2011-08-11T15:05:10-05:00 2010-09-30 Ernst & Young US LLP 55 Ivan Allen Jr Blvd Suite 1000 Atlanta GA 30308 990 2009-10-01 060966963 Natchaug Hospital Inc NATC 8604561311 189 Storrs Road Mansfield Center CT 06226 PAUL V MALONEY 8604561311 2011-08-11 0 4048748300 2009 2016-02-24 21:20:13Z Stephen W Larcen PHD 189 Storrs Road Mansfield Center CT 06226 43245123 0 X WWW.NATCHAUG.ORG X 1954 CT To provide inpatient and outpatient psychiatric healthcare services. 13 12 623 61 0 0 199924 152730 40166684 43075045 43747 17348 0 40410355 43245123 0 0 31027479 33901449 0 41958 8876015 8786033 39903494 42687482 506861 557641 17214864 17697436 8646634 8848155 8568230 8849281 To provide a continuum of accessible, community-based services for those living with psychiatric illness and chemical dependency or emotional and related educational disabilities, with a commitment to the dignity and privacy of those needing service, empowering them to participate in their own care, education and recovery. 0 0 15161250 15564191 Inpatient TreatmentNatchaug Hospital provides a full range of inpatient psychiatric and substance-abuse treatment for children, adolescents and adults at our 57-bed Mansfield Center facility. The highly qualified, experienced and dedicated professional staff of Natchaug Hospital provides expert care in a supportive, therapeutic setting - helping people regain their stability and return as soon as possible to their own homes.Intermediate Care (ICC)An acute level of care for a longer length of stay for persons living with prolonged and severe mental illness. Historically, people from Eastern Connecticut who were in need of an extended length of stay were referred to Cedarcrest Hospital in Newington. Natchaug Hospital ICC provides this much needed care for persons from the Eastern Region, closer to the communities where they live and work. United Services and the Southeastern Mental Health Authority are the Local Mental Health Authorities (LMHA's) responsible for authorizing admission to the Intermediate Care Program. The above includes the authorization of Department of Mental Health and Addiction Services (DMHAS) funds to pay for care in the event the patient is medically indigent, has exhausted his/her Medicare benefit, or has no Medicare hospitalization coverage. Patients are most likely to be referred from Eastern Region hospital inpatient units when it becomes clear that the patient will not be able to safely return to the community following an acute care stay. Upon admission each patient is assessed by a psychiatrist, a registered nurse and a primary therapist and a treatment plan is developed. The treatment team works closely with the client, their family and community providers to develop a discharge plan and ensure that community supports are in place.In-Patient Treatment Programs Treats 57 clients on a daily basis at the Mansfield location. Inpatient treatment includes: Comprehensive bio-psycho-social assessment Formulation of a treatment plan developed with the client/family which may include the use of medications Group therapy (a primary treatment approach) Family therapy and individual therapy Formulation of a discharge/aftercare plan Case management services Client referral to in-patient programs: Majority (over 80%) come from emergency rooms Self-referral via phone call or walk-in Referral from a Natchaug Program (PHP, IOP, school) Referral from community providersTypical client experience: The majority of our clients arrive via ambulance through the ambulance entrance. All clients receive an initial assessment by a registered nurse and psychiatrist which is completed within 8 hours of admission. Clients are oriented to the unit, the milieu, and the schedule. Our clients are closely monitored for the first 24-48 hours, depending on presentation and symptoms. Groups are scheduled from morning through evening. In addition, the clients meet with their Primary Therapist and Psychiatrist regularly.Contact with the family/guardian is during the admission process or within the following 48-72 hours. Family meetings are scheduled by the Primary Therapist. The clients on the child and adolescent units attend school in the building for 5 hours per day, with groups during the day, after school, and in the evening. Staffing pattern: Each inpatient unit is staffed 24-7 with: Registered NursesPsychiatristsMental Health Workers Licensed Practical Nurses (Adult Unit only) Also on the clinical treatment team are:Nurse Manager Licensed Primary TherapistsCase Manager (Adult Unit Only)Unit ClerkDieticianCertified Occupational Therapists (COTA)Occupational Therapist (OT)Family Practice Physician on site M-FInpatient Units: Adult rooms all semi-private plus one four-bed room. Child/Adolescent rooms are all private Units include group room space Meals are served in the dining roomOther points:Licensed by Connecticut Department of Public Health.Surveyed by Joint Commission under the Hospital StandardsSurveyed by the Center for Medicaid Services (federal program) 7724788 8351409 Joshua CentersPartial Hospital Program (PHP) The Partial Hospital Program provides four hours of intensive psychiatric support daily for up to five days per week. This is a morning program for adults, after-school for children and adolescents. The program can eliminate the need for a hospital stay, and/or help with the transition back to home and regular school after a period of inpatient care.Intensive Outpatient Program (IOP) The Intensive Outpatient Program is somewhat less intense than the PHP, providing three hours of intensive treatment each day for up to five days each week. This program is offered both in the morning and during the evening for adults, after-school for children and adolescents. The IOP program is designed to help continue progress with behavioral health stabilization and recovery.Extended Day Treatment (EDT)This special program, partially funded in part by the Connecticut Department of Children, supports children and adolescents who have emotional or behavioral health issues that put them at risk of needing psychiatric residential or inpatient care. The Extended Day Treatment program is particularly helpful for children with special needs who are in foster care.Child & Adolescent Treatment Programs: Treat about 250 children and adolescents daily in all programs/locations May prevent hospitalization Aids in transition back to the community following hospitalization Transportation to PHP, IOP & EDT: Most of this transportation is provided by Natchaug Hospital staff, driving Natchaug Hospital vans that pick clients up from their school or home. Average length of stay in PHP/IOP program, 6 - 8 weeks; EDT and IICAPS, 6 months.Joshua Program treatment services include: Comprehensive bio-psycho-social assessment Group Therapy (the primary treatment approach) Family and individual therapy Medication management Occupational and creative rehabilitation therapy Comprehensive aftercare/discharge planningPartial Hospital Program (PHP): four hours of treatment for up to five days per week Intensive Outpatient program (IOP): three hours of treatment up to five days per week Extended Day Treatment (EDT) is a specialized therapeutic after-school support program that provides structured groups for three hours a day up to five days per week to learn and practice social skills such as group interaction, listening, cooperative leisure activities. Intensive In-Home Child & Adolescent Psychiatric Services(IICAPS): developed and monitored by the Yale University Child Study Center, provides in home services 2-3 times per week to help meet the needs of families with children with persistent psychiatric disorders. Client referral to a Child/Adolescent Treatment Program: Referred from an inpatient program in Connecticut Community providers (Child & Family Services; United Children & Families; Emergency Rooms) School systems Private providers (community psychiatrists or therapists) Family and friendsTypical client experience in a Child/Adolescent Program:Initial referral phone call results in an intake appointment with a masters level clinician to complete a bio-psycho-social assessment. The client must be accompanied by their parent/guardian. After admission to the Program, the client/guardian meets with the psychiatrist/APRN for treatment planning and medication management.In a treatment day, clients arrive after being picked up from their school (or home) in one of Natchaug Hospital vans and will attend four groups in PHP and three groups in IOP. Groups include a psychotherapy group, educational groups and an activity group. The activity group is led by a Mental Health Worker or a CRS Staff member; all other groups are led by a masters level clinician. Education groups might include managing emotions; dangers of substance abuse; handling relationships, etc. Natchaug Hospital Group Levels: Psychotherapy/Process Group: is based on exploration and analysis of the interaction of a person's thoughts, feelings & beliefs and the group process for the purpose of facilitating an interpersonal change process and is led by a mental health professional with a graduate degree in a clinical discipline. Educational/Skills Group: Involves the acquisition of knowledge and/or skills, improved coping responses, or the sharing of experiences (such as Goals or Wrap-up Group). Group goals are to reduce stress, improve problem solving and learn new coping behaviors. This group is led by a staff member with documented training and/or experience in group leadership. The group includes: Registered Nurses, Certified Occupational Therapy Assistants, Mental Health Workers, Pharmacists, and Dieticians, CRS staff (music, art or recreational therapists).Leisure Activity Groups: involve the client/patient/student within a meeting/group format in order to practice the development of healthy social relationships. This may include a specific activity (art, music, games) planned with the goal of improving attention and/or social interactions; led by a staff member with the desire and supervisor-determined competency to lead a leisure activity group.Other points:Surveyed by Joint Commission using Behavioral Health Standards; PHP/IOP licensed by the Department of Public Health; EDT is licensed by the Department of Children & Families. 9179898 10014248 EducationClinical Day Treatment School Programs (CDT)Natchaug's clinical day treatment programs, which are approved by the Connecticut Department of Education, offer special education services to students in grades 1 - 12 whose social, emotional or behavioral health problems prevent them from functioning successfully in a regular school environment. Each student's individual academic and clinical treatment plan is designed to address their special needs and return them to their regular schools as soon as possible. Natchaug Hospital schools operate in Enfield, Danielson, Mansfield, Norwich, Montville and Windham. Natchaug is also the contracted operator of two schools for the town of Norwich.Natchaug Hospital's Board of Directors serves a number of functions similar to a Board of Education, with responsibilities for the oversight and the implementation of certain State statutes and Federal legislation.Natchaug Hospital School Programs Each school day, an average of 200 students attend Natchaug Hospital's school programs Approved by the Connecticut Department of Education: Inpatient School Journey House School Clinical Day Treatment School in six sites Natchaug contracts with the Norwich Public Schools to provide services located at: Deborah Tennant-Zinewicz Hickory Street School Students come to the Inpatient School on an emergency basis, and for non-educational reasons; school staff determines if the student receives special education services, and if there is an Individual Education Plan (IEP) to be implemented. Students come to the Journey House School on a planned basis and for non-educational reasons. Each student's school files are evaluated for proper placement in School. Girls who receive special education, Section 504, and regular education all are educated at the Journey School. Students come to the six CDT sites via a Planning and Placement Team (PPT) Meeting from their home school district. They may be placed on a diagnostic basis with PPT meetings every two weeks while psychiatric, psychological and educational assessments are performed. Students also may enter the program already receiving special education services with an IEP (Individualized Education Plan) in place. Students come to the Hickory Street School and DTZ School by placement by the Norwich Board of Education. All students are identified as special education and have an IEP in place.Transportation to all day school programs is provided by the Local Education Authority (LEA) that placed the student; however, transportation during the school day for field trips is often provided using Natchaug vans with school staff driving; sometimes school field trips are transported by outside vendors. Student Referral to the Inpatient and Journey Schools Placement for non-educational reasons (inpatient or residential treatment admission)Student Referral to the six CDT sites These are only made by the Local Education Authority (LEA), which is designated by the state to be the "town of nexus," which takes numerous requirements into consideration, such as where the parent resides. Referral to the Hickory and DTZ schools These are only made by the Norwich Board of EducationDescription of typical day:A typical day in the Inpatient and Journey House School is a five-hour day that covers all academic areas, including electives of Art and PE. A typical day in the CDT schools is similar to any traditional school day, with academic subjects in addition to psycho-educational groups led by school clinicians. 