2012-08-14T06:50:01-05:00 2011-09-30 SASLOW LUFKIN & BUGGY LLP TEN TOWER LANE AVON CT 06001 990 2010-10-01 060646768 THE HOSPITAL OF CENTRAL CONNECTICUT HOSP 8602245900 100 GRAND STREET NEW BRITAIN CT 06050 CLARENCE J SILVIA 8602245900 2012-08-07 1 Beth Thurz 8606789200 2010 2016-02-24 21:20:13Z CLARENCE J SILVIA 100 GRAND STREET NEW BRITAIN CT 06050 397611132 0 X WWW.THOCC.ORG X 1893 CT HCC'S MISSION IS TO FOSTER, SUSTAIN AND IMPROVE THE HEALTH STATUS OF THE PEOPLE IN THE COMMUNITIES WE SERVE. 20 13 3175 434 3183128 0 3693619 2983328 374951028 388490564 7880077 1783908 2647941 2826098 389172665 396083898 0 0 0 0 198282289 205409513 12000 17800 904025 182370011 163198089 380664300 368625402 8508365 27458496 337017403 374049690 203037088 208172025 133980315 165877665 X THE HOSPITAL OF CENTRAL CONNECTICUT ("HCC") REFLECTS THE COMBINED TALENT, RESOURCES, AND CAPABILITIES OF NEW BRITAIN GENERAL HOSPITAL AND BRADLEY MEMORIAL HOSPITAL. IT IS A 414-BED ACUTE CARE TEACHING HOSPITAL AFFILIATED WITH THE UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE AND SERVES AS THE PRIMARY REFERRAL CENTER FOR THE CENTRAL CONNECTICUT REGION, SERVING A POPULATION OF 250,000. AS A FULL-SERVICE HOSPITAL, THE HOSPITAL OF CENTRAL CONNECTICUT OFFERS MANY CLINICAL SERVICES THAT ARE RECOGNIZED FOR THEIR COMPREHENSIVENESS AND EXCELLENCE. THEY INCLUDE: THE GEORGE BRAY CANCER CENTER; THE WOLFSON PALLIATIVE CARE PROGRAM; THE JOSLIN CENTER FOR DIABETES AT THE HOSPITAL OF CENTRAL CONNECTICUT; THE WOUND CARE CENTER; THE FAMILY BIRTHPLACE; CRITICAL CARE SERVICES, AND THE SLEEP DISORDERS CENTER. 1 0 38843227 86668962 THE INPATIENT MEDICAL, SURGICAL AND INTENSIVE CARE SERVICE AREAS SERVED 18,061 WITH TOTAL PATIENT DAYS OF 70,771. 73% AND 60% OF THE NEW BRITAIN AND SOUTHINGTON COMMUNITY NEEDS ARE RESPECTIVELY MET WITH THESE SERVICES. THE AREAS OF SPECIALTY INCLUDE STROKE SERVICES, BARIATRIC CARE, JOINT REPLACEMENT AND DIABETES. 22906399 49110524 TOTAL PATIENT VISITS FOR BOTH EMERGENCY ROOMS WERE OVER 109,000. THIS WAS AN INCREASE OF 3,140 PATIENTS OR 3% FROM THE PREVIOUS YEAR. THE VOLUMES WERE APPROXIMATELY 90,000 AND 19,000 AT THE NBG AND BRADLEY MEMORIAL CAMPUSES RESPECTIVELY. ADDITIONAL STAFFING AND IMPROVEMENTS TO OUR WORK FLOW PROCESSES HAVE BEEN IMPLEMENTED IN ORDER TO MEET THE DEMANDS OF OUR INCREASING PATIENT VOLUMES. THE EMERGENCY ROOM OF THE HOSPITAL OF CENTRAL CONNECTICUT HAS CONTINUED TO RANK IN THE 90TH PERCENTILE FOR CUSTOMER SATISFACTION. 37563291 52286328 RADIOLOGY-DERIVED INFORMATION IS AN INTEGRAL COMPONENT OF OUR PATIENTS' CARE CONTINUUM. AS IMAGING TECHNOLOGY CONTINUED TO EVOLVE IN 2011, THE RADIOLOGY DEPARTMENT AT THE HOSPITAL OF CENTRAL CONNECTICUT WAS POSITIONED CENTER-STAGE, COLLABORATING WITH PHYSICIANS TO PROVIDE THE EXAMINATIONS THAT PRODUCED OPTIMAL CLINICAL OUTCOMES. MOREOVER, DOSE-REDUCTION STRATEGIES, ALWAYS A FOCUS, WERE AFFORDED EVEN GREATER ATTENTION IN 2011 WITH THE CONVENING OF A MULTI-DISCIPLINARY TEAM OF RADIOLOGISTS, PHYSICISTS, PHYSICIANS OF VARIOUS SUB-SPECIALTIES, TECHNOLOGISTS, AND ADMINISTRATIVE REPRESENTATION. THE IMAGING SERVICES AREA HAS ADDED NEW TECHNOLOGY TO PROVIDE A CENTRAL POINT OF ACCESS FOR OUR PATIENTS. OVER 164,000 IMAGING EXAMS WERE PERFORMED AT THE NEW BRITAIN AND BRADLEY MEMORIAL CAMPUSES. OF THESE, MORE THAN 70% WERE PERFORMED ON OUTPATIENTS. WHILE THERE WAS AN OSTENSIBLE 2% OVERALL DECLINE IN IMAGING EXAMS IN FY2011 VS. THE PRIOR YEAR, A CHANGE IN CPT CODING REQUIREMENTS ACCOUNTED FOR NEARLY THE ENTIRE 2% OBSERVED YEAR-TO-YEAR DIFFERENCE. 230916265 197516639 OTHER ROUTINE SERVICES SUCH AS LABORATORY, MATERNITY, NEWBORN, PSYCHIATRIC AND PEDIATRIC AND ANCILLARY SERVICES PROVIDED TO PATIENTS. 