2013-08-13T11:17:25-05:00 2012-09-30 060903326 WHITTLESEY & HADLEY PC 147 CHARTER OAK AVE HARTFORD CT 061065100 990 2011-10-01 060653151 ROCKVILLE GENERAL HOSPITAL ROCK 8606461222 31 UNION STREET ROCKVILLE CT 06066 MICHAEL D VEILLETTE 8606461222 2013-08-13 ROBERT W MCCALL P00592560 8605223111 2011 2016-02-25 16:41:14Z MICHAEL D VEILLETTE 31 UNION STREET ROCKVILLE CT 06066 74581064 0 X WWW.ECHN.ORG X 1921 CT ROCKVILLE GERNERAL HOSPITAL IS A 102 BED HOSPITAL OFFERING VARIOUS HEALTHCARE SERVICES TO ALL MEMBERS OF THE COMMUNITY, INCLUDING THE INDIGENT AND UNDERSERVED. 22 20 615 128 892045 0 968143 663448 66490894 73307595 442844 495855 -596128 83143 67305753 74550041 0 0 0 0 38374407 40311117 0 0 0 29606237 33696814 67980644 74007931 -674891 542110 82393533 79868772 53376169 58553761 29017364 21315011 X ROCKVILLE GENERAL HOSPITAL IS A 102 BED HOSPITAL OFFERING VARIOUS HEALTHCARE SERVICES TO ALL MEMBERS OF THE COMMUNITY, INCLUDING THE INDIGENT AND UNDERSERVED. 0 0 14042160 32214661 INPATIENT SERVICES - ROCKVILLE GENERAL HOSPITAL OFFERS COMPREHENSIVE MEDICAL SERVICES IN A 102 BED ACCUTE CARE COMMUNITY HOSPITAL, WITH A TOTAL OF 2519 INPATIENTS TREATED IN FISCAL YEAR 2012. SERVICES ARE OFFERED TO THE COMMUNITY, REGARDLESS OF ANY INDIVIDUALS ABILITY TO PAY. 5091840 4911206 RADIOLOGY - A WIDE RANGE OF IMAGING DIAGNOSTIC AND TREATMENT SERVICES IS OFFERED, INCLUDING X-RAYS, CT, MRI, PET, ULTRASOUND, NUCLEAR MEDICINE, AND MAMMOGRAPHY. 6424997 17426143 EMERGENCY DEPARTMENT - EMERGENCY CARE IS OFFERED 24 HOURS PER DAY, AND PROVIDES NEEDED EMERGENCY MEDICAL CARE TO THE COMMUNITY, REGARDLESS OF ANY INDIVIDUALS ABILITY TO PAY. 37374137 17926726 SEE SCHEDULE H, PART VI 37374137 17926726 62933134 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 174 0 1 615 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 22 20 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X JAMES RAY 8606461222 71 HAYNES STREET MANCHESTER CT 06040 DENNIS O'NEILL MD 1.00 X X 0 0 0 ROBIN MURDOCK MEGGERS 1.00 X X 0 0 0 MICHELE CONLON MD 1.00 X X 0 0 0 CRAIG LAPPEN 1.00 X X 0 0 0 PAUL BERTE 1.00 X 0 0 0 GORON BRODIE MD 1.00 X 0 0 0 GLORIA BROOKS 1.00 X 0 0 0 THOMASINA CLEMONS 1.00 X 0 0 0 ANTHONY DISTEFANO MD 1.00 X 0 0 0 MILTON DOREMUS 1.00 X 0 0 0 JOY DORIN 1.00 X 0 0 0 DAVID ENGELSON 1.00 X 0 0 0 DAVID GONCI 1.00 X 0 0 0 JEFFREY HEIDTMAN 1.00 X 0 0 0 REBECCA JANENDA 1.00 X 0 0 0 JOSEPH JEAMEL JR 1.00 X 0 0 0 CLAUDIO MILITE MD 1.00 X 0 0 0 PETER MULLIGAN 1.00 X 0 0 0 ROSEMARIE PAPA 1.00 X 0 0 0 THOMAS SCANLON 1.00 X 0 0 0 WILSON VEGA 1.00 X 0 0 0 LENORA WILLIAMS MD 1.00 X 0 0 0 PETER J KARL 37.50 X 0 766216 125567 KEVIN G MURPHY 37.50 X 0 435547 77082 MICHAEL D VEILLETTE 37.50 X 0 301364 51959 DEBORAH GOGLIETTINO 37.50 X 0 281288 47022 DENNIS MCCONVILLE 37.50 X 0 258851 37601 DEBORAH PARKER 37.50 X 0 267792 51529 JOEL REICH MD 37.50 X 0 388378 49746 CHARLES COVIN 37.50 X 0 208398 20047 LEONA CROSSKEY 37.50 X 0 183913 23753 KATHLEEN SIMS 37.50 X 0 211111 31762 ROBERT CARROLL MD 37.50 X 0 388212 37540 CAROLYN MCKENNA 37.50 X 0 107944 8609 DAVID NEUHAUS MD 37.50 X 290240 0 10538 ELLEN G NEUHAUS MD 37.50 X 208610 0 25591 PAMELA LORD 37.50 X 123172 0 17428 SALVATORE NAPOLITANO 37.50 X 124726 0 3741 KATHLEEN RYAN 37.50 X 135152 0 11556 881900 3799014 631071 22 1 1 0 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LABORATORY 1603029 CONNECTICUT HOSPITAL ASSOCIATION PO BOX 90 WALLINGFORD CT 06492 VARIOUS SERVICES 509319 ALLIANCE HEALTHCARE SERVICES INC PO BOX 96485 CHICAGO IL 60693 RADIOLOGY 383184 PATHOLOGY & LABORATORY SERVICES LLC 11 RESEARCH DR 4 WOODBRIDGE CT 06525 PATHOLOGY SERVICES 245333 HEALOGICS WOUND CARE & HYPERBARIC SERVIC 3087 MOMENTUM PLACE CHICAGO IL 60689 WOUND SERVICES 234903 5 