Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
Midstate Medical Center
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
435 Lewis Avenue
 
Room/suite
City or town, state or country, and ZIP + 4
Meriden, CT06451
D Employer identification number

06-0646715
E Telephone number

G Gross receipts $ 221,498,802
F Name and address of principal officer:
Ralph W Becker
435 Lewis Ave
Meriden,CT06451
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MIDSTATEMEDICAL.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1885
M State of legal domicile: CT
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: The Mission of MidState Medical Center is to promote, restore, and maintain the health and well-being of the people of central Connecticut.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 17
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 12
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,351
6 Total number of volunteers (estimate if necessary) .... 6 316
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a -47,229
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -52,919
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 885,632 756,441
9 Program service revenue (Part VIII, line 2g) ......... 190,681,262 205,061,681
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 14,322,922 10,618,913
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,175,463 2,284,187
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 208,065,279 218,721,222
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 92,277,296 101,701,646
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet333,615    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 103,492,758 107,840,027
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 195,770,054 209,541,673
19 Revenue less expenses. Subtract line 18 from line 12...... 12,295,225 9,179,549
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 241,873,393 246,981,756
21 Total liabilities (Part X, line 26)............ 164,071,324 173,911,992
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 77,802,069 73,069,764
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: The mission of MidState Medical Center is to promote, restore, and maintain the health and well-being of the people of central Connecticut. That mission comes to life in the various ways hospital staff interacts with people beyond the walls of the institution. More than just a place to come for medical care, MidState holds in its mission a deep commitment to be there for the communities it serves by reaching out to people of all backgrounds and providing them with the guidance they need to live and maintain a healthy, active life.For many years, MidState has worked especially close with the United Way of Meriden & Wallingford to assist in creating opportunities for a better tomorrow. MidState has been a staunch supporter of the United Way's LIVE UNITED CAMPAIGN, calling on hospital employees to be good stewards in our community.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 14,164,388 including grants of $   ) (Revenue $ 34,394,563 )
The Surgical Services department is proud to provide patients throughout central Connecticut with the very best in surgical care. From surgical weight loss, vascular surgery, gall bladder removal to oncological surgeries and more, our patients can count on MidState to provide sound, innovative clinical solutions that offer the greatest physical and emotional comfort, as well as the potential for the best possible outcome.MidState's Operating Suite at its main campus (435 Lewis Avenue, Meriden) includes nine operating rooms and one procedure room. A new 700 square foot fully digitalized robot operating room was opened in June 2011 to accommodate the new technology.Surgical Care is delivered to outpatient and inpatients in an integrated operating room. Major surgical specialties that are offered are: General Surgery - include minimally invasive surgery, robotics and bariatric surgery.Gynecological - Major and minor gynecological procedures, robotic surgery, vaginal hysterectomies, and uro-gyno procedures.Obstetrical - Caesarean SectionENT- Nasal surgery, Head and Neck surgery, PE Tubes, Tonsillectomies, 3 D imaging sinus surgery, and Cryosurgery.Ophthalmology - Cataract extraction with or without lens implant.Maxillofacial - Orthognatic surgery Orthopedics - Total Joint replacements, Sports Medicine, Trauma fractures and spine surgery.Urological - Includes minimally invasive renal and prostate surgery, including robotic surgery, Green Light Laser for stone removal. ESWL for stone removal, Brachtherapy, and Urinary incontinence procedures, Vascular and Thoracic, Plastic, Neurosurgery of the Spine, and CO2 Laser Surgery Open heart, craniotomies, and transplants are not available at MidState.Surgical Services at MidState serves the pediatric, adolescent, adult and geriatric population. In FY2011, MidState performed 7,953 inpatient and outpatient procedures, which is in line with national trends that indicate that 74% of surgeries are outpatient surgeries. All patients receive the same quality of nursing care regardless of race, diagnosis, creed or ability to pay. Operating utilization for 2010 was 62 %Response time for on-call personnel is 30 minutes from receiving call to on duty. As per hospital policy, two hospital employees are required for every major operative procedure, and one must be the RN circulator. A third or dedicated person is required for all Laser surgery. A RN and a Perioperative Technician may do Cystos, D&Cs and Closed Reductions. A Surgical Technologist may assist with circulating duties.The team concept is utilized for delivery of care. The Team Leaders of major specialties are selected by staff and fulfill the major responsibility for resource management for their service.All MidState OR rooms are multi-functional and any procedure may be performed in any room. CO2 laser may be utilized in any OR. Holmium and Green light Laser procedures are room specific.All decontamination, re-assembly and storage of surgical instruments and equipment are performed in the surgical suite with sterilization occurring in CSR.A Charge Nurse designated by the manager is on duty 3:00 - 11:00 p.m. off shift. Approximately 66% of direct care staffs are RN's.GSA, CCA and Perioperative Technicians provided support to OR, CSR and PACU. The top 5 procedures performed are:* Cataract procedures* Urological procedures* D&C's diagnostics and therapeutic* Arthroscopic surgery* Breast surgeryPlan to Improve Quality of Care is based on high risk, high volume and problem prone processes. Improvement processes are reviewed annually.
4b (Code:   ) (Expenses $ 10,283,834 including grants of $   ) (Revenue $ 43,460,501 )
The Emergency Department (ED) at MidState Medical Center strives to provide compassionate, high-quality care to all of its patients regardless of their financial ability to pay. FY 2011 was a year of dramatic growth and improvement for the Emergency Department. Working around two distinct goals, the staff of the MidState ED aimed to: exceed patient and family expectations, and improve the patient experience. Thanks to an ED expansion project that was completed in 2010, a new space along with process changes helped to meet these goals.Overall, the total number of ED visits for FY 2011 was 58,430, a 9% increase in visits since the previous year and more patients seen in a given year than ever before. Current numbers show that volume is likely to double for the next fiscal year. In FY 2011, 12% of patients were admitted to MidState Medical Center as inpatients. The percentage of patients who left without being seen was 1.2%, which was below the national benchmark of 2%. Approximately 25% of patients arrived by ambulance. In September 2010, MidState completed a two-year, $45 million ED expansion that resulted in enormous improvements in patient care and operational efficiencies. The revamped ED features 53 private treatment spaces, including an 11-bed Assessment Unit, a secure and private Acute Behavioral Health Unit and centrally dedicated Radiology suite for x-ray services. This is double the number of rooms than was previously available. These physical changes have brought numerous benefits to the patient and have allowed for more patient-centered care. In fiscal year 2011, patients no longer had to wait for medical care in a traditional waiting room. A redesigned triage process meant that patients would be immediately taken to a private assessment room in the ED once they arrived. Registration was completed confidentially at the bedside, and patients were afforded comfort and amenities such as access to a television and telephone. Given the department's significant increase in patient volumes this fiscal year, the state-of-the-art expansion project likely attracted more patients. The MidState ED is now well positioned to accommodate the growing need for emergency care in the communities it serves. New StaffGiven the Emergency Department's significant increase in volumes this fiscal year, the ED expanded its staffing. This included registered nurses, as well as emergency department technicians. Emergency Medicine Physicians (EMP)This year, MidState contracted with Emergency Medicine Physicians (EMP) to provide care to patients in the ED. EMP is a group of over 600 residency trained, board certified emergency physicians who provide care to over 2.5 million patients per year at 60 emergency departments across the country. All of MidStates full-time clinical ED physicians elected to join and partner with the newly created EMP of New Haven County. EMP focuses on patient satisfaction, medical staff satisfaction and providing exceptional emergency care. Electronic Health RecordThis fiscal year the ED rolled out a new AllScripts program and introduced an almost complete electronic health record for ED patients. Several hours of staff education and training was implemented to get staff up-to-speed on the new process and program. The new electronic health record is making care more seamless for patients. Collection ManagerThe ED implemented the Collection Manager in fiscal year 2011, a device that scans a patient's wrist and creates labels for phlebotomy draws, thus increasing patient safety. Patient SatisfactionPatient satisfaction increased dramatically from FY 2010. Overall patient satisfaction scores for FY 2011 were in the 79th percentile, and overall rating of care was in the 70th percentile. For the second consecutive year, 99% of patients said the triage process was private. The ED continues to make reduced wait times a priority, with the goal of patients being seen by a provider within 30 minutes of arrival. To improve patient satisfaction and customer service, ED staff and physicians began a discharge phone call project in 2010, and to date, 45% of patients receive a discharge phone call to follow up with patients on their care and treatment. The discharge phone calls have been well received and offer the opportunity to educate patients, correct any misconceptions patients may have about their care, and clarify discharge instructions. The ED has seen a direct correlation between the phone calls and patient satisfaction. Community OutreachThe staff of the ED are committed to community service and enriching the lives of others. In FY 2011, the ED participated in the United Way of Meriden & Wallingford's Adopt-a-Family program, where ED staff contributed several hundred dollars to provide a family in need with a holiday wish list. The department also donated money and non-perishable food items to Girls' Inc., and also to a family member in need in the department. Additionally, the ED participated in community health fairs, including a Healthy Family FunFest held at the Aqua Turf in March 2011, in which ED staff presented information for the family on bicycle safety. The event drew nearly 2,000 people from across central Connecticut. Partnerships The MidState ED does not work alone in providing excellent care to those it serves. In FY 2011, the ED provided ongoing education to local EMS providers, both of the Wallingford Fire Department and Hunter's Ambulance. The ED continued to build its relationship with the Meriden Police Department and work more collaboratively in situations when emergency care intersects with law enforcement matters.The MidState ED also partners with Hartford Hospital's LifeStar helicopter to deliver life saving care to critically ill patients that need a higher level of care than what MidState can provide. EducationIn FY 2011, the MidState ED continued to play a critical role in staff education of stroke protocols and treatment and worked collaboratively with other health care team providers to educate staff and patients on early detection of stroke using the F.A.S.T. acronym.