230916265 197516639 330229182 1 1 0 1 0 0 0 0 1 1 1 0 0 1 0 1 1 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 274 0 1 3175 1 1 1 1 CA BD UK 0 0 0 0 0 0 0 0 X 20 13 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 CT X RALPH BECKER 8602245900 389 JOHN DOWNEY DRIVE NEW BRITAIN CT 060512924 X LAURENCE A TANNER 0.50 X X 0 1007618 112404 CLARENCE J SILVIA 50.00 X X 2253336 117409 409121 JOHN W ANDREOLI JR MD 1.50 X 47000 0 0 FRANK R MILLER 2.00 X 0 0 0 EDWARD P TOFFOLON MD 4.00 X 16255 0 0 MARIE S GUSTIN PHD 2.00 X 0 0 0 LINDSLEY WELLMAN 1.70 X 0 0 0 CONNIE W COLLINS 1.00 X 0 0 0 JOHN E DILLAWAY 1.50 X X 0 0 0 JOHN S MANNING 2.50 X X 0 0 0 ANTHONY CIARDELLA MD 2.00 X 30000 0 0 JOSEPH R CRISPINO 2.50 X 0 0 0 DANIEL DAIGLE 1.00 X 0 0 0 JOHN J PATRICK JR 0.50 X 0 0 0 DENNIS J STANEKJR 1.00 X 0 0 0 ROBERT A LAPKIN MD 1.50 X 147605 0 0 BARBARA R MACKAY 2.00 X 0 0 0 WILLIAM W WEBER 1.50 X X 0 0 0 LETTERIO ASCIUTO MD 1.50 X 20000 0 0 REV THOMAS A MILLS JR 2.00 X 0 0 0 ANNETTE B SALINA 1.00 X 0 0 0 BRIAN A ROGOZ 50.00 X 348020 0 65289 STEVEN D HANKS MD 50.00 X 570856 0 165889 ELIZABETH A LYNCH 50.00 X 367876 0 82950 JOYCE HAWRYLIK 40.00 X 60550 0 21089 STEVEN A GODFREY 50.00 X 260110 0 114177 MAUREEN FITZSIMMONS 50.00 X 152586 0 27016 NANCY KROEBER 50.00 X 119187 0 61453 DENISE PETERSON 50.00 X 166412 0 30623 JEFFREY A FINKELSTEIN MD 50.00 X 380593 0 153221 MICHAEL BALKUNAS MD 50.00 X 312316 0 149957 MICHAEL GREY MD 50.00 X 369592 0 105461 JAMES L MASSI MD 50.00 X 285627 0 39459 FRANCIS H PINTO 50.00 X 196857 0 111354 ANTOINETTA CAPRIGLIONE MD 32.00 X 347467 0 125556 ELIZABETH SCHLAFF 50.00 X 182972 0 62254 HAKLAI P LAU MD 50.00 X 446859 0 53719 JAMES F FLAHERTY 50.00 X 367114 0 54815 MICHELLE MCDADE 50.00 X 342335 0 49039 RONALD G CLARK 50.00 X 337279 0 52072 RENE HIPONA 50.00 X 334802 0 97002 8463606 1125027 2143920 234 0 1 0 ACS CONSULTANT CO INC DEPT 1135401 PO BOX 67000 DETROIT MI 482671354 INFORMATION SERVICES 20531370 UCONN HEALTH CENTER FARMINGTON AVE FARMINGTON CT 060301915 RESIDENCE SERVICES 5562064 CERNER CORPORATION 2702 ROCKCREEK PARKWAY KANSAS CITY MO 64117 INFORMATION SYSTEMS 5122884 DOWNES CONSTRUCTION COMPANY LLC 200 STANLEY STREET PO BOX 727 NEW BRITAIN CT 06050 CONSTRUCTION SERVICES 3626484 MRI OF NEW BRITAIN 40 HART ST NEW BRITAIN CT 06050 MRI SERVICES 3343653 226 114157 785899 2083272 2983328 PATIENT SERVICE REVENU 900099 345627998 345627998 LABORATORY SERVICES 621500 37688466 34608491 3079975 OTHER PATIENT SERVICE 900099 5174100 5174100 388490564 1750831 1750831 1413047 1168766 244281 244281 -33727 278008 45071 23644 20860 14778 24211 8866 33077 33077 136060 114157 104122 31938 31938 403194 218708 184486 184486 DIETARY/ CAFETERIA 722210 1636029 1636029 CHILD CARE INCOME 624410 450092 29472 420620 OUTSIDE SERVICES 518210 279272 171864 107408 2365393 396083898 385582453 3183128 4334989 8878311 8878311 145950025 137878404 7655836 415785 10842136 10831897 10239 29083849 26482000 2601849 10655192 9808936 813662 32594 745022 20463 724559 567309 567309 17800 17800 32953620 28975787 3977833 1341500 1129543 211957 66144811 63953980 2190831 15646075 13174084 2471991 8666078 7294461 1371617 691193 581985 109208 206375 173768 32607 870864 733268 137596 18679688 14350645 4329043 7024537 6911456 113081 DIETARY 2923690 2463524 460166 BAD DEBT 2389422 2389422 RECRUITMENT 1167029 982638 184391 DUES 1027099 864817 162282 TRAINING & EDUCATION 898107 756206 141901 1255670 471898 345926 437846 368625402 330229182 37492195 904025 X 23662582 17548741 10398 0 36543623 48945018 211274 65580 4904577 5642776 3335302 4287847 413039974 260274904 125427098 152765070 128465902 128888836 8752634 8643214 5704013 7262608 337017403 374049690 25218831 23363595 339220 434859 30545000 35743805 7562096 6983052 139371941 141646714 203037088 208172025 X 97047576 129061862 16296477 16726765 20636262 20089038 133980315 165877665 337017403 374049690 X 27458496 4438854 