2011-08-09T13:24:20-05:00 2010-09-30 SASLOW LUFKIN & BUGGY LLP TEN TOWER LANE AVON CT 06001 990 2009-10-01 060646768 THE HOSPITAL OF CENTRAL CONNECTICUT HOSP 8602245900 100 GRAND STREET NEW BRITAIN CT 06050 CLARENCE J SILVIA 8602245900 2011-08-01 1 Beth Thurz 8606789200 2009 2016-02-24 21:20:13Z CLARENCE J SILVIA 100 GRAND STREET NEW BRITAIN CT 06050 468506432 0 X WWW.THOCC.ORG X 1893 CT 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. HCC's mission is to foster, sustain and improve the health status of the people in the communities we serve. 20 17 3210 476 3944310 0 3525539 3693619 380918834 374951028 5210707 7880077 710219 2647941 390365299 389172665 0 0 188216313 198282289 12000 12000 555111 184176989 182370011 372405302 380664300 17959997 8508365 321313298 337017403 198453540 203037088 122859758 133980315 The Hospital of Central Connecticut at New Britain General provides medicine and surgery and numerous specialties. Centers of excellence include the Center for Cardiovascular Medicine; Center for Joint Care, Ferdinand Sauer, MD Family Birthplace, Joslin Diabetes Affiliate, Sleep Disorders Center; and George Bray Cancer Center. The Hospital also operates medical, surgical, pediatric and ob/gyn outpatient clinics; and outpatient diagnostic and laboratory services in New Britain and surrounding towns; and runs various community events and programs.Medical centers include Behavioral Health, Bone and Osteoporosis Center, George Bray Cancer Center, The Center for Joint Care, Cardiology, Clinical Research, Ferdinand Sauer, MD Family BirthPlace, Fertility and Women's Health, Joslin Diabetes Affiliate, Sleep Disorders, Weigh Your Options clinical weight loss center, Wolfson Palliative Care and 24 hour emergency department. 1 0 36402999 46745069 The inpatient medical, surgical and intensive care service areas served 16,912 with total patient days of 69,737. 73% and 61% of the New Britain and Southington community needs, respectively, are met with these services. The areas of specialty include Stroke Services, Bariatric Care, Joint Replacement and Diabetes. 20038086 44263817 The emergency room served 105,662 patients from the community during 2010 which was an increase of 2.53% over 2009. The emergency department has CT services within the newly renovated area to provide cutting edge technology to all patients regardless of ability to pay. The emergency room of the Hospital of Central Connecticut continues to rank in the 90th percentile for customer satisfaction. 21629701 52564490 The imaging services area has added new internal technology to provide a central point of access for our patients. Radiological scans totaled 173,588 for 2010. The array of services spans from simple x-rays to complex angioplasty services, PET scans and nuclear studies. 263588011 227689909 Other routine services such as laboratory, maternity, newborn, psychiatric and pediatric and ancillary services provided to patients. 263588011 227689909 341658797 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 258 0 1 3210 1 1 1 1 CA BD 0 0 0 0 0 0 0 20 17 1 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 CT X Brian A Rogoz 8602245194 389 JOHN DOWNEY DRIVE NEW BRITAIN CT 060512924 LAURENCE A TANNER 50.00 X X 0 2810856 518362 CLARENCE J SILVIA 50.00 X X 0 472443 838880 JOHN W ANDREOLI JR MD 1.00 X 46082 0 0 FRANK R MILLER 1.00 X 0 0 0 EDWARD P TOFFOLON MD 1.00 X 16255 0 0 MARIE S GUSTIN PHD 1.00 X 0 0 0 LINDSLEY WELLMAN 1.00 X 0 0 0 CONNIE W COLLINS 1.00 X 0 0 0 JOHN E DILLAWAY 1.00 X X 0 0 0 JOHN S MANNING 1.00 X X 0 0 0 ANTHONY CIARDELLA MD 1.00 X 27500 0 0 JOSEPH R CRISPINO 1.00 X 0 0 0 DANIEL DAIGLE 1.00 X 0 0 0 JOHN J PATRICK JR 1.00 X 0 0 0 DENNIS J STANEKJR 1.00 X 0 0 0 ROBERT A LAPKIN MD 1.00 X 124984 0 0 BARBARA R MACKAY 1.00 X 0 0 0 WILLIAM W WEBER 1.00 X X 0 0 0 LETTERIO ASCIUTO MD 1.00 X 18333 0 0 TERI K POLASKE 1.00 X 0 0 0 REV THOMAS A MILLS JR 1.00 X 0 0 0 DAVID R NEWTON 50.00 X 0 1970288 265814 BRIAN A ROGOZ 50.00 X 252472 0 73613 STEVEN D HANKS MD 50.00 X 528125 0 123936 BRIDGET WHEELER RN 50.00 X 69845 0 17218 ELIZABETH A LYNCH 50.00 X 253841 0 89694 BARBARA W ANDREWS 50.00 X 65228 0 9658 JOYCE HAWRYLIK 50.00 X 56029 0 6489 STEVEN A GODFREY 50.00 X 204654 0 70624 JEFFREY A FINKELSTEIN MD 50.00 X 383961 0 115594 MICHAEL BALKUNAS MD 50.00 X 