2026-08-11T18:22:57-05:00 2025-09-30 390859910 BAKER TILLY ADVISORY GROUP LP 1 HIGHWOOD DRIVE TEWKSBURY MA 01876 990 2024-10-01 060646718 MIDDLESEX HOSPITAL MIDD 8603586395 28 CRESCENT STREET MIDDLETOWN CT 06457 SUSAN MARTIN VP FINANCE & TREASURER 8603586395 2026-08-11 1 1 MARY-EVELYN ANTONETTI P00431862 9785575300 2026-08-11 2024 2025-03-06 01:10:19Z VINCENT CAPECE JR 28 CRESCENT STREET MIDDLETOWN CT 06457 593865199 0 X WWW.MIDDLESEXHEALTH.ORG X 1895 CT A NON-PROFIT, ACUTE CARE, COMMUNITY HOSPITAL IN MIDDLETOWN, CT. (SEE SCHEDULE O)MIDDLESEX HOSPITAL IS COMMITTED TO PROVIDING HIGH QUALITY INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. THE HOSPITAL RECOGNIZES COMMUNITY TRANSPARENCY AND INTEGRITY AS FUNDAMENTAL RESPONSIBILITIES. 12 11 3868 170 537816 32506 4909299 12406175 505943479 531587937 21589831 10074675 7212877 8579603 539655486 562648390 167590 164337 0 0 286737465 305208166 0 0 1179286 206832793 219446206 493737848 524818709 45917638 37829681 614139759 657423312 146576115 161140323 467563644 496282989 X MIDDLESEX HOSPITAL EXISTS TO PROVIDE THE SAFEST, HIGHEST-QUALITY HEALTH CARE AND THE BEST EXPERIENCE POSSIBLE FOR OUR COMMUNITY. (CONTINUED ON SCHEDULE O) 0 0 469647049 164337 537835060 MIDDLESEX HOSPITAL CONTINUES TO PROVIDE UPDATES AND ACCESS TO RESOURCES TO HELP MEMBERS OF THE COMMUNITY STAY SAFE AND HEALTHY DURING THESE CHALLENGING TIMES. ARMED WITH SKILLED STAFF, PROGRESSIVE DIAGNOSTIC TOOLS AND ADVANCED SURGICAL TECHNIQUES, THE HOSPITAL WAS WELL POSITIONED TO ENSURE A COMFORTABLE, SAFE ENVIRONMENT FOR EXCEPTIONAL MEDICAL TREATMENT AND RECOVERY. IN THE FISCAL YEAR ENDING 9/30/25, INPATIENT CARE REPRESENTED 11,436 DISCHARGES AND 55,487 PATIENT CARE DAYS. INPATIENT CARE FROM REGISTRATION THROUGH DISCHARGE IS CAREFULLY MANAGED TO EXCEED REGULATORY REQUIREMENTS AND ENSURE QUALITY, PATIENT SATISFACTION, AND BEST PRACTICE WITH EACH ASPECT OF THE INPATIENT EXPERIENCE, INCLUDING ALL ELEMENTS OF CARE FROM NURSING COMPETENCY AND COMPASSION, TO MEAL QUALITY, LAB AND DIAGNOSTIC TESTING, SAFE AND SECURE PHYSICAL SURROUNDINGS TO PATIENT EDUCATION. MIDDLESEX HOSPITAL, LICENSED FOR 275 BEDS AND 22 BASSINETS, PROVIDES ACUTE CARE FROM DEDICATED HEALTH CARE TEAMS WHICH INCLUDE SURGEONS, HOSPITALISTS, FAMILY PRACTITIONERS AND RESIDENTS, MEDICAL STAFF PHYSICIANS, MAGNET NURSES, PHYSICIAN ASSISTANTS, PATIENT CARE TECHNOLOGISTS, DIAGNOSTIC TECHNICIANS, PATHOLOGISTS, ADMINISTRATORS, ENVIRONMENTAL SERVICES, SECURITY, ENGINEERING AND A HOST OF OTHERS WORKING TOGETHER TO ENABLE THE ORGANIZATION'S SUCCESS.THE HOSPITAL UNITS INCLUDING INTENSIVE AND CRITICAL CARE, MEDICAL SURGICAL, ONCOLOGY, ORTHOPEDIC, PULMONOLOGY, VASCULAR AND CARDIOLOGY, GASTROINTESTINAL, MATERNITY, A 20-BED PSYCHIATRIC FLOOR, AND HOSPICE SERVICES SPECIALIZE IN THE SPECIFIC NEEDS OF THEIR PATIENTS AND ARE STAFFED TO ACCOMMODATE THE UNIQUE TREATMENT REQUIREMENTS OF EACH. ALL ANCILLARY SERVICES INCLUDING LABS, RADIOLOGY, FOOD SERVICES, PATHOLOGY, PHARMACY, MEDICAL TRANSCRIPTION AND INFORMATION SERVICES TOO ARE A PART OF THE HOSPITAL TEAM. PATIENT CARE IS DEVELOPED WITH FULL CONSIDERATION OF THE WHOLE INDIVIDUAL, AS THEY ARE ASSIGNED TO CONDITION SPECIFIC CARE PATHWAYS AND SERVICES TO SECURE BEST TREATMENT AND RECOVERY. 469647049 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 1 269 0 1 3868 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CT X X SHANNON ST HILAIRE 8603586000 28 CRESCENT STREET MIDDLETOWN CT 06457 VINCENT CAPECE JR PRESIDENT/CEO 40.00 4.00 X X 1377038 0 337894 DAVID C BENOIT DIRECTOR 1.00 3.00 X 0 0 0 JEAN M D'AQUILA VICE CHAIR (AS OF 6/2025) 1.00 4.00 X X 0 0 0 JOHN J GAUTHIER DIRECTOR 1.00 3.00 X 0 0 0 ROBERT C HINTON DIRECTOR 1.00 3.00 X 0 0 0 CHANDLER J HOWARD CHAIR (AS OF 6/2025) 1.00 3.00 X X 0 0 0 JONATHAN D LEVINE MD SECRETARY 1.00 4.00 X X 0 0 0 MARK D LORENZE MD ASST SECRETARY 1.00 3.00 X X 0 0 0 DARRELL G PATASKA CHAIRMAN (TILL 7/2025) 1.00 3.00 X X 0 0 0 CHRISTINE H REPASY DIRECTOR 1.00 3.00 X 0 0 0 GARY M WALLACE DIRECTOR 1.00 3.00 X 0 0 0 MARK BERTOLAMI DIRECTOR 1.00 3.00 X 0 0 0 ELIZABETH G JUDD DIRECTOR 1.00 3.00 X 0 0 0 SUSAN MARTIN VP FINANCE/TREASURER 40.00 4.00 X 658668 0 52451 TODD BISCHOP CHIEF DEPT OF MED 40.00 0.00 X 467099 0 26342 DAVID GIUFFRIDA VP FACILITIES & SUPPORT SVCS 40.00 0.00 X 478666 0 39049 EVAN JACKSON VP & CIO 40.00 0.00 X 520594 0 106903 DONNA STRONESKI VP HUMAN RESOURCES 40.00 0.00 X 473112 0 74481 DAVID COSENTINO VP QUALITY & PATIENT SAFETY 40.00 0.00 X 596898 0 116076 KELLY HAECKEL VP PATIENT CARE SVCS/CNO 40.00 0.00 X 463059 0 92482 LELAND MCKENNA VP PLANNING & EXTERNAL AFF 40.00 0.00 X 363893 0 52971 JUSTIN DREW VP AMBULATORY & CLINICAL SVCS 40.00 0.00 X 360571 0 58779 JONATHAN BANKOFF CHAIRMAN EMERGENCY MEDICINE 40.00 0.00 X 541616 0 61982 JEFFREY SHELTON CHAIRMAN DEPT PSYCH 40.00 0.00 X 462912 0 51369 THEODORE HARTENSTEIN MED DIRECTOR, UTILIZATION MGMT 40.00 0.00 X 532907 0 61582 RICARDO PEREZ PULMONOLOGIST 40.00 0.00 X 509304 0 55082 ALINA FILOZOV PHYSICIAN, INFECTIOUS DISEASE 40.00 0.00 X 468056 0 24111 JESSE WAGNER MD FORMER KEY EMPLOYEE 40.00 0.00 X 106233 0 0 8380626 0 1211554 734 0 1 0 EPIC SYSTEMS 1979 MILKY WAY VERONA WI 53593 TECHNOLOGY SERVICES 4600622 QUEST DIAGNOSTICS INC PO BOX 844217 BOSTON MA 02284 LABORATORY SERVICES 2718124 ARAMARK CORPORATION PO BOX 651009 CHARLOTTE NC 28265 DIETARY/HOUSEKEEPING SERVICES 2541251 MEDIATELY LLC 525 S FLAGLER DRIVE SUITE 300 WEST PALM BEACH FL 33401 MARKETING 1868021 ANESTHESIOLOGISTS OF MIDDLETOWN 145 S MAIN ST MIDDLETOWN CT 06457 ANESTHESIA SERVICES 963046 109 461 232808 3213494 8959412 252550 12406175 NET PATIENT SERVICE REVENUE 621400 530030250 530030250 NET INCOME FROM JOINT VENTURES 900003 1050500 1050500 SPECIMEN LAB 621500 507187 507187 531587937 7002053 7002053 24659 24659 1191723 1191723 0 32837198 29789235 3047963 3047963 3047963 96278 232808 101993 -5715 -5715 1631 476 1155 1155 258285 133382 124903 124903 PURCHASE DISCOUNTS 900003 2215701 2215701 CAFETERIA REVENUE 722514 1674321 1674321 IN-SYSTEM BILLING MANAGEMENT FEES 541610 975890 975890 3593348 3562719 30629 8459260 562648390 537835060 537816 11869339 X 164337 164337 7572421 6057937 1514484 426104 426104 243832999 223548138 20284861 11382061 10561893 820168 24733309 22685372 2047937 17261272 15880370 1380902 2139686 829986 130414 1179286 442754 442754 200860 200860 171658 171658 543496 543496 58522445 46064096 12458349 3180513 23338 3157175 6309587 5374064 935523 1265156 671699 593457 10294455 6607717 3686738 1175249 1141842 33407 983480 747355 236125 696121 696121 28114752 24549519 3565233 8733306 8733306 MEDICAL SUPPLIES 59257164 59184022 73142 STATE HOSPITAL TAX 29838640 29838640 FOOD 2059693 1000631 1059062 DUES & LICENSES 1009329 383414 625915 4507862 4477148 30714 524818709 469647049 53992374 1179286 2685252 4487385 60898185 44438250 1103976 1187252 62426314 68145898 46592 0 1809484 2230944 6215106 7939846 659215906 422303030 221980459 236912876 232608662 252749138 258600 201133 24107129 39130590 614139759 657423312 66081379 69033696 0 137880 21081766 17347252 1284222 1029820 58128748 73591675 146576115 161140323 X 445750847 473260023 21812797 23022966 467563644 496282989 614139759 657423312 X 37829681 13421825 -22532161 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 171658 171658 0 PART II-B, LINE 1: MIDDLESEX HOSPITAL PAYS DUES TO BOTH THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE CONNECTICUT HOSPITAL ASSOCIATION (CHA). A PERCENTAGE OF THOSE DUES FUNDED LOBBYING ACTIVITIES DURING THE FISCAL YEAR. THE PORTION OF AHA DUES TOTALED $20,560 AND THE PORTION OF CHA DUES TOTALED $66,848. IN ADDITION, MIDDLESEX HOSPITAL CONTRACTED WITH TWO CONSULTANTS WHO PERFORMED LOBBYING ACTIVITIES. THOSE EXPENSES TOTALED $84,250. 187788000 45000 19656000 166000 207323000 155313000 142000 32486000 153000 187788000 138207000 77000 17164000 135000 155313000 167025000 99000 -28415000 502000 138207000 139852000 140000 27444000 411000 167025000 0.93324 0.00000 0.06676 0 0 14639397 14639397 379287992 258629336 120658656 4011246 2818744 1192502 236183149 157264957 78918192 25094122 3589993 21504129 236912876 DEPOSITS 1744090 LIFE INSURANCE CASH SURRENDER VALUE 115242 ESTIMATED SELF-INSURANCE ASSETS 10697937 DUE FROM THIRD PARTY 536487 DEFERRED FINANCING COSTS 265733 RIGHT-OF-USE ASSETS 23890346 DUE FROM RELATED PARTIES 1880755 39130590 EST. SELF-INSURANCE LIABILITIES 31350760 ACCRUED RETIREMENT LIABILITIES 4768917 ASSET RETIREMENT OBLIGATION 745058 THIRD-PARTY SETTLEMENTS 11639401 OTHER LIABILITIES 311462 SECURITY DEPOSITS 4172 HOME CARE 9511 OPERATING LEASE LIABILITIES 24762394 73591675 X PART V, LINE 4: THE WITHOUT DONOR RESTRICTIONS RECORDED IN THE BOARD-DESIGNATED (QUASI-ENDOWMENT) FUNDS ARE ASSETS SET ASIDE BY THE BOARD FOR FUTURE UNSPECIFIED USES AND TO SUPPORT EDUCATION AND OTHER PROGRAMS OVER WHICH THE BOARD RETAINS CONTROL AND MAY, AT ITS DISCRETION, SUBSEQUENTLY USE FOR OTHER PURPOSES. PERMANENT ENDOWMENT FUNDS ARE ASSETS RECEIVED WITH THE DONOR STIPULATION THAT THE PRINCIPAL BE INVESTED IN PERPETUITY AND THAT ONLY THE INCOME EARNED THEREON IS AVAILABLE FOR SPECIFIC OR GENERAL SERVICES, SUCH AS FREE BED FUNDS AND SUPPORT OF HOSPITAL OPERATIONS. THESE ARE NOT IDENTIFIED ON THE AUDIT STATEMENTS IN THIS FASHION FOR FY2025. THEY ARE IN AS EITHER WITH OR WITHOUT DONOR RESTRICTIONS. TEMPORARILY RESTRICTED ENDOWMENT FUNDS ARE ASSETS RESTRICTED BY THE DONOR EITHER AS TO PURPOSE AND/OR AS TO TIME OF EXPENDITURE, SUCH AS EDUCATION, HEALTH SERVICES AND CAPITAL PURCHASES. PART X, LINE 2: BELOW IS AN EXCERPT FROM FOOTNOTE 2 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR MIDDLESEX HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE SYSTEM ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF ASC 740, "INCOME TAXES," WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM 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 SYSTEM DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2025 AND 2024. IT IS THE SYSTEM'S POLICY TO RECORD PENALTIES AND INTEREST ASSOCIATED WITH UNCERTAIN TAX PROVISIONS AS A COMPONENT OF OPERATING EXPENSES. AS OF SEPTEMBER 30, 2025 AND 2024, THE SYSTEM DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE SYSTEM'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 1400000 0 0 0 0 0 0 1400000 0 1400000 1 0 0 0 0 0 TPC GOLF 177620 108200 69420 7300 31916 22591 1727 HOSPICE GOLF 115778 88920 26858 3700 8640 13428 895 1 35688 35688 7900 1300 2596 329086 232808 96278 11000 40556 43919 1300 5218 101993 -5715 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 1036 5781962 4308933 1473029 0.00280 21578 99273702 69568355 29705347 0.05660 22614 105055664 73877288 31178376 0.05940 19414 19115696 113613 19002083 0.03620 808 15656732 3631261 12025471 0.02290 39766 113485836 76370680 37115156 0.07070 59 247076 0 247076 0.00050 3873 313665 8855 304810 0.00060 63920 148819005 80124409 68694596 0.13090 86534 253874669 154001697 99872972 0.19030 20926 20926 0.00000 33 86583 86583 0.00020 100 10751 2798 7953 0.00000 133 118260 2798 115462 0.00020 0 21531629 2153163 40796492 44948633 -4152141 X 1 1 1 MIDDLESEX CENTER FOR ADVANCED ORTHOPEDIC SURGERY LLC ORTHOPEDIC SURGERY 0.24510 1 1 MIDDLESEX HOSPITAL 28 CRESCENT STREET MIDDLETOWN CT 06457 WWW.MIDDLESEXHEALTH.ORG 000069 X X X X MIDDLESEX HOSPITAL 1 0 0 1 X X X X X X X X X X 25 1 0 0 1 X SEE STATEMENT X X 1 25 1 SEE STATEMENT 0 1 X 100.000000000000 500.000000000000 X X 1 1 X X X 1 X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X X 1 X 0 X 1 X 0 0 MIDDLESEX HOSPITAL PART V, SECTION B, LINE 3J: IN ADDITION TO THE ELEMENTS SELECTED IN PART V, LINE 3, MIDDLESEX HOSPITAL'S MOST RECENTLY COMPLETED (2025) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EXAMINED HOW SOCIAL DRIVERS OF HEALTH AND HEALTH DISPARITIES IMPACT HEALTH OUTCOMES. THE REPORT CONTINUED TO RAISE AWARENESS ABOUT HEALTH-RELATED SOCIAL NEEDS, WELL-BEING AND QUALITY OF LIFE, HEALTH DISPARITIES, AND VULNERABLE POPULATIONS. ACHIEVING HEALTH EQUITY THE ATTAINMENT OF THE HIGHEST LEVEL OF HEALTH FOR ALL PEOPLE STARTS WITH ASKING THE APPROPRIATE QUESTIONS RELATIVE TO DRIVERS OF HEALTH AND HOW THEY DISPROPORTIONATELY AFFECT CERTAIN GROUPS OF PEOPLE; NEXT STEPS INVOLVE ADDRESSING THE CONDITIONS THAT PREVENT THE REALIZATION OF GOOD HEALTH FOR THESE VULNERABLE OR MARGINALIZED GROUPS. THROUGH EXAMINATION OF THE INFLUENCE OF DRIVERS OF HEALTH, IT IS POSSIBLE TO DEVELOP STRATEGIES THAT ELIMINATE PERSISTENT AND PERVASIVE HEALTH DISPARITIES, PROMOTE HEALTH EQUITY, IMPROVE HEALTH OUTCOMES AND REDUCE FINANCIAL COST. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 5: IN COMPLETING ITS MOST RECENT (2025) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), MIDDLESEX HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF ITS COMMUNITY SERVED, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. A COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE WAS FORMED TO PROVIDE INPUT AND GUIDANCE ON THE CHNA PROCESS, INCLUDING REVIEW OF THE STUDY'S DATA COMPONENTS, INPUT ON SIGNIFICANT HEALTH AND HEALTH-RELATED NEEDS IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), REVIEW AND INPUT ON DEVELOPMENT OF THE MIDDLESEX HEALTH COMMUNITY SURVEY (COMPLETED AS PART OF THE CHNA IMPLEMENTATION STRATEGY PROCESS), AND REVIEW OF COMMUNITY RESOURCES AND ASSETS. THE ADVISORY COMMITTEE WAS COMPOSED OF STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING LOCAL HEALTH DEPARTMENTS, HEALTH CARE ORGANIZATIONS, COMMUNITY-BASED ORGANIZATIONS, FAITH-BASED ORGANIZATIONS, ADVOCACY GROUPS, COMMUNITY MEMBERS, AND SUPPORT PROFESSIONALS EMBEDDED IN THE COMMUNITY (I.E., COMMUNITY HEALTH WORKERS) TO ENSURE COMMUNITY VOICE WAS REPRESENTED. IN ADDITION TO MIDDLESEX HEALTH, CHNA ADVISORY COMMITTEE MEMBERS WERE FROM THE FOLLOWING ORGANIZATIONS: CHATHAM HEALTH DISTRICT, CITY, COMMUNITY HEALTH CENTER, INC., CONNECTICUT RIVER AREA HEALTH DISTRICT, CROMWELL HEALTH DEPARTMENT, MIDDLESEX COUNTY CHAMBER OF COMMERCE, MIDDLESEX COUNTY NAACP, MIDDLESEX UNITED WAY, MIDDLESEX YMCA, MIDDLETOWN DEPARTMENT OF HEALTH, MINISTERIAL HEALTH FELLOWSHIP, ST. VINCENT DE PAUL MIDDLETOWN, INC., THE SHORELINE SOUP KITCHENS & PANTRIES, VALLEY SHORE YMCA AND THE WESTBROOK HEALTH DEPARTMENT. TO CAPTURE BROAD COMMUNITY INPUT ON HEALTH NEEDS, SOCIAL DRIVERS OF HEALTH AND HEALTH EQUITY, MIDDLESEX HOSPITAL ADMINISTERED A COMMUNITY SURVEY AS A COMPANION TO ITS COMPLETED CHNA AND CHNA IMPLEMENTATION STRATEGY. SURVEY TOPIC AREAS INCLUDED KEY HEALTH ISSUES AND HEALTH BEHAVIORS, HEALTH CARE ACCESS, ACCESS TO TRUSTED HEALTH INFORMATION, AND SOCIAL DRIVERS OF HEALTH. ALL THE SURVEY RESPONSE OPTIONS WERE POSED IN QUANTITATIVE FORM THROUGH LIKERT SCALES. A QUALITATIVE OPEN-ENDED TEXT BOX WAS PROVIDED AT THE END OF THE SURVEY TO ALLOW FOR COMMENTS. THE SEVEN QUESTION SURVEY (FIVE FOCUSED QUESTIONS, ONE DEMOGRAPHIC QUESTION AND AN OPTION TO ADD COMMENTS) WAS ADMINISTERED ELECTRONICALLY THROUGH THE ONLINE SURVEYMONKEY FORMAT. TO ENSURE RESPONSES FROM A WIDE RANGE OF REPRESENTATIVE COMMUNITY MEMBERS AND LEADERS WITH DIVERSE BACKGROUNDS, PERSPECTIVES AND FIRST-HAND KNOWLEDGE ABOUT THEIR COMMUNITIES, THE SURVEY WAS EXTENSIVELY DISSEMINATED TO AN ARRAY OF SECTOR CONTACTS; FORWARDED TO MULTIPLE COLLABORATIVE E-DISTRIBUTION LISTS; POSTED ON WEBSITES AND SOCIAL MEDIA PLATFORMS; AND INCLUDED IN E-NEWSLETTERS THROUGHOUT MIDDLETOWN, MIDDLESEX COUNTY AND THE PERIPHERY TOWNS OF MIDDLESEX HEALTH'S SERVICE AREA. SECTORS INCLUDED ADVOCACY GROUPS, ALLIANCES / COALITIONS, THE BUSINESS COMMUNITY, EDUCATIONAL INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS, COMMUNITY RESIDENTS, ELECTED OFFICIALS, MUNICIPAL STAFF, FAITH-BASED ORGANIZATIONS, FOUNDATIONS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), LOCAL HEALTH DEPARTMENTS, MENTAL HEALTH ORGANIZATIONS, SUBSTANCE TREATMENT FACILITIES, AND YOUTH AND FAMILY SERVICES. COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE MEMBERS WERE ASKED TO BROADLY SHARE THE COMMUNITY SURVEY LINK, AND ALL SURVEY RECIPIENTS WERE INVITED TO SHARE THE LINK WITH COWORKERS, FRIENDS AND FAMILY OR ANYONE WHO LIVES OR WORKS IN MIDDLESEX COUNTY. A TOTAL OF 124 SURVEYS WERE COMPLETED AND RESPONSE RESULTS WERE WIDELY SHARED AND MADE AVAILABLE TO THE PUBLIC. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 7D: MIDDLESEX HOSPITAL POSTED ITS MOST RECENTLY COMPLETED CHNA (2025) ON ITS WEB-SITE (HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT) AND ELECTRONICALLY DISTRIBUTED IT THROUGH THE FOLLOWING DISSEMINATION CHANNELS: THE CHNA ADVISORY COMMITTEE; COMMUNITY MEMBERS; AND EXISTING HOSPITAL-COMMUNITY BASED PARTNERSHIP DISTRIBUTION LISTS. RECIPIENTS WERE ENCOURAGED TO WIDELY SHARE THE ASSESSMENT. PAPER COPIES OF THE CHNA ARE PROVIDED UPON REQUEST. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 11: MIDDLESEX HOSPITAL COMPLETED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2025, WHICH WAS APPROVED BY MIDDLESEX HEALTH'S GOVERNING BODY.MEMBERS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE PARTICIPATED IN PLANNING MEETINGS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COMMUNITY CONSERVATION AND CHNA IMPLEMENTATION STRATEGY. THE ADVISORY COMMITTEE WAS COMPOSED OF STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING LOCAL HEALTH DEPARTMENTS, HEALTH CARE ORGANIZATIONS, COMMUNITY-BASED ORGANIZATIONS, FAITH-BASED ORGANIZATIONS, ADVOCACY GROUPS, AND COMMUNITY MEMBERS. A FACILITATED VIRTUAL COMMUNITY CONVERSATION WAS HELD TO REVIEW, PRIORITIZE, AND DISCUSS STRATEGIES AND SOLUTIONS FOR THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN MIDDLESEX HEALTH'S 2025 COMMUNITY HEALTH NEEDS ASSESSMENT, THEREBY INFORMING MIDDLESEX HEALTH'S CHNA IMPLEMENTATION STRATEGY. A FLIER AND INVITATION WERE BROADLY DISTRIBUTED TO CONTACTS IN MIDDLETOWN, MIDDLESEX COUNTY, AND THE SURROUNDING TOWNS WITHIN MIDDLESEX HEALTH'S PRIMARY SERVICE AREA TO ENCOURAGE PARTICIPATION FROM COMMUNITY LEADERS, STAKEHOLDERS, AND RESIDENTS WITH DIVERSE BACKGROUNDS, PERSPECTIVES, AND LIVED EXPERIENCE. A TOTAL OF 47 PEOPLE PARTICIPATED, REPRESENTING VARIOUS SECTORS INCLUDING ADVOCACY GROUPS, ALLIANCES / COALITIONS, COMMUNITY-BASED ORGANIZATIONS, COMMUNITY RESIDENTS, EDUCATIONAL INSTITUTIONS, ELECTED OFFICIALS, FAITH-BASED ORGANIZATIONS, HEALTHCARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), LOCAL HEALTH DEPARTMENTS, MUNICIPAL AGENCIES, AND YOUTH AND FAMILY SERVICES. PARTICIPANTS REVIEWED KEY HEALTH CONCERNS WITHIN THE CONTEXT OF SOCIAL DRIVERS OF HEALTH AND HEALTH DISPARITIES AND DISCUSSED POTENTIAL COMMUNITY-BASED RESPONSES. THE RESULTS OF THE COMMUNITY CONVERSATION SERVED AS A GUIDE FOR MIDDLESEX HEALTH'S SELECTION OF PRIORITY AREAS FOR ITS CHNA IMPLEMENTATION STRATEGY. AS A RESULT OF THIS PROCESS, MIDDLESEX HEALTH WILL FOCUS ON FOUR PRIORITY AREAS: 1) BEHAVIORAL HEALTH; 2) HEALTHY AGING; 3) HEALTHY LIVING (CHRONIC CONDITIONS); AND, 4) PERINATAL HEALTH. WITH REGARD TO NEEDS THAT ARE NOT BEING ADDRESSED, MIDDLESEX HOSPITAL RECOGNIZES THAT IT CANNOT FOCUS ON EVERY HEALTH AND SOCIAL NEED IDENTIFIED IN ITS MOST CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT AND IS THEREFORE COMMITTED TO ALLOCATING RESOURCES AND IN-KIND TIME TO THE HIGHEST AREAS OF IDENTIFIED NEED AND/OR AREAS WITH GREATEST POTENTIAL FOR IMPACT AND FEASIBILITY (THE SELECTED PRIORITY AREAS). RESOURCE CONSTRAINTS PREVENT THE HOSPITAL FROM ADDRESSING EVERY NEED, AND IN MANY CASES, OTHER LOCAL COMMUNITY BASED ORGANIZATIONS MAY BE BETTER SUITED TO TAKE A LEADERSHIP ROLE IN IMPROVING CERTAIN HEALTH OUTCOMES. AS WITH OUR PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENTS, THE HOSPITAL WILL CONTINUE TO BE A WILLING PARTNER, WHEN ABLE, FOR