9110365 9145197 Natchaug Hospital provides inpatient acute behavioral health services for patients at its main site in Mansfield Center. Natchaug Hospital also operates a number of structured day programs providing partial hospital, intensive outpatient, extended day treatment, and outpatient services for persons with behavioral health and substance abuse needs. These programs are provided at a variety of sites throughout eastern Connecticut. The Hospital also provides specialized residential treatment to adolescent girls in the care of custody of the Connecticut Department of Children and Families. 9110365 9145197 41176301 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 56 0 1 623 1 0 0 0 0 0 0 0 0 0 13 12 1 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X Paul V Maloney 8604561311 189 Storrs Road Mansfield Center CT 06226 Colin K Rice 2.00 X 0 0 0 Antoinette Ellzey 2.00 X 0 0 0 Rev Laurence AM LaPointe 2.00 X 0 0 0 Harriotte W Wilson 2.00 X 0 0 0 William E Anderson Jr 2.00 X 0 0 0 Edward S Sawicki MD 2.00 X 0 0 0 Carol A Wiggins PHD 2.00 X X 0 0 0 Michael G Pallein CPA 2.00 X 0 0 0 Pedro J Johnson 2.00 X 0 0 0 Karla Harbin Fox Esq 2.00 X 0 0 0 Kimberly A Colfer Esq 2.00 X 0 0 0 Elizabeth B Ritter 2.00 X 0 0 0 Dana McGee Esq 2.00 X 0 0 0 Stephen W Larcen PHD 40.00 X 0 445279 68344 Paul Maloney 40.00 X 0 139551 31545 David Klein PHD 40.00 X 146119 0 34295 Deborah Weidner 40.00 X 55579 0 7006 Peter J Smith 40.00 X 206282 0 33503 Jonathan L Chasen 40.00 X 197504 0 32218 Rajesh C Parekh 40.00 X 185846 0 32188 Teodora Andrei 40.00 X 204727 0 32643 Bonnie L Viens 40.00 X 182219 0 14536 1178276 584830 286278 17 0 1 0 United Community Family Services 34 East Town St Norwich CT 06360 Social Workers, RN's 448784 Hartford Provision Co Dept No 385 POBox 150473 Hartford CT 06115 Food Services 285222 Mansfield Family Practice Mansfield Professional Park Storrs CT 06268 Physician Consultations 240678 Medical Staffing Network PO Box 202996 Dallas TX 75320 Contract Nurses 156249 Shipman & Goodwin LLP One Constitution Plaza Hartford CT 06103 Legal 137859 8 152730 152730 Contract Revenue 624100 43075045 43075045 43075045 17348 17348 43245123 43075045 0 17348 999192 999192 25136344 25117909 18435 1284228 1232619 50418 1191 4413704 4237377 173281 3046 2067981 1985383 81188 1410 401668 401668 55081 55081 92461 92461 17602 17602 1443028 1443028 64128 64128 2384961 2379456 5505 613589 613589 125684 125684 43534 43534 265707 265707 968333 968333 547897 547897 Bad Debt 774964 774964 Purchased Services 584093 571722 12371 Repairs & Maintenance 283348 283348 Dues & Subscriptions 85368 85368 Education/Tech Training 34587 34587 42687482 41176301 1469223 41958 6700 6851 587390 982263 269096 4443082 4221388 120905 116117 116288 417439 18650995 7220504 11469754 11430491 470745 253791 17214864 17697436 4138675 4653144 4073412 3762124 434547 432887 8646634 8848155 X 8387400 8639928 180830 209353 8568230 8849281 17214864 17697436 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 17602 0 0 17602 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Natchaug Hospital paid Kenneth L. Przybysz LLC and Connecticut Hospital Association (CHA) for their lobbying efforts on behalf of the organization during the fiscal year. Both CHA and Mr. Przybysz lobbies Connecticut State Legislators in the interest of a group of specialty hospitals in the State of Connecticut. 195897 195897 12989350 3949376 9039974 923146 163230 759916 3640124 2536180 1103944 902478 571718 330760 11430491 Due To Affiliated Corporation 432887 432887 43245123 42687482 557641 -276590 -276590 281051 42733656 0 42733656 511467 511467 43245123 42284107 0 42284107 403375 403375 42687482 Part X: Description of Uncertain Tax Positions Under FIN 48: The Audited financial statement did not include a FIN 48 footnote. Part XI, Line 8 - Other Adjustments: Change in Net Assets Related to Pension Plan: -276590. Part XII, Line 4b - Other Adjustments: Revenue Reclassed From Net Expenses: 403375. Restricted Contributions Not Reported In Operations: 152730. Net Assets Released From Restrictions: -44638. Part XIII, Line 4b - Other Adjustments: Revenue Reclassed From Net Expenses: 403375. 1 1 X 1 X 1 X 1 1 1 0 1 1 177239 68 177171 0.00420 12913203 11946217 966986 0.02310 1896367 1833668 62699 0.00150 14986809 13779953 1206856 0.02880 261611 261611 0.00620 134151 134151 0.00320 406131 406131 0.00970 198320 198320 0.00470 1000213 1000213 0.02380 15987022 13779953 2207069 0.05260 998 998 0.00000 1 6375 6375 0.00020 1 7373 7373 0.00020 1 840479 214658 4081086 4591906 -510820 X 1 1 Natchaug Hospital