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 41206 0 0 0 41206 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: CENTRAL CT HEALTH ALLIANCE, THE PARENT COMPANY OF THE HOSPITAL OF CENTRAL CONNECTICUT, ENGAGED THE FIRM OF GAFFNEY BENNETT ASSOCIATES TO LOBBY ON ITS BEHALF. PAYMENTS TO GAFFNEY BENNETT WERE $57,500. CCHA ALSO ENGAGED THE FIRM OF KOZAK & SALINA TO LOBBY ON ITS BEHALF. PAYMENTS TOTALED $29,500. THE HOSPITAL OF CENTRAL CONNECTICUT IS ALSO A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE CONNECTICUT HOSPITAL ASSOCIATION WHO ENGAGE IN LOBBYING AND ADVOCACY EFFORTS ON BEHALF OF ITS MEMBERS. 128449477 2086374 -2356272 1687950 126491629 115483988 2672254 11693366 1400131 128449477 110529502 2235178 4211109 1491801 115483988 0.70860 0.15880 0.13260 1 0 1130776 5007483 6138259 7504979 213178978 116014595 104669362 200978 4259828 2394476 2066330 475691 173482737 137687400 36271028 7798524 4178433 3620091 152765070 FUNDS HELD IN TRUST BY OTHERS 13488598 F MUTUAL FUNDS 106402592 F CURRENT ASSETS WHOSE USE IS LIMITED 2397202 F PERMANENTLY RESTRICTED INVESTMENTS 6600444 F 128888836 DUE TO THIRD PARTIES 21951248 PENSION PLAN AND SELF INSURANCE LIABILITY 105133129 ACCRUED COMPENSATION 12301012 DUE TO (FROM) AFFILIATES -371339 OTHER LIABILITIES 2632664 141646714 396083898 368625402 27458496 -3325286 7764140 4438854 31897350 392623636 -994407 -994407 393618043 2465855 2465855 396083898 368303332 0 368303332 322070 322070 368625402 Description of Intended Use of Endowment Funds: Part V, Line 4: THE TEMPORARY AND PERMANENTLY RESTRICTED ENDOWMENTS ARE RESTRICTED BASED ON THE DONOR'S REQUEST. THE OTHER BOARD DESIGNATED ENDOWMENTS ARE INTENDED TO SUPPORT THE HOSPITAL'S FUTURE NEEDS IN PROVIDING HEALTH CARE SERVICES TO THE COMMUNITY. Part XI, Line 8 - Other Adjustments: CHANGE IN ASSETS HELD IN TRUST BY OTHERS -547,224. PENSION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS -14,071,226. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -1,742,303. CHANGE IN BEGINNING BALANCE OF AUXILIARY NET WORTH 867. FIXED ASSET FAIR VALUE ADJUSTMENT 24,394,080. EARLY EXTINGUISHMENT OF DEBT -270,054. Part XII, Line 2d - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS 747,896. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -1,742,303. Part XII, Line 4b - Other Adjustments: CONTRIBUTIONS 1,878,379. AUXILIARY SPECIAL EVENTS- GOLF TOURNAMENT AND BALL 135,095. AUXILIARY GIFT STORE INCOME 184,486. AUXILIARY FASHION SHOWS 11,000. INVESTMENT INCOME- TEMP RESTRICTED 256,895. Part XIII, Line 4b - Other Adjustments: AUXILIARY EXPENSES 322,070. 1 THE GIVING COLLABORATIVE LLC 53 Morgan Avenue East Haven CT 06512 FEASIBILITY STUDY FOR NEW CANCER CENTER CAMPAIGN 0 0 17800 -17800 17800 -17800 GOLF TOURNAMENTS 119429 70429 49000 0 8999 13662 10105 0 3595 CHRYSANTHEMUM BALL 107125 39775 67350 0 1336 0 43794 3050 6919 1 23663 3953 19710 0 252 12138 0 250 22 250217 114157 136060 10587 25800 53899 3300 10536 104122 31938 1 1 1 X 250.000000000000 1 X 1 1 1 0 0 18597 4153793 1550356 2603437 0.00710 861 72399751 56800617 15599134 0.04260 0 0 0 19458 76553544 58350973 18202571 0.04970 67 13966 1206526 31509 1175017 0.00320 14 816 10877542 2859635 8017907 0.02190 0 0 0 0 1 0 338712 0 338712 0.00090 4 190 17221 0 17221 0.00000 86 14972 12440001 2891144 9548857 0.02600 86 34430 88993545 61242117 27751428 0.07570 0 3192427 123084 99163004 97726959 1436045 X 1 0 1 Total Laundry Collaborative LLC Laundry Services 0.37000 3 New Britain Alliance Occupational Health Occupational Health Services 0.86000 0.14000 4 Central CT Sports Medicine LLC Sports Medicine Provider 0.50000 5 New Britain MRI LP Magnetic Resonance Imaging 0.43000 6 Central CT Endoscopy Center LLC Endoscopy Services 0.06500 0.50000 2 1 Hospital of Central CT- New Britain Cam

100 Grand Steet New Britain CT 06050

