2015-10-20T14:08:40-05:00 2014-09-30 111986323 MARCUM LLP CITY PLACE II 185 ASYLUM STREET HARTFORD CT 06103 990 2013-10-01 061422973 MOUNT SINAI REHABILITATION HOSPITAL INC MOUN 8607143500 114 WOODLAND STREET HARTFORD CT 06105 DAVID BITTNER SENIOR VICE PRESIDENT & CFO 8607143500 2015-10-16 1 DOUGLAS FARRINGTON P00370668 8607600600 2013 2016-02-25 16:41:14Z X DAVID BITTNER 114 WOODLAND STREET HARTFORD CT 06105 40160257 0 X WWW.STFRANCISCARE.ORG X 1995 CT REHABILITATION SERVICES 14 8 272 76 0 0 281207 1021110 34747105 39026323 100462 15130 83835 97694 35212609 40160257 0 0 0 0 14899215 15050996 0 0 0 12125684 14431835 27024899 29482831 8187710 10677426 23757748 22736170 4307911 2608907 19449837 20127263 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 27127324 39058847 TO PROVIDE COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL REHABILITATION SERVICES IN THE GREATER HARTFORD CONNECTICUT COMMUNITY AS PART OF THE SAINT FRANCIS CARE HEALTH SYSTEM. 27127324 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 1 272 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 1516996 894739 DELORES GRAHAM VICE CHAIRMAN 1.00 0.00 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 0.00 X X 0 0 0 JEANNINE MARA TREASURER 1.00 0.00 X X 0 0 0 JOHN SUISMAN DIRECTOR 1.00 2.00 X 544 0 1200 MICHAEL E CUMMINGS DIRECTOR 1.00 0.00 X 0 0 0 WENDY E ELBERTH DIRECTOR 2.00 0.00 X 0 0 0 ANDREW MANDELL DIRECTOR 1.00 0.00 X 0 0 0 BRAD DAVIS DIRECTOR 2.00 0.00 X 0 0 0 DAVID BITTNER ASSISTANT TREASURER 2.00 63.00 X X 0 345714 16058 SURRENDRA KHERA MD DIRECTOR 1.00 56.00 X 0 451352 31159 JOHN RODIS MD ASSISTANT SECRETARY 1.00 56.00 X X 0 773627 34542 ANNE-MARIE ALCIDE STAFF RN 55.00 0.00 X 123653 0 22247 MAURA A MURRAY EXECUTIVE DIRECTOR SERVICE 55.00 0.00 X 159041 0 15926 JANETTE M GORDON STAFF RN II 55.00 0.00 X 115964 0 10818 DONNA RICKETTS NURSE MANAGER 55.00 0.00 X 115265 0 21886 KAREN M PRIOR-TOPALIS NURSE MANAGER 55.00 0.00 X 115442 0 12864 ROLF KNOLL MD FORMER DIRECTOR 0.00 57.00 X 0 162942 4124 KATHLEEN M ROCHE MSRN FORMER ASSISTANT SECRETARY 0.00 0.00 X 0 640052 10215 629909 3890683 1075778 16 1 1 0 MEDIWARE INFORMATION SERVICES PO BOX 204176 KANSAS CITY MO 64141 SOFTWARE SERVICES 171200 MEDISERVE INFORMATION SYSTEMS 585 NORTH JUNIPER DR STE 100 CHANDLER AZ 85226 SOFTWARE SERVICES 120495 2 724954 296156 1021110 PATIENT CARE SERVICES 622110 39026323 39026323 39026323 15130 15130 63215 0 63215 63215 63215 WELLNESS REVENUE 900099 30366 30366 COMPUTERIZED ECG READINGS 900099 1865 1865 COFFEE SHOP REVENUE 722213 1393 1393 855 293 562 34479 40160257 39058847 0 80300 544 544 11792791 10414591 1378200 688582 608109 80473 1470667 1347950 122717 1098412 970043 128369 19200 19200 1871599 1453410 418189 46883 21522 25361 142089 84308 57781 418963 418053 910 110908 70877 40031 713089 713089 14877 14877 DRUGS 9970103 9970103 BAD DEBTS 629112 629112 MEDICAL SUPPLIES 212581 212581 LICENSES & FEES 161311 142635 18676 121120 70397 50723 29482831 27127324 2355507 0 1373830 3856965 13232560 8270027 3068549 3796796 6460 6460 15378933 9940016 5881367 5438917 194982 157719 0 1209286 23757748 22736170 1747556 1768565 2560355 840342 4307911 2608907 X 18408243 18391636 1041594 