339768 0 53928 MICHAEL GREY MD 50.00 X 381208 0 66917 JAMES L MASSI MD 50.00 X 291438 0 10282 FRANCIS H PINTO 50.00 X 218500 0 77785 ANTOINETTA CAPRIGLIONE MD 50.00 X 372271 0 98066 ELIZABETH SCHLAFF 50.00 X 183708 0 39208 MILTON J SANDS JR MD 50.00 X 346733 0 103708 LOUIS G GRAFF 50.00 X 343414 0 60666 HAKLAI P LAU MD 75.00 X 400537 0 11291 JAMES F FLAHERTY 50.00 X 323509 0 11291 DAVID BUONO MD 50.00 X 333188 0 32054 5581583 5253587 2695078 274 0 1 0 ACS CONSULTANT CO INC DEPT 135401 PO BOX 67000 DETROIT MI 482671354 INFORMATION SYSTEMS 19162114 UCONN HEALTH CENTER FARMINGTON AVE FARMINGTON CT 060301915 RESIDENCE SERVICES 4640410 MRI OF NEW BRITAIN 40 HART ST NEW BRITAIN CT 06050 MRI SERVICES 3432455 BEY-SELL CONSTRUCTION CO OF CT 387 EAST MAIN STREET WALLINGFORD CT 064922566 CONSTRUCTION SERVICES 2573147 CERNER CORPORATION 2702 ROCKCREEK PARKWAY KANSAS CITY MO 64117 INFORMATION SYSTEMS 2558402 101 184929 1003877 2504813 3693619 PATIENT SERVICE REVENU 900099 334525684 334525684 LABORATORY SERVICES 621500 38265532 34421153 3844379 OTHER PATIENT SERVICE 900099 2159812 2159812 374951028 3368216 3368216 1321940 997256 324684 324684 -18710 343394 82496725 16200 78001064 4495661 16200 4511861 4511861 130100 184929 104361 25739 25739 404585 231086 173499 173499 DIETARY/ CAFETERIA 722210 1458939 1458939 CHILD CARE INCOME 624410 403411 13608 389803 OUTSIDE SERVICES 518210 261669 156636 105033 2124019 389172665 371263285 3944310 10271451 5674966 5674966 141645178 128957550 12401695 285933 13039541 12295147 744394 27547768 24791635 2756133 10374836 9218586 1129859 26391 637620 101099 536521 146067 146067 12000 12000 28417741 25815108 2602633 1396375 1198090 198285 66579362 64781777 1797585 32301906 27715113 4586793 7834329 6718558 1115771 574177 492392 81785 111353 95492 15861 1905156 1680644 224512 17446295 14287626 3158669 7538816 7440558 98258 BAD DEBT 10952307 10952307 DIETARY 2187899 1877677 310222 DUES 1174110 1006870 167240 RECRUITMENT 870856 746812 124044 TRAINING & EDUCATION 623615 534788 88827 1672027 950968 490272 230787 380664300 341658797 38450392 555111 X 22559224 23662582 74093 10398 36493910 36543623 197933 211274 5056092 4904577 2143994 3335302 371508433 246081335 124178254 125427098 115553749 128465902 8926927 8752634 6129122 5704013 321313298 337017403 21371282 25218831 760583 339220 32115000 30545000 8211505 7562096 135995170 139371941 198453540 203037088 X 87818285 97047576 15200271 16296477 19841202 20636262 122859758 133980315 321313298 337017403 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 33219 0 0 0 33219 0 Part IV, Supplemental Information: Central Connecticut Health Alliance (CCHA), the parent company of the The Hospital of Central Connecticut (HCC) engaged the firm of Gaffney Bennett & Associates to lobby on its behalf. The annual payment made by CCHA was $56,875. CCHA also engaged the firm of Kozak & Salina LLC to lobby on its behalf. Payment for the year to Kozak & Salina amounted to $40,000. CCHA also paid the Carmen Group for lobbying in the amount of $12,500. HCC is also a member of the Connecticut Hospital Association (CHA) and the American Hospital Association (AHA) who engage in lobbying and advocacy efforts on behalf of its member hospitals. 115483988 2672254 11693366 1400131 128449477 110529502 2235178 4211109 1491801 115483988 0.71260 0.16070 0.12670 1 0 1052227 1585032 2637259 7246519 182831120 108460738 81616901 200978 4259827 2270261 2190544 475693 165500377 131405317 34570753 8356660 3945019 4411641 125427098 FUNDS HELD IN TRUST BY OTHERS 14035818 F MUTUAL FUNDS 107813213 F CURRENT ASSETS WHOSE USE IS LIMITED 16427 F PERMANENTLY RESTRICTED INVESTMENTS 6600444 F 128465902 DUE TO THIRD PARTIES 19449485 PENSION PLAN AND SELF INSURANCE LIABILITY 108102248 ACCRUED COMPENSATION 11779341 DUE TO AFFILIATES 40867 139371941 389172665 380664300 8508365 4177508 -1565316 2612192 11120557 386916870 -198552 -198552 387115422 2057243 2057243 389172665 381476536 1144549 1144549 380331987 332313 332313 380664300 Part V, Line 4: Description of Intended Use of Endowment Funds: 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 X: Description of Uncertain Tax Positions Under FIN 48: During 2010, the Hospital adopted certain provisions of FASB ASC 740, "Income Taxes" which provide a new framework for how companies