILL REMIND THE PATIENT OF THE AVAILABILITY OF CHARITY CARE. PART VI, LINE 4: GENERAL DEMOGRAPHICSTHE COMMUNITIES THAT COMPRISE THE SERVICE AREA OF LMH INCLUDE TEN TOWNS ALONG THE CONNECTICUT SHORELINE BETWEEN RHODE ISLAND AND THE CONNECTICUT RIVER AND INLAND TO MONTVILLE, CT. OUR COMMUNITIES REPRESENT A BROAD MIX OF URBAN, SUBURBAN, AND RURAL AREAS.ACCORDING TO THE 2014 AMERICAN COMMUNITY SURVEY, THE POPULATION OF GREATER NEW LONDON IS 174,814, HAVING GROWN BY ABOUT 2,500 PEOPLE IN THE PAST 5 YEARS. THE POPULATION IS NEARLY EVENLY DIVIDED BY SEX, WITH 50.5% BEING MALE, THOUGH THE POPULATION 65 YEARS AND OLDER IS MADE UP OF MORE FEMALES (55.8%). OF PARTICULAR IMPORTANCE IS THE LARGE WAVE OF THOSE IN AND AROUND THE BABY BOOM GENERATION (AGES 50-70). AS THIS GROUP CONTINUES TO AGE, IT WILL PLACE INCREASING HEALTH, SOCIAL AND ECONOMIC PRESSURES ON FAMILIES, SOCIAL SERVICE AND GOVERNMENTAL AGENCIES. BOTH IN ABSOLUTE TERMS AND AS A PERCENTAGE OF THE POPULATION (24%), THE POPULATION OF NON-WHITE MINORITIES HAS GROWN IN GREATER NEW LONDON OVER THE PAST 5 YEARS (UP FROM 20% IN 2009). THEIR GROWTH HAS BEEN DRIVEN PRIMARILY BY THOSE IDENTIFYING AS HISPANIC OR LATINO, WHOSE POPULATION HAS GROWN FROM 7.7% OF THE POPULATION IN 2009 TO 10.4% IN 2014.MAJOR EMPLOYERSTHE REGION HAS TRANSITIONED FROM A LARGELY DEFENSE INDUSTRY-BASED ECONOMY TO ONE THAT RELIES HEAVILY UPON EMPLOYMENT IN THE SERVICE AND TRADE SECTORS AND IN GENERAL HAS A HIGHER PERCENTAGE OF PERSONS EMPLOYED IN THOSE SECTORS -WITH CORRESPONDING LOWER RATES OF PAY- WHICH IS CORRELATED WITH THE LOWER PER CAPITA INCOME AND GREATER ECONOMIC VULNERABILITY. MAJOR EMPLOYERS INCLUDE THE MASHANTUCKET PEQUOT AND MOHEGAN TRIBES (FOXWOODS RESORT AND CASINO AND MOHEGAN SUN CASINO RESPECTIVELY), PFIZER GLOBAL RESEARCH AND DEVELOPMENT, EDUCATIONAL INSTITUTIONS (CONNECTICUT COLLEGE, MITCHELL COLLEGE AND THE U.S. COAST GUARD ACADEMY), GENERAL DYNAMICS/ELECTRIC BOAT, DOMINION, AND LMH. PRIMARY SOCIAL AND HEALTH CARE FACTORSIN THE URBAN CENTERS OF THE REGION, RACIAL AND ETHNIC HEALTH DISPARITIES, HIGHER POVERTY AND UNEMPLOYMENT RATES, LOWER LEVELS OF EDUCATIONAL ATTAINMENT, LIMITED ACCESS TO AFFORDABLE HOUSING AND TRANSPORTATION, HIGHER RATES OF DEATH FROM CHRONIC ILLNESS, AND A GREATER LIKELIHOOD OF RESIDENTS NOT HAVING HEALTH INSURANCE, ALL OF WHICH PRESENT PARTICULAR CHALLENGES. MEDIAN HOUSEHOLD INCOME IN THE LMH SERVICE AREA IS FAR BELOW THAT OF THE STATE, WITH AFRICAN AMERICAN AND HISPANIC FAMILIES' INCOMES SIGNIFICANTLY LOWER THAN WHITE FAMILIES' INCOMES. THE REGION INCLUDES ONE PRIORITY SCHOOL DISTRICT. THREE OF OUR COMMUNITIES HAVE A GREATER PERCENTAGE OF CHILDREN LIVING IN POVERTY THAN THE STATE AVERAGE OF 26.1% - GROTON 27.7%, NEW LONDON 59.7% AND NORWICH 43.4% (CHILDREN UNDER 200% OF THE FEDERAL POVERTY LEVEL 2006 - 2010, CT VOICES FOR CHILDREN). PART VI, LINE 5: LMH'S COMMUNITY BENEFIT