4A (Expenses $ 99687932 including grants of $ 0) (Revenue $ 106572940)
DAY KIMBALL HEALTHCARE PROVIDES A COMPREHENSIVE HEALTHCARE SYSTEM OFFERING PRIMARY CARE AND A MULTITUDE OF MEDICAL AND SURGICAL SPECIALTIES ALONG WITH LEADING-EDGE TECHNOLOGY AND SOPHISTICATED DIAGNOSTICS. OUR SERVICE AREA INCLUDES NORTHEAST CONNECTICUT AS WELL AS NEARBY MASSACHUSETTS AND RHODE ISLAND COMMUNITIES. DAY KIMBALL HEALTHCARE'S COMPREHENSIVE NETWORK OFFERS MORE THAN 1,000 EMPLOYEES INCLUDING MORE THAN 200 HIGHLY SKILLED PHYSICIANS, SURGEONS AND SPECIALISTS.

4B (Expenses $ 10922918 including grants of $ 0) (Revenue $ 11677316)
PHYSICIAN OFFICE PROVIDING PRIMARY CARE AND OUTPATIENT VISITS TO NORTHEASTERN CONNECTICUT COMMUNITIES.

SCHEDULE H, PART V, LINE 5
COMMUNITY INPUT: DAY KIMBALL HOSPITAL CONDUCTED A COMPREHENSIVE NEEDS ASSESSMENT UTILIZING FOCUS GROUPS AND PHONE SURVEYS OF COUNTY RESIDENTS ALONG WITH STATE AND FEDERAL DATA TO IDENTIFY AND PRIORITIZE THE HEALTHCARE NEEDS IN WINDHAM COUNTY. A BROAD RANGE OF INFORMATION WAS COLLECTED FROM THE FOLLOWING SOURCES: - ANONYMOUS PAPER AND ELECTRONIC SURVEYS TO EMPLOYEES AND DKH CORPORATORS FOCUSING ON ACCESS, QUALITY, AND SERVICES NEEDED. - INTERVIEWS WITH MORE THAN 50 COMMUNITY LEADERS. - DAY KIMBALL HEALTHCARE BOARD OF DIRECTORS. - DATA REVIEW FROM MULTIPLE PUBLICLY REPORTED RESOURCES

SCHEDULE H, PART V, LINE 6A
CHNA CONDUCTED WITH OTHER HOSPITALS: DAY KIMBALL HOSPITAL CONDUCTED ITS NEEDS ASSESSMENT IN CONJUNCTION WITH THE WINDHAM COUNTY HEALTHCARE CONSORTIUM. THE MEMBERS OF THIS CONSORTIUM INCLUDE WINDHAM HOSPITAL, DAY KIMBALL HOSPITAL, NATCHAUG HOSPITAL, GENERATIONS FAMILY HEALTH CENTER, UNITED SERVICES, VNA EAST, NORTHEAST DISTRICT DEPARTMENT OF HEALTH AND COMMUNITY HEALTH RESOURCES (CHR).

