2014-08-08T08:22:58-05:00 2013-09-30 346565596 Ernst & Young US LLP 2005 Market St 700 Philadelphia PA 19103 990 2012-10-01 060646966 Windham Community Memorial Hospital WIND 8604566821 112 Mansfield Avenue Willimantic CT 06226 Thomas Marchozzi 8604566821 2014-08-08 0 Wendy J Clavin P00870950 2154485000 2012 2015-11-30 17:44:51Z David Whitehead 112 Mansfield Avenue Willimantic CT 06226 80692518 0 X WWW.WCMH.ORG X 1908 CT Windham Hospital's primary mission is to enhance the health of the residents in our 17-town service area, primarily Windham county and Tolland county. The Hospital works to achieve its mission by maintaining suitable facilities in the town of Windham for the provision of healthcare. Additionally, Windham Hospital has always encouraged progress and flexibility to meet the changing needs of our patients and all residents in our service areas. The Hospital confronted the issues required to enhance the health and welfare of the residents by providing quality healthcare regardless of ethnic background, age or ability to pay, all the while maintaining a high degree of responsiveness to changes, particularly those of the community. The Hospital is committed to serve all members of its community regardless of ability to pay. This is accomplished through various means-tested programs (i.e., Medicare and Medicaid). 14 11 904 246 853396 -78532 3487639 2456891 85165168 74955965 31783 221336 1664667 2548186 90349257 80182378 0 0 0 0 58243227 54423477 0 0 64539 32284811 34118282 90528038 88541759 -178781 -8359381 78468684 78266860 122636279 87584585 -44167595 -9317725 X To enhance the lives and well being of people in the communities we serve by providing quality healthcare. 0 0 15154306 13077166 The Emergency Team consists of nurses, physicians' assistants, APRNs, physicians, patient care technicians, and paramedics who are trained to handle any type of emergency that might arise...morning, noon, or night. The Windham Hospital Emergency Department provides treatment for approximately 38,000 patients annually.Wait times in the ED are posted on the hospital's website, and are available by downloading a free iPhone app (from the Apple store). The physicians in the Emergency Department strive to see each patient within 30 minutes of their arrival at the hospital.At Windham Hospital, the Emergency Department physicians are from Northeast Emergency Medicine Specialists, a private practice group. They are dedicated to providing prompt access to healthcare, understanding the concerns of their patients, ensuring safety, and using a respectful and friendly approach.The Emergency Department is located on the first floor. Signs are conveniently posted outside the hospital for visitors. In 2006, a major expansion of the Emergency Department was funded by contributions from the community, and named for its major benefactor, Jeffrey P. Ossen. The department doubled in size, and includes 20 treatment rooms, 2 critical care suites, isolation and decontamination rooms, and state of the art equipment and systems throughout the department.A new computer-based Emergency Department Informatics System (EDIS) provides staff with a centralized data system that makes accurate tracking and treatment information available to all caregivers on the Hospital's secure network. The Picture Archival and Communications System (PACS) allows images obtained at the Hospital to be read onsite by physicians from Jefferson Radiology, or sent to their specialists through special high-speed computer connections. The new, efficient space allows optimal privacy, security, and comfort for our patients. Many of the rooms feature personal TVs. In-room, bedside registration improves confidentiality and reduces the amount of time patients wait before their treatment.Windham Hospital is proud to offer the Emergency Department services as a community resource 24 hours a day, 365 days a year. We are grateful to the many individuals and organizations that played vital roles in design, fundraising and operational implementation of this facility.Patients arriving at the Emergency Center can expect the following process:1. A trained nurse with experience in emergency medicine will give the patient a rapid assessment of the patient's condition, called "triage," and will determine the patient's acuity.2. The patient will be placed in a treatment room according to availability.3. Patients are then treated by appropriate staff members.4. While the patient is in the treatment room, registration personnel will complete the registration process. Registration ensures that the hospital has the patient's correct contact information as well as information required of all patients.All Emergency Department patients (whether insured or not) will be given the opportunity to pay either their insurance co-pay or a deposit on charges at the time of the discharge. Insurance or payment (or lack of) will not affect the quality of care. Patients receive top-quality care, regardless of ability to pay.At Windham Hospital's Emergency Center, there is an assortment of physicians with differing specialties. This ensures that patients will have the best care during their visit to the Center. 