189 Storrs Rd PO Box 260 Mansfield Center CT 06250

X Care Plus

1353 Gold Star Highway Center Groton CT 06340

Day Treatment Center Clinical Day Treatment Windham

345 Jackson Sreet Willimantic CT 06226

Day Treatment Center Joshua Center - Northeast

934 North Main Street Danielson CT 06239

Day Treatment Center Joshua Center - Enfield

72 Shaker Road Suite 7 Enfield CT 06082

Day Treatment Center Joshua Center - Montville

20 Maple Avenue Uncasville CT 06382

Day Treatment Center Quinebaug Day Treatment Center

320 Pomfret Street Putnam CT 06260

Day Treatment Center Rivereast Day Treatment Center

428 Hartford Tpke Vernon CT 06066

Day Treatment Center Thames Valley Clinical Day Program

One Ohio Avenue Norwich CT 06360

Clinical Day Program Part I, Line 3c: Natchaug Hospital used Federal Poverty Guidelines to determine eligibility. Beginning in fiscal year 2011, the hospital will increase the federal poverty guidlines for eligibility for free care and discounted care to 250% and 400% respectively. Part I, Line 7: The organization used cost to charge ratio as determined by the Medicare Cost Report. Part I, Line 7g: No physician clinic costs were included in the Subsidized Health Services cost calculations. Part I, Line 7f: Part III, Line 4: The organization's financial statements are provided in accordance with Generally Accepted Accounting Principles (GAAP). GAAP does not require a footnote for bad debt expenses, however, the charity care footnote reads as follows: "A patient is classified as a charity patient by reference to the established policies of the Hospital. Essentially, these policies define charity care services as those services for which no payment is anticipated. In assessing a patient's inability to pay, the Hospital utilizes the generally recognized poverty income levels for the State of Connecticut, but also includes certain cases where incurred charges are significant when compared to patients' incomes". In the event a patient fails to qualify for financial assistance or fails to pay their portion of discounted charges, and the patient does not pay timely their obligation to the Hospital, the Hospital reserves the right to institute and pursue collection actions and to pursue any remedies available at law or in equity, including but not limited to, imposing wage garnishments or filing and foreclosing on liens on primary residences or other assets, instituting and prosecuting legal actions and reporting the matter to one or more credit rating agencies. In the event the Hospital is unable to collect, the outstanding amounts are written off as bad debt. For those patients who qualify for financial assistance and are cooperating in good faith to resolve outstanding accounts, the Hospital may offer extended payment plans and will not impose collection efforts described above.The organization used cost to charge ratio as determined by the Medicare Cost Report. The Audited Financial Statement amount is the total amount of bad debt at contracted rates. The amount reported on Part III Line 2 is the corresponding cost determined by taking those services, grossing them back up to charge and then applying the Medicare Cost Report determined Cost to Charge ratio. The amount reported on Part III, Line 3 was determined by reviewing the demographics as well as the insurance plans of the patients for whom accounts were written off as Bad Debt during the year and extrapolating the likelihood that they would be eligible under the Hospital's Charity Care Program. Part III, Line 8: Providing care for those in need, including Medicare and Medicaid patients, and serving all patients regardless of ability to pay is an essential part of the community benefit standard, as well as our mission in our community. We serve these patients without regard to the payment shortfall. The organization used a cost to charge ratio as determined by the Medicare Cost report. Part III, Line 9b: The following is included in the Natchaug Hospital's Financial Assistance Policy: For those patients that qualify for financial assistance and who are cooperating in good faith to resolve the Hospital's outstanding accounts, the Hospital may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to outside collection agencies and will cease all collection efforts. Once a patient qualifies for financial assistance, the patient will be contacted via written communication and the patient account will be documented as appropriate to reflect the level of approval that was granted. Patient Accounting will make all necessary adjustments to the account. Other parties, such as collection agencies, and other billing parites will also be notified of the adjustments. Part VI, Line 2: A community needs assessment conducted by Natchaug Hospital at the request of health care providers and educators in the 12-town region of Greater Essex/Old Saybrook identified an unmet need for adolescent behavioral health care services, leading to the 2010 creation by Natchaug of a new Joshua Center program to provide adolescents with special education, partial hospitalization and intensive outpatient treatment programs. Surveys are conducted to assess the effectiveness of community benefit activities, and to assess whether Natchaug Hospital is meeting the needs of health care providers in the region. Natchaug Hospital assesses data from the Connecticut Hospital Association (CHA) and providers throughout the state regarding bed availability and days in emergency departments while