2011-05-13T14:13:45-05:00 2010-09-30 SASLOW LUFKIN & BUGGY LLP TEN TOWER LANE AVON CT 06001 990 2009-10-01 060647014 GRIFFIN HOSPITAL GRIF 2037327528 130 DIVISION STREET DERBY CT 06418 PATRICK S CHARMEL 2037327528 2011-05-12 1 8606789200 2009 2016-02-24 21:20:13Z PATRICK S CHARMEL 130 DIVISION STREET DERBY CT 06418 124629497 0 X GRIFFINHEALTH.ORG X 1908 CT GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT. 22 16 1566 430 3728197 -1762445 1612552 1920282 122174298 121430800 527876 841246 393933 437169 124708659 124629497 0 0 67736780 70362492 0 0 55926925 55257077 123663705 125619569 1044954 -990072 122494989 122021131 131312019 139168392 -8817030 -17147261 GRIFFIN HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED, HUMANISTIC, CONSUMER-DRIVEN HEALTH CARE IN A HEALING ENVIRONMENT; TO EMPOWERING INDIVIDUALS TO BE ACTIVELY INVOLVED IN DECISIONS AFFECTING THEIR CARE AND WELL-BEING THROUGH ACCESS TO INFORMATION AND EDUCATION, AND TO PROVIDING LEADERSHIP TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE. 0 0 110183502 105300350 GRIFFIN HOSPITAL IS AN ACUTE CARE HOSPITAL PROVIDING MEDICAL CARE TO PATIENTS IN COMMUNITIES SERVED, INCLUDING SUBSIDIZED CARE, CHARITY CARE, AND EDUCATIONAL SERVICES TO HEALTH PROFESSIONALS TO HELP PREPARE THE NEXT GENERATION OF CAREGIVERS. 3092064 8012849 PROVIDE CANCER RELATED RADIOLOGY SERVICES TO THE COMMUNITY. 1900287 2953114 PROVIDE PSYCHIATRIC SERVICES TO THE COMMUNITY ON AN OUTPATIENT BASIS. 371405 1436290 PROVIDE HOSPICE SERVICES TO THE COMMUNITY. 371405 1436290 115547258 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 178 0 1 1566 1 1 1 0 0 0 0 0 0 0 0 22 16 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 CT X JAMES DOWNEY 2037327528 130 DIVISION STREET DERBY CT 06418 HENDRICKS DAVID 40.00 X 299431 0 14879 CHARMEL PATRICK 40.00 X X 361132 0 58806 BORIS GREGORY 40.00 X 301458 0 25651 DOBULER KENNETH 40.00 X 208026 0 47152 SCHWARTZ KENNETH 40.00 X 166056 0 67670 STUMPO BARABARA J 40.00 X X 153424 0 41537 ANDREANA JOSEPH 1.00 X 0 0 0 BALDYGA KENNETH 1.00 X 0 0 0 BETKOSKI JOHN W III 1.00 X X 0 0 0 CHRISTON WILHEMENIA 1.00 X 0 0 0 JANESKY LAWRENCE 1.00 X 0 0 0 FOX ROBERT A 1.00 X 0 0 0 GENTILE LINDA M 1.00 X 0 0 0 JONES JEAN CRUM 1.00 X 0 0 0 KLARIDES THEMIS 1.00 X 0 0 0 LOGAN GEORGE S 1.00 X 0 0 0 NUSSBAUM PAUL B 1.00 X 0 0 0 OSAK FRANK M 1.00 X 0 0 0 MEZZO ROBERT 1.00 X 0 0 0 REISS ROBERT G 1.00 X 0 0 0 WEINER GERALD T 1.00 X 0 0 0 ZAPRZALKA JOHN J 1.00 X 0 0 0 MOYLAN JAMES J 40.00 X 219320 0 37662 POWANDA WILLIAM 40.00 X 164205 0 48487 DEEGAN MARGARET 40.00 X 160367 0 17875 SHEPARD SETH 40.00 X 163228 0 20118 FRAMPTON SUSAN 40.00 X 235698 0 28282 BERNS EDWARD 40.00 X 135365 0 37156 MARTIN KATHLEEN 40.00 X 133621 0 38277 D'SOUSA SEEMA 30.00 X 178823 0 21980 HALSTEAD EDWARD 40.00 X 194171 0 68697 KUSTER GORDON 40.00 X 243440 0 54385 NAWAZ HAQ 40.00 X 243762 0 28115 BELL GREGORY 40.00 X 227653 0 17770 3789180 0 674499 57 0 1 0 TURNER CONSTRUCTION 440 WHEELERS FARM RD MILFORD CT 06460 CONSTRUCTION 6518786 BISMARK CONTRUCTION 100 BRIDGEPORT AVE MILFORD CT 06460 CONSTRUCTION 1913348 UNIDINE CORPORATION 75 REMITTANCE DRIVE CHICAGO IL 60675 FOOD SERVICE 1183116 RINALDI LINEN SERVICES 47 COMMONS COURT WATERBURY CT 06704 LINEN SERVICE 360884 THE OUTSOURCE GROUP 90 NATIONAL DRIVE GLASTONBURY CT 06033 COLLECTION AGENCY 269894 14 1920282 1920282 PATIENT REVENUE 621500 118098624 114370427 3728197 OTHER PROGRAM SERVICES 621500 3332176 3332176 121430800 300561 300561 437169 437169 437169 437169 540685 540685 540685 540685 124629497 117702603 3728197 1278415 4485778 3186233 1299545 49619010 44657109 4961901 4054960 3649464 405496 7902217 7111996 790221 4300527 3870475 430052 175035 175035 138119 138119 246270 246270 11304446 10174002 1130444 488370 439533 48837 179089 161181 17908 696521 626869 69652 275495 247946 27549 216651 194986 21665 6080997 6080997 140338 140338 6320417 6320417 1495789 1346211 149578 MEDICAL & DRUG SUPPLIES 15173899 15173899 UTILITIES 3319847 3319847 RESEARCH GRANT EXPENSES 1600391 1440352 160039 BAD DEBT 1246165 1246165 FOOD 1116441 1116441 5042797 5042797 125619569 115547258 10072311 0 3879223 3905172 17001631 15222331 707439 785363 1593156 1775274 141096371 77052767 62723943 64043604 9689549 10721743 17750564 14810452 9149484 10757192 122494989 122021131 23725478 25047155 563771 16630 55294548 54196490 51728222 59908117 131312019 139168392 X -16756232 -24966200 2260107 2014450 5679095 5804489 -8817030 -17147261 122494989 122021131 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 0 0 0 0 0 0 1 11014 11014 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: THE GRIFFIN HOSPITAL PAID FOR MEMBERSHIP DUES TO THE CONNECTICUT HOSPITAL ASSOCIATION FOR THE FISCAL YEAR ENDED 9/30/2010. $11,014.49 OF MEMBERSHIP DUES PAID WAS USED FOR LOBBYING ON ISSUES RELEVANT TO THE ORGANIZATION'S EXEMPT PURPOSE. 