1735627 19449837 20127263 23757748 22736170 X 10677426 -10000000 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10360565 6712420 3648145 1240835 269230 971605 2441139 1904909 536230 1336394 1053457 282937 5438917 EMPLOYEE ASSISTANCE LOANS 1570 DUE FROM AFFILIATES 1207716 1209286 DUE TO THIRD PARTIES REIMBURSEMENT AGENCIES 840342 840342 1 1 X 1 X 1 X 1 1 0 1 1 74012 74012 0.00250 386892 386892 0.01310 460904 460904 0.01560 65026 65026 0.00220 140442 140442 0.00480 621816 518180 103636 0.00350 42828 42828 0.00150 870112 518180 351932 0.01200 1331016 518180 812836 0.02760 73529 73529 0.00250 73529 73529 0.00250 0 189872 8145462 7463270 682192 X 1 1 1 1 MOUNT SINAI REHABILITATION HOSPITAL 490 BLUE HILLS AVENUE HARTFORD CT 06112 X MOUNT SINAI REHABILITATION HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X SAINTFRANCISCARE.COM X CT.GOV.DPH.COM X X X X X X 0 0 1 1 200.000000000000 1 250.000000000000 1 X X X 1 1 X X X X X 1 0 0 X X X 0 0 MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 1J: 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 3: 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 4: 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 7: 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 PREVENTIONSTRATEGIES TO ADDRESS THESE NEEDS AND TO MEASURE THE IMPACT OF OUR APPROACH ARE STILL UNDERWAY. SAINT FRANCIS PLACES A PREMIUM ON THE VALUE OF THE PROGRAMS DESIGNED TO ADDRESS COMMUNITY NEEDS AND WITH THE LEADERSHIP OF THE CURTIS D. ROBINSON CENTER FOR HEALTH EQUITY AT SAINT FRANCIS USES AN APPROACH THAT INVOLVES SIGNIFICANT COMMUNITY ENGAGEMENT. THUS WORK TO ADDRESS THESE NEEDS IS UNDERWAY BUT OUTCOMES ARE NOT YET AVAILABLE TO MEASURE IMPACT. THE 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.GIVEN THE COMPLEXITY OF THE SOCIAL DETERMINANTS OF HEALTH AND THE LONG-TERM INVESTMENT NEEDED TO HAVE AN IMPACT ON THESE NEEDS, THE WORK IN THIS AREA HAS JUST BEGUN. FINDING APPROPRIATE PARTNERS FOR THIS WORK TAKES TIME AND THE APPROACH TAKEN BY SAINT FRANCIS IS TO PARTNER WITH ORGANIZATIONS THAT HAVE A PROVEN TRACK RECORD AND ABILITY TO HAVE A SUSTAINED IMPACT ON THE DEVELOPMENT OF THE COMMUNITY AND ENHANCEMENT OF QUALITY OF LIFE FOR THOSE WHO LIVE HERE. MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 19D: THE HOSPITAL FACILITY PROVIDES INPATIENT AND OUTPATIENT REHABILITATION SERVICES. THE FACILITY DOES NOT HAVE AN EMERGENCY DEPARTMENT. IN CASE OF AN EMERGENCY THE PATIENT WOULD BE TRANSFERRED TO SAINT FRANCIS HOSPITAL AND MEDICAL CENTER FOLLOWING 911 EMERGENCY PROCEDURES. SAINT FRANCIS HOSPITAL AND MEDICAL CENTER'S WRITTEN POLICY WOULD THEN APPLY. THE POLICY REQUIRES THE HOSPITAL TO PROVIDE, WITHOUT DISCRIMINATION, CARE FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. 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. 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 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 STUDENT 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. 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. 