SCHEDULE H, PART V, LINE 7A
CHNA AVAILABILITY: THE ORGANIZATION'S CHNA REPORT WAS MADE AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/ABOUT-DAY-KIMBALL-HEALTHCARE/IN-THE-COMMUNITY/C OMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 10A
IMPLEMENTATION STRATEGY AVAILABILITY: THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/ABOUT-DAY-KIMBALL-HEALTHCARE/IN-THE-COMMUNITY/C OMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 11
"ADDRESSING IDENTIFIED NEEDS: DAY KIMBALL LEADERS CONTINUE TO HAVE ACTIVE DISCUSSIONS WITH REGIONAL OFFICIALS, SCHOOL ADMINISTRATORS, AND OTHER MEMBERS OF THE COMMUNITY REGARDING OVERARCHING HEALTH CARE RELATED ISSUES ACROSS THE REGION. THROUGH THESE ONGOING DISCUSSIONS, DAY KIMBALL HAVE IDENTIFIED THOSE NEEDS, GOALS TO CLOSE THE GAPS, AND IMPLEMENTATION STRATEGY FOR DOING SO OVER THE NEXT SEVERAL YEARS. DAY KIMBALL HOSPITAL WILL CONTINUE TO WORK WITH COMMUNITY PARTNERS AND ADVOCATES TOWARDS ADDRESSING SOCIAL AND ECONOMIC FORCES THAT CONCURRENTLY IMPACT THE HEALTH AND WELFARE OF THOSE THEY SERVE. IDENTIFIED NEEDS THAT DAY KIMBALL HOSPITAL IS COMMITTED TO ADDRESSING INCLUDE: - MAINTAIN PARTNERSHIPS WITH STATE AND LOCAL AGENCIES TO ASSESS RISK, REDUCE TRANSMISSION AND PROMOTE PREVENTION OF COVID-19. *CONTINUE FOLLOWING EMERGING DATA, POLICIES, AND REGULATIONS. *EXPLORE ALTERNATE RECRUITING STRATEGIES TO ADDRESS DYNAMIC CHANGES IN WORKFORCE. - INCREASE AVAILABILITY OF TRANSPORTATION IN THE REGION. *INCREASE ADVOCACY FOR STATE AND FEDERAL SUPPORT OF IMPROVED TRANSPORTATION SYSTEMS. *PROVIDE ONGOING SUPPORT OF ENHANCED TRANSPORTATION SYSTEMS; I.E. RIDESHARES AND BUSSING SERVICES. *ONGOING EXPLORATION OF GRANT OPPORTUNITIES - ADDRESS NUTRITIONAL CONCERNS FOR HEMATOLOGY/ONCOLOGY PATIENTS. *ADDRESSING THE NEEDS OF CANCER PATIENTS WHO STRUGGLE WITH FOOD PROVISIONS. *PROVIDE SHELF-STABLE AND PERISHABLE FOOD TO DKH ONCOLOGY PATIENTS. *PROVIDE NUTRITION EDUCATION AND INTERVENTIONS. - REDUCE FALLS AND DECREASE UTILIZATION OF FALL RELATED SERVICES WITH THE COMMUNITY. *EXPAND FALL PREVENTION EFFORTS THROUGH THE ""CONTINUUM OF HEALTHCARE"" INCLUDING: DKH HOSPITAL, HOMEMAKERS, OUTPATIENT REHAB, AND BEYOND. *BOLSTER COMMUNITY PARTNERSHIPS TO PROVIDE EXPANDED PROGRAMS. - PROVIDE EDUCATION TO REDUCE MORBIDITY AND MORTALITY ASSOCIATED WITH STROKE. *EDUCATION ON STROKE INTERVENTION, DIAGNOSIS, TREATMENT, AND MANAGEMENT. *EDUCATION ON POST-STROKE CARE AND MANAGEMENT. *REDUCE POSSIBILITY OF DISABILITY ASSOCIATED WITH STROKE. - PROVIDE SERVICES TO TREAT THE INCREASED NUMBER OF LOCAL CANCER CASES IN THE COMMUNITY. *RECRUIT TWO MEDICAL ONCOLOGISTS *SUPPORT CANCER SERVICE LINE GROWTH *MAINTAIN A SUCCESSFUL ACCREDITED CANCER CARE PROGRAM AT DKH. - EFFECTIVELY OPTIMIZE SURGICAL PATIENTS TO PREVENT SURGICAL SITE INFECTIONS AND MANAGE PAIN CONTROL. *UTILIZE ENHANCED RECOVERY AFTER SURGERY (ERAS) MEASURES TO PREVENT SURGICAL SITE INFECTIONS (SSI) *DECREASE OPIOID USAGE UTILIZING ALTERNATIVE MODALITIES FOR PAIN. - MANAGE PATIENT ENDOCRINE AND METABOLIC DISORDERS WITH EXPANDED SPECIALTY CARE SERVICES. *ADDRESS THE TRANSPORTATION ISSUES OF OUR DIABETIC PATIENTS BY PROVIDING EDUCATION AND INSTRUCTION ABOUT HOW TO PERFORM DIABETIC SELF-CARE AT HOME. *PROVIDE A MORE DEFINED EDUCATIONAL PROGRAM TO PRE-DIABETIC PATIENTS. - PROVIDE COMPREHENSIVE ASSESSMENT, DIAGNOSIS, AND TREATMENT FOR A RANGE OF PSYCHIATRIC CONDITIONS FOR NORTHEASTERN CONNECTICUT COMMUNITY MEMBERS. *ADDRESS EMOTIONAL NEEDS OF SCHOOL-AGE CHILDREN AND THEIR FAMILIES. *MAKE SIGNIFICANT INVESTMENTS IN TECHNOLOGY RESOURCES TO PROTECT PATIENT PRIVACY. *IMPLEMENT NEW PROGRAMS THAT SUPPORT AND ADDRESS STIGMA."