PROGRAMS AND SERVICES FORWARD THE ORGANIZATIONAL MISSION "TO IMPROVE THE HEALTH OF THE REGION AND ALIGN WITH THE PRINCIPLES AS SET FORTH IN THE ORGANIZATION'S COMMUNITY BENEFIT POLICY. THOSE PRINCIPLES INCLUDE:1. EMPHASIS ON PROGRAMS TO MEET A SIGNIFICANT UNMET HEALTH NEED INCLUDING EFFORTS TO IDENTIFY AND INCLUDE VULNERABLE POPULATIONS OR THOSE MOST AT-RISK AS DETERMINED BY RISK FACTORS WHICH PREDISPOSE THOSE POPULATIONS TOWARD A HIGHER INCIDENCE OF DISEASE AND/OR BARRIERS TO OBTAINING APPROPRIATE HEALTHCARE.2. EMPHASIS ON PRIMARY PREVENTION AND INCLUDING AT LEAST ONE OF THREE PRIMARY PREVENTION STRATEGIES: HEALTH PROMOTION, DISEASE PREVENTION, AND HEALTH PROTECTION. HEALTH PROMOTION ENTAILS ENCOURAGING HEALTHY LIFESTYLES; DISEASE PREVENTION FOCUSES ON INDIVIDUALS IDENTIFIED AS AT-RISK FOR HEALTH PROBLEMS; HEALTH PROTECTION ACTIVITIES INFLUENCE THE ENVIRONMENT TO SUPPORT HEALTHY BEHAVIORS.3. PROGRAMS SHOULD DEVELOP EVIDENCE-BASED LINKS BETWEEN CLINICAL SERVICES AND HEALTH IMPROVEMENT ACTIVITIES DELIVERED BOTH INSIDE AND OUTSIDE THE HOSPITAL. 4. PROGRAMS SHOULD FOCUS ON TARGETING CHARITABLE RESOURCES THAT MOBILIZE AND BUILD CAPACITY WITHIN EXISTING COMMUNITY ASSETS WHILE MINIMIZING DUPLICATION OF EFFORT.5. PROGRAMS SHOULD EMPHASIS COLLABORATION WITH COMMUNITY STAKEHOLDERS.AS EVIDENCED BY THE WIDE RANGE OF COMMUNITY BENEFIT PROGRAMS AND SERVICES OFFERED, LMH IS ENGAGED IN MEETING THE IDENTIFIED HEALTH NEEDS OF THE COMMUNITIES WE SERVE. THERE IS AN ORGANIZATIONAL HISTORY OF COLLECTING DATA TO DETERMINE HOW BEST TO DIRECT OUR RESOURCES AND HOW TO MAKE THE GREATEST IMPACT IN PROMOTING COMMUNITY HEALTH. OUR ANNUAL COMMUNITY BENEFIT REPORT PUBLICATION DESCRIBES A SAMPLING OF PROGRAMS AND THE AMOUNT OF INVESTMENT THAT LMH MAKES IN CARRYING OUT THESE PROGRAMS.COMMUNITY INVOLVEMENT IN GOVERNANCE AND ADVISORY GROUPSCOMMUNITY ENGAGEMENT IN THE PLANNING, IMPLEMENTATION AND EVALUATION OF LMH INITIATIVES IS OF UTMOST IMPORTANCE. CONSUMERS AND STAKEHOLDER ORGANIZATIONS PARTICIPATE IN A RANGE OF ACTIVITIES SO AS TO ENSURE THAT MANY PERSPECTIVES ARE CONSIDERED. LMH'S BOARD OF TRUSTEES IS MADE UP OF COMMUNITY LEADERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE STRATEGIC PLANNING, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP AMONG OTHER RESPONSIBILITIES. OUR CORPORATORS ARE OUR COMMUNITY-LIAISONS AND REPRESENT ALL SECTORS OF OUR COMMUNITIES PROVIDING INPUT AND FEEDBACK REGULARLY. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PART VI, LINE 6: THE ENTITIES OF L+M HEALTHCARE INCLUDE LMH, THE L+M MEDICAL GROUP (LMMG, PHYSICIAN PRACTICES), THE VISITING NURSE ASSOCIATION OF SOUTHEASTERN CT (VNASC), AND WESTERLY HOSPITAL (RHODE ISLAND) EACH OF WHICH HAVE A ROLE IN PROMOTING THE HEALTH OF OUR COMMUNITIES. THE L+M HOSPITAL ROLE IS DESCRIBED IN QUESTION 5 ABOVE AND WESTERLY HOSPITAL OPERATES IN SIMILAR FASHION: IMPLEMENTING