6543204 6721651 Scope of Service - The Operating Room is a five-room suite on the second floor of the Windham Hospital, with operational hours Monday - Friday and a call system in place to provide care for after-hours surgical procedures. The average utilization is 75%. Service is provided to patients of all ages from infants to geriatrics. * Care is provided for patients undergoing: 1. One Day Surgical Procedures 2. Same Day Admission Procedures 3. Inpatients * Procedures include the following specialties: 1. Orthopaedic 2. General Gastrointestinal 3. ENT 4. GYN 5. GU 6. Laser Laparoscopic Procedures 7. Peripheral Vascular 8. Pediatric 9. Ophthalmic Staffing Plan - A modified primary nursing care model is used as the method to deliver care on this unit. There is a Surgical Services Manager assigned five days a week. There is a Clinical Coordinator who facilitates the day-to-day operative schedule. An RN is assigned to all patients undergoing invasive procedures. The RNs, and Surgical Technologists are required to take call for emergent and urgent procedures. The OR Associates and OR Technicians are required to take call for housekeeping duties related to weekend and holiday emergent and urgent procedures. Direct hours exclude the Manager. * The unit is comprised of individuals who work 8 or 10-hour shifts - RNs - Surgical Technologists - OR Technicians - OR Associates - Surgical Schedulers 6297997 6294251 Shortness of breath associated with lung disease can certainly compromise your lifestyle, but there are always ways to better manage your breathing problems. Windham Hospital's Outpatient Pulmonary Rehabilitation Program can help those coping with lung disease breath easier and more efficiently.The Outpatient Pulmonary Rehabilitation Program is individually tailored to meet each patient's needs and include classes, which take place on Tuesdays and Thursdays at Windham Hospital, held for eight consecutive weeks. The program emphasizes physical conditioning, education about breathing and energy conservation. It also highlights education about their specific lung disease and respiratory medications associated with them. Aerobic and strengthening exercises have been shown to be beneficial in reducing the effects of lung disease on daily activities and reducing physician office visits and hospitalization.Those interested in joining the program need a referral from their physician.Some preadmission testing is necessary, including:* Pulmonary function test * Exercise oximetry * Arterial blood gas samplingAfter a physician's referral is obtained, and preadmission testing is complete, an interview will be scheduled with the respiratory therapist and physical therapists.Payment for the Outpatient Pulmonary Rehabilitation at Windham Hospital is usually covered by Medicare, Anthem Blue Cross, PHS and other insurance providers.For those who are uninsured or underinsured we now have additional resources from the Senior Resources Area Agency on Aging to help seniors continue their Pulmonary Maintenance Program even after insurance benefits expire.For more information about the Outpatient Pulmonary Rehabilitation program, contact Renee Clinton at Windham Hospital Pulmonary Rehabilitation Program at 860 456-6879. The hours are: Phase 1 (for new clients) 10 am -12 pm. Maintenance Phase 8-10am or 12-3:00pm. 50240066 50024114 Windham Hospital Operations serve health care needs with numerous inpatient and outpatient services to the communities of Andover, Ashford, Brooklyn Canterbury, Chaplin, Colchester, Columbia, Coventry, Eastford, Franklin, Hampton, Hebron, Lebanon, Mansfield, Scotland, Sprague, Willington and Windham Connecticut. The hospital also offers specific needs within those communities. These programs include student health services, diabetes and nutritional education, pre-natal services, senior wellness services and paramedic intercept program. Windham hospital operates its mobile Healthlink van throughtout its service area, providing regular health screenings for blood sugar and cholesterol, as well as other screenings such as skin cancer and hearing, numerous times during the year. 50240066 50024114 78235573 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 133 0 1 904 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 11 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 X David Whitehead 8604566821 112 Mansfield Avenue Willimantic CT 06226 Theodore Armata 2.00 X 0 0 0 Catina Caban-Owen MD 2.00 X 0 0 0 Diane Wishnafski 2.00 X 0 0 0 Nadia Nashid MD 2.00 X 0 0 0 Karla Fox 2.00 X 0 0 0 Bruce Johnson 2.00 X 0 0 0 Linda Klein PhD 3.00 X X 0 0 0 Delia Berlin 2.00 X 0 0 0 Kenneth Porter 2.00 X 0 0 0 Rheo Brouillard 3.00 X X 0 0 0 Ethan Foxman MD 2.00 X 0 0 0 Charles Shooks MD 2.00 X 0 0 0 Pat Crosbie 2.00 X 0 0 0 David Whitehead 30.00 30.00 X X 0 1054517 39768 Stephen W Larcen 30.00 30.00 X X 0 605497 131389 Carmen Cid 2.00 X 0 0 0 Craig Elliott MD 2.00 X 0 0 0 Gerald G Hertkorn Jr 60.00 X 147880 0 0 Carolyn Trantalis 60.00 X 188854 0 21380 Martin L Levine 60.00 X 136817 0 36595 Michael Dion 60.00 X 149274 0 33249 Shawn Maynard 60.00 X 83438 0 19301 Kismatkumar Detroja 60.00 X 356272 0 44370 Robert Bundy 