4c (Code:   ) (Expenses $ 10,579,906 including grants of $   ) (Revenue $ 82,306,629 )
Radiology Services at MidState Medical Center is comprised of various modalities that serve patients of all ages, from newborns through geriatrics. Imaging services available include nuclear medicine, ultrasound, MRI, mammography and PET/CT scanning. Radiology Services meets patients' imaging needs for routine health care, as well as for circumstances related to trauma and surgery. This includes diagnostic procedures, invasive techniques, and non-invasive modalities. Services are consistently subject to quality assurance and evaluation to ensure the highest standards are being met for patient care. In fiscal year 2011, Radiology Services performed the following volume of procedures: 60,460 diagnostic, 2,699 nuclear medicine, 477 PET scans, 13,991 ultrasounds, 23,292 CT scans, 7,294 MRIs, and 5,853 special procedures. Radiology services are provided in a total of seven locations across central Connecticut and beyond.Patient Satisfaction Radiology Services utilizes both Press Ganey, Inc., as well as another outpatient survey tool to track feedback from its patients and make necessary process improvements. Management also contacts patients to discuss positive and negative feedback when necessary and per the patient's request. Patient satisfaction data for fiscal year 2011 shows the following in comparison to Baldridge award winner hospitals across the country:Waiting time for Radiology - 82% Baldridge average - 42%Courtesy of Radiology Staff - 88% Baldridge average - 62%Concern for Comfort - 90% Baldridge average - 71%Equipment/Technology Improvements Several improvements were made in fiscal year 2011 to enhance the quality of patient care and patient comfort. These include:- The purchase of a specific comfort pad for stereotactic breast patients that lie on their stomach in an uncomfortable position for approximately 30-60 minutes. The comfort pad will help make this procedure more tolerable for patients. - The replacement of three analog units for three new digital portable units. This will help achieve faster reading times.- The addition of a new software package for the 64-slice CT Scanner that will be used for stroke patients. This software gives Radiologists the ability to evaluate deeper brain vessels.- The purchase of new ultrasound probes which helps cut scanning time in half and allows the physician performing a biopsy to view the needle in two planes. Renovation Project This fiscal year Radiology began and completed a renovation project to redesign the patient check-in/registration area. The goals of this project were to create a more efficient working space for staff, improve patient flow during registration, increase patient privacy during the registration process and speed up the registration process. With the project now complete, Radiology team members have heard positive feedback from patients about the increased space and privacy. There are now three separate and private check-in areas where patients can sit and complete the registration process. Prior to the project, patients had to stand. Staff are also quite pleased with the new working space. Recognition This year MidState presented its annual Crystal Obelisk Award to a Radiologist. Since 1991, the Crystal Obelisk Award has honored individuals and groups for outstanding contributions to health care. Radiologist Sherwin Borsuk, MD was named as the 2011 recipient. Dr. Borusk joined the Medical Staff of Meriden-Wallingford Hospital in 1978, and for over 30 years, has served the hospital in a variety of capacities. Most recently, in 2011, he became an active member of the Board's Quality Committee, which sets quality goals, establishes, monitors and assesses measures of performance, quality of care, clinical safety, and adverse events.
(Code:   ) (Expenses $ 169,651,415 including grants of $   ) (Revenue $ 44,849,225 )
The mission of MidState Medical Center is to improve the health and healing of the people and communities we serve. In towns across central Connecticut, MidState is committed and focused on efforts to promote health and wellness.Each year, MidState makes a concerted effort to go above and beyond its call to the community. Our physicians, nurses, and staff have reached out to thousands of individuals in the last year through health-related programs and special events. Additionally, MidState has partnered with various community organizations to improve the quality of life of its residents. These include key opinion leaders, faith communities, business leaders, government officials, and a variety of social service organizations. These partners come together on a monthly basis in Community Vision meetings to discuss plans to address community need and determine the best means to effect change.MidState and these Community Vision partners have also been leaders in establishing several food drives throughout the year and creating a process for a more efficient, effective food collection and distribution method. This fiscal year, MidState hosted a food drive that resulted in the collection of over 50 boxes of non-perishable food items and personal care items that were distributed to Master's Manna in Wallingford and the Meriden Soup Kitchen. Additionally, MidState participates in the United Way of Meriden and Wallingford's Adopt-a-Family holiday program; approximately 20 hospital departments have adopted families in the community, more than any other organization in Meriden and Wallingford. MidState has also contributed to the community in the following ways:Health Fairs, Programs & ScreeningsMidState has coordinated and participated in nearly 400 health programs between October 2010 and September 2011, including health fairs, educational seminars and screenings. In particular, MidState hosted a well attended skin screening in May, resulting in the detection of skin cancer among one of the patients who signed up to attend. Three prostate screenings were also offered in September, again where one individual in the community was found to have a problematic screening. Finally, several appointments were available this year for reduced cost mammograms and free breast cancer risk assessment consultations. The LaPlanche Clinic & Geriatric OutreachMidState's LaPlanche Clinic was established in 1979 to meet the growing needs of the senior population in town. Working collaboratively with the Meriden Senior Center, the clinic is staffed by a registered nurse who provides education and care to seniors. Screenings offered include blood pressure, cholesterol and glucose, as well as regular programming on health topics such as nutrition, heart health, cancer prevention, healthy lifestyles and more. The clinic sees approximately 2,000 patient visits each year. A similar clinic operates out of the Cheshire Senior Center once per week, where another several dozen seniors in MidState's core community receive outstanding clinical care and free blood pressure screenings. MidState also runs an 8-week program called Diet Watch that focuses on nutrition basics to help seniors live healthy lifestyles. Speakers' BureauMidState physicians and clinicians hold speaking engagements at various community locations to offer individuals the opportunity to ask questions and learn about specific health conditions and ways of leading a healthier lifestyle. Programming is consistently offered for local senior centers, libraries, YMCAs, womens groups, faith communities, Rotary clubs, Kiwanis, and other community groups.Community PartnersMidState takes a collaborative approach to building a healthier community, working with a variety of organizations on a number of initiatives to enhance the health and well-being of those we serve. In the last year, MidState is privileged to have worked with the United Way of Meriden & Wallingford, the Cheshire and Wallingford YMCAS, its local health departments and the Meriden Chamber Health and Wellness Council. MidState has been particularly involved this year in the Activate Wallingford initiative with the Wallingford YMCA to address the issue of childhood obesity in the Wallingford Community. Additionally, The Palladino Family Cancer Center operated by MidState has worked collaboratively with local YMCAs to promote their new LIVESTRONG program for cancer survivors. Tremaine Resource CenterOur medical and consumer health library offers a broad range of resources and services to support the needs of patients, caregivers and area residents for accurate and current health information. The Tremaine Resource Center supports student research and offers services to patients in the hospital. The library saw 6,607 visitors last year and responded to 912 requests for information.John Barry School Business Partnership In 1995, MidState formed a school-business partnership with nearby John Barry Elementary School. Over the last 16 years, hospital departments have "adopted" classes and collaborated with teachers to plan regular activities that include health fairs, career days, hospital tours, holiday breakfasts, and an annual "Read Aloud Day." Hospital employees have donated books to the school, as well as offered age-appropriate education on topics such as "The Warning Signs of Stroke" and "When to Call 9-1-1." Volunteer SupportMidState is fortunate to have an active group of adult and junior volunteers who each day offer their skills and talents to the hospital. Last year 316 volunteers generously contributed over 42,000 hours of service to 45 different departments. The work of the hospital could not be done without these loyal ambassadors.
4d Other program services. (Describe in Schedule O.)
(Expenses $ 169,651,415 including grants of $   ) (Revenue $ 44,849,225 )
4e Total program service expensesMediumBullet$ 204,679,543
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
Yes
 