345288 318160 663448 PATIENT SERVICES REVEN 900099 67847638 67847638 OTHER HEALTHCARE REVEN 621500 5459957 4567912 892045 73307595 495855 495855 51430 31023 20407 20407 CAFETERIA REVENUE 722210 242697 242697 NON-OPERATING GAIN/LOS 621500 -179961 -179961 62736 74550041 72478286 892045 516262 30268404 25728143 4540261 1726119 1467201 258918 6552372 5569516 982856 1764222 1499589 264633 356436 356436 3300572 1980343 1320229 36824 36824 132562 66281 66281 114152 57076 57076 1729940 1470449 259491 3342 2841 501 15394 13085 2309 719106 719106 3811952 2287171 1524781 1757862 1494183 263679 MEDICAL SUPPLIES 11345950 11345950 ECHN ALLOCATION 3862268 3282928 579340 BAD DEBT 3309948 3309948 PHYSICIAN FEES 2427226 2427226 773280 212098 561182 74007931 62933134 11074797 0 4739455 1463822 10246785 10959584 1576971 1519666 270651 218800 93619303 63146530 31151850 30472773 16854373 20261427 17553448 14972700 82393533 79868772 4898569 5969615 25775116 24199518 1332509 1466237 21369975 26918391 53376169 58553761 X 24688727 17066097 912532 615748 3416105 3633166 29017364 21315011 82393533 79868772 X 542110 -8244463 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13293 13293 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE CONNECTICUT HOSPITAL ASSOCIATION (CHA) HAS DETERMINED THAT FOR ITS FISCAL YEAR ENDING APRIL 30,2012 THAT 8% OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES. THE TOTAL LOBBYING PORTION FROM CHA FOR ROCKVILLE GENERAL HOSPITAL WAS $8,747. THE AMERICAN HOSPITAL ASSOCIATION (AHA) HAS INDICATED THAT 25% OF 2012 DUES WERE USED FOR LOBBYING PURPOSES.THE TOTAL LOBBYING PORTION FROM AHA FOR ROCKVILLE GENERAL HOSPITAL WAS $4,546. 9113580 1593536 10707116 9026890 86690 9113580 8595357 8524 423119 110 9026890 9683898 -1088541 8595357 0.84000 0.12000 0.04000 0 1 1 1152087 1152087 46922917 20189205 26733712 1458506 460312 998194 43997511 42497013 1500498 88282 88282 30472773 DUE FROM AFFILIATES 3401900 INTEREST IN NET ACCESS OF ECHN COMMUNITY HEALTH CARE FOUNDATION 3254583 OTHER, NET 831619 BOND INDENTURES 931964 BENEFICIAL INTEREST IN TRUST ASSETS 2104303 ESTIMATED SETTLEMENTS DUE FROM THIRD PARTY PAYORS 853555 CURRENT PORTION OF ASSETS WHOSE USE IS LIMITED 467223 INVESTMENTS IN JOINT VENTURES 3127553 14972700 ESTIMATED SELF INSURANCE 3307458 ACCRUED PENSION BENEFITS 17147802 CURRENT POSTRETIREMENT BENEFITS 1164039 CONDITIONAL ASSET RETIREMENT OBLIGATION 128578 DUE TO AFFILIATED ENTITIES 3297171 ESTIMATED SRTTLEMENT DUE TO 3RD PARTY PAYORS 1157913 OTHER CURRENT LIABILITIES 715430 26918391 74550041 74007931 542110 3532935 -11777398 -8244463 -7702353 66336601 3532935 -11777398 -8244463 74581064 -31023 -31023 74550041 74038954 31023 31023 74007931 0 74007931 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE PRINCIPAL AND INCOME FROM THE UNRESTRICTED ENDOWMENT FUNDS AND THE INCOME FROM THE TERM ENDOWMENTS ARE FOR CAPITAL AND OPERATING NEEDS OF ROCKVILLE GENERAL HOSPITAL. THE INCOME FROM THE PERMANENT ENDOWMENTS AND PRINCIPAL FROM THE TERM ENDOWMENTS ARE FOR THE USE OF ROCKVILLE GENERAL HOSPITAL AS RESTRICTED BY THE DONORS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH PROVISIONS OF FASB ASC 740,"INCOME TAXES" WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. THE HOSPITAL MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2012 AND 2011. AS OF SEPTEMBER 30, 2012 AND 2011, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL TRUST ASSETS 217,061. CHANGE IN ACCRUED PENSION AND POST RETIREMENT -3,804,398. TRANSFERS TO AFFILIATES, NET -8,190,061. TOTAL TO SCHEDULE D, PART XI, LINE 8: -11,777,398. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL TRUST ASSETS 217,061. CHANGE IN ACCRUED PENSION AND POST RETIREMENT -3,804,398. TRANSFERS TO AFFILIATES -8,190,061. PART XII, LINE 4B - OTHER ADJUSTMENTS: COST OF GOODS SOLD - GIFT SHOP -31,023. PART XIII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD - GIFT SHOP 31,023. 1 1 X 1 X 125.000000000000 1 X 1 0 1 1 1026 747729 5645 742084 0.01180 14094 10464938 6833581 3631357 0.05790 15120 11212667 6839226 4373441 0.06970 14 40751 1170622 1170622 0.01870 7 183 285701 285701 0.00460 1 8604 8604 0.00010 5 700 35611 35611 0.00060 27 41634 1500538 1500538 0.02400 27 56754 12713205 6839226 5873979 0.09370 0 0 1 0 342 342 0.00000 3 83 1770 1770 0.00000 0 0 0 0 0 0 0 0 3 103 1132 1132 0.00000 0 0 7 186 3244 3244 1 3309948 2192753 19857848 23069217 -3211369 X 1 1 1 NORTHEAST REGIONAL RADIATION ONCOLOGY NETWORK INC ONCOLOGY SERVICES 0.25000 2 TOLLAND IMAGING CENTER MEDICAL IMAGING SERVICES 0.35000 1 1 ROCKVILLE GENERAL HOSPITAL

31 UNION STREET VERNON CT 06066

X X X X ROCKVILLE GENERAL HOSPITAL 1 1 1 125.000000000000 1 400.000000000000 1 X X X 1 1 X X X X 1 0 1 X 0 0 PART II: AS PART OF EASTERN CONNECTICUT HEALTH NETWORK, ROCKVILLE GENERAL HOSPITAL (RGH) PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY COMMITTING THE EXPERTISE AND RESOURCES OF THE ORGANIZATION TO A NUMBER OF COMMUNITY BUILDING ACTIVITIES THAT SUPPORT ASSOCIATIONS, BUSINESSES, PROGRAMS, INITIATIVES AND OTHER VALUABLE LOCAL COMMUNITY ASSETS. EFFORTS INCLUDE SUPPORTING THE ANNUAL FOOD DRIVE AND YOUTH GROUP OF THE HOCKANUM VALLEY COMMUNITY COUNCIL, A HUMAN SERVICES AGENCY IN VERNON; SERVING ON THE ROTARY CLUB OF ROCKVILLE, WHICH WORKS TO ADDRESS MANY HUNGER, HEALTH, AND HUMANITY ISSUES IN THE TOWNS OF VERNON, TOLLAND AND ELLINGTON; HOSTING ART EXHIBITS OF THE VERNON ART ASSOCIATION; AND PARTNERING WITH THE LOCAL SCHOOL SYSTEM TO SUPPORT THE SCHOOL TO BUSINESS AND ALLIED HEALTH WORKFORCE DEVELOPMENT PROGRAMS AT ROCKVILLE HIGH SCHOOL. ROCKVILLE GENERAL HOSPITAL PART V, SECTION B, LINE 11H: FAMILY SIZE IS USED WITH INCOME LEVEL. ROCKVILLE GENERAL HOSPITAL PART V, SECTION B, LINE 19D: CHARGES ARE UNIFORMALLY SET FOR ALL PATIENTS REGARDLESS OF PAYOR, AND CHARITY CARE DISCOUNT IS APPLIED BASED ON INCOME. PART VI, LINE 2: ROCKVILLE GENERAL HOSPITAL, AS PART OF THE EASTERN CONNECTICUT HEALTH NETWORK, CONDUCTS A REGULAR COMMUNITY HEALTH NEEDS ASSESSMENT TO GATHER CURRENT STATISTICS AND QUALITATIVE INPUT TO DETERMINE THE KEY HEALTH ISSUES FACING RESIDENTS OF ITS 19-TOWN SERVICE AREA. THE ASSESSMENT IS COMPRISED OF TWO RESEARCH COMPONENTS: 1. A SECONDARY DATA PROFILE, WHICH COLLECTS DATA FROM COMMUNITY, CIVIC AND SOCIAL SERVICE AGENCIES TO DEPICT THE DEMOGRAPHICS, MORBIDITY AND MORTALITY STATISTICS AND HEALTH INDICATORSWITHIN THE SERVICES AREA. 2, PRIMARY STATISTICAL RESEARCH USING THE CENTER FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) TOOL. THE MOST RECENT ASSESSMENT WAS CONDUCTED IN 2010 AND IDENTIFIED SPECIFIC AREAS OF NEED, WHICH HAVE BEEN USED TO DEVELOP TARGETED COMMUNITY BENEFIT AND EDUCATION PROGRAMS AND INITIATIVES THROUGHOUT THE ORGANIZATION.WITH THE SUPPORT OF A COMMUNITY PROGRAM ADVISORY COMMITTEE, CONSISTING OF MEDICAL STAFF LEADERSHIP AND ECHN ADMINISTRATION, THE ORGANIZATIONS COMMUNITY BENEFIT & EDUCATION DEPARTMENT EVALUATES, COORDINATES AND IMPLEMENTS PROGRAMS TO ADDRESS THESE NEEDS. EFFORTS INCLUDE FREE HEALTH EDUCATION LECTURES PRESENTED BY THE MEDICAL STAFF, HEALTH SCREENINGS, HEALTH FAIR PARTICIPATION, AND SUPPORT GROUPS.COMMUNITY HEALTH NEEDS ARE ALSO IDENTIFIED THROUGH REGULAR SOLICITATION OF THE GENERAL PUBLIC AND THEMEDICAL COMMUNITY TO IDENTIFY PERTINENT HEALTH NEEDS THEY FEEL NEED TO BE ADDRESSED. PART VI, LINE 4: ROCKVILLE GENERAL HOSPITAL, PART OF THE EASTERN CONNECTICUT HEALTH NETWORK, PRIMARILY SERVES THE FOLLOWING TOWNS LOCATED EAST OF THE CONNECTICUT RIVER