X X X X 2 Hospital of Central CT- Bradley Campus

81 Meriden Ave Southington CT 06489

X X X X Hospital of Central Connecticut 2 4 New Britain MRI Limited Partnership

100 Grand Street New Britain CT 06050

Magnetic Resonance Imaging Services Central Connecticut Endoscopy Center

440 New Britain Avenue Plainville CT 06062

Endoscopy Services New Britain Occupational Health

440 New Britain Avenue Plainville CT 06062

Occupational Health Services Central Connecticut Sports Medicine Cent

15 Massirio Drive Berlin CT 06037

Sports Medicine Provider/Rehabilitation Facility Part I, Line 3c: HCC uses Federal Poverty Guidelines to determine eligibility. Part I, Line 7: Charity care is at Cost. Cost to charge ratio was derived from Worksheet 2, Ratio of Patient Care Cost to Charges.In FY11/TY10 a process was initiated to allocate uncollected patient accounts as Charity Care. This was allowable for purposes of the audited financial statement. However, upon completing the Schedule H it became apparent that this practice is not allowable within those requirements. These accounts were then sent to Search America for review of income, asset status and credit rating. It was then decided that accounts with family incomes of 250% of the FPG would be accepted as Charity Care. This follows the Hospital's Financial Assistance Policy guidelines for Charity Care income levels as reported in Part I, Line 3a of the Schedule H. The remainder of the accounts were then classified as Bad Debt. These are the numbers reported on this Schedule. The practice of allocating uncollectable accounts to Charity Care is no longer conducted. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 2389422. Part I, Line 6a: The Hospital of Central Connecticut does not prepare an annual community benefit report. Part II: For the FY11 tax year, The Hospital of Central Connecticut did not conduct any community building activities and primarily focused on both community health programs, in addition to health professions education. Part III, Line 4: There is no Footnote for Bad Debt Expense included in the Financial Statements. Part III, Line 8: The costing methodology used for bad debt expense was based on the Financial Services - Calculation of Ratio of Patient Care Costs to Charges worksheet, which is provided in the Lyon's CBISA Online (Community Benefits) software program. Part III, Line 9b: The Bad Debt Guideline states the following:The Pre-List Exception Report (FFR385) is produced during the last week of the month to identify all accounts eligible for transfer to Bad Debt, but have the following exceptions and will not transfer:- Account Balance is not completely the patient's responsibility- Account has a credit balance- Account Balance is $5,000 and greaterThe Pre List Exception Report is reviewed by collection staff for:- Alternative sources of payment- Potential Free Bed/Charity Care applicant- Resolution of balance transfer problemsThe collection agency is responsible to provide the hospitals free bed/charity care summary with each collection notice (PA 3-266). If a patient contacts either the hospital or collection agency to apply for such funds, the collection agency is responsible to stop collection activity until notified by the hospital of the outcome of application.Self-pay admissions that are not collectable through standard practices are referred to an outside agency that acts on our behalf to establish Medicaid eligibility. If they are unsuccessful in establishing Medicaid eligibility and can establish payment arrangements with the patient, they retain the account. These accounts are also placed in Bad Debt on the last day of the month when referred to the outside agency. Part VI, Line 2: Planning is underway for The Hospital of Central Connecticut's