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
Yes
 
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
234
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,351
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
17
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
Yes
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
Ralph W Becker
181 Patricia M Genova Dr
Newington,CT06111
(860) 696-6200
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Gail G McCormack
Director
 2.00 X           0 0 0
(2) Lawrence M McGoldrick
Director
 2.00 X           0 0 0
(3) Lloyd T Nurick
Director
 2.00 X           0 0 0
(4) Lucille A Janatka
President/CEO
 40.00 X   X       622,904 0 133,652
(5) Kenneth R Kurz MD
Immediate Past Chief of Staff
 5.00 X           60,000 0 0
(6) Bruce C Eldridge
Chair of the Board
 2.00 X           0 0 0
(7) Joseph E Mirra
Chair, Dev. Committee
 2.00 X           0 0 0
(8) James N Smith
Director
 2.00 X           0 0 0
(9) James V Kalamajka
Director
 2.00 X           0 0 0
(10) Marcia B Proto
Secretary
 2.00 X           0 0 0
(11) James L Pellegrino
Director
 2.00 X           0 0 0
(12) Paul Zimmering MD
Immediate Past Chief of Staff
 2.00 X           30,000 0 0
(13) Janet B Dickinson MD
Medical Director, ED
 2.00 X           4,000 0 0
(14) Frederick Ulbrich III
Director
 2.00 X           0 0 0
(15) Linda S Durhan
Director
 2.00 X           0 0 0
(16) Carl D Grant
Director
 2.00 X           0 0 0
(17) Rajani Nadkarni
Chief Of Medical Staff
 2.00 X   X       36,296 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Ralph W Becker
Vice President & CFO
 40.00     X       0 357,735 72,345
(19) Kenneth W Cesca
Vice President, HR
 40.00     X       208,916 0 47,537
(20) Cindy L Russo
SVP, Operations
 40.00     X       243,682 0 56,086
(21) Catherine Stevens
VP, Patient Care
 40.00     X       0 0 0
(22) Harold Kaplan
Vice President, Med Affair
 40.00     X       224,583 0 44,996
(23) Maryanne Volkringer
VP, Business Development
 40.00     X       0 0 0
(24) Howard Dubin MD
ED Physician
 40.00         X   287,512 0 54,603
(25) Fred Tilden MD
ED Physician
 40.00         X   393,708 0 83,441
(26) Richard A Remnick MD
ED Physician
 40.00         X   277,811 0 63,601
(27) Michael R Tinkler
ED Physician
 40.00         X   302,991 0 63,386
(28) Giac-Chan Tan MD
ED Physician
 40.00         X   284,958 0 70,435
(29) John J Meehan
Former Dir.-Non Voting
             X 0 1,189,989 12,187
(30) Linda Spivak
Former - VP
             X 0 266,453 14,729
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,977,361 1,814,177 716,998
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet114
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
FIP Construction Inc
10 McKee Place
Cheshire,CT06410 		Construction 10,215,970
Intuitive Surgical Inc
Dept 33629 PO Box 39000
San Francisco,CA94139 		Equipment Services 2,589,884
Clinical Laboratory Partners LLC
129 Patricia M Genova Dr
Newington,CT06111 		Lab Services 1,411,764
Signal Medical Services Inc
PO Box 847689
Dallas,TX75284 		Medical Services 1,322,955
Eastern Rehabilitation Network
181 Patricia M Genova Dr
Newington,CT06111 		Medical Services 759,248
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet42
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 18,410
d Related organizations...1d 80,750
e Government grants (contributions)1e 264,924
f All other contributions, gifts, grants, and
similar amounts not included above1f 		392,357
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 756,441
Program Service Revenue Business Code
2a Outpatient Care 621,400 107,111,444 107,111,444    
b Inpatient Care 624,100 96,669,437 96,669,437    
c Supply Vendor Rebate 900,099 448,869 448,869    
d Lab Services 621,500 285,478 281,944 3,534  
e Other Health Programs 621,300 138,468 138,468    
f All other program service revenue . 407,985 407,985    
g Total. Add lines 2a–2f........MediumBullet 205,061,681
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 10,608,055   3,376 10,604,679
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents 2,359,382  
b Less: rental expenses 554,468  
c Rental income or (loss) 1,804,914  
d Net rental income or (loss).......MediumBullet 1,804,914     1,804,914
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 2,203,077 15,100
b Less: cost or other basis and sales expenses 2,189,623 17,696
c Gain or (loss) 13,454 -2,596
d Net gain or (loss)..........MediumBullet 10,858     10,858
8a Gross income from fundraising events (not including
$ 18,410
of contributions reported on line 1c). See Part IV, line 18 ...
a 2,840
b Less: direct expenses ...b 15,793
c Net income or (loss) from fundraising events..MediumBullet -12,953   -12,953
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a Cafeteria Income 722,210 546,365     546,365
b Loss-Pass Thru Entity 900,003 -54,139   -54,139  
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 492,226
12 Total revenue. See Instructions....MediumBullet 218,721,222 205,058,147 -47,229 12,953,863
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21    
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 3,473,399   3,473,399  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 71,330,515 71,044,979   285,536
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 9,692,846 9,358,616 334,230  
9 Other employee benefits ....... 11,990,579 11,807,948 182,631  
10 Payroll taxes ........... 5,214,307 5,113,430 100,877  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 268,280   268,280  
c Accounting ........... 138,330   138,330  
d Lobbying ........... 30,768   30,768  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 576,088 576,088    
g Other .......... 12,699,175 12,699,175    
12 Advertising and promotion .... 768,809 768,809    
13 Office expenses ....... 26,866,724 26,834,436   32,288
14 Information technology ...... 75,231 75,231    
15 Royalties ..        
16 Occupancy ........... 7,007,443 7,007,443    
17 Travel ............ 96,085 96,085    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 46,181 46,082   99
20 Interest ........... 3,893,032 3,893,032    
21 Payments to affiliates ....... 13,550,214 13,550,214    
22 Depreciation, depletion, and amortization ..... 13,848,536 13,848,536    
23 Insurance .............. 5,492,045 5,492,045    
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a Purchased Services 8,806,829 8,799,951   6,878
b Bad Debt 8,300,420 8,300,420    
c Repairs & Maintenance 4,051,833 4,043,842   7,991
d Dues & Subscriptions 571,113 570,290   823
e Miscellaneous Expense 548,892 548,892    
f All other expenses 203,999 203,999    
25 Total functional expenses. Add lines 1 through 24f 209,541,673 204,679,543 4,528,515 333,615
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 9,828 1 9,106
2 Savings and temporary cash investments ....... 28,242,765 2 19,324,329
3 Pledges and grants receivable, net ......... 459,057 3 271,910
4 Accounts receivable, net ......... 26,560,361 4 29,777,260
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 700,000 7 700,000
8 Inventories for sale or use .............. 1,599,146 8 1,896,399
9 Prepaid expenses and deferred charges ............ 1,146,914 9 2,417,557
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 243,393,798
b Less: accumulated depreciation. ..... 10b 111,524,941 134,233,723 10c 131,868,857
11 Investments—publicly traded securities .......... 12,946,811 11 12,501,552
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 35,974,788 15 48,214,786
16 Total assets. Add lines 1 through 15 (must equal line 34)... 241,873,393 16 246,981,756
Liabilities 17 Accounts payable and accrued expenses . 16,443,261 17 14,704,807
18 Grants payable ..........   18  
19 Deferred revenue .......... 181,547 19 102,759
20 Tax-exempt bond liabilities .......... 82,915,000 20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 64,531,516 25 159,104,426
26 Total liabilities. Add lines 17 through 25..... 164,071,324 26 173,911,992
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 62,867,012 27 58,642,494
28 Temporarily restricted net assets ..... 1,962,184 28 1,966,917
29 Permanently restricted net assets ..... 12,972,873 29 12,460,353
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 77,802,069 33 73,069,764
34 Total liabilities and net assets/fund balances ..... 241,873,393 34 246,981,756
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
218,721,222
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
209,541,673
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
9,179,549
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
77,802,069
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-13,911,854
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
73,069,764
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
Midstate Medical Center
 
