2016-08-15T10:01:52-05:00 2015-09-30 111986323 MARCUM LLP CITY PLACE II 185 ASYLUM STREET HARTFORD CT 06103 990 2014-10-01 061422973 MOUNT SINAI REHABILITATION HOSPITAL INC MOUN 8607143500 114 WOODLAND STREET HARTFORD CT 06105 JENNIFER SCHNEIDER VP FINANCE 8607143500 2016-08-12 1 DOUGLAS FARRINGTON P00370668 8607600600 2014 2016-09-27 15:27:22Z JENNIFER SCHNEIDER 114 WOODLAND STREET HARTFORD CT 06105 45933420 0 X WWW.STFRANCISCARE.ORG X 1995 CT REHABILITATION SERVICES 14 8 267 72 0 0 1021110 322915 39026323 45527991 15130 20466 97694 62048 40160257 45933420 0 50 0 0 15050996 16590665 0 0 0 14431835 16546262 29482831 33136977 10677426 12796443 22736170 26038981 2608907 3115275 20127263 22923706 TO OPERATE A REHABILITATION HOSPITAL IN HARTFORD, CONNECTICUT, AND PROVIDE INPATIENT AND OUTPATIENT REHABILITATION SERVICES TO PERSONS WHO ARE DISABLED WITH PHYSICAL OR MENTAL HANDICAP. 0 0 30170927 50 45511216 TO PROVIDE COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL REHABILITATION SERVICES IN THE GREATER HARTFORD CONNECTICUT COMMUNITY AS PART OF THE SAINT FRANCIS CARE HEALTH SYSTEM. 30170927 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 267 1 0 0 0 0 0 0 0 0 0 0 X 14 8 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X X DONNA GILBERT 8607149632 114 WOODLAND STREET MS 5-103-58 HARTFORD CT 06105 HOWARD W ORR JR CHAIRMAN 2.00 1.00 X X 0 0 0 CHRISTOPHER M DADLEZ PRESIDENT & CEO 2.00 63.00 X X 0 2894865 1021627 DELORES GRAHAM VICE CHAIRMAN 1.00 X X 0 0 0 P ANTHONY GIORGIO PHD SECRETARY 1.00 2.00 X X 0 0 0 EDWARD S JOHNSON DDS DIRECTOR / ASST SECRETARY 1.00 X X 0 0 0 JEANNINE MARA TREASURER 1.00 X X 0 0 0 JOHN SUISMAN DIRECTOR 1.00 2.00 X 341 0 1226 MICHAEL E CUMMINGS DIRECTOR 1.00 X 0 0 0 WENDY E ELBERTH DIRECTOR 2.00 X 0 0 0 ANDREW MANDELL DIRECTOR 1.00 X 0 0 0 BRAD DAVIS DIRECTOR 2.00 X 0 0 0 DAVID BITTNER ASSISTANT TREASURER 2.00 61.00 X X 0 395908 39261 SURRENDRA KHERA MD DIRECTOR 1.00 56.00 X 0 488019 55696 JOHN RODIS MD ASSISTANT SECRETARY 1.00 57.00 X X 0 914647 59160 ROBERT KRUG MD PRESIDENT & CEO 2.00 58.00 X X 0 378241 34814 ANNE-MARIE ALCIDE STAFF RN 55.00 X 155554 0 32942 MAURA A MURRAY EXECUTIVE DIRECTOR SERVICE 55.00 X 163587 0 26120 JANETTE M GORDON STAFF RN II 55.00 X 136316 0 15624 DONNA RICKETTS NURSE MANAGER 55.00 X 111273 0 31539 KAREN M PRIOR-TOPALIS NURSE MANAGER 55.00 X 119961 0 22053 KATHLEEN M ROCHE MSRN FORMER ASSISTANT SECRETARY 0.00 X 0 287380 5985 687032 5359060 1346047 20 1 1 0 MEDIWARE INFORMATION SYSTEMS PO BOX 204176 KANSAS CITY MO 64141 SOFTWARE SERVICES 462581 AMN HEALTHCARE INC 2735 COLLECTIONS CENTER DR CHICAGO IL 60693 NURSE STAFFING SERVICES 102521 2 58523 264392 322915 PATIENT CARE SERVICES 622110 45527991 45527991 45527991 20466 