IN NORTHERN CONNECTICUT: VERNON, ELLINGTON,TOLLAND, WILLINGTON, MANCHESTER, SOUTH WINDSOR, BOLTON, COVENTRY AND ANDOVER. ITS SECONDARY SERVICE AREA INCLUDES THE TOWNS OF ASHFORD, SOMERS, STAFFORD, UNION, EAST HARTFORD, EAST WINDSOR, GLASTONBURY,HEBRON, COLUMBIA AND MANSFIELD. THE SERVICE AREAS CONTAIN MUNICIPALITIES IN HARTFORD, TOLLAND AND WINDHAM COUNTIES.BASED ON DATA COLLECTED IN 2010, THE POPULATION OF THE RGH/ECHN SERVICE AREA IS OVER 328,000; 49 PERCENT MALE, 51 PERCENT FEMALE. RESIDENTS BETWEEN 45 AND 64 YEARS OF AGE REPRESENT THE HIGHEST PERCENTAGE OF THE POPULATION (28%), FOLLOWED BY RESIDENTS BETWEEN 25 AND 44 YEARS OF AGE (26%) AND OVER THE AGE OF 65 YEARS OF AGE (18%). THE RACE OF THE RESIDENTS IS PREDOMINANTLY WHITE (83%) FOLLOWED BY BLACK/AFRICAN AMERICAN (7.5) AND HISPANIC OR LATINO (7%).EIGHTY-SEVEN PERCENT OF THE POPULATION AGE 25 AND OVER HAVE A HIGH SCHOOL DEGREE AND 32 PERCENT HAVE A BACHELORS DEGREE OR HIGHER. THE MEDIAN HOUSEHOLD INCOME FOR THE SERVICE AREA IS $71,280.SEVEN PERCENT OF HOUSEHOLDS HAVE ANNUAL INCOME LESSTHAN $15,000.THE UNEMPLOYMENT RATE IS 2.6%. PART VI, LINE 5: COMMUNITY HEALTH EDUCATION INITIATIVES/PROGRAMS ARE OFFERED TO THE COMMUNITY AND INCLUDE LECTURE PRESENTATIONS, DEVELOPMENT AND DISTRIBUTION OF A WELLNESS MAGAZINE TO MORE THAN 150,000 HOUSEHOLDS IN THE SERVICE AREA, DEMONSTRATIONS, AND HEALTH FAIR PARTICIPATION. AREAS OF PARTICULAR FOCUS INCLUDE: ARTHRITIS, BREAST HEALTH, CARDIOVASCULAR DISEASE, CHOLESTEROL AWARENESS, COLORECTAL CANCER, DIABETES, HYPERTENSION AWARENESS, LYME DISEASE AND PRE-NATAL CARE, WHICH WERE IDENTIFIED AS AREAS OF NEED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2010. MORE THAN 40,000 PEOPLE BENEFITTED FROM THESE SERVICES IN FY 12.FREE HEALTH SCREENINGS INCLUDING DIABETIC FOOT CHECKS, PROSTATE AND SKIN CANCER SCREENINGS, MAMMOGRAMS, BLOOD PRESSURE, STROKE SCREENINGS, VITAL SIGN CHECKS AND MEDICAL EXAMS ARE OFFERED IN THE COMMUNITY. TARGETING UNINSURED/UNDERINSURED POPULATIONS, 493 PEOPLE BENEFITTED FROM THESE SERVICES IN FY 12.HEALTHCARE SUPPORT SERVICES ARE PROVIDED BY THE HOSPITAL TO INCREASE ACCESS AND QUALITY OF CARE TO INDIVIDUALS IN NEED. EFFORTS INCLUDE REFERRALS TO SOCIAL SERVICES AND PHYSICIANS ACCEPTING MEDICAID OR OTHER GOVERNMENT PROGRAMS, FREE LIFELINE PERSONAL RESPONSE SYSTEM SERVICE. 63 PEOPLE BENEFITTED FROM THESE EFFORTS IN FY 12.PARTNERING WITH LOCAL EDUCATIONAL INSTITUTIONS, MANCHESTER MEMORIAL HOSPITAL PROVIDES A CLINICAL SETTING FOR PHYSICIANS, NURSES, RADIOLOGIC TECHNICIANS, RESPIRATORY TECHNICIANS AND PHYSICAL THERAPISTS AND OTHERSFROM THE UNIVERSITY OF NEW ENGLAND COLLEGE OF OSTEOPATHIC MEDICINE, UNIVERSITY OF CONNECTICUT, CENTRAL CONNECTICUT STATE UNIVERSITY, CAPITAL COMMUNITY COLLEGE, QUINNIPIAC UNIVERSITY AND UNIVERSITY OF HARTFORD.SPECIFIC RESEARCH INITIATIVES CONDUCTED BY THE HOSPITAL INCLUDE AN INSTITUTIONAL REVIEW COMMITTEE.FINANCIAL AND IN-KIND SERVICES AND GOODS ARE DONATED TO COMMUNITY GROUPS AND OTHER NOT FOR PROFIT ORGANIZATIONS INCLUDING PATIENT MEALS, LOCAL FUNDRAISERS, FACILITY SPACE TO HOST FIVE BLOOD DRIVES AND 10 HEALTH SUPPORT GROUP ORGANIZATIONS MEETINGS. PART VI, LINE 6: ROCKVILLE GENERAL HOSPITAL (RGH) IS AN AFFILIATE OF EASTERN CONNECTICUT HEALTH NETWORK (ECHN). THE ECHN NETWORK OF AFFILIATES INCLUDES:RGH, A COMMUNITY HOSPITAL LICENSED FOR 102 BEDS, THAT OFFERS MEDICAL AND SURGICAL SERVICES, 24-HOUR EMERGENCY CARE, MEDICAL IMAGING, CARDIAC & PULMONARY REHABILITATION, PHYSICAL REHABILITATION, HOSPICE CARE, A MATERNITY CARE CENTER FOR UNINSURED WOMEN, OUTPATIENT ADOLESCENT BEHAVIORAL HEALTH SERVICES, AND LABORATORY SERVICES.MANCHESTER MEMORIAL HOSPITAL, A COMMUNITY HOSPITAL LICENSED FOR 249 BEDS AND 34 BASSINETS, THAT OFFERS MEDICAL