should recognize, measure, present and disclose uncertain tax positions in their consolidated financial statements. With these changes, the Hospital may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The Hospital does not have any uncertain tax positions as September 30, 2010. As of September 30, 2010, the Hospital did not record any penalties or interest associated with uncertain tax positions. Therefore, the certain provisions of FASB ASC 740, which were adopted during 2010, had no impact on the Hospital's consolidated financial statements. Part XI, Line 8 - Other Adjustments: CHANGE IN ASSETS HELD IN TRUST BY OTHERS: 795060. PENSION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS: 714815. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP: -1343101. DEBT FORGIVENESS GRANTED TO AFFILIATE: -586456. CHANGE IN BEGINNING BALANCE OF AUXILIARY NET WORTH: -1085. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS: -1144549. Part XII, Line 2d - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS: 1144549. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP: -1343101. Part XII, Line 4b - Other Adjustments: CONTRIBUTIONS: 1308868. AUXILIARY SPECIAL EVENTS- GOLF TOURNAMENT AND BALL: 193569. AUXILIARY GIFT STORE INCOME: 173499. INCOME FROM INVESTMENTS: 364208. AUXILIARY FASHION SHOWS: 17099. Part XIII, Line 2d - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS: 1144549. Part XIII, Line 4b - Other Adjustments: AUXILIARY EXPENSES - NEW BRITAIN CAMPUS: 302206. AUXILIARY EXPENSES - BRADLEY CAMPUS: 30107. GOLF TOURNAMENTS 130245 83245 47000 0 6691 11069 14782 300 5435 CHRYSANTHEMUM BALL 156700 89350 67350 0 1336 0 43794 3500 6469 2 28084 12334 15750 0 118 0 10775 92 315029 184929 130100 8145 11069 69351 3800 11996 104361 25739 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 0 18600 3595584 3595584 0.00940 349 56575435 53327976 3247459 0.00850 18949 60171019 53327976 6843043 0.01790 63 9656 1160640 29570 1131070 0.00300 20 745 8658464 2328195 6330269 0.01660 1 46028 46028 0.00010 4 78 8267 8267 0.00000 88 10479 9873399 2357765 7515634 0.01970 88 29428 70044418 55685741 14358677 0.03760 1 300239 300239 0.00080 1 300239 300239 0.00080 0 2801770 327968 92737635 100529722 -7792087 X 1 1 Total Laundry Collaborative Laundry Service 0.37000 Grand Indemnity Co Inc Liability Insurance Captive 1.00000 New Britain Occupational Health Health Care 0.86000 0.14000 Central CT Sports Medicine LLC Health Care 0.50000 New Britain MRI LP Health Care 0.43000 Central CT Endoscopy Center Physician GI Center 0.06500 0.50000 Hospital of Central CT- New Britain Cam

100 Grand Steet New Britain CT 06050

X X X X Hospital of Central CT- Bradley Campus

81 Meriden Ave Southington CT 06489

X X X X Part III, Line 8: The shortfall is not included in Community benefit as the government program does not meet definition. Cost to charge ratio is in correlation with Medicare Cost Report. Part III, Line 9b: Accounts are reviewed for alternative payment options before sending to collections. Charity care applications are provided before collections begin.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 exception 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 hospital's 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 the application.Exception to sequence #1. Self-pay admissions that are not collectible 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: The Hospital conducted a needs assessment two years ago, in partnership with other community health organizations including The Hospital of Special Care and the City of New Britain Department of Public Health. The assessment was a multi-faceted input process that included interviews and focus groups with community members and leaders and other forms of input from community, government and healthcare providers. It also included data analysis from a wide variety of data sources, both national and local. HCC also analyzes claims based data to understand what medical diagnoses and surgical procedures are attributed to its local population in order to plan for program growth and/or capacity. Another method the hospital employs is through continuous contact and collaboration with local community groups. These groups often identify medical services that are needed in the community that the