20466 73192 0 73192 73192 73192 WELLNESS REVENUE 900099 35038 35038 CONTRACT REVENUE 900099 18897 18897 MISCELLANEOUS REVENUE 900099 4142 4142 -69221 -70710 1489 -11144 45933420 45511216 0 99289 50 50 177238 168377 8861 12888893 11058965 1829928 731343 627761 103582 1640825 1529101 111724 1152366 990767 161599 19200 19200 1799574 1328971 470603 38369 12553 25816 211291 149104 62187 427534 427007 527 95088 12858 82230 668389 668389 14939 14939 DRUGS 12555356 12555356 BAD DEBTS 261895 261895 MEDICAL SUPPLIES 244134 244134 DUES & SUBSCRIPTIONS 66231 915 65316 144262 134724 9538 33136977 30170927 2966050 0 3856965 4626014 8270027 10290493 3796796 2644726 6460 49980 15527550 10608405 5438917 4919145 157719 86825 1209286 3421798 22736170 26038981 1768565 2012503 840342 1102772 2608907 3115275 X 18391636 21161028 1735627 1762678 20127263 22923706 22736170 26038981 X 12796443 -10000000 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10360565 7110338 3250227 1310142 337993 972149 2508010 2035329 472681 1348833 1124745 224088 4919145 DUE FROM AFFILIATES 3421798 3421798 DUE TO THIRD PARTIES REIMBURSEMENT AGENCIES 1102772 1102772 1 1 X 1 X 1 X 1 1 0 1 1 62907 62907 0.00190 674732 674732 0.02050 737639 737639 0.02240 2 175 29303 29303 0.00090 1 20 48260 48260 0.00150 1 450000 375000 75000 0.00230 1 40961 40961 0.00120 5 195 568524 375000 193524 0.00590 5 195 1306163 375000 931163 0.02830 57004 57004 0.00170 57004 57004 0.00170 0 77232 8427957 7948541 479416 X 1 1 1 1 MOUNT SINAI REHABILITATION HOSPITAL 490 BLUE HILLS AVENUE HARTFORD CT 06112 X MOUNT SINAI REHABILITATION HOSPITAL 1 0 0 1 X X X X X X X X 12 1 1 0 1 X SAINTFRANCISCARE.ORG X CT.GOV.DPH.COM X 1 13 1 SEE PART V, SECTION C 0 0 1 X 200.000000000000 250.000000000000 X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X 1 X 0 1 X 0 0 MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 3J: THE HOSPITAL AUGMENTED THE CHNA COMPLETED IN PARTNERSHIP WITH THE OTHER HOSPITALS IN HARTFORD WITH INFORMATION FROM QUESTIONNAIRES WITH PATIENTS; FOCUS GROUPS WITH COMMUNITY MEMBERS AND INTERVIEWS WITH HEALTH CARE PROVIDERS SO AS TO GAIN A MORE COMPREHENSIVE PICTURE OF THE NEEDS AS WELL AS THE PRIORITIES. MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 5: KEY INFORMANTS WHO REPRESENT THE COMMUNITY WERE INTERVIEWED AS A PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THIS GROUP INCLUDED LEADERS OF NON-PROFIT ORGANIZATIONS; HUMAN SERVICE ORGANIZATIONS; CHURCH LEADERS AND OTHERS. SPECIFICALLY THE GROUPS CONSULTED INCLUDED: CT ASSOCIATION OF HUMAN SERVICES, THE VILLAGE, MALTA HOUSE OF CARE, INC., LATINO COMMUNITY SERVICES, CT VOICES FOR CHILDREN, BOYS AND GIRLS CLUBS, CASEY FAMILY SERVICES, INTERVAL HOUSE, GAY AND LESBIAN HEALTH