36.00 24.00 X 165000 251885 45137 Anne B Lovejoy 60.00 X 208160 0 29760 Melisha Cumberland 60.00 X 277703 0 30003 Syera Mathews 60.00 X 202903 0 35121 James N Papadakos 0.00 X 119995 0 39279 2036296 1911899 505352 10 1 1 0 The Casle Corporation 200 Fisher Drive Avon CT 06001 Construction 3975940 Siemens Medical Solutions USA Inc PO Box 120001 Dallas TX 75312 Software Services 544622 Medical Solutions Inc 9101 Western Ave Ste 101 Omaha NE 68114 Medical Services 455728 Comphealth Medical Staffing Inc PO Box 972670 Dallas TX 75397 Medical Services 304601 Clinical Lab Partners LLC 129 Patricia M Genova Drive Newington CT 06111 Laboratory Services 284502 31 199393 2257498 2456891 Inpatient & Outpatient Services 621400 74102569 74102569 Ref. Testing & Fees 621500 853396 853396 74955965 207738 207738 813453 501228 312225 312225 312225 15094 7416 8912 0 6182 7416 13598 13598 Other Operating Income 900099 1803978 1803978 Cafeteria Income 722210 246975 246975 Classes/Tuition 900099 210635 210635 -25627 -25627 2235961 80182378 76117182 853396 754909 1619566 1200796 418770 40162811 38925607 1187656 49548 4192625 4026457 161196 4972 5443787 5228031 209300 6456 3004688 2885602 115523 3563 117202 117202 340175 340175 18556 18556 906431 882098 24333 713666 6299 707367 738625 568901 169724 1544324 1391422 152902 60014 19562 40452 117566 51360 66206 1122124 38705 1083419 1360155 1205914 154241 4154949 4154949 543025 543025 Purchased Services 11173455 7645383 3528072 Medical Supplies 7273089 7120102 152987 Service Agreements 2861448 1676290 1185158 Repairs & Maintenance 408687 369731 38956 664791 295339 369452 88541759 78235573 10241647 64539 3194557 7021350 610831 109514 75402 20670040 11889554 1105979 1150602 147150 241110 118978181 75000515 40433345 43977666 1619196 1949967 411373 383679 10166699 11577530 78468684 78266860 10065013 6209709 2156071 8309976 231199 110183996 73064900 122636279 87584585 X -48579469 -14071036 1033637 1218970 3378237 3534341 -44167595 -9317725 78468684 78266860 X -8359381 1195600 42013649 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 18556 0 0 18556 0 Explanation of Lobbying Activities: Part II-B, Line 1: Windham Community Memorial Hospital paid American Hospital Association (AHA) and Connecticut Hospital Association (CHA) annual dues. Both AHA and CHA allocate a portion of their dues as lobbying expenses for their lobbying efforts on behalf of the organization during the fiscal year. Efforts mainly include the lobbying of Connecticut State Legislators in the interest of a group of affiliated hospitals in the State of Connecticut. The portion of dues allocated as lobbying expenses is calculated under current Medicare rules. AHA and CHA conduct lobbying activities under current Medicare rules. 1747544 234012 17314 1964242 1752043 272346 276546 1747544 2056455 350 -8245 296517 1752043 2164017 5121 168421 2000 279104 2056455 2866917 67938 1500 9887 2923468 0.59000 0.41000 0 1 1 107910 1331371 1439281 833124 57255068 24975939 33112253 539223 5700245 4093156 2146312 78222 53126603 45931420 7273405 6415 6415 43977666 Other Receivable 5168601 Current Assets Whose Use Is Limited 551749 Beneficial Interest In Perpetual Trust 2371175 Unamortized Bond Discount 263600 Debt Service Reserve Fund 1439934 Deposits & Other Assets 881094 Deferred Expenses 339595 Motor Service 561782 11577530 Accrued Pension & Other Long-Term Liabilities 5090126 Interest Rate Swap Obligation 2701010 Accrued Pension Plan - Other 9596072 Other Liabilities 2813677 IBNR Malpractice Reserve 302884 Accrued Post Ret - Non Pension 16661390 Long Term Debt - Intercompany Bonds 19157649 Long Term Debt - Other 59406 Due to Affiliates 16682686 73064900 Description of Intended Use of Endowment Funds: Part V, Line 4: The primary objective of the endowment fund is to provide long-term support for the Hospital's capital and operating programs. The Hospital's investment goals are to maximize total return (capital appreciation, dividends and interest) while also protecting the Hospital's inflation adjusted value over time. Management evaluates endowment spending in light of capital replacement and expansion plans. The spending policy does not apply a prescribed rate of spending in a given year but does consider expenditures based on need and current market conditions as well as long term investment goals. North America/Caribbean 0 Program Services Insurance 400452 0 0 0 0 0 0 400452 0 400452 1 0 0 0 0 0 1 1 1 X 250.000000000000 1 X 1 1 1 0 1 1 1224611 1224611 0.01380 23676715 15173898 8502817 0.09600 24901326 15173898 9727428 0.10980 638824 10536 628288 0.00710 735156 735156 0.00830 399632 399632 0.00450 408154 208254 199900 0.00230 2181766 218790 1962976 0.02220 27083092 15392688 11690404 0.13200 1 1125 1125 0.00000 3 93 10924 10924 0.00010 4 93 12049 12049 0.00010 0 4079212 663051 29717806 33457774 -3739968 X 1 1 1 1 Windham Community Memorial Hospital

112 Mansfield Avenue Willimantic CT 06226

X X X Windham Community Memorial Hospital 1 1 X X X X X X X X X 11 1 1 1 X X X X X X X X 0 0 1 1 250.000000000000 1 400.000000000000 1 X X X 1 1 X X X X 1 0 X X X 1 X X 0 0 3 Windham Middle School Health Center

123 Quarry Street Willimantic CT 06226