Employer identification number

06-0646715
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
Midstate Medical Center
  		Employer identification number

06-0646715
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
Midstate Medical Center
  		Employer identification number

06-0646715
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
Midstate Medical Center
  		Employer identification number

06-0646715
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
30,768
i
Other activities? If "Yes," describe in Part IV ..........................
 
No
 
j
Total. lines 1c through 1i ...................................
30,768
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Explanation of Other Lobbying Activities: Part II-B, Line 1i: Midstate Medical Center (MMC) is a member of both Connecticut Hospital Association (CHA) and American Hospital Association (AHA). Both CHA and AHA engage in lobbying activities on behalf of all their members. Efforts mainly include lobbying activities that are directly related to communications with legislators or actions on specific legislative bills on healthcare matters. Both CHA and AHA allocate a portion of their dues as lobbying expenses. The total amount of dues allocated as lobbying expenses for FY11 were $30,768.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 12,946,811 11,876,168 11,791,694
b Contributions ........ 258,750 229,064  
c Investment earnings or losses ... -330,623 1,188,658 200,326
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		287,232 270,479 115,852
f Administrative expenses .... 86,153 76,599  
g End of year balance ...... 12,501,553 12,946,811 11,876,168
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet87.000 %
b
Permanent endowment: SchDMd Bullet6.000 %
c
Term endowment: SchDMd Bullet7.000 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   1,250,000 1,250,000
b Buildings ................   114,490,932 29,990,042 84,500,890
c Leasehold improvements ............   8,283,537 4,584,695 3,698,842
d Equipment ................   119,031,109 76,950,204 42,080,905
e Other .................   338,220   338,220
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 131,868,857
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Escrow Funds 6,312,325
(2) Funds Held In Trust 11,682,166
(3) Other Assets 226,315
(4) Security Deposits 22,554
(5) Other Investments 26,707,905
(6) Amortizable Bond Issue Costs 1,819,787
(7) Deferred Comp Trust 1,443,734


Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 48,214,786
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
Accrued Pension Liability 55,589,753
Accrued Post Retirement - Non Pension 2,159,582
Accrued Pension Plan - Other 2,262,107
IBNR Malpractice Reserve 4,164,000
Bond Rebate Fund 5,720,218
Other Liabilities 454,123
Long Term Debt - Intercompany 88,754,643


Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 159,104,426
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Description of Intended Use of Endowment Funds: Part V, Line 4: The Medical Center has adopted investment and spending policies for endowment assets that attempt to provide a predictable stream of funding to programs supported by its endowment while seeking to maintain purchasing power of the endowment assets. The Medical Center's spending policy is that investment income and realized gains and losses associated with the endowments are appropriated for spending every year, and unrealized gains and losses are reinvested back in to the endowment as accumulated earnings. Endowment assets includes those assets of donor-restricted funds that the Medical Center must hold in perpetuity or for donor specific periods as well as board designated funds. The Medical Center's endowment consists of approximately 100 individual funds established for a variety of purposes. The endowment includes both donor-restricted endowment funds and funds designated by the Board of Directors to function as endowments. Net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments, are classified and reported based on the existence or absence of donor-imposed restrictions.
Description of Uncertain Tax Positions Under FIN 48: Part X: The audited financial statement did not include a FIN 48 Foootnote.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
North America/Caribbean 0 0 Investments Insurance 4,766,472
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 4,766,472
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 4,766,472
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
Other Information Schedule F, Part V Hartford Hospital is a brother/sister entity to Midstate Medical Center. They are both owned by Hartford HealthCare Corporation. Hartford Hospital files form 5471 on behalf of itself and Midstate Medical Center.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


Software ID:  
Software Version:  



SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

A Toast to Technology
(event type) 		(b) Event #2

 
(event type) 		(c) Other Events

  
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 21,250     21,250
2 Less: Charitable
contributions . . . 		18,410     18,410
3 Gross income (line 1
minus line 2) . . . 		2,840     2,840
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages . . 15,175     15,175
8 Entertainment . . .        
9 Other direct expenses . 618     618
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 15,793
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -12,953
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    1,282,617 95,903 1,186,714 0.590 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    33,008,412 21,728,451 11,279,961 5.610 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    34,291,029 21,824,354 12,466,675 6.200 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    244,655 6,080 238,575 0.120 %
f Health professions education
(from Worksheet 5) .. 		    375,896 0 375,896 0.190 %
g Subsidized health services
(from Worksheet 6) .. 		    5,449,144 4,070,795 1,378,349 0.680 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    17,173 0 17,173 0.010 %
jTotal Other Benefits ...     6,086,868 4,076,875 2,009,993 1.000 %
kTotal. Add lines 7d and 7j. ..     40,377,897 25,901,229 14,476,668 7.200 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     654   654 0 %
4 Environmental improvements            
5 Leadership development and training for community members     421   421 0 %
6 Coalition building     2,352   2,352 0 %
7 Community health improvement advocacy            
8 Workforce development     5,612   5,612 0 %
9 Other            
10 Total     9,039   9,039  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
2,751,025
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
990,369
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
51,989,732
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
57,085,920
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-5,096,188
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 Midstate Medical Center
435 Lewis Avenue
Meriden,CT06451 		X                
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Not Required
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?1
Name and address Type of Facility (Describe)
1 Mediquick-Midstate Medical Center
61 Pomeroy Avenue
Meriden,CT06450 		Urgent Care Center
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    Part I, Line 3c: Midstate Medical Center used the Federal Poverty Guidelines to determine eligibility.
    Part I, Line 7: The organization utilized an overall cost to charge ratio, (RCC), developed from the audited Financial Statements, (AFS). Total expense was adjusted for: bad debt expense, directly identified community benefit expense and non-patient care expense, (as adjusted from the Medicare cost report). This was then divided by the total AFS gross revenue to develop the cost to charge ratio. This cost to charge ratio was used to calculate costs for Part I lines 7a, b, & g, (most programs), and Part III Section A2. The exception to the overall cost to charge ratio used was on Urgent Care, Diabetes Center and Inpatient Psychiatric program costs. The array of services in these programs was significantly different than the overall hospital array, therefore a specific RCC was developed and then reduced for a community benefit and non-patient care factor. The costs associated with the activities reported on Part I, Line 7e were captured using actual time multiplied by an average salary rate. These costs were removed from the calculations above to avoid duplication. Costs reported in Part III, Section B6, were calculated from the Medicare cost report and reduced for Medicare costs previously reported on Part I Lines 7g.
    Part I, Line 7g: No physician clinic costs were included in the subsidized Health Services cost calculations.
    Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 8300420.
    Part II: MidState Medical Center has a very robust community benefits program. MidState coordinates a Community Vision group that interacts with the community to address needs and facilitate responses to identified needs. Through Community Vision, MidState has collaborated with the United Way of Meriden and Wallingford to address food collection and distribution for the needy while also conducting semi-annual food collections within the hospital for distribution to those in need. More specifically, MidState is involved in a Family Zone in Meriden that is modeled after the Harlem Children Zone in New York and provides extended services to families who reside in a targeted segment of the community. MidState representatives also serve on a housing coalition that addresses the need for housing and shelter in its primary service area. Since basic needs, such as food and housing, are tied to health status, MidState's participation in these initiatives alongside the United Way has been important and beneficial to the community the hospital serves. MidState staff is also involved in workforce development activities through a regional board that is focused on training, education, and employment opportunities. This enhances the training of the workforce and also can lead to career opportunities at MidState Medical Center. Furthermore, MidState is proud of the school-business partnerships it has in the community, further addressing workforce development efforts among the area's youth and understanding that employment is another factor tied to health status.Since the mid-1990s, MidState has had a close-knit relationship with nearby John Barry Elementary School which has provided opportunities for staff to adopt classrooms and enrich the academic experience of students through read-a-loud days and other classroom activities, as well as promote tailored education to students on important health topics including the signs and symptoms of stroke. By educating students on disease risk factors at an early age, it is the hope that their knowledge base will increase, they will share information with their families and perhaps recognize a health problem in a loved one. Over 20 years ago MidState and its community partners, under the Healthy Meriden initiative, established the Multidisciplinary Geriatric Service Provider Team to bring together all the geriatric service providers in the area to address health issues that the elderly face and how the organizations around the table can better address those issues through collaboration, more coordinated service, and networking. The team still continues to meet monthly and participation is strong. MidState assists with organizing these meetings and serves as a meeting location for the group. Through this specialized team, work is being done to improve the healthcare services available to our aging population.For FY11, the Medical Center expended $9,039 on community building activities as reported on Part II of schedule H and in the narratives above.
    Part III, Line 4: The organization's financial statements are prepared in accordance with Generally Accepted Accounting Principles (GAAP). GAAP does not require a foot note for bad debt expenses, however, the charity care footnote reads as follows: "The Medical Center accepts all patients regardless of their ability to pay. A patient is classified as a charity patient by reference to the established policies of the Medical Center. Essentially, these policies define charity care services as those services for which no payment is anticipated. In assessing a patient's inability to pay, the Medical Center utilizes the generally recognized poverty income levels for the State of Connecticut, but also includes certain cases where incurred charges are significant when compared to incomes". These charges are not included in net patient service revenue for financial reporting purposes. In the event a patient fails to qualify for financial assistance or fails to pay their portion of discounted charges, and the patient does not pay timely their obligation to the Center, the Center reserves the right to institute and pursue collection actions and to pursue any remedies available by law or in equity, including but not limited to, imposing wage garnishments or filing and foreclosing on liens on primary residences or other assets, instituting and prosecuting legal actions and reporting the matter to one or more credit rating agencies. In the event the Center is unable to collect, the outstanding amounts are written off as bad debt. For those patients who qualify for financial assistance and are cooperating in good faith to resolve outstanding accounts, the Center may offer extended payment plans and will not impose collection efforts described above.The organization utilized an overall cost to charge ratio, (RCC), developed from the audited Financial Statements, (AFS). This cost to charge ratio was developed and applied to the Bad Debt expense on Part III, Line 2 & 3. In FY10, in order to determine the amount of bad debt that could be reasonably attributable to patients who would likely qualify for financial assistance, the organization reviewed and analyzed random patient accounts in order to determine the likelihood of the ability for those patients to pay based upon certain criteria. Eligibility criteria for financial assistance included, but were not limited to such factors as family size, household income and poverty guidelines. This information was analyzed using an independent database. The result of the analysis was used to determine the amount of bad debt that could have qualified for charity care reported on Part III, Line 2. As of August 2011, the organization has implemented a new process including updated software to assist in qualify patients for appropriate financial assistance before initiating the collection process. As a result of these changes, the amount of bad debt that would qualify for charity care should be significantly reduced.For FY11, the organization took the FY10 bad debt expense at cost that could have qualified for charity care and divided the amount by the total bad debt expense at cost from prior year, thus establishing a percentage. This percentage was applied to the bad debt expense at cost for FY 11 and reported the amount on line 3. The organization asserts that this amount should be considered as community benefit.
    Part III, Line 8: Providing for those in need, including Medicare patients and serving all patients regardless of their ability to pay is an essential part of the organization's mission. The hospital serves all patients without regard to any payment shortfall. The organization Medicare Cost Report was used to accumulate actual costs related to Part III, Section B, Line 6.
    Part III, Line 9b: Midstate Medical Center has adopted the Financial Assistance Policy of its Parent Company, Hartford HealthCare Incorporation. The following is included in the Financial Assistance Policy: For those patients that qualify for financial assistance and who in the System's sole determination are cooperating in good faith to resolve the System's outstanding accounts, the Systems' facilities may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to outside collection agencies and will cease all collection efforts.
    Part VI, Line 2: MidState Medical Center conducts needs assessment every three years. The assessment includes: 1. Primary data, including focus groups, surveys both on paper and on the phone. This data addresses behaviors and perceptions.2. Secondary data, including morbidity and mortality data, crime statistics, housing and homeless information, substance abuse, alcohol, and tobacco survey results, workforce data, and demographic information.3. Other available data from various local, state, and national resources.This data is correlated and evaluated and leads to specific issues related to basic needs, health, housing, workforce, and issues related to specific age groups, including seniors and youth. A community group, incorporating MidState Medical Center, United Way, Chamber of Commerce, as well as other health and human service organizations, key opinion leaders, business leaders, clergy, and other volunteers collaborate to address these issues. This group has convened community-based task forces to address identified issues.