needs assessment to occur in 2012. Part VI, Line 3: The Hospital of Central Connecticut disseminates information about its Financial Assistance Policy as follows: (i) provide signage regarding this 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 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: The Hospital of Central Connecticut (HCC) serves primarily the communities located in greater New Britain and the surrounding towns including Berlin, Plainville and Southington, with some coverage of Bristol, Burlington, Cheshire, Cromwell, Farmington, Meriden, Newington and West Hartford. The total population in HCC's service area is 441,300 as defined by CERC town profiles for 2010. The most prominent race is Caucasian at about 84% of the total population which has been declining as the Hispanic population has grown to approximately 12% of the total 12 town primary and sub-service areas. Within HCC's primary service area of Berlin, Plainville, New Britain and Southington, the Hispanic population counts for 16%. The population in HCC's service area is older than the US and CT as a whole with approximately 16% in the over 65 category in some of the primary towns. The median household income in HCC's communities varies significantly, averaging $72,000 with 18.7% of NB's population living beneath the federal poverty level. Part VI, Line 6: The Hospital of Central Connecticut (HCC) is responsive to the community by having a completely open medical staff and a board of trustees with diverse membership that reflects the community at large. HCC is a Disproportionate Share Hospital with one of the highest rates of Medicaid patients in the state. We provide space for the Medicare Choices program to help community members select the Medicare programs that are best for them. We have a full graduate medical education program for physician training with UCONN, and also provide training for nursing and allied health students, including a specialty echosonographer program. HCC is a major sponsor of the New Britain Health Academy, a program that exposes local high school students to careers in the healthcare field. Presented in partnership with other community organizations, the Academy offers students an opportunity to learn about the types of jobs available, and facilitates contact with healthcare professionals who can guide program participants. As we have in the past, in FY 2011 we sponsored a community service organization fair where area not-for-profits are invited to the hospital to share with HCC's community about their mission and purpose. In addition, various hospital staff members and departments support community events on an ongoing basis, as well as frequent monetary and in-kind donations to area organizations in need. On a related note, HCC also participates in the Medical Legal Partnership Program. This program recognizes that there are many issues that may affect children and families seeking health care that are not specifically healthcare problems. These include landlord tenant and housing issues. The program helps healthcare providers' direct families to resources that can assist with these issues. Among our outreach services is our Mothers Offering Mothers Support (M.O.M.S.) program, a weekly support program for mothers 21 years old and under. Program leaders are women who were also young mothers and now are helping others. And, The Hospital of Central Connecticut has a program in which indigent patients who are being discharged from the hospital who do not have prescription drug coverage receive dosages of their prescribed medications to help them recover and comply with treatment guidelines and to reduce readmission rates. Part VI, Line 7: The Hospital of Central Connecticut is an Affiliate 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 largest of the system hospitals. 