COLLECTIVE, MY SISTER'S PLACE, GREATER HARTFORD INTERFAITH COALITION AND VARIOUS OTHERS. MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 6A: THE CHNA WAS COMPLETED IN PARTNERSHIP WITH HARTFORD HOSPITAL; CONNECTICUT CHILDREN'S MEDICAL CENTER, UCONN MEDICAL CENTER AND THE CITY OF HARTFORD HEALTH AND HUMAN SERVICES DEPARTMENT. ADDITIONALLY A CONSULTANT WAS USED TO COMPLETE SOME OF THE DATA COLLECTION AND ANALYSIS. MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 11: THE IMPLEMENTATION STRATEGY WHICH ADDRESSES THE NEEDS FOUND IN THE CHNA HIGHLIGHTS FOUR AREAS OF WORK THAT WILL FOCUS OUR STRATEGIC INITIATIVES TO ADDRESS THE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, THEY INCLUDE: COMMUNICATION; STRUCTURAL ISSUES THAT IMPACT ACCESS TO CARE; CLINICAL AREAS OF NEED; AND SOCIAL DETERMINANTS OF HEALTH. DURING THIS PAST YEAR DISEASE PREVENTION HAS TAKEN ON A MORE SIGNIFICANT ROLE IN OUR STRATEGY (IN PART DUE TO COMMUNITY INPUT) AND HAS RESULTED IN A MORE SPECIFIC FOCUS FOR OUR CLINICAL CARE STRATEGIES.INITIATIVES ARE ALREADY IN PLACE TO IMPROVE COMMUNICATION BETWEEN PATIENTS AND PROVIDERS, THESE INCLUDE: - RELATIONSHIP BASED CARE- CENTER FOR HEALTH EQUITY STRATEGIC PLANNING- LANGUAGE SERVICES PROGRAM- DIVERSITY COLLABORATIVE TEAMINITIATIVES THAT ADDRESS THE STRUCTURAL BARRIERS TO ACCESSING CARE INCLUDE: - CONNECTICUT INSTITUTE FOR PRIMARY CARE INNOVATION- COMMUNITY AND POPULATION HEALTH MODEL- NAVIGATION SERVICES- EMERGENCY MEDICINE - PRIMARY CARE COORDINATIONFOR CLINICAL SERVICES THE HOSPITAL HAS DEVELOPED THREE AREAS OF FOCUS BASED ON CONTINUED MONITORING OF HEALTH OUTCOMES. THESE INCLUDE: - BEHAVIORAL HEALTH- PREVENTION SCREENING- DIABETES AND OBESITY PREVENTIONTHE SOCIAL DETERMINANTS OF HEALTH THAT WILL BE TARGETED BY SAINT FRANCIS IN PARTNERSHIP WITH COMMUNITY ORGANIZATIONS INCLUDE HOUSING, ACCESS TO HEALTHY FOOD, SECURITY AND EDUCATION. THE CORRESPONDING PARTNERSHIPS FOR THIS WORK INCLUDE THE COMMUNITY SOLUTIONS; THE HARTFORD FOOD SYSTEMS AND REACH COALITION; THE PEACE BUILDERS PROGRAM; AND THE HARTFORD ACADEMY FOR SCIENCE AND MATH. DESCRIPTION: MOUNT SINAI REHABILITATION HOSPITAL IS CONNECTICUT'S ONLY FREESTANDING ACUTE CARE REHABILITATION HOSPITAL. IT WAS FOUNDED IN 1923 AND MERGED WITH SAINT FRANCIS HOSPITAL AND MEDICAL CENTER IN 1995. THE MOUNT SINAI REHABILITATION HOSPITAL HAS 60 LICENSED BEDS AND PROVIDES SPECIALIZED SERVICES FOR REHABILITATION IN BOTH THE INPATIENT AND OUTPATIENT SETTING. ADDITIONALLY THE HOSPITAL PROVIDES A COMPREHENSIVE SET OF SERVICES FOR THOSE WHO SUFFER WITH MULTIPLE SCLEROSIS AT THE MANDELL CENTER. MOUNT SINAI REHABILITATION HOSPITAL SHARES RESOURCES WITH SAINT FRANCIS HOSPITAL IN A VARIETY OF AREAS INCLUDING THE DEPARTMENTS OF: HUMAN RESOURCES, FINANCE, ACCOUNTING, ADMINISTRATION, ENGINEERING AND PURCHASING. SUPPLEMENTAL INFORMATION ABOUT COMMUNITY BENEFITS REPORTED ON THE SCHEDULE H FOR SAINT FRANCIS HOSPITAL INCLUDES ACTIVITIES FROM THESE SHARED DEPARTMENTS. MOUNT SINAI REHABILITATION HOSPITAL: PART V, LINE 16A, FAP WEBSITE:HTTP://WWW.SAINTFRANCISCARE.COM/PAY_YOUR_HOSPITAL_BILL_ONLINE/BILLING_AND_FINANCIAL_SERVICES.ASPX MOUNT SINAI REHABILITATION HOSPITAL: PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTP://WWW.SAINTFRANCISCARE.COM/PAY_YOUR_HOSPITAL_BILL_ONLINE/BILLING_AND_FINANCIAL_SERVICES.ASPX MOUNT SINAI REHABILITATION HOSPITAL: PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE:WWW.SAINTFRANCISCARE.COM/ABOUT_US/HOSPITAL_PUBLICATIONS.ASPX PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: SEE PART V, SECTION C MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: SEE PART V, SECTION C PART I, LINE 3C: N/APART I, LINE 4: MOUNT SINAI REHABILITATION HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE OF CONNECTICUT, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES. IN ADDITION, ALL SELF-PAY PATIENTS RECEIVE A 45% DISCOUNT FROM CHARGES WHICH IS NOT INCLUDED IN NET PATIENT SERVICE REVENUE FOR FINANCIAL REPORTING PURPOSES. PART I, LINE 6A: MOUNT SINAI REHABILITATION HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT JOINTLY WITH SAINT FRANCIS HOSPITAL & MEDICAL CENTER, A RELATED ENTITY. THIS REPORT IS AVAILABLE ON THE SAINT FRANCIS HOSPITAL WEBSITE. PART I, LINE 7: MOUNT SINAI REHABILITATION HOSPITAL USES A COST ACCOUNTING SYSTEM WITHIN THE DECISION SUPPORT SYSTEM PRODUCT. IT IS A FULLY ABSORBED COSTING SYSTEM USING REMAPS OF EXPENSE AND REVENUES WHERE NEEDED. INDIRECT, OR OVERHEAD, COSTS ARE ALLOCATED USING STATISTICS IN ORDER TO ALLOCATE THE COSTS TO THE REVENUE PRODUCING DEPARTMENTS. THE METHOD OF ALLOCATING DOLLARS TO THE CHARGE ITEMS IS CURRENTLY PRIMARILY BASED ON A RCC METHOD USING OUR CHARGE ITEM PRICE AS THE DRIVER. WE HAVE INTERSPERSED SOME NATIONAL RVU'S FROM THE CMS FEE SCHEDULE TO MANY DEPARTMENTS AS WELL AS USING COSTS TO HELP ALLOCATE OUR PHARMACY AND SUPPLY EXPENSES. ALL CHARGE ITEMS OBTAIN A COST AND ALL PATIENT SEGMENTS ARE FULLY COSTED. PART I, LINE 7G: N/A PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 261,895. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL IS INVOLVED IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES WHICH ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS. SOME ARE SPECIFIC TO THE COMMUNITY SERVED AND OTHERS ARE MORE GLOBAL IN APPROACH, SUCH AS ADVOCACY WORK AND BOARD MEMBERSHIP IN LOCAL ORGANIZATIONS THAT PROVIDE CRITICAL SERVICES TO THOSE IN NEED. COALITION BUILDINGEXECUTIVE STAFF AT MOUNT SINAI IS