In-depth health and mental health assessment Windham High School Wellness Center

355 High Street Willimantic CT 06226

In-depth health and mental health assessment Charles H Barrows STEM Academy

141 Tuckie Road North Windham CT 06256

School based health center Part I, Line 3c: Organization uses Federal Poverty Guidelines (FPG) to determine eligibility. Part I, Line 7: The organization utilizes the Medicare cost report developed Ratio of Cost to Charges (RCC) to accumulate actual costs related to Part I, Lines 7 b, e, & f. This same percentage is applied to the Financial Assistance amount on Part I line 7a. Part I, Line 7g: No physician clinic costs were included in the subsidized Health Services cost calculations. Part II: Our participation in Community Building activities plays an important role in promoting the health and well being of our community. We work closely with key community partners, such as fire, police, health districts and town governments to ensure the safety of the community and to prepare for potential disasters. Windham Hospital also partners with Windham County SafeKids to ensure that all children have access to car seats and bicycle helmets as well as other safety information to keep our children safe. Many of the community initiatives would not be successful or effective without the involvement, support and expertise of hospital administrative and clinical staff on an in-kind basis. The Hospital spent approximately $12,000 on community building activities in fiscal year 2013. Part III, Line 4: Please see the text of the footnote that describes bad debt expense beginning on page 16 of the Audited Financial Statement.Bad debt attributable to patients eligible for charity care taken from procedure analysis report. 98-Bad Debt Payment / 09518-BD ADJ-IP Charity Care 09226-BD ADJ-OP Charity Care Part III, Line 8: Providing for those in need, including Medicare patients, and serving all patients regardless of ability to pay is an essential part of our community benefit standards, as well as our mission in our community. We serve those patients without regard to any payment shortfall. Therefore the Medicare shortfall should be considered to be a community benefit. The organization utilizes the Medicare cost report developed ratio of cost to charge. Part III, Line 9b: The following is included in the Financial Assistance Policy: For those that qualify for financial assistance the Hospital will not impose wage garnishments or liens on primary residences, will not send unpaid bills to outside collection agencies and will cease all collection efforts. Once a patient qualifies for financial assistance, the patient will be contacted via written communication and the patient account will be documented as appropriate to reflect the level of approval that was granted. Patient Accounting will make all necessary adjustments to the account. Other parties such as collection agencies, and other billing parties will also be notified of the adjustments. Windham Community Memorial Hospital Part V, Section B, Line 3: The needs assessment took into account the comments and observation of seven focus groups that were made up of first responders, Latinos, community leaders, school based health providers, boomers, faith based groups and youth groups. The telephone survey consisted of 630 interviews of residents from 15 municipalities. Windham Community Memorial Hospital Part V, Section B, Line 4: Windham conducted the hospital facility's CHNA with Natchaug Hospital and Day Kimball HealthCare. Windham Community Memorial Hospital Part V, Section B, Line 5c: The Needs Assessment results were posted on the hospital's website and made available upon request. In addition, a news release on the completion of the needs assessment was made to the local media. Windham Community Memorial Hospital Part V, Section B, Line 7: For the hospital to be the most effective and make the greatest impact on our community, it is understood that not all needs can be addressed at once. The following areas of need uncovered in the 2011 Needs assessment that are not being directly addressed by Windham Hospital are health insurance, physical activity, dental visits, heart attacks, stroke, smoking, flu shots, prostate cancer screening, fruit and vegetables. The two key priority areas identified, diabetes and access to care, are expected to also have a significantly influential impact on BMI's, diets containing fruits and vegetables, physical activity, cardiac disease and strokes. In order to avoid duplication of efforts, behavioral and mental health issues in the community will be led by the specialists at Natchaug Hospital and United Services. However, the hospital is currently working on a strategic initiative with Natchaug Hospital to develop and implement an inpatient program to identify behavioral and mental health issues as comorbidities to coordinate care and decrease length of stay for the patient. Windham Community Memorial Hospital Part V, Section B, Line 18e: Financial Assistance Policy is also availabe upon request Windham Community Memorial Hospital Part V, Section B, Line 20d: Part V, Section B, Linde 19b: Windham Hospital is