COMMUNITY HEALTH IMPROVEMENT ACTIVITIES, PROVIDING OPPORTUNITIES FOR HEALTH PROFESSIONS STUDENTS, ENSURING ACCESS TO CARE, PROMOTING PRIMARY PREVENTIVE CARE, PROVIDING SUBSIDIZED HEALTH SERVICES AND SERVING AS A SAFETY NET PROVIDER. VNASC CARES FOR EVERYONE FROM THE ELDERLY WHO WISH TO REMAIN IN THEIR HOMES FOR AS LONG AS THEY CAN AND PATIENTS RECOVERING FROM SURGERY OR ILLNESS, TO NEW MOTHERS, SCHOOLCHILDREN, AND THE HOMELESS USING THE MOST CURRENT MEDICAL ADVANCES AND TECHNOLOGIES IN HOME HEALTHCARE, AND STRENGTHEN COMMUNITY RESOURCES FOR EVERYONE. LMMG, THROUGH ITS PATIENT-CENTERED MEDICAL HOME PRIMARY CARE AND SPECIALTY PRACTICES PROVIDES DIAGNOSTIC, THERAPEUTIC AND PREVENTIVE HEALTH CARE THROUGH PHYSICIANS OF FAMILY PRACTICE, INTERNAL MEDICINE, PEDIATRICS, DERMATOLOGY, ENDOCRINOLOGY, GENERAL SURGERY, ORTHOPEDIC SURGERY, NEUROSURGERY, BREAST AND RECONSTRUCTIVE SURGERY, NEUROLOGY, REHABILITATION MEDICINE, OBSTETRICS, GYNECOLOGY, CARDIOLOGY AND INTERVENTIONAL PAIN MANAGEMENT IN MULTIPLE LOCATIONS THROUGHOUT SOUTHEASTERN CT AND SOUTHWESTERN RI. PART VI, LINE 7, REPORTS FILED WITH STATES CT 1 CONNECTICUT SPORTS FOUNDATION AGAINST CANCER INC 455 BOSTON POST RD SUITE 203B OLD SAYBROOK CT 06475 061240574 501C3 6000 SUPPORT ORGANIZATION THE NEW LONDON HOMELESS HOSPITALITY CENTER INC 730 STATE PIER RD PO BOX 1651 NEW LONDON CT 06320 205606908 501C3 48168 SUPPORT ORGANIZATION NATIONAL MULTIPLE SCLEROSIS SOCIETY CONNECTICUT CHAPTER 659 TOWER AVE 1ST FLOOR HARTFORD CT 06112 060792055 501C3 5069 SUPPORT ORGANIZATION NEW LONDON ADULT EDUCATION (NEW LONDON PUBLIC SCHOOL) 3 SHAWS COVE NEW LONDON CT 06320 060935363 11700 SUPPORT ORGANIZATION UNITED COMMUNITY AND FAMILY SERVICES INC 34 EAST TOWN STREET NORWICH CT 06360 060653142 501C3 13000 SUPPORT ORGANIZATION 5 0 TRANSPORTATION, PATIENT ASSISTANCE FUNDING, ENSURE DISTRIBUTION PROGRAM 500 31086 16964 CASH TRANSPORTATION VOUCHERS FORM 990, SCHEDULE I, PART IV NONE OF THE AMOUNTS REPORTED ON SCHEDULE I, PART II ARE GRANTS. THESE AMOUNTS ARE DONATIONS AND SPONSORSHIPS GIVEN TO ORGANIZATIONS TO ASSIST IN THE FURTHERANCE OF THEIR CHARITABLE MISSION. LAWRENCE + MEMORIAL HOSPITAL ("LMH") CARRIES OUT DUE DILIGENCE IN PROVIDING MONETARY ASSISTANCE ONLY TO QUALIFYING 501(C)3 ORGANIZATIONS THAT COMPLEMENT ITS MISSION OR SUPPORT THE GREATER GOOD IN THE COMMUNITIES SERVES. LMH VERIFIES EACH ORGANIZATION'S EIN AS LISTED ON IRS FORM W-9 THAT HAS BEEN SUBMITTED TO LMH. ASSISTANCE DONATED BY LMH TO THESE QUALIFYING ORGANIZATIONS IS NOT OUTCOMES-BASED AND IS GIVEN IN SUPPORT OF AN INDIVIDUAL ORGANIZATION'S FUNDRAISING EVENTS OR IN SUPPORT OF DIRECT SERVICES. LMH MAINTAINS FULL AND COMPLETE RECORDS OF ALL MONETARY ASSISTANCE PROVIDED, HOWEVER DOES NOT MONITOR SPECIFIC FUNDS. X 0 1 X X X X X 0 1 0 0 0 0 0 0 0 BRUCE D CUMMINGS PRESIDENT/CEO AND TRUSTEE 505747 0 0 0 133352 0 10600 0 40165 0 689864 0 0 0 