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 X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 LAURENCE A TANNER 0 324502 0 41804 0 641312 0 83102 0 29302 0 1120022 0 388366 CLARENCE J SILVIA 491610 76955 29250 2000 1732476 38454 309629 73595 25805 92 2588770 191096 1719039 0 BRIAN A ROGOZ 255764 0 24990 0 67266 0 46045 0 19244 0 413309 0 48234 0 STEVEN D HANKS MD 459778 0 25600 0 85478 0 141663 0 24226 0 736745 0 0 0 ELIZABETH A LYNCH 255652 0 25000 0 87224 0 75188 0 7762 0 450826 0 31500 0 STEVEN A GODFREY 186407 0 12299 0 61404 0 90775 0 23402 0 374287 0 43386 0 MAUREEN FITZSIMMONS 132500 0 20000 0 86 0 19879 0 7137 0 179602 0 0 0 NANCY KROEBER 113230 0 4875 0 1082 0 43438 0 18015 0 180640 0 0 0 DENISE PETERSON 164412 0 2000 0 0 0 9221 0 21402 0 197035 0 0 0 JEFFREY A FINKELSTEIN MD 333125 0 41402 0 6066 0 96805 0 56416 0 533814 0 0 0 MICHAEL BALKUNAS MD 297381 0 14935 0 0 0 96081 0 53876 0 462273 0 0 0 MICHAEL GREY MD 308487 0 52913 0 8192 0 72292 0 33169 0 475053 0 0 0 JAMES L MASSI MD 272012 0 13615 0 0 0 29820 0 9639 0 325086 0 0 0 FRANCIS H PINTO 187257 0 9600 0 0 0 61039 0 50315 0 308211 0 0 0 ANTOINETTA CAPRIGLIONE MD 298087 0 14976 0 34404 0 91570 0 33986 0 473023 0 2528 0 ELIZABETH SCHLAFF 176400 0 6572 0 0 0 32844 0 29410 0 245226 0 0 0 HAKLAI P LAU MD 250000 0 160957 0 35902 0 29493 0 24226 0 500578 0 0 0 JAMES F FLAHERTY 344630 0 22484 0 0 0 25404 0 29411 0 421929 0 0 0 MICHELLE MCDADE 257966 0 77824 0 6545 0 25880 0 23159 0 391374 0 0 0 RONALD G CLARK 257966 0 78120 0 1193 0 26806 0 25266 0 389351 0 0 0 RENE HIPONA 294017 0 39633 0 1152 0 39102 0 57900 0 431804 0 0 0 Part I, Line 1a "GROSS-UPS" ON A CASH BENEFIT PAID TO THE CEO EQUAL TO THE ANNUAL MAXIMUM 403(B) ELECTIVE DEFERRAL. ALSO ON THE PORTION OF THE SPLIT DOLLAR THAT WAS ANNUALLY REPORTED ON THE CEO'S W-2. Part I, Lines 4a-b MAUREEN FITZSIMMONS WAS PAID SEVERANCE OF $255,764 UPON TERMINATION OF HER EMPLOYMENT WITH THE HOSPITAL DURING THE REPORTING YEAR. THERE WERE NO SPECIFIED TERMS OR CONDITIONS ASSOCIATED WITH THIS SEVERANCE PAYMENT. NONQUALIFIED RETIREMENT PLANS (SERP) HAVE BEEN ESTABLISHED FOR CERTAIN EMPLOYEES, WHICH ARE MAINTAINED PRIMARILY FOR THE PURPOSE OF PROVIDING DEFERRED COMPENSATION FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES WITHIN THE MEANING OF SECTIONS 201(2), 301(A) (3) AND 401(A)(1) OF ERISA. PAYMENTS FROM SUCH PLANS DURING THE YEAR ARE AS FOLLOWS: ANTOINETTA CAPRIGLIONE - $35,107 L.A. TANNER - $520,082 STEVE GODFREY - $52,117 ELIZABETH LYNCH - $68,375 BRIAN A. ROGOZ - $58,221 A NONQUALIFIED RETIREMENT PLAN (SERP) HAS BEEN ESTABLISHED TO PROVIDE A SUPPLEMENTAL RETIREMENT BENEFIT TO CLARENCE SILVIA UPON CERTAIN TERMINATION EVENTS OR UPON DISABILITY, DEATH OR ATTAINMENT OF AGE 65 WHILE EMPLOYED. THE PLAN IS INTENDED TO BE "A PLAN WHICH IS UNFUNDED AND IS MAINTAINED BY AN EMPLOYER PRIMARILY FOR THE PURPOSE OF PROVIDING DEFERRED COMPENSATION FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES" WITHIN THE MEANING OF SECTIONS 201(2), 301(A) (3) AND 401(A)(1) OF ERISA, AND SHALL BE INTERPRETED AND ADMINISTERED IN A MANNER CONSISTENT THEREWITH. AMOUNT OF BENEFIT: THE SUPPLEMENTAL RETIREMENT BENEFIT PAYABLE TO THE PARTICIPANT SHALL BE (A) MINUS (B) MINUS (C) WHERE: (A) IS THE LUMP SUM ACTUARIAL EQUIVALENT OF A SINGLE LIFE ANNUITY EQUAL TO THE EXCESS OF 60% OF HIS AVERAGE ANNUAL EARNINGS OVER THE SUM OF THE ACTUARIAL EQUIVALENT SINGLE LIFE ANNUITY BENEFIT, AS DETERMINED AS OF HIS NORMAL RETIREMENT DATE, ACCRUED UNDER THE QUALIFIED PLAN, ONE-HALF OF HIS SOCIAL SECURITY BENEFIT PAYABLE AT HIS NORMAL RETIREMENT DATE AND THE ACTUARIAL EQUIVALENT SINGLE LIFE ANNUITY BENEFIT, DETERMINED AS OF HIS NORMAL RETIREMENT DATE, ACCRUED AND VESTED UNDER ANY QUALIFIED RETIREMENT