SCHEDULE H, PART V, LINES 16A, 16B, & 16C
FINANCIAL ASSISTANCE POLICY AVAILABILITY: THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE POLICY APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.DAYKIMBALL.ORG/RESOURCES/FINANCIAL-SERVICES/

SCHEDULE H, PART I, LINES 3A, 3B, & 3C
"DETERMINING ELIGIBILITY FOR FREE & DISCOUNTED CARE: TO QUALIFY FOR FREE CARE, AN INDIVIDUAL MUST MEET ALL OF THE CRITERIA: - SINGLE ACCOUNT BALANCE OF $250 OR GREATER OR ACCOUNTS SPANNING SIX MONTHS TOTALING $500 OR GREATER (INDIVIDUAL) OR ACCOUNTS SPANNING SIX MONTHS TOTALING $1000 OR GREATER FOR 2 OR MORE FAMILY MEMBERS (UNDER SAME GUARANTOR). - ANNUAL INCOME IS LESS THAN 250% OF THE CURRENT FEDERAL INCOME POVERTY LEVEL (FPL). - LIQUID ASSETS MUST NOT EXCEED $100,000 (INCLUDES STOCKS, BONDS, CASH, 401K, IRA, CD, PROPERTY AND BUSINESS VALUE, AND RECREATIONAL VEHICLES). TO QUALIFY FOR A 75% CHARITY CARE DISCOUNT, AN INDIVIDUAL MUST MEET ALL OF THE FOLLOWING CRITERIA: - SINGLE ACCOUNT BALANCE OF $250 OR GREATER OR ACCOUNTS SPANNING SIX MONTHS TOTALING $500 OR GREATER (INDIVIDUAL) OR ACCOUNTS SPANNING SIX MONTHS TOTALING $1000 OR GREATER FOR 2 OR MORE FAMILY MEMBERS (UNDER SAME GUARANTOR). - ANNUAL INCOME IS LESS THAN 250% OF THE CURRENT FEDERAL INCOME POVERTY LEVEL (FPL). - LIQUID ASSETS MUST NOT EXCEED $100,000 INCLUDING (STOCKS, BONDS, CASH, 401, IRA, CD, PROPERTY AND BUSINESS VALUE AND RECREATIONAL VEHICLES). - INSURED PATIENTS WHO HAVE NO ADDITIONAL COVERAGE (AND HAVE DOCUMENTATION THAT THEY HAVE EXHAUSTED THEIR INSURANCE) FOR THE REMAINDER OF THEIR PLAN YEAR WILL BE DEEMED ""UNINSURED"" UNDER SECTION A OF THIS POLICY. IF GRANTED CHARITY CARE, IT WILL BE ONE-TIME GRANTING."

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY: THE COSTING METHODOLOGY THAT WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS DAY KIMBALL HOSPITAL'S COST-TO-CHARGE RATIO THAT WAS REPORTED IN THE FY2022 MEDICARE COST REPORT.

SCHEDULE H, PART I, LINE 7G
SUBSIDIZED SERVICES: DAY KIMBALL HOSPITAL PARTNERS WITH NORTHEASTERN CONNECTICUT COUNCIL OF GOVERNMENTS (NECCOG) TO PROVIDE LOCAL PARAMEDIC INTERCEPT SERVICES. DAY KIMBALL HOSPITAL AND NECCOG AGREED THAT THE ABSENCE OF PARAMEDIC INTERCEPT SERVICES IN NORTHEASTERN CONNECTICUT, COMPRISED OF MANY RURAL TOWNS, WOULD CREATE A SIGNIFICANT DEFICIENCY IN THE AVAILABILITY AND ACCESSIBILITY OF MEDICAL SERVICES IN THE COMMUNITY. THE HOSPITAL PROVIDES CERTAIN MONETARY AND IN-KIND SERVICES FOR THE PROVISION OF PARAMEDIC INTERCEPT SERVICES.