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 THAT 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 THE 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 873996 0 643000 0 0 0 849381 0 45358 0 2411735 0 0 DAVID BITTNER ASSISTANT TREASURER 0 240714 0 105000 0 0 0 0 0 16058 0 361772 0 0 SURRENDRA KHERA MD DIRECTOR 0 451352 0 0 0 0 0 13583 0 17576 0 482511 0 0 JOHN RODIS MD ASSISTANT SECRETARY 0 698627 0 75000 0 0 0 15000 0 19542 0 808169 0 0 MAURA A MURRAY EXECUTIVE DIRECTOR SERVICE 143452 0 15589 0 0 0 8720 0 7206 0 174967 0 0 0 ROLF KNOLL MD FORMER DIRECTOR 0 162942 0 0 0 0 0 0 0 4124 0 167066 0 0 KATHLEEN M ROCHE MSRN FORMER ASSISTANT SECRETARY 0 431719 0 0 0 208333 0 0 0 10215 0 650267 0 0 PART I, LINES 4A-B CHRISTOPHER DADLEZ PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR WITH AN ESTIMATED BENEFIT OF $834,000. KATHLEEN M ROCHE RECEIVED A SEVERANCE BENEFIT OF $208,333. 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 SAINT FRANCIS HOSPITAL & MEDICAL CENTER AUDIT AND CORPORATE COMPLIANCE COMMITTEE HAS RESPONSIBILITY FOR REVIEWING THE FORM 990 AND REPORTS BACK TO THE FULL BOARD REGARDING THEIR REVIEW OF THE FORM 990. 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. AMENDED RETURN: IN THE ORIGINAL FILING OF THE FORM 990, THE TAX YEAR THAT THE HOSPITAL FACILITY LAST CONDUCTED A CHNA WAS INCORRECTLY REPORTED AS 2011. THE YEAR HAS BEEN CHANGED TO 2012 IN THE AMENDED FILING. THE FOLLOWING PARTS AND SCHEDULES OF THE FORM 990 WERE AMENDED: - SCHEDULE H, PART V, SECTION B, LINE 2 ASYLUM HILL FAMILY MEDICAL CENTER 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH SERVICES CT 501(C)(3) LINE 3 SAINT FRANCIS CARE 0 ONE THOUSAND CORPORATION 1000 ASYLUM STREET HARTFORD CT 06105 060922325 PROPERTY MANAGEMENT CT 501(C)(2) ST FRANCIS HOSPITAL & MEDICAL CENTER 0 SAINT FRANCIS CARE INC 114 WOODLAND STREET HARTFORD CT 06105 061491191 SUPPORTS HEALTH CARE ORGANIZATIONS CT 501(C)(3) LINE 11A, I N/A 0 SAINT FRANCIS FOUNDATION INC 114 WOODLAND STREET HARTFORD CT 06105 061008255 FUNDRAISING CT 501(C)(3) LINE 11A, I SAINT FRANCIS CARE 0 SAINT FRANCIS EMERGENCY MEDICAL GROUP INC 114 WOODLAND STREET HARTFORD CT 06105 451994612 HEALTH SERVICES CT 501(C)(3) LINE 3 SAINT FRANCIS MEDICAL GROUP INC 0 SAINT FRANCIS MEDICAL GROUP INC 114 WOODLAND STREET HARTFORD CT 06105 061450168 HEALTH SERVICES CT 501(C)(3) LINE 3 SAINT FRANCIS CARE 0 SAINT FRANCIS HOSPITAL & MEDICAL CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 060646813 HOSPITAL CT 501(C)(3) LINE 3 SAINT FRANCIS CARE 0 TOTAL LAUNDRY COLLABORATIVE 114 WOODLAND STREET HARTFORD CT 06105 208335788 LAUNDRY SERVICES CT N/A MEDWORKS LLC 375 EAST CEDAR STREET NEWINGTON CT 06111 061490483 REHABILITATION SERVICES CT N/A SFH-FF LLC 1000 ASYLUM AVE HARTFORD CT 06105 061422973 FITNESS MGMT CT N/A RELATED 35074 206294 0 0 SAINT FRANCIS CARE MEDICAL GROUP PC 114 WOODLAND STREET HARTFORD CT 06105 061432373 HEALTH SERVICES CT N/A C 0 SAINT FRANCIS BEHAVIORAL HEALTH GROUP 114 WOODLAND STREET HARTFORD CT 06105 061384686 BEHAVIOR HEALTH SERVICES CT N/A C 0 SAINT FRANCIS HEALTH CARE PARTNERS 95 WOODLAND ST FOURTH FLOOR HARTFORD CT 06105 061391257 MGMT AND ADMIN SERVICES CT N/A C 0 SAINT FRANCIS HEALTHCARE PARTNERS ACO INC 95 WOODLAND ST FOURTH FLOOR HARTFORD CT 06105 461315402 MGMT AND ADMIN SERVICES CT N/A C 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 0