AND SURGICAL SERVICES, 24-HOUR EMERGENCY CARE, MEDICAL IMAGING, A MODERN FAMILY BIRTHING CENTER AND NEONATOLOGY SERVICES, REHABILITATION SERVICES, A CERTIFIED SLEEP DISORDERS CENTER, INTENSIVE CARE SUITES, A WOUND HEALING CENTER WITH HYPERBARIC THERAPY, HOSPICE CARE, DIABETES SELF-MANAGEMENT PROGRAM, CARDIAC & PULMONARY REHABILITATION, A COMPREHENSIVE RANGE OF ADOLESCENT AND ADULT INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES, NUTRITION COUNSELING, LABORATORY SERVICES, AND THE EASTERN CONNECTICUT CANCER INSTITUTE AT THE JOHN A. DEQUATTRO CANCER CENTER.WOODLAKE AT TOLLAND SKILLED NURSING & REHABILITATION CENTER, A 130-BED LONG-TERM SKILLED NURSING CARE AND SHORT-TERM REHABILITATION FACILITY. CUSTOMIZED REHABILITATION TREATMENT SERVICES INCLUDE JOINT REPLACEMENT REHABILITATION, ORTHOPEDIC POST-HOSPITAL CARE, STROKE/NEUROLOGICAL REHAB, POSTMEDICAL/ SURGICAL RECONDITIONING, AND PERSONALIZED, PROGRESSIVE, AND INTERDISCIPLINARY CARE SERVICES.EASTERN CONNECTICUT MEDICAL PROFESSIONALS (ECMP) FOUNDATION, INC., A MULTI-SPECIALTY PHYSICIAN GROUP PRACTICE THAT OFFERS A FULL RANGE OF HEALTHCARE SERVICES, INCLUDING PRIMARY AND SPECIALTY CARE IN THE TOWNS OF EAST HARTFORD, ELLINGTON, MANCHESTER, SOMERS, SOUTH WINDSOR, TOLLAND, AND VERNON/ROCKVILLE. ADDITIONAL INFORMATION THE ROCKVILLE GENERAL HOSPITAL, INC. IS A NOT-FOR-PROFIT 102-BED ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF VERNON-ROCKVILLE, CT AND SURROUNDING TOWNS. THE HOSPITAL IS A SUBSIDIARY OF THE EASTERN CONNECTICUT HEALTH NETWORK, INC., WHICH WAS FORMED IN 1995 BY A MERGER OF MMH CORP. AND ROCKVILLE AREA HEALTH SERVICES, INC. ECHN WAS ORGANIZED TO PROVIDE A BROADER HEALTH CARE SYSTEM FOR THE SURROUNDING COMMUNITIES WITH QUALITY MEDICAL CARE AT A REASONABLE COST AND TO FOSTER AN ENVIRONMENT CONDUCIVE TO HEALTH AND WELL BEING WHETHER IN THE HOME OR IN THE COMMUNITY.ROCKVILLE GENERAL HOSPITAL PATIENTS NOT HAVING INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY QUALIFIED CARE (UNINSURED PATIENTS), AS WELL AS UNDERINSURED PATIENTS, SUBJECT TO INCOME LIMITS AND FAMILY SIZE RECEIVE FREE OR DISCOUNTED CARE. ROCKVILLE GENERAL HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. CHARGES FOR CARE PROVIDED TO PATIENTS ARE DETERMINED BY ESTABLISHED RATES, SUBJECT TO POSSIBLE ADJUSTMENTS OR DISCOUNTS FOR LOW INCOME PATIENTS; CONTRACTUAL DISCOUNTS, OR DISCOUNTS FOR PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES. CHARITY CARE FOR FY 2012 WAS $2,192,753 FOR 1026 APPROVED APPLICANTS. EXPENSES RELATED TO SERVICES PERFORMED FOR PATIENTS OF ROCKVILLE GENERAL HOSPITAL CONTRIBUTE IMPORTANTLY TO ITS EXEMPT PURPOSE BECAUSE THE EXPENSES ARE INCURRED IN THE DIAGNOSIS, CURE, MITIGATION, TREATMENT AND PREVENTION OF DISEASE, AND FOR MEDICAL PURPOSES AFFECTING THE STRUCTURE OR FUNCTION OF THE HUMAN BODY.ROCKVILLE GENERAL HOSPITAL PROVIDED NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF ANY INDIVIDUALS ABILITY TO PAY. TWO THOUSAND FIVE HUNDRED NINTEEN (2,519) INPATIENTS WERE CARED FOR IN FY12 REPRESENTING 13,056 PATIENT DAYS. ONE HUNDRED FIVE THOUSAND FOUR HUNDRED FIFTY THREE (105,453) OUTPATIENT VISITS WERE RECORDED.INCLUDED IN THE 2,519 INPATIENTS WERE 1,998 GOVERNMENT RELATED PATIENTS. THE GOVERNMENT INPATIENTS FALL INTO THE FOLLOWING GROUPS.MEDICARE 1,309 MEDICARE MANAGED CARE 346MEDICAID 252MEDICAID MANAGED CARE 18CHAMPUS 63TOTAL GOV PATIENTS 1,852TOTAL NON GOV PATIENTS 531TOTAL PATIENTS 2,519INCLUDED IN THE 105,453 OUTPATIENT VISITS THE FOLLOWING WERE GOVERNMENT RELATED. THE VISITS ARE A PRODUCT OF GROSS REVENUE RELATIONSHIP TO TOTAL VISITS.MEDICARE 20,478MEDICARE MANAGED CARE 6,269MEDICAID 16,683MEDICAID MANAGED CARE 2,670CHAMPUS 2,976TOTAL GOV PATIENTS 49,076TOTAL NON GOV PATIENTS 