in the process of adopting proposed 501r regulations. Once the regulations are final, the hospital will be in compliance. Part VI, Line 2: A variety of methods is used to assess needs for programs that we offer to the community. Needs assessment data is collected when applying for grants at the local, state, and federal level utilizing census data, public health district data, state agency data, as well as federal data from the Centers for Disease Control and Prevention and other sources. More informal methods to assess needs include feedback from Advisory Councils, support groups, and individuals who may need assistance in accessing healthcare services. We coordinate closely with the federally qualified health center in Willimantic, which serves the healthcare needs of low-income residents, as well as numerous other organizations including the public schools, other non-profit organizations, senior centers, and government agencies in our region. The statewide Connecticut Hospital Association, of which we are a member, provides data collection and networking opportunities with other hospitals in Connecticut so that we can share best practices in this area. Secondary data from other organizations is also utilized to take advantage of other resources such as the United Way, Eastern Highlands Health District, Visiting Nurses, and partner organizations within Hartford Healthcare. Part VI, Line 3: Windham Hospital disseminates information about its Financial Assistance Policy as follows: (i) provide signage regarding the policy and written summary information describing the Policy along with financial assistance contact information in the Emergency Department, Labor and Delivery areas and all other Hospital patient registration areas; (ii) directly provide to each patient written summary information describing the Policy along with financial assistance contact information in all admission, patient registration discharge, billing and collection written communications; (iii) post the Policy on the Hospital's home web page; (iv) educate all admission and registration personnel regarding the Policy so that they can serve as an informational resource to patients regarding the Policy. Part VI, Line 4: Windham Hospital services 17 towns in Eastern Connecticut which include a portion of Windham County and several towns in New London and Tolland counties. Census data for 2010 reports a population of 118,145 in Windham County. People of Hispanic origin make up 10.9 percent of Connecticut population, and 14.4 percent of the total U.S. population, however in four Connecticut counties, including Windham County, the Hispanic population more than doubled between 1990 and 2005. In the Town of Windham, where the Hospital is located, 29.9% ( 2010 Census) of the population is of Hispanic origin.The poverty rate in Windham County is 10.3% ( 2010 Census) as compared to 8.7 % statewide. The unemployment rate is 9.3 in Windham County (October 2012), with a rate of 7.8% for the State of Connecticut (December 2012). Average income per median household in Windham County is $60,063 as compared to $69,243 in CT, based on 2010 census data. County Health Rankings, a program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Institute reported in 2010 that Windham County ranked last of eight counties with respect to health outcomes (mortality and morbidity), as well as health behaviors including tobacco use, diet & exercise, alcohol use and unsafe sex. Social and economic factors including education, employment, income, family & social support and community safety were also ranked last in Windham County. Windham Hospital receives 50% of its revenue from Medicare and Medicaid. Payers include:* Commercial insurance 40% * Medicare 31% * Medicaid 19% * Charity care, self-pay, other 10% Part VI, Line 5: Windham Community Memorial Hospital was formed to serve its community and has been an important resource for nearly 80 years. A local community board governs the hospital, is responsible for maintaining outstanding quality services, and credentials its medical staff. All members of the Board of Directors reside in our service area and are neither employees, family members, nor contractors of the Hospital. The Hospital extends medical staff privileges to all qualified physicians in its community. The Windham Hospital Foundation, a related organization, raises funds to assure that the latest advancements in technology are available to our patients, as well as a range of community benefit programs that are not funded by other sources. We are a true community resource as we offer space for other community groups to meet at no charge, bring together other health providers for health fairs and educational sessions for the community, and encourage the involvement of our staff on various boards and councils that promote the overall health of the community. The Hospital uses its surplus funds to provide additional benefits to its patients and the community it serves. Part VI, Line 6: Windham Community Memorial Hospital is a subsidiary of Hartford HealthCare Corporation (HHC). HHC strives to provide compassionate care designed to deliver the necessary health