SCHEDULE H, PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR IS EQUAL TO TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF FORM 990.

SCHEDULE H, PART III, LINE A, LINE 2
BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.

SCHEDULE H, PART III, SECTION A, LINE 3
BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS ESTIMATED USING THE PERCENTAGE OF THE POPULATION THAT IS BELOW THE POVERTY LINE IN THE HOSPITAL'S SERVICE AREA.

SCHEDULE H, PART III, SECTION A, LINE 4
BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.

SCHEDULE H, PART III, SECTION B, LINE 8
COMMUNITY BENEFIT RATIONALE: THE SHORTFALLS BETWEEN DAY KIMBALL HOSPITAL'S MEDICARE COSTS AND PAYMENTS ARE CONSIDERED COMMUNITY BENEFIT BECAUSE THE SERVICES WERE PROVIDED BY DAY KIMBALL HOSPITAL EVEN THOUGH THE COSTS WERE NOT COVERED OR REIMBURSED. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 WAS GROSS CHARGES REDUCED BY THE COST TO CHARGE RATIO THAT WAS REPORTED IN THE FY2022 MEDICARE COST REPORT.

SCHEDULE H, PART III, SECTION B, LINE 9B
"COLLECTION POLICY: IT IS THE PHILOSOPHY AND POLICY OF DAY KIMBALL HOSPITAL THAT MEDICALLY NECESSARY HEALTH CARE SERVICES SHOULD BE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE POLICY WAS WRITTEN IN ACCORDANCE WITH SECTION 9007 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACT), SIGNED INTO LAW ON MARCH 23, 2010, WHICH ADDS NEW SECTIONS 501(R) AND 4959 TO THE INTERNAL REVENUE CODE. SECTION 510(R) INCLUDES A SERIES OF SPECIFIC REQUIREMENTS FOR HOSPITALS TO RECEIVE AND MAINTAIN SECTION 501(C)(3) ""TAX EXEMPT"" STATUS."

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT: DAY KIMBALL HOSPITAL HAS RECENTLY COMPLETED A COMMUNITY NEEDS ASSESSMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS UNDERTAKEN TO IDENTIFY SPECIFIC HEALTH CARE NEEDS IN WINDHAM COUNTY. FOCUS GROUPS, TELEPHONE SURVEYS AND STATE AND FEDERAL DATA WAS USED TO IDENTIFY THE SPECIFIC HEALTH CARE NEEDS DURING THIS ASSESSMENT.

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH: THE MISSION OF DAY KIMBALL HOSPITAL IS TO MEET THE HEALTH NEEDS OF OUR COMMUNITY THROUGH OUR CORE VALUES OF CLINICAL QUALITY, CUSTOMER SERVICE, FISCAL RESPONSIBILITY AND LOCAL CONTROL. DAY KIMBALL HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND PHYSICIANS. THE MEDICAL STAFF IS OPEN TO ALL PHYSICIANS IN THE COMMUNITY WHO MEET MEMBERSHIP AND CLINICAL PRIVILEGE REQUIREMENTS. INPATIENT, OUTPATIENT AND EMERGENCY SERVICES THAT ARE MEDICALLY NECESSARY ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.