hospital ought to address. Part VI, Line 3: Free Bed Summary signage is in English, Spanish and Polish, and is posted in the following areas: Admitting, Emergency Department, Social Services Department and Patient Accounts/Billing Office. The Admitting Department and the hospital case worker for the State of Connecticut will advise the patient of Free Bed and provide them with a Free Bed Summary letter. Social Services and the Counseling Center will advise the patient of Free Bed and assist patients with the process of the Free Bed Application. The Free Bed Summary is included in all three languages with the patient's hospital statement and collection agency statements. All of these areas are educated regarding the hospital's Free Bed Policy. Note: Free Bed and Charity Care are considered to be interchangeable. FREE BED FUND SUMMARY:If you are coping with a personal financial hardship, and are facing significant debts owed to The Hospital of Central Connecticut, "Free Bed Funds" may be available to cover the cost (partially or fully) for inpatient, outpatient and emergency services rendered at the hospital. The following is required:- Applied for financial assistance programs within the State you reside and been denied eligibility. Proof of Denial is required.- Have a household income at or below 250% of the Federal Poverty Income Guidelines. Proof of income and/or assets is required.If you meet the above criteria, to obtain a Free Bed application please contact a Patient Financial Representative at (860) 224-5181 and include the following required documentation when returning the application (parents or guardians may complete if the patient is a minor):- A photo I.D. such as a valid CT driver's license, passport or immigration identification card (Green Card).- A letter of denial from the State of Connecticut Department of Social Services for medical assistance or similar program if not a resident of Connecticut.- Proof of income and/or assetsYou are entitled to reapply for Free Bed Funds if previously rejected. Part VI, Line 4: The Hospital of Central Connecticut ("HCC") serves primarily the communities located in greater New Britain and 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, New Britain, Plainville and Southington, the Hispanic population accounts 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 New Britain's population living beneath the Federal Poverty Level. Part VI, Line 5: By participating in activities promoting community readiness beyond what is mandated by law for disasters and activities such as Bioterrorism, we are educating people and first responders about steps to be taken in the event of such disaster. Increased preparation for such disasters helps to ensure that if such unfortunate incidents occur, that community healthcare needs will continue to be met in the most effective way. Depending on the nature of these crises, working with our community can ensure people have access to medications, medical care, and disaster-specific remedies including antidotes for toxins and other poisons that might be released in events ranging from terrorist acts to natural disaster. By working with other community agencies such as fire health and local and state government, we are helping to ensure a coordinated and unified response to such disasters that puts the health and well-being of our communities first. Part VI, Line 6: The Hospital of Central Connecticut furthers its tax exempt purpose by promoting the health of community through multiple services and programs, which include:-Providing uncompensated care to uninsured and underinsured patients, in particular through the assignment of Free Bed Funds, financial assistance in discounts and payment plans, and the delivery of care to Medicaid patients at reimbursement rates well below the cost of providing care.-Graduate medical education and training for dozens of residents from the University of Connecticut-Undergraduate and graduate education and training for nursing professionals from three different colleges and universities.-Open medical staff in which all applicants are offered practicing and admitting privileges with no conditions.-Sponsoring and participating in several medical and pharmaceutical research projects, including clinical trials related to new psychiatric therapeutic drugs.