2773278 124305 1337 2896246 2677652 97031 1405 2773278 0.78000 0.22000 1 0 4015091 4015091 70796376 31583816 39212560 65956153 45263124 20693029 328751 205827 122924 64043604 FIXED INCOME SECURITIES 9660079 F MARKETABLE EQUITY SECURITIES 1061664 F 10721743 LIMITED USE ASSETS - CURRENT 522512 F BOARD DESIGNATED INVESTMENTS 319085 F BENEFICIAL INTEREST IN TRUSTS 3644228 F UNDER INDENTURE AGREEMENT 4477576 F INVESTMENTS IN NET ASSETS OF AFFILIATES 5847051 F 14810452 OTHER RECEIVABLES 1126936 DUE FROM AFFILIATES 6250422 OTHER ASSETS 2994897 THIRD PARTY 220661 DEFERRED REVENUE 164276 10757192 ACCRUED POSTRETIREMENT - CURRENT 438000 ACCRUED POSTRETIREMENT - NON CURRENT 6381956 PROFESSIONAL AND GENERAL LIABILTY 725821 MINIMUM PENSION LIABILITY 36275269 WORKERS COMPENSATION - LONG TERM 1340515 ACCRUED INTEREST PAYABLE 391610 OTHER LIABILITIES 7417394 RETIREMENT OBLIGATION 130976 CAPITAL LEASE - NET OF CURRENT 5037671 L.T. - CURRENT PORTION 1768905 59908117 124629497 125619569 -990072 44948 -7385107 -7340159 -8330231 124674445 44948 44948 124629497 0 124629497 125619569 0 125619569 0 125619569 Part V, Line 4: Description of Intended Use of Endowment Funds: THE HOSPITAL'S ENDOWMENT FUNDS CONSIST OF DONOR RESTRICTED FUNDS TO BE INVESTED IN PERPETUITY TO PROVIDE A PERMANENT SOURCE OF INCOME. Part X: Description of Uncertain Tax Positions Under FIN 48: FIN 48 IS NOT APPLICABLE TO GRIFFIN HOSPITAL. Part XI, Line 8 - Other Adjustments: TRANSFERS BETWEEN AFFILIATES: -2320462. MINIMUM PENSION LIABILITY ADJUSTMENT: -5314605. CHANGE IN INTEREST IN NET ASSETS OF AFFILIATES: 273587. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS: -245657. CHANGE IN INVESTMENT IN AFFILIATE: 96636. CHANGE IN BENEFICIAL INTEREST IN TRUSTS: 125394. 1 1 1 X 1 X 1 1 1 0 1 1 455 3045931 0 3045931 0.02420 8662 9195672 6137085 3058587 0.02430 174 154287 116558 37729 0.00030 9291 12395890 6253643 6142247 0.04880 16 60367 928710 73146 855564 0.00680 3 80 6444730 4990191 1454539 0.01160 3 38805 19402925 19617571 -214646 0.00000 1 1229117 0 1229117 0.00980 4 5255 14801 0 14801 0.00010 27 104507 28020283 24680908 3339375 0.02830 27 113798 40416173 30934551 9481622 0.07710 1 2505 12499 440 12059 0.00010 1 2505 12499 440 12059 0.00010 1 394161 43304664 47471724 -4167060 X 1 1 GRIFFIN HOSPITAL

130 DIVISION STREET DERBY CT 06418

X X X X X X Part I, Line 3c: PATIENT MAY BE REQUIRED TO PROVIDE:1. PATIENT W-2 FORM2. THREE CONSECUTIVE PAY STUBS FROM PATIENT'S CURRENT EMPLOYMENT3. DEPENDENT INFORMATION (FAMILY SIZE)4. ANY OR ALL BANK AND CHECKING ACCOUNT STATEMENTS Part I, Line 6a: GRIFFIN HOSPITAL MAKES ITS ANNUAL COMMUNITY BENEFIT REPORT AVAILABLE TO THE PUBLIC IN ITS ANNUAL REPORT THAT CAN BE ACCESSED ONLINE. Part III, Line 4: THERE IS NO FOOTNOTE ON THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE. Part III, Line 8: THE COSTS RELATED TO THE SHORTFALL WERE DERIVED FROM THE GRIFFIN HOSPITAL'S PATIENT LEVEL COST ACCOUNTING SYSTEM. PROCEDURAL CHARITY CARE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. COSTS ARE APPLIED TO ALL PATIENTS' BILLS. Part III, Line 9b: YES THE GRIFFIN HOSPITAL CHARITY CARE POLICY CONTAINS COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IT STATES IT IS THE RESPONSIBILITY OF GRIFFIN HOSPITAL TO RESPOND TO ALL PATIENT REQUESTS FOR CHARITY ELIGIBILITY DURING ANY ONE OR MORE PATIENT BUSINESS INTERACTIONS NAMELY PREREGISTRATION, REGISTRATION AND DISCHARGE OR AT ANY OTHER TIME THE FACILITY STAFF ENCOUNTERS INFORMATION DETAILING THE PATIENTS FINANCIAL NEED. CHARITY WILL BE RESCREENED THROUGHOUT THE REVENUE CYCLE WHEN ACCOUNT EVENTS TRIGGER REVIEW. Part VI, Line 2: NEEDS ASSESSMENT:GRIFFIN HOSPITAL NEEDS ASSESSMENT PROCESS HAS HAD AN EVOLUTION OF STAGES. GRIFFIN HOSPITAL WAS A HEALTHCARE INDUSTRY PIONEER IN USING MARKET RESEARCH TECHNIQUES USED BY OTHER INDUSTRIES INCLUDING FOCUS GROUPS, PATIENT SURVEYS, AND CONSUMER COMMUNITY SURVEYS. GRIFFIN CONDUCTED ITS FIRST COMMUNITY SURVEY IN 1982 TO MEASURE COMMUNITY PERCEPTION OF GRIFFIN HOSPITAL AND THE SERVICES IT PROVIDED. THE HOSPITAL REPEATED THE SURVEY REGULARLY AND OVER THE PAST DECADE HAS DONE THE SURVEY ABOUT EVERY TWO YEARS. THE YALE-GRIFFIN PREVENTATIVE RESEARCH CENTER PRODUCES A BI-ANNUAL COMMUNITY HEALTH PROFILE FOR THE SIX TOWN REGION SERVED BY GRIFFIN HOSPITAL. THE PROFILE REPORTS DISEASE SPECIFIC MORTALITY RATES AND OTHER HEALTH AND SOCIAL INDICATOR DATA AND COMPARES THEM TO STATE RATES. THE REPORT IS WIDELY USED BY VALLEY COUNCIL OF HEALTH AND HUMAN SERVICES ORGANIZATIONS TO IDENTIFY NEEDS AND DEVELOP INTERVENTIONS. PERFORMING STUDIES AND COLLECTING DATA IS PART OF