EXPECTED TO PARTICIPATE IN COMMUNITY IMPROVEMENT ACTIVITIES SUCH AS SERVING ON BOARDS, ASSISTING SMALL NON-PROFITS WITH FUNDRAISING ACTIVITIES, PROVIDING EXPERTISE AND IN-KIND SUPPORT AND PROVIDING MEETING SPACE FREE OF CHARGE. THIS DATA IS INCLUDED IN THE SAINT FRANCIS SCHEDULE H GIVEN THE OVERLAP OF EXECUTIVE MANAGEMENT ROLES. WORKFORCE DEVELOPMENTIN THE AREA OF WORKFORCE DEVELOPMENT MOUNT SINAI OFFERS TRAINING OF OCCUPATIONAL HEALTH THERAPIST; PHYSICAL THERAPISTS AND NURSING STAFF IN THE AREA OF REHABILITATION. INTERNSHIP OPPORTUNITIES FOR COLLEGE STUDENTS AS WELL AS HIGH SCHOOL STUDENTS DURING THE SUMMER MONTHS TO EXPOSE THEM TO CAREERS IN REHABILITATION ARE ON-GOING. MASTERS AND PHD LEVEL STUDENTS ARE ALSO RECRUITED TO PARTICIPATE IN A VARIETY OF PROJECTS SO THAT THEY BETTER UNDERSTAND THE OPPORTUNITIES AVAILABLE IN THE WORKPLACE. PART III, LINE 4: MOUNT SINAI REHABILITATION HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE OF CONNECTICUT, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES. IN ADDITION, ALL SELF-PAY PATIENTS RECEIVE A 45% DISCOUNT FROM CHARGES, WHICH IS NOT INCLUDED IN NET PATIENT SERVICE REVENUE FOR FINANCIAL REPORTING PURPOSES. PART III, LINE 8: N/A FOR SHORTFALL REPORTED IN LINE 7.MEDICARE ALLOWABLE COSTS OF CARE ON LINE 6 WERE DETERMINED FROM THE MEDICARE COST REPORTS. PART III, LINE 9B: SEE PART III, LINE 4 PART III, LINE 2: BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS, NET OF ACCOUNTS WRITTEN OFF AT CHARGES. PART VI, LINE 2: MOUNT SINAI REHABILITATION HOSPITAL PARTICIPATED IN A COMMUNITY HEALTH ASSESSMENT WITH THE THREE OTHER HOSPITALS LOCATED IN HARTFORD, SAINT FRANCIS HOSPITAL AND MEDICAL CENTER, CONNECTICUT CHILDREN'S MEDICAL CENTER, AND HARTFORD HOSPITAL AND THE CITY OF HARTFORD HEALTH AND HUMAN SERVICES DEPARTMENT TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. MEETINGS OF THE "COMMUNITY NEEDS ASSESSMENT WORKGROUP" TOOK PLACE OVER A 6 MONTH PERIOD EVERY TWO WEEKS TO DISCUSS THE DESIGN AND IMPLEMENTATION OF THE NEEDS ASSESSMENT. AN INVENTORY OF LOCAL RESOURCES WAS CONDUCTED TO DETERMINE HOW BEST UTILIZE RESOURCES AT THE LOCAL COLLEGES AND UNIVERSITIES, LOCAL COMMUNITY ORGANIZATION, CITY GOVERNMENT AND THE HOSPITALS THEMSELVES. THE NEXT CHNA IS DUE TO BE COMPLETED BY THE END OF FY16. DATA COLLECTION FOR THIS BEGAN IN JUNE OF 2015 AND WILL INCLUDE INPUT FROM COMMUNITY MEMBERS; KEY INFORMANTS; PROGRAM PARTICIPANTS AND HEALTHCARE PROVIDERS.SECONDARY DATA PROFILE FINDINGS:HARTFORD IS A VERY DIVERSE (42% HISPANIC AND 37% AFRICAN AMERICAN), YOUNG (49% BETWEEN THE AGES OF 15-45), POOR (32% OF ALL PEOPLE BELOW THE POVERTY LEVEL) AND UNDER EDUCATED (32% OF 25 YEAR OLDS DID NOT GRADUATE FROM HIGH SCHOOL) CITY. THE UNEMPLOYMENT RATE