services needed by the community. The Strategic Planning and Community Benefit Committee of the HHC Board of directors ensures the oversight for these services by each hospital community. In addition, HHC continues to take important steps toward achieving its vision of being "nationally respected for excellence in patient care and most trusted for personalized, coordinated care."HHC affiliation creates a strong integrated health care delivery system with a full continuum of care across a broader geographic area. This allows the small communities easy and expedient access to the more extensive and specialized services the larger hospitals are able to offer. This includes continuing education of health care professionals at all the affiliated institutions through the Center of Education, Simulation and Innovation located at Hartford Hospital, the flagship tertiary medical center.The affiliation further enhances the hospitals' abilities to support their missions, identity, and respective community roles. This is achieved through integrated planning and communication to meet the changing needs of the region. This includes responsible decision making and appropriate sharing of services, resources and technologies, as well as cost containment strategies. Reports Filed With States Part VI, Line 7 CT 0 0 0 0 0 0 0 1 0 David Whitehead 0 664686 0 0 0 389831 0 22000 0 17768 0 1094285 0 0 Stephen W Larcen 0 396648 0 161500 0 47349 0 102350 0 29039 0 736886 0 0 Carolyn Trantalis 183684 0 0 0 5170 0 11457 0 9923 0 210234 0 0 0 Martin L Levine 134797 0 0 0 2020 0 8635 0 27960 0 173412 0 0 0 Michael Dion 144170 0 0 0 5104 0 9051 0 24198 0 182523 0 0 0 Shawn Maynard 82921 0 0 0 517 0 5197 0 14104 0 102739 0 0 0 Kismatkumar Detroja 347731 0 1000 0 7541 0 13228 0 31142 0 400642 0 0 0 Robert Bundy 165000 250012 0 100 0 1773 0 10088 9577 25472 174577 287445 0 0 Anne B Lovejoy 203624 0 0 0 4536 0 12132 0 17628 0 237920 0 0 0 Melisha Cumberland 277656 0 0 0 47 0 0 0 30003 0 307706 0 0 0 Syera Mathews 199941 0 0 0 2962 0 6203 0 28918 0 238024 0 0 0 James N Papadakos 117070 0 0 0 2925 0 21682 0 17597 0 159274 0 0 0 Part I, Line 3 Hartford HealthCare Executive Compensation Committee approves CEO and other Executive compensation. See detailed explanation on Sch O. Part I, Line 7 The hospital has an At Risk Plan that encourages and rewards achievements of significant functional goals for management that contribute to organization(s) strategic and financial direction. The Plan utilizes market practice alignment to ensure competitive recruitment and retention. Awards are based on CEO and/or Hartford HealthCare Corporation's Compensation Committee discretionary assessment of overall organization performance and individual contribution to results. See Part V See Part V See Part V 0 Schedule L Part IV Business Transactions Involving Interested Persons: (a)Name of Person: Dr. Ethan Foxman(b)Relationship Between Interested Person and Organization: Board Member(c)Amount of Transactions: $743,846(d)Description of Transaction: Dr. Ethan Foxman is a board member of Windham Community Memorial Hospital, an affiliate of Hartford HealthCare Corporation (HHC). HHC has a professional services agreement with Jefferson Radiology P.C. where Dr. Foxman is a partner and serves as President & CEO. HHC paid Jefferson Radiology approximately $743,846 during the year. (e)Sharing of Organization's Revenue? No(a)Name of Person: Rheo Brouillard(b)Relationship Between Interested Person and Organization: Board Member(c)Amount of Transactions: $286,648(d)Description of Transaction: Rheo Brouillard is a board member at Windham Community Memorial Hospital. Mr. Brouillard is currently the President of the Savings Institute Bank & Trust. The bank does business with Windham Community Memorial Hospital. During the year, the Hospital paid the bank $286,648 worth of interest and principal payments on a an outstanding loan.(e)Sharing of Organization's Revenue? No Form 990, Part VI, Section A, line 6 Windham Hospital is organized as a non-stock not for profit entity. Hartford HealthCare Corporation is the sole member. Form 990, Part VI, Section A, line 7a The sole member of the organization has the authority to approve/remove members of the governing body. Form 990, Part VI, Section A, line 7b The sole member of the organization has the right to review, approve, disapprove and deny significant transactions such as mergers, acquisitions, dissolutions etc. Form 990, Part VI, Section B, line 11 The Form 990 was prepared by Hartford HealthCare's Tax Department. It was then reviewed by an independent accounting firm. It was then forwarded to the organization's top management including the CFO for review. The final Form was then sent to each member of the board for review. Once the entire review process was completed, the form was signed by the CEO and then filed with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The hospital's board has adopted the policy of the member, Hartford HealthCare Corporation (HHC). HHC's Conflict of Interest Policy (Policy) requires all covered individuals, including board members and officers, to provide a disclosure of relationships that create or have