THE PRC'S MISSION. THE OTHER PART IS WORKING CLOSELY WITH COMMUNITIES, USING THE RESULTS OF PREVENTION REASEARCH TO INFORM AND EMPOWER LOCAL RESIDENTS. AT GRIFFIN, WE BELIEVE THAT FOR HEALTH RESEARCH TO SUCCEED, YOU NEED BOTH TO BE ABLE TO MAKE A DIFFERENCE IN THE COMMUNITY AND TO MEASURE THE DIFFERENCE YOU MAKE. THE PREVENTION RESEARCH CENTER EXCELS IN BOTH AREAS, CREATING A POWERFUL FORMULA FOR POSITIVE CHANGE FOR THE DEVELOPMENT OF THE PROFILES. PRESENTLY GRIFFIN'S BOARD OF DIRECTORS AND SENIOR MANAGEMENT ARE IN THE PROCESS OF DEVELOPING GRIFFIN HOSPITAL'S STRATEGIC PLAN FOR THE 2010-2012 PERIODS. THE CURRENT STRATEGIC PLAN INCLUDES AN INITIATIVE RELATED TO TRANSPARENCY WITH WORK BEING DONE BY MANAGEMENT FOR INCREASED PUBLIC REPORTING ON THE GRIFFIN WEB SITE. THE STRATEGIC AFFAIRS COMMITTEE OF THE BOARD HAS UNDERTAKEN THE TASK OF BROADENING THAT INITIATIVE TO ONE OF CORPORATE SOCIAL RESPONSIBILITY IN THE NEW STRATEGIC PLAN. THE FOLLOWING PARTIAL SET OF CORPORATE SOCIAL RESPONSIBILITY GOALS HAS BEEN PROPOSED FOR INCLUSION IN GRIFFIN HOSPITAL'S FINAL STRATEGIC PLAN: COMMUNITY HEALTH NEEDS ASSESSMENT; CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AND ADOPT A STRATEGY TO MEET COMMUNITY HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT. THE ASSESSMENT WILL INCLUDE INPUT FROM A BROADLY DIVERSE CROSS SECTION OF THE COMMUNITY THE HOSPITAL SERVES. POST THE ASSESSMENT ON THE CORPORATE SOCIAL RESPONSIBILITY SECTION OF THE HOSPITAL'S WEB SITE. THIS WILL EXPAND THE COMMITMENT OF THE GRIFFIN PRC TO PRODUCE A BIANNUAL COMMUNITY HEALTH PROFILE AND THE NEW INITIATIVE "VALLEY CARES" WHICH EXPAND THE INDICATORS BEYOND HEALTH.CURRENTLY THESE GOALS ARE BEING ACCOMPLISHED WITH GRIFFIN HOSPITAL AND THE YALE-GRIFFIN PREVENTION RESEARCH CENTER SUPPORTING A COLLABORATIVE INITIATIVE "VALLEY CARES", A COMMUNITY ASSESSMENT AND PLANNING EFFORT SPONSORED BY THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS. THE COUNCIL RECOGNIZED THE NEED TO DEVELOP AN ON-GOING SYSTEM FOR ACCESSING INFORMATION ABOUT QUALITY OF LIFE IN THE VALLEY COMMUNITY. VALLEY CARES INCLUDES TWO MAIN GOALS TO IMPROVE THE LOCAL CAPACITY TO TRACK INFORMATION ABOUT KEY QUALITY OF LIFE INDICATORS SO THAT VALLEY RESIDENTS, ORGANIZATIONS AND STAKEHOLDERS HAVE ON-GOING ACCESS TO INFORMATION ABOUT COMMUNITY STRENGTHS AND CHALLENGES, AND TO DISSEMINATE INFORMATION ABOUT VALLEY QUALITY OF LIFE BROADLY WITHIN THE COMMUNITY AND ENGAGE COMMUNITY MEMBERS IN ANALYZING ASSESSMENT FINDINGS AND PLANNING SOLUTIONS TO IDENTIFIED COMMUNITY CHALLENGES. THE YALE GRIFFIN PREVENTION RESEARCH CENTER WHICH IS A COUNCIL MEMBER AGENCY ALONG WITH GRIFFIN HOSPITAL, WITH EXTENSIVE EXPERIENCE IN COMPILING THE VALLEY COMMUNITY HEALTH PROFILE HAS EXPANDED ITS RESEARCH TO INCLUDE INFORMATION ON INDICATORS BEYOND HEALTH. THE COUNCIL ALSO CONTRACTED A SURVEY RESEARCH FIRM TO CONDUCT A COMMUNITY SURVEY TO OBTAIN INFORMATION ABOUT RESIDENT VIEWS. THE TOPICS TO BE COVERED IN THE VALLEY CARES COMMUNITY ASSESSMENT REPORT INCLUDE: CREATING A COMMUNITY CONTEXT THAT ALLOWS RESIDENTS TO THRIVE, EMPLOYMENT AND ECONOMIC INDICATORS, HOUSING TRANSPORTATION, PROVIDING EDUCATION AND TRAINING FOR LIFE LONG SUCCESS, PRESERVING THE NATURAL ENVIRONMENT, ENSURING RESIDENT SAFETY, PROMOTING SOCIAL AND EMOTIONAL WELL BEING, ADVANCING COMMUNITY HEALTH, OFFERING ARTS CULTURE AND RECREATION, AND FOSTERING COMMUNITY HARMONY AND ENGAGEMENT. Part VI, Line 3: THE PATIENT IS REGISTERED BY THE ADMITTING REGISTRAR WHO WILL IDENTIFY THE PATIENT AS HAVING NO MEDICAL INSURANCE SELF PAY. THE PATIENT WILL BE GIVEN A FINANCIAL ASSISTANCE PAMPHLET THAT WILL IDENTIFY ALL GRIFFIN HOSPITAL FREE CARE ASSISTANCE PROGRAMS. THE PAMPHLET ALSO INCLUDES HOSPITAL CONTACTS FOR PATIENTS SEEKING STATE WELFARE, SAGA, CITY WELFARE, OR OTHER STATE PROGRAMS. PATIENTS WHO REGISTER AS HAVING NO MEDICAL INSURANCE WITH ACCOUNT BALANCES OVER 3,000 DOLLARS WILL BE REFERRED TO THE HOSPITAL ELIGIBILITY WORKER. THE PATIENT WILL BE SEEN WITHIN 24 HOURS OF ADMISSION. IF THE ELIGIBILITY WORKER IS UNABLE TO FULFILL THIS REQUIREMENT DUE TO ABSENCE THE FINANCIAL ADVISOR WILL TAKE THE NECESSARY STEPS TO FULFILL THIS REQUIREMENT. ALL ACCOUNTS UNDER 3,000 DOLLARS WILL BE REFERRED TO THE HOSPITAL FINANCIAL ADVISORS. THE HOSPITAL ELIGIBILITY WORKER WILL COMPLETE A FINANCIAL SCREENING FOR THOSE PATIENTS SEEKING TITLE 19 ELIGIBILITY AND FOR THE UNINSURED STATUS. THE HOSPITAL ELIGIBILITY WORKER WILL IDENTIFY PATIENTS MEETING THE STATE SAGA AND HUSKY PROGRAM CRITERIA. FOR PATIENTS MEETING THE CRITERIA THE APPLICATION PROCESS WILL BE COMPLETED AND ALL PAPERWORK FORWARDED TO THE APPROPRIATE STATE DEPARTMENT FOR PROCESSING. THE PATIENTS WHO DO NOT MEET THE CRITERIA FOR THE SAGA AND HUSKY PROGRAMS