INITIATIVES NOT RELATED TO ITS SELECTED CHNA IMPLEMENTATION STRATEGY PRIORITY AREAS.EXAMPLES OF MIDDLESEX HEALTH'S INVOLVEMENT IN ADDRESSING IDENTIFIED PRIORITY AREAS ARE OUTLINED BELOW. IN ALL EXAMPLES, A CENTRAL TENET OF THE WORK IS ADVANCING HEALTH EQUITY THROUGH INCLUSION AND INTENTIONALITY AND ALL WORK IS GUIDED BY COMMUNITY VOICE. IN RESPONSE TO THE OPIOID EPIDEMIC AND THE SIGNIFICANT UPWARD TREND SPECIFICALLY FOR FENTANYL INVOLVEMENT FOR ACCIDENTAL DRUG-RELATED DEATHS IN MIDDLESEX HEALTH'S SERVICE AREA DUE TO "ANY OPIOID", MIDDLESEX HEALTH IS A FOUNDING MEMBER OF THE GREATER MIDDLETOWN OPIOIDS TASK FORCE ("TASK FORCE"). THE TASK FORCE IS COMPOSED OF MORE THAN 35 AGENCIES, AND HAS A DISTRIBUTION LIST OF MORE THAN 100 MEMBERS. PARTNER AGENCIES INCLUDE MUNICIPALITIES, HEALTH DEPARTMENTS, POLICE AND FIRE DEPARTMENTS, HEALTH CARE ORGANIZATIONS, PARAMEDIC AND AMBULANCE SERVICES, BEHAVIORAL HEALTH SERVICES, TREATMENT AND RECOVERY SERVICES, HARM REDUCTION SERVICES, FAITH-BASED SERVICES, SCHOOLS AND COLLEGES AND COMMUNITY-BASED ORGANIZATIONS. THE TASK FORCE AIMS TO ENGAGE THE GREATER MIDDLETOWN COMMUNITY IN WORKING TOGETHER TO PROMOTE OPIOID AWARENESS, EDUCATION, PREVENTION, HARM REDUCTION AND ACCESS TO TREATMENT THEREBY REDUCING OPIOID-RELATED OVERDOSES AND DEATH. IT ALSO STRIVES TO BUILD A HEALTHY, SAFE AND DRUG-FREE COMMUNITY, AND TO DEVELOP A COMMUNITY THAT WORKS TOGETHER TO PREVENT AND HELP PEOPLE EXPERIENCING OPIOID USE CHALLENGES. MIDDLESEX HEALTH IS AN INTEGRAL MEMBER OF THE GREATER MIDDLETOWN HEALTH ENHANCEMENT COMMUNITY COALITION ("GMHEC"). THE GMHEC'S OBJECTIVE IS TO BE A PLACE-BASED INITIATIVE THAT ADVANCES HEALTH EQUITY, SUPPORTS LONG-TERM, COLLABORATIVE AND CROSS-SECTOR EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELL-BEING THROUGH BROAD, SYSTEMIC CHANGE. ITS GOAL IS TO BUILD HEALTHY AND EQUITABLE COMMUNITIES THAT ACTIVELY WORK TOGETHER TO PREVENT THE DEVELOPMENT OF DISEASE. THE COALITION ENGAGES IN INITIATIVES THAT ADVANCE HEALTH EQUITY, IMPROVE THE SOCIAL, ECONOMIC AND PHYSICAL CONDITIONS WITHIN COMMUNITIES THAT ENABLE INDIVIDUALS AND FAMILIES TO MEET BASIC NEEDS, ACHIEVE THEIR HEALTH AND WELL-BEING GOALS AND THRIVE THROUGHOUT THEIR LIVES. THE COALITION HAS A 90+ PERSON DISTRIBUTION LIST AND IS MADE UP OF 35+ DIFFERENT AGENCIES AND INCLUDES COMMUNITY MEMBERS. CENTERING COMMUNITY VOICE IS CRITICAL TO THE COALITION'S PURPOSE, WHICH ENSURES THAT PRIORITY AREAS AND PROGRAMS ARE DEVELOPED IN RESPONSE TO COMMUNITY DESIRES AND NEEDS. THROUGH ITS EXTENSIVE DISTRIBUTION LIST, THE GMHEC IS ABLE TO SHARE INFORMATION ABOUT UPCOMING COMMUNITY HEALTH AND WELL-BEING EVENTS, WHICH HELPS TO INCREASE ATTENDANCE AT THESE EVENTS. MIDDLESEX HEALTH STAFF MEMBERS ARE PART OF GMHEC LEADERSHIP TEAM AND PROVIDE ADMINISTRATIVE AND GRANT WRITING SUPPORT. WITH A STRONG AND COLLABORATIVE STRUCTURE IN PLACE, THE COALITION CONTINUES TO BUILD PARTNERSHIPS, STRENGTHEN COMMUNITY ENGAGEMENT, AND DEVELOP PROGRAMS THAT RESPOND TO IDENTIFIED HEALTH AND WELL-BEING NEEDS.MIDDLESEX HEALTH ALSO PARTICIPATES IN THE GMAHEC'S NUTRITIOUS FOODS SUBCOMMITTEE ("SUBCOMMITTEE") WHICH WAS FORMED TO FULFILL A COMMUNITY NEED FOR MORE EQUITABLE AND SUSTAINABLE ACCESS TO FRESH, NUTRITIOUS FOODS. A MIDDLESEX HEALTH STAFF MEMBER CO-CHAIRS THE HEC NUTRITIOUS FOODS SUBCOMMITTEE. THE SUBCOMMITTEE RECOGNIZES THAT 1) FOOD INSECURITY IS AN ISSUE IN OUR COMMUNITY; 2) THE BENEFITS OF NUTRITIOUS FOODS TO ADDRESS CHRONIC DISEASE PREVENTION AND MANAGEMENT; 3) THE POTENTIAL TO LEVERAGE MULTIPLE COMMUNITY ASSETS TO CREATE SUSTAINABLE, EQUITABLE ACCESS TO HEALTHY FOOD; AND 4) THAT FOOD (GROWING, PREPARING, EATING) IS A POWERFUL VEHICLE FOR COMMUNITY CONNECTION AND WELL-BEING. THROUGH LISTENING SESSIONS AND COMMUNITY SURVEYING THE SUBCOMMITTEE LEARNED THAT ACCESS TO HEALTHY FRUITS AND VEGETABLES WAS A BARRIER FOR MANY IN THE GREATER MIDDLETOWN COMMUNITY AND GROWING ONE'S OWN VEGETABLES WAS A PREFERRED SOLUTION. IN RESPONSE, THE SUBCOMMITTEE OVERSEES THE STARTER PLANT INITIATIVE, HYDROPONICS GROWING PROGRAM AND A CONTAINER GARDENING PILOT. AS GROWING ONE'S OWN VEGETABLES IS ASSOCIATED WITH GREATER FRUIT AND VEGETABLE INTAKE (ALAIMO, 2023), THESE PLANTING OPTIONS ARE A WAY TO GET ADULTS, CHILDREN AND FAMILIES ENGAGED AND INTERESTED IN HOME VEGETABLE GARDENING. MIDDLESEX HOSPITAL PART V, SECTION B, LINE 13H: MIDDLESEX HOSPITAL'S SLIDING SCALE OUTLINES THE FACTORS THAT IT USES TO DETERMINE FINANCIAL ASSISTANCE DETERMINATIONS: THE FEDERAL POVERTY INCOME GUIDELINES AND NUMBER OF PERSONS IN HOUSEHOLD. PART V, SECTION B, LINE 7A: HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 10A: HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 16A, FAP WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART V, SECTION B, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART V, SECTION B, LINE 16C, FAP PLAIN LANGUANCE SUMMARY WEBSITE: HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES PART V, SECTION B, LINE 20A: WRITTEN NOTICE ABOUT UPCOMING ECAS WAS NOT REQUIRED BECAUSE THE ORGANIZATION DID NOT PURSUE ANY EXTRAORDINARY COLLECTION ACTION'S DURING THE YEAR. IF AN ECA WAS PURSUED IN THE FUTURE, PROPER NOTICE WOULD BE GIVEN. 1 1 - MIDDLESEX HOSPITAL HOMECARE 770 SAYBROOK ROAD MIDDLETOWN CT 06457 HOMECARE SERVICES, REHAB, HEART HEALTH, OTHER SERVICES PART I, LINE 3C: IN GENERAL, MIDDLESEX HOSPITAL ("THE HOSPITAL") USES FPG TO DETERMINE ELIGIBILITY. THERE ARE, HOWEVER, SPECIAL CIRCUMSTANCES (SUCH AS A CATASTROPHIC EVENT) WHICH MAY AFFECT A PATIENT'S ABILITY TO PAY. IN THIS CASE, THE HOSPITAL EVALUATES THE APPLICATION WITH CONSIDERATION GIVEN TO THE PATIENT'S CURRENT SITUATION. WITH SPECIAL CIRCUMSTANCES, IN ORDER TO MAXIMIZE THE AMOUNT OF FINANCIAL ASSISTANCE DISCOUNT, THE FPG THRESHOLD MAY BE IGNORED AND THE HOSPITAL MAY USE THE PATIENT'S ASSETS AND/OR TAX RETURN ITEMIZED DEDUCTIONS TO DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE. PART I, LINE 7: FOR PART 1, LINE 7 SECTIONS (A) FINANCIAL ASSISTANCE AT COST, (B) MEDICAID, (C) COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS, PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, AND (G) SUBSIDIZED HEALTH SERVICES, THE COSTING METHODOLOGY USED IS A HYBRID COST ACCOUNTING/MEDICARE COST-TO-CHARGE RATIO CALCULATION. THE PERCENTAGES ARE DERIVED FROM THE MOST CURRENT MEDICARE COST REPORT AND APPLIED BY CHARGE LINE APPROPRIATELY. INDIRECT COSTS WERE APPLIED TO SUBSIDIZED HEALTH SERVICES. THE MEDICARE COST REPORT DOES NOT ADDRESS ALL AREAS OF THE HOSPITAL IN THE SAME DETAIL, BUT DOES ACCURATELY ADDRESS INPATIENT AND OUTPATIENT, HOMECARE AND TO AN EXTENT PHYSICIAN SERVICES. SECTIONS (E) COMMUNITY HEALTH IMPROVEMENT; PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, (H) RESEARCH, AND (I) CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS ARE COMPRISED (EXCEPT FOR CASH DONATIONS AND IN-KIND MATERIAL DONATIONS) OF 1) SUPPLY EXPENSES; 2) PURCHASED SERVICES; AND 3) THE DIRECT SALARY COSTS FOR HOSPITAL STAFF WHOSE TIME WAS COMPENSATED BY THE HOSPITAL FOR TIME SPENT PARTICIPATING IN ACTIVITIES THAT QUALIFY AS COMMUNITY BENEFITS PLUS THE CURRENT FISCAL YEAR FRINGE BENEFIT RATE. IN ADDITION TO SUBSIDIZED SERVICES, INDIRECT COSTS WERE APPLIED TO A SMALL SELECTION OF SALARIES AND SERVICES UNDER COMMUNITY HEALTH IMPROVEMENT, RESEARCH, AND COMMUNITY BENEFIT OPERATIONS, BUT NOT BROADLY ACROSS ALL COMMUNITY BENEFIT ACTIVITY ENTRIES. PART I, LINE 7G: MIDDLESEX HOSPITAL INCLUDES ITS FAMILY MEDICINE GROUP AS A SUBSIDIZED SERVICE. FOR FY25, 8,712 UNIQUE INDIVIDUALS WERE SERVED WITH A TOTAL HOSPITAL SUBSIDY OF $611,286. MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDE TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS) FOR PRIMARY CARE (MIDDLETOWN SERVICE AREA; LOW INCOME POPULATION), MENTAL HEALTH (MIDDLESEX COUNTY; HIGH NEED GEOGRAPHIC) AND DENTAL HEALTH (CENTRAL MIDDLETOWN; LOW INCOME POPULATION). MIDDLESEX HOSPITAL'S FAMILY MEDICINE GROUP FILLS A VITAL COMMUNITY HEALTH NEED BY PROVIDING ACCESS TO PRIMARY CARE SERVICES. PART I, LINE 6B: SINCE THE INCEPTION OF MIDDLESEX HEALTH'S COMMUNITY BENEFIT POLICY IN 2007, AND PRIOR TO THE MANDATE OF THE AFFORDABLE CARE ACT, CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ORDER TO PRIORITIZE SPECIFIC COMMUNITY BENEFIT INITIATIVES HAS BEEN A CORE ELEMENT OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM. IN ADDITION TO COMPLETING A CHNA, THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVICES ON AN ON-GOING BASIS THROUGH A VARIETY OF METHODS. EXAMPLES INCLUDE UNDERSTANDING THE LOCAL AND STATE-WIDE NEEDS DERIVED FROM: 1) PARTICIPATION IN COMMUNITY HEALTHCARE COALITIONS AND BOARDS, WHICH INCLUDE STRATEGIC PLANNING THAT IS RESPONSIVE TO COMMUNITY NEED; 2) PARTICIPATION IN THE LEADERSHIP TEAM OF THE GREATER MIDDLETOWN HEALTH ENHANCEMENT COMMUNITY (GMHEC) COALITION, A PLACE-BASED INITIATIVE THAT SUPPORTS LONG-TERM, COLLABORATIVE, AND CROSS-SECTOR EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELL-BEING THROUGH BROAD, SYSTEMIC CHANGE BY BUILDING HEALTHY AND EQUITABLE COMMUNITIES THAT ACTIVELY WORK TOGETHER TO PREVENT THE DEVELOPMENT OF DISEASE; 3) PARTICIPATION IN THE STATE'S HOSPITAL ASSOCIATION POPULATION AND COMMUNITY HEALTH INITIATIVES BASED ON STATE-WIDE AND LOCAL COMMUNITY HEALTH ISSUES; 4) ANY REAL-TIME COMMUNITY BASED INPUT, FEED-BACK, RECOMMENDATIONS AND SUGGESTIONS; AND 5) CONTINUOUS ASSESSMENT AND ADJUSTMENTS, WHEN NECESSARY, OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAMS THROUGH SURVEYS AND PATIENT/PARTICIPANT FEED-BACK. HAVING A STRONG PRESENCE IN COMMUNITY COALITIONS AND PARTNERSHIPS, IN ADDITION TO BEING RESPONSIVE TO THE NEEDS EXPRESSED BY OUR COMMUNITY RESIDENTS, ALLOWS MIDDLESEX HOSPITAL TO CONTINUALLY ASSESS THE HEALTHCARE NEEDS OF OUR COMMUNITY IN BETWEEN COMMUNITY HEALTH NEEDS ASSESSMENT CYCLES. PART II, COMMUNITY