    Part VI, Line 3: MidState Medical Center disseminates information about its Financial Assistance Policy as follows: (i) provide signage regarding this Policy and written summary information describing the Policy along with financial assistance contact information in the Emergency Department, Labor and Delivery areas and all other Hospital patient registration areas: (ii) directly provide to each patient written summary information describing the Policy along with financial assistance contact information in all admission, patient registration discharge, billing and collection written communications; (iii) post the Policy on the Hospital's Website; (iv) educate all admission and registration personnel regarding the Policy so that they can serve as an informational resource to patients regarding the Policy.
    Part VI, Line 4: MidState Medical Center serves its primary area, including Meriden, Wallingford, Southington, and Cheshire as well as the communities of Berlin, North Haven, Middlefield, Durham and surrounding communities. The population of the towns in the primary service area is 29,411 (Cheshire), 58,801(Meriden), 45,030 (Wallingford) and 42,534 (Southington). The media household income in Cheshire is $101,392, $50,439 in Meriden, $69,216 in Wallingford, and $73,985 in Southington, with poverty rates at 2.5, 15.8, 6.4, and 3.7, respectively. Unemployment rates are as follows: 6.3 in Cheshire, 10.2 in Meriden, 7.5 in Cheshire and 7.2 in Southington.Due to the nature of the services MidState provides, patients are primarily over the age of 65. However, since the hospital also offers emergency, surgical, and labor and delivery services, the hospital's core customers vary in age from children through geriatrics. Approximately 65% of MidState's patients have government insurance, about 55% of which is Medicare and 18% which is Medicaid. The other 25% to 30% is private pay, which would include the privately insured as well as the uninsured. MidState's patient base is fairly diverse in terms of race. However, because of the hospital's location in Meriden, it serves a larger portion of Hispanics than other population.
    Part VI, Line 6: The mission of MidState Medical Center is to improve the health and healing of the people and communities we serve. In towns across central Connecticut, MidState is committed and focused on efforts to promote health and wellness.The majority of MidState Medical Center's governing board is comprised of persons who either reside or work in its primary service area, and they are neither employees nor contractors of the Hospital.MidState Medical Center extends medical staff privileges to all qualified physicians in its community. The Hospital/Medical Center has partnered with the Community Health Center to provide health services to the underserved in the community. In addition, the MidState participates in Community Vision to improve community health and well-being.MidState has contracted to use the services of an organization to assist its patients in determining eligibility and applying for state and federal ?means-tested programs such as Medicare and Medicaid, as well as for the MidState Medical Center Financial Assistance Program. Additionally, the MidState Emergency Department and satellite MediQuick Urgent Care facility provides medical care regardless of patients' ability to pay for services. Each year, MidState makes a concerted effort to go above and beyond its call to the community. Our physicians, nurses, and staff have reached out to thousands of individuals in the last year through health-related programs and special events. Additionally, MidState has partnered with various community organizations to improve the quality of life of its residents. These include key opinion leaders, faith communities, business leaders, government officials, and a variety of social service organizations. MidState and these partners come together on a monthly basis in Community Vision meetings to discuss plans to address community need and determine the best means to promote positive change. Many of the issues address focus on the ongoing work related to the 2008 Community Needs Assessment Project conducted by MidState and the United Way of Meriden and Wallingford. An updated needs assessment is planned for FY 2012.MidState and Community Vision partners have also been leaders in establishing several community food drives throughout the year and creating a process for a more efficient, effective food collection and distribution method. Last fiscal year, MidState hosted a food drive that resulted in the collection of over 50 boxes of non-perishable food items and personal care items that were distributed to Master's Manna in Wallingford and the Meriden Soup Kitchen. Additionally, MidState participated in the United Way of Meriden and Wallingford's Adopt-a-Family holiday program; approximately 20 hospital departments have adopted families in the community, more than any other organization in Meriden and Wallingford. MidState has also contributed to the community in the following ways:Health Fairs, Programs & ScreeningsMidState has coordinated and participated in nearly 400 health programs between October 2010 and September 2011, including health fairs, educational seminars and screenings. In particular, MidState hosted a well attended skin screening in May, resulting in the detection of skin cancer among one of the patients who signed up to attend. Three prostate screenings were also offered in September, again where one individual in the community was found to have a problematic screening and was scheduled for follow-up care. Finally, several appointments were available this year for reduced cost mammograms and free breast cancer risk assessment consultations. The LaPlanche Clinic & Geriatric OutreachMidState's LaPlanche Clinic was established in 1979 to meet the growing needs of the senior population in town. Working collaboratively with the Meriden Senior Center, the clinic is staffed by a registered nurse who provides education and care to seniors. Screenings offered include blood pressure, cholesterol and glucose, as well as regular programming on health topics such as nutrition, heart health, cancer prevention, healthy lifestyles and more. The clinic sees approximately 2,000 patient visits each year. A similar clinic operates out of the Cheshire Senior Center once per week, where another several dozen seniors in MidState's core community receive outstanding clinical care and free blood pressure screenings. MidState also runs an 8-week program called Diet Watch that focuses on nutrition basics to help seniors live healthy lifestyles. To date, over 100 seniors have participated in this program.Speakers' BureauMidState physicians and clinicians hold speaking engagements at various community locations to offer individuals the opportunity to ask questions and learn about specific health conditions and ways of leading a healthier lifestyle. Programming is consistently offered for local senior centers, libraries, YMCAs, women's groups, faith communities, Rotary clubs, Kiwanis, and other community groups.Community PartnersMidState takes a collaborative approach to building a healthier community, working with a variety of organizations on a number of initiatives to enhance the health and well-being of those we serve. In the last year, MidState is privileged to have worked with the United Way of Meriden & Wallingford, the Cheshire and Wallingford YMCAS, its local health departments and the Meriden Chamber Health and Wellness Council. MidState has been particularly involved this year in the Activate Wallingford initiative with the Wallingford YMCA to address the issue of childhood obesity in the Wallingford Community. Additionally, The Palladino Family Cancer Center operated by MidState has worked collaboratively with local YMCAs to promote their new LIVESTRONG program for cancer survivors. Tremaine Resource CenterOur medical and consumer health library offers a broad range of resources and services to support the needs of patients, caregivers and area residents for accurate and current health information. The Tremaine Resource Center supports student research and offers services to patients in the hospital. The library saw 6,607 visitors last year and responded to 912 requests for information.John Barry School Business Partnership In 1995, MidState formed a school-business partnership with nearby John Barry Elementary School. Over the last 16 years, hospital departments have "adopted" classes and collaborated with teachers to plan regular activities that include health fairs, career days, hospital tours, holiday breakfasts, and an annual "Read Aloud Day." Hospital employees have donated books to the school, as well as offered age-appropriate education on topics such as "The Warning Signs of Stroke" and "When to Call 9-1-1." Volunteer SupportMidState is fortunate to have an active group of adult and junior volunteers who each day offer their skills and talents to the hospital. Last year 298 volunteers generously contributed over 42,000 hours of service to 45 different departments. The work of the hospital could not be done without these loyal ambassadors. Additionally, job shadowing opportunities are provided through the Volunteer Department and give young adults the chance to learn more about their interests in the health care field. Education and Research In fiscal year 2011, a group of 20 medical careers students from Sheehan and Lyman Hall High Schools in Wallingford visited MidState and toured the Emergency Department, Pharmacy, Family Birthing Center and Radiology to learn more about the hospital environment and work that goes on in the respective departments, as well as possible careers in those areas. Additionally, MidState provides a wealth of free professional education for both clinical and non-clinical staff through the Nursing Education department, as well as through Workforce Development. Last fiscal year, MidState also became one of only four hospitals in the country to participate in a National Institutes of Health Research Study to assist providers with post-discharge referrals. The overarching goals of this nationally recognized study are to improve the identification of patients who need post-acute care, assure that patients get the most appropriate care, prevent hospital readmissions, and build a decision support system suitable for patient discharge planning.
    Part VI, Line 7: MidState Medical Center is an Affiliate of Hartford Healthcare Corporation (HHC). HHC strives to provide compassionate care designed to deliver the necessary health services needed by the community. The Strategic Planning and Community Benefit Committee of the HHC Board of Directors ensures the oversight for these services by each hospital community. In addition, HHC continues to take important steps toward achieving its vision of being "nationally respected for excellence in patient care and most trusted for personalized, coordinated care". HHC affiliation creates a strong integrated health care delivery system with a full continuum of care across a broader geographic area. This allows the small communities easy and expedient access to the more extensive and specialized services the larger hospitals are able to offer. This includes continuing education of health care professionals at all the affiliated institutions through the Center of Education, Simulation and Innovation located at Hartford Hospital, the largest of the system hospitals.The affiliation further enhances the hospitals' abilities to support their missions, identity, and respective community roles. This is achieved through integrated planning and communication to meet the changing needs of the region. This includes responsible decision making and appropriate sharing of services, resources and technologies, as well as cost containment strategies.
Reports Filed With States Part VI, Line 7 CT
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Lucille A Janatka (i)
(ii)		 474,733
0 		141,917
0 		6,254
0 		91,409
0 		42,243
0 		756,556
0 		0
0
(2) Ralph W Becker (i)
(ii)		 0
278,883 		0
55,121 		0
23,731 		0
57,522 		0
14,823 		0
430,080 		0
0
(3) Kenneth W Cesca (i)
(ii)		 176,432
0 		32,484
0 		0
0 		19,251
0 		28,286
0 		256,453
0 		0
0
(4) Cindy L Russo (i)
(ii)		 201,196
0 		42,486
0 		0
0 		22,050
0 		34,036
0 		299,768
0 		0
0
(5) Harold Kaplan (i)
(ii)		 186,584
0 		37,999
0 		0
0 		20,790
0 		24,206
0 		269,579
0 		0
0
(6) Howard Dubin MD (i)
(ii)		 256,435
0 		26,396
0 		4,681
0 		23,973
0 		30,630
0 		342,115
0 		0
0
(7) Fred Tilden MD (i)
(ii)		 345,753
0 		34,006
0 		13,949
0 		51,271
0 		32,170
0 		477,149
0 		0
0
(8) Richard A Remnick MD (i)
(ii)		 256,743
0 		18,082
0 		2,986
0 		33,112
0 		30,489
0 		341,412
0 		0
0
(9) Michael R Tinkler (i)
(ii)		 283,396
0 		17,218
0 		2,377
0 		32,532
0 		30,854
0 		366,377
0 		0
0
(10) Giac-Chan Tan MD (i)
(ii)		 262,032
0 		18,450
0 		4,476
0 		39,842
0 		30,593
0 		355,393
0 		0
0
(11) John J Meehan (i)
(ii)		 0
0 		0
4,935 		0
1,185,054 		0
0 		0
12,187 		0
1,202,176 		0
0
(12) Linda Spivak (i)
(ii)		 0
235,305 		0
24,415 		0
6,733 		0
0 		0
14,729 		0
281,182 		0
0




Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  Part I, Line 4a Mr. John Meehan (former Director - Non Voting) severance agreement began in January of 2009 with related organization - Hartford Hospital. Per the agreement, Mr. Meehan received 24 months of severance based upon an annual salary of $868,400 plus incentive award of $250,000. Total severance payment to Mr Meehan was $1,118,900. 2010 SERP accrual - Lucille Janatka $51,719 The Hospital desires to supplement the Employee's retirement benefits so as to compensate Ms. Janatka for the reduction in benefits payable under the qualified plan by reason of the imposition of the Section 401(a)(17) Cap and the Section 415 Limitations. The Hospital also desires to supplement the Employee's retirement benefits provided under the Qualified Plan by providing Employee a Supplemental Retirement Benefit that would, if the Employee retired from the Hospital at age 65 in the year 2014, provide Employee with a combined retirement benefit at age 65 from the Qualified Plan and this Agreement which equals fifty percent (50%) of Employee's Final Average Earnings (the "Target Benefit") as defined in the Qualified Plan but without the imposition of the Section 401(a)(17) Cap. To achieve the Target Benefit at age 65 for the Employee, the Hospital intends to credit Employee under this Agreement with a Supplemental Retirement Benefit outside of the Hospital's Qualified Plan based on an enhanced accrual rate of3.2% (instead of 1.5%) of her Final Average Earnings (as defined in the Qualified Plan but without the imposition of the Section 401(a)(17) Cap) for each Year of Credited Service she completes with the Hospital after 1999, up to a maximum of 10 such years completed. The Hospital is willing to provide the Employee this Supplemental Retirement Benefit provided Employee is willing to agree to certain conditions of employment.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) See Part V See Part V   See Part V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Part IV Business Transactions Involving Interested Persons (a) Name of Interested Person: Joseph E. Mirra(b) Relationship between Interested Person and Organization: Director(c) Amount of Transactions: $335,158(d) Description of Transaction: Mr Joseph Mirra is a board member of Midstate Medical Center (MMC). Mr Mirra is the owner of Business Resources Center, LLC. The company provides physician billing and provider enrollment services for Midstate Medical Center and Windham Community Memorial Hospital (WCMH), a related entity. MMC and WCMH paid the Company $319,931 for physician billing services and $15,197 for provider enrollment services during the year.(e) Sharing of Organization Revenues? = No(a) Name of Interested Person: Paul Zimmering, M.D.(b) Relationship between Interested Person and Organization: Director(c) Amount of Transactions: $365,000(d) Description of Transaction: Dr. Paul Zimmering is an officer at Midstate Medical Center. He is also partner at Comprehensive Orthopaedics and Musculoskeletal Care, LLC. Midstate Medical Center paid $365,000 to Comprehensive Orthopaedics and Musculoskeletal Care, LLC for services provided per service line agreement. (e) Sharing of Organization Revenues? = No (a) Name of Interested Person: Fred Tilden, M.D.(b) Relationship between Interested Person and Organization: Highest Compensated Employee(c) Amount of Transactions: $90,615(d) Description of Transaction: Dr. Fred Tilden is the owner of Midstate Medical Group PC with which Midstate Medical Center does business. Midstate paid the PC $90,615 during the fiscal year.(e) Sharing of Organization Revenues? = No
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
contribution amounts
1 Art—Works of art .... X 1 0 FMV
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( Jazz Quartet for Fundraising Event ) X 1 0 FMV
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2010
Schedule M (Form 990) 2010
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33. Also complete this part for any additional information.
Identifier Return Reference Explanation
Non Reporting of Revenue: Part I, Line 33: Currently the organization does not assign a value to certain non-cash gifts. These gifts are also not reported as contributions on the income statement. The organization is in the process of formulating a policy that will require all gifts to be valued and reported in the financial statement.
Schedule M (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Identifier Return Reference Explanation
Form 990, Part VI, Section A, line 6   Midstate Medical Center is organized as a non-stock not for profit entity. Hartford Health Care Corporation is the sole member.
Form 990, Part VI, Section A, line 7a   The sole member of the organization has the authority to approve/remove members of the governing board.
Form 990, Part VI, Section A, line 7b   The sole member of the organization has the right to review, approve, disapprove or deny fundamental transactions such as mergers, aquisitions, dissolutions, etc.
Form 990, Part VI, Section B, line 11   The Form 990 was prepared by Hartford Hospital's Tax Department. It was then reviewed by an independent accounting firm. It was then forwarded to the organization's top management including the CFO for review. The Form was then made available to the board for review. Once the entire review process was completed, the form was signed by the CFO and then filed with the Internal Revenue Service.
  Form 990, Part VI, Section B, line 12c The Medical Center's board has adopted the policy of the member organization, Hartford Health Care Corporation. All directors and officers of the organization shall complete and sign a Conflict of Interest statement. The statement will include an itemization and description of any actual or potential conflict of interest and all material facts related thereto for such director or officer by virtue of his or her activities or the activities of related persons. Directors and officers are urged to be inclusive in this disclosure since the disclosure of potential and actual conflicts of interest is essential to ensuring discussion of the conflict. Disclosure statements shall be returned to the Compliance Officer. All disclosures made will be reviewed by the Compliance Officer and the Director of Internal Audit, under the direction of the Chairman and the President, who shall exercise good faith judgment as to whether a conflict exists. The Chairman and President shall be responsible for monitoring transactions or arrangements in which a director or officer may have a conflict of interest and for assuring that the director or officer serves the Center's best interests. The Compliance Officer, Director of Internal Audit, Chairman and/or President may consult with any director or officer and obtain information necessary for an ordinarily prudent person to make a judgment as to whether a conflict exists and each director and officer shall cooperate with such requests. The Compliance Officer, Director of Internal Audit, Chairman and/or the President shall provide guidance to the director or officer and to the board of directors as to the appropriate course of action. The Chairman and the President shall seek the advice and approval of the full Board of Directors in determining whether a conflict of interest exists and that the director or officer serves the organization's best interests. When a conflict of interest is discovered, such director and/or officer with the conflict will be required to refrain from participating in any discussion or action concerning such conflicted situation in accordance with the section entitled "Restraint on Participation" set forth in the Conflict of Interest policy. If, after completing and signing the annual disclosure statement, an actual or potential conflict arises, the director or officer with the conflict shall promptly notify the Compliance Officer and Director of Internal Audit in writing.
  Form 990, Part VI, Section B, line 15 The Compensation Committee is responsible for governing the chief executive pay. The chief executive pay along with compensation of other executives is developed in cooperation with Hartford Health Care Corporation. 1. Peer group of health care corporations are identified. 2. Salary surveys based on appropriate peer groups and relevant geographic proximity are reviewed. 3. Using the survey data, market values and salary ranges are determined consistent with the executive pay philosophy of Hartford Health Care Corporation and Midstate Medical Center. 4. The President and Midstate Medical Center recommends and approves pay increases based on performance for all executives. This is consistent with Hartford Health Care Corporation and Midstate Medical Center philosophy and standard practice. 5. CEO performance is reviewed by the Board committee and a salary recommendation is made to the President of Hartford Health Care Corporation for final approval.
  Form 990, Part VI, Section C, line 19 The Form 990, Form 990T and Form 1023 and its attachments are available upon request. The organization's governing documents, financial statements and Conflict of Interest Statements are also made available upon request.
Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -709731. Change in Swap Value -214447. Change in Funding Status of Pension -12286285. Gain from pass thru entities 52919. Net assets released from restrictions -241164. Unrealized loss on funds held in trust -513144. Rounding -2. Total to Form 990, Part XI, Line 5: -13911854.
  Form 990, Part XII, Line 2 The organization's financial statements were audited by an independent accountant as part of a consolidated financial statement. In addition, the organization has a committee that assumes responsibility for oversight of the audit of its financial statements and selection of an independent accountant.
  Form 990, Part XII, Line 2c Midstate Medical Center did not receive a separate audited financial statement, it is included in a consolidated audited financial statement. The process has not changed from prior years.
Average Hours Per Week Part VII, Column B The employees reported on Part VII are full time salaried employees. These employees usually work a significant amount of overtime, however, they are not required to keep track of actual number of hours worked.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) Midstate MSO LLC
435 Lewis Avenue
Meriden,CT06451
20-4312072 		Management Services CT -285,903 5,885,767 N/A