WILL BE REFERRED TO THE HOSPITAL FINANCIAL ADVISOR. THE FINANICAL ADVISOR WILL BEGIN A REVIEW TO DETERMINE IF THE PATIENT MEETS THE UNINSURED CRITERIA IDENTIFIED IN PUBLIC ACT 03266. A LETTER WILL BE SENT TO THE PATIENT REQUESTING THE PATIENT TO VERIFY THAT THEY DO NOT HAVE MEDICAL INSURANCE AS IDENTIFIED DURING THEIR HOSPITAL REGISTRATION PROCESS. THE LETTER WILL ALSO REQUEST ADDITIONAL PATIENT INFORMATION REGARDING THE PATIENT INCOME IF NECESSARY. THE CRITERIA THE PATIENT MUST MEET AS IDENTIFIED IN PUBLIC ACT 03266 ARE AS FOLLOWS: PATIENT INCOME BASED ON FAMILY SIZE FALLS UNDER 250% OF THE POVERTY INOME GUIDELINES, POVERTY INCOME GUIDELINE SCALE AVAILABLE UPON REQUEST, HOSPITAL HAS MADE A FULL DETERMINATION AS TO THE STATUS OF THE SAGA AND HUSKY PROGRAMS AND ALL GRIFFIN HOSPITAL FREE BED FUNDS HAVE BEEN REVIEWED AND DETERMINED NON-APPLICABLE FOR THE PATIENT IN REVIEW. IF THE PATIENT RESPONDS TO THE LETTER SENT OUT BY THE FINANCIAL ADVISOR THIS WILL BEGIN THE APPLICATION PROCESS FOR THE VERIFICATION OF THE UNINSURED PATIENT STATUS. THE FOLLOWING INFORMATION WILL NEED TO BE FINALIZED WITH THE PATIENT IN ORDER FOR THE UNINSURED DETERMINATION TO BE MADE: PROOF OF PATIENT INCOME AND FAMILY SIZE. HOSPITAL HAS MADE A FINAL DETERMINATION AS TO THE STATUS OF THE STATE SAGA AND HUSKY PROGRAMS. VERIFICATION OF ALL FREE BED FUNDS BEING REVIEWED WITH THE PATIENT UPON DETERMINATION THAT A PATIENT MEETS THE OUTLINED CRITERIA THE PATIENT WILL BE CLASSIFIED AS FOLLOWS: UNINSURED STATUS. THE PATIENT'S ACCOUNT WILL BE TAKEN FROM TOTAL GROSS CHARGES AND REDUCED TO COST BY APPLYING FACTOR SUPPLIED ANNUALLY BY THE OFFICE OF HEALTH CARE ACCESS. THE PATIENT WILL BE INFORMED OF THIS DECISION AND WILL BE SENT A LETTER THAT WILL REFLECT THE BALANCE AT REDUCTION ON ALL APPLICABLE ACCOUNTS. THE PATIENT WILL BE ADVISED OF THE BALANCE THAT IS DUE AND PAYABLE. THE FINANCIAL ADVISOR WILL CONTACT THE PATIENT TO ACCOMPLISH THE FOLLOWING: ATTEMPT PAYMENT ARRANGEMENT WITH THE PATIENT ON THE REMAINING BALANCE. IF THE PATIENT IDENTIFIES TO THE FINANCIAL ADVISOR THAT THEY CANNOT AFFORD THE REMAINING BALANCE, AN APPLICATION FOR FREE CARE ASSISTANCE WILL BE COMPLETED. IF A PATIENT APPLIES FOR FREE CARE ASSISTANCE THE FINANCIAL ADVISOR WILL MAKE A DECISION ON FREE CARE ELIGIBILITY BASED ON THE PATIENT FAMILY SIZE AND INCOME. FREE CARE WILL BE OFFERED BASED ON THE GRIFFIN HOSPITAL FREE CARE ASSITANCE SLIDING SCALE, AVAILABLE UPON REQUEST. THE FINANCIAL ADVISOR WILL ADVISE THE PATIENT OF THE FREE CARE DETERMINATION THAT WILL BE APPLIED TO THE PATIENT'S REMAINING BALANCE. THE FINANCIAL ADVISOR WILL COMPLETE ALL APPROPRIATE LOGS WITH THE DECISIONS AND AMOUNTS. FREE CARE ASSISTANCE POLICY PROCEDURE: ANY PATIENT REQUESTING FINANCIAL ASSISTANCE IN PAYING THEIR GRIFFIN HOSPITAL BILL CAN APPLY FOR THE FREE CARE ASSISTANCE PROGRAM BY CONTACTING THE HOSPITAL FINANCIAL ADVISORY STAFF. THE FINANCIAL ADVISOR WILL BE CONTACTED BY THE PATIENT TO COMPLETE THE FREE CARE APPLICATION PROCESS. THE FINANCIAL ADVISOR WILL OBTAIN THE FOLLOWING INFORMATION FROM THE PATIENT IN ORDER TO COMPLETE THE FREE CARE APPLICATION: PATIENT W-2 FORM (TAX STATEMENT FROM PREVIOUS AND CURRENT YEAR), THREE CONSECUTIVE PAY STUBS FROM PATIENT'S CURRENT EMPLOYMENT, DEPENDANT INFORMATION/FAMILY SIZE, AND ANY OR ALL BANK AND CHECKING ACCOUNT STATEMENTS. THE FINANCIAL ADVISOR WILL REFER TO THE GRIFFIN HOSPITAL SLIDING SCALE. THIS IS BASED ON THE FEDERAL POVERTY INCOME GUIDELINES SLIDING SCALE, AVAILABLE UPON REQUEST. THE FINANCIAL ADVISOR WILL MAKE A DETERMINATION OF FREE CARE ELIGIBILITY STATUS. IF THE PATIENT QUALIFIES FOR FREE CARE ASSISTANCE THE APPLICABLE DISCOUNT PERCENTAGE WILL BE APPLIED TO THE PATIENT ACCOUNT BALANCE. IF A PATIENT BALANCE REMAINS, THE FINANCIAL ADVISOR WILL PURSUE ONE OF THE FOLLOWING WITH THE PATIENT: REQUIRE PAYMENT IN FULL OR SET UP A MONTHLY PAYMENT ARRANGEMENT. IF THE PATIENT DOES NOT MAINTAIN THE AGREED UPON PAYMENT SCHEDULE THE ACCOUNT WILL BE FORWARDED TO AN OUTSIDE COLLECTION AGENCY AT THE FULL REMAINING BALANCE. IF A PATIENT DOES NOT QUALIFY FOR FREE CARE ASSISTANCE THE FINANCIAL ADVISOR WILL ATTEMPT TO OBTAIN PAYMENT IN FULL OR SET UP A MONTHLY PAYMENT ARRANGEMENT. IF THE PATIENT DOES NOT MAINTAIN THE AGREED UPON PAYMENT SCHEDULE THE ACCOUNT WILL BE FORWARDED TO AN OUTSIDE COLLECTION AGENCY AT THE FULL REMAINING BALANCE. IN SOME CASES IT IS NECESSARY TO OVERRIDE THE POLICY GUIDELINES ON INCOME DUE TO SPECIAL CIRCUMSTANCE REQUIREMENTS SUCH AS SOCIAL ADMIT, MAXED OUT DAY, OR DECEASED PATIENTS. AN OVERRIDE CAN BE OBTAINED BY THE SUPERVISOR AND DIRECTOR OR CFO ALLOWING FOR CONSIDERATION OF ELIGIBILITY. THE COLLECTION SUPERVISOR WILL MAINTAIN ALL MONTHLY SPREADSHEETS THAT WILL IDENTIFY ALL