CHRISTOPHER O'CONNOR TRUSTEE START 9/16 0 822935 0 283340 0 104299 0 358561 0 29654 0 1598789 0 0 DAVID F REISFELD TRUSTEE 287338 0 8194 0 22330 0 10600 0 52798 0 381260 0 0 0 MAUREEN ANDERSON ASSISTANT SECRETARY 269134 0 0 0 16710 0 10600 0 63561 0 360005 0 0 0 SETH VAN ESSENDELFT VP/CFO 356172 0 0 0 18810 0 10600 0 37416 0 422998 0 0 0 DONNA EPPS VP CHIEF HR OFFICER 202689 0 0 0 25242 0 10600 0 16382 0 254913 0 0 0 KIMBERLY KALAJAINEN VP CHIEF INFORMATION OFFICER 273654 0 0 0 16094 0 10600 0 32478 0 332826 0 0 0 CHRISTOPHER LEHRACH CHIEF TRANSFORMATION OFFICER 382176 0 0 0 19635 0 10600 0 52121 0 464532 0 0 0 DANIEL RISSI VP CHIEF MEDICAL OFFICER 429087 0 0 0 45564 0 10600 0 58211 0 543462 0 0 0 WILLIAM STANLEY VP DEV & COMMUNITY RELATIONS 199733 0 0 0 12680 0 9846 0 33789 0 256048 0 0 0 LAUREN WILLIAMS VP PATIENT CARE SERVICES 240926 0 0 0 30847 0 10600 0 39481 0 321854 0 0 0 GERALDINE RUFFA MEDICAL DIRECTOR, PHYSICIAN 181546 0 5280 0 42089 0 9652 0 12845 0 251412 0 0 0 TINA DICIOCCIO CORPORATE CONTROLLER 149097 0 700 0 43290 0 9604 0 27297 0 229988 0 0 0 GARY CASS DIRECTOR HR/LABOR RELATIONS 158739 0 500 0 27810 0 7604 0 25689 0 220342 0 0 0 WARREN ROGERS PHARMACY DIRECTOR 152872 0 900 0 23724 0 0 0 38902 0 216398 0 0 0 GREGORY GEORGES RN, CRISIS INTERVENTION 156825 0 0 0 10735 0 7118 0 21529 0 196207 0 0 0 HENRY AMDUR FORMER OFFICER 189867 0 69050 0 43980 0 10600 0 40945 0 354442 0 0 0 PART I, LINE 1A WILLIAM STANLEY, VP OF DEVELOPMENT, HAS A NONTAXABLE MEMBERSHIP TO THE THAMES CLUB IN NEW LONDON. THE THAMES CLUB IS A SOCIAL CLUB THAT ALLOWS NETWORKING WITH POTENTIAL DONORS OR BOARD MEMBERS. NO PERSONAL USE IS ALLOWED AND ALL USE IS FOR BUSINESS PURPOSES. BRUCE CUMMINGS, PRESIDENT & CEO, AUTHORIZES WILLIAM STANLEY'S MEMBERSHIP IN THE THAMES CLUB IN HIS ROLE AS VICE PRESIDENT OF DEVELOPMENT & COMMUNITY RELATIONS OF LAWRENCE & MEMORIAL HOSPITAL. IN AN EFFORT TO CONDUCT BUSINESS IN THE COMMUNITY AND REPRESENT LAWRENCE & MEMORIAL HOSPITAL, THE THAMES CLUB PROVIDES AN APPROPRIATE SETTING FOR MEETINGS WITH BOARD MEMBERS AND BOTH CURRENT AND POTENTIAL DONORS. PART I, LINE 4B THE INDIVIDUAL LISTED BELOW IS A PARTICIPANT IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OF A RELATED ORGANIZATION. THESE ACCRUALS ARE INCLUDED IN THE AMOUNTS REPORTED IN PART II, COLUMN C (DEFERRED COMPENSATION) AND REPRESENTS BOTH THE REPORTING ENTITY'S AND RELATED ENTITY'S COMBINED AMOUNTS THAT HAVE NOT YET BEEN VESTED CONSISTENT WITH THE COMPENSATION REPORTING PER IRS. SEVERANCE NONQUALIFIED EQUITY-BASED CHRISTOPHER O'CONNOR $0 $198,811 $0 THE SUPPLEMENTAL RETIREMENT INCOME PLAN (SRIP) IS DESIGNED TO ENSURE THE PAYMENT OF A COMPETITIVE LEVEL OF RETIREMENT INCOME WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME IN ORDER TO ATTRACT AND RETAIN KEY MANAGEMENT EMPLOYEES SERVING AS CORPORATE OFFICERS. THE PLAN PROVIDES SUPPLEMENTAL RETIREMENT