IS 18% AND SAFETY IS A MAJOR CONCERN FOR RESIDENTS WITH RATES OF LARCENY, DRUG ABUSE, ASSAULT AND MURDER ALL HIGHER THAN STATE LEVELS. HEALTH ISSUES OF THE CITY'S RESIDENTS INCLUDE HIGH RATES OF DIABETES, OBESITY, ASTHMA, DRUG ABUSE AND MENTAL ILLNESS. RATES OF HEART DISEASE AND CANCER ARE ON AVERAGE LOWER THAN THE REST OF THE STATE WHICH IS LIKELY DUE TO THE AGE OF THE CITY'S RESIDENTS. KEY INFORMANT INTERVIEW FINDINGS:RESULTS FROM THE KEY INFORMANT INTERVIEWS SERVED TO CLARIFY THE ISSUES THAT THOSE WORKING IN THE COMMUNITY SEE AS KEY COMMUNITY NEEDS. INTERESTINGLY, THE INFORMATION ON THE MOST IMPORTANT HEALTH ISSUES WAS RIGHT ON TARGET WITH DIABETES, OBESITY, MENTAL ILLNESS AND DRUG ABUSE ALL INCLUDED IN THE TOP 5 KEY HEALTH ISSUES. ADDITIONALLY, KEY INFORMANTS FELT THAT NEIGHBORHOOD SAFETY WAS A MAJOR CONCERN AS IS THE QUALITY OF HOUSING AND THE LIMITED NUMBER OF JOB OPPORTUNITIES. PART VI, LINE 3: PATIENTS' ABILITY TO PAY FOR HEALTH CARE IS ASSESSED DURING THE INTAKE PROCESS. IF IT BECOMES CLEAR THAT THE PATIENT DOES NOT HAVE COVERAGE OR HAS MINIMAL COVERAGE THEY ARE REFERRED TO A FINANCIAL COUNSELOR WHO REVIEWS THEIR CURRENT INCOME TO DETERMINE ELIGIBILITY FOR EITHER STATE ASSISTANCE OR HELP FROM MOUNT SINAI CHARITY CARE DOLLARS. IN AREAS OF THE HOSPITAL WHERE NEW PATIENTS ARRIVE: THE REHABILITATION CLINIC, THE MANDELL CENTER, AND THE ADMISSIONS AREA, SIGNAGE IS POSTED ABOUT THE FINANCIAL ASSISTANCE AVAILABLE TO ALL PATIENTS WHO QUALIFY. THIS INFORMATION OUTLINES, IN BOTH ENGLISH AND SPANISH, THE AVAILABILITY OF FINANCIAL COUNSELING AND ASSISTANCE FOR MEDICAL BILLS. ADDITIONALLY, A "PATIENT AND FAMILY INFORMATION NOTEBOOK" WHICH INCLUDES A CHAPTER ON THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR PATIENTS WHO EITHER DO NOT HAVE COVERAGE OR ARE NOT COVERED FULLY BY THEIR HEALTH INSURANCE IS LOCATED IN EACH PATIENT ROOM. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS ALSO INCLUDED IN DISCHARGE MATERIALS. MOUNT SINAI DOES NOT TURN PATIENTS AWAY DUE TO THEIR INABILITY TO PAY. FINALLY, PATIENTS WHO HAVE NOT BEEN FORTHCOMING IN THEIR NEED FOR FINANCIAL ASSISTANCE PRIOR TO THE DELIVERY OF HEALTH CARE SERVICES ARE PROVIDED WITH INFORMATION ABOUT OUR CHARITY CARE POLICY WHEN THEY RECEIVE A BILL FOR THE SERVICES RENDERED. THEY ARE ENCOURAGED TO TALK TO A FINANCIAL COUNSELOR TO DISCUSS A PAYMENT PLAN AND TO DETERMINE IF THEY ARE ELIGIBLE FOR STATE ASSISTANCE OR IF A PORTION OF THEIR BILL CAN BE "WRITTEN OFF" TO CHARITY CARE. THE FINANCIAL ASSISTANCE POLICY IS REVIEWED AT A MINIMUM ON AN ANNUAL BASIS AND MORE OFTEN AS NEEDED. CLARIFICATIONS ABOUT THE CHANGES IMPLEMENTED DUE TO THE AFFORDABLE CARE ACT WERE INCORPORATED INTO THE POLICY IN JANUARY 2014; FURTHER EDITS