56,377TOTAL OUTPATIENT VISITS 105,453THE HOSPITAL PROVIDED UNCOMPENSATED CARE TO 14,094 MEDICAID PATIENTS FOR A NET COMMUNITY BENEFIT AMOUNT OF $3,631,357 AFTER MEDICAID REIMBURSEMENT. ADDITIONAL INFORMATION REGARDING PROGRAMS FOR THE COMMUNITY AT RGH: COMMUNITY HEALTH IMPROVEMENT SERVICES (A) COMMUNITY HEALTH EDUCATION (A1) 40,195 $ 108,900 COMMUNITY BASED CLINICAL SERVICES (A2) 493 $1,000,090 HEALTH CARE SUPPORT SERVICES (A3) 63 $ 718**** COMMUNITY HEALTH IMPROVEMENT SERVICES 40,751 $1,109,708HEALTH PROFESSIONS EDUCATION (B) PHYSICIANS/MEDICAL STUDENTS (B1) 5 $ 87,437 NURSES/NURSING STUDENTS (B2) 65 $ 161,766 OTHER HEALTH PROFESSIONAL EDUCATION (B3) 113 $ 36,498**** HEALTH PROFESSIONS EDUCATION 183 $ 285,701RESEARCH (D) OTHER RESEARCH (D3) 0 $ 8,604**** RESEARCH 0 $ 8,604FINANCIAL AND IN-KIND CONTRIBUTIONS (E) CASH DONATIONS (E1) 0 $ 13,857 IN-KIND DONATIONS (E3) 700 $ 21,754**** FINANCIAL AND IN-KIND CONTRIBUTIONS 700 $ 35,611COMMUNITY BUILDING ACTIVITIES (F) ECONOMIC DEVELOPMENT (F2) 0 $ 342 COMMUNITY SUPPORT (F3) 83 $ 1,770 WORKFORCE DEVELOPMENT (F8) 103 $ 1,132**** COMMUNITY BUILDING ACTIVITIES 186 $ 3,244COMMUNITY BENEFIT OPERATIONS (G) DEDICATED STAFF (G1) 0 $ 60,914**** COMMUNITY BENEFIT OPERATIONS 0 $ 60,914FINANCIAL ASSISTANCE FINANCIAL ASSISTANCE 1,026 $ 742,084**** FINANCIAL ASSISTANCE 1,026 $ 742,084GOVERNMENT SPONSORED HEALTH CARE MEDICAID 14,094 $3,631,357**** GOVERNMENT SPONSORED HEALTH CARE 14,094 $3,631,357TOTALS - COMMUNITY BENEFIT 56,940 $5,877,223GRAND TOTALS 56,940 $5,877,223 REPORTS FILED WITH STATES PART VI, LINE 7 CT X X X X X 0 1 0 0 0 1 1 0 0 PETER J KARL 0 560216 0 206000 0 0 0 103459 0 22108 0 891783 0 0 KEVIN G MURPHY 0 351064 0 84483 0 0 0 52124 0 24958 0 512629 0 0 MICHAEL D VEILLETTE 0 233486 0 67878 0 0 0 32701 0 19258 0 353323 0 0 DEBORAH GOGLIETTINO 0 232603 0 48685 0 0 0 31939 0 15083 0 328310 0 0 DENNIS MCCONVILLE 0 207451 0 51400 0 0 0 22062 0 15539 0 296452 0 0 DEBORAH PARKER 0 220350 0 47442 0 0 0 30078 0 21451 0 319321 0 0 JOEL REICH MD 0 323358 0 65020 0 0 0 34478 0 15268 0 438124 0 0 CHARLES COVIN 0 179710 0 28688 0 0 0 5548 0 14499 0 228445 0 0 LEONA CROSSKEY 0 153009 0 30904 0 0 0 4875 0 18878 0 207666 0 0 KATHLEEN SIMS 0 181487 0 29624 0 0 0 11978 0 19784 0 242873 0 0 ROBERT CARROLL MD 0 383712 0 4500 0 0 0 17738 0 19802 0 425752 0 0 CAROLYN MCKENNA 0 62142 0 45802 0 0 0 1585 0 7024 0 116553 0 0 DAVID NEUHAUS MD 290240 0 0 0 0 0 9338 0 1200 0 300778 0 0 0 ELLEN G NEUHAUS MD 208610 0 0 0 0 0 5795 0 19796 0 234201 0 0 0 PART I, LINE 3 THE BOARD OF TRUSTEES (THE "BOARD") APPOINTS AN EXECUTIVE COMPENSATION COMMITTEE (THE "COMMITTEE") AND HAS DELEGATED THE RESPONSIBILITY OF COMPLETING AN ANNUAL MARKET ANALYSIS OF THE CEOS COMPENSATION AND OTHER SENIOR EXECUTIVES AND COMPLETION OF THE CEOS ANNUAL PERFORMANCE REVIEW. THE EVALUATION OF THE CEO IS AN IMPORTANT RESPONSIBILITY OF THE BOARD AND IS CRITICAL TO THE GOVERNANCE RESPONSIBILITIES OF THE BOARD. THE EXECUTIVE COMPENSATION COMMITTEE SOLICITS FEEDBACK ABOUT THE PERFORMANCE OF THE CEO FROM EVERY ACTIVE BOARD MEMBER WHICH WHEN RECEIVED IS ANALYZED AND REVIEWED BY THE MEMBERS OF THE COMMITTEE. THE CEO COMPLETES A SELF- EVALUATION AND AN EVALUATION FOR ALL ELIGIBLE MEMBERS OF THE SENIOR LEADERSHIP TEAM, WHO COMPLETE BOTH A SELF-EVALUATION AND A PEER EVALUATION. THE RESULTS OF THE ASSESSMENTS COMPLETED BY MEMBERS OF THE SENIOR LEADERSHIP TEAM ARE REVIEWED BY THE CEO WHO DISCUSSES THE RESULTS WITH THE MEMBERS OF THE COMMITTEE ON AN ANNUAL BASIS. THE EXECUTIVE COMPENSATION COMMITTEE IN COLLABORATION WITH THE CEO EVALUATES AND APPROVES ORGANIZATIONAL PERFORMANCE OBJECTIVES BOTH ON AN ANNUAL AND LONG TERM BASIS AND FOCUSES ON THOSE GOALS WITH THE GREATEST IMPACT TO THE ORGANIZATIONS