BUILDING ACTIVITIES: THE MAJORITY OF MIDDLESEX HOSPITAL'S COMMUNITY BASED HEALTH IMPROVEMENT WORK IS CAPTURED UNDER COMMUNITY BENEFIT CATEGORIES. THE HOSPITAL'S PARTICIPATION IN COMMUNITY BUILDING ACTIVITIES, HOWEVER, HAS A VITAL ROLE IN CONTINUING TO PROMOTE THE HEALTH, WELL-BEING AND SAFETY FOR RESIDENTS IN ITS SERVICE AREA. THE HOSPITAL OFFERS ITS RESOURCES AND EXPERTISE TO SUPPORT AND STRENGTHEN COMMUNITY ASSETS IN A VARIETY OF WAYS THAT FALL UNDER THE SCOPE OF COMMUNITY BUILDING. STAFF MEMBERS PARTICIPATE IN MULTIPLE COMMUNITY PARTNERSHIPS AND COALITIONS, THE SUCCESS OF WHICH ARE GREATLY ENHANCED BY HOSPITAL COLLABORATION - MANY COMMUNITY INITIATIVES WOULD NOT BE AS EFFECTIVE WITHOUT THE HOSPITAL'S ADMINISTRATIVE AND CLINICAL STAFF IN-KIND INVOLVEMENT, SUPPORT AND EXPERTISE.IN FY25 THE HOSPITAL'S COMMUNITY BUILDING EXPENSE TOTALED $115,462, SERVING 133 INDIVIDUALS. EXAMPLES INCLUDE (BUT ARE NOT LIMITED TO): 1) DISASTER READINESS WHERE THE HOSPITAL PLAYS A PIVOTAL ROLE BY PREPARING FOR DISASTERS. EXAMPLES INCLUDE THE HOSPITAL HOSTING YEARLY RADIATION DRILLS FOR THE STAFF OF A LOCAL NUCLEAR POWER PLANT, AND THE HOSPITAL PURCHASING AND STOCK-PILING LARGE QUANTITIES OF EXTENSIVE PANDEMIC SUPPLIES TO BE USED SHOULD A COMMUNITY-WIDE DISASTER OCCUR. INCLUDED IN THIS STOCK-PILE ARE MEDICATIONS FOR INFECTIOUS DISEASE AND CHEMICAL EXPOSURE CURATIVES. THE MAJORITY OF THE VALUE OF THE SUPPLIES, SPACE UTILIZATION AND COSTS ASSOCIATED TO MONITOR AND REPLENISH PANDEMIC PRODUCTS (WITHIN EXPIRATION DATES) ARE ABSORBED BY THE HOSPITAL, AND, 2) WORKFORCE DEVELOPMENT, EXAMPLES INCLUDE THE HOSPITAL'S SHORELINE MEDICAL CENTER (SMC)'S A WELL-DEVELOPED EDUCATIONAL PROGRAM FOR LOCAL STUDENTS INTERESTED IN MEDICAL CAREERS. SHORTAGES OF CERTAIN TRAINED MEDICAL PROFESSIONALS SUCH AS NURSES AND RADIOLOGIC TECHNOLOGISTS SERVED AS THE IMPETUS FOR STARTING THESE PROGRAMS. THE SMC CAREER DAY IS AN EXPERIENTIAL LEARNING EVENT WHERE HIGH SCHOOL STUDENTS INTERACT WITH STAFF MEMBERS FROM A VARIETY OF CLINICAL FIELDS AND PARTICIPATE IN INTERACTIVE MOCK DEMONSTRATIONS / SIMULATIONS. PART III, LINE 2: DUE TO THE ADOPTION OF ASC NO 2014-09 CONTRACTS WITH CUSTOMERS (TOPIC 606) BAD DEBT EXPENSE IS NO LONGER REPORTED ON THE AUDITED FINANCIAL STATEMENT. RATHER IT IS TREATED AS A PRICE CONCESSION. THE BAD DEBT EXPENSE FOR FY25 WAS $21,531,629. PART III, LINE 3: THE HOSPITAL ESTIMATES THAT 10% OF ITS BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL HAS A WELL-ESTABLISHED PROCESS WITH ITS THIRD PARTY AGENCIES TO CAPTURE AS MANY PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE AS POSSIBLE AND AWARDS FINANCIAL ASSISTANCE TO THOSE PATIENTS IN COLLECTIONS WHO ARE KNOWN TO QUALIFY. ONCE IN COLLECTIONS, THERE ARE TWO METHODS WHICH ENABLE PATIENTS TO RECEIVE FINANCIAL ASSISTANCE AWARDS: 1) PATIENTS EITHER COMPLETE A FINANCIAL ASSISTANCE APPLICATION, MEET ELIGIBILITY CRITERIA AND ARE APPROVED; OR 2) THE THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE HOSPITAL TO COLLECT BALANCES SCREEN FOR FINANCIAL ASSISTANCE ELIGIBILITY. IN ORDER TO ENSURE THAT ALL PATIENTS IN COLLECTIONS ARE AWARE OF FINANCIAL ASSISTANCE AVAILABILITY, THE HOSPITAL REQUIRES THIRD PARTY ORGANIZATIONS TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WITHIN THE POLICY THERE IS A PROVISION WHEREBY COLLECTION AGENCIES, USING GUIDELINES SET FORTH BY THE HOSPITAL, ASSIST THE HOSPITAL IN IDENTIFYING PATIENTS WHO DO NOT HAVE A MEANS TO PAY FOR SERVICES AND THEREFORE QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM WHILE THESE PATIENTS HAVE NOT GONE THROUGH THE FORMAL APPLICATION PROCESS, THEY MEET THE ELIGIBILITY GUIDELINES FOR FINANCIAL ASSISTANCE AS DEFINED BY THE HOSPITAL. THESE PATIENTS ARE THEN TRANSFERRED AND INCLUDED UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE UMBRELLA. WHILE THIS PROCESS CAPTURES THE MAJORITY OF THOSE WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL RECOGNIZES IT WILL STILL HAVE A POPULATION OF PATIENTS WHO COULD POTENTIALLY QUALIFY FOR FINANCIAL ASSISTANCE AND DO NOT RECEIVE AWARDS THOSE WHO ARE UNRESPONSIVE OR HAVE MOVED AWAY. BAD DEBT DOLLARS ARE NOT INCLUDED IN ANY OF THE HOSPITAL'S PROGRAMMATIC COMMUNITY BENEFIT VALUES AND, WHILE NOTED, ARE NOT INCLUDED IN THE HOSPITAL'S COMMUNITY BENEFIT TOTALS IN ANY HOSPITAL COMMUNITY BENEFIT PUBLICATION. PART III, LINE 4: THE HOSPITAL ESTIMATES A RESERVE FOR UNCOLLECTIBLE ACCOUNTS AGAINST ITS PATIENT ACCOUNTS RECEIVABLES. WHEN BAD DEBTS ARE IDENTIFIED, THEY ARE ACCOUNTED FOR AS A COMPONENT OF THE NET PATIENT REVENUE PROVISION FOR BAD DEBTS NET OF RECOVERIES. PAGE 16 OF THE MIDDLESEX HEALTH SYSTEM'S CONSOLIDATED FY25 AUDITED FINANCIAL STATEMENT STATES: THE SYSTEM DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE FROM THAT CATEGORY OF PAYOR. PART III, LINE 8: THE MEDICARE COST REPORT IS THE COSTING METHODOLOGY SYSTEM USED TO DETERMINE THE AMOUNT REPORTED ON PART III, LINES 5 AND 6. THE HOSPITAL UTILIZES WORKSHEET 6 FOUND IN THE FORM 990 INSTRUCTIONS FOR SCHEDULE H TO CALCULATE ITS SUBSIDIZED SERVICES. THE INSTRUCTIONS STATE THAT "THE FINANCIAL LOSS IS MEASURED AFTER REMOVING LOSSES, MEASURED BY COST, ASSOCIATED WITH BAD DEBT, CHARITY CARE, MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS". GIVEN THAT WORKSHEET 6 DOESN'T SUGGEST REMOVING LOSSES ASSOCIATED WITH MEDICARE, A PORTION OF MEDICARE IS INCLUDED IN THE HOSPITAL'S SUBSIDIZED SERVICE CALCULATIONS. SO AS NOT TO DOUBLE COUNT MEDICARE VALUES IN PART III, SECTION B, LINES 5 AND 6, THE PORTION OF MEDICARE SHORTFALL INCLUDED IN OUR SUBSIDIZED SERVICES CALCULATIONS HAS BEEN SUBTRACTED FROM THE MEDICARE REVENUE AND COSTS DERIVED FROM THE MEDICARE COST REPORT. THE VALUES INDICATED IN PART III, LINES 5 AND 6 ARE THEREFORE WHAT REMAINS AFTER THE MEDICARE REVENUE AND COSTS INCLUDED IN THE SUBSIDIZED SERVICES CALCULATIONS HAS BEEN SUBTRACTED OUT. GIVEN THIS, THE RESULTING VALUES (PART III, LINES 5, 6 AND 7) WOULD NEED TO BE COMBINED WITH THE MEDICARE REVENUE/COSTS INCLUDED IN OUR SUBSIDIZED SERVICES TO GET THE FULL OVERVIEW OF MEDICARE REVENUE, COSTS AND ANY REMAINING SHORTFALL OR SURPLUS. WE AGREE WITH THE CURRENT SUBSIDIZED SERVICES CALCULATION METHODOLOGY THAT ALLOWS THE INCLUSION OF MEDICARE DOLLARS AS THE MEDICARE POPULATION COMPRISES AN IMPORTANT SEGMENT OF THOSE RECEIVING SUBSIDIZED SERVICES CARE. THE HOSPITAL TREATS ALL MEDICARE PATIENTS EQUALLY AND DOES NOT DISCRIMINATE AGAINST LOWER-MARGIN YIELDING SERVICES. AS A NOT-FOR-PROFIT HOSPITAL, MIDDLESEX HOSPITAL IS THE SAFETY-NET IN THE COMMUNITY FOR ALL MEDICARE PATIENTS, REGARDLESS OF LEVEL OF MEDICARE COVERAGE AND REGARDLESS IF A SURPLUS OR DEFICIT RESULTS. THIS OPEN ACCESS FOR MEDICARE PATIENTS PROMOTES ACCESS TO CARE, A FUNDAMENTAL TENET OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM.THERE REMAINS A DISPROPORTIONATE PERCENTAGE OF OLDER ADULTS IN MIDDLESEX COUNTY WHEN COMPARED TO STATE AVERAGES. MIDDLESEX HOSPITAL'S MOST RECENTLY COMPLETED (2025) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOUND THAT, WHEN EXTRACTING THE AGE 65+ POPULATION, MIDDLESEX COUNTY (22%) EXCEEDS CONNECTICUT (19%), AND THE MAJORITY OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA CONTINUE TO HAVE A GREATER CONCENTRATION OF OLDER ADULTS WHEN COMPARED TO CONNECTICUT. THE TOWNS OF COLCHESTER, MARLBOROUGH, MIDDLETOWN, PORTLAND, AND EAST HAMPTON FALL BELOW THE AGE 65+ STATE AVERAGE OF 19%. DURHAM AND HADDAM ARE ON PAR WITH THE AGE 65+ STATE AVERAGE, WHILE DEEP RIVER, CROMWELL, CLINTON, KILLINGWORTH, MIDDLEFIELD, EAST HADDAM, AND OLD LYME EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 20%-24% AND LYME, CHESTER, ESSEX, OLD SAYBROOK, AND WESTBROOK CONSIDERABLY EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 26%-32% (MIDDLETOWN AND CONNECTICUT: U.S. CENSUS AMERICAN COMMUNITY SURVEY 2023 5-YEAR ESTIMATES. OTHER TOWNS AND MIDDLESEX COUNTY: U.S. CENSUS AMERICAN COMMUNITY SURVEY 2021 5-YEAR ESTIMATES). AS MIDDLESEX COUNTY HAS A DISPROPORTIONATE LEVEL OF COMMUNITY MEMBERS AGE 65+ WHEN COMPARED TO THE STATE AVERAGE, THE SHORTFALL THAT THE HOSPITAL EXPERIENCES IN PROVIDING CRITICAL HEALTHCARE SERVICES TO THE MEDICARE POPULATION SHOULD BE CONSIDERED A COMMUNITY BENEFIT WITHIN THE HOSPITAL'S SUBSIDIZED SERVICES, WHICH THOSE AGE 65+ ALSO RELY HEAVILY ON FOR CARE. THE HOSPITAL FILLS A HEALTHCARE DELIVERY GAP FOR MEDICARE PATIENTS, ONE WHICH WOULD BE DETRIMENTAL TO THE COMMUNITY IF THE HOSPITAL WAS NOT PRESENT. PART III, LINE 9B: MIDDLESEX HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. THE POLICY STATES THAT PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE WILL BE RESPONSIBLE FOR PAYING ANY BALANCE REMAINING AFTER THE FINANCIAL ASSISTANCE ALLOWANCE HAS BEEN APPLIED (THAT IS, IF 100% FINANCIAL ASSISTANCE HAS NOT BEEN AWARDED). THE POLICY ALSO OUTLINES THE PROCESS FOR PAYING OUTSTANDING BALANCES SHOULD THE PATIENT BE FOUND TO HAVE THE MEANS TO PAY A PARTIAL AMOUNT AFTER THE HOSPITAL'S FINANCIAL ASSISTANCE DETERMINATION CRITERIA HAS BEEN APPLIED. FOR SUCH BALANCES, THE HOSPITAL WILL NOTIFY THE PATIENT OF HIS/HER LIABILITY. IF PAYMENT IS NOT MADE, THE POLICY STATES THAT THE HOSPITAL WILL USE APPROPRIATE METHODS TO PURSUE COLLECTION, WHICH MAY INCLUDE COLLECTIONS AGENCIES. THIS PRACTICE IS BROADLY UTILIZED FOR ALL PATIENTS WITH OUTSTANDING BALANCES. THE HOSPITAL MAKES EVERY EFFORT TO ENSURE THAT ALL PATIENTS KNOW PAYMENT PLANS ARE AVAILABLE FOR ANY BALANCE, INCLUDING THOSE PATIENTS WHO HAVE A BALANCE LEFT OVER AFTER A FINANCIAL ASSISTANCE AWARD HAS BEEN APPLIED. IN ORDER TO CAPTURE THE PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE HOSPITAL HAS PROVISIONS IN ITS COLLECTION POLICY. IN THE CASE WHERE PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE DO NOT COMPLETE A FINANCIAL ASSISTANCE APPLICATION AND ARE PLACED INTO COLLECTIONS, THE THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE HOSPITAL TO COLLECT BALANCES SCREEN FOR FINANCIAL ASSISTANCE ELIGIBILITY. THE THIRD PARTY ORGANIZATIONS FOLLOW HOSPITAL POLICY BY ALERTING ALL PATIENTS IN COLLECTIONS TO THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WITHIN THE HOSPITAL'S COLLECTION POLICY THERE IS A PROVISION WHEREBY COLLECTION AGENCIES, USING GUIDELINES SET FORTH BY THE HOSPITAL, ASSIST THE HOSPITAL IN IDENTIFYING PATIENTS WHO DO NOT HAVE A MEANS TO PAY FOR SERVICES AND THEREFORE QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM WHILE THESE PATIENTS HAVE NOT GONE THROUGH THE FORMAL APPLICATION PROCESS, THEY MEET THE ELIGIBILITY GUIDELINES FOR FINANCIAL ASSISTANCE AS DEFINED BY THE HOSPITAL. THESE PATIENTS ARE THEN TRANSFERRED AND INCLUDED UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE UMBRELLA. THIS PROCESS WAS PUT IN PLACE BY THE HOSPITAL IN ORDER TO CAPTURE AS MANY PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE AS POSSIBLE. PART VI, LINE 2: SINCE THE INCEPTION OF MIDDLESEX HEALTH'S COMMUNITY BENEFIT POLICY IN 2007, AND PRIOR TO THE MANDATE OF THE AFFORDABLE CARE ACT, CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ORDER TO PRIORITIZE SPECIFIC COMMUNITY BENEFIT INITIATIVES HAS BEEN A CORE ELEMENT OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM. IN ADDITION TO COMPLETING A CHNA, THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVICES ON AN ON-GOING BASIS THROUGH A VARIETY OF METHODS. EXAMPLES INCLUDE UNDERSTANDING THE LOCAL AND STATE-WIDE NEEDS DERIVED FROM: 1) PARTICIPATION IN COMMUNITY HEALTHCARE COALITIONS AND BOARDS, WHICH INCLUDE STRATEGIC PLANNING THAT IS RESPONSIVE TO COMMUNITY NEED; 2) PARTICIPATION IN THE LEADERSHIP TEAM OF THE GREATER MIDDLETOWN HEALTH ENHANCEMENT COMMUNITY (GMHEC) COALITION, A PLACE-BASED INITIATIVE THAT SUPPORTS LONG-TERM, COLLABORATIVE, AND CROSS-SECTOR EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELL-BEING THROUGH BROAD, SYSTEMIC CHANGE BY BUILDING HEALTHY AND EQUITABLE COMMUNITIES THAT ACTIVELY WORK TOGETHER TO PREVENT THE DEVELOPMENT OF DISEASE; 3) PARTICIPATION IN THE GREATER MIDDLETOWN OPIOIDS TASK FORCE ("TASK FORCE") (MIDDLESEX HEALTH IS A FOUNDING MEMBER), WHICH AIMS TO ENGAGE THE GREATER MIDDLETOWN COMMUNITY IN WORKING TOGETHER TO PROMOTE OPIOID AWARENESS, EDUCATION, PREVENTION, HARM REDUCTION AND ACCESS TO TREATMENT THEREBY REDUCING OPIOID-RELATED OVERDOSES AND DEATH, AND STRIVES TO BUILD A HEALTHY, SAFE AND DRUG-FREE COMMUNITY, AND TO DEVELOP A COMMUNITY THAT WORKS TOGETHER TO PREVENT AND HELP PEOPLE EXPERIENCING OPIOID USE CHALLENGES.; 4) PARTICIPATION IN THE STATE'S HOSPITAL ASSOCIATION POPULATION AND COMMUNITY HEALTH INITIATIVES BASED ON STATE-WIDE AND LOCAL COMMUNITY HEALTH ISSUES; 5) ANY REAL-TIME COMMUNITY BASED INPUT, FEED-BACK, RECOMMENDATIONS AND SUGGESTIONS; AND 6) CONTINUOUS ASSESSMENT AND ADJUSTMENTS, WHEN NECESSARY, OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAMS THROUGH SURVEYS AND PATIENT/PARTICIPANT FEED-BACK. HAVING A STRONG PRESENCE IN COMMUNITY COALITIONS AND PARTNERSHIPS, IN ADDITION TO BEING RESPONSIVE TO THE NEEDS EXPRESSED BY OUR COMMUNITY RESIDENTS, ALLOWS MIDDLESEX HOSPITAL TO CONTINUALLY ASSESS THE HEALTHCARE NEEDS OF OUR COMMUNITY IN BETWEEN COMMUNITY HEALTH NEEDS ASSESSMENT CYCLES. PART VI, LINE 3: GREAT CONCERN IS TAKEN TO ENSURE THAT PATIENTS ARE APPRISED OF THE AVAILABILITY OF FEDERAL/STATE/LOCAL GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE PLAN. NOTICE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS DISPLAYED CONSPICUOUSLY IN ENGLISH AND SPANISH AT THE ENTRY OF EACH FACILITY AND AT ALL PATIENT REGISTRATION POINTS. THE NOTIFICATION INCLUDES AN OVERVIEW OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM; THE AVAILABILITY OF FREE BED FUNDS AND OTHER FINANCIAL ASSISTANCE; SLIDING SCALE; AND FINANCIAL COUNSELOR CONTACT INFORMATION. AT THE TIME OF REGISTRATION, HOSPITAL ACCESS STAFF REVIEWS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND ASKS PATIENTS IF THEY WOULD LIKE A FINANCIAL ASSISTANCE PACKAGE. BUILT INTO THE REGISTRATION DATABASE IS A REQUIRED FINANCIAL ASSISTANCE FIELD WHICH MUST BE COMPLETED AS PART OF THE ADMISSIONS PROCESS. ONCE THE PATIENT EXPRESSES THE DESIRE TO RECEIVE A FINANCIAL ASSISTANCE PACKAGE, PAPERWORK WITH PATIENT NAME AND MEDICAL RECORD IS AUTOMATICALLY PRINTED AT THE REGISTRATION STATION AND HANDED TO THE PATIENT. OTHER METHODS OF COMMUNICATION TO INCREASE AWARENESS REGARDING THE FINANCIAL ASSISTANCE AND FREE BED FUND PROGRAM INCLUDE 1) A FINANCIAL ASSISTANCE BROCHURE THAT AIDS PATIENTS IN THE PROCESS, ANSWERS KEY QUESTIONS AND PROVIDES EASY ACCESS FOR HELP (AVAILABLE AT MULTIPLE HOSPITAL DEPARTMENTS AND LOCATIONS, INCLUDING KIOSKS AT EVERY HOSPITAL ENTRY POINT); 2) A SEPARATE AND DISTINCT FINANCIAL ASSISTANCE SERVICES SECTION ON THE HOSPITAL'S WEB-SITE (HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES) WHICH INCLUDES APPLICATION, INSTRUCTIONS, AND SLIDING SCALE; 3) INCLUSION OF FINANCIAL ASSISTANCE INFORMATION IN THE HOSPITAL'S INPATIENT ADMISSIONS BOOKLET; 4) NOTICE OF THE PROGRAM AND FINANCIAL COUNSELOR CONTACT INFORMATION ON EVERY BILLING STATEMENT; 5) NOTIFICATION AT DISCHARGE; AND 6) A LETTER OUTLINING THE PROGRAM SENT TO EVERY SELF-PAY PATIENT FOLLOWING DISCHARGE. MIDDLESEX HEALTH'S FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN THE TOP 15 LANGUAGES IN ITS SERVICE AREA AND THIS AVAILABILITY IS COMMUNICATED ON THE BACK OF THE STATEMENT IN EACH LANGUAGE.THE HOSPITAL HAS A TEAM OF FINANCIAL COUNSELORS WHO ARE AVAILABLE TO ASSIST PATIENTS THROUGH THE APPLICATION PROCESS EITHER BY PHONE OR VISIT. THE ROLE OF THE COUNSELORS IS TO HELP PATIENTS NAVIGATE THE HOSPITAL'S FINANCIAL ASSISTANCE PROCESS AND TO AID IN APPLICATION FOR MEDICAID/STATE PROGRAMS. ALL COUNSELORS RECEIVE DEPARTMENTAL TRAINING ON THE IMPORTANCE OF ASSISTING PATIENTS IN NEED OF STATE/GOVERNMENTAL OR HOSPITAL FINANCIAL ASSISTANCE, THE HOSPITAL'S FINANCIAL ASSISTANCE PROTOCOLS, SYSTEMS, NEW PROGRAM ENHANCEMENTS, AND HOW TO PROVIDE SUPPORT AND FOLLOW-UP FOR MEDICAID/STATE ENROLLMENT. THE HOSPITAL'S SOCIAL WORKERS ALSO ASSIST PATIENTS WITH COMPLETION OF HOSPITAL FINANCIAL ASSISTANCE APPLICATIONS AS WELL AS MEDICAID/STATE APPLICATIONS.IN FY25, MIDDLESEX HOSPITAL GRANTED $1,501,404 IN FINANCIAL ASSISTANCE TO 1,036 UNIQUE RECIPIENTS AND ABSORBED $29,696,195 IN UNPAID COSTS OF MEDICAID, SERVING 21,578 INDIVIDUALS. PART VI, LINE 4: MIDDLESEX HOSPITAL IS THE SOLE HOSPITAL PROVIDER IN ITS SERVICE AREA, WHICH INCLUDES THE LARGE GEOGRAPHIC AREA OF MIDDLESEX COUNTY AND SURROUNDING TOWNS. IT ENCOMPASSES 24 MUNICIPALITIES, INCLUDING THE 15 TOWNS OF MIDDLESEX COUNTY. THERE ARE NINETEEN TOWNS IN ITS PRIMARY SERVICE AREA: CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, ESSEX, HADDAM, KILLINGWORTH, MIDDLEFIELD, MIDDLETOWN, OLD SAYBROOK, PORTLAND, AND WESTBROOK (THE FIFTEEN TOWNS OF MIDDLESEX COUNTY) AND COLCHESTER, LYME, MARLBOROUGH AND OLD LYME; AND, FIVE TOWNS IN ITS SECONDARY SERVICE AREA: GUILFORD, HEBRON, MADISON, MERIDEN, AND ROCKY HILL. BY LAND AREA, MIDDLESEX COUNTY (369.3 SQUARE MILES) IS THE SMALLEST COUNTY OF THE EIGHT COUNTIES IN CONNECTICUT AND IS THE SIXTH IN POPULATION SIZE (U.S. CENSUS, 2020). MUNICIPALITY SIZES BY LAND MASS VARY THROUGHOUT THE COUNTY, FROM 10.40 SQUARE MILES (ESSEX) TO 54.25 SQUARE MILES (EAST HADDAM) WITH MIDDLETOWN HAVING 41.02 SQUARE MILES OF LAND AREA. THE CITY OF MIDDLETOWN (ZIP CODE 06457) IS CENTRALLY LOCATED 16 MILES SOUTH OF HARTFORD. THE POPULATION IN MIDDLETOWN IS ECONOMICALLY AND RACIALLY / ETHNICALLY MORE DIVERSE WHEN COMPARED TO OTHER MUNICIPALITIES IN MIDDLESEX COUNTY AND IS ONE OF THE FEW COMMUNITIES IN CONNECTICUT TO INCLUDE URBAN, SUBURBAN, AND RURAL CHARACTERISTICS. THE DATA THAT FOLLOWS IS PER MIDDLESEX HEALTH'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT (2025).WITH A POPULATION OF 48,152, MIDDLETOWN IS THE LARGEST MUNICIPALITY IN MIDDLESEX COUNTY. THE REMAINING TOWNS IN MIDDLESEX HEALTH'S PRIMARY SERVICE AREA FALL INTO THREE POPULATION RANGES. COLCHESTER, CROMWELL, CLINTON, EAST HAMPTON AND OLD SAYBROOK HAVE POPULATIONS BETWEEN 10,000 AND 15,600. PORTLAND, EAST HADDAM, HADDAM, OLD LYME, DURHAM, WESTBROOK, ESSEX, KILLINGWORTH AND MARLBOROUGH HAVE POPULATIONS BETWEEN 5,000 AND 9,999. DEEP RIVER, MIDDLEFIELD, CHESTER AND LYME HAVE POPULATIONS LESS THAN 5,000 (DATAHAVEN CONNECTICUT TOWN DATA VIEWER, AMERICAN COMMUNITY SURVEY 2022). THE CONNECTICUT OFFICE OF RURAL HEALTH (CT-ORH) DEFINES RURAL AS ALL TOWNS WITH A POPULATION CENSUS OF 10,000 OR LESS AND A POPULATION DENSITY OF 500 OR FEWER PEOPLE PER SQUARE MILE. BASED ON THIS METRIC, THE TOWNS OF CHESTER, DEEP RIVER, DURHAM, EAST HADDAM, HADDAM, KILLINGWORTH, LYME, MARLBOROUGH, MIDDLEFIELD, OLD LYME, PORTLAND AND WESTBROOK ARE CONSIDERED RURAL (ACS, 20192023). CLINTON, COLCHESTER, CROMWELL, EAST HAMPTON, ESSEX (DUE TO DENSITY) AND OLD SAYBROOK ARE DEFINED AS SUBURBAN, AND MIDDLETOWN IS CLASSIFIED AS URBAN PERIPHERY (LEVY, ET AL., 2015), WHICH IS CHARACTERIZED AS A BLEND OF URBAN AND SUBURBAN ELEMENTS.FOR THE AGE DISTRIBUTIONS, MIDDLESEX COUNTY IS LOWER THAN THE STATE AVERAGE IN THE 0-19 AND 20-44 AGE GROUPS AND EXCEEDS THE STATE AVERAGE IN THE 45-64 AND 65+ AGE GROUPS. MIDDLETOWN IS LOWER THAN THE STATE AVERAGE IN THE 0-19 AGE GROUP, IS SIGNIFICANTLY HIGHER THAN THE STATE AVERAGE IN THE 20-44 AGE GROUP AND LOWER THAN THE STATE AVERAGE IN THE 45-64 AND 65+ AGE GROUPS. WHEN EXTRACTING AGE 65+, MIDDLESEX COUNTY (22%) EXCEEDS CONNECTICUT (19%), AND THE MAJORITY OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA CONTINUE TO HAVE A GREATER CONCENTRATION OF OLDER ADULTS WHEN COMPARED TO CONNECTICUT. THE TOWNS OF COLCHESTER, MARLBOROUGH, MIDDLETOWN, PORTLAND, AND EAST HAMPTON FALL BELOW THE AGE 65+ STATE AVERAGE OF 19%. DURHAM AND HADDAM ARE ON PAR