FREE BED FUNDS UNINSURED AND FREE CARE ASSISTANCE ALLOCATED ON A MONTHLY BASIS. Part VI, Line 4: GRIFFIN HOSPITAL IS A GENERAL ACUTE CARE COMMUNITY TEACHING HOSPITAL LOCATED IN DERBY CT. IT SERVES THE GEOGRAPHIC AREA ENCOMPASSING THE LOWER NAUGATUCK RIVER VALLEY TOWNS OF ANSONIA, DERBY, SHELTON, OXFORD, SEYMOUR, AND BEACON FALLS WHICH HAVE A COMBINED POPULATION OF APPROXIMATELY 103,800 PEOPLE WITH AN ADDITIONAL 60,200 FROM THE EXPANDED AREA TOWNS OF NAUGATUCK, SOUTHBURY, AND WOODBURY. THE GEOGRAPHIC LOCATION IS SURROUNDED BY THE KEY WATERWAYS LOCATED IN THE SOUTH CENTRAL PART OF CT AND HAS A SHARED HISTORY OF IMMIGRANTS WHO SETTLED IN THE REGION TO WORK IN ITS MANUFACTURING CENTERS. SINCE 1990 THE REGIONAL ECONOMY HAS EXPERIENCED A SHIFT FROM A MANUFACTURING BASED ECONOMY TO ONE THAT IS MORE DIVERSE BUT LESS DEPENDANT ON THE FACTORY SECTOR. IN ADDITION TO INCREASING IN POPULATION SIZE THE VALLEY COMMUNITY IS UNDERGOING CHANGES AS NEW IMMIGRATION ALTERS THE MIX OF ETHNIC AND LINGUISTIC DIVERSITY AMONG RESIDENTS. FOR EXAMPLE, THE PERCENTAGE OF HISPANIC RESIDENTS GREW TO A TOTAL OF 6 PERCENT OF THE VALLEY WIDE POPULATION BY 2009. THE VALLEY COMMUNITY INCLUDES RESIDENTS WITH A DIVERSITY OF NATIONAL ORIGINS AND NATIVE LANGUAGES. A 2009 DEMOGRAPHIC SNAPSHOT REPORT ESTIMATES THAT 9 PERCENT OF THE VALLEY RESIDENTS SPEAK AN INDO-EUROPEAN LANGUAGE, ALMOST 4 PERCENT SPEAK SPANISH, AND 1 PERCENT SPEAKS ASIAN/PACIFIC ISLANDER LANGUAGE. THE STUDENTS ENROLLED IN PROGRAMS AT VALLEY REGIONAL ADULT EDUCATION IN THE 2009-2010 FISCAL YEAR CAME FROM OVER 60 COUNTRIES SHOWING THE INCREASING WAYS THE GLOBAL COMMUNITY IS REPRESENTED IN THE VALLEY COMMUNITY. EVEN THOUGH VALLEY INCOME LEVELS ROSE OVER THE PAST DECADE, INCREASING NUMBERS OF RESIDENTS DO NOT HAVE ACCESS TO THE ECONOMIC OPPORTUNITIES NEEDED TO BUILD A STRONG QUALITY OF LIFE. THE UNEMPLOYMENT RATE IN THE VALLEY HAS RISEN SUBSTANTIALLY SINCE 2005, REACHING AN ANNUAL AVERAGE OF 8 PERCENT IN 2009 AND ALMOST 9 PERCENT THROUGH SEPTEMBER OF 2010, WITH EVEN HIGHER LEVELS IN SOME TOWNS. ALTHOUGH THE CURRENT FEDERAL DEFINITION OF POVERTY UNDERESTIMATES THE PERCENTAGE OF RESIDENTS FACING ECONOMIC HARDSHIP, THE VALLEY POVERTY RATE IN 2000 WAS 4.7 PERCENT OF THE OVERALL POPULATION. AT THAT TIME 10 PERCENT OR MORE OF CHILDREN WERE LIVING IN POVERTY IN SEVERAL VALLEY TOWNS. IT IS LIKELY THAT THE POVERTY RATE HAS RISEN SHARPLY IN RECENT YEARS AS IS TRUE IN THE STATE. THE PERCENTAGE OF FAMILIES QUALIFYING FOR FREE OR REDUCED PRICE LUNCH IN VALLEY SCHOOL DISTRICTS INCREASED IN THE PAST DECADE, AN INDICATION OF GROWING ECONOMIC HARDSHIP. IN 2007-2008 ABOUT 2 OUT OF 10 VALLEY PUBLIC SCHOOL CHILDREN (19 PERCENT) MET THE INCOME REQUIREMENT FOR FREE OR REDUCED PRICE LUNCH. IN SOME DISTRICTS THE LEVEL REACHED 40 PERCENT OR MORE OF STUDENTS. ALSO ADDING TO THE CHANGING ECONOMIC COMPOSITION, THE VALLEY POPULATION HAS BEEN AGING LIKE THE POPULATION OF THE NATION AND THE STATE AS A WHOLE, AND THERE ARE OTHER DEMOGRAPHIC SHIFTS UNDERWAY AS WELL. Part VI, Line 5: BEYOND THE INPATIENT CARE AND OUTPATIENT SERVICES IT PROVIDES TO THE COMMUNITY, GRIFFIN HOSPITAL HAS A HISTORY OF COMMUNITY SERVICE AND SOCIAL RESPONSIBILTY DATING BACK TO ITS FOUNDING IN 1909. IN 1970 GRIFFIN ESTABLISHED ONE OF THE FIRST HOSPITAL DEPARTMENTS OF COMMUNITY HEALTH IN THE COUNTRY TO FOCUS ON THE HEALTH AND WELL BEING OF THE COMMUNITY IT SERVES PROVIDING A VARIETY OF HEALTH SCREENINGS AND PREVENTIVE PROGRAMS AND SERVICES. OVER THE PAST DECADE HOWEVER, GRIFFIN HAS BEEN EXPANDING ITS REACH INTO THE COMMUNITY LIKE NEVER BEFORE. IN ADDITION TO PROVIDING HEALTH INFORMATION AND SERVICES TO THE PUBLIC AT THE HOSPITAL AND OTHER SATELLITE LOCATIONS GRIFFIN TAKES THESE ACTIVITIES INTO THE COMMUNITIES WHERE PATIENTS LIVE, WORK AND WORSHIP. BY OFFERING A VARIETY OF SUPPORT GROUPS, TRAINING SESSIONS, EDUCATIONAL PROGRAMS AND OTHER COMMUNITY-BASED RESOURCES AND ACTITITIES AND COLLABORATING WITH OTHER NON-PROFIT ORGANIZATIONS AND GOVERNMENT ENTITIES, GRIFFIN HAS EXTENDED ITS MISSION TO PROVIDE LEADERSHIP TO IMPROVE THE HEALTH OF THE COMMUNITY SERVED FAR BEYOND THE HOSPITAL WALLS.NEW VALLEY CARES COMMUNITY ASSESSMENT RESEARCH AND EDUCATION FOR SOLUTIONS: GRIFFIN HOSPITAL AND THE YALE-GRIFFIN PREVENTION RESEARCH CENTER ARE SUPPORTING A COLLABORATIVE INITIATIVE, VALLEY CARES, A COMMUNITY ASSESSMENT AND PLANNING EFFORT SPONSORED BY THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS. THE COUNCIL RECOGNIZED THE NEED TO DEVELOP AN ON-GOING SYSTEM FOR ACCESSING INFORMATION ABOUT QUALITY OF LIFE IN THE VALLEY COMMUNITY. VALLEY CARES INCLUDES TWO MAIN GOALS; TO IMPROVE THE LOCAL CAPACITY TO TRACK INFORMATION ABOUT KEY QUALITY OF LIFE INDICATORS SO THAT VALLEY RESIDENTS, ORGANIZATIONS