WERE INCLUDED AND APPROVED IN NOVEMBER OF 2015. PART VI, LINE 4: MOUNT SINAI REHABILITATION HOSPITAL SERVES PATIENTS FROM ALL OVER CONNECTICUT, AND ON OCCASION NATIONALLY DUE TO THE STRONG REPUTATION OF THE REHABILITATION PROGRAM AND THE MULTIPLE SCLEROSIS MANDELL CENTER. THE MAJORITY OF PATIENTS, HOWEVER, COME FROM HARTFORD COUNTY, WHICH INCLUDES THE STATE CAPITAL, HARTFORD, AND THIRTY-FIVE SURROUNDING URBAN AND SUBURBAN COMMUNITIES. HARTFORD IS THE CAPITAL OF THE STATE OF CONNECTICUT AND THE SEVENTH LARGEST CITY IN NEW ENGLAND. IT IS ONE OF THE OLDEST CITIES IN THE COUNTRY AND AT ONE POINT WAS ONE OF THE WEALTHIEST. THE POPULATION IN HARTFORD IS 125,000 WITH A PROPORTIONALLY YOUNGER AGE DISTRIBUTION THAN THE US OVERALL. THIS IMPACTS NUMEROUS ASPECTS OF HEALTH INCLUDING RATES OF SOME TYPES OF CANCER, VIOLENCE AND LEVELS OF UNINTENDED INJURY. OVER 70% OF CHILDREN IN THE HARTFORD PUBLIC SCHOOLS RECEIVED FREE OR REDUCED PRICE LUNCH. THE RATE OF INFANTS BORN LOW-BIRTH WEIGHT (LESS THAN 2500 G) IS 9.4%, WELL OVER THE NATIONAL AVERAGE OF 6.8%. HARTFORD IS AN URBAN COMMUNITY, THE MAJORITY OF HARTFORD RESIDENTS ARE MINORITIES WITH 42% LATINO, 37% AFRICAN AMERICAN, 17% WHITE AND 4% OTHER RACES. ACUTE REHABILITATION SERVICE ARE AVAILABLE IN HARTFORD AT NURSING HOME FACILITIES BUT MOUNT SINAI IS THE ONLY LICENSED REHABILITATION HOSPITAL IN THE AREA. PART VI, LINE 5: THE HOSPITAL IS INVOLVED IN A VARIETY OF INITIATIVES THAT FOCUS ON IMPROVING THE HEALTH OF THE COMMUNITY OVERALL. COLLABORATIVE EFFORTS WITH A VARIETY OF LOCAL COMMUNITY FOUNDATIONS AND NON-PROFIT ORGANIZATIONS ARE NUMEROUS. THE MT. SINAI REHABILITATION - ROWING DISABLED PERSONS INCLUDING VETERANS IS VERY WELL KNOWN IN THE HARTFORD REGION AND HAS ENABLED NUMEROUS PATIENTS TO REGAIN PHYSICAL AND SOCIAL CONFIDENCE. NUMEROUS RESOURCES ARE DONATED BY THE HOSPITAL AND PARTNERING ORGANIZATIONS INCLUDING RIVERFRONT RECAPTURE, THE JAYCEES FOUNDATION, THE CHRISTOPHER REEVES FOUNDATION AND OTHERS. THE GOLFERS IN MOTION PROGRAM IS DESIGNED TO RE-INTRODUCE GOLF INTO THE LIVES OF THOSE WHO HAVE SUFFERED AN INJURY OR ILLNESS RESULTING IN DISABILITY. THE PROGRAM HAD DEVELOPED ADAPTIVE EQUIPMENT AND SPECIALIZED REHABILITATION SERVICES TO ENABLE GOLFERS TO RETURN TO THE COURSE AND BEGIN TO NORMALIZE THEIR LIVES. A PROGRAM FOR SUPPORTING CAREGIVERS IS NOW IN PLACE THAT PROVIDES TRAINING AND SUPPORT TO FAMILY MEMBERS WHO ARE TAKING CARE OF THOSE WITH CHRONIC ILLNESS; DEMENTIA OR OTHER LONG TERM HEALTH CHALLENGES. PART VI, LINE 6: THE ORGANIZATION IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM.PART VI, LINE 7: COMMUNITY BENEFITS ARE REPORTED TO THE STATE'S OFFICE OF THE HEALTH CARE ADVOCATE IN CONNECTICUT. A COMMUNITY BENEFIT REPORT IS