INCOME THROUGH AN UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION ARRANGEMENT UNDER SECTION 457(F) AND THROUGH A DEFERRED COMPENSATION PLAN UNDER SECTION 409A OF THE INTERNAL REVENUE CODE AND A MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES' PLAN UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). LAWRENCE & MEMORIAL HOSPITAL ESTABLISHED A SECTION 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR THE HOSPITAL'S SENIOR MANAGEMENT. AMOUNTS FOR BRUCE CUMMINGS ARE CREDITED TO THE RETIREMENT ACCOUNT IN MONTHLY INSTALLMENTS THROUGHOUT EACH PLAN YEAR. PLAN AMOUNTS FOR ALL OTHER MEMBERS OF SENIOR MANAGEMENT ARE CREDITED TO THE PLAN ANNUALLY. PLAN AMOUNTS WILL BE PAID ONLY IF CERTAIN CONDITIONS ARE MET, INCLUDING REMAINING EMPLOYED BY THE HOSPITAL THROUGH AGE 65, AS OUTLINED IN THE PLAN AGREEMENT. SECTION 457 (F) CONTRIBUTIONS ARE PAID OUT AND REPORTED ON THEIR W-2'S. DURING 2015, SECTION 457(F) CONTRIBUTION WAS CREDITED TOWARDS THE PLAN AS FOLLOWS: BRUCE CUMMINGS $86,945 A CHEFA - SERIES F 060806186 20774YCS4 2011-09-15 61831040 CONSTRUCTION 0 0 0 B CHEFA - SERIES G 060806186 000000000 2013-10-10 30000000 CONSTRUCTION 0 0 0 C CHEFA - SERIES H 060806186 20774YQAB 2013-11-05 21405000 REFINANCE SERIES E 0 0 0 A 14045000 61831726 1021760 25286469 35523497 2012 1 0 1 1 B 2475000 30000152 299001 29701151 2014 0 0 1 1 C 21405025 367342 75381 217718 20744584 2013 1 0 1 1 A 0 1 0 0 0.00540 0.00000 0.00540 0 0 0 B 0 1 0 0 0.00200 0.00000 0.00200 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 1 0 0 1 0 0 0 0 A 0 B 0 C 0 SCHEDULE K, PART II, LINE 3: SERIES F, G AND H THE DIFFERENCE BETWEEN THE ISSUE PRICE REPORTED ON PART I, COLUMN (E) AND TOTAL PROCEEDS REPORTED ON PART II, LINE 3 IS DUE TO EITHER INVESTMENT EARNINGS OR PREMIUM RECEIVED FROM PURCHASER. FORM 990, SCHEDULE K, PART III, LINE 9; PART IV, LINE 7; & PART V IN GENERAL, L&M HOSPITAL WORKS TO ENSURE POST ISSUANCE COMPLIANCE FOR ITS TAX-EXEMPT BONDS IN ACCORDANCE WITH BOND ISSUANCE DOCUMENTS. L&M HOSPITAL IS IN THE PROCESS OF DEVELOPING WRITTEN PROCEDURES FOR POST ISSUANCE COMPLIANCE FOR THE FOLLOWING: - TO ENSURE ALL NONQUALIFIED BONDS OF THE ISSUANCE ARE REMEDIATED IN ACCORDANCE WITH REQUIREMENTS OF REGULATIONS SECTIONS 1.141-12 & 1.145-2. - TO MONITOR THE REQUIREMENTS OF SECTION 148. - TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION IS NOT AVAILABLE UNDER APPLICABLE REGULATIONS. SUBST CONTR #4 VENDOR 313466 LEGAL CONSULTANT 0 SUBST CONTR #5 VENDOR 363157 LEGAL CONSULTANT 0 X 3125 FAIR MARKET VALUE X 1 19560 FAIR MARKET VALUE X 4 475 FAIR MARKET VALUE X ENTERTAINMENT 69 13265 FAIR MARKET VALUE X DINING 20 7510 FAIR MARKET VALUE X MISCELLANEOUS 22 3875 FAIR MARKET VALUE X PHOTOGRAPHY 2 400 FAIR MARKET VALUE 0 1 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING IN PART I, COLUMN (B), THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART III, LINE 3 EFFECTIVE SEPTEMBER 8, 2016, LAWRENCE AND MEMORIAL HOSPITAL ("LMH") AND ITS RELATED ORGANIZATIONS BECAME AFFILIATED WITH THE YALE NEW HAVEN HEALTH SYSTEM. THROUGH THE ADDITIONAL SUPPORT OF THE AFFILIATION, LMH WAS ABLE TO EXPAND PROGRAM SERVICES AS FURTHER DETAILED IN THE PROGRAM SERVICE ACCOMPLISHMENT ON FORM 990, PART III, LINE 4. FORM 990, PART III, LINE 4A: LAWRENCE & MEMORIAL HOSPITAL ("LMH") PROVIDES QUALITY MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF LMH, WE RECOGNIZE THAT NOT ALL PERSONS HAVE THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES; AND, FURTHER, WE BELIEVE THAT A PART OF OUR MISSION IS TO CARE FOR THE MEDICALLY UNDER-SERVED IN OUR COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. IN KEEPING WITH OUR HOSPITAL'S MISSION OF "IMPROVING THE HEALTH OF OUR REGION AND OUR COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, WE PROVIDE: - FREE CARE AND/OR SUBSIDIZED CARE. - CARE PROVIDED TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT BELOW COST. - A BROAD RANGE OF HEALTH CARE ACTIVITIES, PROGRAMS AND SERVICES TO SUPPORT OUR COMMUNITY. - A SPECIAL COMMUNITY OUTREACH PROGRAM. THE DEFINING CHANGE OF THE PAST YEAR FOR LMH WAS THE INTEGRATION WITH YALE NEW HAVEN HEALTH SYSTEM. IN ADDITION, LMH INCREASED ITS NEUROSURGERY CAPACITY WITH A YALE MEDICINE NEUROSURGEON, SUPPORTED BY TWO ADDITIONAL NEUROSURGEONS, AND BRING CRITICAL RESOURCES AND CARE TO RESIDENTS OF SOUTHEASTERN CONNECTICUT. THE PHYSICIANS AT THE LMH CANCER CENTER IN WATERFORD BECAME COLLEAGUES WITH ONCOLOGISTS AT SMILOW CANCER HOSPITAL AT YALE NEW HAVEN, WHICH FACILITATED REFERRALS, CONSULTATIONS AND THE RESOURCES OF SMILOW THROUGH THE LMH CANCER CENTER. THE PEDIATRIC PROGRAM AT LMH SAW AN EIGHT-FOLD INCREASE IN PATIENTS DURING PAST YEAR, A DIRECT RESULT OF LMH'S COMMITMENT TO BUILD A PROGRAM DIRECTLY BENEFITTING ITS COMMUNITY. PEDIATRIC HOSPITALISTS FROM THE YALE SCHOOL OF MEDICINE ARE ON DUTY AROUND-THE-CLOCK ON THE LMH INPATIENT UNIT, AND A SEPARATE PEDIATRIC EMERGENCY PROGRAM SERVES CHILDREN EXCLUSIVELY DURING PEAK HOURS. THE PEDIATRIC TEAMS COORDINATE CLOSELY WITH YALE NEW HAVEN HOSPITAL TO SEAMLESSLY TRANSFER CASES REQUIRING FURTHER SPECIALTY AND HIGHER LEVELS OF CARE. LMH CONTINUED TO PARTICIPATE IN THE OVERALL L+M HEALTHCARE CLINICAL SUSTAINABILITY INITIATIVE TO INCREASE VALUE BY IMPROVING CARE DELIVERY PROCESSES WHILE SIMULTANEOUSLY REDUCING COSTS. IN TWO YEARS, THE OVERALL SYSTEM REALIZED SAVINGS OF APPROXIMATELY $37 MILLION. LMH ALSO QUALIFIED FOR THE FEDERAL 340B DRUG-PURCHASING DESIGNATION WHICH ENABLED THE PURCHASE OF MEDICATIONS AT A DISCOUNT BEGINNING IN JULY. PART I, LINE 4 & PART VI, LINE 1B NUMBER OF INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY THE ORGANIZATION SOUGHT TO CONFIRM THE INDEPENDENCE OF EACH VOTING MEMBER OF ITS GOVERNING BODY BY REQUESTING THAT EACH