AND STAKEHOLDERS HAVE ON-GOING ACCESS TO INFORMATION ABOUT COMMUNITY STRENGTHS AND CHALLENGES AND TO DISSEMINATE INFORMATION ABOUT VALLEY QUALITY OF LIFE BROADLY WITHIN THE COMMUNITY AND ENGAGE COMMUNITY MEMBERS IN ANALYZING ASSESSMENT FINDINGS AND PLANNING SOLUTIONS TO IDENTIFIED COMMUNITY CHALLENGES. THE VALLEY CARES TASKFORCE: CURRENT AND PAST TASKFORCE MEMBERS FROM GRIFFIN HOSPITAL INCLUDE BETH PATTON COMERFORD, MS YALE-GRIFFIN PREVENTION RESEARCH CENTER (TASKFORCE CO-CHAIR), JESSE REYNOLDS, MS YALE-GRIFFIN PREVENTION RESEARCH CENTER, TARA RIZZO, MPH GRIFFIN HOSPITAL, SUSAN NAPPI, MPH GRIFFIN HOSPITAL CURRENTLY YALE UNIVERSITY.VALLEY CARES QUALITY OF LIFE REPORT 2010: PRIMARY FUNDING FOR THE CREATION OF THIS REPORT PROVIDED BY KATHARINE MATTHIES FOUNDATION, BANK OF AMERICA N.A. TRUSTEE. ADDITIONAL SUPPORT FOR THE VALLEY CARES INTIATIVE PROVIDED BY YALE-GRIFFIN PREVENTION RESEARCH CENTER, NAUGATUCK VALLEY HEALTH DISTRICT, GRIFFIN HOSPITAL, AND BIRMINGHAM GROUP HEALTH SERVICES, INC. THE YALE-GRIFFIN PREVENTION RESEARCH CENTER WHICH IS A COUNCIL MEMBER AGENCY ALONG WITH GRIFFIN HOSPITAL WITH EXTENSIVE EXPERIENCE IN COMPILING THE VALLEY COMMUNITY HEALTH PROFILE HAS EXPANDED ITS RESEARCH TO INCLUDE INFORMATION ON INDICATORS BEYOND HEALTH. THE COUNCIL ALSO CONTRACTED A SURVEY RESEARCH FIRM TO CONDUCT A COMMUNITY SURVEY TO OBTAIN INFORMATION ABOUT RESIDENT VIEWS. THE TOPICS TO BE COVERED IN THE VALLEY CARES COMMUNITY ASSESSMENT REPORT INCLUDE CREATING A COMMUNITY CONTEXT THAT ALLOWS RESIDENTS TO THRIVE, EMPLOYMENT AND ECONOMIC INDICATORS, HOUSING, TRANSPORTATION, PROVIDING EDUCATION AND TRAINING FOR LIFE LONG SUCCESS, PRESERVING THE NATURAL ENVIRONMENT,ENSURING RESIDENT SAFETY, PROMOTING SOCIAL AND EMOTIONAL WELL BEING, ADVANCING COMMUNITY HEALTH, OFFERING ARTS CULTURE AND RECREATION,AND FOSTERING COMMUNITY HARMONY AND ENGAGEMENT. YALE-GRIFFIN PRC NUTRITION DETECTIVES PROGRAM: IN AN ATTEMPT TO HELP CURB THE INCIDENCE OF CHILDHOOD OBESITY, DR. DAVID KATZ, DIRECTOR OF THE YALE-GRIFFIN PREVENTION RESEARCH CENTER PROVIDED COMPLIMENTARY COPIES OF THE NUTRITION DETECTIVES DVD TO ALL SCHOOL DISTRICT SUPERINTENDENTS IN CONNECTICUT. NUTRITION DETECTIVES IS A 90 MINUTE NUTRITION PROGRAM DESIGNED FOR ELEMENTARY SCHOOL AGED CHILDREN. DR. KATZ DEVELOPED THE PROGRAM TO HELP ADDRESS THE GROWING EPIDEMIC OF OBESITY IN CHILDREN. THROUGH A NEW DVD FORMAT CHILDREN ARE TAKEN INTO A MAGICAL CLASSROOM. THROUGH SPECIAL EFFECTS AND SIMULATION SIX STUDENTS IN THE MAGICAL CLASSROOM ARE CONVERTED INTO CERTIFIED NUTRITION DETECTIVES. THE DVD TAKES THE VIEWING AUDIENCE ON A HEALTH PROMOTING JOURNEY. THE DVD TEACHES VALUABLE LESSONS ABOUT THE IMPORTANCE OF EATING WELL WITH AN EMPHASIS ON PRACTICAL SKILLS NEEDED TO IDENTIFY AND CHOOSE NUTRITIOUS FOODS. THE PROGRAM TEACHES CHILDREN TO BE CLUED INTO HEALTH AND GIVES THE 5 ESSENTIAL CLUES A NUTRITION DETECTIVE NEEDS TO GET RIGHT TO THE TRUTH ABOUT NUTRITION ON ANY FOOD PACKAGES; SEE PAST DECEPTIVE MARKETING CLAIMS, DISTINGUISH WHOLE GRAIN FOODS FROM REFINED GRAINS, AND RECOGNIZE THE IMPORTANCE OF EATING NATURAL WHOLE FOODS SUCH AS FRUITS AND VEGETABLES. THE PROGRAM, PREVIOUSLY IN PRINT FORM, IS BEING TAUGHT IN SCHOOLS THROUGHOUT THE COUNTRY AND DATA ARE CURRENTLY BEING COLLECTED IN A 3 YEAR CONTROLLED EVALUATION OF THE HEALTH EFFECTS OF THE PROGRAM IN 13 ELEMENTARY SCHOOLS IN INDEPENDENCE, MISSOURI. FOUNDING THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS, GRIFFIN WAS ALSO THE LEADER IN ESTABLISHING THE VALLEY COUNCIL OF HEALTH AND HUMAN SERVICE ORGANIZATIONS WHICH HAS BECOME A MODEL FOR MANY OTHER COMMUNITIES. THE VALLEY COUNCIL IS A COOPERATIVE VENTURE LINKING APROXIMATELY 50 NON-PROFIT HEALTH AND HUMAN SERVICE PROVIDERS THROUGHOUT THE VALLEY. ITS MISSION IS TO IDENTIFY, PLAN, IMPLEMENT AND COORDINATE A COMPREHENSIVE SYSTEM OF HUMAN SERVICE DELIVERY AND TO ADVOCATE FOR COMMUNITY WIDE AND CULTURALLY DIVERSE PLANNING APPROACHES IN THE LARGER VALLEY COMMUNITY. DECISION MAKERS FROM EACH OF THE ACTIVE MEMBERS MEET MONTHLY. THE COUNCIL OBJECTIVES ARE: TO ENGAGE IN PERIODIC ASSESSMENT AND IDENTIFICATION OF LOCAL SERVICE NEEDS, INCLUDING CLIENT INPUT, COLLABORATIVELY EVALUATE CURRENT SERVICES, IDENTIFY GAPS AND STRATEGIZE ON HOW TO FILL GAPS IN SERVICES, SERVE AS THE PRIMARY PLANNING AND COORDINATING BODY FOR THE REGION'S SERVICE PROVISION SYSTEM, PROVIDE A PLACE FOR SUPPORT AND NETWORKING AMONG THE VALLEY HUMAN SERVIES COMMUNITY, ADVOCATE FOR THE NEEDS OF LOCAL RESIDENTS AND FOR RESOURCES TO MEET THOSE NEEDS ON A LOCAL, STATE AND FEDERAL LEVEL, SEEK TO DEVELOP PARTNERSHIPS WITH OTHER COMMUNITY SYSTEMS I.E. SCHOOLS, BUSINESSES, STATE AND LOCAL GOVRNMENTS AND PUBLIC SAFETY TO ENHANCE SERVICE DELIVERY. GRIFFIN