-Operating a 24/7 emergency department that services the whole community with 105,000 visits per year, and in many cases is the only place of care for the uninsured or underinsured. -State of the art obstetrics and neo-natal services that helps bring to the world most of the newborn residents of our community.-Information services, assessments and referrals for seniors - a resource for our large geriatric population, including implementation of the innovative Connecticut Center for Healthy Aging.-Innovative training and coaching of parental skills for new mothers, through the well established and acclaimed "Nurturing Families Program."-Many health promotion programs that promote healthy lifestyles and high quality of life, including nutrition, physical activity and therapy, and tobacco cessation.-Providing community education through disease-specific workshops and seminars, including a cancer survivor support group and a related resource: the George Bray Cancer Library.-Participation and leadership in the community's Emergency Preparedness and Response Plans.-Sponsoring an Early Detection Program for breast and cervical cancer screenings. -Providing immunizations at outpatient clinics and other events.-Assessing the health needs of the community with a large scale survey reaching 1000 households in our service areas.-Supporting safety net services in the community such as the Friendship Service Center, a homeless shelter and a leading sponsorship of the New Britain Food and Resource Center, a new food pantry in the north part of town.-Sponsoring many community events and supporting several regional collaborative efforts to improve health and education, such as the Discovery Collaborative for School Readiness.The Hospital of Central Connecticut (HCC) is responsive to the community by having a completely open medical staff and a board of directors 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 echo sonographer 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. Every year we sponsor 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. We do a variety of clinical research including cancer, diabetes and behavioral health.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 included landlord tenant and housing issues. The program helps healthcare providers direct families to resources that can assist with these issues. In addition, the hospital has a special initiative to help improve the care and overall health of children with asthma, and to reduce emergency department visits. The program involves working with pediatricians, schools, and others to develop and disseminate asthma treatment plans and guidelines for each child, to appropriately treat symptoms as they occur. 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 works in many ways to promote the health of our community. These include free lecture series on topics of particular interest to our community, targeting the specific healthcare demographics of our community, which includes increasing numbers of Hispanics. Examples of this include informational sessions on high blood pressure, cholesterol, diabetes, asthma, and arthritis. We also conduct or participate in many free community screenings for heart disease, high blood pressure, cholesterol and other common but often undetected medical conditions that are common in our community.In addition, the Hospital partners with other local organizations to improve the standard of care and overall health status of our community, including organizations ranging from those that deal with chronic illnesses or disease conditions to local YMCAs. One such program is the New Britain Asthma initiative. Under this program, our hospital partners with community agencies, including the city Health Department as well as local physicians to ensure that children who have asthma have a predetermined treatment plan to minimize visits to the Emergency Department and to ensure that evidence-based medical protocols are followed when a child experiences an exacerbation of their symptoms, whether they are at home, at school, or traveling. In addition, we are supporting and offering related educational and exercise programs for children with asthma. We also reach out to help meet needs of indigent families and children