PUBLISHED AND WIDELY DISTRIBUTED IN THE LOCAL COMMUNITY AND IT IS POSTED ON THE WEBSITE FOR FULL VIEWING. PART VI, LINE 7, REPORTS FILED WITH STATES CT 1 1 0 0 0 0 0 0 0 CHRISTOPHER M DADLEZ PRESIDENT & CEO 0 886803 0 696000 0 1312062 0 946067 0 75560 0 3916492 0 1312062 DAVID BITTNER ASSISTANT TREASURER 0 320908 0 75000 0 0 0 9308 0 29953 0 435169 0 0 SURRENDRA KHERA MD DIRECTOR 0 418019 0 70000 0 0 0 20909 0 34787 0 543715 0 0 JOHN RODIS MD ASSISTANT SECRETARY 0 732647 0 182000 0 0 0 23992 0 35168 0 973807 0 0 ROBERT KRUG MD PRESIDENT & CEO 0 365741 0 12500 0 0 0 16650 0 18164 0 413055 0 0 ANNE-MARIE ALCIDE STAFF RN 155554 0 0 0 0 0 6745 0 26197 0 188496 0 0 0 MAURA A MURRAY EXECUTIVE DIRECTOR SERVICE 151087 0 12500 0 0 0 8836 0 17284 0 189707 0 0 0 JANETTE M GORDON STAFF RN II 136316 0 0 0 0 0 4343 0 11281 0 151940 0 0 0 KATHLEEN M ROCHE MSRN FORMER ASSISTANT SECRETARY 0 0 0 0 0 287380 0 0 0 5985 0 293365 0 0 PART I, LINES 4A-B CHRISTOPHER DADLEZ PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR WITH AN ESTIMATED BENEFIT OF $927,000. KATHLEEN M ROCHE RECEIVED A SEVERANCE BENEFIT OF $287,380. PART I, LINE 3: MOUNT SINAI REHABILITATION HOSPITAL RELIED ON SAINT FRANCIS HOSPITAL TO ESTABLISH THE COMPENSATION OF ITS CEO USING THE FOLLOWING: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE OF TRINITY HEALTH-NEW ENGLAND,INC. (FORMERLY KNOWN AS SAINT FRANCIS CARE, INC.) HAS THE RESPONSIBILITY FOR OVERSEEING THE REVIEW OF THE FORM 990 INCLUDING ENSURING APPROPRIATE DIRECTORS AND MANAGEMENT PERSONNEL HAVE REVIEWED, ANY ISSUES ARE COMMUNICATED TO THE COMMITTEE AND FORM 990S ARE AVAILABLE TO THE BOARD OF DIRECTORS. THE FORM 990 IS AVAILABLE ON THE BOARD'S INTERNAL SECURE WEB PORTAL. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY INCLUDES AN OBLIGATION OF EACH BOARD MEMBER TO ANNUALLY DISCLOSE ALL MATERIAL FACTS AND RELATIONSHIPS AND REFRAIN FROM VOTING ON ANY MATTER WHEN THERE IS A CONFLICT OF INTEREST. THE GOVERNANCE AND NOMINATIONS COMMITTEE REVIEWS THE RESULTS OF THESE SUBMISSIONS ANNUALLY FOR COMPLIANCE WITH GOVERNANCE POLICIES. FORM 990, PART VI, SECTION B, LINE 15 REFER TO PART III OF SCHEDULE J FOR PROCESS. FORM 990, PART VI, SECTION C, LINE 19 A LINK ON THE SAINT FRANCIS WEBSITE HAS BEEN ESTABLISHED FOR INDIVIDUALS TO REQUEST GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990 AND FINANCIAL STATEMENTS. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATES -10,000,000. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS HAS DELEGATED ITS OVERSIGHT RESPONSIBILITY OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS TO SAINT FRANCIS HOSPITAL AND MEDICAL CENTER AUDIT & CORPORATE COMPLIANCE COMMITTEE. 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