PLAN OF ANY FORMER EMPLOYER. (B) IS THE NET CASH SURRENDER VALUE, AS OF HIS NORMAL RETIREMENT DATE, OF ALL SPLIT DOLLAR LIFE INSURANCE POLICIES INSURING THE PARTICIPANT'S LIFE WITH RESPECT TO WHICH THE EMPLOYER HAS PAID SOME OR ALL OF THE PREMIUMS THEREON AND WITH RESPECT TO WHICH THE EMPLOYER HAS A COLLATERAL ASSIGNMENT INTEREST. (C) IS THE ACTUARIAL EQUIVALENT OF THE VALUE OF ANY BENEFIT PAID HEREUNDER TO THE PARTICIPANT PAYMENT FROM THE PLAN DURING THE YEAR IS AS FOLLOWS: CLARENCE J. SILVIA - $1,719,039 Supplemental Information Part III X 2138 FMV X 6412 FMV X GIFT CARDS & CERTIFICATES 53 4062 FACE VALUE X TICKETS TO EVENTS 2 1200 FACE VALUE X AUCTION ITEMS 82 18586 FAIR MARKET VALUE 0 0 0 0 New Program Services Form 990, Part III, line 2 HCC UNDERTOOK VARIOUS PROGRAM ENHANCEMENTS IN SEVERAL CATEGORIES IN ORDER TO BETTER MEET THE NEEDS OF OUR COMMUNITY. THEY ARE AS FOLLOWS: CLINICAL TECHNOLOGY: UPDATED THE EMERGENCY ROOM CT SCANNER TO A HIGH SPEED 64 SLICE UNIT FACILITY IMPROVEMENTS: RELOCATED OUTPATIENT PSYCHIATRY FROM VARIOUS LOCATIONS IN NEW BRITAIN TO ONE BUILDING ON 73 CEDAR STREET, NEW BRITAIN, CT. Form 990, Part VI, Section A, line 2 A BOARD MEMBER IS A "TRANSITION PARTNER" IN A LAW FIRM THAT DOES WORK FOR THE HOSPITAL OF CENTRAL CONNECTICUT. ALSO A BOARD MEMBER'S SON OWNS A COMMERCIAL REAL ESTATE BUSINESS WHO LEASES SPACE TO THE HOSPITAL OF CENTRAL CONNECTICUT. ALSO SEVERAL PHYSICIAN BOARD MEMBERS HAVE MEDICAL DIRECTOR CONTRACTS WITH THE HOSPITAL OF CENTRAL CONNECTICUT. ONE PHYSICIAN BOARD MEMBER IS A PRINCIPAL IN AN ENDOSCOPY CENTER THAT IS A JOINT VENTURE WITH THE HOSPITAL OF CENTRAL CONNECTICUT. Form 990, Part VI, Section A, line 4 The Hopsital's Bylaws and Certificate of Incorporation were amended to reflect the affiliation with Hartford Health Care effective February 1, 2011. Form 990, Part VI, Section A, line 6 THE ORGANIZATION HAS A SINGLE MEMBER, NAMELY, CENTRAL CONNECTICUT HEALTH ALLIANCE, INC. Form 990, Part VI, Section A, line 7a The Member shall have such rights, powers and responsibilities as are accorded to members under the Act, under the Certificate of Incorporation and under these Bylaws; provided, however, that HHC shall, as the parent company of the Corporation's Member, have the reserved rights and powers set forth in Article 3 hereof. Form 990, Part VI, Section A, line 7b CCHA's authority is subject to the Parent Company, Hartford HealthCare. See amended bylaws article 3, section 3.2. Form 990, Part VI, Section B, line 11 FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY FOR REVIEW AND COMMENTS PRIOR TO FILING. Form 990, Part VI, Section B, line 12c ANNUAL DISCLOSURE FORMS ARE SENT OUT TO DIRECTORS, OFFICERS AND APPROPRIATE EMPLOYEES AND REVIEWED BY THE COMPLIANCE OFFICER, CEO AND GENERAL COUNSEL (AND CHAIRMAN OF THE BOARD FOR OFFICERS AND DIRECTORS). Form 990, Part VI, Section B, line 15 EVERY OTHER YEAR, THE HOSPITAL'S PARENT, CENTRAL CONNECTICUT HEALTH ALLIANCE, EXECUTIVE COMPENSATION COMMITTEE ENGAGES AN EXECUTIVE COMPENSATION CONSULTING FIRM TO CONDUCT A COMPETITIVE ASSESSMENT OF TOTAL COMPENSATION (INCLUDING CASH COMPENSATION AND EXECUTIVE BENEFITS) AND TO VALIDATE THE REASONABLENESS OF SUCH COMPENSATION. SULLIVAN AND COTTER COMPLETED THEIR MOST RECENT ASSESSMENT IN NOVEMBER 2010. THIS ASSESSMENT INCLUDED ALL OF THE OFFICERS AND PHYSICIAN CHIEFS. GOING FORWARD, IT IS ANTICIPATED THAT, WITH THE AFFILIATION WITH HARTFORD HEALTHCARE, THE EXECUTIVE COMPENSATION COMMITTEE OF HARTFORD HEALTHCARE WILL REPLACE THE CCHA EXECUTIVE COMPENSATION COMMITTEE. WHEN DETERMINING COMPENSATION FOR THE HOSPITAL'S DEPARTMENT HEADS, RELEVANT MARKET DATA IS COLLECTED FROM A NUMBER OF SOURCES TO ASSURE THAT EACH INCUMBENT IS PAID COMPETITIVELY. SOURCES INCLUDE THE CONNECTICUT HOSPITAL ASSOCIATION SALARY SURVEY PREPARED