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Hartford Hospital

80 Seymour Street

Hartford,CT06102
06-0646668 		Healthcare Services CT 501(C)(3) 3 Hartford HealthCare Corporation
 
Yes
 
(2) Hartford HealthCare Corp

80 Seymour Street

Hartford,CT06102
22-2672834 		Support and Management Services to Hartford Hospital and Affiliates CT 501(C)(3) 11(c) N/A
Yes
 
(3) Windham Community Memorial Hospital

112 Mansfield Avenue

Willimantic,CT06226
06-0646966 		Healthcare Services CT 501(C)(3) 3 Hartford HealthCare Corporation
 
Yes
 
(4) Windham Hospital Foundation Inc

112 Mansfield Avenue

Willimantic,CT06226
56-2546632 		Supporting Organization CT 501(C)(3) 11(a) Windham Community Memorial Hospital
 
Yes
 
(5) Natchaug Hospital Inc

189 Storrs Road

Mansfield Center,CT06226
06-0966963 		Behavioral Health CT 501(C)(3) 3 Hartford HealthCare Corporation
 
Yes
 
(6) VNA Health Care Inc

103 Woodland Street

Hartford,CT06105
06-0646938 		Home Health Care CT 501(C)(3) 7 Hartford HealthCare Corporation
 
Yes
 
(7) Rushford Center Inc

883 Paddock Avenue

Meriden,CT06450
06-0932875 		Substance Abuse Health Care Services CT 501(C)(3) 7 Hartford HealthCare Corporation
 
Yes
 
(8) Hartford Hospital Auxiliary co Hartford Hospital

80 Seymour Street

Hartford,CT06102
06-6040747 		Fundraising CT 501(C)(3) 11(c) Hartford Hospital
 
Yes
 
(9) Connecitcut Health System Inc

80 Seymour Street

Hartford,CT06102
22-2779421 		Coordination of Health Delivery CT 501(C)(3) 11(c) N/A
Yes
 
(10) Institute of Living

200 Retreat Aveue

Hartford,CT06106
06-0646683 		Psychiatric Services CT 501(C)(3) 11(c) Hartford HealthCare Corporation
 
Yes
 
(11) VNA Health Resources Inc

103 Woodland Street

Hartford,CT06105
06-1161422 		Home Health Care CT 501(C)(3) 7 Hartford HealthCare Corporation
 
Yes
 
(12) Midstate Medical Center Auxiliary

435 Lewis Avenue

Meriden,CT06451
06-6063082 		Fundraising CT 501(C)(3) 3 Midsate Medical Center
 
Yes
 
(13) The Hatch Hospital Corp

112 Mansfield Avenue

Willimantic,CT06226
06-6076412 		Healthcare Services CT 501(C)(3) 3 Windham Community Memorial Hospital
 
Yes
 
(14) WCMH Women's Auxiliary Inc

112 Mansfield Avenue

Willimantic,CT06226
06-0677728 		Fundraising CT 501(C)(3) 11(a) Windham Community Memorial Hospital
 
Yes
 
(15) The Hospital of Central CT

100 Grand Street

New Britain,CT06050
06-0646768 		Healthcare Services CT 501(C)(3) 3 Central CT Health Alliance
 
Yes
 
(16) Central CT Senior Health Svcs dba Southington Care Center

45 Meride Avenue

Southington,CT06489
22-2635676 		Sub-Acute & Long Term Healthcare CT 501(C)(3) 9 Central CT Health Alliance
 
Yes
 
(17) Bradley Health Services

100 Grand Street

New Britain,CT06050
06-1367014 		Healthcare Services CT 501(C)(3) 9 Central CT Health Alliance
 
Yes
 
(18) Central CT Health Alliance

100 Grand Street

New Britain,CT06050
22-2785033 		Support & Management Svcs. to THOCC and Affiliates - Shell CT 501(C)(3) 11(b) Hartford HealthCare Corporation
 
Yes
 
(19) VNA of Central CT Inc

205 West Main Street

New Britain,CT06050
06-0646940 		Public Health Nursing & Home Care CT 501(C)(3) 9 Central CT Health Alliance
 
Yes
 
(20) The Orchards of Southington

34 Hobart Street

Southington,CT06489
06-1490803 		Residential Services for Senior Citizens CT 501(C)(3) 9 Central CT Senior Health Services Inc
 
Yes
 
(21) Community Mental Health Affiliates

270 John Doney Drive

New Britain,CT06051
06-0934544 		Mental Health & Substance Abuse Treatment Provider CT 501(C)(3) 7 Central CT Health Alliance
 
Yes
 
(22) Mulberry Gardens of SouthingtonLLC

58 Mulberry Street

Plansvill,CT06479
82-0586577 		Assisted Livin & Adult Day Care Facility CT 501(C)(3) 9 Central CT Senior Health Services Inc
 
Yes
 
(23) Jerome Home

975 Corbin Avenue

New Britain,CT06052
06-0646690 		Nursing Home CT 501(C)(3) 9 Central CT Health Alliance
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Central CT Sports Medicine Ctr LLC

15 Masairio Drive
Berlin,CT06037
22-3196509 		Physical Therapy CT N/A
                  
(2) New Britain MRI Limited Partnership

100 Grand Street
New Britain,CT06050
06-1271349 		Magnetic Resonance Imaging CT N/A
                  
(3) New Britain Occupational Health Center LLC

440 New Britain Avenue
Plainville,CT06062
06-1484904 		Occupatioal Healthcare CT N/A
                  
(4) Hartford HealthCare Endowment LLC

80 Seymour Street
Hartford,CT06102
45-4181103 		Endoment Management CT N/A
                  
(5) Ambulance Service of Mancheser LLC

PO Box 300
Manchester,CT06450
06-1557358 		Ambulatory Services CT N/A
                  
(6) Connecticut Imaging Partners LLC

111 Founders Plaza
East Hartford,CT06108
13-4298940 		Imaging Services CT N/A
                  
(7) Glastonbury Endoscopy Center LLC

300 Western Blvd Suite B
Glastonbury,CT06033
26-1721234 		Endoscopy Services CT N/A
                  
(8) Glastonbury Surgery Center LLC

195 Eastern Boulevard
Glastonbury,CT06033
26-2600828 		Surgery Services CT N/A
                  
(9) Hartford - Middlesex Clinical System LLC

80 Seymour Street
Hartford,CT06110
06-1543605 		Affilate Support Services CT N/A
                  
(10) Med-East Assoc LLC

1703 West main Street
Willimantic,CT06226
06-1469575 		Outpatient Care Clinic CT N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) HHMOB Corporation & Subsidiary
80 Seymour Street
Hartford,CT06102
06-1140244 		Real Estate Parking CT N/A
 C      
(2) CHS Insurance LTD
40 Church Street
  Hamilton  
BD
Captive Insurance BD N/A
 C      
(3) Windham Health Services Inc
112 Mansfield Avenue
Willimantic,CT06226
06-1461101 		Home Health Care CT N/A
 C      
(4) Windham Physician Hospital Organization
112 Mansfield Avenue
Willimantic,CT06226
06-1441614 		Medical Services CT N/A
 C      
(5) Windham Family Medical Services
112 Mansfield Avenue
Willimantic,CT06226
06-1491649 		Medical Services CT N/A
 C      
(6) CenConn Services Inc
100 Grand Street
New Britain,CT06050
22-2836001 		Investment Management CT N/A
 C      
(7) Grand Indemnity Co LTD
40 Church Street
  Hamilton  
BD
98-0609499 		Professional Liability CT N/A
 C      
(8) Hartford Physician Services PC
80 Seymour Street
Hartford,CT06102
06-1254082 		Medical Services CT N/A
 C      
(9) Meriden Imaging Center
101 North Plains Indusrial Park
Meriden,CT06429
06-1541468 		Imaging CT Midstate Medical Center
  		S -52,447   80.000 %
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Midstate MSO LLC

 Q 2,050,000 FMV
(2) Hartford Hospital

 O 3,672,468 FMV
(3) Hartford Hospital

 L 7,747,286 FMV
(4) Hartford Hospital

 N 1,868,574 FMV
(5) CHS Insurance limited

 Q 4,698,822 FMV
(6) CHS Insurance limited

 N 55,308 FMV
(7) Eastern Rehabilitation Network

 L 804,515 FMV
(8) Rushford Inc

 L 1,123,365 FMV
(9) Midstate Medical Center Auxiliary

 C 80,750 FMV
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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