WITH THE AGE 65+ STATE AVERAGE, WHILE DEEP RIVER, CROMWELL, CLINTON, KILLINGWORTH, MIDDLEFIELD, EAST HADDAM, AND OLD LYME EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 20%-24% AND LYME, CHESTER, ESSEX, OLD SAYBROOK, AND WESTBROOK CONSIDERABLY EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 26%-32% (MIDDLETOWN AND CONNECTICUT: U.S. CENSUS AMERICAN COMMUNITY SURVEY 2023 5-YEAR ESTIMATES. OTHER TOWNS AND MIDDLESEX COUNTY: U.S. CENSUS AMERICAN COMMUNITY SURVEY 2021 5-YEAR ESTIMATES). MIDDLETOWN HAS A MORE DIVERSE RACIAL / ETHNIC DEMOGRAPHIC RELATIVE TO THE OTHER TOWNS IN MIDDLESEX COUNTY AND RESEMBLES CONNECTICUT EXCEPT IN THE LATINO CATEGORY, WHERE MIDDLETOWN HAS A SMALLER POPULATION. MIDDLESEX COUNTY'S RACE AND LATINO ORIGIN COMPOSITION IS 82% WHITE; 5% BLACK; 7% LATINO; AND 3% OTHER. MIDDLETOWN'S RACE AND LATINO ORIGIN COMPOSITION IS 66% WHITE; 13% BLACK; 11% LATINO; AND 10% OTHER (MIDDLETOWN AND CONNECTICUT: DATAHAVEN CONNECTICUT TOWN DATA VIEWER, AMERICAN COMMUNITY SURVEY 2022, ACCESSED 7.18.2025. MIDDLESEX COUNTY: CT DATA COLLABORATIVE, U.S. CENSUS AMERICAN COMMUNITY SURVEY 2021 5-YEAR ESTIMATES). THE MEDIAN HOUSEHOLD INCOME PER TOWN IN MIDDLESEX HEALTH'S SERVICE AREA RANGES FROM RANGING FROM $64,695 IN WESTBROOK TO $133,652 IN DURHAM COMPARED TO $91,665 IN CONNECTICUT AND TOWNS EXCEPT DEEP RIVER, ESSEX, MIDDLETOWN, MIDDLEFIELD AND WESTBROOK EXCEED CONNECTICUT'S MEDIAN INCOME OF $91,665 (MIDDLETOWN, OLD LYME AND CONNECTICUT: U.S. CENSUS AMERICAN COMMUNITY SURVEY 2023 5-YEAR ESTIMATES; OTHER TOWNS AND MIDDLESEX COUNTY: U.S. CENSUS AMERICAN COMMUNITY SURVEY 2021 5-YEAR ESTIMATES). THERE ARE SIGNIFICANT MEDIAN HOUSEHOLD INCOME DISPARITIES WHEN DATA POINTS ARE DISAGGREGATED BY RACE AND ETHNICITY. IN MIDDLETOWN, WHITE HOUSEHOLDS EARN 1.7 TIMES MORE THAN BLACK HOUSEHOLDS AND 1.4 TIMES MORE THAN LATINO HOUSEHOLDS. IN MIDDLESEX COUNTY, WHITE HOUSEHOLDS EARN 1.8 TIMES MORE THAN BLACK HOUSEHOLDS AND 1.5 TIMES MORE THAN LATINO HOUSEHOLDS. WHILE THE GAP IS NARROWER, WHITE HOUSEHOLDS EARN 1.1 TIMES MORE (MIDDLETOWN) AND 1.4 TIMES MORE (MIDDLESEX COUNTY) THAN ASIAN HOUSEHOLDS (CT DATA COLLABORATIVE. MIDDLETOWN AND CONNECTICUT: AMERICAN COMMUNITY SURVEY 2023 5-YEAR ESTIMATES; MIDDLESEX COUNTY: AMERICAN COMMUNITY SURVEY 2021 5-YEAR ESTIMATES). FOR POVERTY STATUS, MIDDLETOWN (12%) HAS A SIGNIFICANTLY HIGHER POVERTY RATE WHEN COMPARED TO MOST OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA AND EXCEEDS THE POVERTY RATE FOR CONNECTICUT (10%) (DATAHAVEN CONNECTICUT TOWN DATA VIEWER, AMERICAN COMMUNITY SURVEY 2022, ALL TOWNS AND CONNECTICUT; U.S. CENSUS, 2021 AMERICAN COMMUNITY SURVEY 1-YEAR ESTIMATES, MIDDLESEX COUNTY). THE UNDER 18 POVERTY RATE FOR MIDDLETOWN AT 15% EXCEEDS MIDDLESEX COUNTY AT 7% AND THE STATE OF CONNECTICUT AT 13%. THE AGE 65+ POVERTY RATE FOR MIDDLETOWN AT 10% EXCEEDS MIDDLESEX COUNTY AT 4% AND THE STATE OF CONNECTICUT AT 8% (MIDDLETOWN AND CONNECTICUT: DATAHAVEN CONNECTICUT TOWN DATA VIEWER, AMERICAN COMMUNITY SURVEY 2022; MIDDLESEX COUNTY: U.S. CENSUS AMERICAN COMMUNITY SURVEY 2021 1-YEAR ESTIMATES). POVERTY RATES ARE SIGNIFICANTLY MORE PRONOUNCED AMONG BLACK AND LATINO POPULATIONS IN MIDDLETOWN AND MIDDLESEX COUNTY WHEN COMPARED TO WHITE POPULATIONS. BLACK RESIDENTS ARE 1.9 TIMES MORE LIKELY (MIDDLETOWN) AND 3 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE RESIDENTS. LATINO RESIDENTS ARE 2.6 TIMES MORE LIKELY (MIDDLETOWN) AND 2.8 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE RESIDENTS (CT DATA COLLABORATIVE. MIDDLETOWN AND CONNECTICUT: AMERICAN COMMUNITY SURVEY 2023 5-YEAR ESTIMATES; MIDDLESEX COUNTY: AMERICAN COMMUNITY SURVEY 2021 5-YEAR ESTIMATES).COST-BURDEN HOUSEHOLDS ARE THOSE THAT SPEND AT LEAST 30% OF THEIR ANNUAL HOUSEHOLD INCOME ON HOUSING COSTS. IN MIDDLESEX HEALTH'S SERVICE AREA, RENTERS ARE DISPROPORTIONATELY IMPACTED BY HOUSING COST-BURDEN. BETWEEN 18% - 39% OF HOMEOWNERS IN THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA EXPERIENCE A HOUSING COST BURDEN COMPARED TO 19% - 74% OF RENTERS IN THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA (EXCLUDING KILLINGWORTH) WHO EXPERIENCE A HOUSING COST BURDEN (CT DATA COLLABORATIVE. ALL TOWNS AND CONNECTICUT: AMERICAN COMMUNITY SURVEY 2023 5-YEAR ESTIMATES; MIDDLESEX COUNTY: AMERICAN COMMUNITY SURVEY 2021 5-YEAR ESTIMATES).FOR HEALTH INSURANCE STATUS, ADULTS AGES 18 - 64, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (8%) (ALL TOWNS AND CONNECTICUT: DATAHAVEN CONNECTICUT TOWN DATA VIEWER, AMERICAN COMMUNITY SURVEY 2022, ACCESSED 7.18.2025. MIDDLESEX COUNTY: U.S. CENSUS AMERICAN COMMUNITY SURVEY 2021 1-YEAR ESTIMATES, AGE 19 64). FOR PERCENT OF POPULATION ENROLLED IN MEDICAID, MIDDLETOWN AT 36% EXCEEDS THE AVERAGE OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA (23%) AND CONNECTICUT (32%) (DEPARTMENT OF SOCIAL SERVICES, 2023). IN 2025, THE PERCENT OF HOSPITAL DISCHARGES FOR MEDICAID//UNINSURED COMBINED WERE: 17% INPATIENT; 14% OUTPATIENT; 26% EMERGENCY DEPARTMENT NON-ADMISSION; AND, FOR THE FOLLOWING SERVICES: 37% MATERNITY; 40% NEWBORN; 47% INPATIENT PSYCHIATRY; 10% AMBULATORY SURGERY AND 14% OTHER OUTPATIENT SERVICES. PART VI, LINE 5: AS MIDDLESEX HOSPITAL IS A COMMUNITY HOSPITAL, INVOLVING COMMUNITY MEMBERS IN KEY FUNCTIONS HAS ALWAYS BEEN A PRIORITY. MIDDLESEX HOSPITAL'S BOARD IS COMPRISED MAINLY OF COMMUNITY MEMBERS WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS NOR CONTRACTORS OF THE ORGANIZATION, BUT ARE LONG-TERM RESIDENTS WHOSE PRIMARY INTEREST IS THE HEALTH AND WELL-BEING OF THE COMMUNITY AT LARGE. MIDDLESEX HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY BASED ON THE HOSPITAL'S CURRENT AND PROJECTED PATIENT CARE, TEACHING AND RESEARCH NEEDS, AND OVERALL COMMUNITY NEED. MEDICAL STAFF INPUT AND PARTICIPATION IS HIGHLY VALUED BY THE HOSPITAL AS EVIDENCED BY INCLUSION IN THE HOSPITAL'S MEDICAL EXECUTIVE COMMITTEE, THE MEDICAL STAFF COUNCIL AND COUNTLESS OTHER WORKING COMMITTEES. MIDDLESEX HOSPITAL HAS A FORMAL PROCESS FOR ALLOCATION OF SURPLUS FUNDS; A MULTIDISCIPLINARY CAPITAL BUDGETING COMMITTEE MEETS AND SETS PRIORITIES FOR INVESTMENTS IN PATIENT CARE, EDUCATION AND RESEARCH, AND PHYSICAL STRUCTURE. THE APPROACH TAKES INTO CONSIDERATION PATIENT, COMMUNITY AND STAFF NEEDS. EACH YEAR THE HOSPITAL ALLOCATES A PORTION OF SURPLUS FUNDING TO A WIDE ARRAY OF COMMUNITY BENEFIT PROGRAMS AND SERVICE LINES, INCLUDING SUBSTANTIAL HEALTH AND WELLNESS ACTIVITIES AND INITIATIVES, SUBSIDIZED SERVICES, MEDICAL EDUCATION, RESEARCH AND HEALTH ASSESSMENT COSTS. CONTINUOUS DEDICATION TO THE COMMUNITIES IT SERVES REMAINS THE HALLMARK OF MIDDLESEX HOSPITAL'S VISION, MISSION, AND STRATEGIC PLANNING. AMBITIOUS COMMUNITY BENEFIT GOALS, THE INCORPORATION OF COMMUNITY BENEFIT INTO ANNUAL ORGANIZATIONAL PLANNING, AND THE PROVISION OF COMMUNITY BENEFIT PROGRAMS THAT TARGET THE COMMUNITY'S MOST VULNERABLE AND AT-RISK POPULATIONS HAS ALLOWED THE HOSPITAL TO PUT A FORMAL STRUCTURE AROUND ITS FUNDAMENTAL PURPOSE. THE HOSPITAL'S COMMUNITY BENEFIT TOTAL FOR FY25 WAS $99,872,973 (EXCLUDING COMMUNITY BUILDING) WITH 86,534 SERVED (EXCLUDING COMMUNITY BUILDING). THE FOLLOWING IS AN OVERVIEW OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM: COMMUNITY HEALTH IMPROVEMENT SERVICES: THE HOSPITAL UNDERWRITES A VAST RANGE OF COMMUNITY HEALTH EDUCATION AND HEALTH IMPROVEMENT PROGRAMS, NONE OF WHICH ARE DEVELOPED FOR MARKETING PURPOSES, ALL OF WHICH ARE SUPPORTED AS A MEANS OF FULFILLING THE HOSPITAL'S MISSION TO SERVE ITS COMMUNITY. 100% OF THE TIME THESE SERVICES ARE OFFERED FREE OF CHARGE (IN THE RARE INSTANCE WHERE A NOMINAL FEE IS ASSESSED THE COST OF PROVIDING THE SERVICE IS NOT COVERED). COMMUNITY HEALTH EDUCATION IS PROVIDED TO THE COMMUNITY AT LARGE. SOME OF THE PROGRAMS REPRESENT ONE TIME EVENTS, HOWEVER MOST ARE ONGOING AND OVER THE YEARS HAVE BECOME ENTRENCHED IN THE COMMUNITY AS A SOURCE OF SUPPORT AND CONTINUED EDUCATION FOR A HEALTHFUL FUTURE. EXAMPLES OF COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE (BUT ARE NOT LIMITED TO): 1) HEALTH EDUCATION (COMMUNITY EDUCATION PRESENTATIONS; HEALTH AND WELLNESS EVENTS/HEALTH FAIRS; SUPPORT GROUPS; LARGE SCALE CANCER AWARENESS AND EDUCATIONAL EVENTS; AND THE AVAILABILITY OF HEALTH LITERATURE); 2) COMMUNITY-BASED CLINICAL SERVICES (CLINICS AND SCREENINGS; ANNUAL FLU SHOTS; BLOOD PRESSURE CLINICS); AND 3) HEALTHCARE SUPPORT SERVICES OFFERED TO INCREASE ACCESS AND QUALITY OF CARE TO INDIVIDUALS, ESPECIALLY THOSE LIVING IN POVERTY AND / OR OTHER VULNERABLE POPULATIONS. IN FY25, THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT SERVICES SERVED 19,414 INDIVIDUALS AT A TOTAL COST OF $18,744,777 TO THE HOSPITAL. HEALTH PROFESSIONS EDUCATION: HELPING TO PREPARE FUTURE HEALTH CARE PROFESSIONALS IS A LONG-STANDING COMMITMENT OF MIDDLESEX HOSPITAL AND DISTINGUISHING CHARACTERISTIC THAT CONSTITUTES A SIGNIFICANT COMMUNITY BENEFIT. THE HOSPITAL'S FAMILY MEDICINE RESIDENCY PROGRAM GRADUATES FAMILY PRACTICE PHYSICIANS, MANY OF WHOM CONTINUE TO PRACTICE IN THE MIDDLESEX COUNTY AREA AFTER THEIR TRAINING IS COMPLETE. THIS IS ESPECIALLY IMPORTANT GIVEN THAT MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA (MUA) EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDES TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS THAT MIDDLESEX COUNTY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY MEDICAL CARE. THE HOSPITAL ALSO WELCOMES MEDICAL AND NURSING STUDENT INTERNS AND PROVIDES ON-SITE TRAINING DURING CLINICAL ROTATIONS. NURSING STUDENTS FROM LOCAL COLLEGES AND PROGRAMS RECEIVE HANDS-ON MENTORSHIP IN THE MAJORITY OF CLINICAL SERVICE LINES YEAR-ROUND. OTHER HEALTHCARE PROFESSIONAL EDUCATION INCLUDES THE HOSPITAL'S RADIOLOGY SCHOOL (WHICH OPERATES AT A LOSS FOR THE HOSPITAL) AND CLINICAL/NON-CLINICAL EDUCATIONAL STUDENT TRAINING IN MULTIPLE