BY OLNEY/HRADVANTAGE, MERCER'S INTEGRATED HEALTH NETWORKS SURVEY, INTEGRATED HEALTHCARE STRATEGIES NATIONAL HEALTHCARE LEADERSHIP COMPENSATION SURVEY AND SULLIVAN AND COTTER'S SURVEY OF MANAGER AND EXECUTIVE COMPENSATION IN HOSPITALS AND HEALTH SYSTEMS. SURVEY DATA IS CONSIDERED BY STATE, REGION, AND SIZE OF HOSPITAL. THE PERFORMANCE OF EACH DEPARTMENT HEAD AND AVAILABLE MONIES ARE OTHER FACTORS IN THE DELIBERATION PROCESS. AFTER COLLATING AND ANALYZING ALL RELEVANT DATA, A RECOMMENDATION AS TO APPROPRIATE SALARY IS MADE BY HUMAN RESOURCES MANAGEMENT. THE ADMINISTRATIVE ADVISOR OF EACH DEPARTMENT HEAD THEN CONSIDERS THE RECOMMENDATIONS AND APPROVES OR REVISES THE FIGURES BASED ON THE INFORMATION PRESENTED. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements aren't made available to the public. FORM 990, PART VII, COMPENSATION OF OFFICERS, DIRECTORS: A. DR. ANDREOLI- COMPENSATION PROVIDED FOR PROVISION OF PROFESSIONAL SERVICES AS OB/GYN SITE DIRECTOR RESIDENCY PROGRAM AT THE HOSPITAL OF CENTRAL CONNECTICUT (HCC). B. DR. ASCIUTO- COMPENSATION PROVIDED FOR PROVISION OF PROFESSIONAL SERVICES AS ASSOCIATE CHIEF OF MEDICAL STAFF, BRADLEY MEMORIAL CAMPUS OF HCC. C. DR. CIARDELLA- COMPENSATION PROVIDED FOR PROFESSIONAL SERVICES AS ASSOCIATE CHIEF, DEPARTMENT OF MEDICINE, BRADLEY MEMORIAL CAMPUS OF HCC. D. DR. LAPKIN- COMPENSATION PROVIDED FOR PROFESSIONAL SERVICES AS CHIEF OF STAFF AND MEDICAL DIRECTOR OF THE DIALYSIS UNIT AT HCC. E. DR. TOFFOLON- COMPENSATION PROVIDED FOR PROFESSIONAL SERVICES AS AN ON-CALL PHYSICIAN AT HCC. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -3,325,286. CHANGE IN ASSETS HELD IN TRUST BY OTHERS -547,224. PENSION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS -14,071,226. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -1,742,303. CHANGE IN BEGINNING BALANCE OF AUXILIARY NET WORTH 867. FIXED ASSET FAIR VALUE ADJUSTMENT 24,394,080. EARLY EXTINGUISHMENT OF DEBT -270,054. Total to Form 990, Part XI, Line 5: 4,438,854. FORM 990, Part XII, Line 2C: Oversight committee is of Hartford Healthcare since the affiliation on February 1, 2011. Form 990, Part III, Line 1 (continued): The Hospital of Central Connecticut at Bradley Memorial, founded in 1938, is an acute care hospital located at 81 Meriden Avenue, Southington, Connecticut. It provides a wide range of inpatient and outpatient services to a geographic area centered on the town of Southington. The Bradley Memorial Campus is licensed for 84 beds. Maternity services are not provided, therefore, there are no bassinets. It currently staffs 30 beds. The beds are divided into 27 medical and surgical beds and 3 ICU beds. Inpatient: The Bradley Memorial campus offers inpatient care in general medicine and surgery and various specialties, including but not limited to cardiology, physical medicine, radiology, 24-hour emergency care, neurosurgery and intensive care. Outpatient: The campus provides ambulatory surgery, cardiac testing and rehabilitation, physical medicine, respiratory therapy and other types of outpatient services, as well as Women's Center, Diagnostic services, including lab testing and radiology and Wound Care Center. Both campuses provide a wide array of medical services. Since operating under a single license, patients can receive services offered at either campus without any interruption. Patients are also offered continuity of care since the clinical oversight of each service is shared between campuses. Form 990, Part VI, Line 3: HISTORICALLY, CCHA PROVIDED MANAGEMENT DUTIES TO THE HOSPITAL AND OTHER AFFILIATES. IN MARCH OF 2010, THE HOSPITAL'S PRESIDENT AND CEO BECAME AN EMPLOYEE OF THE HOSPITAL. L. TANNER RETIRED IN JUNE OF 2011 AND AT THAT POINT CCHA NO LONGER HAD ANY EMPLOYEES. 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