SUCH VOTING MEMBER RESPOND TO A QUESTIONNAIRE CONTAINING THE PERTINENT INSTRUCTIONS AND DEFINITIONS AND DESIGNED TO ELICIT THE INFORMATION NECESSARY TO DETERMINE INDEPENDENCE. BASED ON RESPONSES TO THE QUESTIONNAIRES RECEIVED BY THE ORGANIZATION AND ANNUAL CONFLICTS OF INTEREST DISCLOSURES, THE ORGANIZATION WAS ABLE TO CONFIRM THAT SEVEN (7) VOTING MEMBERS ARE INDEPENDENT. FORM 990, PART VI, SECTION A, LINE 2 THE ORGANIZATION'S CURRENT OFFICERS AND/OR TRUSTEES SERVE AS OFFICERS AND/OR DIRECTORS OF TAXABLE AFFILIATES WITHIN THE ORGANIZATION'S CORPORATE SYSTEM OR JOINT VENTURES IN WHICH THE ORGANIZATION'S CORPORATE SYSTEM HAS AN OWNERSHIP INTEREST. THE INDIVIDUAL OFFICERS DO NOT HAVE PERSONAL FINANCIAL INTERESTS IN THE TAXABLE AFFILIATE AND SERVE ONLY AS A FUNCTION OF THEIR ROLES WITH THE ORGANIZATION OR WITHIN THE ORGANIZATION'S CORPORATE SYSTEM. FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE SEPTEMBER 8, 2016, LAWRENCE + MEMORIAL CORPORATION ("LMC") AND ITS RELATED ORGANIZATIONS BECAME AFFILIATED WITH THE YALE NEW HAVEN HEALTH SYSTEM PURSUANT TO THE TERMS OF AN AFFILIATION AGREEMENT BETWEEN LMC AND YALE NEW HAVEN HEALTH SERVICES CORPORATION ("YNHHSC") DATED AS OF JULY 17, 2015 (THE "AFFILIATION AGREEMENT"). AS A RESULT OF THE CLOSING OF THE AFFILIATION TRANSACTION, YNHHSC BECAME THE SOLE MEMBER OF LMC. ADDITIONALLY, THE CERTIFICATES OF INCORPORATION AND BYLAWS OF LMC AND ITS SUBSIDIARIES LAWRENCE & MEMORIAL HOSPITAL, LMW HEALTHCARE, INC., L+M PHYSICIAN ASSOCIATION, INC. AND VISITING NURSE ASSOCIATION OF SOUTHEASTERN CONNECTICUT, INC. WERE REVISED AS AGREED UPON IN THE AFFILIATION AGREEMENT TO REFLECT YNHHSC AS THE ULTIMATE CORPORATE PARENT AND DESCRIBE THE RETAINED POWERS AND OF YNHHSC CONSISTENT WITH ITS OTHER AFFILIATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 6 LAWRENCE + MEMORIAL CORPORATION IS THE SOLE MEMBER OF LAWRENCE & MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A LAWRENCE + MEMORIAL CORPORATION, AS SOLE MEMBER OF LAWRENCE & MEMORIAL HOSPITAL, ELECTS THE BOARD OF TRUSTEES OF LAWRENCE & MEMORIAL HOSPITAL, SUBJECT TO THE ADDITIONAL APPROVAL OF LAWRENCE + MEMORIAL CORPORATION'S SOLE MEMBER, YALE NEW HAVEN HEALTH SERVICES CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL'S SOLE MEMBER, LAWRENCE + MEMORIAL CORPORATION, HAS THE RIGHT TO ELECT THE BOARD OF TRUSTEES OF THE ORGANIZATION AND APPOINT THE PRESIDENT, AND HAS THE FOLLOWING ADDITIONAL RIGHTS, ALL SUBJECT THE ADDITIONAL APPROVAL OF ITS SOLE MEMBER, YALE NEW HAVEN HEALTH SERVICES CORPORATION: TO APPROVE OPERATING, CASH FLOW AND CAPITAL BUDGETS; TO APPROVE GRADUATE AND UNDERGRADUATE MEDICAL EDUCATION ARRANGEMENTS; TO APPROVE MAJOR NEW CLINICAL PROGRAMS AND SERVICES AND CONTINUATION OF SAME; APPROVAL OF STRATEGIC PLANS; AND ADOPTION OF SAFETY AND QUALITY ASSESSMENT POLICIES; TO APPROVE THE MERGER, CONSOLIDATION, DISSOLUTION OR THE