FIELDS. IN FY25, THE HOSPITAL'S HEALTH PROFESSIONS EDUCATION CATEGORY SERVED 808 INDIVIDUALS AT A TOTAL COST OF $12,025,471 TO THE HOSPITAL. SUBSIDIZED HEALTH SERVICES: THE HOSPITAL'S SUBSIDIZED HEALTH SERVICES REPRESENT A SIGNIFICANT PORTION OF MIDDLESEX HOSPITAL'S ANNUAL COMMUNITY BENEFIT AGGREGATE FINANCIALS AND NUMBERS SERVED. SUBSIDIZED SERVICES ARE PARTICULAR CLINICAL PROGRAMS PROVIDED TO THE COMMUNITY DESPITE A FINANCIAL LOSS, WITH NEGATIVE MARGINS REMAINING AFTER SPECIFIC DOLLARS (FINANCIAL ASSISTANCE AND BAD DEBT) AND SHORTFALLS (MEDICAID) ARE REMOVED. IN ORDER TO QUALIFY AS A SUBSIDIZED SERVICE, THE PROGRAM MUST MEET CERTAIN HEALTH DELIVERY CRITERIA; MEET AN IDENTIFIED NEED IN THE COMMUNITY; AND WOULD BECOME UNAVAILABLE OR THE RESPONSIBILITY OF A GOVERNMENTAL OR ANOTHER NOT-FOR-PROFIT AGENCY TO PROVIDE IF THE HOSPITAL DISCONTINUED THE SERVICE. MIDDLESEX HOSPITAL'S SUBSIDIZED SERVICES INCLUDE: 1) AMBULATORY INFUSION; 2) BEHAVIORAL HEALTH (INPATIENT); 3) BEHAVIORAL HEALTH (OUTPATIENT); 4) CENTER FOR CHRONIC CARE MANAGEMENT DISEASE MANAGEMENT OUTPATIENT PROGRAMS (ADULT ASTHMA; CHILD ASTHMA; DIABETES EDUCATION AND DISEASE MANAGEMENT; MEDICAL NUTRITION THERAPY; SMOKING CESSATION; CHRONIC HEART FAILURE; AND CHILDHOOD WEIGHT MANAGEMENT); 5) FAMILY PRACTICE SERVICES; 6) HOMECARE; 7) MIDDLESEX MEDICAL GROUP (WHICH INCLUDES MIDDLESEX HOSPITAL CASH SUBSIDIES FOR THE MMG PHYSICIAN SPECIALTY OUTPATIENT CLINICS FOR PRIMARY CARE, URGENT CARE, CRESCENT STREET OB, UROLOGY AND PALLIATIVE CARE WHICH ARE SERVICES THAT WOULD BE UNAVAILABLE IN THE COMMUNITY IF MIDDLESEX HEALTH DID NOT OFFER THEM, THE COMMUNITY'S CAPACITY TO PROVIDE THE SERVICES WOULD BE BELOW THE COMMUNITY'S NEED, AND THE SERVICES WOULD BECOME THE RESPONSIBILITY OF GOVERNMENT OR ANOTHER TAX-EXEMPT ORGANIZATION IF MIDDLESEX HEALTH DID NOT OFFER THEM); 8) MULTISPECIALTY GROUP (WHICH INCLUDES PHYSICIAN SPECIALTY OUTPATIENT CLINICS FOR ENDOCRINE / GENDER MEDICINE; RHEUMATOLOGY; INFECTIOUS DISEASE; PULMONOLOGY; NEUROLOGY, WHICH ARE SERVICES THAT WOULD BE UNAVAILABLE IN THE COMMUNITY IF MIDDLESEX HEALTH DID NOT OFFER THEM, THE COMMUNITY'S CAPACITY TO PROVIDE THE SERVICES WOULD BE BELOW THE COMMUNITY'S NEED, AND THE SERVICES WOULD BECOME THE RESPONSIBILITY OF GOVERNMENT OR ANOTHER TAX-EXEMPT ORGANIZATION IF MIDDLESEX HEALTH DID NOT OFFER THEM); 9) PARAMEDICS; 10) WIC (SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN); AND 10) WOUND CARE. IN FY25 THE HOSPITAL'S SUBSIDIZED SERVICES SERVED 39,766 PEOPLE WITH A TOTAL COST OF $37,115,156 TO THE HOSPITAL. RESEARCH: MIDDLESEX HOSPITAL CONDUCTS RESEARCH IN THE DOMAINS OF CLINICAL AND COMMUNITY HEALTH. CLINICAL EXAMPLES INCLUDE NATIONAL TRIALS BY THE HOSPITAL'S CANCER CENTER. FOR FY25, THE HOSPITAL'S ASSOCIATED COSTS FOR ALL (NON-INDUSTRY) RESEARCH PROJECTS TOTALED $247,076 AND SERVED 59 INDIVIDUALS. FINANCIAL AND IN-KIND CONTRIBUTIONS: MIDDLESEX HOSPITAL SUPPORTS THE COMMUNITY IN THE FORM OF FINANCIAL AND IN-KIND CONTRIBUTIONS. EACH YEAR THE HOSPITAL MAKES SUBSTANTIAL CASH DONATIONS TO CAREFULLY SELECTED MISSION-DRIVEN COMMUNITY ORGANIZATIONS THROUGHOUT ITS SERVICE AREA. THE HOSPITAL'S FY25 SUPPORT FOR FINANCIAL AND IN-KIND CONTRIBUTIONS TOTALED $304,810, SERVING 3,873 INDIVIDUALS. COMMUNITY BENEFIT OPERATIONS: COMMUNITY BENEFIT OPERATIONS INCLUDE ACTIVITIES AND COSTS ASSOCIATED WITH COMMUNITY BENEFIT STRATEGIC PLANNING, ADMINISTRATION, ANNUAL GOAL ATTAINMENT, AND COMMUNITY HEALTH NEEDS ASSESSMENT (AND CHNA IMPLEMENTATION STRATEGY) PRODUCTION AND IMPLEMENTATION. MIDDLESEX HOSPITAL HAS A DEDICATED DIRECTOR OF COMMUNITY HEALTH IMPROVEMENT WHO OVERSEES THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM AND A REPORTING STRUCTURE THAT OVERSEES COMMUNITY BENEFIT PLANNING AND OPERATIONS. OUTSIDE OF ON-GOING COMMUNITY BENEFIT ACTIVITIES, KEY COMPONENTS OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM IS CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOPING A CHNA IMPLEMENTATION STRATEGY EVERY THREE TAXABLE YEARS, ENSURING THAT THE CHNA IMPLEMENTATION STRATEGY GOALS ARE ADDRESSED THROUGH COLLABORATION WITH COMMUNITY PARTNERS, AND FOCUSING ON HEALTH EQUITY AND HEALTH-RELATED SOCIAL NEEDS. THE HOSPITAL'S FY25 COMMUNITY BENEFIT OPERATIONS EXPENSE TOTALED $257,306. PART VI, LINE 6: THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. MIDDLESEX HEALTH IS A FULLY COMPREHENSIVE NETWORK OF EXPERT HEALTH CARE PROVIDERS THAT HAS CONVENIENT LOCATIONS THROUGHOUT CENTRAL CONNECTICUT AND THE SHORELINE. MEMBERS OF THE COMMUNITY ARE ALWAYS CLOSE TO CARE FOR EVERY FAMILY MEMBER AT EVERY AGE. MIDDLESEX HEALTH PROVIDES THE BEST CARE POSSIBLE FOR JUST ABOUT ALL ITS COMMUNITY MEMBERS' HEALTH AND WELLNESS NEEDS. THE ORGANIZATIONS INCLUDED IN THE AFFILIATED HEALTH CARE SYSTEM ARE AS FOLLOWS: MIDDLESEX HOSPITAL - A NON-PROFIT, ACUTE CARE, COMMUNITY HOSPITAL IN MIDDLETOWN, CT MIDDLESEX HEALTH SERVICES - PROVIDING INTEGRATIVE MEDICINE SERVICES TO THE COMMUNITY. MHS PRIMARY CARE - PROVIDES PATIENT-CENTERED, COMPASSIONATE CARE TO ALL MEMBERS OF THE COMMUNITY. MIDDLESEX HOSPITAL FOUNDATION - SUPPORTS MIDDLESEX HOSPITAL. MIDDLESEX HEALTH SYSTEM - PARENT OF AND PROVIDES FUNDRAISING SERVICES FOR MIDDLESEX HOSPITAL. PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT: CONNECTICUT GENERAL STATUTES 19A-127K REQUIRES THAT ON OR AFTER JANUARY 1, 2023, EACH HOSPITAL IN CONNECTICUT SUBMIT ANNUAL COMMUNITY BENEFIT PROGRAM REPORTING TO THE CONNECTICUT OFFICE OF HEALTH STRATEGY. AS MIDDLESEX HOSPITAL MEETS THE STATUTE AS HAVING A COMMUNITY BENEFIT PROGRAM IN PLACE, IT REPORTS ANNUALLY TO THE STATE OF CONNECTICUT'S OFFICE OF HEALTH STRATEGY. 1 MIDDLESEX CHAMBER OF COMMERCE 393 MAIN STREET MIDDLETOWN CT 06457 060452410 501(C)(6) 74000 0 GENERAL SUPPORT COMMUNITY FOUNDATION OF MIDDLESEX COUNTY 211 SOUTH MAIN STREET MIDDLETOWN CT 06457 061477711 501(C)(3) 10500 0 2025 BECKY THATCHER RIVER CRUISE SUPPORT VARSITY COMMUNICATIONS INC 5720 204TH ST SUITE 100 LYNNWOOD WA 98036 911430177 17000 0 2025 CT GOLF SHOW SPONSORSHIP CONNECTICUT STATE GOLF ASSOCIATION 35 COLD SPRING ROAD SUITE 212 ROCKY HILL CT 06067 222587856 501(C)(3) 35000 0 CSGA SPONSORSHIP ST VINCENT DEPAUL FOUNDATION 617 MAIN STREET MIDDLETOWN CT 06457 061387081 501(C)(3) 7837 0 GENERAL SUPPORT 3 2 PART I, LINE 2: THE PUBLIC RELATIONS DEPARTMENT HAS A POLICY REGARDING WHICH ORGANIZATIONS THEY ARE WILLING TO PARTNER WITH AND GIVE GRANTS OR ASSISTANCE. THEN ONCE THE GRANT OR ASSISTANCE IS AWARDED THE PUBLIC RELATIONS DEPARTMENT WORKS CLOSELY WITH EACH OF THE ORGANIZATIONS TO ENSURE THAT THE GRANT OR ASSISTANCE IS USED FOR THE INTENDED PURPOSES. THIS IS DONE BY CONTACT AND ATTENDANCE AT THE SPONSORED EVENTS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 VINCENT CAPECE JR PRESIDENT/CEO 912188 0 200000 0 264850 0 300820 0 37074 0 1714932 0 237124 0 DAVID COSENTINO VP QUALITY & PATIENT SAFETY 483969 0 71000 0 41929 0 76850 0 39226 0 712974 0 37468 0 SUSAN MARTIN VP FINANCE/TREASURER 519272 0 76000 0 63396 0 22220 0 30231 0 711119 0 52703 0 EVAN JACKSON VP & CIO 414649 0 62000 0 43945 0 66600 0 40303 0 627497 0 38657 0 JONATHAN BANKOFF CHAIRMAN EMERGENCY MEDICINE 495531 0 45515 0 570 0 24150 0 37832 0 603598 0 0 0 THEODORE HARTENSTEIN MED DIRECTOR, UTILIZATION MGMT 504457 0 28000 0 450 0 20700 0 40882 0 594489 0 0 0 RICARDO PEREZ PULMONOLOGIST 393489 0 115545 0 270 0 17250 0 37832 0 564386 0 0 0 KELLY HAECKEL VP PATIENT CARE SVCS/CNO 324623 0 108500 0 29936 0 55485 0 36997 0 555541 0 27807 0 DONNA STRONESKI VP HUMAN RESOURCES 346066 0 91000 0 36046 0 62500 0 11981 0 547593 0 29978 0 DAVID GIUFFRIDA VP FACILITIES & SUPPORT SVCS 378874 0 55500 0 44292 0 22103 0 16946 0 517715 0 38150 0 JEFFREY SHELTON CHAIRMAN DEPT PSYCH 431722 0 30500 0 690 0 24150 0 27219 0 514281 0 0 0 TODD BISCHOP CHIEF DEPT OF MED 415854 0 50795 0 450 0 24150 0 2192 0 493441 0 0 0 ALINA FILOZOV PHYSICIAN, INFECTIOUS DISEASE 253060 0 214546 0 450 0 17973 0 6138 0 492167 0 0 0 JUSTIN DREW VP AMBULATORY & CLINICAL SVCS 284045 0 73500 0 3026 0 48816 0 9963 0 419350 0 0 0 LELAND MCKENNA VP PLANNING & EXTERNAL AFF 288043 0 73500 0 2350 0 47006 0 5965 0 416864 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES - REPRESENTS A CORPORATE MEMBERSHIP AT A GOLF CLUB USED FOR VARIOUS BUSINESS PURPOSES. THE ASSOCIATED COST IS INCLUDED IN THE TAXABLE COMPENSATION OF THE EXECUTIVE STAFF MEMBER ACCORDING TO IRS RULES AND REGULATIONS. THIS BENEFIT WAS PROVIDED TO THE FOLLOWING INDIVIDUAL: VINCENT CAPECE PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED COMPENSATION FROM A SERP, WHICH WAS INCLUDED IN PART II, COLUMN B(III) AND COLUMN F: VINCENT CAPECE = $237,124 SUSAN MARTIN = $52,703 DAVID COSENTINO = $37,468 EVAN JACKSON = $38,657 DAVID GIUFFRIDA = $38,150 DONNA STRONESKI = $29,978 KELLY HAECKEL = $27,807 SERP CONTRIBUTIONS WERE MADE FOR THE FOLLOWING INDIVIDUALS AND ARE INCLUDED IN PART II, COLUMN C: VINCENT CAPECE = $276,120 DAVID CONSENTINO = $49,250 EVAN JACKSON = $42,450 DONNA STRONESKI = $34,900 KELLY HAECKEL = $33,150 LELAND MCKENNA = $29,400 JUSTIN DREW = $29,400 PART II, COLUMN (B)(II) - BONUS & INCENTIVE COMPENSATION: THE AMOUNTS REPRESENT INCENTIVE COMPENSATION PAYMENTS MADE IN CALENDAR YEAR 2024. PAYMENTS INCLUDE AMOUNTS EARNED IN 2023 AND DEFERRED, WHERE APPLICABLE. A CHEFA - SERIES O 060806186 20774YWD5 2015-05-19 19491965 REFINANCE L BONDS 0 0 0 B CHEFA - SERIES P 060806186 2016-06-10 9683000 REFINANCE M BONDS 0 0 0 C CHEFA - SERIES Q 060806186 2017-11-21 11599000 REFINANCE N BONDS 0 0 0 A 6855000 19491965 388960 19103010 2015 0 1 1 1 B 8081301 10347540 193660 10153880 2016 0 1 1 1 C 7861646 11599000 231980 11367020 2021 0 1 1 1 A 0 0 1 1 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CHEFA - SERIES O DATE THE REBATE COMPUTATION WAS PERFORMED: 05/19/2025 ISSUER NAME: CHEFA - SERIES P DATE THE REBATE COMPUTATION