the appearance of creating a conflict of interest or commitment. The Policy requires updates if changes in circumstances arise during the year that either (a) create a new potential conflict of interest or commitment or (b) change or eliminate a conflict of interest or commitment previously disclosed. Conflict of Interest disclosure statements are maintained by the HHC Office of Compliance, Audit & Privacy (OCAP). All employee disclosures are reviewed by OCAP to determine if there is a potential conflict. Legal counsel will review all cases where the individual has a significant financial interest and these cases are forwarded to the System Executive Compliance Steering Committee. The System Executive Compliance Steering Committee will assess and may recommend 1) the conflict be eliminated, 2) the proposed activity be prohibited, or 3) a Conflict of Interest management plan be implemented. Results of the survey of board members are reported to the HHC Nominating and Governance Committee for determinations of conflicts and the management of them, where applicable. Form 990, Part VI, Section B, line 15 The Independent Executive Compensation Committee hires an outside consultant, Integrated Healthcare Strategies, to determine best practices in governing executive compensation for those employees who report directly to the CEO of Hartford HealthCare Corporation. The following steps are taken: - Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of Windham Community Memorial Hospital, established and regularly reviews Executive Compensation Philosophy - Committee regularly reviews scope and depth of positions taking into account complexity and the financial impact and accountability of all "disqualified persons" - National and regional peer groups are selected for comparative purposes based on organizational size, operating revenue, geography and other relevant factors - Analysis of current total compensation versus market performed by independent third party compensation consulting firm, reviewed by the committee - Recommendations made based on data analysis to ensure appropriate competitive positioning within parameters of compensation philosophy - CEO compensation determined by Committee based on comparative market information and organizational performance - All changes reviewed and approved by Executive Compensation Committee The CEO compensation determination process is reviewed on an annual basis. All other executive compensation are regularly reviewed for scope and depth of positions taking into account complexity and the financial impact and accountability. Form 990, Part VI, Section C, line 18 The Form 990, 990T and 1023 and its attachments are available for public inspection at the organization's address upon request. Form 990, Part VI, Section C, line 19 The organization's governing documents, financial statements and Conflict of Interest statements are also made available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: K-1 Adjustments 25,942. Change In Funding Status of Pension 34,385,130. Transfer From Hartford HealthCare Corp. 7,324,652. Transfer From Windham Foundation 199,393. Reference Testing UBIT 78,532. Organization's Financial Statements Part XII, Line 2 The organization's financial statements were audited by an independent accounting firm as part of a consolidated financial statement. In addition, the organization has a committee that assumes responsibility for oversight of the audit of its financial statements. Form 990 Part XII Line 3a & b Although the organization was not required to undergo A-133 Federal Audit, the results were included in a consolidated A-133 audit performed at the parent level Hartford HealthCare Corporation. Hartford Hospital 80 Seymour Street Hartford CT 06102 060646668 Healthcare Services CT 501(C)(3) 3 Hartford HealthCare Corporation 1 Windham Hospital Foundation Inc 112 Mansfield Avenue Willimantic CT 06226 562546632 Supporting Organization CT 501(C)(3) 11(A) Windham Community Memorial Hospital 1 Midstate Medical Center 435 Lewis Avenue Meriden CT 06451 060646715 Healthcare Services CT 501(C)(3) 3 Hartford HealthCare Corporation 1 Hartford HealthCare Corporation One State Street Suite 19 Hartford CT 06103 222672834 Support & Management Svcs.to HH and Affiliates CT 501(C)(3) 11(C) N/A 1 Natchaug Hospital Inc 189 Storrs Road Mansfield Ctr CT 06226 060966963 Behavioral Health CT 501(C)(3) 3 Hartford HealthCare Corporation 1 Hartford HealthCare At Home Inc 1290 Silas Deane Hwy Suite 4B Wethersfield CT 06109 060646938 Home Healthcare CT 501(C)(3) 7 Hartford HealthCare Corporation 1 Rushford Center Inc 883 Paddock Avenue Meriden CT 06450 060932875 Substance Abuse Healthcare Services CT 501(C)(3) 7 Hartford HealthCare Corporation 1 Hartford Hospital Auxiliary co Hartford Hospital 80 Seymour Street Hartford CT 06115 066040747 Fundraising CT 501(C)(3) 11(C) Hartford Hospital 1 Connecticut Health System Inc 80 Seymour Street Hartford CT 06102 222779421 Coordination of Health Care Delivery CT 501(C)(3) 11(C) N/A 1 Institute of Living 200 Retreat Avenue Hartford CT 06106 060646683 Supporting Organization to Hartford Hospital CT 501(C)(3) 11(C) Hartford HealthCare