REMAINS AN ACTIVE MEMBER OF THE COUNCIL. NOT ONLY IS GRIFFIN HOSPITAL A CONTINUING MEMBER, THE VALLEY PARISH NURSE PROGRAM AND THE YALE-GRIFFIN PREVENTION RESEARCH CENTER ALSO ARE MEMBERS. HEALTHY VALLEY COMMUNITY PROJECT: GRIFFIN HOSPITAL WAS ONE OF THE FOUNDERS OF HEALTHY VALLEY AND WAS THE ONLY CORPORATE FUNDING SPONSOR. HEALTHY VALLEY, LAUNCHED IN 1994, WAS CONNECTICUT'S FIRST HEALTHY COMMUNITY PROJECT AND RECEIVED RECOGNITION AND AWARDS AS A MODEL FOR OTHER COMMUNITIES ACROSS THE COUNTRY. DURING ITS DEVELOPMENT IT WAS A GRASSROOTS INITIATIVE INVOLVING OVER 200 STAKEHOLDERS. THE COMMUNITY GOAL WAS TO USE RESEARCH, QUANTITATIVE DATA AND A BROAD-BASED VISIONING AND PARTICIPATORY PROCESS TO IDENTIFY AND GAIN CONSENSUS ON PRIORITY COMMUNITY NEEDS AND PROBLEMS AND IDENTIFY RESOURCES TO ADDRESS THEM. THE GOAL OF THE HEALTHY VALLEY PROJECT IS TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF RESIDENTS BY MAKING THE VALLEY A BETTER PLACE IN WHICH TO LIVE, WORK, SHOP AND ENJOY LIFE. GRIFFIN'S LEADERSHIP AND EMPLOYEES WERE ACTIVE MEMBERS OF THE ORGANIZATION'S STAKEHOLDER GROUP. GRIFFIN VICE PRESIDENT, BILL POWANDA, CHAIR OF THE HEALTHY VALLEY STEERING COMMITTEE, WAS INVITED TO PRESENT AT THE PRESIDENTS' SUMMIT FOR AMERICA'S FUTURE AND THE HOFSTRA UNIVERSITY CONFERENCE OF THE PRESIDENCY OF GEORGE H. W. BUSH. THE HEALTHY VALLEY RESEARCH IDENTIFIED THAT COLON CANCER, BREAST CANCER AND PROSTATE CANCER DEATHS WERE SIGNIFICANTLY HIGHER THAN THE STATE AVERAGE AS A RESULT OF LOW RATES OF SCREENING AND PRIMARY CARE ACCESS. GRIFFIN INITIATED AND CONTINUES A SERIES OF INTIATIVES INVOLVING MULTIPLE COMMUNITY ORGANIZATIONS AND AGENCIES TO INCREASE SCREENING RATES. THE HEALTH VALLEY PROJECT CONTINUES TODAY. ALL AMERICA CITY AWARD: GRIFFIN VICE PRESIDENT, BILL POWANDA, LED A COMMUNITY WIDE EFFORT THAT RESULTED IN THE SEVEN TOWN LOWER NAUGATUCK VALLEY REGION BEING NAMED AN ALL-AMERICA CITY BY THE NATIONAL CIVIC LEAGUE IN 2000 GAINING NATIONAL RECOGNITION OF THE CAPACITY AND COMMUNITY BUILDING EFFORT OF MULTIPLE ORGANIZATIONS AND PEOPLE. A TEAM OF 75 VALLEY RESIDENTS INCLUDING SEVEN GRIFFIN EMPLOYEES TRAVELED TO KENTUCKY TO MAKE A PRESENTATION AT THE COMPETITION. JUDGES PRAISED THE COMMUNITY FOR PARTNERSHIPS, TEAMWORK AND INNOVATION IN SELECTING THE VALLEY FOR THE AWARD. MORE THAN 40,000 DOLLARS WAS RAISED TO SUPPORT TRAVEL TO KENTUCKY. GRIFFIN HOSPITAL WAS ONE OF THE CORPORATE SPONSORS. (SEE SCHEDULE O FOR CONTINUATION) Part VI, Line 6: Part VI, Line 7: CT X X X 0 0 0 0 0 0 0 0 0 HENDRICKS DAVID 299431 0 0 0 0 0 8481 0 6398 0 314310 0 0 0 CHARMEL PATRICK 361132 0 0 0 0 0 43935 0 14871 0 419938 0 0 0 BORIS GREGORY 301458 0 0 0 0 0 19501 0 6150 0 327109 0 0 0 DOBULER KENNETH 208026 0 0 0 0 0 47152 0 0 0 255178 0 0 0 SCHWARTZ KENNETH 166056 0 0 0 0 0 53069 0 14601 0 233726 0 0 0 STUMPO BARABARA J 153424 0 0 0 0 0 26666 0 14871 0 194961 0 0 0 MOYLAN JAMES J 219320 0 0 0 0 0 37047 0 615 0 256982 0 0 0 POWANDA WILLIAM 164205 0 0 0 0 0 34858 0 13629 0 212692 0 0 0 DEEGAN MARGARET 160367 0 0 0 0 0 17260 0 615 0 178242 0 0 0 SHEPARD SETH 163228 0 0 0 0 0 19503 0 615 0 183346 0 0 0 FRAMPTON SUSAN 235698 0 0 0 0 0 22224 0 6058 0 263980 0 0 0 BERNS EDWARD 135365 0 0 0 0 0 22285 0 14871 0 172521 0 0 0 MARTIN KATHLEEN 133621 0 0 0 0 0 23406 0 14871 0 171898 0 0 0 D'SOUSA SEEMA 178823 0 0 0 0 0 7379 0 14601 0 200803 0 0 0 HALSTEAD EDWARD 194171 0 0 0 0 0 53826 0 14871 0 262868 0 0 0 KUSTER GORDON 243440 0 0 0 0 0 54040 0 345 0 297825 0 0 0 NAWAZ HAQ 243762 0 0 0 0 0 13244 0 14871 0 271877 0 0 0 BELL GREGORY 227653 0 0 0 0 0 11620 0 6150 0 245423 0 0 0 CHEFA SERIES B 2005-02-01 24800000 CONSTRUCTION OF NEW WING 0 0 CHEFA SERIES C 2007-05-01 23125000 CONSTRUCTION OF NEW CANCER CENTER & RENOVATION OF EMERGENCY DEPARTMENT 0 0 25769812 24573303 435721 760791 1996 1 0 1 1 22982209 1406958 234306 1133492 20207453 2010 1 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 1 1 WACHOVIA BANK 2037.000000000000 0 0 0 Form 990, Part VI, Section A, line 6 GRIFFIN HOSPITAL IS A NON-STOCK CORPORATION THAT DOES NOT HAVE STOCKHOLDERS OR MEMBERS, BUT WHICH DOES HAVE A BOARD OF INCORPORATORS WHO SERVE AS REPRESENTATIVES OF THE COMMUNITY TO CARRY OUT THE EXEMPT AND CHARITABLE PURPOSES OF THE HOSPITAL. Form 990, Part VI, Section A, line 7a THE BOARD OF TRUSTEES MAKES RECOMMENDATIONS TO THE INCORPORATORS OF THE HOSPITAL REGARDING NOMINATIONS OF MEMBERS OF THE COMMUNITY TO SERVE AS TRUSTEES. Form 990, Part VI, Section B, line 11 FORM 990, INCLUDING SCHEDULE H, IS REVIEWED PRIOR TO FILING. Form 990, Part VI, Section B, line 12c EACH YEAR ALL MEMBERS OF THE HOSPITAL BOARD, OFFICERS, DIRECTORS, AND KEY EMPLOYEES RECEIVE, SIGN, AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE. THE DISCLOSURES