awaiting admission. In fact, this alerted Natchaug Hospital to the need to expand its child and adolescent inpatient program. Data from health needs assessments conducted by Backus Hospital, Lawrence & Memorial Hospital and the United Way is also reviewed. Natchaug Hospital conducted a needs analysis during 2009 with providers and educators in the 12-town region of Greater Essex/Old Saybrook regarding access to services for emotionally disturbed youth. Needs are also assessed through Systems of Care meetings, and by tracking waiting lists for admission to programs. A formal Community Health Needs Assessment of Windham County is planned for 2011. Part VI, Line 3: Natchaug Hospital displays its Charity Care Policy in all waiting areas, sends in summary with our monthly statements, is part of the monthly statements sent by our collection agency, is distributed individually by front desk staff & social services and is displayed on the Hartford HealthCare Website. The Notice states in English and Spanish: NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE Financial assistance is offered by Natchaug Hospital which provides a reduced cost rate for medically necessary services incurred by state of Connecticut legal residents whose household income does not exceed 250% of the Federal Income Poverty Guidelines for a family unit. Patients must meet the State of CT definition of "uninsured", and need to apply and be denied eligibility for any medical or health care coverage provided under the General Assistance Program or the CT Medicaid program, or not be eligibility for coverage under Medicare or CHAMPUS programs, or any other governmental or privately sponsor health or accident insurance. Patients must furnish proof of income to qualify for Financial Assistance. There are Financial Counselors available to assist patients with the application for Financial Assistance. Please contact Financial Counseling at 860-456-1311, X-236 or X-236 for more information. Part VI, Line 4: Natchaug Hospital admits residents of, on average, 150 of Connecticut's 169 towns and six states each year. Natchaug Hospital's service area is comprised of 62 towns, primarily east of the Connecticut River, which together represent approximately half the State's land area. Natchaug Hospital's clients represent urban, suburban and rural areas. Admissions reflect the demographics and prevalence of behavioral health illnesses of the region: during FY 2010, admissions were composed of 46% female, 54% male; .65% American Indian or Alaskan Native, .4% Asian, 6.9% African American, 85.9% Caucasian, .31% Native Hawaiian, 5.83% other or unknown; 62.8% of clients were age 19 or older,27.6% were between 12 and 18 years of age, 9.47% were age 4 to 11. The majority of Natchaug Hospital clients (approximately 76%) are financially stressed, as measured by the number of students meeting Federal free/reduced lunch criteria and the number of clients overall who are un-insured or participating in a public support plan such as HUSKY, Medicaid, Medicare or SAGA. Part VI, Line 5: To reduce economic impact of untreated mental illness and improve the quality of life for those living with this disease (and the community in which they live) Natchaug Hospital pursues opportunities increase awareness of the symptoms of mental illness, awareness that mental illness is a treatable disease, a reduction in the stigma associated with mental illness (which is the largest barrier to treatment), and awareness of treatment resources.To these ends, Natchaug Hospital:1) Helps bring mental illness "out of the closet" by organizing community service projects for our students in which they give back to the community, improve the environment of the community, and allow themselves to be openly identified as a person with emotional disturbances who is getting help. 2) Created and chairs the Health Council at the Chamber of Commerce so as to ensure that behavioral health needs are an integral part of Chamber initiatives, and to make a business case for the cost benefit for businesses to support treatment for their employees.3) Participates in the Community Foundation's "Listen & Learn" program so as to ensure behavioral health needs are included in the Foundation's strategic plan as a priority for fund development and grant distributions4) Seeks opportunities to serve in leadership positions in regional initiatives with the potential to impact attitudes and resources for behavioral health, such as serving on the steering committee of Enfield's "Healthy Enfield Committee"5) Participates intensively in "Systems of Care" meetings, both regionally and locally, so as to advocate (when appropriate) for mental illness being considered as a potential underlying issue, maintain awareness that it is a treatable disease, and help identify resources for treatment. Part VI, Line 6: Natchaug Hospital is one of only five hospitals in Connecticut offering inpatient treatment for children as young as five,and one of only nine for adolescents.Natchaug Hospital's ten-site network of community-based partial hospital, intensive outpatient and special education programs is unique within the state for its depth, breadth and accessibility. Natchaug Hospital's Journey House is the only locked behavioral health residential treatment program in Connecticut for parole status adolescent females.Natchaug Hospital serves the behavioral health needs of the Greater Windham area, the general hospital for which, Windham Memorial