Corporation 1 VNA Health Resources Inc 1290 Silas Deane Hwy Suite 4B Wethersfield CT 06109 061161422 Home Healthcare CT 501(C)(3) 9 Hartford HealthCare Corporation 1 WCMH Women's Auxiliary Inc 112 Mansfield Avenue Willimantic CT 06226 060677728 Fundraising CT 501(C)(3) 11(A) Windham Community Memorial Hospital 1 The Hatch Hospital Corporation 112 Mansfield Avenue Willimantic CT 06226 066076412 Healthcare Services CT 501(C)(3) 3 Windham Community Memorial Hospital 1 The Hospital of Central CT and Bradley Memorial 100 Grand Street New Britain CT 06050 060646768 Healthcare Services CT 501(C)(3) 3 Hartford HealthCare Corporation 1 Central CT Senior Healh Svc dba Southington Care Center 45 Meriden Avenue Southington CT 06489 222635676 Sub-Acute & Long Term Healthcare CT 501(C)(3) 9 Hartford HealthCare Corporation 1 Bradley Health Services 100 Grand Street New Britain CT 06050 061367014 Healthcare Services CT 501(C)(3) 9 Hartford HealthCare Corporation 1 Central CT Health Alliance 100 Grand Street New Britain CT 06050 222785033 Support & Management Svcs. To THOCC and Affiliates - Shell CT 501(C)(3) 11(B) Hartford HealthCare Corporation 1 Rushford Foundation Inc 883 Paddock Avenue Meriden CT 06450 061432692 Supporting Organization CT 501(C)(3) 11(A) Rushford Center Inc 1 The Orchards of Southington 34 Hobart Street Southington CT 06489 061490803 Residential Services for Senior Care CT 501(C)(3) 9 Central CT Senior Health Services Inc 1 Mulberry Gardens of Southington LLC 58 Mulberry Street Plantsville CT 06479 820586577 Assisted Living & Adult Day Care Facility CT 501(C)(3) 9 Central CT Senior Health Services Inc 1 Midstate Medical Center Auxiliary 435 Lewis Avenue Meriden CT 06451 066063082 Fundraising CT 501(C)(3) 3 Midstate Medical Center 1 HHC PhysiciansCare Inc 80 Seymour Street Hartford CT 06102 454456939 Practice Medicine and Provide Health Care Services to the Public CT 501(C)(3) 9 Hartford HealthCare Corporation 1 Hartford HealthCare Accountable Care Org Inc 200 Retreat Avenue Fl 9 Hartford CT 06102 460886367 To Manage and Coordinate Care for Medicare Beneficiares CT 501(C)(3) HHC PhysiciansCare Inc 1 Hartford HealthCare Corp Group (VEBA) 777 Main Street Hartford CT 06102 266671355 To Provide Medical Benefits to Employees CT 501(C)(9) N/A Hartford HealthCare Corporation 1 Backus Corporation 326 Washington Street Norwich CT 06360 222757608 Support CT 501(C)(3) 11(B) Hartford HealthCare Corporation 1 The William W Backus Hospital 326 Washington Street Norwich CT 06360 060250773 Support CT 501(C)(3) 3 Hartford HealthCare Corporation 1 Backus HealthCare Inc 326 Washington Street Norwich CT 06360 222481794 Support CT 501(C)(3) 11(A) Hartford HealthCare Corporation 1 New Britain MRI Limited Partnership 100 Grand Street New Britain CT 06050 061271349 Magnetic Resonance Imaging CT N/A Hartford HealthCare Endowment LLC 80 Seymour Street Hartford CT 06102 454181103 Endowment Management CT 55472 1906098 0 0 0.00260 Ambulance Service of Manchester LLC PO Box 300 Manchester CT 06450 061557358 Ambulatory Services CT N/A Connecticut Imaging Partners LLC 111 Founders Plaza East Hartford CT 06108 134298940 Imaging Services CT N/A Glastonbury Endoscopy Center LLC 300 Western Blvd Suite B Glastonbury CT 06033 261721234 Endoscopy Services CT N/A Glastonbury Surgery Center LLC 195 Eastern Boulevard Glastonbury CT 06033 262600828 Surgery Services CT N/A Hartford-Middlesex Clinical System LLC 80 Seymour Street Hartford CT 06110 061543605 Affiliate Support Services CT N/A Med-East Assoc LLC 1703 West Main Street Willimantic CT 06226 061469575 Outpatient Care Clinic CT N/A Related -24589 278400 0 0 0.50000 Omni Home Health Services E CTLLC 12 Case Street 317 Norwich CT 06360 061458837 Home Health Care CT N/A Windham Health Services Inc 112 Mansfield Avenue Willimantic CT 06226 061461101 Home Healthcare CT Windham Community Memorial Hospital C -250 152638 1.00000 1 HHMOB Corporation & Subsidiary 80 Seymour Street Hartford CT 06102 061140244 Real Estate Parking CT N/A C 1 CHS Insurance LTD 40 Church Street Hamilton BD Captive Insurance BD N/A C 1 Windham Physician Hospital Organization 112 Mansfield Avenue Willimantic CT 06226 061441614 Medical Services CT Windham Community Memorial Hospital C -1087 65633 0.50000 1 Windham Family Medical Services 112 Mansfield Avenue Willimantic CT 06226 061491649 Medical Services CT Windham Community Memorial Hospital C 1 CenConn Services Inc 100 Grand Street New Britain CT 06050 222836001 Holding Company CT N/A C 1 Grand Indemnity Co LTD FB Perry Building 40 Church Street Hamilton BD 980609499 Professional Liability BD N/A C 1 Hartford Physician Services PC 80 Seymour Street Hartford CT 06102 061254082 Medical Services CT N/A C 1 Meriden Imaging Center 101 North Plains Industrial Road Meriden CT 06429 061541468 Imaging CT N/A S 1 Hartford Physician Hospital Organization Inc 80 Seymour Street Hartford CT 06102 222785918 Physician & Hospital Support CT N/A C 1 Aetna Ambulance Service Inc PO BOX 1150 Manchester CT 06045 060795431 Ambulance Services CT N/A 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Rehabilitation Network LLC M 223617 FMV Natchaug Hospital A 15547 FMV Natchaug Hospital O 71366 FMV