ARE REVIEWED BY THE HOSPITAL BOARD AND DOCUMENTED IN THE MINUTES. ANY DISCLOSURE OF A CONFLICT PREVENTS THE INDIVIDUAL FROM INVOLVEMENT WITH OR PARTICIPATION IN SUBJECT MATTER THAT MIGHT AFFECT THE DISCLOSED CONFLICT. SUCH ACTIONS ARE DOCUMENTED IN BOARD MINUTES. ALL CONFLICTS ARE DISCLOSED TO BOARD MEMBERS AND CORPORATORS AT THE ANNUAL MEETING OF THE CORPORATION. Form 990, Part VI, Section B, line 15a COMPENSATION OF OFFICERS AND KEY EMPLOYEES ARE REVIEWED ANNUALLY BY THE COMPENSATION COMMITEE WHICH IS A SUBCOMMITTEE OF THE HOSPITAL BOARD. THIS COMMITTEE SETS THE COMPENSATION FOR THE CEO BASED ON INDUSTRY DATA. COMPENSATION OF OTHER OFFICERS AND DIRECTORS IS SET BY THE CEO IN CONJUNCTION WITH THE HUMAN RESOURCE DEPARTMENT. AGAIN INDUSTRY COMPENSATION DATA IS THE BASIS FOR DETERMINING THE APPROPRIATENESS OF COMPENSATION. THE CEO REVIEWS WITH THE COMPENSATION COMMITTEE ALL OFFICERS AND DIRECTORS ON AN ANNUAL BASIS. Form 990, Part VI, Section C, line 19 THE GOVERNING DOCUMENTS ARE FILED WITH THE OFFICE OF HEALTH CARE ACCESS AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR SELECTING AN INDEPENDENT AUDIT FIRM AND FOR OVERSEEING THE FINANCIAL STATEMENT PREPARATION PROCESS. THERE HAVE BEEN NO CHANGES IN THESE PROCEDURES SINCE THE PRIOR YEAR. FORM 990, SCHEDULE H, PART VI, LINE 5 (CONTINUED) A COMMUNITY-WIDE CELEBRATION WAS HELD ATTENDED BY MORE THAN 500 PEOPLE INCLUDING FEDERAL AND STATE LEGISLATORS, LOCAL OFFICIALS, COMMUNITY LEADERS AND RESIDENTS. NEW VALLEY UNITED WAY SUPPORT: AS PART OF ITS CENTENNIAL CELBRATION GRIFFIN HOSPITAL HOSTED THE ANNUAL VALLEY UNITED WAY CAMPAIGN KICK OFF ATTENDED BY CLOSE TO 300 PEOPLE AND ASSUMED A LEADERSHIP GIFT ROLE. THE VALLEY UNITED WAY PROVIES FUNDING TO TWENTY-FOUR COMMUNITY NON-PROFIT AGENCIES. GRIFFIN EMPLOYEES PROVIDED A LEADERSHIP GIFT OF 28,300 DOLLARS TO THE 2009/2010 CAMPAIGN. NEW COMMUNITY INVOLVEMENT: MANY GRIFFIN EMPLOYEES ARE INDIVIDUALLY INVOLVED IN PHILANTHROPIC CAUSES IN SUPPORT OF LOCAL HEALTH AND HUMAN SERVICE ORGANIZATIONS. GRIFFIN HOSPITAL AND MANAGEMENT MEMBERS PARTICIPATE IN FUNDRAISERS AND COMMUNITY EVENTS FOR OTHER ORGANIZATIONS AND CAUSES. A FEW EXAMPLES ARE THE ANNUAL WOMEN MAKING A DIFFERENCE IN THE VALLEY LUINCHEON WITH PROCEEDS GOING TO PROVIDE FUNDING FOR MAMMOGRAMS FOR UNINSURED OR UNDERINSURED WOMEN AND THE GO RED FOR WOMEN LUNCHEON AWARENESS BUILDER AND FUNDRAISER TO EMPOWER WOMEN TO LOVE AND SAVE THEIR HEARTS THROUGH LIFESTYLE CHOICES AND ACTIONS. PROCEEDS GO TO THE AMERICAN HEARAT ASSOCIATION AND GRIFFIN HOSPITAL WOMEN AND HEART DISEASE FUND. GRIFFIN HOSPITAL EMPLOYEES ARE HELPING THEIR FELLOW CITIZENS IN MANY DIFFERENT CAPACITIES. PRESIDENT PATRICK CHARMEL IS CHAIRMAN OF THE BOARD OF THE GREATER VALLEY CHAMBER OF COMMERCE, ELLEN PRICE IS SECRETARY OF THE BOARD OF DIRECTORS TO THE VALLEY YMCA AND CHAIR OF THE MEMBERSHIP PROGRAMMING COMMITTEE. SHE ALSO VOLUNTEERS FOR THE FESTIVAL OF ARTS AND IDEAS IN NEW HAVEN. KATHLEEN MARTIN, VICE PRESIDENT QUALITY AND CARE IMPROVEMENT, HAS VOLUNTARILY FACILITATED A COMMUNITY SUPPORT GROUP WEEKLY FOR CANCER SURVIVORS FOR 23 YEARS. SHE IS ALSO ON THE QUALITY BOARD OF CONNECTICUT HOSPITAL ASSOCIATION. RITA CRANA, SOCIAL SERVICE COORDINATOR, SERVES ON THE EXECUTIVE BOARD OF TEAM, THE COMMUNITY ACTION AGENCY OF THE VALLEY AND IS ALSO A MEMBER OF THE CONNECTICUT ASSOCIATION OF SCHOOL BASED HEALTH CENTERS. LISA BISSON, SALES ASSOCIATE, OCCUPATIONAL MEDICINE IS VALLEY UNITED WAY CABINET MEMBER, VALLEY CHAMBER OF COMMERCE AMBASSADOR COMMITTEE MEMBER FOR RELAY FOR LIFE AND A CORPORATOR FOR BIRMINGHAM GROUP SERVICES. GRIFFIN HEALTH SERVICES CORPORATION 130 DIVISION STREET DERBY CT 06418 222560257 HOLDING COMPANY CT 501(C)(3) 509(A)(3)(B)(I) N/A GRIFFIN FACULTY PRACTICE PLAN INC 130 DIVISION STREET DERBY CT 06418 061463147 MEDICAL/EDUCATION CT 501(C)(3) 509(A)(2) N/A THE GRIFFIN HOSPITAL DEVELOPMENT FUND 130 DIVISION STREET DERBY CT 06418 222560254 FUND RAISING CT 501(C)(3) 509(A)(1) GRIFFIN HEALTH SERVICES CORPORATION PLANETREE INC 130 DIVISION STREET DERBY CT 06418 061505284 EDUCATION CT 501(C)(3) 509(A)(2) N/A GRIFFIN PHARMACY & GIFT 130 DIVISION STREET DERBY CT 06418 222560257 PHARMACY CT 501(C)(3) 509(A)(2) GRIFFIN HEALTH SERVICES CORPORATION GH VENTURES INC 130 DIVISION STREET DERBY CT 06418 222560247 MANAGE MEDICAL BILLING CT N/A C HEALTHCARE ALLIANCE INSURANCE COMPANY LTD 130 DIVISION STREET DERBY CT 06418 OFFSHORE CAPTIVE CT N/A C CT PRACTICE MANAGEMENT INC 130 DIVISION STREET DERBY CT 06418 INACTIVE CT N/A C 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 HEALTHCARE ALLIANCE INSURANCE COMPANY LTD D 4112001 GRIFFIN PHARMACY AND GIFT O 190000 GH VENTURES INC D 205000 GRIFFIN DEVELOPMENT FUND O 486000 PLANETREE INC O 529000