SALE OF ALL OR SUBSTANTIALLY ALL THE ORGANIZATION'S ASSETS; TO AMEND THE CERTIFICATE OF INCORPORATION AND BYLAWS OF THE ORGANIZATION, TO APPROVE THE EXECUTION OF LONG-TERM OR MATERIAL AGREEMENTS, AND TO AUTHORIZE THE EXECUTION OF CONTRACTS WITH AN UNRELATED THIRD PARTY FOR MANAGEMENT OF THE ASSETS OR OPERATIONS OF THE ORGANIZATION. YALE-NEW HAVEN HEALTH SERVICES CORPORATION RETAINS THE FOLLOWING AUTHORITY: ADOPTION OF BUDGETARY TARGETS, INDEBTEDNESS, MANAGEMENT AND CONTROL OF LIQUID ASSETS, AND APPOINTMENT OF THE INDEPENDENT AUDITOR. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S PROCESS TO REVIEW FORM 990: THE FORM 990 TAX RETURN AND ATTACHED SCHEDULES WERE PREPARED BY EMPLOYEES OF THE SYSTEM TAX DEPARTMENT. THE RETURN IS INITIALLY REVIEWED BY THE HOSPITAL DIRECTOR OF CORPORATE FINANCE. SUBSEQUENTLY, IT IS SENT TO KPMG LLP FOR THEIR INITIAL REVIEW. AFTER ALL COMMENTS FROM THE ABOVE GROUPS ARE RECEIVED AND REVIEWED, THE RETURN IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER OF THE HOSPITAL AND A FINAL VERSION OF THE RETURN IS SENT BACK TO KPMG US LLP FOR FINAL REVIEW. PRIOR TO FILING, THE ORGANIZATION MADE AVAILABLE A COMPLETE COPY OF THE RETURN TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C L&M HOSPITAL REQUIRES ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. QUESTIONNAIRES ARE COMPLETED ANNUALLY AND ARE REVIEWED BY L&M HOSPITAL'S GENERAL COUNSEL. ANY ACTUAL OR POTENTIAL CONFLICTS DISCLOSED ARE PRESENTED TO THE BOARD. APPROPRIATE CORRECTIVE ACTIONS ARE DECIDED ON A CASE BY CASE BASIS. FORM 990, PART VI, SECTION B, LINE 15 L&M HOSPITAL EXECUTIVE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE SALARIES OF ITS EXECUTIVE MANAGEMENT. UTILIZING AN INDEPENDENT COMPENSATION CONSULTANT, THE EXECUTIVE COMPENSATION COMMITTEE APPROVES COMPENSATION. THE COMMITTEE'S DELIBERATIONS ARE REFLECTED IN ITS MINUTES. CEO'S COMPENSATION IS APPROVED BY THE FULL BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A NIALL DUHIG, MD IS COMPENSATED AS MEDICAL STAFF AND NOT AS A TRUSTEE. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF IRREVOCABLE TRUSTS -10,261. TRANSFER TO AFFILIATES -17,946,351. TRANSFER TO PERMANENTLY RESTRICTED -70,383. INCREASE IN FUNDS HELD IN TRUST BY OTHERS 160,858. CHANGE IN MINIMUM PENSION LIABILITY -6,148,934. REALIZED LOSS NOT PREVIOUSLY BOOKED -15,932. CONTRIBUTIONS NOT PREVIOUSLY BOOKED 3,040. MISC CHANGE IN NET ASSET -27. 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THROUGH 5/12/16, AFTER YALE NEW HAVEN HEALTH SERVICES CORPORATION. NAME OF RELATED ORGANIZATION: PERRYRIDGE CORPORATION DIRECT CONTROLLING ENTITY: GREENWICH HEALTH CARE SERVICES, INC. THROUGH 5/12/16, AFTER GREENWICH HOSPTIAL. NAME OF RELATED ORGANIZATION: THE GREENWICH HOSPITAL ENDOWMENT FUND INC DIRECT CONTROLLING ENTITY: GREENWICH HEALTH CARE SERVICES, INC. THROUGH 5/12/16, AFTER GREENWICH HOSPTIAL.