SCHEDULE H, PART VI, LINE 6
AFFILIATE STRUCTURE: DAY KIMBALL HOSPITAL HAS A RELATIONSHIP WITH UMASS MEMORIAL MEDICAL CENTER AS ITS TERTIARY CARE SITE. WHEN PATIENTS' CARE REQUIRES SPECIALIZED TREATMENTS, DAY KIMBALL COLLABORATES WITH PROMINENT MEDICAL CENTERS TO PROVIDE THE CARE THEY NEED. FOR INSTANCE, DAY KIMBALL PARTNERS WITH UMASS MEMORIAL MEDICAL CENTER IN WORCESTER, MA, FOR CARDIAC CARE AND HAS DEVELOPED A SYSTEMATIC APPROACH TO STABILIZING AND TRANSPORTING HEART ATTACK PATIENTS TO UMASS FOR FURTHER TREATMENT.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ALL PATIENTS WHO ARE UNINSURED ARE REFERRED TO THE FINANCIAL COUNSELING DEPARTMENT; INPATIENTS ARE ALL VISITED BY A FINANCIAL COUNSELOR (OR GIVEN A FINANCIAL COUNSELING PACKET) PRIOR TO DISCHARGE WITH ALL OF THE AVAILABLE PROGRAMS THAT ARE AVAILABLE THROUGH OUR FINANCIAL ASSISTANCE (CHARITY CARE) POLICY. ANY SCHEDULED PATIENTS WHO ARE UNINSURED ARE CALLED BY THE FINANCIAL COUNSELORS IN ADVANCE TO PROVIDE ALL OF THE OPTIONS INCLUDING SCREENING FOR MEDICAID ASSISTANCE, CHARITY CARE, AS WELL AS SEVERAL OTHER LOCAL FUNDING SOURCES THAT THEY MAY QUALIFY FOR. ALL PATIENT STATEMENTS HAVE INFORMATION ABOUT OUR CHARITY CARE POLICY AS WELL AS DOWNLOADABLE CHARITY CARE APPLICATION. ALL OF OUR THIRD PARTY VENDORS, INCLUDING OUR BAD DEBT AGENCIES AND OUR LONG TERM PATIENT FINANCING PROGRAM THROUGH CAREPAYMENT ALSO PROVIDE OUR CHARITY CARE POLICY TO PATIENTS UPON REQUEST. OUR FINANCIAL ASSISTANCE GUIDELINES ARE ALSO POSTED IN ALL PATIENT REGISTRATION AREAS OF THE HOSPITAL.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: DAY KIMBALL HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF 13 TOWNS IN THE NORTHEASTERN CORNER OF CONNECTICUT AS WELL AS BORDERING MASSACHUSETTS AND RHODE ISLAND TOWNS. DAY KIMBALL'S SERVICE AREA IS OVER 438 SQUARE MILES AND CONTAINS APPROXIMATELY 116,192 IN WINDHAM COUNTY. THE POPULATION RANGES FROM LONG-TERM, MULTI-GENERATIONAL FAMILIES TO NEWLY IMMIGRATED WIDE RANGE OF SOCIO-ECONOMIC FACTORS INCLUDING VERY HIGH INCOME TO POVERTY; ADVANCED EDUCATION TO INCOMPLETE HIGH SCHOOL. THE MEDIAN HOUSEHOLD INCOME IN 2010 IN WINDHAM COUNTY WAS $58,489 (THE LOWEST INCOME OF ANY COUNTY IN THE STATE OF CONNECTICUT), WHILE THE STATE MEDIAN WAS $69,519. ACCORDING TO THE HEALTHY CONNECTICUT 2020 STATE HEALTH ASSESSMENT THAT WAS RELEASED IN MARCH 2014 THE LEADING CAUSE OF DEATH IN CONNECTICUT ARE HEART DISEASE AND CANCER. RESIDENTS FROM URBAN AREAS. ACCORDING TO THE 2010 CENSUS, 11.7% OF THE POPULATION IS UNDER POVERTY LEVEL AND 14.3% ARE OVER AGE 65. THERE IS A WIDE RANGE OF SOCIO-ECONOMIC FACTORS INCLUDING VERY HIGH INCOME TO POVERTY; ADVANCED EDUCATION TO INCOMPLETE HIGH SCHOOL. THE MEDIAN HOUSEHOLD INCOME IN 2010 IN WINDHAM COUNTY WAS $58,489 (THE LOWEST INCOME OF ANY COUNTY IN THE STATE OF CONNECTICUT), WHILE THE STATE MEDIAN WAS $69,519. ACCORDING TO THE HEALTHY CONNECTICUT 2020 STATE HEALTH ASSESSMENT THAT WAS RELEASED IN MARCH 2014 THE LEADING CAUSE OF DEATH IN CONNECTICUT ARE HEART DISEASE AND CANCER.