Community Hospital, does not have a psychiatric unit.All of our Board Member and management reside within our service area. Our all-volunteer Board of Directors represent the communities we serve. Natchaug Hospital's Chief Medical Officer, Dr. Weidner, is also serving as Medical Director of Behavioral Health Services at Windham Hospital, where she works with all Windham Hospital psychiatrists and physicians to assure quality care and enhanced coordination of services in inpatient and emergency department settings.Natchaug Hospital President & CEO, Stephen Larcen, served on the National Association of Psychiatric Health Systems, facilitating changes in Federal law to improve access to behavioral health care through 1) parity for insurance coverage and 2) modifications to criteria for CHAMPUS TriCare participants so as to improve access to behavioral health care for military personnel and their dependents.Natchaug Hospital offers the use of its facilities, for free, to recovery support groups, including AA, Al-Anon, ACOA, NAMI and other community groups. With regular weekly and monthly meetings, attendance over the course of each year is more than 3,000. Natchaug Hospital staff actively contributes to the community. For example, Program Director Peter DeRosa serves on the Eastern Connecticut Chamber of Commerce's Health Advisory Committee and as a Chamber Trustee, Natchaug's Director of School Programs, Jill Bourbeau, serves as the President of CAPSEF, at least three Natchaug staff serve on their local Boards of Education, and Dr. Larcen serves on his town's Board of Finance.Natchaug Hospital extends medical staff privileges to all qualified physicians in its community. In a review of the entire tax return, it should be noted that a significant amount of the hospital resources are expended on community benefit activities. The Hospital also expends a large amount of its resources updating its facilities and employing the most qualified staff in order to enhance patient care. Part VI, Line 7: Natchaug Hospital is an affiliate of Hartford Health Care Corporation (HHC). The vision and mission of HHC is to be a national and local leader in elevating the standards of patient safety, quality, outcomes, scientific discovery and dissemination of clinical knowledge. In addition, HHC strives to provide compassionate care designed to supply the necessary health services needed by the community.The affiliation creates a strong and organized integrated health care delivery system capable of providing high quality and coordinated care for the benefit of the communities served by the affiliated hospitals, while containing costs to the maximum extent possible. The affiliated hospitals share a mutual commitment to offer expanded geographic coverage, a full continuum of care, strong local primary and secondary care services, the highest standards of clinical care, enhanced patient access, including for underserved populations, and the most advanced technologies. The affiliation further enhances the hospitals' abilities to support their missions, identity, and respective community roles. Through integration and planning to meet the changing needs of the region, including responsible decision making and appropriate sharing of services, resources and technologies, the hospitals achieve certain economies of scale that benefit the communities they serve. CT X X X X 0 0 0 0 0 0 0 0 0 Stephen W Larcen PHD 0 318420 0 88110 0 38749 0 45900 0 22444 0 513623 0 0 Paul Maloney 0 134224 0 5120 0 207 0 14391 0 17154 0 171096 0 0 David Klein PHD 137500 0 8594 0 25 0 9523 0 24772 0 180414 0 0 0 Peter J Smith 194183 0 8250 0 3849 0 9859 0 23644 0 239785 0 0 0 Jonathan L Chasen 193198 0 0 0 4306 0 9716 0 22502 0 229722 0 0 0 Rajesh C Parekh 185821 0 0 0 25 0 8840 0 23348 0 218034 0 0 0 Teodora Andrei 204702 0 0 0 25 0 9021 0 23622 0 237370 0 0 0 Bonnie L Viens 182194 0 0 0 25 0 0 0 14536 0 196755 0 0 0 See Sch O See Sch O See Sch O 0 0 0 Form 990, Part VI, Section A, line 2 See detailed explanations on Schedule L, Part IV. Form 990, Part VI, Section A, line 6 Natchaug Hospital is organized as a non-stock not for profit entity. Hartford Health Care Corporation is the sole member. Form 990, Part VI, Section A, line 7a The sole member of the organization has the authority to approve/deny members of the governing body. Form 990, Part VI, Section A, line 7b The sole member of the organization has the right to review, approve, disapprove and deny significant transactions such as mergers, acquisitions, dissolutions etc. Form 990, Part VI, Section B, line 11 The Form 990 was prepared by Hartford Hospital's Tax Department. It was then reviewed by an independent accounting firm. It was then forwarded to the organization's top management including the CFO for review. The Form was then made available to the board for review. Once the entire review process was completed, the form was signed by the CFO and then filed with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The hospital's board has adopted the policy of the member organization, Hartford Health Care Corporation. All directors and officers of the organization shall complete and sign a Conflict of Interest statement. The statement will include an itemization and description of any actual or potential conflict of interest and all material facts related thereto for such director or officer by virtue of his or her activities or the activities of related persons. Directors and officers are urged to be inclusive in