through our Medical-Legal Partnership, which helps connect patients and families with community resources such as fuel assistance, and legal aid to prevent eviction. Our free community offerings also include programs to support young mothers and educate them about the medical and emotional needs of a newborn, including a hotline they can call for assistance when they are feeling overwhelmed by the challenges of parenthood.The Hospital of Central Connecticut also produces and distributes newsletters and magazines that educate the community on common health concerns, conditions, treatments and prevention techniques, and offers a physician referral service that helps connect people with the medical resources they are seeking. CT X 0 0 X X X X X 0 1 0 0 0 1 0 0 0 LAURENCE A TANNER 0 633971 0 57587 0 2119298 0 497183 0 21179 0 3329218 0 60882 CLARENCE J SILVIA 0 392095 0 32561 0 47787 0 811932 0 26948 0 1311323 0 0 DAVID R NEWTON 0 361205 0 32561 0 1576522 0 259592 0 6222 0 2236102 0 209268 BRIAN A ROGOZ 219382 0 20552 0 12538 0 70592 0 3021 0 326085 0 0 0 STEVEN D HANKS MD 392996 0 34521 0 100608 0 122445 0 1491 0 652061 0 0 0 ELIZABETH A LYNCH 227847 0 21124 0 4870 0 80431 0 9263 0 343535 0 0 0 STEVEN A GODFREY 179458 0 20285 0 4911 0 67933 0 2691 0 275278 0 0 0 JEFFREY A FINKELSTEIN MD 318908 0 56412 0 8641 0 78826 0 36768 0 499555 0 0 0 MICHAEL BALKUNAS MD 294963 0 44805 0 0 0 20530 0 33398 0 393696 0 0 0 MICHAEL GREY MD 295582 0 82500 0 3126 0 50292 0 16625 0 448125 0 0 0 JAMES L MASSI MD 264938 0 26500 0 0 0 9800 0 482 0 301720 0 0 0 FRANCIS H PINTO 190000 0 28500 0 0 0 52120 0 25665 0 296285 0 0 0 ANTOINETTA CAPRIGLIONE MD 313350 0 14640 0 44281 0 68446 0 29620 0 470337 0 44281 0 ELIZABETH SCHLAFF 176106 0 7602 0 0 0 34314 0 4894 0 222916 0 0 0 MILTON J SANDS JR MD 301378 0 45355 0 0 0 72254 0 31454 0 450441 0 0 0 LOUIS G GRAFF 265750 0 71193 0 6471 0 58701 0 1965 0 404080 0 0 0 HAKLAI P LAU MD 248769 0 101483 0 50285 0 9800 0 1491 0 411828 0 0 0 JAMES F FLAHERTY 323509 0 0 0 0 0 9800 0 1491 0 334800 0 0 0 DAVID BUONO MD 267051 0 59242 0 6895 0 30563 0 1491 0 365242 0 0 0 Part I, Line 1a "Gross-ups" on a cash benefit paid to the CEO, the COO and the CFO equal to the annual maximum 403(b) elective deferral; and a cash benefit paid to the CEO equal to the maximum annual contribution to a 457 account. Also on the portion of the split dollar that was annually reported on the CEO, COO and the CFO's W-2s. All employees are eligible for a discount at Health Trax and the local Y's. Part I, Line 1b The organization did seek legal opinion regarding these special tax gross up payments and believes these payments are consistent with the Board's prior approval of their compensation packages. Part I, Line 4b: D.R. Newton - Payment $1,462,073 Antoinetta Capriglione - Payment $44,281 L.A. Tanner - Payment $2,048,349 Part I, Line 6 The Management Incentive Plan's trigger for payment eligibility is the organization's operating margin. The Officers are eligible for a bonus of up to 5% if the operating margin target is met and the middle managers achieve their goals at specified levels. Supplemental Information Part III On March 5th, 2010, Clarence J. Silvia was named President and CEO of THOCC and President of CCHA. Larry A. Tanner remains the CEO of CCHA through June 2010, when he will retire. On July 1st, 2010, Clarence Silvia will become CEO of CCHA. CONNECTICUT HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (CHEFA) 060806186 20774UH40 2008-08-08 33690000 HCC refunded its CHEFA Series A bonds by issuing Series B within 30 days. 0 0 33690000 487616 2008 1 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 Bank of America 3.000000000000 0 0 0 X 1204 FMV X 30746 FMV X 1 246330 DPH GRANT X GIFT CARDS & CERTIFICATES 46 2750 FACE VALUE OF GIFT CARD & CERTIFICATE X TICKETS TO EVENTS 1 6000 FACE VALUE OF TICKET X AUCTION ITEMS 66 23233 FMV 0 0 0 0 Form 990, Part III, line 2 New Program Services The Hospital of Central Connecticut undertook various program enhancements in several categories in order to better meet the needs of our community. They are as follows: Clinical Technology: da Vinci Robotic Surgery at New Britain General campus Facility Improvements: New Britain General campus N4 Aesthetic upgrade and Hart Street Employee Garage