STRATEGY AND MISSION. THE COMMITTEE ENSURES AN ANNUAL REVIEW OF THE CEOS PERFORMANCE IN RELATION TO THESE GOALS; REVIEWS THE TALLY SHEETS TO UNDERSTAND THE ECONOMICS OF THE EMPLOYEE BENEFITS; RETAINS AND ENSURES THE INDEPENDENCE OF ITS EXTERNAL CONSULTANTS AND ADVISORS AND INVOLVES RELEVANT ORGANIZATIONAL RESOURCES AS APPROPRIATE TO CARRY OUT ITS RESPONSIBILITIES. THE COMMITTEE ENSURES TRANSPARENCY AND DISCLOSURE TO THE BOARD BY PRESENTING THE RESULTS OF THE ANNUAL PERFORMANCE AND MARKET REVIEWS PROVIDING THE BOARD WITH THE OPPORTUNITY FOR FURTHER INPUT AND CONSIDERATION AND ASKING THAT THE BOARD TAKE ACTION ON THE RECOMMENDATION OF THE COMMITTEE IF THE RECOMMENDATION IS APPROPRIATE. THE BOARD HAS THE OPPORTUNITY TO CHANGE ANY RECOMMENDATIONS OF THE COMMITTEE IF IT SO DESIRES. MEMBERS OF THE BOARD AND OF THE COMMITTEE WHO MAY BE INTERESTED PARTIES ARE ASKED TO RECUSE THEMSELVES FROM ANY REQUIRED VOTES TO AVOID CONFLICTS OF INTEREST. THE COMMITTEE ENSURES THAT THE PROCESS MEETS COMPLIANCE STANDARDS. PART I, LINE 4B PETER KARL - $77,249 KEVIN MURPHY - $35,201 MICHAEL VEILLETTE - $17,626 DEBORAH GOGLIETTINO - $17,625 DEBORAH PARKER - $15,814 DENNIS MCCONVILLE - $15,421 JOEL REICH - $24,383 PART I, LINE 6 THE ECHN EXECUTIVE INCENTIVE COMPENSATION PLAN IS A PLAN THAT HAS BEEN DEVELOPED, REVIEWED AND IS ANNUALLY APPROVED BY MEMBERS OF THE BOARD EXECUTIVE COMPENSATION COMMITTEE WITH CONSULTANT THIRD PARTY OVERSIGHT. THE PLAN ESTABLISHES GOALS IN 4 AREAS OF PERFORMANCE: SYSTEM- WIDE FINANCIAL PERFORMANCE BASED ON PROFIT FROM OPERATIONS, TWO QUALITY OUTCOMES IN CLINICAL CORE MEASURES AND PATIENT SATISFACTION AND AN INDIVIDUAL GOAL FOR EACH MEMBER OF THE INCENTIVE PROGRAM MEMBERS OF THE INCENTIVE PROGRAM INCLUDE THE FOLLOWING: POSITION TITLE - KEY EMPLOYEE NAME PRESIDENT AND CEO - PETER J. KARL EVP, TREASURER - KEVIN G. MURPHY SVP, CHIEF FINANCIAL OFFICER - MICHAEL D. VEILLETTE SVP, HUMAN RESOURCES - DEBORAH GOGLIETTINO SVP, STRATEGIC PLANNING - DENNIS MCCONVILLE SVP, PATIENT CARE SERVICES - DEBORAH PARKER SVP, MEDICAL AFFAIRS - JOEL REICH, M.D. VP AND CIO - CHARLES COVIN VP QUALITY - LEONA CROSSKEY VP, OPERATIONS - KATHERINE SIMS MED. DIR. EMERGENCY DEPARTMENT - ROBERT CARROLL, M.D. STATE OF CONNECTICUT HEALTH & EDL FACS AUTH REV SERIES E 060806186 20774U5W1 2010-12-21 20145000 REDEEM PRIOR ISSUE AND FUND INTEREST RATE SWAP TERMINATION PAYMENTS 0 0 0 STATE OF CONNECTICUT HEALTH & EDL FACS AUTH REV SERIES C 060806186 20774UAZ8 2005-11-09 37579404 ADVANCE REFUND AND DEFEASE A PORTION OF THE SERIES 2000A BONDS. 0 0 0 STATE OF CONNECTICUT HEALTH & EDL FACS AUTH REV SERIES D 060806186 NONEAVAIL 2009-05-14 15250000 WOODLAKE EXPANSION, EQUIPMENT PURCHASE, PRIOR ISSUE REFUND. 0 0 0 20145000 1065002 17048821 402900 92225 1536052 2011 1 0 1 1 37579404 3556957 32759288 632013 631146 2006 0 1 1 1 15250000 9966919 305000 4978081 2009 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 0 0 0 0 0 1 0 1 1 TD BANK 5.000000000000 0 0 0 0 1 DR DENNIS O'NEILL RGH TRUSTEE OWNING MORE THAN 5% OF P.C.; 20% SHARE 209715 ECPC, PC PROVIDES PATHOLOGY SERVICES AND LAB MANAGEMENT SERVICES TO MMH; PAYMENTS REPORTED REPRESENT TOTAL BY RGH. 0 DR MICHELE CONLON RGH TRUSTEE OWNING MORE THAN 5% OF P.C.; 20% SHARE 209715 ECPC, PC PROVIDES PATHOLOGY SERVICES AND LAB MANAGEMENT SERVICES TO MMH; PAYMENTS REPORTED REPRESENT TOTAL BY RGH. 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS DENNIS O'NEILL AND MICHELE CONLON ARE BUSINESS PARTNERS. FORM 990, PART VI, SECTION A, LINE 7A CORPORATORS HAVE THE AUTHORITY TO ELECT BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B CORPORATORS HAVE THE AUTHORITY TO VOTE ON SIGNIFICANT ISSUES. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO THE FILING THE 990, THE FOLLOWING STEPS ARE TAKEN: 1) THE DIRECTOR OF ACCOUNTING AND TAXATION, TOGETHER WITH OTHER MEMBERS OF THE FINANCE DEPARTMENT, CONDUCT A REVIEW OF THE 990 ALONG WITH A REVIEW AND RECONCILATION OF THE 990 TO THE AUDITED FINANCIAL STATEMENTS; 2) DIRECTOR OF ACCOUNTING AND TAXATION CONDUCTS AN EXTENSIVE REVIEW AND DISCUSSION OF THE 990 WITH THE CPA FIRM THAT PREPARES THE RETURN; 3) AN ELECTRONIC COPY OF THE 990 IS MADE AVAILABLE TO THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES (THE GOVERNING BOARD), AND SENIOR MANAGEMENT OF THE ORGANIZATION, FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CORPORATE COMPLIANCE/INTERNAL AUDIT DEPARTMENT PROVIDES TO OFFICERS, DIRECTORS, OR TRUSTEES AND KEY EMPLOYEES THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND DISCLOSURE STATEMENT, AND EACH INDIVIDUAL IS REQUIRED TO RETURN TO THE DEPARTMENT, A SIGNED DOCUMENT, ACKNOWLEDGING RECEIPT OF THE POLICY AND DISCLOSURE STATEMENT AND DISCLOSE ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. A SUMMARY OF THE DISCLOSURES IS SHARED WITH THE CHAIRMAN OF THE BOARD OF TRUSTEES AND WITH THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD. INDIVIDUALS WHO ARE IDENTIFIED AS HAVING A CONFLICT OF INTEREST ARE PROHIBITED IN PARTICIPATING IN THE GOVERNING BODIES DELIBERATIONS AND DECISIONS RELATED TO THE TRANSACTION. THE RETURNED STATEMENTS ARE RETAINED BY THE CORPORATE COMPLIANCE/INTERNAL AUDIT DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE TAKES THE FOLLOWING STEPS WITH AN INDEPENDENT COMPENSATION CONSULTANT (1) REVIEWS DATA RELATED TO CURRENT MARKET VALUES CONSISTENT FOR ORGANIZATIONS EXECUTIVES BY REVIEW OF COMPENSATION LEVELS AND PLANS CONSISTENT WITH HOSPITALS AND HEALTH SYSTEMS OF COMPARABLE SIZE AND LOCATION; (2) COMPLETES A REVIEW OF DATA ON CURRENT AND FUTURE PLANS FOR THE ORGANIZATION, INCLUDING STRUCTURE AND JOB DESCRIPTIONS; (3) REVIEWS AND APPROVES AND RECOMMEND SALARY RANGES FOR EACH POSITION, ALONG WITH RELATED BENEFITS; (4) REVIEWS AND APPROVES A TIERED EXECUTIVE STRUCTURE WITH APPROPRIATE INCENTIVE OPPORTUNITY, BENEFITS, AND COMPENSATION; FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION, WILL, UPON REQUEST, ALLOW FOR REVIEW OF OUR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND MOST RECENT ANNUAL AUDITED FINANCIAL STATEMENTS AT AN OFFICE OF THE ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 3,532,935. CHANGE IN BENEFICIAL TRUST ASSETS 217,061. CHANGE IN ACCRUED PENSION AND POST RETIREMENT -3,804,398. TRANSFERS TO AFFILIATES, NET -8,190,061. TOTAL TO FORM 990, PART XI, LINE 5: -8,244,463. EASTERN CONNECTICUT HEALTH NETWORK 71 HAYNES STREET MANCHESTER CT 06040 222546079 INTEGRATED HEALTHCARE SYSTEM CT 501(C)3 170(B)(1)(A) 0 MANCHESTER MEMORIAL HOSPITAL 71 HAYNES STREET MANCHESTER CT 06040 060646710 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) 0 ECHN COMMUNITY HEALTHCARE FOUNDATION INC 71 HAYNES STREET MANCHESTER CT 06040 222546080 FUNDRAISING CT 501(C)3 170(B)(1)(A) 0 ECHN ELDERCARE SERVICES INC 26 SHENIPSIT LAKE ROAD TOLLAND CT 06084 061149193 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) 0 EASTERN CONNECTICUT MEDICAL PROFESSIONAL FOUNDATION INC 71 HAYNES STREET MANCHESTER CT 06040 222546079 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) 0 VISITING NURSE & HEALTH SERVICES OF CT INC 8 KEYNOTE DRIVE VERNON CT 06066 060646795 SKILLED HEALTHCARE SERVICES CT 501(C)3 170(B)(1)(A) 0 ECHN ENTERPRISES INC 71 HAYNES STREET MANCHESTER CT 06040 222546828 REAL ESTATE HOLDING CT C 100 100 1.00000 HAYNES STREET PROPERTY MANAGEMENT LLC 71 HAYNES STREET MANCHESTER CT 06040 222546028 REAL ESTATE PROPERTY MANAGEMENT CT C 100 100 1.00000 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0