this disclosure since the disclosure of potential and actual conflicts of interest is essential to ensuring discussion of the conflict. Disclosure statements shall be returned to the Compliance Officer. All disclosures made will be reviewed by the Compliance Officer and the Director of Internal Audit, under the direction of the Chairman and the President, who shall exercise good faith judgment as to whether a conflict exists. The Chairman and President shall be responsible for monitoring transactions or arrangements in which a director or officer may have a conflict of interest and for assuring that the director or officer serves the hospital's best interests. The Compliance Officer, Director of Internal Audit, Chairman and/or President may consult with any director or officer and obtain information necessary for an ordinarily prudent person to make a judgment as to whether a conflict exists and each director and officer shall cooperate with such requests. The Compliance Officer, Director of Internal Audit, Chairman and/or the President shall provide guidance to the director or officer and to the board of directors as to the appropriate course of action. The Chairman and the President shall seek the advice and approval of the full Board of Directors in determining whether a conflict of interest exists and that the director or officer serves the organization's best interests. When a conflict of interest is discovered, such director and/or officer with the conflict will be required to refrain from participating in any discussion or action concerning such conflicted situation in accordance with the section entitled "Restraint on Participation" set forth in the Conflict of Interest policy. If, after completing and signing the annual disclosure statement, an actual or potential conflict arises, the director or officer with the conflict shall promptly notify the Compliance Officer and Director of Internal Audit in writing. Form 990, Part VI, Section B, line 15 All except the CEO and CFO are reviewed against market using Connecticut Hospital Association (CHA) data, Hartford Hospital (HH) data and appropriate published compensation surveys periodically and reviewed with the Hospital's Executive Committee of the Board annually. The CEO and CFO scales are also reviewed annually against surveys and reviewed and approved by the Hartford Health Care Corporation Compensation Committee. Form 990, Part VI, Section C, line 19 Form 990 and 1023 and its attachments are available upon request. The Hospital's governing documents, financial statements and Conflict of Interest statements are also made available upon request. Part XI, Line 2 The organization's financial statements were audited by an independent accounting firm. In addition, the organization has a committee that assumes responsibility for oversight of the audit of its financial statements. Schedule L, Part IV Business Transactions Involving Interested Persons: (a)Name of Person: William E. Anderson, Jr. (b)Relationship Between Interested Person and Organization: Member - at - Large (c)Amount of Transactions: $264,598.32 (d)Description of Transaction: Mr. William Anderson is a board member of Natchaug Hospital. Natchaug Hospital maintains deposit bank accounts at the Savings Insitute Bank. Mr. Anderson is an officer at the bank. (e)Sharing of Organization's Revenue? No Eastern Rehabilitation Network 181 Patricia M Genova Drive Newington CT 06111 043276256 Rehabilitation Services CT N/A Midstate MSO LLC 435 Lewis Avenue Meriden CT 06451 204312072 Management Services CT N/A Clinical Laboratory Partners LLC 129 Patricia M Genova Drive Newington CT 06111 061525596 Laboratory Services CT N/A Hartford Hospital 80 Seymour Street Hartford CT 06102 060646668 Health Services CT 501 (c) (3) 3 N/A Windham Community Memorial Hospital 112 Mansfield Avenue Willimantic CT 06226 060646966 Health Services CT 501 (c) (3) 3 N/A Windham Hospital Foundation Inc 112 Mansfield Avenue Willimantic CT 06226 562546632 Supporting Organization CT 501 (c) (3) 11 (a) N/A Midstate Medical Center 435 Lewis Avenue Meriden CT 06451 060646715 Health Services CT 501 (c) (3) 3 N/A Hartford Health Care Corp 80 Seymour Street Hartford CT 06102 222672834 Support and Management Svcs. to Hartford Hospital and Affiliates CT 501 (c) (3) 11 (c) VNA Health Care Inc 103 Woodland Street Hartford CT 06105 060646938 Home Healthcare CT 501 (c) (3) 7 N/A Rushford Center Inc 883 Paddock Avenue Meriden CT 06450 060932875 Substance Abuse Healthcare Services CT 501 (c) (3) 7 N/A Hartford Hospital Auxiliary co Hartford Hospital 80 Seymour Street Hartford CT 06115 066040747 Fundraising CT 501 (c) (3) 11 (c) N/A Connecticut Health System Inc 80 Seymour Street Hartford CT 06102 222779421 Coordination of Health Delivery CT 501 (c) (3) 11 (c) N/A Institute of Living 200 Retreat Avenue Hartford CT 06106 060646683 Psychiatric Services CT 501 (c) (3) 11 (c) N/A VNA Resources Inc 103 Woodland Street Hartford CT 06105 061161422 Home Healthcare CT 501 (c) (3) 9 N/A Meriden Imaging Center 101 North Plains Industrial Road Meriden CT 06429 061541468 Imaging CT Midstate Medical Center Unrelated 0 0 HHMOB Corporation & Subsidiary 80 Seymour Street Hartford CT 06102 061140244 Real Estate Parking CT N/A C Immediate Medical Care Center 80 Seymour Street Hartford CT 06102 061087544 Primary Care CT N/A C Windham Health Services Inc 112 Mansfield Avenue Willimantic CT 06226 061461101 Home Healthcare CT N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0