Rehabilitation 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 a Endoscopy Center that is a joint venture with The Hospital of Central Connecticut. Form 990, Part VI, Section A, line 3 Central Connecticut Health Alliance (CCHA) provided management duties through March 2010, at which time, the President and CEO became an employee of the Hospital. Form 990, Part VI, Section A, line 6 HCC has more than 800 Corporators who are dedicated to the Hospital's mission. Form 990, Part VI, Section A, line 7a There are two classes of Members, the first are known as Corporators. Corporators comprise individuals interested in the purposes of the Hospital and represent a broad section of the communities served. Corporators have the right to vote for the election of Directors. The second class of member is comprised solely of the parent organization, Central Connecticut Health Alliance (CCHA). CCHA has the right to nominate and approve candidates for election to the Board and the right to elect additional Corporators. Form 990, Part VI, Section A, line 7b CCHA has the authority to approve significant actions as outlined in the Hospital's bylaws as well as the right to amend the Hospital's Certificate of Incorporation or its bylaws. 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,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. 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 individual 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 XI, Line 2c: The organization's audit committee assumes responsibility for oversight of the audit of its financial statements and selection of an independent accountant. 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 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. Bradley Health Services Inc 100 Grand St New Britain CT 06050 061367014 Healthcare CT 501(C)(3) LINE 9 Central CT Health Alliance Capital Area Health Consortium Inc 270 Farmington Ave Farmington CT 06032 510173264 Healthcare CT 501(C)(3) LINE 11,III-FI Central CT Health Alliance 100 Grand St New Britain CT 06050 222785033 Healthcare Administration CT 501(C)(3) LINE 11,II Central CT Senior Health Services Inc 45 Meriden Ave Southington CT 06489 222635676 Sub-Acute & Long Term Healthcare CT 501(C)(3) LINE 9 Central CT Health Alliance Community Mental Health Affiliates Inc 270 John Downey Drive New Britain CT 06051 060934544 Mental Health & Substance Abuse Treatment Provider CT 501(C)(3) LINE 7 Central CT Health Alliance Mulberry Gardens of Southington LLC 58 Mulberry St Plantsville CT 06479 820586577 Assisted Living & Adult Day Care Facility CT 501(C)(3) LINE 9 Central CT Senior Health Services Inc The Orchards of Southington 34 Hobart St Southington CT 06489 061490803 Residential Services for Senior Citizens CT 501(C)(3) LINE 9 Central CT Senior Health Services Inc VNA of Central Connecticut Inc 205 West Main Street New Britain CT 06050 060646940 Public Health Nursing & Home Care CT 501(C)(3) LINE 9 Central CT Health Alliance Jerome Home 975 Corbin Ave New Britain CT 06052 060646690 Nursing Home CT 501(C)(3) LINE 9 Central CT Sports Medicine CtrLLC 15 Massirio Drive Suite 104 Berlin CT 06037 223196509 Physical therapy CT CCHA RELATED 17628 287671 0 0 New Britain MRI Limited Partnership 100 Grand Street New Britain CT 06050 061271349 Magnetic resonance imaging CT CenConn Services Inc RELATED 357345 2873036 0 0 New Britain Occupational Health Center LLC 440 New Britain Avenue Plainville CT 06062 061484904 Occupational healthcare CT HCC RELATED 67441 479144 0 1 CenConn Services Inc 100 Grand Street New Britain CT 06050 222836001 Investment Management CT CCHA C Grand Indemnity Company Ltd FB Perry Building 40 Church Street Hamilton BD 980609499 Professional Liability BD HCC C 1716671 34153903 1.00000 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 Central CT Health Alliance N 938430 Central CT Sports Medicine Center LLC N 1756079 New Britain Occupational Health I 222283 New Britain MRI Limited Partnership N 700106 CenConn Services Inc N 95420 Central CT Health Alliance P 1698384 New Britain MRI Limited Partnership P 264833 Community Mental Health Affiliates I 218866 New Britain Occupational Health N 239233 New Britain MRI Limited Partnership I 117976 Central CT Health Alliance O 991355 New Britain Occupational Health B 586456