WAS PERFORMED: 06/10/2021 ISSUER NAME: CHEFA - SERIES Q DATE THE REBATE COMPUTATION WAS PERFORMED: 11/21/2022 SCHEDULE K, PART II, LINE 3: SERIES P BONDS (COLUMN B) AND SERIES Q BONDS (COLUMN C) - THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE TOTAL PROCEEDS IS INVESTMENT EARNINGS. SCHEDULE K, PART II, LINE 11: THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES O BONDS (COLUMN A) WAS USED TO REFUND THE CHEFA SERIES L BONDS DATED DECEMBER 7, 2006. THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES P BONDS (COLUMN B) WAS USED TO REFUND THE CHEFA SERIES M BONDS DATED DECEMBER 7, 2006. THE AMOUNT INCLUDED IN PART II, LINE 11, OTHER SPENT PROCEEDS FOR THE SERIES Q BONDS (COLUMN C) WAS USED TO PARTIALLY REFUND THE CHEFA SERIES N BONDS DATED JULY 26, 2011. IN ADDITION, $736 WAS A PREPAYMENT OF INTEREST. SCHEDULE K, PART III, LINE 3: SERIES O BONDS (COLUMN A) AND SERIES P BONDS (COLUMN B) - THE ORGANIZATION HAS DETERMINED THAT ALL MANAGEMENT/SERVICE CONTRACTS MEET THE SAFE HARBOR UNDER REV. PROC. 2017-13, 2017-6 I.R.B. 787. SCHEDULE K, PART III, LINE 3A: THE ORGANIZATION HAS REVIEWED ITS MANAGEMENT CONTRACTS AND DETERMINED THAT THEY COMPLY WITH THE APPLICABLE SAFE HARBOR PROVISIONS OF REVENUE PROCEDURE 2017-13, INCLUDING THE REQUIREMENTS OF SECTIONS 5.02 THROUGH 5.07. ACCORDINGLY, THE ORGANIZATION BELIEVES THESE ARRANGEMENTS DO NOT GIVE RISE TO PRIVATE BUSINESS USE. DAVID GIUFFRIDA KEY EMPLOYEE 728171 SEE PART V 0 JESSE WAGNER MD FORMER KEY EMPLOYEE 83738 SEE PART V 0 DAVID COSENTINO KEY EMPLOYEE 342366 SEE PART V 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 5173485 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 1265415 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 321351 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 4352051 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 224737 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 1302114 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 252579 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 366499 INDEPENDENT CONTRACTOR ARRANGEMENT 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF INTERESTED PERSON: DAVID GIUFFRIDA(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN INDEPENDENT CONTRACTOR ARRANGEMENT WITH GUIFFRIDA ELECTRIC, CO., WHICH IS MORE THAN 35% OWNED BY A FAMILY MEMBER OF DAVID GIUFFRIDA.(A) NAME OF INTERESTED PERSON: JESSE WAGNER, MD(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN EMPLOYMENT ARRANGEMENT WITH RUTH WAGNER, REGISTERED NURSE, WHO IS A FAMILY MEMBER OF JESSE WAGNER, MD.(A) NAME OF INTERESTED PERSON: DAVID COSENTINO(D) DESCRIPTION OF TRANSACTION: MIDDLESEX HOSPITAL HAS AN EMPLOYMENT ARRANGEMENT WITH MEGAN COSENTINO, WHO IS A FAMILY MEMBER OF DAVID COSENTINO. X 7 252550 FMV 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN B IS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: MIDDLESEX HOSPITAL IS AN ACUTE CARE GENERAL HOSPITAL SERVING THE RESIDENTS OF MIDDLESEX COUNTY AND VARIOUS SURROUNDING COMMUNITIES PROVIDING SELECTED HIGH-QUALITY INPATIENT AND OUTPATIENT HEALTH SERVICES. THE HOSPITAL MAINTAINS FORMAL RELATIONSHIPS WITH SPECIALIZED PROVIDERS TO ASSURE COORDINATION OF CARE WHEN SERVICES ARE NOT LOCALLY AVAILABLE. AN INTEGRAL PART OF THE CORE PROGRAMS, SPANNING THEIR TRADITIONAL DIAGNOSTIC AND TREATMENT SERVICES, ARE THE SCORES OF SPECIAL PROGRAMS OFFERED TO THE COMMUNITIES SERVED, MANY OF WHICH FOCUS ON THE DISADVANTAGED AND UNDERSERVED, THOSE SPECIAL POPULATIONS SUCH AS MINORITIES, OLDER PERSONS, PERSONS LIVING IN POVERTY WITH DISABILITIES, CHRONICALLY MENTALLY ILL PERSONS, AND OTHER DISENFRANCHISED PERSONS. MANY OTHER SPECIAL PROGRAMS WITH A FOCUS TO REACH OUT TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF ECONOMIC CONDITION OR SOCIAL STATUS RESPOND TO PUBLIC HEALTH NEEDS AND INVOLVE EDUCATION OR RESEARCH THAT IMPROVES OVERALL COMMUNITY HEALTH. ALL OF THESE SPECIAL PROGRAMS ARE OFFERED FREE OF CHARGE OR OFFERED AT A RATE THAT IS CONSIDERABLY LESS THAN THE COST OF PROVIDING THEM. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE HOSPITAL IS MIDDLESEX HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, MIDDLESEX HEALTH SYSTEM, INC. HAS THE RIGHT TO ANNUALLY ELECT THE BOARD OF DIRECTORS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, MIDDLESEX HEALTH SYSTEM, INC., HAS ALL RIGHTS CONFERRED BY LAW, THE CERTIFICATE OF INCORPORATION AND MIDDLESEX HOSPITAL BY-LAWS, BY VOTE OF ITS BOARD OF DIRECTORS, ITS PRESIDENT, OR BY OR THROUGH ANY OTHER PERSON(S) DESIGNATED BY ITS BOARD OF DIRECTORS IN ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF THE FORM 990 IS PROVIDED TO EACH BOARD MEMBER FOR THEIR REVIEW AND CHANGES FROM PRIOR YEAR ARE HIGHLIGHTED. ANY QUESTIONS OR COMMENTS THEY HAVE ARE PRESENTED TO EXECUTIVE MANAGEMENT. A COMPLETE COPY OF THE FINAL FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST FORMS ARE DISTRIBUTED ANNUALLY TO KEY EMPLOYEES, OFFICERS, AND THE BOARD OF DIRECTORS. RESPONSES ARE RETURNED TO, TRACKED, AND REVIEWED BY THE SYSTEM COMPLIANCE OFFICER. MATERIAL CONFLICTS ARE REPORTED TO THE AUDIT COMMITTEE FOR REVIEW AND DETERMINATION. IN ADDITION TO COMPLETING THE ANNUAL CONFLICT OF INTEREST FORM, BOARD MEMBERS MUST IMMEDIATELY DISCLOSE ANY INTEREST AND ALL MATERIAL FACTS TO THE BOARD OF DIRECTORS, AS THEY OCCUR. THE BOARD THEN REVIEWS THE FACTS AND MAKES THE DETERMINATION AS TO WHETHER A SIGNIFICANT CONFLICT OF INTEREST EXISTS. IF SO, THE BOARD FOLLOWS DISABLING GUIDELINES TO DETERMINE IF THE BOARD MEMBER SHOULD BE ASKED TO RESIGN OR BE REMOVED. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE TEAM COMPENSATION IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. THE COMMITTEE HAS A CHARTER AND A POLICY STATEMENT SETTING FORTH A PROCESS AND CERTAIN GUIDELINES FOR DETERMINING COMPENSATION. EXECUTIVES RECEIVE A BASE SALARY AND HAVE THE OPPORTUNITY FOR INCENTIVE COMPENSATION WITHIN A RANGE SET BY THE POLICY. FOLLOWING THE CLOSE OF EACH FISCAL YEAR, THE COMMITTEE RECEIVES A MARKET ANALYSIS FROM INDEPENDENT CONSULTANTS REGARDING COMPENSATION AT PEER GROUPS OF COMPARABLE HOSPITALS AND HEALTH SYSTEMS. POSITIONS WITHIN THE THE EXECUTIVE TEAM ARE COMPARED TO BENCHMARK POSITIONS WITHIN THIS MARKET DATA AND THEIR COMPENSATION IS COMPARED TO THE DATA BOTH WITH RESPECT TO CASH COMPENSATION AND TOTAL COMPENSATION INCLUDING FRINGE BENEFITS. THE CEO RECOMMENDS THE INCENTIVE AWARDS AND BASE SALARY ADJUSTMENTS TO THE COMPENSATION OF THE EXECUTIVES WHO REPORT TO HIM, AND THE COMMITTEE REVIEWS THOSE RECOMMENDATIONS, APPROVES OR MODIFIES THEM, AND ALSO DETERMINES ANY INCENTIVE AWARD AND BASE SALARY ADJUSTMENT FOR THE CEO. THE CONSULTANTS PROVIDE A WRITTEN OPINION ANNUALLY CONFIRMING THAT THE COMPENSATION OF THE EXECUTIVES, AS ADJUSTED BY THIS PROCESS, IS "REASONABLE" WITHIN APPLICABLE IRS GUIDELINES. KEY EMPLOYEE COMPENSATION IS SET FOLLOWING THE GUIDELINES SET FORTH IN THE HOSPITAL COMPENSATION POLICY. THE OBJECTIVE OF THIS POLICY IS TO PAY EMPLOYEES BASED UPON HOSPITAL NEED, THE PROPER EXTERNAL LABOR MARKET AND PERFORMANCE. THE LAST COMPENSATION REVIEW OCCURRED 12/2024. FORM 990, PART VI, SECTION C, LINE 19 MIDDLESEX HOSPITAL MAINTAINS A QUALITY AND COMPLIANCE SECTION ON ITS WEBSITE, MIDDLESEXHOSPITAL.ORG. THE HOSPITAL POSTS THE MOST CURRENT AUDITED FINANCIAL STATEMENTS AND FORM 990 WITH THOSE OF OTHER AFFILIATES AS THEY BECOME AVAILABLE, AS WELL AS STATEMENTS AND FORMS FROM AT LEAST TWO PREVIOUS FISCAL YEARS. THE HOSPITAL'S CONFLICT OF INTEREST POLICY IS ALSO POSTED ON THE WEBSITE IN THE VENDORS AND SUPPLIERS SECTION. IN ADDITION, THE ORGANIZATION'S FORM 990 IS AVAILABLE AT WWW.GUIDESTAR.ORG AND UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 38,613,596. MANAGEMENT AND GENERAL EXPENSES 10,995,176. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,608,772. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 6,743,404. MANAGEMENT AND GENERAL EXPENSES 87,293. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,830,697. CONSULTING FEES: PROGRAM SERVICE EXPENSES 658,418. MANAGEMENT AND GENERAL EXPENSES 659,782. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,318,200. OTHER SERVICES: PROGRAM SERVICE EXPENSES 48,678. MANAGEMENT AND GENERAL EXPENSES 716,098. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 764,776. FORM 990, PART XI, LINE 9: TRANSFER (TO) / FROM MIDDLESEX HEALTH SYSTEM, INC. -621,975. TRANSFER (TO) / FROM MHS PRIMARY CARE -22,143,846. TRANSFER (TO) / FROM SERVICES -8,627. CHANGE IN ASSETS HELD IN TRUST 242,287. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 3B: MIDDLESEX HOSPITAL DOES NOT HAVE A SEPARATE AUDIT PERFORMED UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. MIDDLESEX HOSPITAL IS INCLUDED IN THE A-133 AUDIT PERFORMED FOR MIDDLESEX HEALTH SYSTEM FOR PURPOSES OF THE A-133 AUDIT. THE RELEVANT ACTIVITIES AND EXPENDITURES OF MIDDLESEX HOSPITAL ARE REVIEWED AND THE RESULTS ARE INCLUDED IN THE SINGLE A-133 AUDIT REPORT FOR MIDDLESEX HEALTH SYSTEM. MIDDLESEX HEALTH SYSTEM INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676137 SUPPORT CT 501(C)(3) LINE 12B, II N/A 0 MIDDLESEX HEALTH SERVICES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 222676140 HEALTHCARE CT 501(C)(3) LINE 10 MIDDLESEX HEALTH SYSTEM INC 1 MIDDLESEX HOSPITAL FOUNDATION INC 28 CRESCENT STREET MIDDLETOWN CT 06457 273720822 SUPPORT CT 501(C)(3) LINE 12B, II MIDDLESEX HOSPITAL 1 MHS PRIMARY CARE INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061472743 HEALTHCARE CT 501(C)(3) LINE 10 MIDDLESEX HEALTH SYSTEM INC 1 MIDDLESEX HEALTH RESOURCES INC 28 CRESCENT STREET MIDDLETOWN CT 06457 061089925 RENTAL REAL ESTATE CT N/A C 0 INTEGRATED RESOURCES FOR THE MIDDLESEX AREA LLC 28 CRESCENT STREET MIDDLETOWN CT 06457 061462230 OUTPATIENT CARE CT N/A C 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1